PEDIATRIC PHYSICIAN“An effective physician is a scientist, teacher, counselor, detective, mentor, politician, businessman, performer, and a friend.” Dr. Michael Hobaugh
A pediatric physician is a professional medical doctor who specializes in children’s health. Pediatricians diagnose and treat diseases and disorders which specifically affect children, as well as encourage and foster behaviors and habits inherent in a healthy lifestyle. From infections and injuries to genetic defects and malignancies; pediatricians focus on treating their patients from birth to around 21 years of age. Aside from physical wellbeing concerns, pediatric physicians also participate in the healing process of issues surrounding behavioral difficulties, developmental disorders, social stresses, and depression or anxiety disorders. Most pediatricians work in family health clinics, hospitals, and private practice; and many also teach or assist at colleges and universities. Since most specialists work in the context of heath care organizations, it is vital that they are able to work well in a team setting; consulting with nurses, therapists, radiologists, laboratory techs and many other professionals who are needed to provide the full, proper care for any individual child. Along with working in conjunction with a professional team, the doctor must also, of course, work and communicate well with the patient’s family. Dr. Michael Hobaugh is a pediatrician who specializes in rare, pediatric chronic medical conditions. Along with providing proper care to the child, he prioritizes his vision to optimizing the outcome for the entire family system the parents, siblings, extended family and the community.
Dr. Michael Hobaugh specializes in the care of children with chronic and often progressive medical conditions. Combining a host of responsibilities with a taxing schedule, Dr. Hobaugh has dedicated a vast portion of his career to treating children with rare diseases and conditions. Always with his mind on the bigger picture, Dr. Hobaugh feels rewarded for his efforts by “sending patients home for the first time either since birth or since their life altering diagnosis or injury.”
He explains, “It is a tremendous honor to be the person parents reach out to when they are worried about the most precious person in their lives: their child. When we are finally able to get a family reunited under their own roof at home it is an exciting day.”
“Success Comes in Many Flavors”
Dr. Hobaugh thrives on the fact that his specialty combines a plethora of skills and challenges into one profession. With a seemingly limitless amount of energy, Dr. Hobaugh worked 19 years to get his first faculty position. He now is an Assistant Professor of Pediatrics at the University of Chicago, where he teaches medical students and residents. In addition, he does clinical work at La Rabida Children’s Hospital in Chicago, where he cares for children with a variety of acute and chronic medical conditions. As a man who truly loves what he does, he explains that “Success comes in many flavors.” He believes doing the job out of genuine aspiration and desire is what gives someone the taste of those flavors. “Don’t become a doctor because it is the Mt. Everest of professions and you have to have a drive to climb mountains.”
Dr. Hobaugh majored in chemistry at Trinity University in San Antonio, TX where he performed research in the field of excited state dynamics of organic compounds. It was at Trinity that he learned about the Medical Scientist Training Program; a program which provides student funding for both medical school and a concurrent PhD. Dr. Hobaugh was able to pursue this opportunity at The University of Chicago, where he completed an MD and PhD in Biochemistry (his thesis work was on the three dimensional structure of abacterial toxin). After finishing medical school, he completed a residency in Pediatrics; also at the University of Chicago. He is the coauthor of a chapter in an X Ray crystallography research compilation and penned several articles that were part of his dissertation research.
Dr. Hobaugh, how many hours do you work each week?
I work between 35 and 65 hours each week depending on whether I am on inpatient service or between service weeks.
How much time are you able to spend with your family, friends?
When I am on service, things are pretty busy. I am out of the house around 7 am and return around 7 pm. We might see friends a couple of nights per week. We have a simple family dinner most evenings when my wife and I get home. On those weeks that I am not covering the inpatient service, I have a good bit more time to devote to family and friends. I miss many of my kids’ school activities when they are during the day.
Do you have time for hobbies and recreational activities?
I play trumpet in an orchestra. There is an evening rehearsal once per week and a concert about once every 5 weeks. My wife and I are part of a book club that meets once every couple of months and also a group that reads plays about 8 times per year. Occasionally I miss a rehearsal or sit out a concert cycle when things are getting too busy at the hospital.
A “Day with the Doctor”
Dr. Houbough, would you please describe a day in your busy life?
