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The Informed Parent

The Making of a Pediatrician (2 of 2)

by John H. Samson, M.D., F.A.A.P.
Published on Apr. 10, 1999

Last week we took the prospective pediatrician up to graduation from medical school In the senior year of medical school the student would have been interviewed for further training as a resident physician. At this point of time the student decides which field of medicine he or she will dedicate his life. By March of the senior year hopefully one has been accepted into a program in the field of his choice.

The length of time varies depending on the particular residency programs. Pediatrics currently involves three years of training beyond medical school. The new physician spends time in outpatient and inpatient care settings. He or she works under the supervision of fully trained general pediatricians, as well as pediatricians who have sub-specialized in pediatric neurology, psychiatry, kidney diseases, intestinal problems, infectious diseases, endocrine abnormalities and pediatric surgery.

The resident spends four-to-six weeks on these varying services, providing care and learning the intricacies of diagnosis and treatment. Reflecting on my own training this was the best time of my entire educational process.

Upon completion of these three years the new pediatrician is faced with more choices: 1) go directly into the practice of general pediatrics. 2) spend an extra year as Chief Pediatric Resident if, in fact, the position is offered to you. 3) go into a pediatric sub-specialty fellowship program involving another two-to-three years of supervised training before stepping into a practice setting.

Regardless of the choice one makes, it will be time to take the Pediatric Board examination. Upon successful completion of these exams you will now be a Board Certified Pediatrician, adding the initials F.A.A.P. after your M.D. degree. This stands for Fellow of the American Academy of Pediatrics. The examination is a comprehensive test of basic diagnostic and therapeutic skills. Once passed a similar exam is taken at regular intervals to maintain board certification.

This educational odyssey has taken at least ll years following high school. It has cost thousands of dollars and long hours of dedicated study. Why endure such a travail?

I have been a practicing pediatrician since 1970. I can think of no better way to make a living. There comes the immense satisfaction of seeing one's efforts improve the lives of the patients. There is the rewarding opportunity to teach medical students and residents. There is the undeniable trust built up by the families you have cared for. Often you are treated as a member of their family. The children, adolescents and young adults relate to you as a friend and confidant as you help them struggle through their formative years. You are a medical caregiver, a teacher, a counselor, and a friend to your patients.

What is the down side to being a pediatrician? In my point of view there is only one--night and weekend call duty. It would be nice to work from 8:00 a.m. to 6:00 p.m., five days a week. But that is not reality. It is imperative to be phone ready and geographically near enough to respond to an emergency call when one draws the duty. If one is careful your family need not suffer from the burden of on call duty. The advent of the cellular phone afforded me the ability to attend all sporting contests or theatrical performances of my children. No significant family event was missed because of being on call. Office hours were always scheduled allowing me to eat dinner with my family. I was never an uninvolved or absentee father because of my profession. Admittedly, this negative aspect of being a practicing pediatrician is more a nuisance than a handicap. It should be noted that our patients at Pediatric Medical Center are respectful of this on call time, and have never abused our 24 hour availability. It is true that one can work for a large managed care practice and, thus, avoid frequent after hours on call duty. Some large groups sign out to urgent care centers which free their physician employees from the rigors of "being on call". This is a tradeoff. The lack of availability at emergent times diminishes the feeling of loyalty between patient and physician. This bond makes the practice of medicine much more satisfying.

In conclusion I would like to warn anyone who is contemplating becoming a physician; DO NOT
LISTEN TO THE DOOMSAYERS!! They are the disgruntled people who say medicine as a profession is a hopeless way to make a living; managed care has made, and will continue to make, the profession of medicine a drudgery. Admittedly, it has not helped, but the current trend for physicians fighting to remain outside the clutches of an HMO is growing. This is still a profession which allows you to decide where and who you will work for. There remains the choice to still work for your patients and not for a medical administrative conglomerate which dictates what you can do for your patients, independent of what they need.

Parents must encourage their children to have goals and dreams within reach of their physical and intellectual abilities. Discouraging them needlessly only destroys motivation. The world will always need physicians. There will always be a job, and if the physician is conscientious and kind, there will always be patients. Despite negative media information about the practice of medicine, applications for medical school have been increasing over the past several years.

Remember, if you have the calling there is no better way to make a living than by being a pediatrician.

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