Peds Externship: Week 3

Week 3 marked the beginning of my second 2-week "mini-rotation": primary care pediatrics. I think it may be slightly rigged that all the externs are to do their time in primary care peds in an inner city clinic (that, or I just failed to hear that detail in the externship description).

Peds Externship: Week 3

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There's no real point in distinguishing each day from the next, as all the days were fairly similar. The pediatrician I'm working with is in the clinic from 8am until 8pm, Mondays through Wednesday (so I got Thursday and Friday off this week). However, I wasn't in clinic with him that entire time. During the mornings, he's at one clinic where there are very few pediatric patients; so, he often dismisses me and tells me to not bother coming in when there are no patients. In the late afternoon/evening, he goes to another clinic where there are a lot of pediatric patients, so it's a lot busier. There are a few things of note.

First, the pediatrician I'm working with is really young (late-30s to early-40s) and really into social media and networking. I mean, he has several Twitter accounts! He's also the only pediatrician at both clinics (both clinics are under the same company), everyone else are either family physicians or PAs (physician assistants). After this week, I get the feeling that most/all the doctors don't want to work there, but do so out of some obligation or some sense of "doing good" or "giving back." They just don't look that happy.

Second, being in inner city areas, the patient demographic is almost entirely African-American. Which is interesting, because it seems that the patient demographic in the suburbs is almost entirely Caucasian. I should expect this, but it's still rather contrasting. We did see some immigrant families from Nigeria and Liberia and such.

Third, being in inner city areas, almost all (if not all) the patients are on Medicare/Medicaid. The pediatrician held up 5 billing statements and said: "See these? These amount to about $600 because all these patients are on Medicare. If they all had private insurance, it'd be closer to $2000." That's pretty shocking, even though (again) I probably shouldn't be surprised.

Fourth, most of the kids I saw were babies or really young kids (less than 6-years-old or so). There was one day where we saw pretty much only 1-month-olds that were all born within a week of each other. o_O I've realized that I know next to nothing about babies. After almost every well-baby visit, I'd ask the pediatrician, "Is that normal?" Is that umbilical cord normal? Is there supposed to be stuff oozing out of it? Are they supposed to peel? Apparently, the answer to all those questions is: yes. One of the dads looked at me and said, "You don't have a kid, do you? You have that look on your face." Why yes, you'd be correct sir.

It's all just such a contrast. The suburban clinic was really nice. The hospital was even nicer (like, amazingly so). And these two inner city clinics . . . well, you can tell that they don't have much money invested into them. I wish things were different. As the pediatrician told me: while we'd like to think that everyone has a fair shot in the US, that everyone's born equal, the truth is that it's not. Doctors treat patients differently due to access to health care, even if they don't mean to.

It's just . . . unfair.