On Call: Catching Up With A Group of Pediatricians

What have graduates of the University of Wisconsin School of Medicine and Public Health been up to lately? Seven medical school alumni who are pediatricians share their stories.

 

Carmen T. Garcia, MD '86

 

I work in the Pediatric Emergency Department at Jackson Memorial Hospital (JMH)/Holtz Children's Hospital in Miami. JMH is an inner-city, tertiary care, level-one trauma center.

 

I see a wide variety of cases-primary care pediatrics, pediatric subspecialties (medical and surgical) and trauma. During a shift, I may take care of a colicky infant, a child with a multi-visceral transplant in shock and an adolescent who has been involved in a motor vehicle collision.

 

Miami has the advantage of being an international destination, so we frequently have patients coming from Latin America seeking medical care. We also see patients from even more remote locations, such as Africa or Europe. This affords us the opportunity to see pathology we would rarely encounter in our own patient population.

 

One case that really stands out was during a code. Parental presence in the resuscitation room can be controversial, but during this code, we allowed the child's mother to remain. The patient had serious chronic medical problems and had spent most of his life in and out of hospitals. He did not survive but all during the code, the mother was calmly stroking her child's foot. She later thanked me for our efforts. I will always be thankful to her for allowing me to witness such pure love.

 

I knew early on in medical school that I wanted to take care of children. During residency at Baylor College of Medicine/Texas Children's Hospital, I considered different subspecialties.

 

I chose emergency medicine because of the uncertainty that comes with the job. When I show up for work, I never know what the day will bring. On the other hand, I do know that it will be challenging. Thinking quickly on your feet, dealing with patients and families during difficult times, being the first and sometimes last resort are all reasons to keep coming back for more.

 

I tell medical students that this is the best job you could ever have. Where else can you show up for work on Halloween dressed as a pumpkin and have a mother trust you with the life of her child?

 

Peter Roloff, MD '07

 

My medical practice is with Affinity Medical Group at the Children's Health Clinic in Neenah, Wisconsin. I see patients three days a week and I am the chief medical information officer two days per week. I am building and overseeing the implementation of the electronic health record for 220 providers in our system.

 

I am a general pediatrician seeing children from birth through college. Since we are 90 miles away from any tertiary care centers, we handle many more complicated cases with the consultation of subspecialists. I specialize in asthma, diabetes, ADHD and well child.

 

Pediatric behavioral health is not always the most glamorous or enjoyable field. But I've had much satisfaction. One mom who brought her three-and-a-half-year-old son to me wanted to know how to "give him up." He had such bad ADHD that he was running away from daycare and hurting his older brother. Mom was about to lose her job because of constantly being called to get him.

 

I asked for one month to work with the family, and was able to diagnose ADHD and start the boy on stimulant therapy. The medication allowed him to slow down enough to be able to be in daycare, Mom to be at work and support the family and the family to remain together. Now, four years later, he is at the top of his class in reading, and his family is stable.

 

I did my residency at Children's Hospital of Columbus, Ohio, now called Nationwide Children's Hospital. I chose pediatrics because I have always loved working with children. There is great joy in watching them grow and explore their environments. Helping the family grow along with the child also brings immense satisfaction.

 

I tell students that medicine is science, and all fields within it are relatively similar. Choose your specialty based on which group of patients you truly enjoy working with, because this is what will sustain you through your career.

 

Brian Reeder, MD '99

 

I have a split practice in general pediatrics and sports medicine. I am currently in practice with the Dean Clinic, in Sun Prairie and at our East Madison Clinic.

 

I do routine well-baby and well-child care as well as pediatric illnesses, but my practice has a relatively high volume of young athletes.

 

The great thing about pediatrics is the continuity. I started seeing some patients when they were in middle school and are now graduating high school. I have gotten to see them on the sidelines with my sports event coverage and feel a nice connection with their families.

 

The case I will never forget was a high school swimmer with hip pain. Initial X-rays were negative, but his pain persisted despite physical therapy. Within three months, the pain was waking him at night. Repeat imaging finally showed a large osteosarcoma involving the hemipelvis and hip joint. He eventually had hemipelvectomy and cadaveric implant. So, not every sports injury is what it may seem.

 

I didn't enter medical school thinking I would go into pediatrics. I knew I really enjoyed the musculoskeletal (MSK) system, but I did not know how to put it together into a career. I struggled for quite a while, trying to figure out what to pursue. But over the months, regardless of the specialty rotation, I found I really enjoyed the young patients.

