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Family Bonds, Healthcare Benefits

Aug 26, 2016 12:45PM ● By MED Magazine

Eldon & Brandt Becker (and Brooks)

By Alex Strauss


From family farms to family-owned diners, hardware stores, and insurance companies, there is a long tradition across the Northern Plains of passing on passion for a special line of work from one generation to the next. It turns out that the passion for the medical profession is no exception. While national surveys find fewer than half of today’s doctors would recommend the same path to a young person, we found many notable exceptions - and their physician offspring - in our region. In the first installment of a series, we explore these medical family bonds and the ways in which the profession is changing.



Fahima Qalbani, MD, Radiologist, and her son, Adnan Qalbani, MD, Radiologist

Mercy Breast Cancer Center, Dakota Dunes, South Dakota


Dr. Fahima Qalbani and her husband, pathologist Askar Qalbani, MD, were new Pakistani immigrants and new doctors when they met during their training in New Jersey. When their son Adnan was just 3, the couple settled in the Siouxland area where Dr. Fahima founded the Mercy Breast Cancer Center. Dr. Adnan Qalbani is a graduate of the University of Iowa Medical School and completed a breast imaging fellowship at the University of Chicago. Although he started his career in Denver, he began practicing with his mother while waiting for his Colorado medical license.


Q: How do you think Adnan’s upbringing impacted his decision to go into medicine?


Dr. Fahima: I think it just happened. He was good in science and math and he would accompany me to radiology meetings sometimes. At first, I discouraged him from going into radiology because of the lack of patient contact, but after the Breast Center opened, that was different.


Dr. Adnan: I grew up with a lot of friends whose parents were doctors. A lot of docs tell their kids not to go into medicine but my parents never told me that. To some extent, that may be cultural. It is a big thing in the Indian and Pakistani community to go into medicine. I was not forced or pushed so much as much influenced. I didn’t really know much else when I went to college, so I definitely sensed a sort of inevitability about it.


As far as choosing radiology, when I was growing up, there was a lot of discussion about cancer cases before I even went to college. So this was something I was comfortable and familiar with.


Q: How do you think your experience of medicine will differ from that of your parent/child?


Dr. Adnan: In the 80’s, doctors had a lot more freedom. Their challenges were more about transition to a different kind of system. The challenge for my generation is about finding professionalism and meaning in those changes. Doctors my age and younger don’t have the same set of expectations about how much money they’ll make or how much career control they’ll have.


Another generational difference is that we don’t think of our careers as static. Technology is changing rapidly and radiology will almost certainly not look the same in ten years. It may change the way we have to practice or even what we are doing from day to day.


Dr. Fahima: This generation is more into lifestyle. My son likes to ski and be outdoors. I think there will be less chance of burnout and suicide among younger physicians because of this. They are willing to make less money if they have to in order to have the lifestyle they want and this is a good thing.


On the other hand, they have to worry a lot more about reimbursement, whereas that is something that we did not really even have to think about. It never occurred to us that we might not always be doing as well as we did.


Q: What is it like to work with your mom?


Dr. Adnan: She has the perspective of experience and I have the recently-educated perspective, so I think patients benefit from that. In school, they teach you how to read films but they don’t necessarily teach you how to interact with patients, so I have really benefitted from her experience there.




David Munson, MD, Pediatrician/Neonatologist, and his son Patrick Munson, MD, Pediatric Ear Nose and Throat Specialist

Sanford Health, Sioux Falls


After graduating from the University of Minnesota medical school, David Munson, MD, started in pediatrics as an intern at the former Sioux Valley Hospital in SIoux Falls. After seven years at Central Plains Clinic, he completed a fellowship in neonatology back in Minnesota and returned to Sioux Falls to raise his young family. Early on, Patrick showed a passion for science and people. After an ENT fellowship at Arkansas Children’s he became Sioux Falls’ first pediatric ENT.


Q: What was said about medicine as a career when Patrick was growing up?


Dr. David: I told my kids they should follow what their hearts tell them to do, what they feel called to do. Pat is the kind of person who is very sensitive. He enjoys working with people. He is very concerned about people and what is going on with them. He is kind of a servant guy with a good heart so I think the personal aspects of medicine appealed to him.


