What You’ll Learn

A pediatrician shares the clinical, administrative, and personal challenges of her speciality–and why burnout is so widespread among her colleagues. Hint: It’s not the time she spends caring for kids.¬†

Interviewee: My specialty is pediatrics. I’ve been practicing for about seven years after residency. And I’m located in Maryland.

VIVO: What type of practice are you in? Is it a large one? Part of a hospital system? Private?

Interviewee: It’s part of a hospital system, but it’s outpatient. The hospital system has different outpatient offices scattered throughout the Maryland area. There’s five physicians, two nurse practitioners. And I would say on a weekly basis, me personally, I see about 80 to a hundred patients a week on a five-day week during the busy months. Now, I’m back to school in wintertime.

VIVO: When was the last time something new inspired you at work?

Interviewee: That’s a good question. Something new. You don’t see a whole lot of new things. I feel like after a while, at least where I’m at now in my career, you don’t want to see too much new in terms of processes. I guess we do get a good turnover just because where we’re located is by a military base. So, we have a lot of families who ship out to other locations and then they come back, or new families who were from out of town coming back. Seeing new faces every year helps to keep things fresh, keep your mind working because you’re not seeing the same patients all the time.

VIVO: How has business been over the past couple of years? Have you seen anything change or anything different that’s come up in the past few years?

Interviewee: I’ve definitely seen, especially since the pandemic, more mental health problems, especially in our adolescents and teenagers. And I feel like I’ve seen more neurodivergent patients like with autism, ADHD in the past few years as well.

VIVO : Are you seeing that come up in the adolescent patients or younger?

Interviewee: Younger more for the autism. ADHD in the adolescents and teens.

VIVO: What’s been the most persistent challenge to doing your work well?

Interviewee: There’s a few. I’d say just the nature of it being pediatrics and you’re trying to treat, especially in the younger kids and infants, they can’t tell you what’s wrong with them. So, you just have to go based off of what you know about medicine, and then your physical exam. But then also just the day-to-day administrative tasks that you have to deal with in addition to the patient care, trying to balance that and making sure that you’re spending enough time with your patients, but then also getting that administrative stuff done, too. It can definitely be challenging to get everything done in a timely manner while still feeling like you’re taking the necessary time with your patients.

VIVO: Makes sense. Do you feel like those administrative tasks, have they changed? Is there more of it, less of it as you’ve gone through your experience?

Interviewee: I don’t know if objectively it’s more. It feels like more. When I started, I was single, kid-free. Now I’m divorced, two kids, and so it feels like there’s always a lot on your plate. I don’t know if it’s more, but it feels like more.

VIVO: Why did you get into pediatrics? What made you want to become a pediatrician?

Interviewee: Even when I was young, I’ve always been drawn towards kids. I was always the one wanting to babysit my cousins. And when I was going through med school, I shifted thinking I wanted to do OB-GYN. But then we did the clinical rotations for OB-GYN and I realized after the baby was born, I was drawn more towards the baby than the mom. So, I figured that pediatrics was the way to go. And then once I did my sub internship within the pediatrics on the pediatrics floor, then I realized that yes, this is what I wanted to do.

VIVO: Makes sense. Has it been what you expected when you stepped into pediatrics?

Interviewee: Yes and no. I love the patient care part. I love getting to watch my patients grow, seeing them from a newborn to then now they’re going off to kindergarten, because I’ve been in the same place for the whole seven years, and watching my patients grow, it’s been really amazing. I love that part of it. Again, it’s just more the day-to-day tasks outside of patient care that I didn’t really realize were going to be such a big part. That’s the only thing that hasn’t been what I thought it would be.

VIVO: What percent of your time is spent on that administrative side of work?

Interviewee: Probably a good 40 percent. Ir someone actually timed me in a day, it may be more like 30, but it feels like 40.

VIVO: What wisdom have you gained from pediatrics?

Interviewee: As I’ve learned to listen more, especially to parents and my older patients, instead of always trying to solve the problem, they may not always be a solve, but just listen to what the patient needs and is looking for, because sometimes it’s just reassurance that they need as opposed to a treatment plan. Giving them the space to tell me their story about what’s going on without interjecting, and that definitely helps me form a better relationship with them and it helps me take care of them the best way that they need.

VIVO: Do you think that that’s the same in other specialties? Or do you feel like there’s a difference in pediatrics when it comes to caring for patients?

