Richard Oken, MD, FAAP

Marcus Welby, MD, the respected family doctor from the world of 1970s television, is as far removed from modern medicine as his plaid suits and wide ties are from current fashion. In fact many of today's graduating pediatric residents may not even know who Marcus Welby was. How medical practice has changed will be examined October 3 during an NCE plenary session.

"The Primary Care Physician — An Endangered Species?" (P2058) will look at where general pediatric practice was and where it appears to be heading, said plenary speaker Richard Oken, MD, FAAP. Dr. Oken is a clinical professor of pediatrics at the University of California, San Francisco, and a general pediatrician in Berkeley, California.

"My focus will be to look at the plight of the general pediatrician," Dr. Oken said. " I have been a general pediatrician for 35 years, but it may no longer be a viable profession or title because one can no longer practice general pediatrics in the old way.

"The current challenge of practicing general pediatrics involves considering the motivations of people who complete a primary care pediatrics residency, the economics of the business model as well as what one owes at the point when one starts practice and what the opportunities are in different parts of the country."

In 1974, Dr. Oken borrowed $25,000 to start a "mom-and-pop practice" that was available 24 hours a day, charged $10 for an office visit and participated in all insurance plans.

"Today, that model is nonviable. The influx of patients in your practice is now dictated by external forces that have nothing to do with where you trained, how good you are, how well you communicate or what your plans are for your practice," he said.

The focus of a successful medical practice in 2010 is very different than it was in 1974.

"'You change or you die' means that you may have to adapt or modify what you thought you were going to do," Dr. Oken said, adding that he will offer an economic, a public health and a needs analysis of a successful practice, based on his experience. "The candidates who want to practice are a very different breed than those of who have been doing this for the last 30 years."

Dr. Oken said he would discuss opportunities, options, economics, what is best for the patients and what a general pediatrician may need  to do in the coming years, emphasizing that there is no single model that will serve all.

"You have to change and adapt, depending on when and where you are, and depending on your location and what patients are available for you to survive," he said. "No two places are going to be the same.

"Those of us who are still surviving in general practice may either be owned or operated by universities or a large corporation or foundation, or we have to figure out if we still like what we are doing, and how to survive and prosper in this new environment."