I used to talk to the kids a lot about what I did, but I did not either promote or discourage medicine. They could see that I liked my job, although I didn’t always like my hours. I told them that if you go into medicine for the right reasons, it is an enjoyable field to be in.


Dr. Patrick: I vividly remember people coming up to my dad in the community and saying ‘Hey, Dr. Munson, this is my daughter that you took care of five years ago.’ I am now seeing patients whose parents were NICU babies that my dad took care of.


I loved science and I felt that medicine offered both the intellectual and personal side of things. You care for people and really invest in their lives.


Q: How do you think your experience of medicine will differ from that of your parent/child?


Dr. Patrick: The quality of life as a physician in easier now than when my dad was first working. He had to be in the hospital at all times and couldn’t leave, but now we have more ancillary helpers to offload the work burden. On the down side, there is a lot more regulation and bureaucracy now, which is something that he did not have to deal with as much in the past.

But I still feel like medicine is a fantastic field. I have four boys and I wouldn’t hesitate to recommend it to any of them if they felt called to it.


Dr. David: When I came out of school, there were a lot more private practices. You were able to work more independently. Now, medicine as a whole has become more large-group focused so we are more likely to be employed by an organization. But the changes also allow for much better work-life balance. We overdid it and our families suffered. This generation has learned to put things in better perspective.


Q: Do you ever work together? What’s that like?


Dr. David: He does consults with some of my patients in the NICU and I have the opportunity to work along side him and see what he does. That has been rewarding for me. I really enjoy the collegiality of working with one of my kids. I also get secondary rewards from all the good things that he does!


Dr. Patrick: The fact that our practices could overlap was a big part of my decision to come back and work in this area.




Dermatologists Roger Knutsen, MD, and Siri Knutsen-Larson, MD

West River Dermatology, Rapid City


Dr. Roger Knutsen was on track for a career in cardiology when he suddenly decided to change courses and pursue dermatology instead. A graduate of the USD School of Medicine, Dr. Knutsen trained under the famed surgeon Dr. Frederic Mohs at the University of Wisconsin. After a locum tenens in the ER in Rapid City, he opened his own practice. Siri Knutsen also attended USD for medical school and made a similar course correction after a year as an ObGyn resident at the University of Colorado.


Q: How do you think Siri’s upbringing impacted her career choice?


Dr. Roger: The only thing I ever told her is that medicine is the best job in the world. But I never said you should go into medicine. I could see that she was above average intelligence and could get into medical school if she wanted to.


Dr. Siri: I feel like I was always very encouraged to pursue the path into medicine. There was never any ‘maybe you should think twice about this’. I have done everything in the office from cleaning toilets when I was young to filing charts in high school to being a medical assistant in college and now being a physician. So it has definitely been a progression and it has been fun to come back and work with a lot of same people who have been here since the beginning and saw me initially as a child.


Q: What about the decision to pursue dermatology?


Dr. Roger: I never told her to go into dermatology. But I did tell her that there are few decisions in one’s life where you have no regrets at all and going into dermatology was one of those decisions for me. It has rewarded me in ways I’d never dreamed of.


Dr. Siri: At first I said that I would never be a dermatologist and that I would never come back to South Dakota. I thought dermatology was boring. But I realized just a few weeks into my ObGyn residency that it wasn’t going to be for me so I switched to dermatology. I am the kind of person that no one can tell me something, I have to figure out things for myself. He was very supportive and did not try to sway me.


Q: How do you think your experience of medicine is different from that of your parent/child?


Dr. Roger: She is definitely going to have to deal with managed care more often than I have. But on the other hand she has been trained in different treatment modalities and with different drugs than I have. And she gets to work with a lot of new technology. And because she is acclimated to EMR, the learning curve was not as steep for her.


Dr. Siri: There are a lot more hoops to jump through now. It is no longer that the doctor just does what best. Now we have so many other things we have to take into consideration - insurance companies dictating what procedures are appropriate and what we can and cannot prescribe. There is also more government oversight dictating what things have to go on the patient record. Sometimes, I watch my dad trying to adjust to some of this and I think yeah, we have all these new-fangled systems, but not all of them are better than what came before.




