Dear Readers: Sincerely,
Dr. Warren hopes to help all who ask his advice and to enlighten all who read Ask Dr. Warren. For your own well being please keep in mind that
advice you read here may not apply exactly to your own situation, and that if you are sick, no information on the web can take the place of a hands on examination by your physican who knows you and cares about you.
Dr. Warren
-Cinthya
C'mon Cinthya: You didn't look very hard.
Typical Day: Previously answered here. Keep in mind that that's a description of my typical day. A pediatric resident or fellow in a hospital would have a very different day usually starting with rounds to review patients status and orders, attending rounds to review cases, and follow up labs and treatments. In between there would be hospital admissions and a variety of conferences on special topics. The day would end with rounds to sign out the patients to whichever doctor is on call for the night.
Dress Code: There really isn't one. It stands to reason that a physician is a professional and is concerned about the impression his appearance makes. Nobody has to tell him not to show up in the office wearing scuba gear or a bathing suit. When I go to work, I wear neat, wash & wear clothing. No sense getting spit up on wearing a suit. I wear a tie and probably look just like your teacher in the front of the classroom. I don't wear a white coat. Children learn to fear those. If I'm exercising and have to make an emergency run to the office after hours, nobody complains if I show up wearing my sweats. Since pediatricians deal with kids, nobody considers it unprofessional for us to dress a little special for Hallowe'en.
Hospital based physicians often wear scrub suits.
Kind of Task Performed: It really drives me nuts when kids do this kind of assignment without thinking about the questions. Your teacher asked the questions a certain way to make sure you understood the profession, but that doesn't mean you have to be spoon fed the answers exactly the way the questions were given to you. When you read about my day don't you get enough information to know what tasks I perform? I examine children, diagnose illnesses, prescribe treatments, give advice.
Equipment:
Sincerely,
Dr. Warren
-Dale
Dear Dale: Consider yourself lucky. Since I don't have a lot of e-mail this week, I'll take the time to answer yours; however, you have ignored the specific instructions on my web site for submitting questions. Dr. Warren gets very aggravated when he has to answer the same student questions again and again which is why you're supposed to read previous interviews to find the answers to your questions before submitting them.
You need to go to medical school to become a physician. A school of osteopathy is an alternative. In order to attend these schools, you must be a college graduate unless you get into a program which combines the medical and undergraduate degree. Since getting into medical school is competitive, it stands to reason that getting excellent grades at a college with a top reputation such as an Ivy League school increases your chances, but medical schools do take students from other schools. Some students may do better at becoming an outstanding student at some other colleges. Therefore, Id have to say get into any good school and do your best. We can't all go to Harvard. I didn't.
You might want to read some of the previous interviews because I'm sure I've spoken about a pediatrician's responsibilities in a variety of ways. A pediatrician is a physician for children. He does checkups to make sure children are healthy. At these checkups he assesses growth, gives immunizations, give guidance, and does an examination which, at a minimum, usually includes looking at the child's eyes, ears, nose, and throat, listening to the heart and lungs, palpating (feeling) the lymph nodes and abdomen, checking the spine and extremities, and examining the genitals.
A pediatrician also sees sick children in order to diagnose and treat their illnesses. This requires taking a history (the story of the illness) and asking questions which help him determine what the cause of the symptoms are and ruling out other causes. The examination may not include some parts of the routine exam which are not necessary for a specific complaint and may include some steps which are not part of the routine exam (I may not need to look in the ears of a patient complaining of leg pain, but I would have to feel his joints for heat and swelling and put the extremity through range of motion). It's a little like being Sherlock Holmes to make a diagnosis. After the diagnosis, then the doctor has to treat the patient. This may involve a prescription for medication, a shot, a referral for additional tests, and advice on symptom management.
A recent article in Medical Economics listed average annual income for pediatricians at approximately $129,600 and indicated that income has been rising but not keeping up with the increase in the cost of living. The income for pediatricians varies widely depending on where they practice, what type of practice they have, and how many hours they work. I have no idea where in this country is the greatest demand for pediatricians. I believe you can get to Medical Economics through www.pdr.net. Perhaps they have that information.
I use math primarily for calculating medication dosages which are generally based on weight. This involves converting the weight from pounds to kilos, using a proportion based on mg./kg. to calculate a dose, and then figuring out how much medication the patient needs based on the number of mg./tsp. Since growth is followed on a growth chart, it is essential to understand how to plot data on a graph. Some understanding of statistics is useful to understand research papers.
