Being a private practice pediatrician in a pandemic [PODCAST]

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“The hospital systems ignored us by putting us lowest on the totem pole for the COVID vaccine.  The pharmaceutical companies overlooked the strains on us and increased our vaccine prices.  The medical supply companies took advantage of us by limiting our supplies and increasing prices astronomically.  Worst of all, the insurance companies (knowing we are already the lowest reimbursed field) changed coding and billing requirements and reimbursements in 2021, ultimately decreasing our reimbursements even further.  So now we are paid even lower than we were prior to the pandemic.”

Jamie S. Hutton is a pediatrician.

She shares her story and discusses her KevinMD article, “Being a pediatrician in a pandemic.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Jamie Hutton. She is a pediatrician, and she wrote a KevinMD article, “Being a pediatrician in a pandemic.” Jamie, welcome to the show.

Jamie S. Hutton: Thanks for having me, Kevin. I’m excited to be here. Thanks for everything you do. I always listen to your podcast, and it’s really important for us in medicine.

Kevin Pho: Well, thank you so much for listening and for writing that KevinMD article, and we’ll get into that in a little bit. But first off, can you just share your story and journey to where you are today?

Jamie S. Hutton: I am a general pediatrician located in a small town in Virginia. I grew up in this town, and growing up in this area, there weren’t very many pediatricians around. And so I saw the need, and I also just had a love for kids. So at a very early age, in elementary school, I decided I wanted to be a pediatrician. Nobody in my family was in medicine at all, not even nurses. And so this was a totally foreign world to me, but I was determined this is what I was going to do. And so in high school, college, and med school, I was at the top of my class in all three, because I was determined: I’m going to be the best pediatrician I can, and I’m going to come back to this town and provide great care for these kids. I just saw the kids as being the future, and why don’t they deserve the best? They’re what we’re looking forward to each and every day.

And it’s actually kind of funny, because I met my husband in high school, and after a couple dates, I looked at him and I said, “You know, I’m going to med school. You’re either in this or you’re not.” And he luckily went along for the ride. As you go into med school and residency, it’s hard. It’s long hours, as you know. It is a lot of work. But I never changed my mind. I decided this is what I was going to do. There were other fields that I kind of liked, but nothing that really had the passion like pediatrics.

So I graduated residency. I actually stayed in Virginia for all of this training. And then I came back to the small town and joined a small group practice. I was with that group practice for about two years, and then I became partner at that practice. And that’s when I learned the business of medicine, which is, as you know, a whole new ballgame. I stayed on as partner for about five years, and then I realized my ideals and my partner’s ideals were a little different. We wanted to practice medicine a little differently. They didn’t necessarily align. So I broke off and started my own private practice from the ground up. And that’s where I am today. It’s six years later, and I have employed two other pediatricians along with me. I have three amazing nurses, office staff, and in-house billing, and I love what I do. It’s definitely a lot of work, but I definitely love what I do. The pandemic has been interesting.

Kevin Pho: I talk to a lot of physicians, and the number of private practice physicians is slowly going down. And you also practice in a small town, to boot. So share some of the challenges of being a private practice physician in today’s health care system.

Jamie S. Hutton: Yeah, it’s definitely challenging. We don’t get the resources that the large hospital systems get. Even during this pandemic, we didn’t get any of the money from the CARES Act. None of that went to us. There were some payment protection programs, but very few of us actually qualified. One of the practices in town did end up closing, and so we did absorb those patients, which helped us out a lot.

And we saw things that we never expected, like not being able to get gloves. In pediatrics, we use gloves a lot. We give a lot of vaccines, and I’ve never not been able to buy a box of gloves. Not being able to get needles. Having to wear the same gown for three months in a row. It’s odd wanting that NICU gown back and paying $20 for the thing. It’s definitely been a challenge. It’s been a stretch. And then, through it all, we’ve actually seen that not only have the prices increased on some of our normal everyday supplies, but then our reimbursements actually decreased this year, which was a big blow to all of us.

Kevin Pho: Now, for those residents or medical students who may be listening to this podcast and are deciding between private practice versus going to an employed model, what are some advantages to going into a private practice?

Jamie S. Hutton: I definitely recommend private practice, even through all of this. It’s a labor of love, but you get to practice the way you want to practice. In a lot of hospital systems, it’s all about numbers. They want as many patients as possible, because pediatrics doesn’t bring in a lot of money, so the more you see, the more money they make. In your own private practice, you get to choose. Personally, I love breastfeeding medicine. So I spend hours with new moms helping them nurse, seeing this baby not latching and mom crying in the beginning, to the end, the mom nursing and the baby gaining 2 ounces at the end of it. It’s totally rewarding, and I would highly recommend private practice.

Kevin Pho: Now, isn’t private practice, in a way, also a little bit about the numbers, too, because in effect you’re running a small business?

Jamie S. Hutton: It is. Yeah, it definitely is. You do have to think of your overhead. You have to think of your costs. There are ways to make it work, definitely. With the coding and billing, it is tricky, and of course, you all want to do it legally. But there are definitely ways that you learn to make the practice work for you. With my breastfeeding medicine, those are visits that take a long time, so I code according to time rather than medical necessity in those. With supplies, you just learn how to get the best price possible. You learn how to keep your overhead as low as possible. And so definitely have the office staff you need, but don’t overstaff by any means.

My office is fairly new. We actually moved to a new location right before the pandemic. But I have never taken out a single loan for my practice. I have always been in the black, and that is very, very rewarding.