Interviewee: There’s definitely a difference because say you have a patient who can express to you what’s going on with them, but then you also have the parent’s perspective of what’s going on. So, you have two different perspectives that you have to take into account and figure out where the middle is because you want to take both of their inputs into account of what’s going on. And in terms of how you approach pediatric patients as opposed to adults, you definitely have to have a special touch, I would say, and a good demeanor so that they feel comfortable with you and feel that trust.

VIVO: What do you think pediatrics will look like in 10 years?

Interviewee: That’s a good question. I feel like the core of it won’t change much. Kids are always going to get sick and they’re always going to need antibiotics, or this or that. I am hoping that in terms of the time we get to spend with each patient, doesn’t continue to get shorter and shorter just for capitalism and companies wanting to make more money and see more patients per day. But I can see that happening. I do think more virtual care will become available too, just for the small things that you are able to deal with virtually. I think that’ll definitely be more of a bigger landscape over time.

VIVO: About how many of your patients are virtual today?

Interviewee: I usually get a couple at most, two or three per day.

VIVO: How do you find virtual? What do you think about it?

Interviewee: I think it is helpful for certain concerns for sure. My patients who have ADHD and I’m managing their medication, if they’re in school and they can get an early morning, virtual appointment, that’s definitely more convenient for them. And I don’t have to do a whole exam to discuss the medication, and the side effects, and how they’re doing on it. In certain regards, other things like rashes, things where I don’t have to touch the patient, check their lungs, I definitely think it’s helpful in those instances.

VIVO: What is not being said in pediatrics that needs to be said?

Interviewee: Pediatricians are burnt out. And I don’t even know what the solve is, but there needs to be some kind of change. I don’t know what that change is.

VIVO: I you had to take a stab at even just what you feel like is causing burnout, setting aside the admin work, because that’s clearly a piece of it as well. But even just on the patient-pediatrician ratio, what do you think is happening there?

Interviewee: Definitely trying to squeeze in more patients than should be seen. But then you have to keep up your revenue. It affects your compensation if you’re not seeing a certain amount of patients. So, then you get concerned about that, so you want to keep your schedule packed. And because of that, you are always worried about making sure you don’t get too behind on your schedule. So, you try to go as quickly as you can, but you don’t want to miss anything. So, say a patient takes longer than their allotted time, then the next patient is waiting, they may get upset, then you get worried about patient satisfaction scores because they’re upset that they waited too long. And it’s just this whole big cycle, day in, day out.

VIVO: What is the most common type of patient that you see most often?

Interviewee: The most common patient that I’m seeing each day. I guess right now, it’s a lot of back-to- school checkups. So, they’re just patients who want to make sure that their overall health is okay and mental health, too.

VIVO: Can you tell me about one of your most challenging patients and why they were so challenging?

Interviewee: This patient, she was out of town when she got injured, severely injured. Fell off a horse, sustained traumatic brain injury. And she was out of state, so she had to be hospitalized out of state. And then she came back in town. She was in the ICU, I’m going to say seven days, and then went to the regular pediatrics floor for another few days and then was discharged and came back to Maryland. So, when I saw her for a follow-up, she was a completely different child from what I remembered. And there was a lot of different things I had to tackle in terms of getting the records from the outside hospital, making sure all of the specialists that she would need here in Maryland were on board, figuring out pain control, making sure mom was able to stay home from work so that she could take care of her child because that specific patient would have these episodes where she would just pass out out of nowhere. So, safety was definitely a big issue.

When I first saw her, it was a little overwhelming just trying to get everything in place. But I tried to reassure mom that now that she was back home, that we would do everything we needed to take care of her and get all the specialists on board. But it was hard in that the logistics of it, but also just seeing the stark difference between… because I had seen her for her checkup maybe back in May, and then the difference between then and now was hard. And she was 16, so she was able to express to me how she felt and how much pain she would be in, and how frustrated she was that she wasn’t able to do the things that she usually could do. That was difficult.

VIVO Strategist: So, it sounds like it’s a combination of course, of the actual work that needed to be done, but also just having a patient come back completely different than you first saw them.

Interviewee: Yeah.

VIVO Strategist: So, you’re the one who’s managing all those relationships with the different specialists and coordinating that as to who should be on her team, her care team, essentially?

Interviewee: Yeah.

VIVO Strategist: Makes sense. Can you tell me a little bit about one of your most rewarding patients and why they were so rewarding?

