What it’s like in pediatric neurosurgery: Shadowing Dr. Tomei

As a medical student, do you ever wonder what it’s like to specialize in pediatric neurosurgery? Meet Krystal Tomei, MD, MPH, a pediatric neurosurgeon and a featured physician in the AMA’s “Shadow Me” Specialty Series, who offers direct advice from physicians about living in their specialties. Check out her insights to determine if a career in pediatric neurosurgery might be right for you.

The AMA’s Specialty Guide simplifies the medical student selection process, highlights key specialties, provides detailed training information, and provides access to related association information. It is produced by FREIDA™, the AMA Residency & Fellowship Database®.

Learn more about the medical specialty of pediatric neurosurgery with the AMA.

“Shadow” Dr. tomei

Specialty: Pediatric neurosurgery.

Practice setting: Academic Hospital.

Type of employment: Working at hospital.

Years in practice: Seven years.

A typical day and week in my practice: My day varies depending on whether I do administrative work, in the clinic or in an operating room. My surgery days usually run from 6:30 a.m. to sometime around 5:00 p.m., but can be longer if I have a long series of surgeries. Clinics take place two half-days a week, in the morning or in the afternoon between 8:00 AM and 5:00 PM, and sometimes with an additional half-day session from a multidisciplinary clinic.

My administrative time is a hodgepodge of paperwork, research, calling patients and all the clinical stuff thrown in there too. Every day I visit my admitted patients. And in the evenings, I can go through my “extracurricular activities” in organized medicine, prepare and plan a difficult case, catch up on magazine articles, or just enjoy a relaxing evening watching mindless TV.

I generally expect to be at work from about 7 a.m. to 5 p.m. on any given day. Sometimes I finish a little earlier, often I get stuck a little later. I’m on call about a third of the year and those days can range from incredibly busy to incredibly slow. But the calling schedule is very dependent on the number of people in the practice you join.

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The most challenging and rewarding aspects of pediatric neurosurgery: It’s the same for any specialty: we see patients at their most vulnerable, and we know that despite our best efforts, we may not always be able to provide a cure. In neurosurgery we mainly deal with the brain, the entity that gives people and children their personality, their ability to run and jump and play and talk, their interactions with the world and how they experience it.

We know that what we treat and what we do can sometimes change everything. And it certainly doesn’t get any easier. I often tell my patients’ parents that I know I’m the last person they want to know, but I’m there for them when they need me.

Despite the hard parts, neurosurgery and pediatric neurosurgery are so incredibly rewarding. In my work I see children grow and develop to their greatest potential, knowing that I played a small part. In some of the pathologies I treat, I give children back their quality of life, which is incredibly amazing to watch.

How life in pediatric neurosurgery has been affected by the global pandemic: Frankly, not much has changed. Even many of the most elective cases in neurosurgery are very time sensitive, so we still see children who need our services. The greatest impact in neurosurgery was in patients who required spinal surgery for chronic pain from nerve root compression, many of whom saw their surgeries postponed as hospitals became overwhelmed.

The other concern is that people have not sought the care they would otherwise seek before being sent to us, so failing to evaluate them will delay their referral to neurosurgery.

The one thing that was hardest to see in pediatric neurosurgery was an increase in cases of abuse or neglect. The combination of financial and health concerns surrounding the pandemic, as well as reduced childcare resources and constant disruption to schooling has significantly increased the stress associated with family life. I hope that now with vaccines and increased measures to keep children safe in school, some of these factors will decrease.

The long-term impact the pandemic will have on pediatric neurosurgery: Telemedicine has fundamentally changed healthcare. While a full neurological exam is a bit difficult – especially if the patient is a toddler who keeps pushing the hang up button – this has proven to be a great asset to healthcare. It provides improved access to specialists, ease of routine follow-up appointments, and can help streamline in-person visits by allowing virtual visits to determine if imaging is needed. The families also love that this is much more convenient. Particularly in a field where many patients and their families otherwise drive several hours for routine follow-up.

Three adjectives to describe the typical pediatric neurosurgeon: Firm, empathetic and precise.

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How my lifestyle matches or differs from what I imagined: It’s about what I expected: a stay is tough, while life is much better. The hours are long no matter where you work out or after, but once you’re there, you have more control over your schedule.

The hours may certainly be longer than you might expect, but the personal satisfaction of what we can do and who we can help is far greater than you can imagine. As for work-life balance, it’s what you make of it. There will always be work to do at the end of the day, one more scan to review, one more article to read, one more note to sign, one more paper to write. It’s up to you to protect that piece of personal time.

It is helpful if the family also understands the demands of the job. Our good days can be pretty amazing, but our bad days can get pretty rough. Having friends and family who understand that you may not always be able to make everything, but that you always want the invite is also important. As for starting a family, almost everyone I know will tell you that there is no good time to have children or make plans to have children. So if you want kids, just go for it when it’s right for you.

Skills that every physician in training for pediatric neurosurgery should have, but which are not tested on the exam: Grit and resilience are the key words. This road is long and difficult and emotionally taxing, but at the end of each day I can still look back and be happy that I’m doing what I’m doing.

Time management is necessary for everyone, and especially important in the work-life balance arena. Communication is also key. It is so important to be able to communicate with colleagues, but equally important to be able to communicate with patients on a level that they and their loved ones understand. It’s hugely important when setting expectations for surgery — or not doing surgery.

A question that doctors in training should ask themselves before performing pediatric neurosurgery: Why be I’m doing this, and do I see myself doing anything else? If the answer to the latter is yes, then perhaps explore your options. Ultimately, if you’re in your 15th year of practice and come in at 2 a.m. for the third night in a row during your on-call week, you should be able to be happy with your life choice.

When you’re having a rough day, it’s so much easier to say, “But I’m so glad I can do what I’m doing,” instead of, “Wow, I wish I had.” [insert anything else here].”

Books that any medical student interested in pediatric neurosurgery should read:

Handbook of Neurosurgery, by Mark S. Greenberg, MD. They’re basically the bullet points of absolutely everything you need to know. A great (big) pocket guide. Rhoton’s Cranial Anatomy and Surgical Approaches, by Albert L. Rhoton Jr., MD. dr. Rhoton is probably one of the most influential neurosurgeons in assembling neuroanatomical structures and approaches. The dissections are just incredible. Do No Harm: Stories of Life, Death and Brain Surgery, by Dr, Henry Marsh. It touches on the humanity of what we do and how we deal with the results when they are not what we hoped for.

Quick insights I would give students considering pediatric neurosurgery: Whatever you decide to do, make sure you love it. Loving what you do will turn a job into a career. The best way to find out if you like neurosurgery is to see it, but I would encourage you to experience more than just going to the OR to see surgery.

It is important to see the good, the bad and the ugly. Spend time with residents if you have them, make sure you see what it’s like to care for patients in an ICU and on the floor, spend some time in the clinic.

It’s easy to get caught up in surgery because that determines so much of what we do, but it’s important to like all aspects of the specialty once you know you like working in the operating room.

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