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How to set up a flourishing Pediatric Practice
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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