Advice to My Younger Self: Independent Pediatricians Reflect on the Early Days

by Emily Graf ■ Aug 2024

Graphic representing a mature person speaking to their younger self

Advice to My Younger Self: Independent Pediatricians Reflect on the Early Days

by Emily Graf ■ Aug 2024

What advice would you give to your younger self?

For this series, we asked pediatricians for advice they’d give to their younger selves as they were just getting into independent pediatric practice. Taking the leap to go independent can be exciting, daunting, and full of unknowns. These pediatricians, who have been in independent practice for decades, offer responses that are insightful, warm, and at times, surprising. Highlighting these voices in independent pediatrics feels especially relevant in an era where pediatric residencies are on the decline. By showcasing the success and fulfillment possible in independent pediatric practice, we hope to bring visibility to the many paths to thriving in the field of pediatrics.

Dr. Nelson Branco on the Importance of Relationships

Dr. Nelson Branco, MD, FAAP, practices with Tamalpais Pediatrics in the Bay Area. Dr. Branco has been practicing pediatrics in California since 2001, and is also an Assistant Clinical Professor of Pediatrics at UCSF.

“I have long believed that as physicians, and especially pediatricians, we are in a relationship business.”
Dr. Nelson Branco

It’s an interesting question. Of course it ignores the bigger question— would my younger self have taken my advice? That’s a toss-up. [This] question made me think about the things I’ve done so far in my career, and what I’ve learned from working, volunteering, and visiting a wide variety of places. I have long believed that as physicians, and especially pediatricians, we are in a relationship business. Relationships with our patients and their families, as well as our colleagues, co-workers, mentors, friends and our own families, are central to our success and satisfaction. Given this fact, I think the single most important piece of advice I could give my younger self, or any newly independent pediatrician, is to make sure you are working with people you like and respect. Most importantly your partners and the other clinicians in your practice, but also your staff. If you get that right, you will be happy and successful.

Dr. Brian Bowman on Building Self-Awareness

Dr. Brian Bowman, MD, PhD practices with Cary Pediatrics in Apex, North Carolina. Dr. Bowman joined Apex in 2001, and has been practicing there full-time ever since. His special interests include child behavioral development and children with disabilities. Dr. Bowman is an at-large board member of the North Carolina Pediatric Society, has chaired the Department of Pediatrics at WakeMed Cary, is a member of the Pediatric Advisory Group at Wake Med Children’s Hospital and on the Physician’s Advisory Group with BCBS of NC.

“Who would’ve thought a simple pediatrician would engender such significant responses from people of all different paths of life? I needed to learn to build self-awareness around my impact on my team.”
Dr. Brian Bowman

Something I wish I could go back and impress upon my younger self is the amount of time or effort you need to invest to build a good, healthy practice culture. There are plenty of resources through PCC, PMI, and other organizations that can help you run and manage your business, but I wasn’t utilizing them as a younger practitioner. I wasn’t aware of the importance of developing my leadership skills, or how much my employees looked to me for guidance. I didn’t realize that my personality or mood on a given day affected the personalities of those around me. Who would’ve thought a simple pediatrician would engender such significant responses from people of all different paths of life? I needed to learn to build self-awareness around my impact on my team.

So, I’d recommend spending time on a retreat with practice partners, whether they are physicians, practice managers, or other important key stakeholders in the culture and the future of your practice. An independent pediatrician can be flush with cash if they work hard, but the real value, the real legacy, comes from having vision and building a practice that reflects who you are and what you want to be in your community.

Dr. Hiral Lavania on Tapping into Your Resources

Dr. Hiral Lavania, founder of One Family Pediatrics in Cumming, GA, has built an independent practice where she would be happy to bring her own kids (though she doesn’t, of course, for ethical reasons). Dr. Lavania is IBCLC certified and the Director of Breastfeed Atlanta, so she’s able to uniquely support new moms and newborns in breastfeeding. Additionally, she’s trained with the REACH Institute to serve as a resource for children’s mental health.

