20 Questions: Dennis Stokes, MD, MPH, Pediatric Pulmonologist

Dr. Dennis C. Stokes is a Professor of Pediatrics and Chief of the Program in Pediatric Pulmonary Medicine at Children’s Medical Center-St. Jude Children’s Research Hospital-UT Health Science Center. He is also the Director of the University of Tennessee Cystic Fibrosis Care and Research Center.

Dr. Stokes graduated from the University of Kentucky College of Medicine and obtained a Master of Public Health degree from Indiana University-Purdue University. He completed his medical internship and pediatric residency at Johns Hopkins Hospital, with fellowship training at Children’s Hospital Medical Center and Harvard University Medical School.

Dr. Stokes has consistently been named among America’s Best Doctors®, and is known for his expertise in asthma and cystic fibrosis.

Dr. Stokes has graciously agreed to be interviewed by The Student Doctor Network in order to impart some of his wisdom and perspective to prospective doctors.

Describe a typical day at work.
I work in a group of four pediatric pulmonologists. Since we cover two children’s hospitals, my work day is quite variable. When we’re on the inpatient service, we see patients with a variety of pulmonary conditions, including cystic fibrosis, asthma, chronic lung disease of infancy (BPD), and consult on a even wider variety of pulmonary problems. At St. Jude Children’s Research Hospital, we see patients with pulmonary complications of cancer therapy, including bone marrow transplantation. These complications include drug and radiation-induced lung injury, as well as infections. We teach residents and medical students, as well as lecture to area pediatricians and St. Jude staff. We also have outside clinics in surrounding communities to serve families who would prefer not to drive into downtown Memphis.

What mix of clinical, research and teaching work do you do? How much power do you have to change that mix?
Our division is primarily dependent upon clinical revenue and teaching, so that has been our primary emphasis. However, after the addition of new faculty, we are now beginning to expand our research work in cystic fibrosis, and hope to add more faculty who will focus instead on research as their primary role. The old days of an individual physician being a “triple threat” are long gone, but it is still possible for a division with adequate staff to be outstanding in clinical care, research and teaching by working as a group, and building on each individual member’s strengths.

If you had it to do all over again, would you still become a doctor? If not, what would you have done instead?
I love medicine and would definitely make the same choice again.

Why did you choose your specialty?
My father worked in a TB sanatorium in Kentucky, so I am sure working several summers with him had a big influence on my interest in pulmonary infections. Later, as a pediatric resident, I became interested in pulmonary infections in the immunocompromised host, a relatively new phenomenon in the 1970’s. This led me to pursue a fellowship in pediatric pulmonary medicine, along with a desire to better understand pulmonary physiology.

Did you plan to enter your current specialty prior to entering medical school?
I had no specific plans when I entered the University of Kentucky College of Medicine. I loved surgery, and did consider pediatric surgery, but I thought that I was too nearsighted to be an effective surgeon in 20 years. While doing an incidental appendectomy with Dr. Ward Griffin, chief of surgery, I cut on the wrong side of a suture. That probably helped seal my decision, as did my admiration for Dr. Jackie Noonan and the other pediatric faculty with whom I worked.

Do you feel that your choice of specialty has met your expectations?
I was the first of a new group of pediatric pulmonologist trainees, so at the time I entered my fellowship I’m not sure that I had very clear expectations. Clinical care and research are now very different than they were in the 1970’s, when the people who trained me were starting the field. The interesting and challenging aspects of my specialty have kept me from never being bored.

Are you satisfied with your income?
I have reached the point in my career where I have an income that is adequate. However, when I was younger, my income definitely was not what it should have been given the hours that I worked. I had worked at several outstanding academic centers, where simply being there was considered an adequate substitution for the gap in salary!

What do you like most and least about your specialty?
I love working with kids, who never cease to keep me focused on what is truly important. What I like least is the red tape that complicates so much of medical care these days.

If you took out educational loans, was paying them back a financial strain?
I was very fortunate to have a scholarship to the University of Kentucky, and that meant that I left medical school with very little debt. We made very little money as interns, and I can remember the strain we felt repaying the few thousand dollars we owed. I can’t imagine the strain on current medical school graduates who are saddled with hundreds of thousands of dollars in debt. I am sure it influences their career decisions, and consequently gives them less choice than I was fortunate enough to have.

What is your general schedule like? For instance, what are the number of hours a week you work, the number of hours you sleep each night, and the number of weeks of vacation you take a year?
I live 2.5 miles from the hospitals, so I’m available all the time. Fortunately, with four physicians in our group, it means that I am on call much less now than when I was in practice by myself. I am usually in bed by 11 p.m., and try to be up by 6 a.m. My vacation time has varied, but mostly it has been about 4 weeks a year.

If you have a family, do you find that you have enough time to spend with them?
My children are grown and living in Los Angeles and New York now, so currently it is just my wife and myself. I do wish that I had spent more time with my kids when they were younger, although I did try hard to make the important events in their lives when they were growing up. You would have to ask them whether I was around too much or not enough!

What advice do you wish you had been given prior to medical school?
I think the most important advice I wish I had been given was to ask more questions and advice from mentors. Find successful people you admire and talk to them, listen to their advice, and stay focused on what is important.

From your perspective, what is the biggest problem in health care today?
The biggest problem is the lack of health care coverage for large segments of our population, and the lack of quality care for so many people despite the money spent on health care. “The Quality Chasm” is more than just a book title, it is a reality for millions of Americans, including children, who should be our highest priority

From your perspective, what is the biggest problem within your own specialty?
There is going to be a significant shortage of pediatric subspecialists in the future. My generation will begin to retire, and fewer and fewer medical students are choosing pediatrics and are willing to spend an additional three years in training. With the aging of the population, overall the number of pediatricians will probably be adequate, but the role of the subspecialist may have to change.

What is the best way to prepare for your specialty?
Study hard and pick a related area of expertise that you can bring to the specialty. For example, pharmacology, epidemiology, quality improvement, etc.

Where do you see your specialty in 10 years?
My hope is that within the next 10 years we will have important new therapies completing clinical trials in cystic fibrosis, and that they will make a major impact on outcome for CF patients and families. I would also like to see a new generation of pediatric pulmonologists in place, providing leadership and innovations in our field.

What impact do mid-level providers have on your day-to-day practice?
Our division is currently replacing a nurse practitioner, but nurse practitioners can provide an important role in chronic illnesses like CF, asthma, BPD and complex technology-dependent patients. They can provide most of the day-to-day support and care that families need.

What types of outreach or volunteer work do you do? Also, do you do any international work?
None currently, although that is something I hope to do in the future as I move toward more of a part-time role in my specialty.

What do you like to do for relaxation or stress relief? Can you share any advice on finding a balance between work and life?
Fishing, kayaking, running, biking. The best advice regarding balance that I can give comes from an old mentor, Dr. Joseph Simone, the former director of St. Jude Children’s Research Hospital. In his well-known essay, “Understanding Academic Medical Centers: Simone’s Maxims,” he points out that “Institutions Don’t Love You Back.”