Early years

in
Pediatric practice
Dr Pallab Chatterjee
DCH, MD(Ped), DNB(Ped)

Consultant Pediatrician
AMRI, Salt Lake; Apollo Gleneagles Hospital
Bhagirathi Neotia Woman & Child Care Centre
Rabindranath 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 ??
Medical Schools

Private practice

Scarce
Security
Financial stability
Job satisfaction

Professional status
Financial security
Social status
Free time

Fitting the Pieces Together

Co
mm
un
In
Pra icatio
n
cti
ce

Pract
ic

e
c
i
t
c
a
r
P

l
a
i
c
e
sp
r
e
p
Su

n
o
i
t
a
z
i

e sty
le

up
t
e
s

Balance in Life

How to setup a Clinic ?

Practice setup

Practice setup:

Choice of city you want to practice in Metro or Smaller towns ?

Metro town
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

Practice setup:
Metro town
Uptown/posh settingSuburb/Periphery
Glamour
High professional fee

Easier to setup
Less competition
High inflow of young
population

High capital investment

Intense competition
Less inflow of young
population
Less professional fee
(Good if you already have
family practice in the setting)

Practice setup:
Smaller 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

Practice style

Solo/group/Attached to Institute

Solo Practice
Personalized
Professionally
satisfying
High remuneration

Very demanding
Restricts academic
pursuits
Restricts time for
family/social life

Group Practice
Shared duties(night No individual
calls/emergencies)
loyalty of patients
Discussion of
Shared earnings
difficult cases
Account
Encourages
management
academic discussion
difficult
Upgrade practice
setting
More time for
family/social life

Institution/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 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 practice
Computerisation
Record keeping / immunizations
Recall for follow-up
Time saving
Legible prescriptions
Account keeping

Setting 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 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
Cant turn away emergency patients

Communication
in Practice

Communication in pediatric
practice
Parent communication: The mother a
key link
Patient retention/building loyalty
Probing skills to get right diagnosis
Wellness and illness counselling

Super
specialization

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

Super-specialization
Most often an add-on
Leave general practice / start with
specialization
Training facilities
Lot of patience for economic viability

Super specialization in Pediatrics

Disease specific: hemato-oncology/
gastroenterology / pulmonology /
rheumatology / nephrology / critical
care / neurology / endocrinology /
cardiology
Age specific: Neonatology/adolescent
health / developmental pediatrics

Balance in
Practice

Balance 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 practice
Burnout a state of physical,
emotional and mental exhaustion
caused by long term involvement in
situations that are emotionally
demanding

Balance in practice
House-visits
Hobbies
Holidays
Day-off
Conferences / CMEs
Time thieves

Practice setup

Practice style

Balance in Life
Communication
In Practice

Super specialization

How to setup a Clinic