Anesthesiology is a dynamic field that undergoes growth and change, especially within subspecialty disciplines, as physicians share ideas and new innovative research with each other. The subspecialty of pediatric anesthesiology is constantly growing, with literature consistently being published. To be a fellowship-trained pediatric anesthesiologist is an honor and a privilege. Current anesthesiology residents should highly consider completing a pediatric anesthesiology fellowship for many reasons.

As a pediatric anesthesiology fellow, one is exposed to many ages and sizes of patients, ranging from neonates to adolescents, as well as a multitude of various pediatric conditions and syndromes. Additionally, one can learn a myriad of versatile skills, often on patients who may have unique anatomy, such as a difficult airway requiring advanced intubation techniques, or fine movements for successful cannulation of a small vessel. Additionally, with regional anesthesia becoming more popular, acquiring neuraxial and peripheral block skills further enhances patient care.

Additional training with a one-year fellowship after residency makes an anesthesiology job applicant more marketable. There are currently more jobs available than fellows, creating high demand for the fellowship-trained pediatric anesthesiologist. An attending pediatric anesthesiologist, particularly one in a mixed practice setting, is typically able to care for patients of most ages, from the neonatal period through advanced age. To underscore the breadth of the field, it is also noteworthy to mention that a pediatric anesthesiology fellow not only cares for different ages of the aforementioned patients, but also all of the various types of subspecialty surgical volume, which differ significantly in complexity. It takes a particularly savvy clinician to weave through an array of ages and categories of surgeries within a particular day with ease, which is what most pediatric anesthesiologists do in a “normal day.”

Fulfillment can be found in creating and following through with an anesthetic plan that will produce an optimal outcome. This population is vulnerable at baseline, relying on parents, guardians, and family members to make decisions and advocate on their behalf. Therefore, the field not only includes caring for a pediatric patient, but also requires intimate involvement with parents and families. Moreover, pediatric anesthesiologists have the opportunity to work with a close-knit group of surgeons and anesthesiologists. This facilitates an environment of mutual respect and the ability to have effective interdisciplinary discussions when needed. A fellowship in pediatric anesthesiology is a one-year investment in a career with great longevity. It is evident that pediatric anesthesiologists experience relatively lower rates of burnout when compared to other subspecialities, with a recent survey showing 30% of pediatric specialists met burnout criteria versus over 50% in cardiac and pain management (Reg Anesth Pain Med 2021;46:381-7).

ACGME-accredited fellowship training programs for pediatric anesthesiology were first established 26 years ago. The ratio of ACGME-accredited anesthesiology fellows to anesthesiology graduating residents increased from 0.36 in 2008 to 0.59 in 2022. During the same time frame, the ratio of pediatric anesthesiology fellows to anesthesiology residency graduates stayed about the same (0.10 in 2008 to 0.11 in 2022) (Paediatr Anaesth 2024;34:734-41). This has left upward of 42% positions unfilled in recent years – 129 applicants for 211 spots in the 2024 Match, with 39 of 58 programs unfilled (asamonitor.pub/3LhcWOY). This fact may place undue pressure on program directors to fill positions, particularly in the face of ongoing staffing shortages. Some academic centers currently have critical shortages, and many parts of the country remain underserved, with nearly 30% of patients living greater than 50 miles away from a pediatric anesthesiologist (Anesth Analg 2017;125:261-7). The current cycle utilized SF Match rather than the National Resident Matching Program. More applicants applied to pediatric anesthesiology fellowships this cycle (and 98% matched!), but 30% of fellowship spots remain open, leaving many programs unfilled (asamonitor.pub/4eTfIrm).

Staying connected with our pediatric anesthesiology colleagues will allow the field to grow and flourish. This can occur by continuing to organize conferences where we share ideas, valuable information/techniques, and teach each other from our own experiences. We can also inspire and invite students and trainees to get involved and interested in the current conversations, whether during a pediatric anesthesia rotation or with programs offered, for example, through the Society for Pediatric Anesthesia’s Subcommittee in Pediatric Anesthesia Education for Residents and Students, or SPAERS.

One of the best ways of encouraging individuals to pursue a career is to have them see the image through your eyes. The field of pediatric anesthesiology involves the care of patients and their families (YES! You will spend a fair amount of time with your patients’ families!). Many have patients they have cared for in infancy through adolescence. This creates a powerful bond both for the patient and the practitioner. If one is interested in a field that is specialized, with advanced skills and training, yet broad enough to care for almost all surgical subspecialties, they should strongly consider pediatric anesthesiology as a career.