 

Finally the light bulb came on! I still really enjoyed the MSK system and orthopedic care for young athletes, so I decided to do the primary care sports medicine residency at Michigan State University-Kalamazoo Center for Medical Studies after I completed my pediatric residency (and was chief resident) there.

 

Every specialty has an element of routine and monotony. Pediatrics is not immune to this, but there are so many areas of pediatric medicine to explore. I would encourage everyone to practice with passion. Find something to be an expert in, even without subspecialization. Your career will be more fulfilling and you will have something to set you apart and broaden the care you and your partners can provide.

 

Rajiv Naik, MD '95

 

I practice at Gundersen Lutheran, a fully integrated health care system in western Wisconsin, eastern Minnesota and northern Iowa. My main practice site is the Onalaska Clinic just north of La Crosse, but I also see patients in clinic and in the hospital at the La Crosse campus. Gundersen Lutheran is the SMPH's Western Campus so we enjoy the opportunity to spend time with UW medical students.

 

I take care of patients across the pediatrics spectrum, from infancy through adolescence. I practice in ambulatory and inpatient settings, including a primary care pediatric practice, inpatient care for sick children and adolescents as well as the newborn nursery.

 

One of the most memorable cases presented to me a number of years ago. The child was an 18-month-old African American toddler who was almost exclusively breastfed. She presented with tonic spasms of the hands, feet and neck. Closer inspection revealed signs of classic vitamin D-deficiency rickets. She did well with treatment and ended up being one of a series of children who led ultimately to the national practice guideline to supplement vitamin D in breastfed infants.

 

I knew when I entered medical school that I would likely choose pediatrics. I tried to keep an open mind, but my choice to do pediatrics was an easy one. I always enjoyed working with children and my experiences in medical school (coincidentally, on my clinical clerkship at Gundersen Lutheran) were reaffirming.

 

I did my residency at Wake Forest University School of Medicine, Baptist Medical Center (formerly known as Bowman Gray School of Medicine) in Winston-Salem, North Carolina. I enjoyed my time so much there that I stayed on to do a chief resident year, which was one of the most rewarding years of my career.

 

Perhaps my greatest pleasure in pediatrics is witnessing and sometimes influencing the incredible growth and developmental changes children go through. The chance to establish long-term relationships also is priceless.

 

I've had some patients who I saw as struggling adolescents who are now doing well and have had their own children who are now my patients. I enjoy the challenges presented by the variability of disease states and problems across the spectrum of patient ages. I also like practicing preventive care, including vaccinology, and I enjoy infectious disease and evidence-based medicine.

 

I often tell medical students who are considering pediatrics that if they can imagine themselves doing the most routine parts of a given specialty over and over and over again, and could be happy doing it, then they have found the right specialty for them. I can honestly say that this is the case for me.

 

Jackie Busse, MD '06

 

I'm a general pediatrician in private practice in Santa Cruz, California. Our group is part of the Palo Alto Medical Foundation, one of the larger multi-specialty group practices in California. The 10 pediatricians in our department cover several outpatient clinics as well as two community hospitals. I am enjoying the camaraderie and flexibility that a larger practice offers.

 

One thing I love about my job is that I get to do both inpatient and outpatient pediatrics. In the clinic, we see the usual - asthma, gastroenteritis, ear infections, pneumonia. As the hospitalist, I attend C-sections and complicated vaginal deliveries and cover both the nursery and the general peds floor as well as consults from the ER and urgent care. We also follow some less complicated NICU cases.

 

An important aspect of providing primary care is recognizing the few truly sick patients (the zebras) in the crowd. I've been in practice less than a year now and have already seen hemolytic-uremic syndrome, pericarditis, Lemierre's Disease, neonatal sepsis and congenital heart disease, among others. These more difficult cases keep things interesting and challenging. When patients need higher levels of care, we coordinate transfer to Stanford children's hospital.

 

I didn't know what I wanted to do when I started medical school so I explored lots of options by talking to attendings, going to specialty meetings and conferences and doing rotations in many different settings. During my peds rotation, I just felt at home. It didn't feel like work. I was excited to go in each day and enjoyed being there. Now I can't imagine myself doing anything else!

