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PAEDIATRIC surgery is a specialty under stress, and growing the most slowly of all surgical subspecialties, according to Mr Anthony Sparnon, president of the Australian and New Zealand Association of Paediatric Surgeons.
Mr Sparnon, who practises in Adelaide, said paediatrics was the smallest of the surgical subspecialties, with 130 active members.
However, while other surgical subspecialties have seen an increase in the numbers of surgical graduates, in paediatric surgery numbers had stayed the same in the past decade, with about five graduates a year.
Adding to the stress is that general surgeons are increasingly treating older age groups, so the age limit of patients treated by paediatric surgeons has risen to 18 years.
Mr Sparnon said that unlike other surgical specialties that focus on a single body system, paediatric surgeons generally remain generalists and treat a broad range of pathologies and conditions, with inguinal and groin surgery, acute conditions such as abscesses and appendicitis, urology and burns accounting for most of their work.
He said a typical day for a paediatric surgeon includes ward rounds, grand rounds, surgical lists and recordkeeping.
Paediatric surgeons spend less time in the operating theatre than other surgeons as paediatric conditions are more likely to resolve spontaneously than adult conditions.
There is also more conservative observation ― only about 20%–30% of children seen will undergo surgery, he says.
Mr Sparnon says there is more public work in paediatric surgery than in other surgical specialities, so few paediatric surgeons work exclusively in the private system.
Most paediatric surgeons work in children’s hospitals or major metropolitan teaching hospitals, although they may be seconded to sessional work in a regional base hospital for simpler operations that a smaller hospital can support.
Paediatric surgeons are the least well paid of the surgical specialists, earning about a third of the income of orthopaedic surgeons.
About 30% of operative cases are surgical emergencies, so there can be more after-hours work than in other surgical specialities.
Associate Professor Deborah Bailey, chair of the Royal Australasian College of Surgeon’s Board of Paediatric Surgery, said paediatric surgeons experience the highs and lows of working with children.
“You are also closely involved with the rest of the family and the relationship is often ongoing, as many paediatric conditions such as congenital malformations necessitate ongoing treatment and follow-up. So the relationship with the child and the family is a long-term one, which is very satisfying,” Professor Bailey said.
Most of the current trainees were women and paediatric surgery was the first of the surgical subspecialties to actually encourage women into its ranks, she said.
Paediatric surgeons work closely with other specialist staff such as paediatricians and oncologists, as well as with general medical and nursing staff.
Further information is available from the RACS.
The full version of this story will be published in MJA Careers on 21 February 2011.
Posted 14 February 2011