The Role of a Neonatologist
A neonatologist is a doctor who specialises in the care of newborn babies. The birth of a child being a life-changing event, a career in neonatology is accompanied by rewarding and emotionally challenging scenarios alike.
When newborns require extra support, being part of the team with the ability to provide this, can not only save the infant’s life but can also have a huge impact on the surrounding family.
A career in neonatology spans a spectrum of clinical conditions; the care required can vary from critically ill preterm babies in the neonatal intensive care unit (NICU), to the care of well term babies on the postnatal ward(1).
The high level of skill required to undertake technical procedures on newborn infants combined with the ethical and emotional support that is essential as a neonatologist makes for a unique specialty.
The level of family integrated care is unparalleled, and any practised doctor must understand the holistic nature of care required to build a good rapport with the families. A specialty which can be emotionally taxing, neonatologists must be able to communicate expertly when handling difficult situations such as breaking bad news and antenatal counselling.
The work involved in being a neonatologist is balanced between medical and interventional responsibilities, being able to understand the underlying pathology and then implement investigations and management, eg diagnosing a pneumothorax, understanding it could be caused by respiratory distress syndrome and then inserting a needle into the chest cavity to remove the air.
As well as carrying out roles on the ward, clinicians are expected to be part of the transport service which allows the transfer of critically ill babies to different hospitals and requires ongoing care throughout the journey.
Throughout, doctors must develop close working relationships with other multi-professional healthcare staff within the Neonatal Department, Child Health and Maternity services, including nursing colleagues, trainee doctors, nurse practitioners and midwives to be able to provide the best patient-centred care.
A Typical Week As A Neonatal Consultant
A neonatal consultant can expect to work a 40-hour week in a full-time position. Each week is split into 10 Programmed Activities (PAs), with approximately 8 dedicated to direct clinical care and 2 to supporting professional activities (SPAs) such as patient administration, management roles and teaching.
A career in neonatology is therefore noticeably a clinical one, whether this be working in the NICU, helping with transport services, or doing postnatal ward rounds and outpatient clinics.
With neonatal medicine being a small speciality, consultants can expect to be part of a close-knit team. However, with a NICU that needs 24/7 consultant cover this means that time dedicated to on-call can be high.
Depending on the number of consultants in your team, neonatologists can expect a 1:5 to 1:8 PAs on call and will additionally work 1 in 5 weekends although this varies between job plans.
The Route To Becoming A Neonatologist
As a paediatric specialty, reaching the goal of ‘neonatal consultant’ requires doctors to venture down the paediatric training pathway.
The most common route into the paediatric training pathway is to enter the indicative 8-year specialty training programme (ST1-8) straight from foundation training. The steps below outline how to obtain a Certificate of Completion of Training (CCT) in Paediatric medicine with a subspecialty accreditation in Neonatal medicine and become listed on the General Medical Council (GMC) Specialist Register3:
- Apply for specialty training in paediatrics– For those interested in a career in paediatrics applications are made at a national level to the paediatric speciality training programme. This is usually done during the second year of foundation training. Paediatrics is one of the largest consultant specialties, though this does not diminish competition. In 2019, there were 564 applicants for 476 ST1 vacancies4.
- Level 1 (ST1-3)– At this stage trainees learn general paediatric knowledge based in acute settings such as in the emergency department, inpatients and outpatients, and in neonatal units. By the end of ST3, Member of Royal College of Paediatrics and Child Health (MRCPCH) exam must be completed.
- Level 2 (ST4-5) – Level 2 training includes placements in general paediatrics, neonatology, and community paediatrics increasing competencies in skills required to be a paediatrician.
- Apply for ‘GRID’ subspecialty training in neonatal medicine– At the end of Level 2, trainees have the option to continue study in general paediatrics or subspecialise in one of the 17 paediatric subspecialties via ‘GRID’ training. Trainees must undergo competitive selection at a national recruitment level, with applicants required to meet rigorous criteria and perform at interview. Although the biggest subspecialty in paediatrics, Neonatology is still relatively small with a comparatively low number of neonatal consultants required across the UK. This accounts for very high competition when applying for ‘GRID’ training. In 2019, there were 38 positions across the UK and 96 applicants5.
- Level 3 (ST6-8) Neonatal medicine ‘GRID’ training– This stage of training prepares doctors to be neonatal consultants. By the end of 3 years of subspecialty neonatology training doctors must be able to provide comprehensive care to the critically ill infant on the neonatal intensive care unit, whilst ensuring the care of well term infants on the postnatal ward, as well as being expert in providing support for families. Before attaining the CCT, trainees must take the RCPCH START exam for neonatology. This is a formative clinical exam consisting of a circuit of 12 stations, which test different skills and helps to reveal gaps in knowledge.
Top Tips To Succeed At Recruitment Stages
ST1
Show interest early on. As a medical student there are always opportunities to get involved in paediatrics through student selected components, electives and becoming part of your university’s paediatric society. Students can also apply for free affiliate membership of the RCPCH.
Aim to get a paediatric rotation during foundation training. Try to obtain a paediatric rotation in foundation years as this will make it easier to gain relevant experience and become involved in any quality improvement projects ongoing in the ward. However, if this is not possible, taster weeks and taster days in the specialty exist and are worth applying for to prove your interest in paediatrics.
Neonatal medicine ‘GRID’ training
Develop a strong portfolio. Applications are shortlisted and scored depending on involvement in quality improvement projects, teaching opportunities, management roles and research projects5. The highest number of points can be made available by having more than one publication in a peer reviewed journal as a first author.
Subspecialties
As neonatal medicine is a subspecialty in itself, there are fewer options to further subspecialise. Opportunities that exist are to develop special interest in paediatric cardiology for which specific consultant roles exist. Additionally, in neonatal medicine, ethical and legal scenarios are routine due to care being for an infant who cannot express their own interests and values. With this comes opportunity to develop knowledge in ethical legislation and to become a medico-legal adviser for the medical defence union.
Like most medical specialties, doctors can train via an academic route whilst completing specialty training. Academic training is available via Academic Clinical Fellowships (ACF) posts which map to ST1-ST3 and allow for protected time within the post or rotation for research.
After ST3, academic trainees opt to do a PhD before returning to the later years of speciality training posts. Specialty trainees can apply for Out of Programme for Research (OOPR) posts where you can take time out of research to do a PhD without previously having an ‘academic’ post6.