My day begins about 6:15 am. I take my dog out for her morning business and then come in to get my wife and kids up. I leave for the hospital about 7:00 am on my bike – I live about 2.5 mi from the hospital – or the bus if it is super cold or pouring rain. I get to the hospital about 7:30 am; get cleaned up and into a shirt and tie. I have some cereal at my desk and review the events of the night in the EMR. At 8:00 I meet with the overnight pediatric hospitalist. We talk about any pressing issues affecting the inpatients and possible courses of action to take. I go to the inpatient floor about 8:15 to begin rounding. This is the busy part of the day as we go room to room with a large team of residents, students, nurses, therapists, dietitians and case managers. We talk through each patient’s medical problems, sometimes examine the patients together to clarify physical findings and make a plan for the patient’s medical management. In the process, I teach the residents and students about aspects of the medical conditions and their care. Rounds go until about 11 am.
From 11 am – 12 pm, I grab a cup of coffee and talk with our admissions coordinator and unit manager about the admissions planned for the day, and any issues in the care that arose during rounds that might need their attention. I grab a bite to eat in my office and start assessing the residents’ notes from about 12 – 12:30 pm. Between 12:30 pm – 4 pm, I visit the patients in their rooms to examine them and check in with the residents, case managers, nurses and therapists about various aspects of the patient’s care and their clinical condition. I periodically log back into the EMR to check labs and radiology results; see if the residents have put in orders we had discussed on rounds for medicines, therapies, studies, etc. I continue to read and assess the residents’ notes throughout the afternoon. I always keep an email window open as well, as this is how many tasks are coordinated with the care team.
Around 4 pm, I go to our acute care clinic where I sign out to the overnight hospitalist. We discuss all the patients and their ongoing care. I let them know which kids I’m concerned about and what to watch out for.
Around 4:30 pm, I get changed back into my cycling clothes and head out. On the days my kids have after school activities I go to the gym and then we all get home around 6:45 pm. Dinner is usually “leftovers” from the weekend, when we do a lot of cooking or some other simple preparation for meals. My wife works as well, so we rely on our nanny who has been with us for 11 1⁄2 years – since our first child was born. With a two career family – my wife is an attorney with a big firm – this is essential.
Because of administrative work I do at the hospital and also my own sense of physician ethics, I always carry a pager (or have it forwarded to my mobile phone), as I believe it is absolutely essential for a physician to be reachable by their patients and colleagues. I get paged “after hours” about twice a week, so it is not a big burden.
What made you want to become a doctor and a pediatric specialist?
There is no other profession that combines so many skills and challenges into one. An effective physician is a scientist, teacher, counselor, detective, mentor, politician, businessman, performer, and a friend. I feel so lucky to have this job. It is always interesting and challenging. Never do I wake up in the morning and wonder why I should bother to get out of bed. Being a physician – and especially a pediatrician – is intrinsically and obviously “good.”
My own niche’ in pediatrics is the care of children with chronic and often progressive medical conditions. In my approach to this role, the “patient” is expanded to be the whole family system – the parents, siblings, extended family and the community. My team and I seek to optimize the outcome for the whole family as they confront the challenges of a chronically ill child who often has highly medically complex care needs.
How competitive is the job market in your area of expertise?
The world always needs more pediatricians. I receive dozens of solicitations every week. Most of these jobs are in hospital owned outpatient practices or are community pediatric hospitalist positions – 24 hour coverage of a community hospital. Out of residency, the latter type of position was how I got my start. It took about five years doing 24 hour shifts as a community pediatric hospitalist before I got the opportunity to transition into more of a teaching role with out overnight in hospital responsibilities. So, I’d say that in the little corner of general pediatrics – academic pediatrician for hospitalized children – is fairly competitive.
Is forming a private practice a viable option?
I have never worked in a private practice, so I don’t know. My sense is that more practices are being bought by hospitals and then employing the pediatricians. This takes the complexity of running a business in today’s health care market out of the hands of the doctors. That can cut both ways.
Should one be building a brand to make him or herself more marketable?
I think that one must always be conscious of the reality that every interaction – with physician colleagues, parents, nurses, administrators, food service, custodians – builds the impression of you within your work place and community. Over time, a strong positive association yields rewards. I think that bright and talented people with a good attitude and proactive approach to problem solving are valued in every organization. If this is what is meant by “building a brand” then yes, it is essential.
