CHAPTER ONE
UNENVIABLE START TO MY SOLO PEDIATRIC PRACTICE
“Not enjoyment, and not sorrow, is our destined end or way; But to act that each tomorrow finds us farther
than today.” Longfellow
In 1977, after one Pediatric position misadventure with a multispecialty group which turned out to be clinically uncomfortable, I found myself in the unenviable position of starting a solo Pediatric practice in the rural town of Sunbury, Pennsylvania (population of 10,000). Unenviable because nobody in their right mind would start a solo private Pediatric practice. Unenviable because I had no money (Pediatric residents made around 7000 dollars per year) and starting any practice from scratch required significant funds. Unenviable because none of my Pediatric mentors thought that being a solo Pediatrician in a rural area would be consistent with a healthy lifestyle. Unenviable because none of my Pediatric mentors ever mentioned solo Pediatric practice as a future endeavor nor did they prepare us for that possibility. Unenviable because I would, for the most part, be on call 24/7 for the Emergency Room, Nursery, Pediatric floor and my practice. Unenviable because nobody teaches Pediatric residents the business of medicine. Unenviable to a degree because I was the only Pediatrician in all of Northumberland County whose census at the time was 100,000. Unenviable to a certain extent because the General Practitioners/Surgeons and the hospital administrators were hoping that my presence would mean that infants and children with significant illnesses would stay at the Children’s Ward in the Sunbury Community Hospital rather than being transferred to the nearby tertiary care Geisinger Medical Center. My training, of course, would mean that children with significant illnesses would have to be transferred to the tertiary care center at Geisinger.
Fortunately, there were some significant positive factors as well. First of all, the Sunbury Community Hospital wanted to support me financially until my practice was somewhat established. Their help was buttressed by a business manager who taught me the ins and outs of the business aspect of medicine. Secondly, the medical and surgical community welcomed me with open arms. In particular, Dr. John Pagana helped me to get started, covered for me when I was away and became my lifelong friend. Thirdly, my brother-in-law and his wife (Dr. William and Mrs. Mary Ann Weader) allowed my family to stay rent free in their vacation A Frame just outside of Selinsgrove, Pennsylvania. Fourthly, Geisinger was twenty minutes away for my patients who were in need of subspecialty care or inpatient admissions. There were many other positive factors since we were living so close to both of our families.
So, the practice started and grew exponentially. Immediately I started having referrals for infants and children who were being physically and sexually abused. I was the only Pediatrician in all of Northumberland County, so those Children and Youth referrals were being sent my way. There was no question that I felt woefully inept in those initial evaluations. My training in those areas was inadequate as it was for most Pediatric residents at that time. Child maltreatment has existed forever, but it was just being recognized as a clinical entity in the 1960s and 1970s. I, along with my peers, who started doing this work of evaluating children who were abused, always felt that this aspect of our practice chose us; we did not choose it. But I was determined to aim high and do the very best that I could for those children.
“THE GREATER DANGER FOR MOST OF US IS NOT THAT OUR AIM IS TOO HIGH, AND WE MISS IT, BUT THAT IT IS TOO LOW, AND WE REACH IT.”
MICHELANGELO
