Orthopedic experience gives pediatrician a leg up



As he approached residency as a medical student, Dr. Luke Shiver was torn between pediatrics and orthopedic surgery. Now, having just finished his pediatric residency at Georgia Regents University, he is adding to his expertise in a year-long fellowship with pediatric orthopedic surgery in an effort to help children with minor problems who might not be able to get care elsewhere.

The program at GRU is similar to one at the Medical College of Wisconsin, but there might not be any others in the country, said Dr. Norman Chutkan, the chairman of the Department of Orthopedic surgery at GRU.

“I think we’re either the second or third,” he said. “But as pressures to see patients in an efficient manner mount, I think this is a model you are going to see expanded across the country.”

Many sports medicine practices, including some in Augusta, have a primary care sports medicine physician who was in family practice or internal medicine. They also had a fellowship in sports medicine that allows the physician to manage those sports injuries that don’t require surgery. The new GRU program aims to address similar problems in kids, Chutkan said.

“Some are growth-related, some are developmental,” he said. “There’s a lot of minor trauma that don’t really require a surgeon’s involvement but require someone familiar with musculoskeletal care of kids. Most kids who have a broken bone don’t actually require surgery for it.”

They might need follow-up care, however, particularly with broken bones, Chutkan said.

“Especially with kids, you have to follow kids a little longer when there are implications with growth,” he said. “This will help, we’ll have more manpower to do those kinds of things.”

Though the program is not yet accredited, Chutkan said he hopes to work with the Wisconsin school on making a formal presentation about the model to the Pediatric Society of North America.

More important to Shiver is getting experience in the clinic. Most pediatricians are trained on the physiology of disease and don’t get the intense exposure to the musculoskeletal system that the fellowship will provide, Shiver said.

“If nothing else, I’ve gained a skill that most pediatricians don’t have,” he said. “Becoming comfortable with the management of very common pediatric fractures, for example, is not something that most pediatricians do. That would give me a skill that would be useful if say I was in another country or in a smaller community that didn’t have access to a surgeon.”

He already has gone on several overseas trips and would like to continue that with his new training. Chutkan said he will help GRU respond to what seems to be a growing need.

“It is harder and harder for a lot of kids in the state to get seen,” he said. ”A large proportion of the kids in the state of Georgia are only covered by Medicaid, and there are not many places that will see Medicaid, outside of us and the children’s hospitals in Atlanta. We have a large volume of kids and a backlog, so we are trying to get them taken care of as quickly as possible.”

The surgeons are already traveling to do clinics in Athens, Albany, Valdosta and Waycross, but there is still a waiting list, Shiver said.

“They have to kind of triage which cases are most important,” he said.

Shiver, under the supervision of the pediatric orthopedic surgeons, should be able to help lighten that load.

“There’s a lot of things you can do in this field that don’t need surgery,” he said. “One of the great things about children’s medicine in general is that sometimes even when we can’t figure out what necessarily is making them ill they do well. You just support them through it. Children are amazingly resilient in that way.”

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