15 Lessons learned: a journey from pediatrics to corporate America - Careers: Special Report - the career path of one physician

Physician Executive, May-June, 2003 by Raymond Fabius

IN THIS ARTICLE...

Trace one physician's career path and share his insights as he went from a doctor working at an inner-city pediatric clinic to global medical director for General Electric.

As I sit here recounting my career, I am very thankful. While it has included both disappointments and rewards, I have learned many lessons.

Most recently, I celebrate being selected as a Distinguished Fellow of the American College of Physician Executives. All and all, I realize what a great adventure I have had in the pursuit of my passion: health care improvement.

Lesson 1--Your career is most rewarding when it allows you to pursue your passion.

My junior year of medical school was most difficult because I lost my father to the ravages of diabetes and less-than-optimal health care. His complex medical needs led to drug-to-drug and drug-to-disease complications that contributed to his death. The same care that kept him going ultimately caused his death.

Lesson 2--Intelligent and reasonably sophisticated patients can still receive sub-optimal care.

His final gift to me was to appreciate what it means to lose a loved one and how difficult it is to live on without them. This made me a much better doctor. I went through these stages without a doctor's helping hand. Although my professors were supportive. I vowed to help others.

Lesson 3--Even with the best of care, patients die. Denial, anger, bargaining, depression and resolution require time and guidance.

I was always fond of children, so I pursued a first-class residency in pediatrics matching at Children's Hospital of Los Angeles. I returned to my hometown of Philadelphia after the three years of residency, certain that I could treat any pediatric illness. Having come from the inner city, I wanted an opportunity to give back.

My medical school offered me a chance to run an ambulatory pediatric clinic in the North Philadelphia ghetto, so I took it. Supplemented with income from a private practice in the more affluent Northeast, I was able to generate $65,000--more money than my father ever made as public school teacher.

This was perhaps one of the most rewarding periods of my life. Being told that my passion for excellence was infectious and that my hard work was something to emulate by my residents and students was a great incentive to perform well for them and for my patients.

Lesson 4--Teaching residents and medical students is an honor.

Experimenting with many efforts to get black and Hispanic teenage mothers to be compliant, I learned early lessons in medical management. Using local church leaders and a same-day-every-month check up schedule for the first year of life, I was able to demonstrate an 85 percent compliance rate with appointments and a marked reduction in the admission rate in this most fragile population.

Lesson 5--Even the most challenging populations can respond to medical management efforts.

I might still be there today if it were not for the Reagan administration. Less than two years into my tenure and with our first son to be born shortly, I was notified by my medical school, Hahnemann Medical College, that funding for my clinic was being eliminated and I had six weeks to find a new job.

While this was a great disappointment at the time, I learned that you can make lemonade out of lemons.

Lesson 6--Losing your job may be good news.

I landed a position in a practice with two patriarchs of pediatrics in a middle-class area in the western suburbs of Philadelphia. Soon afterwards, we computerized our office. It was the early 1980s.

The computer was half a room in size and could not do what your wristwatch does today, but it was a start. Before long we knew data such as:

* Our most common reasons for admission to the hospital

* The diagnoses causing emergency room Visits

* Reasons for referring our children to specialists

But what changed my career was the utilization statistics it generated. Health plans were forming in the Philadelphia area and we had better pediatric utilization statistics than they did.

Lesson 7--It is always better for you to have the best data about your practice.

Our practice grew to eight doctors and 16,000 children. We were one of the two dominant practices in the county and the largest computerized pediatric office in the Philadelphia area. We were one of the largest practices serving the emerging managed care population.

Lesson 8--It is always better to be a dominant player in your marketplace.

I was asked to serve as a consultant for Travelers Insurance and then became a part-time medical director for Cigna. In fact, I was the first medical director for Cigna's Pennsylvania plan and built that health plan from scratch with the help of a wonderful administrative team.

Lesson 9--It is always better to actively participate in a changing health care environment.

While a part time medical director with Cigna, I joined the American Association of Medical Directors that later became the American College of Physician Executives. ACPE's Physician in Management Seminar and a course on quality convinced me that it was time to move into medical management full time.