Hanging a Shingle in Austin
When I finished my fellowship at Scottish Rite in Dallas, most pediatric orthopedic practices were part of academic centers in large cities. While several opportunities presented themselves, I was drawn back to my childhood home, Austin! Plus, my two older brothers, one an obstetrician and the other a pulmonologist, were already here. Having family in town certainly made it a natural place to open a practice.
In the ten years I’d been away, Austin had grown dramatically, to about 300k people, which was the population base necessary to support a pediatric orthopedic practice.
At that time, there were no other fellowship-trained pediatric orthopedists in Austin, so that helped solidify my decision. Finally ready to roll, I hired my first staff person and started calling on area orthopedists and pediatricians to see how I could support them.
The Early Days
My first call came from a pediatrician whose young patient was suffering with an infected hip. My practice insurance wasn’t slated to take effect until the following Monday, but after a few phone calls they agreed to bump it up so I could help the child. Austin was ready… and so was I.
In the first week, I saw about fifteen patients and my patient load rapidly increased each week following. For the next two years I was on call 24/7--with no relief. So, after a year of searching, I found Dr. John Williams, who was finishing his fellowship at Scottish Rite. Two weeks after he joined the practice, I took off to Disney World with my kids—my first vacation in a long time!
From the outset, Dr. Williams and I have determined to be on the cutting edge of pediatric orthopedic medicine. It was especially tough in the early days, as insurance companies did not recognize pediatric orthopedics from a fee standpoint, and we weren’t on BCBS for the first 10 years. Children’s health was severely underfunded.
Austin in the 90’s
Growing up in the 60’s and 70’s, Austin didn’t have much in the way of food outside of Mexican and BBQ, but my favorites were The Barn Steakhouse (on Mopac, south of 183), El Charro, and El Matamoros.
My mother grew up in Austin and always enjoyed Dirty Martin’s. Dad and granddad had a scrap yard on the east side, and so we used to frequent the old Arckie’s Grill on Ceasar Chavez (E. First Street then).
By the 90’s, Austin was no longer just the home of state government and universities; it was evolving into a high-tech hub. Our sleepy town began to offer new culinary options as well, some of our favorites being Fonda San Miguel for brunch, Italian at Mezzaluna and Jeffery’s for the occasional special night out.
Getting Up & Running
The Children’s Hospital was only about five years old, so the big pediatric surgeries were all taken to Brackenridge. (I was a big proponent for sending pediatric cases to the Children’s Hospital and gradually, we did.)
We did the very first VEPTR surgery in Austin—Vertical Expandable Prosthetic Titanium Rib. Surgeons from San Antonio came to assist; it was a very big deal. Thoracic insufficiency syndrome is a congenital condition where severe deformities of the chest, spine and ribs prevent normal breathing, lung growth and lung development.
A curved metal rod is surgically attached to a child’s ribs, spine or pelvis using hooks on both ends of the device. The VEPTR helps straighten the child’s spine and separate ribs so their lungs can grow and expand as they grow.
As pediatric orthopedics has evolved significantly, so has our practice. When we first started out I did all the HR and office work, while Dr. Williams did the accounting and billing. Along the way we were joined by the well-loved, Dr. Tony Kahn, who was instrumental in helping us take the practice to the next level—he was a partner for more than 20 years before his retirement.
Laughs Along the Way
Around that time, I was asked to take on surgical case involving nerve repair; it was called brachial plexus palsy. I asked Dr. Marybeth Ezaki, a renowned pediatric hand surgeon at Scottish Rite, to come down to Austin assist. On her visit we invited her to our home, which was blessed with three lively children, ages 6, 4 and 2.
The kids each had their own rooms, but that night they all wanted to sleep in the hall closet. Dr. Ezaki came in that night and started laughing when she saw them all piled up in there. I promised her that we didn’t keep them there permanently!
Serving Austin
The best part about serving Central Texas is taking care of the kids; no two ways around it. It’s so satisfying to make a difference in young lives. I guess there’s some selfishness there, because it’s very gratifying. And to do it in my hometown—I mean, come on! And now we’re seeing children whose parents were our patients years ago. (It makes me feel old!)
Lessons from Little Patients
Happiness is a choice. I was taking care of a young boy named Stevie, who was wheelchair bound with cerebral palsy. He could not talk and only made non-verbal sounds, but he had normal intelligence.
He came from a difficult family situation; his parents were divorced, so he lived with his aging grandma. Even so, he was always smiling, waving his hand and in a good mood. When Stevie developed scoliosis, I took the case to fuse his spine.
After that, when I’d become upset or depressed, I’d quickly turn my thoughts back to Stevie—‘What in the world am I complaining about?’ Stevie, even in pain, always had a ready smile.
After that, I often remind my kids that generosity is doing something for others that’s not convenient for you but makes a big difference for them. You don’t have to go 500 miles away—there are plenty of people here in Austin who need our help. About 30% of our practice has always been assisting unfunded or Medicaid kids; Dr. Williams and I hope to never turn down a case.
The Best Part About Working with Kids
Kids are honest. They are who they are. One of my patients, a 3-year-old girl, was sitting up on the table, so I sat on the table next to her. She looked up at me and said, ‘your breath is horrible!’ (Her mother was aghast.) She was right, I tend to have coffee breath, so I went and got a mint!
What’s better than walking into a hospital room and getting a big ol’ hug from a child? Nothing, absolutely nothing!
Founder of Central Texas Pediatric Orthopedics - Celebrating 30 Years!