Sincerely,
Dr. Warren
-Jackie
P.S. so sorry...one more...what kind of grades did you get while in highschool (gpa)?Dear Jackie: There are no fast tracks to completion of training. If you get into a 6 or 7 year MD/BS program you work on your college degree and MD degree at the same time; however, you must complete medical school before residency begins. Residency is on the job training for which an MD or DO degree is an absolute prerequisite. The medical school training is the same no matter what you want to do afterwards. Specialization occurs during residency. A pediatric residency is 3 years (including internship). Further subspecialization adds to the length of the training. Subspecialty training, which includes neonatology, is usually done as a fellowship after completion of a pediatric residency. Some subspecialty training can start after the second year of residency depending on the residency program.
Since you're already in college, I'm curious as to why you would want to know my high school grades. It's a very long time ago. I believe I had a 93.5 average at graduation. My highest grades were in math and science, but I can't remember any details. It was 1966 when I graduated! I was in all honors classes. I was the valedictorian of my high school.
Sincerely,
Dr. Warren
-JH
Dear JH: 
1. "What is the nature of the work?" is a rather broad question. I could probably write a book. The work involves taking care of people, specifically children. It involves examining, diagnosing, advising, treating, and caring.
2. To enter pediatrics you should be caring, kind, gentle, honest, humble (kids aren't impressed by medical degrees), patient, intelligent, and have a sense of humor. You must love kids and parents. You must be diligent and dedicated and be impressed by the awesome responsibility involved in being a physician. You must have the strength and courage not to be overwhelmed by the responsibility.
3. Success is evaluated most by your patients. Do they trust you, respect you? If not you cannot successfully treat them. A good physician will be his own worst critic. Successes will register for difficult diagnoses made, for timely diagnoses and treatments which improved the patient's outcome. Failures will register for diagnoses missed, patients dissatisfied, and patients who have bad outcomes.
4. You may choose to relocate for a variety of reasons including the best practice opportunity, but you may set up practice anywhere you like. You will not be required to relocate. Travel is not an integral part of the job unless you consider trips to the hospital; however, if you become an expert, you knowledge may be in demand around the country.
5. The nature of the job may change as the insurance industry, government, and health care industry work toward the future of health care; however, there will always be a need for pediatricians.
6. Work hard. Study hard. But do things to maintain your humanity. You can't become a physician without hard work or study, but in the end, it will be your humanity which will determine what kind of physician you are.
7. Look on my web site for more student interviews and a link to the American Academy of Pediatrics.
8. Becoming a pediatrician starts with internship (see the next question). Once training is completed, you can become employed by a private practice with the option to become a partner, or, if you have the credentials, you can seek a job as a specialist at a teaching hospital. Jobs are always available at hospitals as house officers, ERs, clinics, etc. Check the job wanted ads for physicians in the NYTimes (it's available on-line).
9. You can't become a pediatrician without on the job training. After completing medical school, you can't get a license to practice until you complete an internship which is on the job training at a certified teaching hospital. To qualify to be a pediatrician, you must complete 2 more years of residency (more on the job training) doing pediatrics. After that you're ready to go into practice in the real world, but do not qualify to take the pediatric boards until you have been practicing for 2 years.
10. I think this question is answered above, but let me do the math for you. You will need to complete high school, college, and medical school. Then you can do a residency for 3 years (includes internship) and then you will be a pediatrician. From there, it depends what your aspirations are.
Sincerely,
Dr. Warren
What is your degree?
Is a degree or a license required for this career?
-Christina
Dear Christina: A license is required to practice any branch of medicine in the USA. The license does not specify any specialty. To become licensed, one must have a degree from a medical school (MD) or a school of osteopathy (DO). My bio, which is on my web site indicates that I graduated from medical school. I have an MD degree. Besides the degree, to become a licensed physician, one must pass medical board exams and complete an internship. Further specialty training to be a pediatrician requires and additional 2 years of residency. There is no requirement that a person must be board certified in order to practice pediatrics, but most parents look for a pediatrician who is board certified.
Sincerely,
Dr. Warren
1. What is the primary goal of this profession?
2. What types of people does someone in this field work with and what other health professionals would one work with regulary?
If you could email me back soon it would be greatly appreciated.
Thanks again!
