if I had won Powerball

Did you see the happy winners in the papers or on the internet? A “once in a lifetime” moment.

Powerball ticket

For most, winning the lottery is not the godsend they have dreamt of.

To suddenly become part of the one per cent is not easy.  Most fritter away their winnings, and end up much less happy than they were before.  So I have thought about this a lot. What would I do if I won a huge amount of money? Of course, its not at all clear to me WHY I daydream about such an event, as I am by nature not a gambling kind of gal. And, they tell me, you can’t win if you don’t play.

So its not likely to happen.

On the other  hand, somehow, maybe some day it WILL happen. So I should be prepared. Don't you agree?

Here is how I would spend my money.

Let’s just assume a check for $100 million after taxes and fees. It’s a nice round number, don’t you think? The first million would likely go to paying off all sorts of debts, such as mortgage, car loans, children’s student loans, and so on The second million (plus whatever is left over from the first million) would go to help secure the future for certain family members (on both my side and my husband’s) who are likely to need support down the line. The rest (about $98 million) would go into a charitable trust, or be used for direct contributions for a variety of purposes. While I can’t tell you what each of these would be (even though I mostly know), there is one thing that I would do right away:

Secure the future of pediatric health care in the Roanoke Valley and throughout southwest Virginia

Hmmm… Isn't’ it already secure?

The answer to that, in one word, is NO The future of health care for children is not secure anywhere, except perhaps in large cities with large, free-standing children’s hospitals, and maybe not even in those places. You see, children are our most vulnerable citizens. They have no power, they cannot vote, they have no money, and they are completely at the mercy of the adults who wield power in our society. They cannot march  on Washington, write letters to their legislators, or influence business leaders in the community. While we can see daily the impact of disease in adults in our society (lost days of work, addiction, obesity, crime, violence, end of life issues), the impact of lack of attention to children’s health care may only become apparent years or even generations later. We tend to close our eyes to it. The first thing that children need is AWARENESS of their needs. Then they need ACCESS to care (access=insurance). Then they need PROVIDERS who can provide excellent care.

Access is expensive.

Access to excellent, evidence-based care is VERY expensive and hard to find.

Think about it. Kids have the same organs as adults. They have a wide range of possible disease processes affecting their organs and systems. However, the great majority of kids are healthy, or at least start out that way. So, while ACCESS means having the same wide range of organ system specialists available, there are so very many fewer children with any specific organ system problem, that there is often not enough VOLUME to support more than a few of any specific type of provider. That means the pediatric subspecialist will work more hours, but be paid less than his or her adult counterpart. That means that for the most part, fewer physicians come out of medical school and choose to pursue a pediatric subspecialty (such as pediatric neurology, pediatric cardiology, etc). Recent data shows that few pediatric subspecialists are able to earn enough more than their general pediatrician colleagues over their working lives to compensate for the much longer training periods at low salaries, with large educational loan balances. And often only one or two or three of them share a practice location. Which could mean being on call every other night and weekend. That is why they gravitate to large children’s hospitals located in big cities where they may be able to work in groups of as many as nine or ten or even more—a much different lifestyle than that faced by the pediatric subspecialists who currently practice in the Roanoke Valley and Southwest Virginia. Almost everything we do for kids tends to take more time and may result in more cost, even though payments for services to children are often much less than the same service provided to an adult (that is a long story and might form the topic of another blog post). Pediatric equipment is more costly because it has to come in multiple sizes. Pediatric nurses have to be comfortable with multiple sizes and ages and developmental stages of children. And the list goes on and on. So, back to my desire to ensure the future of children’s healthcare in the Roanoke Valley and Southwest Virginia. How would Powerball help me to do that? First, I would build a building to house all of the OUTPATIENT needs of our children. All the subspecialists, all the services, all the community resources—in one place. This would help because we have so many children who have to travel great distances and it would be wonderful to have all the providers and services under one roof. It would help because it would give our providers a sense of community. They could more easily see each other, and communicate about their shared patients. They could more easily SHARE things, including having staff who could move between clinical areas as needed. I wouldn’t do this alone, of course. I would make a large donation and then ask the community to help. Why? Because unless the community is interested in the future of children’s healthcare and willing to make a commitment to it, it will never be as great as it can be. Total, we would probably need around $30 million to do this. It would pay off in benefits of making it easier to recruit those hard-to-find subspecialists, because there would be a permanent statement from the community that kids are important to our valley and the surrounding areas. Second, I would ensure that probably another $30 million be put into a fund (endowment) to help keep our subspecialists and other folks critical to pediatric health care employed and well-supported. The fund would generate yearly income to support education and research of young physicians and those still in training. It would take away a bit of the pressure our providers feel every day to do things that generate income when they would prefer to be teaching, learning or researching intricacies of pediatric diseases, or just spending more time caring for their patients.

