Specialist Spotlight: Allergy and Immunology With Burcin Fraser, MD

This article was originally published by the American Medical Association, and republished with minor edits.

Burcin Fraser, MD, is board-certified in allergy and immunology as well as pediatrics. For 12 years, she has treated patients in and around Washington, DC, first at Children’s National Hospital and now at her own private practice, Whole Family Allergy and Immunotherapy. Dr. Fraser has lectured on allergic diseases locally, nationally, and internationally throughout her career.
 

What do a typical day and week look like at your practice?

On a typical day, I come into the office, answer patient cases for 30 minutes, try to finish up some charts, then see 15 – 22 patients per day. I do shut down the office at lunch to catch up, make some calls, do more charting, and sometimes attend a staff meeting for education or practice improvement. I end the day with more cases and charting, then catching up on emails.

My office is open four days per week for patient care. I don’t see inpatients, so there are no hospital rounds. Fridays I usually spend in meetings and catching up on revenue cycle, accounting, and other small business items, including writing blogs and reading.

What are the most challenging and rewarding aspects of allergy and immunology?

My patients are actually amazing. The most challenging aspect is the insurance companies. They are always changing the rules, paying less, and giving the runaround. We make it work, but the system we have to work in is definitely the most difficult aspect of running the business.

Regarding the most rewarding aspect, luckily most of my patients are healthy! And we try to keep them that way. I try to focus on prevention and using disease-modifying approaches to food allergy, allergic rhinitis, and asthma to keep patients feeling their best.

What is the impact of burnout on allergy and immunology?

When I worked in a hospital clinic, I felt burnout significantly because the demand for more work with no pay increase or incentives was persistent. In private practice, I set the pace and do things my way, and although the risk is higher and demands are different, I am so much happier. I might even be working more, but I don’t have burnout.

In my own practice, I make sure we only work four days per week in patient care. I make sure we shut down the office on all major holidays and give all staff four weeks of vacation. This reduces our revenue in some aspects, but secondary revenue due to happy staff and lower turnover increases, and we are better rested and able to take care of our patients more authentically.

How does your lifestyle match — or differ from — what you envisioned?

Depending on the setting, the work-life balance in allergy and immunology is a major draw. You can work in the hospital if you prefer academics more, or in private practice if you are more independent. You can also work in research, pharmaceuticals, and more. The training in immunology allows you to choose from a really large variety of careers.

Allergists used to make a decent salary, but it is definitely lower now with poorer reimbursement rates in private practice. I still love what I do but things definitely seemed more sparkly when I was in medical school.

Once you have a family, there is a lot more push and pull and guilt when you are at work, as well as guilt when you are at home. This is the life of a physician no matter the specialty you are in, but with allergy and immunology there is enough variety of careers that you can make it look however you want.

What skills should every physician in training (even those who don’t plan to go into allergy and immunology) have? And what advice would you give to those who are considering allergy and immunology?

The most important skill is listening to really hear the patient’s priorities, fears and goals of treatment. You need to be the guide, and it is important to ensure that patients feel empowered to manage their care.

You can enter allergy and immunology through pediatrics or internal medicine, and you will end up being certified to see all ages in the end. The field of allergy and immunology right now is really focused on food allergy and drug allergy—the other conditions we see, such as asthma, allergic rhinitis and eczema, are being seen by other specialties creeping in on our business.

For food allergy, having a pediatric background is very helpful because you need to have a solid intuitive understanding of what is normal in children and also of parent-child dynamics. Drug allergy is more of a major issue in adults, so having an internal medicine background is nice to have there but not totally necessary. Internal medicine-pediatrics is also a good background to have, but it will prolong your training.