Interviewee: I have a lot. Let me see. I have one patient who kind of a sad story, but not really. He ended up being diagnosed with neurofibromatosis. But overall, he’s doing well. He has his specialists on board, but every time I see him, he just has a big smile on his face. And I know his things are improving in terms of his condition. And there were some issues with behavior that mom was getting frustrated about. Turns out some of those issues are tied to his diagnosis. So, she took a sigh of relief that, “Okay, now we have an answer as to what’s going on and now we can get him the help that he needs.” And it’s like he just takes it all in stride.

And last time I saw him, he gave me this little… we have this little toy machine where you put a quarter in and it gives you a little toy, and the toy that he got was this little plastic diamond. And before I went into the room, my medical assistant said, “He’s asking for you. He really wants to see.” So, I go in there and he’s like, “Hi, Dr. C.” They call me Dr. C. And he gave me the diamond like, “This is for you.” And I was like, “Oh, thank you.” It was a big diamond, too. I was very impressed. It just put a big smile on my face. He’s always been super bubbly and no matter what’s going on with him, he’s always so happy and excited to see me and it just warms my heart.

VIVO: What’s something that surprised you about your patients when you maybe first started practicing or that you didn’t expect?

¬†Interviewee: I guess just how resilient kids are. And sometimes even when they’re sick as a dog, they’re still bouncing off the wall somehow with energy. They’ll have a 102 fever in the office and they’re still running around, and playing, and talking and happy. That’s not always the case, of course, but that definitely happens more with the kids than I’ve seen with adults. It’s like they can be sick, but they’ll still have that inner joy. That’s always been a big thing and probably why I love kids so much because they have that inner joy.

VIVO Strategist: That is great. I just have one or two more here and then as we wrap up. But I am going to go back to the specialty at large a little bit during the last few minutes here. What do you think makes pediatrics or specifically pediatricians different from other specialties aside from the obvious patients you treat?

Interviewee: Like I said before, I do think it takes a special kind of doctor to deal with kids because it’s not always the happy part. Sometimes it’s the heartbreaking part. I don’t see it as much now in the outpatient side, but during residency when I worked in the hospital and you see the new diagnosis of cancers and the ICU patients… had one patient during residency, nine-month-old baby was taking a nap and ended up getting tangled up in his covers, his blanket and stopped breathing, came into the ER crying, but had some neurological damage due to that time when they were under the covers and then they ended up passing away. So, you take that all knowing that that could happen. And it shouldn’t happen to anybody, but especially not to a child. So, you want to do your best all the time to make sure you can prevent that.

And even during the checkups, talking to my families of newborns of making sure you’re not co-sleeping, make sure there’s no blankets in the bassinet or crib, no pillows. And as a pediatrician, you have to be thinking of the worst case scenarios, and how you can talk to families and make sure that they’re doing all they can at home to prevent those things. You hold the future in your hands. And you have to partner with the parents, and making sure that they can hear you and they can trust you with their most precious thing. So, it’s a lot of responsibility. And all physicians take on responsibilities. Like brain surgeons, I can’t even imagine. But it’s much more of a family approach because you have to take the parents into account to make sure that they’re on board and that they see you as an advocate for their child as well.

VIVO: Is a higher emotional load in pediatrics than some other specialties?

Interviewee: Definitely, yes. Because you do become attached to the patients that you see day in, day out. You watch them grow, they almost become your own little family, too.

VIVO: How do you think the lifestyle of a pediatrician is different from the lifestyle of other specialties? 

Interviewee: To be a little cynical, I know we get paid the least, so that’s definitely going to affect our lifestyle. We’re not going on lavish vacations too often. But I mean overall, I don’t think it differs that much. I feel like outside, you do try to leave work at work. At least I try to. So, outside of the office, I do just try to live my life as just me, not as Dr. Me. And I feel like most physicians try to do that as best we can just find that life work balance.

Participant Profile:

• Female pediatrician
• Located in Maryland
• 7 years of post-residency experience
• Practice setting: Hospital system outpatient office
• Practice size: 5 physicians, 2 nurse practitioners
• Patient volume: 80-100 patients weekly (20 patients daily during busy seasons)
• Notable challenges: Administrative burden (feels like 40% of workload), managing balance between patient care and paperwork
• Priorities: Maintaining quality patient relationships, addressing increasing mental health needs in pediatric patients
• Patient demographics: High military family turnover due to proximity to military base