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A pediatric urologist discusses the fulfillment she derives from her profession


“I am lucky to work for a health care system that believes in serving the patients of the Bronx,” says Amanda C. North, MD.

In this installment of “Begin Your Journey,” urologist Amanda C. North, MD, talks with host Scott A. MacDiarmid, MD, FRCPSC, about the satisfaction derived from practicing pediatric urology. North is an associate professor of urology at Montefiore Medical Center in Bronx, New York. MacDiarmid is a urologist with Alliance Urology Specialists in Greensboro, North Carolina.


MacDiarmid: I think there are a lot of things that are fun and give you short-term happiness. But I've found, when you're serving others, not just in your own job, but if you're serving your spouse, your kids, your neighbor, if you're doing that, you're probably having a pretty good day. There's almost got to be an on/off switch. To drive excellence in urology, you have got to be focused, you have to be emotionally, mentally, and physically there. But you have to be able to switch gears and realize there's a world beyond medicine. And you don't want to find that out 25 years later, especially when the job goes a bit south. Tell me this, do you think pediatric urology is stressful as adult urology in terms of burnout?

North: It's interesting. The burnout data are pretty clear that pediatric urologists have a slightly lower rate of burnout than overall urologists. And when we studied it, our understanding—and this is an imperfect understanding—is that there's something very special about taking care of children that makes it very meaningful for those of us who do it. I've been in practice for 15 and a half years, and I have patients that I met for the first time when they were still in utero with a prenatal visit with their mom, because they had suspected posterior urethral valves or prenatal hydronephrosis of some sort or another. And I met them before they were born, and I met them when they were a day or two old and I've taken care of them, and now they're teenagers. Taking care of adults can have meaning for people, but you're not watching that development from a fetus to an infant to a real live human being, and there's something so special about that. And I think that people who go into peds generally are people who respond to the miracle of life that is pediatrics and so I think it's not that it's not stressful. Having a complication on a pediatric patient is probably the worst thing in the world. So I think that there are stresses in pediatrics that can be very devastating for those of us who do it. But I think [of] the joy of taking care of children. I've had kids come run up to me in the office and give me a big hug. I have a little girl patient that I take care of who knows that I'm a Disney fan, and she makes sure she's always wearing a Disney princess shirt every time she comes to see me so she can talk to me about Disney princesses. No offense, the adults just don't do that.

MacDiarmid: I would think to that—maybe I'm wrong—that it would be less commoditized. I see my patients as my patients, but I don't work for a health care system; they might see them as customers. My feeling would be that pediatrics is still not that way or much less so and hopefully the burnout would be lower, but I remember when I was faculty in Arkansas and when that hypospadias repair fails or that UPJ repair fails, you know the next 40 minutes is a long talk [with the parents]. So there's a lot of stress you're under, but I thank you for serving them.

North: Thank you. I think unfortunately, health care is becoming more and more commoditized regardless of what patient population you take care of. I am lucky to work for a health care system that believes in serving the patients of the Bronx. It is understood that many of our patients are Medicaid patients or underinsured patients, and our hospital considers it our responsibility to take equal care of the patients no matter what. I don't think I could work for a health care system that didn't think that way about children. Regardless of what your political beliefs are, children are children and they're not responsible for the economic situation into which they were born. And the fact that we're able to treat all children equally is so important to me because like I said, I love children and that's what I believe children should be taken care of, no matter what. Again, I chose a place to work that believes that also, so it's a blessing.

This transcript was edited for clarity.

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