Spotlight on Community Paediatrics! Dr. Veronica Chan, University of Ottawa Considering community paediatrics as a career? Residents don t often get the opportunity to explore the full breadth of community practice as most of our learning takes place in the tertiary academic environment. 4 community paediatricians each with very different practices and areas of special interest kindly agreed to talk to us about their journeys and careers below. Dr. Michelle Gordon Through residency I enjoyed all my subspecialty rotations, and did not see myself doing only one area. I also was interested in living in a smaller community. I did a number of community electives, and found that I really enjoyed consulting community pediatrics in a smaller centre. I practice in a community of 30 000, but we serve a population of 300 000, with 5 level 1 hospitals (and surrounding communities) relying on us for their paediatric care. I have a hospital based practice with on call for our pediatrics unit and level 2C NICU as well as an office practice. There is no typical day - the variety is what makes it interesting! Every day starts with hospital rounds, usually from 8-10 am. I am on call typically 1 in 6, and on those days will provide emergency consultations and care for sick infants and children. We do antenatal consults, see sick babies, see ER consults, and provide care for our oncology patients, etc. On non-call days I have a number of clinics I do for the day, each typically 1-2 times a month, including: diabetes, asthma, complex care, neonatal follow-up, general pediatrics office practice, clinic in a surrounding community (Parry Sound), multidisciplinary development clinic in Parry Sound. 2 of the other pediatricians also run our POGO clinic. We are a teaching site for the Hospital for Sick Children and McMaster medical school, so we have a medical student and a resident with us at all times - we do lots of teaching! One of our MDs also sits on the PGME committee at HSC, and we also present at resident rounds at HSC once a year. There is lots of opportunity for research - I do not do as much with my administrative duties, but one of our MDs has written many papers. There is an unbelievable amount of opportunities for advocacy - perhaps even more than in a
big centre. In a small centre, our voices are heard and it is easier to effect change. I have done a lot of advocacy work particularly around our children s complex care navigation program, working with our LHIN and our community to secure funding and ensure ongoing access to services for these children. We are also frequently asked to speak to the media and schools around important child health issues. I am particularly interested in neonatology, and started out neonatal follow up clinic when I started work here 11 years ago. I am very interested in children s complex care, and started our clinic here about 6 years ago. Consulting community pediatrics is an exciting and rewarding career - it gives you an opportunity to use all the skills you learned in residency, and really make a difference! Dr. Sloane Freeman I enjoy the variety that comes with general pediatrics- I can see patients with autism, anemia and asthma all in the same day. Do you practice in an urban or rural environment? Is your practice clinic-based, hospital-based, or both? My practice is at St. Michael's Hospital and is focused on social pediatrics in an inner city population. It is primarily clinic based and I go to various outreach clinics including a schoolbased health center each week. I do not have a typical day. Each day is different and will involve either an inner city outreach clinic, research, teaching, administrative responsibilities, or all of the above. I am fortunate to work at St. Michael's Hospital which is a teaching and research hospital and therefore have many opportunities to be involved with all of the aforementioned activities. Advocacy in particular is a large part of my role with outreach and social pediatrics.
I run a school based health center program, a partnership between our pediatric department and the Toronto District School Board. The program provides health care to students through a clinic located at an inner city school and targets high-risk children facing barriers to health care access. A career in community pediatrics can look like many things. It may involve outpatient and inpatient medicine. It may involve research and teaching and advocacy. My advice it to keep an open mind, be creative with your career and focus on providing the best possible health care. Dr. Leigh Fraser-Roberts While I was a resident, I enjoyed the clinical presentations of all specialties, and the age spectrum within pediatrics. I believe in the strength of being a generalist, and did not wish to spend all time working within a narrow scope of medicine. Although I considered a specialty in Neonatology, I couldn't imagine only doing newborn care and living an intensivist lifestyle. Within general pediatrics, there are many options for developing a practice with a specialized focus that matches your interests. I have always been committed to the health of underserviced groups, and general/community pediatrics allows me to work in rural and remote areas of Canada, such as Nunavut. I am currently employed by CHEO and the Ottawa Hospital. My main responsibilities include Medical Lead for newborn care at TOH (General campus), newborn call and I am part of the high-risk newborn developmental follow up clinic team. I also provide consulting pediatric services to the Wabano Centre for Aboriginal health in Ottawa and outreach to communities Nunavut. I thus have the opportunity to practice in both an academic centre as well as in community clinics in the city, and in remote health centres in northern Canada. I have provided inpatient care for many years both at CHEO and at the Children's Hospital of Winnipeg. I also am one of the general pediatricians providing regional e-consult services. My weeks often vary depending on my clinical duties, so there is no typical day as such. Overall, I run several half-day clinics per week at CHEO and Wabano. Academically, I participate in educational activities with CHEO and the Faculty of Medicine. My administrative
duties are often flexible, as I may work on policies, and projects and other administrative issues the remainder of the week around my clinics. I am frequently interacting with other specialists and community service providers in my clinical, educational and administrative duties. Yes, absolutely. I have held many educational administrative roles over the years and continue to teach and mentor students and residents. There are always opportunities to get involved in teaching and supervision of clinical care through the university. I also have many opportunities for advocacy in my work, both in the city and remote northern regions. Yes, within my practices at Wabano and Nunavut outreach. I aim to improve the health of First Nations and Inuit children, and work on many levels towards that goal. I tend to have a few projects both at CHEO and in the community on the go at all times. I would encourage residents who wish to work in general pediatrics to develop their consulting skills and perhaps create a focus of clinical interest in their practices. I do not believe the future of general pediatrics lies within provision of primary care services, although it is very rewarding and enjoyable. One of the benefits of general pediatrics is the flexiblity of work environments and myriad of opportunities. Having a comfort level with resuscitation and management of level 2 neonates is important for consulting work at community hospitals. Consider spending time working as a locum after graduation to have the opportunity to explore different practice settings. Keeping up a teaching/supervisory role with students and residents supports continuing education and is edifying. Find a passion with advocacy projects. Dr. Fabian Gorodzinsky My interest in the field stems from early experiences during my rotating internship in Israel. I was assigned to a community-based site for paediatrics at the time, and found myself enjoying the high level of responsibility and autonomy that I assumed here. I subsequently pursued subspecialty training. However, due to the attractive opportunity to pursue primary to tertiary level general pediatrics in London, I adopted a community pediatrics practice. My practice is mostly in an urban setting, with time spent as CTU attending physician in the
London Health Sciences Centre, doing office-based consults and primary care, as well as being on-call for well newborns. In addition, I often travel to peripheral communities north of London to see patients in consulting clinics. My days are different depending on whether it is a hospital-based or clinic day. On days when I am acting as ward attending, I typically spend mornings rounding on inpatients and doing teaching for my team of residents and medical students. On office days, I see 5-6 consults per day in diverse topics such as behavioural problems, ADHD, abdominal pain, headache in addition to primary care. There are many opportunities for medical education in my role. I often act as lecturer for undergraduate medical students, as well as supervise students and pediatric residents during clinical rotations. I am also the program director of the community pediatrics fellowship at Western University. I have a special interest in advocacy and global health. I have been leading mission trips to Honduras to bring medical supplies and work in local pediatric clinics since 1998. We often have residents join these trips as well. (6) Any words of advice for residents considering community paediatrics as a career? It is important to have a good level of comfort in acute care and resuscitation if you are interested in working in a smaller community centre. If you re interested in having your own clinic or private practice, there is a need to develop some entrepreneurial skills such as being able to manage income and expenses, an area often overlooked in medical training. Most importantly, I would advise that residents should strive to maintain interests outside of medicine.