Pediatrician
June 13, 2013

Five years out of residency, this Baltimore pediatrician reflects on the transition to private practice. 

Does residency prepare you for community practice?

Yes, in the sense that once again you’re multitasking, dealing with a wide variety of issues, and diagnosing and treating diseases. But practicing in a hospital or a residents’ clinic is not representative of the business of medicine and the labyrinth of insurance issues you face in the community. In the hospital you order a test and it gets done—here you sometimes keep your fingers crossed that the patient gets to where he needs to go.

Other transition issues?

Managing staff, having fewer resources, continuing medical education and the everlooming need to keep reading, reading and reading. You must pace yourself and decide what is most helpful and then disseminate it among staff.

Did you bring anything else with you from residency?

During residency I was introduced to the Reach Out and Read program, which I wanted to continue in practice. The program struck me as an effective way to guide families in preparing their children for school and as a way to gauge the family’s literacy.

What attracted you to Dundalk Pediatrics?

Patients and their families are quite diverse in terms of education, socio-economics and race, so you get a little bit of everything. Medically fragile and complicated patients are often referred to us for primary care due to our ties to Johns Hopkins.

How do you manage those issues?

As a medical home we’re addressing the growing need for holistic treatment of the more chronic conditions. So we treat the medical problems but also focus on prevention and provide a lot of health education. As we learn more about the origins and genetics of disease, we’re developing more early interventions for conditions like diabetes and heart disease.

Do you have enough time for those patients?

Each provider sees about 20 patients each day. We try not to overschedule so that we have adequate time to meet the needs of our families, extract concerns from adolescents and do behavioral counseling and relationship building.

What personal attributes do you see important in practice?

It’s really important to listen with a level of concern and passion that allows parents to feel they have legitimate concerns. Also, you have to be able to see the big picture. Children live in the context of the family and can’t make decisions about their health care—so you’re really taking care of the whole family.

Do you see technology influencing practice?

The transition to electronic patient records has been difficult—there’s always a learning curve and some grumbling in the ranks when change occurs—but we’re more informed each time we see the patient. Technology has also enhanced our communication with specialists.

How about families’ Internet access to medical information?

Families are coming up with their own diagnoses and treatment plans, and it’s a very difficult process of delicately helping them filter the information. On the other hand, technology opens the door for them to be better partners in care. That’s how I see my role—we’re educators and caretakers, treating children and helping parents navigate the health care system, school system and social services. The doctorpatient relationship has morphed from a paternalistic style into a partnership.

How would you describe the stress level in practice today?

There’s always stress. In pediatrics as in most fields, there are expectations to do more in less time and with fewer resources, which forces you to be creative. Every week another hot issue comes out of the AAP, like new dangers of social networking sites. With cyber bullying the rumor mill takes on a whole new life—now it’s broadcast to the entire world.

Are the rewards different in practice?

The rewards are probably the same as they were in residency, and hopefully that’s something that doesn’t change. The reward is being invested in children’s lives and contributing to healthier, happier successful families. That’s certainly why I do this.