July 9, 2014
Rockville, Md., pediatric pulmonologist and asthma expert Sam Rosenberg chose an uncommon path—one that both he and his patients have valued.
What got you interested in medicine?
Growing up in Chevy Chase, Md., I was very interested in science but I didn’t want to work in a lab. I wanted to help people, so I chose medicine. Then, half-way through my combined internal medicine-pediatrics residency at the University of Michigan Hospital, I realized I preferred caring for pediatric patients. I chose pediatric pulmonary because I like taking care of complicated and sick children, but I didn’t want to be a full-time hospital doctor. So, in 1994, I established a private practice.
What disorders are you seeing today?
Asthma is the most common lung problem I manage, although I also see a lot of babies with pulmonary complications of prematurity, and children with chronic cough, cystic fibrosis and sleep apnea.
Are you seeing an increase in asthma?
Yes, definitely, for two major reasons— over the past 20 years pediatricians have become much more aware of asthma and are appropriately referring patients with chronic asthmatic symptoms. The other reason— allergies are on the rise in children.
Is asthma being well managed?
Yes, but there are still many patients I see with a chronic cough who come in with a diagnosis of asthma and leave the office with a different diagnosis, like a sinus problem or reflux. The advantage I have is training in lung function testing, which is very helpful in teasing out some of these patients. I can figure out with a little more certainty whether they really have asthma or not.
We’ve had a hot and cold spring. Do such weather patterns affect asthma?
Yes, weather change is a significant trigger in many asthma patients. Sometimes barometric changes can also make asthma harder to treat. Of course, every spring we see a lot of kids with allergic asthma, and year-round we’re seeing more and more kids with exercise-induced asthma. But old gyms tend to be dusty, too, so is it exerciseinduced asthma or allergic asthma?
Do you see a link between asthma and obesity?
Obesity does play a role in a lot of pediatric breathing problems, including obstructive sleep apnea and asthma. One thing we’re learning is that asthmatic kids who are overweight generally are harder to treat— they don’t respond as well to medications. But when we’re able to get them to lose weight, their asthma and sleep apnea get much better.
The hurdles in treating asthma?
The first issue is compliance with medications. These kids use inhalers every day and over time the child gets disinterested, which can lead to a lot of problems. Adolescents and young adults— especially those going off to college, are often the hardest ones to deal with because they don’t follow directions as well as their parents followed directions.
How do you manage that?
During every asthmatic visit I take a full history, ask about medications and compliance, perform lung function tests, assess what the child’s level of asthma is and whether any change in medication and environment will be indicated. I write out the treatment plan for the family, give them handouts about the meds, and explain to 5 both the parents and the patient what each medication does and why we are giving it. In my experience, if you do that you get better compliance.
And you’re managing all these patients by yourself?
I have a nurse and a medical technician but, yes, I’m the only doctor here. In my field I’m the only one I know of in a solo, private pediatric pulmonary practice in the midAtlantic region, and certainly in Maryland. It just sort of happened—I decided I wanted to have my own practice, to be the chief, cook and bottle washer.
I wanted to have control over the workings of the practice. But as time goes on it’s become more and more difficult, especially with the increasing administrative burden. I have to balance that with the autonomy, the positives of what I do.
What are the positives of going solo?
The major one is continuity of patient care. Also, the accessibility we have for patients can’t be beat. If one of my patients with asthma is sick, we just say bring him/her in. My patients know that when they’re sick I’ll see them—and they know they’ll see me instead of a different doctor every time they come to the office. I think they really appreciate that.
How do you advance your practice knowledge base, keep up to date?
That is a challenge because I don’t have other doctors here to discuss issues with. I do a lot of CME and consult with certain people across the country whom I’ve known for years, and I have the entire NIH library at my fingertips to help me keep up on the latest developments in pediatric pulmonary.
So, what do you really enjoy about practice?
The interactions with the patients are great. My current employees have been with me for between 12 to 20 years—they are wonderful people, the patients know them and they’re comfortable with them—which has allowed us to create a family “mom and pop” atmosphere here. The social interactions are very warm.