 

A great piece of advice I got in med school was to consider which specialty journals I could read every day for the rest of my life and not get sick of (thank you, Dr. Urban!). Medicine is constantly changing and truly requires an attitude of life-long learning. You need to be excited about the subject matter to stay on top of things and provide excellent care.

 

I did my residency at Rush University in Chicago. I stayed on as chief resident for a year before moving out west. I really enjoyed academic medicine and was initially hesitant to leave for private practice. However, I've found there are many opportunities to stay involved in education, training and evidence-based medicine in the community setting. I enjoy the more relaxed pace and lifestyle advantages it affords.

 

I love working with kids - they're innocent, resilient and thoroughly entertaining. We have fun every day at work. I enjoy the focus on preventive medicine, public health issues and community-based care and I like building long-term relationships with the kids and their families.

 

Andrew Collins, MD '92

 

I am currently practicing with Thedacare Physicians in central Wisconsin. My primary office is in Oshkosh, but I also see patients in Ripon and Shawano. I have admitting privileges at Theda Clark Medical Center in Neenah and Aurora Hospital in Oshkosh.

 

I see a whole range of general pediatrics, from newborns in the nursery through adolescents. This includes a lot of well child care, in addition to acute illnesses and chronic problems like ADHD, asthma and diabetes.

 

In addition to my work with pediatric patients, I'm also involved in working with our system's Electronic Health Record. This typically brings me back to the Madison area a couple times a year for meetings at Epic in Verona. I've been involved with various committees and ad hoc groups working on medication issues, decision support and computerized provider order entry. I am working on a master's degree in biomedical informatics from Oregon Health and Science University, and anticipate finishing soon.

 

One of many cases that stands out was one that helped me decide on pediatrics as a specialty. In my pediatrics rotation in the third year of medical school, we admitted a toddler with failure to thrive, severe anemia and a UTI. She responded well to treatment with antibiotics, IV fluids and a transfusion, and it was really nice to see her perk up and become more energetic. Her personality really started to come out.

 

Then we proceeded to work her up for the failure to thrive. Some of the team members were convinced it was due to parental neglect, but with a thorough workup, we were able to show she had celiac disease, and needed a gluten-free diet. It was great to see the progress through the course of her stay, and to know that we were able to have such a positive effect.

 

I originally thought I wanted to do a different specialty, but after doing that specialty's third-year rotation, I didn't have a great feeling of satisfaction from it. Then I did my pediatrics rotation, and it was a lot of fun. Nothing is as energizing as working with children all day. It's great to watch them grow over time and to see how parents change as well. And I feel like that when I do something to improve the life of a child, the effects will be felt for many decades.

 

I did my residency at David Grant U.S. Air Force Medical Center at Travis Air Force Base in northern California. We had rotations at Oakland Children's Hospital and UC Davis as well. I did pediatrics in the Air Force for a total of 11 years before returning to Wisconsin.

 

Tim Richer, MD '98

 

I practice at Tosa Pediatrics, a small private practice in Wauwatosa, Wisconsin. I do pretty much just your bread-and-butter general pediatrics.

 

I enjoyed nearly all of my rotations during medical school but I really enjoyed working with the kids. I also get to work with adults, i.e. parents, but I don't have to fix their medical problems. I don't know how my colleagues in family practice do it! I went into medical school with an open mind but was always drawn to pediatrics. I flirted with obstetrics-gynecology (but found myself more interested in the baby than putting mom back together) and family practice, but ultimately decided to focus on one age group, which made my decision easy.

 

I did my pediatrics residency at St. Christopher's Hospital for Children in Philadelphia - and I loved it!

 

There are many memorable cases - the unusual diagnoses that leave you scratching your head, the cases that inspire parents to write kind thank-you notes, the mistakes (no major ones, fortunately) that you beat yourself up over, and the ones that earn you a pat on the back. Like any specialty, it's a mixed bag ...

 

I wish I had more time for professional activities but, truth be told, running your own practice is like a job on top of my real job (taking care of kids). So between work and family, there just doesn't seem to be enough hours in the day.

 

I encourage medical students to enter pediatrics.It is still fun watching the children grow and being a part of their lives. Kids are durable but when they are ill or injured I am constantly amazed at how quickly and completely they heal. There are always those exceptions, which are tough, but the good outcomes greatly outnumber the bad ones and it's extremely rewarding. I also joke that pediatrics is recession proof - there are always new babies who need pediatricians!

Date Published: 06/09/2011