I can’t specifically remember how or when the idea of being a doctor came into my mind, but it was there for as long as I can remember. As I grew older, my drive to practice medicine became centered on scientific problem-solving and human connection.
Like any job, however, the idealized version is often different from the reality. It wasn’t until residency and my first few years of practice that I began to grasp what being a doctor actually meant. And what surprised me was how much of my day would be shaped by non-clinical tasks and how much the care that my patients received was influenced by decisions made by people outside the exam room.
Most families at our Woodbury office know me as Dr. K. Here’s how I got here, and what I think parents should be able to expect from their pediatrician.
What Was Wrong With the Old Way?
Not the doctors. I still have colleagues in traditional practices. They’re good physicians who want the same things for kids that I do. The problem is the structure around them.
In an insurance-based practice, every visit has a scope. A mother brings in her son for a cough and then mentions, almost on the way out the door, that he hasn’t been sleeping well. Or that her daughter’s stomach hurts every morning before school. Taking the extra time means delivering good care. After all, the family is in the clinic now; why not address it? But, the system nudges you to say “Let’s book another appointment for that.” Veiled behind the concept of dedicating a separate visit to these issues lies another copay for the family, more time off work for the parents, and another billable visit for the practice.
When it comes to annual visits, sometimes insurances would dictate what testing could be performed or when the child could come in for their check up. And if the family wanted to discuss an additional issue at that well visit? The system nudges you to say “Let’s book another appointment for that.”
I kept running into the same question. Do I deliver good care, or care that works for the business? I always chose good care. But making that choice over and over, with less time per patient every year, and in a system that incentivized volume over quality, was burning me out. I loved being a doctor. I wasn’t sure I loved practicing that way.
“The care we deliver is the care we think should be delivered. There’s nobody telling us one way or the other.”
How Did You End Up at Concierge Pediatrics?
Not by plan.
Late last year I was ready for something different. I used to drive past Concierge Pediatrics in Woodbury every day. I had always been interested in direct patient care, but knew it was the path less traveled. I took a walk, thought it over, and called. Dr. Jassey told me they were actually looking to expand. We met, and it worked out.
Now I get to practice the way I always wanted to. We don’t bill insurance, so a visit lasts as long as it needs to. When a parent brings up something outside the reason they came in, we talk about it. That’s the whole point.
What Does It Mean to Really Know a Family?
Picture a parent calling late at night. They want whoever answers to already know their child without having to retell the whole history one more time.
When a doctor knows a child well, the plan of care changes. I have a patient who gets strep and never clears it on the first antibiotic. She always comes back ten days later and ends up on a stronger one. So now we skip that first round and save her, and her family, the time and frustration. Another patient’s constipation reliably turns into a urinary tract infection a few days later. So when the first signs show up, we treat the constipation early and fend the infection off.
Knowing a child also changes how I read a parent’s worry. A couple of years ago we had a wave of walking pneumonia on Long Island. Pneumonia is scary, and that fear sticks around. If I know a child had pneumonia two years ago, and I know how it started, then when that parent comes in because a cough “sounds different,” I understand the medical question in front of me. I also understand what’s driving the worry.
Every doctor wants to know their families that well, but, in offices with thousands of patients, that can become difficult. We keep our patient panels small by design, ensuring every doctor and staff member truly gets to know each child and family.
“People just want to be able to talk with their doctor, and with someone who knows their child.”
What Does Texting Your Pediatrician Actually Look Like?
In a traditional practice, checking on a patient usually means a message through the patient portal which families may not see right away. So doctors end up calling between packed appointments and speaking briefly. If that family misses the call, they likely will have to maneuver through a call tree or call center just to reach the front desk.
Most of our families text us. It’s their main way of reaching us. If a child had a fever last night, I text the next morning: “How was the night?” Before I leave the office, I can text them again – “Just checking in. How’s his fever?” Texting is easy and lowers that barrier to communication that a telephone call creates.
A relative of mine recently saw a new specialist who spent 20 minutes with her. She called it the best experience she’d ever had at a doctor’s office. Twenty minutes. That should be the baseline, not the exception.
What Is the Nonagon, and Why Does It Matter?
Our members get a take-home telehealth exam kit called the Nonagon. The main device works as a pulse oximeter, heart rate monitor, thermometer, and stethoscope. There is a secondary device, which often gets the most use, that is a small camera with attachments for the ears and throat, plus a mode for photographing rashes.
Exams are performed on the Nonagon app and are very straightforward. The app asks which child is sick and what exam is being performed. Once the exam is submitted by the parent, I pull it up on my phone seamlessly and can provide actionable guidance to the family without needing them to be present in the clinic.
Our parents love the nonagon, especially for ear infections. If there is an ear infection, I can call in antibiotics. If the ears look ok, we can monitor the pain at home and repeat an exam in a day or two. And this can all be done from the comfort of your home.
It travels, too. If your child wakes up with ear pain on vacation in Florida, an urgent care visit there can run $200 or more, especially out of network. A video of the ear and a prescription sent to a pharmacy near you saves money and time.
The Nonagon does not replace an in-person exam when your child needs one. If your child is struggling to breathe, is hard to wake, or you just feel that something is off, call us right away. In an emergency, call 911.
Isn’t Concierge Pediatrics Just for Wealthy Families?
I had the same worry before I joined.
It isn’t the right fit for every family, and I’ll say that plainly. If your child is generally healthy, gets sick once a year, and comes in for a well visit, the math may not work out.
Now picture a younger child in their first couple of years of school, coming in every few weeks through the winter. At a $30 copay, a few visits a month adds up fast. Despite paying an out of pocket cost for the membership, families may be able to submit a superbill to their insurance for reimbursement, depending on their plan.
Some families decide they would rather never sit in a waiting room for an hour again, or have the comfort of knowing that they can be seen same-day or speak with their doctors within an hour about a concern, or know that their child is getting a comprehensive annual exam including in-office blood work, hearing and vision screening, and EKGs read by a Cardiologist. And that’s worth something to them.
It’s hard to picture from inside a traditional practice. Once you experience it, it makes sense.
What Should Pediatric Care Look Like in 10 Years?
Like this.
Families should be able to talk with their doctor, and get into the office when they need to. Kids should feel that the doctors in their life know them and care about them.
That takes doctors and clinical staff members who are fulfilled and a system that encourages doctors to spend time with their patients.
The goal is to keep kids as healthy as they can be. Pediatric care should be built around that one goal.
“We’re raising the bare minimum. This shouldn’t be something only a few families can get. It should be how health care is delivered.”
By Dr. Shant Keskinyan, Concierge Pediatrics