Ronald Anderson, MD, ObGyn, and Breanne Anderson Mueller, MD, ObGyn

Sanford Health, Mitchell and Sanford Aberdeen Medical Center


In many ways, Dr. Ronald Anderson’s medical journey and that of his daughter Breanne Mueller mirror each other. A South Dakota native and a graduate of USD School of Medicine, Dr. Anderson followed his older brother into ObGyn, completing a residency in Minneapolis before coming back home to South Dakota to raise his family. Dr. Mueller also attended USD Sanford School of Medicine. She followed her dad’s example and chose ObGyn, completing a residency at Mercy Hospital in St. Louis before coming back to South Dakota to practice.


Q: What messages do you think Breanne got from you that may have influenced her decision to go into medicine?


Dr. Anderson: She picked up the joy I had in my job. She also understood the lifestyle. You miss some Christmases and birthdays, but it’s also a rewarding practice. I let her decision unfold naturally. She said she wanted to do pre-med and I told her what to take in college. That was an advantage.


The other thing when you’re interviewing for medical school, they want to make sure you can handle the workload. They also want to know that you know what you’re getting into. If your dad has been in medicine and you have seen that all the way through, they can feel confident that you really understand the kinds of sacrifices you have to make and that carries some weight too.


Dr. Mueller: When I went college, I found that, of all the things I tried, I liked medicine the most. Even then, my dad never said ‘You should do ObGyn’. In fact,  both of my parents suggested that I try something that doesn’t have night call. But this was the only specialty that really made me happy. As my dad says, this was the specialty where people are usually happy to be coming to the hospital.


In medical school, if I would get called in the night for a diabetic ketoacidosis or an asthma attack, it was always hard to get up. But when I got called in the middle of the night for a delivery, it just didn’t bother me.


Q: How do you think your experience of medicine is different from that of your parent/child?


Dr. Mueller: I’m really used to the computer and I think he hates the computer. I also think that he was very busy and missed a lot of things when we were growing up. I have purposely structured my career so that someone else can manage the business part of things so that I don’t have to work quite as hard as he did.


Dr. Anderson: ObGyn has changed quite a bit. I was trained using forceps and vacuums and they didn’t even teach Breanne those things in her residency. That’s an art that is going away.

On the other hand, her laparoscopic skills are way above mine. She did a lot of robotics in her residency. When I was training, you did all of your surgeries vaginally. It wasn’t until three to five years after my residency that we started doing laparoscopic vaginal hysterectomies.


Q: You two operate together once a month when Dr. Anderson comes up to Aberdeen. What is that like?


Dr. Mueller: It’s fun to see your parent in a whole new light. He’s been running the show for many years, but it’s gotten easier as I have become more assertive. I definitely defer to him, more because he has 20 + years of experience rather than because he’s my parent. We have a good time playing ‘Name that Tune’ in the OR!




Eldon Becker, MD, General Surgeon and his son, General Surgeon Brandt Becker, MD,

Avera Medical Group Pierre


Dr. Eldon Becker grew up along the Missouri River in North Dakota. A biomedical engineering major, he turned to medicine after deciding that big city living wasn’t for him. After completing medical school and surgical residency in North Dakota, the Beckers settled in Pierre, South Dakota where Brandt was born. Brandt stayed in South Dakota to attend medical school at USD and did his surgical training at Hennepin County Hospital in Minneapolis.


Q: How do you think Brandt’s upbringing impacted his career choice?


Dr. Eldon: I had a great relationship with my own dad, who was a farmer, and I had always hoped to farm with him. But that was the 70s and there were substantial hardships. I just couldn’t see returning to the farm. But I could see that the family farm was not the only place where collaboration and idea exchange could happen. It was possible in medical care, too.


Brandt has worked at the hospital and the clinic nearly as long as I have. If he wasn’t outside, he was at my office or a partner’s office. He got to see what life was like as a surgeon. I never gave him advice other than to make a wise decision.


Dr. Brandt: I mowed the lawn at the clinic when I was 8 years old. So it made me comfortable with medicine and with the other docs. It’s always been there as part of my life. I think it’s really not that different from passing on the family farm or local hardware store. That whole gerations thing.