Sincerely,
-Kristen, 8th grade student
Dear Kristen: The primary goal of the pediatrician is to provide health care to infants, children, and adolescents. This includes keeping them healthy by giving immunizations, monitoring their growth, examining them to be sure that they are healthy, and providing guidance on matters that affect their health. It also includes evaluating complaints and illnesses for the purpose of diagnosing and treating diseases.
A pediatrician works with the parents and children; his office staff which may include nurses, aids, secretaries; hospital staff which may include doctors, nurses, aids, therapists, social workers, dietitians, laboratory technicians, x-ray technicians, and probably many others; insurance companies, school health officials, and rarely, public health officials. At times, a pediatrician will consult with colleagues and specialists from other medical fields in order to care for his patients.
Sincerely,
Dr. Warren
Is it true that when you go to med school, you have to dissect a dead human body? That doesn't sound rite, cause why will I need that if I want to be a pediatrician?
Oh, and how good of a student were you in high school? Because I'm a pretty good student, but slack off sometimes, and I dono if Ill make it in the college world.
Thank you for your time.
-Kate
Dear Kate: Every first year medical student studies human anatomy. Part of the study of anatomy involves dissecting a human cadaver. To be a good pediatrician, you have to be a good physician. To be a good physician, you have to know and understand a lot more than you might ever expect to use in clinical practice. Knowledge of anatomy can be crucial to the understanding of symptoms.
I was a good student in high school. In fact I was valedictorian of my class. But high school isn't what counts for getting into medical school. You have to do well in college. We all slack off occasionally. Part of the process of growing up includes figuring out how to still have a life while fulfilling your responsibilities. When you are away in college you will have to set your own priorities. To succeed, you'll have to decide when you have to miss some fun to meet a deadline or complete your studying. You'll also have to decide when you need to make some fun because everybody needs an occasional break.
Sincerely,
Dr. Warren
Sincerely,
-Holly
Dear Holly: I do calculations of medication dosages at least several times each day. I also look at growth charts for every checkup which means I need to understand graphs.
My staff and I use a computer to enter every patient's visits for billing and insurance claims and to enter any payments received. The entries are really the job of my office staff, but I have to know what's going on and solve any computer problems that arise.
The skills necessary for my job relate to examination and communication skills. Please read my other interviews for more details.
There is no dress code for my job, but patients expect me to be neat and dignified in appearance. People have certain expectation for how their doctors will look. I wear a dress shirt, pants, and tie. If I came dressed looking like I was ready to play soccer, I'm sure it would alienate some of my patients.
I am the boss at my job. Nobody will penalize me for the way I dress or for my attendance, etc. Even though I don't think about the business aspect of my practice when I'm taking care of patients, it is my business. If I'm late, don't keep appointments, or am not available to care for my patients, they will go elsewhere. If I get a bad reputation it will hurt my business.
I am on call half the nights, half the weekends, and half the holidays each year. I can get called at home so in a sense, I'm bringing work home. Some emergencies require that I go see patients after hours. I also bring paper work home on weekends.
There aren't many deadlines in pediatrics, but keeping the office running close to on schedule is important to keep the patients satisfied. When patients need referrals, letters, or school forms, they will get upset if the paper work is not done on time. Laboratory proficiency testing and certain legal papers including recredentialing for hospitals and insurance companies must be done on time. If not, my lab could lose its certification or I could lose my hospital privileges or be removed from an HMO panel.
Students need to be well trained in all major disciplines before entering medical school. Science and math are crucial to learning the basics. Communication skills are necessary in working with patients. Please read my prior interviews for other discussions of this question.
Calculating a medication dosage and the amount to order from the pharmacy.
A 22 pound child is being treated with Zithromax (an antibiotic).
The dose is 10 mg./kg. on the first day, and half that dose daily for the next 4 days
Zithromax comes as 100 mg./tsp. or 200 mg./tsp. 1 kg. = 2.2 lbs.
The 22 pound child weighs 22lbs/2.2 lbs./kg. = 10 kg.
His first days dose of Zithromax is 10 mg./kg X 10 kg. = 100 mg. which is 1 tsp.
His dose on days 2-5 is half the first day's dose = 1/2 tsp./day.
He will get 1 tsp. the first day + (1/2 tsp./day X 4 days) = 1 tsp. + 2 tsp. = 3 tsp.
1 tsp. = 5 ml. 3 tsp. X 5 ml./tsp. = 15 ml.
Sincerely,
Dr. Warren
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