Treating Patients With a ‘Community-Side Manner’

Partners for KidsSt. Thomas, V.I.

Dr. Penn’s passion for population health helps her treat a unique community.

Dr. Cecilia Penn, a pediatrician in the U.S. Virgin Islands, has a simple philosophy for running her small practice: “slow and steady wins the race.” But, she is definitely not running on island time. In the nearly three years since she’s opened her practice, Partners 4 Kids, she’s accomplished an incredible amount.

She first opened her practice in June of 2013 as a solo practitioner. Since then, she has added a partner, grown her practice to more than 3,000 patients, expanded her hours, and has plans to open a satellite location in the British Virgin Islands later this year. If that sounds like a frenzied pace, talking with Dr. Penn evokes the opposite impression. She speaks deliberately in a calm, soothing voice. And like Dr. Penn, the practice itself gives off a warm, comfortable vibe with brightly painted rooms, tropical-themed artwork, and soothing background music. Each room is named after an uninhabited island, like Buck Island and Green Key.

“I wanted it to be very salient to where we live,” said Dr. Penn. “I want you to forget you’re at the doctor’s office and provide a very warm, caring environment. Everyone who works here embodies that. If a parent comes in and is frazzled or worried, we’re here to care for them whether they’re a walk-in, are running late, etc. I try to be as calm as I can be.”

Focusing on Population Health

“Clinical care speaks to only a part of what makes up a patient … You also have to look at where they are coming from and what influences their health. Working with one patient at a time has one benefit, but understanding primary care on the community level can affect the multitudes.”
With a passion for health policy, Dr. Penn looks to understand her patient population at the community level in order to better serve them. From her undergraduate degree where she studied biology and society to her master’s degree in public health where she focused on health policy, Dr. Penn has always been interested in the social determinants of health. “Clinical care speaks to only a part of what makes up a patient,” said Dr. Penn. “You also have to look at where they are coming from and what influences their health. Does their financial situation affect the way they eat? Do they live in substandard housing? Working with one patient at a time has one benefit, but understanding primary care on the community level can affect the multitudes.”

Today, Dr. Penn continues to focus on population health management in her practice on St. Thomas — a hilly, 31-square-mile island in the U.S. Virgin Islands that is home to a diverse ethnic population. The Virgin Islands provide a unique location for the practice. St. Thomas is diverse, but has its own set of cultural influences and socioeconomic challenges. According to 2010 U.S. Census data, one-third of residents live below the poverty line and the annual per capita income of island residents was just under $20,000, slightly higher than half the U.S. average. The problem of low income is compounded by the relatively high cost of living.

“You can’t be as effective as a clinician without understanding these factors,” said Dr. Penn. “I look at factors like how many undocumented citizens are there, how many one-parent households, who are the economic haves and have-nots, and why that is so. It’s also important to understand where you live. For instance, produce is very expensive here because we don’t grow anything. That’s a unique constraint.”

Filling a Need in the Community

Pediatricians are scarce in the U.S. Virgin Islands. Dr. Penn opened Partners 4 Kids almost three years ago, after leaving a group family practice in which she was the only pediatrician. The decision to be independent has proved to be a good one, both for herself and her patients because of the specialized pediatric care she is now able to provide. According to Dr. Penn, there are about 25,000 resident children and only a handful of pediatricians. Nearly 80 percent of her former patients transferred to her practice, which is conveniently located in a shopping mall, across from the local hospital and close to a number of daycare centers, schools, and a cruise ship dock.

The isolated location of the Virgin Islands also presents a number of unique geographic challenges, especially for those in need of specialized care. There are no pediatric subspecialists, and the Virgin Islands are physically separated by water from those specialists. Since opening the practice, Partners 4 Kids has offered pediatric specialty services in audiology, physical therapy, speech therapy, and psychology for families who might otherwise have to leave the island for specialist care. Dr. Penn partners with these subspecialists who come from the U.S. states to St. Thomas as often as one day a week or as infrequently as one day a month. Facilitating subspecialty care remains a challenge.

Dr. Celia Penn
For now, she collaborates with a children’s tertiary care center with the goal of establishing a telemedicine program in the near future. With the help of a third party liaison that helps her negotiate insurance contracts, she’s created a proposal for insurance companies to cover the telemedicine visits. “Seeing subspecialists is a huge expense for impoverished families. This could save families upwards of $1,000 and time they would need to take off work each time they have to see a specialist,” said Dr. Penn.

Because of the limited amount of pediatric care available in the U.S. Virgin Islands, Dr. Penn frequently sees patients from the neighboring islands. There are also no pediatricians in the British Virgin Islands and patients currently only have the option of seeing family generalists. Because of this, Dr. Penn plans to open a satellite location in Tortola, the largest of the British Virgin Islands, to help fulfill the need for pediatric care. The initial plan would be for her and her partner to each practice at the satellite location one day a week until they could find someone to be based there more permanently. “The goal is for it to eventually become a fully functional office Thursday through Saturday,” she said.

Staying True to her Vision

While the practice has already filled a great need in the community, winning the “Best of the Virgin Islands” award for pediatric practices the past two years in a row, Dr. Penn continues to look for ways to better fulfill the needs of her patients. In January, the practice started offering Saturday office hours, starting with just one Saturday a month with the possibility of offering more in the future. “It’s been wonderfully received,” she said. “You have to know your demographic and what’s going to be most beneficial to them. We have a ton of walk-ins. We used to be closed for lunch, but we’re now available during lunch hours to help accommodate that.” The benefit of having an independent pediatric practice has been the ability to make these types of small changes to better serve her patients.

Dr. Penn’s unique background in population health has given her the ability to see systemic problems, but it’s her passion for pediatric care that gives her the motivation to fix them. Currently, the public schools in the Virgin Islands have no policy that mandates an annual doctor’s visit for students. “Students have to have their vaccines up-to-date for entry into kindergarten and then they need a physical around the age of 11 or 12 if they want to play sports,” said Dr. Penn. “But, between the ages of 5 and 11, we often don’t see patients unless they’re sick.”

She’s been working with the Department of Education to increase the practice’s ability to work with schools to require annual health risk assessments and put triage protocols in place with school nurses.

While she had been making headway, earlier this year, administration changes in the Department of Education forced her to start over. Dr. Penn said she still hopes to have a pilot school in place for next year. “The goal is to have a designated person to manage a child’s ADHD, asthma, or other chronic illness. We need the schools to be more aware of changes made in individual education programs (IEPs) and get everyone on the same page with what’s going on with these students.”

While accomplishing everything that Dr. Penn has in the three short years since opening the practice is enough to make anyone’s head spin, she has plans to keep growing and continue to add value for the community. But, despite her many accomplishments and plans for the future, Dr. Penn makes thoughtful, deliberate decisions, slowly checking things off a long list of how she can best help her patients and their families.

So, what’s her advice for others? “Don’t rush anything. Set priorities and work towards them. Check back with your master plan like a New Year’s resolution. Am I on target or do I need to change my plan? Reflect on where are we going. Once you’ve gotten there – then what? What’s next?”

“You’ll get to everything eventually. It’s important to not run yourself too thin. Stay grounded and true to what you embodied when you started.”

Katy Demong has a B.A. in English writing from St. Lawrence University and an MFA in writing from Goddard College. She’s been writing about current issues in health care and health information technology for almost 10 years. She lives in Salt Lake City, Utah and loves playing tennis and hiking with her dog.