As she entered her 17th year in private practice, Michelle “Shelley” D. Fiscus, M.D., FAAP, could not deny the truth any longer: She was burned out.
She had built a two-partner practice in one of Tennessee’s wealthiest counties, yet the area had one of the lowest immunization rates in the state. The parents of some longtime patients suddenly questioned the need for vaccines. Diminishing insurance payments, electronic health records and competition from retail-based clinics only compounded her frustrations.
“I just got to a point where I couldn't do it anymore, like many other pediatricians. We’re dropping like flies in some areas, especially with the pressures on people in private practice trying to help families,” Dr. Fiscus said. “I would always ask myself how these parents could think that I would recommend to purposely inject something into their kids that was bad for them. Sometimes, we have had this relationship for 11 or even 16 years and they're actually questioning my intentions now?”
Dr. Fiscus knew she couldn’t stay in private practice much longer. But, as the primary breadwinner, she couldn’t walk away without another job. She felt stuck until an email arrived about an opportunity as deputy medical director of family health and wellness for the Tennessee Department of Health.
New pathways, projects
She started the job four months later, finding the ideal place in which to advocate for children’s health issues and, in particular, the importance of vaccines. In January 2019, she became medical director of the state’s immunization program. In September, she was elected to the AAP Board of Directors as the District IV chair, representing Kentucky, North and South Carolina, Virginia and Tennessee.
“I know this is where I am supposed to be,” Dr. Fiscus said. “I want everyone in pediatrics to feel that way about their work."
Her colleagues say the AAP will benefit from her expertise and candidness.
“She has been open and transparent about her own burnout, which makes her especially prepared to advocate for pediatricians suffering moral injury,” said Suzanne K. Berman, M.D., FAAP, a Tennessee pediatrician who chairs the AAP Section on Administration and Practice Management Executive Committee. “She will work toward the goal of healthy children as well as pediatricians.”
Natural leader ‘Dr. Fixus’
Dr. Fiscus decided in high school that she wanted to be a doctor, but she didn’t consider pediatrics until her fourth year at Indiana University School of Medicine. She considered becoming a pediatric surgeon or an otolaryngologist — until she nearly passed out during her otolaryngology rotation.
During her pediatric residency at Riley Hospital for Children in Indianapolis, she became aware of the AAP and the benefits it offered those in leadership roles. Over the past two decades, Dr. Fiscus has volunteered for key leadership posts at the state and national levels.
She served as chair of the Tennessee Chapter’s (TNAAP) Young Physicians’ Committee and as chapter president. Dr. Fiscus also is co-creator and medical director of Behavioral Health in Pediatrics, a TNAAP initiative to improve the management of behavioral health disorders in primary care.
At the national level, she served on the National Nominating Committee, including one year as chair. She also has worked on AAP immunization efforts.
Her colleagues predict she will bring the same energy and inclusive approach to the Board of Directors.
“Dr. Fiscus involves others in her advocacy efforts so that other pediatricians can learn how to be effective advocates for children as well as leaders within their own community,” said Deborah M. Greenhouse, M.D., FAAP, chair of the Chapter Forum Management Committee. “I have seen her lead, I have seen her advocate and I have seen her teach. She truly excels at all three. She believes in transparency, and that is evident in everything that she does.”
Nowhere is Dr. Fiscus more transparent than on Twitter. Using the handle @DrFixus — the nickname her young patients gave her while she was in private practice — she frequently tweets about the importance of immunizing children, the threat posed by science deniers and the impact of gun violence on children.
One popular tweet reads: “Please don’t put essential oils in your child’s ear. With love, Your friendly neighborhood pediatrician. I don’t want to have to treat their chemical burns. There’s absolutely nothing ‘essential’ about these oils other than they are ‘essential’ to sellers scamming you.”
In another, she encouraged people to keep pushing the importance of vaccinations.
“Keep sharing evidence-based info, no matter how tiresome the trolls. Doing so leaves the lies in the void. #VaccinateYourKids.”
Though she often receives pushback from anti-vaccination groups on social media, Dr. Fiscus refuses to be silent. On a nearly daily basis, she consults with Tennessee pediatricians who think one of their patients has measles.
Recently, a Tennessee resident with measles exposed 537 people, including four individuals who contracted the disease second-hand. The incident bolstered Dr. Fiscus’ determination to use her new AAP position to continue spreading the Academy’s position on vaccines.
"The news cycle is 24 hours a day, and people's attention spans are really short,” she said. “The board is another way to make sure the AAP is continuing to be loud and vocal about the work we do.”
Indeed, Dr. Fiscus does not like to squander opportunities. It’s a perspective sharpened by a battle with breast cancer. She had a double mastectomy nearly five years ago and has been cancer free since the surgery. With her health restored, she believes everything happens for a reason and says the experience has made her stronger.
“Sometimes, you can’t see past that moment, but everything I have been through has contributed to the building of me, so I'm grateful for that,” she said.
Dr. Fiscus enjoys spending time with her husband, Brad, and their children. She is a singer, too, often performing at weddings or joining a local band for the occasional gig.
And she is a wrestling mom who clocks countless hours watching her 16-year-old son, Collins, compete. On many nights, she heads straight from work to the gym, stopping only to pick up a 12-inch sub sandwich.
With the exception of daughter, Maré, 18, who is attending the University of Tennessee-Chattanooga, the family spends two nights a week and all day Saturday at competitions.
“Our family lives and breathes wrestling,” Dr. Fiscus said.
The family is living and breathing politics, too. Brad, who serves on the local school board, is running for state representative. Dr. Fiscus said she is passionate about getting him elected. And like in her day job, she won’t be shy about telling people what they need to know.
"I don't have a problem speaking my mind,” she said.