Paediatric surgery

This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.

Nature of the work

Paediatric surgeons might be performing surgery for a tiny baby born at 25 weeks’ gestation or for a six-foot teenager!

The types of surgery are wide-ranging and include:

• abdominal
• thoracic (oesophageal, lung and bronchial anomalies)
• trauma surgery
• transplantation
• endoscopy [1]
• laparoscopic (keyhole)
• urology

Specialist paediatric surgery includes:

• neonatal [2] surgery (often for congenital abnormalities such as defects in the abdominal wall and diaphragmatic hernia)
• major intestinal surgery
• major trauma surgery
• oncology [3] surgery

Only 11% of operations on children are carried out by paediatric surgeons. The remainder are performed by other specialist surgeons, some of whom specialise in paediatric cases. These include general, orthopaedic, plastic, oral and ophthalmic surgery as well as ENT and urology. Specialist adult surgeons may work in partnership with paediatric surgeons to treat uncommon childhood disorders such as thyroid and certain gastrointestinal conditions.

Surgery is only part of the work. You’ll also attend outpatient clinics and ward rounds where you’ll meet your patients and their parents or carers. Reassurance and advice for concerned parents is an important part of your job.

Most specialised children’s surgery is performed in dedicated children’s hospitals or in paediatric surgical units within larger hospitals. Approximately 338 surgeons work in 29 centres of this kind in the UK. The consultant paediatric surgeon leads a team of health professionals who diagnose, treat and support children with a wide range of conditions, including those diagnosed antenatally.

“Surgery is very satisfying as you make a decision to perform an operation and you can see immediate results”. Kathryn Evans, Consultant paediatric surgeon, St George’s University Hospitals NHS Foundation Trust.

Read Kathryn’s story [4]

Common procedures/interventions

Non-specialist elective [5] paediatric surgery may include the management of common problems including hernias, circumcision or undescended testis

Emergency procedures include appendectomy, correction of torsion of the testis and correction for the narrowing of the opening between the stomach and the intestine.

Paediatric surgeons often perform complex surgery on children with disabilities to improve their standard of living.

Sub-specialties

• urology

There is an increasing trend for consultants to develop further specific expertise in areas of special interest which include:

• neonatal [2] surgery
• urological surgery
• hepatobiliary surgery
• gastrointestinal surgery
• oncological surgery

Some consultants have an interest in paediatric orthopaedics, paediatric neurosurgery and paediatric cardiothoracic, but they come from orthopaedic, neurosurgery and cardiothoracic surgical training routes, rather than paediatric surgery.

Want to learn more?

Find out more about:

• the working life [6] of someone in paediatric surgery
• the entry requirements [7]and training and development [8]
• a first-hand account of life in paediatric surgery [4]

• Pay and conditions

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  This section provides useful information about the pay for junior doctors (doctors in training), SAS doctors (specialty doctors and associate specialists) and consultants.

  Find out more about current pay scales for doctors [9], more information can be found on the BMA website [10].

  NHS Employers [11] provides useful advice and guidance on all NHS pay, contracts terms and conditions.

  Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.

• Where the role can lead

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  Read about consultant and non-consultant roles in paediatric surgery, flexible working and about wider opportunities.

  Consultant roles

  You can apply for consultant roles six months prior to achieving your Certificate of Completion of Training [12] (CCT [13]). You will receive your CCT [13] at the end of your paediatric surgery training.

  Managerial opportunities for consultants include:

  • clinical lead - lead NHS consultant for the team
  • clinical director - lead NHS consultant for the department
  • medical director - lead NHS consultant for the Trust

  Most NHS consultants will be involved with clinical and educational supervision of junior doctors.

  Here are some examples of education and training opportunities:

  • director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards.
  • training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors eg foundation training [14] programme director. This role will be working within the LETB/deanery
  • associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the LETB/deanery

  SAS doctor roles

  SAS surgeons (Staff, Associate Specialists and Specialty Doctors) work as career grade specialty doctors who are not in training or in consultant posts. You will need at least four postgraduate years training (two of those being in a relevant specialty) before you can apply for SAS roles.

  The role of an SAS surgeon can vary greatly. Depending on your experience you might work on complex surgery or relatively minor diagnostic and outpatients work. SAS doctors will frequently participate in routine and elective [5] surgery rather than emergency work. They may also train other staff.

  Some surgeons are attracted to the SAS role as the hours are more regular than those of the consultant, and you’re paid for on-call work and overtime beyond 7am-7pm.

  Find out more information on the SAS doctor roles [15].

  Other non-training grade roles

  These roles include:

  • trust grade
  • clinical fellows

  Academic pathways

  If you have trained on an academic plastic surgery pathway or are interested in research there are opportunities in academic medicine.

  For those with a particular interest in research, you may wish to consider an academic career in plastic surgery. Whilst not essential, some doctors start their career with an Academic Foundation post. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum [16].

  Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) and may progress to a Clinical Lectureship (CL). Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.

  Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC). [17]

  There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine [18].

  The Clinical Research Network [19](CRN) actively encourages all doctors to take part in clinical research.

  Other opportunities

  There are excellent opportunities for a broad-based career in paediatric surgery, which could include teaching, external examining, research, writing and committee participation. Full-time academic posts are rare.

  The opportunities for private practice within paediatric surgery are very limited.

• Job market and vacancies

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  This section provides useful information about the availability of jobs, how to find vacancies and sources of further information.

  Job market information

  NHS Digital regularly publish workforce statistics which show the number of full time equivalent consultants and doctors in training for each specialty: NHS Digital workforce statistics [20]. 

  Competition ratios for medical specialty training places are published on Health Education England's specialty training webpage [21].  

  Core and paediatric surgery training programmes are now open to those who want to train less than full time (LTFT) or job-share.

  For information regarding Scotland, Wales and Northern Ireland please click on the links below.

  NHS Scotland workforce information [22]
  NHS Wales workforce information [23]
  NHS Northern Ireland workforce information [24]

  Where to look for vacancies

  Applications for core surgery training are made via the Core Surgery National Recruitment Office [25].

  Registration and application for core surgery and specialist training is online via Oriel [26].

  The national recruitment for paediatric surgery specialty training ST3 is handled by Health Education England,  Yorkshire and the Humber local office [27].

  The training programmes are open to those who want to train less than full-time (LTFT) – you should apply and request this after getting the job. Restrictions apply.

  Further details person specifications and application deadlines are also available on the Oriel site [28].

  Northern Ireland has its own recruitment process. For further details please visit the Northern Ireland Medical and Dental Training Agency [29] website.

• Further information

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  British Association of Paediatric Surgeons (see also the section for trainees, TriPS) [30]

  British Medical Association [31]

  General Medical Council [32]

  Royal College of Surgeons [33]

  Royal College of Surgeons of Edinburgh [34]

  Royal College of Physicians and Surgeons of Glasgow [35]