All physicians are familiar with the concept of the Hippocratic Oath, a 2,500-year-old promise to uphold professional ethical standards. I have not reviewed the oath since I recited it at my graduation from medical school in 1985, but it came to mind as I faced a monthly red budget statement despite a full-capacity schedule with limited staff support, and low Press Ganey satisfaction scores about lengthy waits for appointments and service.
I truly love my chosen profession. My patients are fascinating and challenging. There is no greater reward than finally seeing a thriving child, comfortable in his own skin, after the hard work of sorting out the pieces of his complicated inflammatory disease, putting the puzzle together, and educating and gaining the trust of his anxious parents so they follow my recommendations. My patients also make up a significant proportion of cases that the residents choose to present at our local conferences and national meetings. Some would not feel the same way, but their "Teacher of the Year" gift was worth more to me than a dermatopathologist's or derm surgeon's salary.
Addressing a shortage
The shortage is in part due to the fact that at least 50 percent of all children in the United States are impoverished and underinsured, and that salaries for pediatric dermatologists are the lowest in the specialty - problems that are not easily solved. Instead, our group decided to focus on ways to provide more education for pediatricians so they can better manage the common skin conditions in children.
We realize that in a fee-for-service system, this plan will require more effort directed toward providing education and will limit our practices to the more challenging and time-consuming patients.