Alumni Notes Spring 2023

Dear CHOP Alumni Family,

Fred M. Henretig, MD, FAAP, FACMT I’m excited to share this year’s installment of Interviews with the Giants! I sat down with Dr. Fred Henretig, our beloved toxicologist and ED attending. We discussed his career at CHOP and more recent endeavors. I hope you enjoy these comments from our conversation.

What is CHOP like now compared to when you first started in 1980?

One thing I miss is that when we were smaller, you knew every resident and the vast majority of faculty colleagues. And there was a McDonald’s off the atrium. This will sound very nutritionally incorrect, but I loved that McD’s; it was a blessing for late night ED shift snacks.

What was most surprising about your career?

Hah! It’s been almost everything I did not initially expect. As an intern in 1973 at St Christopher’s Children’s Hospital, I was terrified by the weight of clinical responsibility for at least the first 6 months. I seriously considered leaving residency after the intern year. But 3 years later I wound up in the St. Chris ED as a young attending and never looked back. When I heard in 1980 about Steve Ludwig and Gary Fleisher starting a full-time program in pediatric emergency medicine (PEM) at CHOP, I wanted in immediately, and was fortunate be invited to join the team.

For almost 40 years I loved being in the peds ED and developed sub-specialty interests in toxicology and poison control, as well as disaster preparedness and response. Now I think I’m too old for any of that, so am working on how to help myself and other pediatricians age gracefully and face potential retirement from clinical practice without too much terror about professional identity loss. I have come full circle on “terror,” haven’t I?

What are you most proud of in your career?

Being the founding medical director of CHOP’s (and therefore, Philadelphia’s) regional Poison Control Center. Or as one of the initial core group of PEM physicians at CHOP (and thus also in the country). Or having edited a few books and written a few decent articles. And of course, a fair number of children I hopefully positively impacted when they were critically ill over the span of my 40 years in the ED.

But really, what I’m proudest of are the amazing CHOP residents and PEM fellows I’ve had the privilege of working with and learning from. I hope I contributed to their becoming awesome pediatricians and PEM physician leaders.

The field of toxicology has advanced tremendously over the past decades. What recent changes are most exciting?

It went from a very small subspecialty back in the 1980s, without formal certification, to having dozens of certified fellowship programs. Toxicologists have contributed to many important advances on poison prevention and treatment efficacy. Sadly though, our work is far from done. New toxic hazards keep threatening our kids; for example laundry detergent pods and edible marijuana gummies over the past decade. The terrible opioid epidemic has not spared children. The PALS curriculum now has a separate algorithm for suspected opioid poisoning.

And recent work by CHOP PEM fellow Chris Gaw and several CHOP faculty colleagues, Allison Curry, Kevin Osterhoudt, Joanne Wood, and Dan Corwin, has highlighted the magnitude of this problem in children. So much more needs to be done, and I hope we can continue to attract pediatric trainees to help us fight this battle.

What advice do you have for physicians entering the senior years of their careers?

This is a complicated question! I’ve been interested in both the decisions faced by senior physicians in making late-career transitions and in the issue of assuring clinical competence as physicians age. We must acknowledge our need to preserve professional (which often equals personal) identity. But various health, financial, and quality-of-life issues, as well as needs and interests of one’s life partners, factor into retirement or “stepping down” decisions.

Some will reach a certain point and want to make an abrupt departure, but others will want to be “carried out of the office in their coffin,” and many will be happier with a more gradual approach, and finding new, nonclinical roles to supplant some of the satisfaction previously derived from direct patient care. Still others will seek diminished administrative responsibilities after having been in leadership positions. I think chatting with trusted colleagues who’ve gone through the process might be helpful to many, but sometimes academic faculty and pediatricians in practice may be uncomfortable even mentioning to colleagues that they’re starting to consider the “r” word. We need to change that culture.

I know you have spent recent years as a life-long learner. Can you share what you have been up to, and how it has impacted your retirement?

Well, it may sound crazy, but I went “back to school” at age 72. I’d been mostly retired for about 3 years and was getting antsy. And Marnie, my wife, told me she “married me for better or worse, but not for lunch”. I wanted to consider ways to use some of my clinical experience in advocacy and education, and I’d heard from several younger colleagues about Penn Med’s Masters in Health Policy program. It seemed a good fit, but could I survive biostatistics? The answer: not really, at least not without a lot of help! My MSHP mentors kindly nursed me along, especially Joanne Wood from General Pediatrics and of course, as you know, from the Child Protection team. Joanne was my assigned research mentor but coached me in all things MSHP. It was pretty cool—though a bit intimidating—to be in a classroom with a lot of CHOP and HUP clinical fellows, most of whom were a decade or more younger than my own sons! But I actually made it through, albeit in 4 years, and graduated in May 2022.

Now I’m hoping to parlay some new skills into more poisoning prevention, emergency preparedness and physician late career transition-related policy and advocacy work. To start, I have a new, very part-time job with the hospital’s Emergency Preparedness team, which is keeping me on my toes. And helping the Department of Pediatrics develop enhanced guidance for late career faculty, and to participate on a national level in a few workshops at PAS about this topic as well.

Maybe there’s one more review article—or book—to be written?

Thank you, Fred, for sharing your wisdom. Until next issue, remember our Alumni motto: Keep … Tradition, Keep … in Mind, Keep … in Touch!

With warmest wishes,

Cindy W. Christian, MD