So, what do you think? What would you do if you won a big lottery (powerball or otherwise), or inherited a huge amount of money? Would you consider helping me secure the future of healthcare for children in our area? Why or why not?

Oh, and by the way, I WOULD NOT stop working. I love what I do way too much.

  photo credit: tsand via photopin cc

Recent Comments

I would give any amount needed to this cause in a heartbeat! My Two oldest daughters were diagnosed with hereditary pancreatitis as children and I've had more than my share of stays in out-of-state hospitals over the years. If there had been even one specialist in this area, we could have stayed here. Even now it would be beneficial to them.

Even though both are grown now, one daughter still has to be admitted at least twice a year for treatment. As sad as it sounds, she still doesn't get proper care because the doctors here just do not know how to properly treat her condition and refuse to look at her chart to see what works.

I'm not a doctor but I have learned a few key things from the big city hospitals over the years with pancreatitis. The first is to treat the pain but You NEVER give drugs or anything by mouth because you essentially want the pancreas to rest and you NEVER give a pancreatitis patient morphine, especially when they are allergic to it.

As it stands, she was just admitted to the hospital but it's going to be a long road to recovery once again because the attending doctor has absolutely no knowledge or experience in treating her illness and it seems that they are also refusing to listen to her and at least look at her chart to see what has worked. Instead of taking the time to research her illness, her doctor wants to give her tylenol by mouth, then loratab, both of which will not work. Now its on to morphine???

If there were a team of specialists in place when she was younger, we could have stayed here and all records would be here on proper and effective treatment. But that would mean taking the time to review charts.

Betty, thank you so much for your comments. I don't know you, but I feel as if I do. I am so sorry for what you and your daughters have gone through. We do have specialists in pediatric gastroenterology now. Although you and your daughters may still have had to spend some time in big city children's hospitals, now we have great ways to manage children with special needs in collaboration with their other specialists in other cities.
Unfortunately, what you report as a problem in your daughter's current care may not be solely related to providers not being knowledgeable about her specific condition. It is that they are not listening to her. No matter how common or rare a disease or condition, every patient responds in a unique way. When you have a chronic or life-long condition, the patient learns what works best and what doesn't in their own situation. Even patients with the common types of pancreatitis can have trouble in the early phases of an "attack" with oral drugs, and also with morphine. The specifics are not important, because, in fact every patient is different.
What is important is something else that I have emphasized in this blog from time to time, and that is the provision of "patient and family centered care" which makes the patient and their chosen family members key members of the health care team. It is what we teach to our students and residents. It is the other way we intend to make sure healthcare for kids in this area is the best it can be. By recruiting and training pediatric residents to offer that kind of care, over time as many will remain in our area, this will get better, I promise.
Best of luck to you and your daughters.

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About Dr. Ackerman

Alice Ackerman, MD, MBA, FAAP, FCCM is the Chair of the Department of Pediatrics at Carilion Clinic and Professor and Founding Chair of Pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care.

She has been at Carilion Clinic since June of 2007. Her primary goals are to enhance the health care of children in the Roanoke Valley and Southwest Virginia, and is actively working to do this both as physician in chief of the children's hospital, as well as through involvement with many state-wide initiatives.

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