Kevin Pho: All right, let’s transition into the KevinMD article that you wrote back in January, and it’s titled “Being a pediatrician in a pandemic.” You talked about some of this already, but for those who didn’t read that article, can you just walk my audience through it and share the story of why you decided to write it?

Jamie S. Hutton: The article talks about why I chose pediatrics, about how I loved it a lot, and how pediatrics, as we all know in medicine, is the lowest-paying field. And most of us go into that knowing that very well. Many of us do have thousands of dollars in loans going into it, so making money is still somewhat important. However, our passion for the kids is what gets us there and what keeps us there. But the pandemic definitely made a lot of us question whether this is the right field for us. Myself, I would never go back. I would never change anything. But the pandemic has definitely made it a much harder field to stay in, with reimbursements decreasing, prices increasing, and demand on us increasing.

We give a lot of our services for free. We answer after-hours calls free all the time. Parents always ask us on the ball field, “What’s this rash?” and we tell them for free. And some of the article is getting the pediatricians to realize that we have a worth and we need to know our self-worth. And we didn’t need to demand the respect and payment that we deserve.

Kevin Pho: Now, you mentioned that one of the other practices in your town closed during the pandemic. Among your peers, during the past year, did anyone lose their passion for practicing pediatrics?

Jamie S. Hutton: Yes, definitely. The burnout was huge, because we had to change the way we practiced. Telemedicine was not something we regularly did in pediatrics, and we had to start that on a dime. We did drive-thru flu clinics. It was exhausting, just constantly changing every single day. And so I do know fellow pediatricians that decided to take some time off, decided to go on maternity leave and not come back. And a lot of them actually didn’t have jobs to come back to. There were many large hospital systems that fired their pediatricians during all of this. And that is one of the things that a lot of doctors just didn’t get exposed to.

Kevin Pho: I’m an internal medicine physician, and I was partially furloughed last year, and that’s one of the reasons why I started a podcast. I had all this extra time from being partially furloughed. And now, just from talking to your peers, for those doctors who didn’t have a job to come back to, what are some of the options that they had?

Jamie S. Hutton: Yeah, there are some good options. In pediatrics, we’re all about education, and so many of them started doing educational programs for parents or for the community. A lot of them started getting on school boards and talking about back to school, and how COVID will change back to school, but getting the kids back in school. Even myself, I changed the way I was teaching myself. I just delved into the psychiatric side of pediatrics, because I knew it was going to be a large need, and I even learned more about breastfeeding medicine, so that way I could make a niche that would make myself very unique and desirable to families, that they would want my practice and choose my practice. And so there are definitely options for pediatricians, but you have to be creative.

Kevin Pho: Now, one of the things that you said earlier is that pediatricians in general have to know their worth, and I think those three words really apply to the medical profession as a whole. Now, from a pediatric lens, what are some specific ways that pediatricians can know their worth?

Jamie S. Hutton: Yeah, I’d say knowing that your knowledge is actually very unique and desirable to many new families. They don’t know how to get a baby back to sleep. They don’t know how to get a baby to latch on. And that is actually worth money. You should know that you have things that are worth money and people’s time. Being able to teach people about the epidemiology of COVID, of the vaccinations, and encouraging your community to vaccinate, that’s worth something, because that’s what’s going to end this pandemic. And so we definitely have a lot of knowledge behind us, and that’s for every field in medicine, that’s for sure. We just don’t realize how much we know.

Kevin Pho: I know that whenever I talk to physicians, either on Facebook, and there are plenty of physician Facebook groups, or just on my own site, there’s that tension between the goodwill of doctors and money, and a lot of doctors do feel uncomfortable in terms of charging for something that they traditionally give away for free. Now, how can you comment on that tension that a lot of doctors have?

Jamie S. Hutton: Yeah, they don’t want to feel like salesmen. You don’t want to feel like a cheap salesman, which I completely understand. If people don’t know what you have, they’re not going to seek you out. You have to advertise what you have, and that doesn’t have to be done cheaply: being on Facebook Live, on your practice site, and showing that you actually have these services that other practices don’t, that you know these things. Even just putting up a 10-second video of “Hey, did you know we have a certified lactation consultant in our practice?” is something that is not sleazy to put out there. You would be the service that people are actually looking for. And so you have to let people know.

Kevin Pho: We’re talking to Jamie Hutton. She is a pediatrician, and she wrote the KevinMD article “Being a pediatrician in a pandemic.” Jamie, if you were to go through this all over again, and hopefully we don’t have to go through this all over again, is there anything that you would have done differently?

Jamie S. Hutton: In my story, there’s definitely a little bit I would have done differently. In medicine, it’s very easy to get beaten down and lose your self-confidence. All of us that go into medicine, we are smart people, we are driven people, and we need to keep our confidence and stick together and not be fighting with one another, because there’s enough outside of medicine that’s pushing us down. So stand up, stand for yourselves, and know what you’re worth and who you are.

Kevin Pho: And my final question: What is your take-home message that you want to leave with the KevinMD audience?

Jamie S. Hutton: Yeah, so this is really a call to action for the pediatricians to know that these after-hours calls and all of these things that we do are worth something. And so, standing together and showing that we are worth something, to make change.

Kevin Pho: Jamie, thank you so much for sharing your time and insight, and thanks again for being on the show.

Jamie S. Hutton: Thank you.

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