“The advice I would give to my younger self about starting my own practice is firstly—don’t give up. It will be hard and scary at first, but so worth it in the end! Remind yourself of why you got into independent practice, and hold the vision for yourself.”
Dr. Hiral Lavania

The advice I would give to my younger self about starting my own practice is firstly—don’t give up. It will be hard and scary at first, but so worth it in the end! Remind yourself of why you got into independent practice, and hold the vision for yourself. Next, get an EHR you love. You will be using it all day long, so it should not be cumbersome to use. Invest in a system that makes your life easier so you have more time to dedicate to your patients. Join a vaccine buying group that will do the legwork of purchasing vaccines—again, so you have more time with patients. Join SOAPM to support yourself in practice management. And definitely reach out to other pediatricians who have opened their own practices. They are excited to mentor!

In Pediatrics, Mentorship Still Matters

In a work culture that is rapidly evolving with technology, accessing apprenticeship or mentorship opportunities can be challenging, or even outside of the norm. Yet, all of these experienced pediatricians name the importance of building relationships, accessing resources, and seeking support and outside wisdom from mentors. As newer pediatricians take the leap into independent practice, stories from those further along the road can bolster confidence, offer reassurance, and provide wisdom and insights that can only be gleaned through experience.

Combatting the Decline in Pediatric Residencies

The draw of independent pediatric practice—be it lifestyle, fulfilling relationships, or opportunities for growth—could be important incentives for new doctors considering their future specialty, especially as the U.S. faces a decline of new doctors going into pediatrics.

In 2024 the number of medical students applying for pediatric residency dropped by 6%. There are a number of factors likely responsible for disincentivizing pediatric specialty for new physicians, but a glaring one is lower earning potential when compared to other specialties. Millions of children are covered through Medicaid, which reimburses at a significantly lower rate than other insurance providers. Given the hefty student debt carried by most medical students, it’s not surprising that students are looking to enter more lucrative fields.

In a July 2024 New York Times op-ed, Dr. Aaron Carroll writes: “my interest in working with families outweighed whatever I might miss by earning less.” But it’s unclear whether medical students have the opportunity to nurture this kind of interest. A 2023 National Academies report advocates for exposing medical students to mentors and role models in pediatric subspecialties, as there can be a lack of visibility for the field in medical schools. Alongside raising pediatric salaries, the report advocates for mentorship and role-modeling in pediatrics, as well as more robust scholarship and loan repayment programs.

The seasoned pediatricians who lent their voice here represent the type of mentorship that’s available for new pediatricians. As Dr. Hiral Lavania says, tapping into your resources is everything. Through building relationships, tapping into resources, and finding joy in the work, new pediatricians can thrive as they embark on starting an independent practice.

Check out these resources for more information about starting a pediatric practice:

Emily Graf is a freelance writer, wilderness educator, and English teacher living in Colorado. She is passionate about telling stories that promote equal access to quality health care. She can be contacted at emgraf11@gmail.com for inquiries.

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Charting the Future: A new pediatric podcast from PCC

Pediatric care is complex enough — navigating for the future shouldn’t be a solo journey. Join host Chip Hart and learn from pediatricians, industry leaders, and policymakers who are shaping the future of pediatric care. Every episode, we explore their stories, their dreams, and the joy they find in medicine. Together, we’re charting the future of children’s healthcare.

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The Independent Pediatrician is brought to you by PCC, which provides tools and services to help pediatricians remain independent and in control of their practices.

PCC itself is a fiercely independent business. As a Benefit Corporation, it puts the interests of its clients, community, and employees on an equal footing with those of its shareholders.

Advice to My Younger Self: Independent Pediatricians Reflect on the Early Days

Advice to My Younger Self: Independent Pediatricians Reflect on the Early Days

What advice would you give to your younger self?

Dr. Nelson Branco on the Importance of Relationships

Dr. Brian Bowman on Building Self-Awareness

Dr. Hiral Lavania on Tapping into Your Resources

In Pediatrics, Mentorship Still Matters

Combatting the Decline in Pediatric Residencies

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Charting the Future: A new pediatric podcast from PCC