A Day in the Life of Doug Kelling, General Internist

Dr. Douglas Kelling is an internist and pulmonologist in full-time practice in Concord, N.C. He treats patients both in the office and in the hospital.

1. What inspired you to choose a career in medicine?

Part of it must be genetic. My great uncle, my grandfather, my uncle and my dad were all doctors. My brother is a radiologist and my youngest daughter is a resident in pediatrics. As long as I can remember I wanted to be a doctor. The opportunity to help relieve pain and suffering was very appealing to me.

2. What is your schedule like? How much time do you spend with each patient?

When I am not on vacation, I work 7 days a week. Monday through Friday I start my hospital rounds between 5:30 am and 6:30 am. Rounds are usually completed by 8:30 am. I then go to my office, which is attached to the hospital. Monday through Thursday I see patients from 8:30 am until 6:00 pm. I take about 1/2 hr for lunch. I eat in the office. On Fridays, I see patients from 8:30 until noon. Friday afternoon is devoted to education and paperwork. After my office is closed, I go back to the hospital to work up new patients. About 7:00 pm I go home for supper. I return to the hospital about 8:00 pm and stay until 10:00 to 10:30 pm to see patients and do paperwork. On Saturday and Sunday I work at the hospital from 9:30 am until 5:00 pm rounds on patients and do paperwork.

I take all outside calls 24 hours a day when I am not on vacation (I do not have an answering service. My home phone number is in the telephone book and is posted in each of my examing rooms). From 6:00 am to 8:00 pm Monday through Friday and 6:00 am to 4:00 pm Saturday and Sunday, I take all calls regarding my patients in the hospital. The other times those calls are taken by in-house physicians who cover for me. I take 4 to 5 days a month in vacation. I spend 5 to 10 minutes with each patient.

3. What are the greatest challenges you have had as a physician? How have you approached them?

Staying educated on new developments. I approach this challenge by reading as much as possible and having drug companies sponsor visits from experts such as professors from Harvard to discuss specific topics such as diabetes, hypertension, etc.

4. How and why did you choose your specialty? How does board certification affect the range of medicine you practice?

I enjoy treating adults with all types of acute and chronic problems. The intellectual challenge is stimulating. Board certification is important to document your expertise, but once you have it, it does not affect the range of medicine you practice as long as you stay within your field (e.g. I do not see children, deliver babies, etc.).

5. What do you enjoy or find most interesting about internal medicine?

Ongoing studies that clearly document how to treat patients with chronic diseases such as diabetes, hypertension, asthma, osteoporosis, etc. Developing new and different ways to deliver quality, cost-effective health care.

6. What factors influenced your decision to go into private practice in Concord, North Carolina?

Nice community to raise a family, well run and progressive hospital and close to a big city, Charlotte.

7. Are you still in private practice? What is your current clinical practice setting?

I am no longer in private practice. I am an employee of NorthEast Medical Center in Concord, N.C. They do all the administrative work, and I am free to spend all of my time seeing patients. I work with five physicians' assistants who see patients with me in the office and in the hospital.

8. What sort of interactions do you have with managed care organizations as a physician? Why are you no longer running your own clinic?

My only interactions with managed care organizations is appealing denial of medications, tests and hospitalizations for my patients by these organizations.

I used to be the president of a multispecialty clinic of 15 physicians. I did not enjoy it as I had to spend too much time on administrative, budgetary and personnel issues. I was not trained to do this. Hence, I became an employee of the hospital and am much happier. In this day and time, I think it is very hard for physicians in primary care to be self-employed. Too many hassles.

9. What issues of health care should premedical students be most aware of?

Many people in the United States do not have access to even basic health care due to cost. This is a tragedy! In a country as wealthy as ours, we should be able to provide basic care (prenatal, well-baby, immunizations, etc.) for all of our citizens. Health care costs are too high, especially since we do not know the quality of the care we are paying for. Physicians should be closely monitored to make sure they are practicing high-quality medicine (following national protocols for chronic diseases, low morbidity and mortality rates post-op, etc.).

10. What is the current identity or role of the physician? How will this change in coming years?

Physicians, basically, have lost their identities due to a number of changes that are occurring in medicine. Due to rising overhead, managed care, malpractice, time constraints and other issues, the majority of physicians have lost sight of the fact that we are here to help all our patients prevent or treat their illnesses to the best of our abilities, energy and enthusiasm. We need to deliver care that is reasonably priced, accessible, and delivered in a friendly, compassionate manner. Until these fundamental principles are reestablished by the medical profession, other forces will dictate how medicine will be practiced in the future.

11. If you had one piece of advice to pass on to the next generation of student-doctors, what would that be?

The practice of medicine is a noble profession that requires a certain amount of personal sacrifice and hard work for those who choose it. Before deciding to become a doctor, make sure you truly want to make that commitment.

Lester Leung is the Editor-in-Chief of the Next Generation and a member of the Harvard College Class of 2006.