Dr. Eldon: It started as a dream but over time became a reality. It’s pretty amazing that it worked out. If not this, our path would have been family farming.


Q: What are some ways that medicine has changed between the time that you two trained?


Dr. Brandt: Medicine is becoming more and more specialized. As a surgeon, it used to be that there would be 35 or 40 procedures you were comfortable with. Now it’s paired down to 5. The generation before dad, we had GPs that did c-sections and took out appendixes and they have gone by the wayside. The good thing is that you have specialists doing what they’re good at.


The other change I see is a move toward a shift work mentality as a way to limit hours. This is a change from the idea of one provider taking care of one patient.


Dr. Eldon: Here in mid South Dakota, trying to meet the emergency needs of our community (Pierre) acutely and provide the same depth of services found in Sioux Falls and strike a balance is difficult. This will be more apparent in his practice than in mine.


Q: What are the plusses and minuses of working together?


Dr. Brandt: One big advantage is not having to feel out your partner because we already know how each other thinks. I have always enjoyed running cases by him that were interesting or challenging. That still continues 15 years later.


Dr. Eldon: One difficulty is that, because there are only three of us, when I am playing, he has to work and when he is playing, I have to work. Also, fishing and operating with the same person day in and day out is not always satisfying but my son has been very tolerant.




David Daniels, MD, Internal Medicine, and his son, Urologist David Daniels, Jr., MD

UnityPoint Clinic Family and Internal Medicine - Sunnybrook, Sioux City, Iowa and Siouxland Urology Associates, Dakota Dunes, South Dakota


Dr. David Daniels, a graduate of Georgetown University School of Medicine, was practicing in Chicago where an Internal Medicine residency at Northwestern when his namesake was born. David, Jr. was about 10 years old when the family relocated to Sioux City. He would go on to medical school at the University of Iowa and a residency at Indiana University.


Q: At what point did either of you you think David might be destined for a career in medicine?


Dr. Daniels, Sr.: The first inkling I had was during a family vacation about 20 years ago. We went to Big Sky and Yellowstone and David was attending a wilderness medicine conference with me. On one of the days, we learned about using fishing line to suture a cut on the scalp. About two days later, we were in a store and David’s youngest sibling was running around and slipped and cut her scalp. So he got some fishing line and he tied it together!


Dr. Daniels, Jr.: My dad always encouraged me to follow my dreams. I remember making rounds with my dad as a kid.  It was profound. I couldn't believe how appreciative people were of the services he provided.  I didn't know at the time exactly what he did for them, but I could tell by his patients' gratitude that it must have been something special. That was cool to see, even as a kid.


Then, on my first day of college, I listened to a lecture from a biology professor who dedicated his life to the study of an exotic crayfish species. I decided at that moment that I'd rather use my love of science in a career dedicated to helping people.


Q: How do you think your experience of medicine is different from that of your parent/child?


Dr. Daniels, Sr.: There was a lot less government intrusion when I started. Now there is a lot more governmental regulation. Also, I was the oldest kid and the first doctor in the family. So, in a sense, I was paving the way and was not as well informed as my son. He knew the board scores needed to get into every program. And they knew exactly what programs were offered where. He went into everything with a great knowledge base.


Dr. Daniels, Jr.:  I entered medicine in the age of computers, significantly increasing regulations and rules.  While it is the only experience I know, I often hear my dad talk about when one could spend a lot more time actually caring for the patient instead of working through the minutia of new regulations and requirements. The patients are still wonderful, the problems challenging, and the work rewarding.  I don't think that will ever change.


Q: What are your thoughts on working together?


Dr. Daniels, Jr.: It’s fun to collaborate as professional at work and have a personal relationship outside of work. I think the patients benefit, too, as we keep an excellent line of communication open between us.


Dr. Daniels, Sr.: Sometimes, when we are both seeing the same patient, it’s hard for people to know which David Daniels to send the records to. I have asked him to change his name but he respectfully declined. Otherwise, it’s great!


Watch for more of our conversations with these doctors, including the reasons they came home to practice, in future issues of MED.