Paediatrics

Nature of the work

It’s a holistic [1] specialty — treatment takes into account symptoms of the disease and other factors (eg mental and social), making it specific for the individual. The aim is to minimise the adverse effects of disease, while allowing children to live as normal a life as possible.

Paediatricians may offer any of these three levels of patient care:

• primary care [2] in the community and general practice settings
• secondary care [3], perhaps in a hospital setting
• tertiary care [4], usually in larger district general hospitals and teaching hospitals

 “I work in a truly multidisciplinary team to provide the care that is needed”. Anu Raykundalia, Community paediatric specialist registrar, Ealing Hospital NHS Trust.

Read Anu’s story [5]

General paediatrics remains the bedrock of the service, but there are opportunities to develop close links with other areas of medicine such as primary care [2], child and adolescent psychiatry and public health. Within paediatrics, specialists may develop skills in a variety of medical fields, including community paediatrics and neonatal [6] intensive care [7].

It’s a large and diverse field, encompassing everything from high-technology specialties, such as neonatology, to community-based services such as managing care for disabled children.

Paediatrics is forward looking and research frequently leads to impressive and exciting medical discoveries.

Associated sub-specialties

There are many sub-specialties within paediatrics, including:

• allergy, immunology and infectious disease
• clinical pharmacology
• diabetes and endocrinology
• emergency medicine
• inherited metabolic [8] medicine
• neonatal [6] medicine
• nephrology
• neurodisability
• neurology
• oncology [9]
• palliative medicine
• gastroenterology, hepatology and nutrition
• intensive care [7] medicine
• respiratory [10] medicine
• rheumatology
• child mental health
• community child health

Want to learn more?

Find out about:

• the working life  [11]of someone in paediatrics
• the entry requirements [12] and training and development [13]

• Pay and conditions

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

  Find out more about the current pay scales for doctors [14], and there's more information on the BMA website [15].  

  NHS employers [16] 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 paediatrics, 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 [17] (CCT [18]). You will receive your CCT [18] at the end of your paediatrics training.

  There are managerial opportunities to take on further responsibility after becoming a consultant such as:

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

  In addition you will find education and training opportunities, as most NHS consultants will be involved with clinical and educational supervision of junior doctors.

  Here are some examples of the opportunities that exist:

  • 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 [19] programme director. This role will be working within the LETB/deanery
  • associate dean - the NHS consultant that is responsible for management of the entirety of a training programme. This role will be also be working within the LETB/deanery

  SAS doctor roles

  There are also opportunities to work at non-consultant level, for example as a SAS (Specialist and Associate Specialist) doctor. SAS doctors are non-training roles where the doctor has at least four years of postgraduate training, two of those being in a relevant specialty. Find out more about SAS doctors roles.

  SAS doctors play an invaluable role in the paediatric workforce. In Community Child Health, for example, they account for nearly 50% of the non-training workforce.

  Other non-training grade roles

  These roles include:

  • trust grade
  • clinical fellows

  Flexible working

  Paediatrics is a specialty with a higher female:male ratio than other specialties. There are a high number of female consultants and SAS doctors, making family friendly working very accessible.

  Academic pathways

  If you have trained on an academic paediatric 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 paediatrics. 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.

  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.

  Entry into Academic Clinical Fellow posts is coordinated via the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC). [20]

  There are also a huge number of 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. [21]

  The Clinical Research Network [22] (CRN) actively encourages all doctors to take part in clinical research.

  Overseas experience

  The well-established RCPCH/Voluntary Service Overseas (VSO) Fellowship Scheme offers specialist trainees one-year placements working to improve child health in developing countries.

  Fellowship placements are out of programme experience (OOPE) with structured support from RCPCH to develop personal and professional learning. Fellows develop their teaching, managerial and clinical skills, working in partnership with local professionals to improve outcomes for some of the poorest children in the world.

  Other opportunities

  There may also be opportunities to work in the private sector.

• 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.

  Workforce statistics can help you understand which specialties are growing, the level of competition for training places, whether there may be consultant vacancies when you achieve entry to the specialist register, in which specialties you are most likely to find opportunities to work flexibly or whether demand for specialists in a particular field is decreasing.

  Job market information

  Paediatrics is one of the largest consultant specialties.

  There are around 2,989 consultant paediatricians and 3,287 medical registrars employed in England (NHS Digital 2016 [23]).

  In 2016, the competition ratio [24] for paediatrics for ST1 was 1.65,  for ST 3 paediatrics was 2.24 and for ST4 1.17 (NHS specialty training 2016). [25]

  On this section we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.

  NHS Scotland workforce information [26]
  NHS Wales workforce information [27]
  Northern Ireland workforce information [28]

  Competition ratios

  Competition ratios tell you how many applications were received, relative to the number of specialty programmes that were available in the previous year’s recruitment. The ratios highlight the least and most subscribed options from this period and may give you an indication of general trends of applicant behaviour.

  As such, they may help you identify areas where you may have a better chance of success as you plan your specialty career. However, it is important to note that they are indicative rather than substantive and therefore should not be used in isolation. To make the best use of the ratio data, look at the number of applications received and cross-reference that information with the number of applicants who were short-listed and subsequently attended an interview.

  Find out the latest competition ratios. [29]

  Where to look for vacancies

  Northern Ireland has its own recruitment process. For further details please visit the Northern Ireland Medical and Dental Training Agency [30] website.

  NHS jobs [31]

  BMJ Careers [32]

  For training posts look on the Royal College of Paediatrics and Child Health website. [33]

• Further information

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  Organisations

  The Royal College of Paediatrics and Child Health [33]

  Video case-studies

  Consultant in paediatrics (HEWM) [34]

  Dr Lucy Cliffe, paediatrics consultant (HEWM) [35]