Not knowing what else to do after finishing my pediatric residency 15 years ago, I became a general pediatrician. Not knowing how to find a job halfway across the country and closer to home, I relied on a recruiter from a smallish town in South Dakota to woo me into private practice. Not knowing how to choose my future partners, I let them choose me.
Despite my unbelievably naive approach to finding my first job as a physician, I think I was pretty lucky. I joined a physician-owned multi-specialty practice that had been founded by the father and uncle of one of the general surgeons. I joined two well-established pediatricians who were kind and welcoming.
I still keep in touch with that general surgeon whose father founded the clinic and think of him as one of my mentors. As tempting as it is to a now-hospitalist to stereotype surgeons, he was a very insightful and humanistic physician. He met with each new doc and told us to “remember what your address is.” He invited me to a book club that met monthly and discussed the writings of Atul Gawande et al.
My own pediatric partners were also exemplary. They had devoted patient panels, worked hard, and were always happy to entertain questions from the newbie. They were just plain good people, too.
Our patients and their families were also mostly good folks. We had a pretty good payer mix and relatively low social chaos for pediatricians. Many of our families were from even smaller towns and drove dozens to hundreds of miles to see us.
I guess what I’m trying to say is that it was a pretty good gig as far as general pediatric gigs go. We saw newborns and pediatric patients who were admitted to the two local hospitals and spent the rest of our time seeing outpatients.
The newness kept me going for awhile. I even picked up a side hustle as a child abuse physician (since no one else wanted to do it) which renewed my sense of purpose for a bit longer. But after only 1 to 2 years into my career as a general pediatrician, I was near despair. How could I do this for another 30+ years? How could I even do this for another five?
I felt confident that my disenchantment with general pediatrics was not due to suboptimal partners or practice. That was a relief, really, because I felt like my three years there were as good a test of general pediatrics as I could get. It was general pediatrics itself which was not the right fit for me.
I knew I had to change my trajectory but was not ready to pigeonhole myself into a subspecialty. I decided to give pediatric hospital medicine a try and made plans to move back to the comfortable setting where I had been a resident.
Telling Rick, Mike, and (by now, my third partner) Christiane that I had decided to leave was very difficult. Not only had I accumulated a patient panel of my own that would have to be absorbed, but their call schedule would revert from 1 in 4 to 1 in 3. I will also never forget the awkward moment when the mom of a patient broke down in tears when I told her I would be leaving the practice. I felt like I was letting a lot of people down.
Replacing a physician is not a quick and easy task. It takes months to recruit, interview, hire, credential, and orient a new doctor. Depending on geography and specialty, it can be very difficult to find a good candidate. Hiring a new physician partner is completely different than hiring a new cashier at a local grocery store. A physician partner is tasked with caring for the entire group’s patients on a regular basis and must have the knowledge and skills to do so in a trustworthy manner.
But being the good guys/gal that they were, my partners understood that I needed to try something new. They threw me a going away party, gave me a beautiful photo collage of the local sights, and never once commented on the inconvenience of my departure from the call schedule.
I am a better hospitalist because of the time I spent in the clinic. I am a better physician because of the relationships I formed with my surgeon mentor, my pediatric partners, and my outpatients. Although it did not end up being my forever job, it was three years well spent.
Lisa Sieczkowski is a pediatrician.
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