Early yearsEarly years in in

Pediatric practicePediatric practice

Dr Pallab ChatterjeeDCH, MD(Ped), DNB(Ped)Consultant PediatricianAMRI, Salt Lake; Apollo Gleneagles HospitalBhagirathi Neotia Woman & Child Care CentreRabindranath Tagore International Institute of Cardiac Sciences

The Positives :• Youth• The enthusiasm• Open outlook• Urge to prove

yourself• Multiple options

The Reality :• The real world..the

real issues• A decision today..

influence lifetime• The foundation to a

successful future

Choice ??Choice ??• Medical Schools

• Scarce • Security• Financial stability• Job satisfaction

• Private practice

• Professional status• Financial security• Social status• Free time

Fitting the Pieces Together…

Practice setup

Practice style

Balance in Life

CommunicationIn Practice

Superspecializatio

n

How to setup a Clinic ?

Practice setup

Practice setup: Practice setup: Choice of city you want to practice in - Choice of city you want to practice in -

Metro or Smaller towns ?Metro or Smaller towns ?

• Glamour of big town

• Professional opportunities

• Better facilities• Big govt/corporate

hospitals

• Difficult to setup• Intense competition• High capital

investment• Decision of area

within metro is critical

Metro town

Practice setup: Practice setup: Metro townMetro town

Uptown/posh setting

• Glamour• High professional fee

• High capital investment • Intense competition • Less inflow of young

population• (Good if you already have

family practice in the setting)

Suburb/Periphery

• Easier to setup• Less competition• High inflow of young

population

• Less professional fee

Practice setup: Practice setup: Smaller townSmaller town

• Setting up easy • Less competitive• Less no of big hospitals• Infrastructure

developing fast

• GP takes away some patient load

• Less facilities• Less glamour • Less professional

fee

Solo/group/Attached to Institute

Practice style

Solo PracticeSolo Practice• Personalized• Professionally

satisfying• High remuneration

• Very demanding• Restricts academic

pursuits• Restricts time for

family/social life

Group PracticeGroup Practice• Shared duties(night

calls/emergencies)• Discussion of

difficult cases• Encourages

academic discussion• Upgrade practice

setting• More time for

family/social life

• No individual loyalty of patients

• Shared earnings• Account

management difficult

Institution/hospital PracticeInstitution/hospital Practice• Scope of learning

immense• Guidance of senior

doctors(hands on training)

• High backup of facilities• Better communication

with linked specialty doctors

• Can be involved in trials

• Hierarchical • Slow growth• Less remunerative in

government hospitals• Practice norms strict

in private hospitals

Setting up a Pediatric Clinic

Setting up Pediatric clinicSetting up Pediatric clinic• Space: How much space (waiting

area/immunization area)• Facilities: Immunization/neonate

care/emergency care• Staffing: Assistant/receptionist• Appointment procedure• Telephonic consultation• Special clinics: Wellness/asthma/nutrition• Consultation fees

Setting up of practiceSetting up of practice• Computerisation

– Record keeping / immunizations– Recall for follow-up– Time saving – Legible prescriptions– Account keeping

Setting up of practiceSetting up of practice• Medicolegal issues

– Neonatologist, intensivist, oncologist– Failure to communicate– Lawyers / jealous colleagues– Medical indemnity– Maintain records– No written reply / waiving off fees

Setting up of practiceSetting up of practice• Medicolegal issues

– Date and time – Keep copies of all reports / discharge– Legible handwriting– Transfer note / documents handed over– OPD records to be given?– Consent in own language– Can’t turn away emergency patients

Communication in Practice

Communication in pediatric Communication in pediatric practicepractice

• Parent communication: The mother a key link

• Patient retention/building loyalty• Probing skills to get right diagnosis• Wellness and illness counselling

Super specialization

General PracticeGeneral Practice• Cheap, easy, hence common• Attached to obstetricians• Attached to local hosp / NH• Routine checkups, immunizations,

common illnesses

Super-specializationSuper-specialization• Most often an add-on• Leave general practice / start with

specialization• Training facilities• Lot of patience for economic viability

Super specialization in PediatricsSuper specialization in Pediatrics

• Disease specific: hemato-oncology/ gastroenterology / pulmonology / rheumatology / nephrology / critical care / neurology / endocrinology / cardiology

• Age specific: Neonatology/adolescent health / developmental pediatrics

Balance inPractice

Balance in practiceBalance in practice• The first five years in practice are

critical• Strike the balance in personal and

professional life• Personal: Get married/first child/buy

house/ car• Professional: Establish yourself in

practice

Balance in practiceBalance in practice

• Burnout – “a state of physical, emotional and mental exhaustion caused by long term involvement in situations that are emotionally demanding”

Balance in practiceBalance in practice• House-visits• Hobbies • Holidays• Day-off• Conferences / CMEs• ‘Time thieves’

Practice setup Practice style

CommunicationIn Practice Super specialization

Balance in Life

How to setup a Clinic