Wednesday, November 12, 2008

My Two Cent’s Worth about General Pediatrics

A new doctor on the medical staff of my hospital parks his Rolls Royce in the MD parking lot. It sticks out among the Mercedes, Suburban’s,and Hondas that other doctors park there. It gives me pause to fantasize about the life this physician has and how different it must be from mine – no school loans, kids grown and out of college, retirement nearing with a nice nest egg (or at least decent after the recent downturn of last month’s market.) As a Pediatrician, I know this will not be my life, and I’m absolutely fine with it. As Nancy Snyderman, MD, told Matt Lauer recently on the Today show, “Pediatricians don’t go into medicine to get rich. They go into medicine because they love children.” Lesson #1: Think about another specialty in medicine or another career altogether if money is high on your life priority list. Don’t get me wrong. My family and I are comfortable, but there’s a reason (which is best left to a future post) pediatrics winds up on the bottom of the pay scale every year.

Lesson #1 has a couple of corollaries. The first is do what you love and the rest will follow. Sometimes what you love changes, and be willing to follow that path, too. It’s ok to reinvent yourself midlife (or sooner) if you decide another field suits you better. Six years ago, I decided to apply for dermatology residency. It was a period of time that had me reaching for the stars, but I had to do it to be happy with my choices. Derm programs are very choosey, and no program wanted to pick up a practicing pediatrician and put them back in the rigors of residency no matter how glowing my letters of references or work experience shined. Instead, I opened my own general pediatric practice, and have found success and happiness in the autonomy that followed.

Corollary number two is if you have wealth as a pediatrician, it is best not to flaunt it. Maybe your great, great uncle with no children left you a trust. Maybe you can get away with driving that Porsche in a really upscale area. In my suburban community, I often encounter parents and patients when I’m grocery shopping or making a Starbuck’s run. They check me out – what car I drive, whether it has a booster seat in the back, what shoes I have on, what’s in my shopping cart. There’s something about taking care of sick and miserable children and displaying luxury possibly gained (or not) from delivering this care that is incongruent to me. It may be the stuff of deep pockets that malpractice lawyers and litigious patients look for. Save the pictures of the fabulous vacation in the Caymans for home.

Lesson number two is that in pediatrics lifestyle and money are two choices (of many) that may determine your path to happiness. One of the beauties of my specialty is that it is family friendly and very flexible. One of my colleagues is getting back into the workforce right now after three years absence. She needed time to care for her daughter with Type 1 Diabetes. Other physicians choose to work part-time or job share. In my practice, I have learned that I deliver the best continuity of care with my patients if I am there at least three days per week (I average 4 days per week), but I also employ a physician who works two days per week and takes no call. My compensation is higher because I see more patients. Her lifestyle is different than mine because she is part time.

Primary care is a production business, and that’s something to consider as you make your choices in medicine. During a typical work day, I need to see at least 23 patients to be able to pay my overhead – office staff salaries, lights, medical supplies, insurance filing fees – before I pay myself. I’m conscientious of this because I own my own practice. Whether you work for yourself or are employed by a major healthcare system, general pediatrics is about seeing lots of patients. Employers track these numbers, too, and compensate you accordingly. So if you like to chat with your patients like I do, you’ll see fewer and be paid less than the guy down the street who sees 60 patients per day and says very little. My whole office is a beehive of activity each day to accomplish each patient encounter. When I hire new staff, I let them know up front that pediatrics is fast paced.

Why, you may ask, have you focused so much on the economics of medicine when all I need is advice about how to be a good clinician or balance my family life? The body of knowledge needed in medicine in infinite, and I am humbled daily by what I don’t know. Yesterday I encountered two new medicines I had never heard of before reading a specialist’s notes. Your focus in training needs to be on assimilating as much of this knowledge as possible. The reality, though, is that medicine doesn’t exist in a vacuum. Eventually you will need to take all you have learned and apply it to the world we live in with all of its variables (insurance, national quality guidelines, patient compliance – just to name a few) – broken healthcare system and all.

1 comment:

  1. I wish that medical school had the scope to include economic considerations into didactic teaching, but then it would probably make it even longer to complete. Nobody wants that!


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