Josephine Enciso, MD, has always had a soft spot for children. However, her first day as a neonatologist, while she was a pediatrics intern, was maybe her last. “The neonatal intensive care unit is a terrifying place,” she describes. “The newborns are in critical condition, the nursing staff is incredibly knowledgeable and high-intensity, and the work is extremely fast-paced.”
Dr. Enciso, an associate clinical professor of pediatrics and neonatology at the David Geffen School of Medicine at UCLA, says that these are some of the reasons she appreciates her profession today. “This is a very comprehensive, data-driven subspecialty that requires extensive research. When dealing with kids as small as 400 grams who are on the verge of being viable, the necessity for extremely exact calculations is nearly constant “” she explains. “I particularly appreciate the NICU’s highly collaborative environment, in which bedside nurses, charge nurses, neonatal nurse practitioners, neonatology fellows, pediatrics residents, and attendings all work closely together.”
Dr. Enciso also finds it pleasant to be the first physician for many of her patients. It is not necessary to rely on the parents to provide a history because all of the information is readily available, she explains. “Patients’ problems are frequently clear, and I enjoy performing an intervention and witnessing its immediate impact. It gives me a great sense of purpose.”
The tiniest of patients
While 23 to 24 weeks’ gestation is often regarded the threshold of viability, Dr. Enciso notes that babies as young as 22 weeks have been successfully resuscitated, albeit with a very poor chance of survival. “We deal with a lot of ethical questions linked with quality of life since the 23- to 25-week babies frequently end up with severe to profound defects,” she continues. “The most difficult aspect of the speciality is that we cannot guarantee the parents that they will receive a healthy kid at the end of the procedure.”
Dr. Enciso considers it rewarding to be of service to the families of her patients. “We’re guiding people through difficult decisions and terrible situations, so compassion, patience, and effective communication skills are crucial,” she says. “We work on the side of the family in terms of their hopes for their child, but we also have to be advocates for the infant as a medical team,” says the doctor.
Of course, every situation is unique. While a baby born with cardiac or gastrointestinal defects may require months of NICU care, at-term babies born with mild respiratory distress following a surgical birth may be able to go home after only a few days in the hospital.
Training that is based on research
To become a neonatologist, doctors must first complete a three-year pediatric residency program. Following that, a three-year neonatology fellowship is completed. In the words of Dr. Enciso, “Neonatology has always been a very research-based fellowship.” Following a year of clinical training, the remainder of the training program is devoted to unique research.
According to Dr. Enciso, neonatologists in academic medicine are unable to devote their full time to clinical care since they are also required to lecture, do research, and perform administrative tasks. She spends almost half of her time at UCLA managing the Neonatal-Perinatal Fellowship Program.
However, neonatologists in community-based settings are largely limited to clinical care. According to her, “we are a physically demanding, adrenalin-fueled specialty.” “Clearly, many of my colleagues find it to be a good fit for them.”
What a day in the life of a neonatologist looks like
Dr. Enciso provides direct patient treatment for a total of 22 weeks every year, which is divided into 11 two-week parts. She normally starts her day at 8 a.m. with rounds with the entire NICU staff, which take the better part of the morning. In the afternoons, she sees patients and provides family counseling services.
She takes charge of emergencies as they happen and may even be called in to assist with tricky deliveries if the situation calls for it. Her day could stop at 5 p.m. or it could go on until the early hours of the morning.
Dr. Enciso also offers backup coverage for the healthy newborn nursery at the Ronald Reagan UCLA Medical Center on an as-needed basis. “It’s lovely, but I immediately miss the intensity of the NICU,” she says.