What role do referrals play in your practice? Is it important to develop referring doctor relationships?
La Rabida Children’s Hospital receives most of its patients as referrals from other hospitals. We accept patients from neonatal and pediatric intensive care units, as well as general inpatient floors. I visit the hospitals from which we receive patients and discuss potential transfers with my colleagues there. These ongoing relationships are very important to our work at La Rabida.
What steps would you recommend in order to increase success?
Success comes in many flavors. One piece of good advice I got along the way was to remember that you have to do the job you aspire to get. Many young adults with ambitions to be physicians have the idea of being a doctor set in their minds by parents society’s values, and peer pressure, without fully exploring the profession. Before you apply to medical school spend 2 or 3 years working in a direct patient care setting either paid or as a volunteer for at least 510 hours per week so that you really see the profession and its business environment for what it is, not what you think it might be. Don’t become a doctor because it is the Mt. Everest of professions and you have a drive to climb mountains.
Health care delivery is more than ever a team enterprise. The physician is an essential part of that team, but so are the nurses, therapists, case managers, pharmacists, radiology and laboratory techs. This whole complex integrated care delivery team comes crashing to a halt when any of these pieces is out of place.
What gets you excited about your job and why?
In our role in the patient’s long journey of chronic illness, we are often the ones who get to send the patient home for the first time – either since birth or since their life altering diagnosis or injury. This is a huge undertaking that produces parents trained to function as nurses for their child – troubleshooting issues with their home ventilator and gastrostomy tube as well as delivering medications throughout the day. When we are finally able to get a family reunited under their own roof at home it is an exciting day.
On a scale from 110 how hard was it to get where you are now?
That’s a hard question to answer as this is the only place I got to. The whole path from that decision in college to pursue the Medical Scientist Training Program Fellowship to getting my faculty position at University of Chicago took 19 years. I haven’t always been an easy person to live with amid all the stresses associated with this journey and there is still a lot of uncertainty in my career as health care undergoes seismic changes at every level. Should we call that an 8?
In your opinion, what have been the 4 most exciting breakthroughs in your career field within the last 5 years?
The most significant change in the practice of medicine for all of us has been the advent of the electronic medical record. This has changed the job from one in which no matter which clinic or hospital you walked into you did your job the same to one in which every hospital and clinic requires the physician to do their job differently. We used to have one piece of paper that said “Notes” and another that said “Orders” and we wrote out our findings and prescriptions in a universal documentation format taught the same way at every medical school. Now, each hospital and clinic has its own unique EMR. Even when they are from the same company, they are customized in unique and confusing ways. This has resulted in an inefficient communication system between physicians and a breakdown over less than a decade of more than a century of physician practice systems. Many of my older colleagues have opted to retire early than try to adapt to these changes.
This change in the medical profession dwarfs anything else I might mention. However, some highlights in the care of hospitalized children over the last few years include:
• The development of devices to assist children with respiratory muscle weakness to cough with more force, helping clear their airways
• Soon we’ll have a mechanical “pancreas” that combines continuous glucose monitoring with an auto adjusting insulin pump that will revolutionize the lives of children with diabetes
• Cooling protocols for premature neonates with brain injuries will hopefully reduce the rates and severity of cerebral palsy
What one thing would you like to see changed in your field?
The health of children is inextricably intertwined with the health of their community. Many of our patients are from families with very limited means and this has a huge impact on their ultimate medical outcome. As a nation we need to realize that we are all in this together. We have to do more to lift children out of poverty.
What do you hope to have accomplished by the end of your career?
I just want to continue to provide great care to needy families and children and hope that my example inspires others to do the same.
What advice would you give someone who wanted to follow in your footsteps?
From a philosophical perspective: You know when you’ve done your best. Sometimes you may be rewarded by your teachers or mentors for work you know you could have done better. Don’t let this lower your own standards. Another time, you may have done your best work and been criticized or overlooked. Don’t let this discourage you. You will be the very finest version of yourself if you always remain your own biggest cheerleader and sharpest critic.
Practically speaking: Maintain your relationships with your mentors and let them know what you hope to achieve with your career. Offer to help out wherever help is needed. When asked for that help, say “yes” and then figure out how you’ll get it done.
Thank you Dr. Michael Hobaugh!
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