Over the past 10 years, Neurology Today has brought you stories of father-son neurologists; mother-daughter neurologists; father-daughter neurologists; and mother-son neurologists. [See “The Neurology Today Family Series.”] The odds of one child following in a parent's footsteps and becoming a neurologist are pretty slim, but the odds of two children deciding to do so are even slimmer. Yet somehow, that's just what happened in the Frontera family.
Alfred T. Frontera Sr., MD, recently retired from his general neurology practice after 37 years, but the tradition of service continues with his daughter Jennifer, a neurointensivist, and his younger son Alfred Jr., an epileptologist.
JENNIFER FRONTERA: NEUROINTENSIVIST
Jennifer Frontera, MD, remembers hearing raves about her father wherever they went in Kingston, NY, and it had a huge impact on her. “He was more than just a physician,” said Dr. Frontera. “He served as the president of the local hospital for several years and was a leader in our community.”
Many of her father's patients also became his friends, so it was not unusual to hear them voice their appreciation when they visited, and although her father did not encourage her to follow in his footsteps, she took note of those enduring relationships and remembers wanting that for herself as well.
She surprised her father when she announced that she wanted to go to medical school, and later when she chose neurology. “It's interesting that a child is able to see what makes you happy, and neurology certainly brought joy into my life,” he said. “Although children ask many questions as they're growing up, their quiet observation is perhaps more revealing,” he mused. “I think she sensed that I was satisfied and happy.”
The senior Dr. Frontera was the only neurologist servicing Kingston for the first five years of his practice, and recalls being on call 24-7 for those years, although he eventually grew the practice to 12 neurologists by the time he retired. But his busy lifestyle was not lost on his daughter, who selected neurointensive medicine as her subspecialty. She has been an assistant professor of neurosurgery and neurology and medical director of the neuroscience intensive care unit at Mt. Sinai Hospital in New York City since 2006.
Unlike her father's early years, she is not on call 24-7. She rotates with other neurointensivists, working (and taking call) five to seven days at a time. The following week, she signs out to another neurointensivist, and focuses on conducting her research and managing the intraoperative monitoring unit from her office. “It's almost like shift work,” she said.
“We cover all the patients in our 16-bed neuro-ICU, which includes primarily neurological and neurosurgical patients, but also ENT patients and occasionally those from surgical and mobile intensive care units, which adds a nice variety to our service,” she explained.
Although she initially had little trepidation about the demands of a career in neurology, as she got older she realized that she didn't want to have to run in to the hospital at any hour, as her father did for many years. Married a year ago, she appreciates the scheduled hours afforded to a neurointensivist.
“It's an underestimated subspecialty in terms of lifestyle,” she said. ”It's very procedure-heavy, and can be demanding work when you're on service, but the rewards of helping severely ill patients during the most difficult time in their lives make it all worthwhile. Additionally, the benefit and balance of having off-service time to fully focus on research cannot be overstated,” she said.
Jennifer, the author of Neurocritical Care: A Pocket Guide (published by Thieme), is the principal investigator for the Intracranial Hemorrhage Outcomes Project, which follows subarachnoid hemorrhage, intracerebral hemorrhage, and subdural hemorrhage patients. She is also the principal investigator of an American Heart Association funded study of early platelet activation after subarachnoid hemorrhage and the Mount Sinai site principal investigator for the NIH funded ARUBA trial of unruptured intracranial aneurysms.
Jennifer admits that she is a workaholic by nature, and suspects that the attribute comes from her father. Proudly, her father agrees that there are probably other personality characteristics — being logical and possessing an intellectual curiosity — that run in the family and might well predispose a child to selecting neurology.
TOM FRONTERA: EPILEPTOLOGIST
Indeed, neurology seemed to follow an autosomal dominant pattern of inheritance as Jennifer's younger brother, Alfred T. Frontera Jr., MD, who goes by the name Tom, also chose the specialty. He currently practices at the University of South Florida, having been recruited there after he completed his training at Columbia-Presbyterian Medical Center two years ago — where his sister had completed her residency and fellowship in stroke and neurointensive care. Tom remained there to complete an epilepsy fellowship.
Tom currently splits his time between two main teaching hospitals — Tampa General Hospital and the James A. Haley Veterans' Hospital, which was recently designated an Epilepsy Center of Excellence within the VA system. He was hired as director of the center with the goal of growing it into a full service epilepsy center offering comprehensive diagnostic and treatment options for veterans with epilepsy.
“Our VA is one of the busiest traumatic brain injury/polytrauma centers in the VA system, which dovetails with my clinical and research interests in post-traumatic epilepsy and EEG monitoring in critically brain injured patients,” he said. He's also extensively involved with resident education and serves as an associate program director for the University of South Florida's neurology residency program.
His father's demanding private practice lifestyle influenced his decision to take an academic job with a more balanced and flexible schedule. But he also took note of his father's love of teaching. “Although my father was in private practice, he was extensively involved in teaching neurology to the family practice residents in Kingston, and the doctors he trained raved about what a good teacher and clinician he was,” Tom recalled. “I think I inherited his passion for teaching and it was ultimately the driving force behind my choosing an academic position over private practice.”
Although neither child remembers hearing about cases at the dinner table while growing up, they all enjoy discussing cases now. “When I've seen patients that I realize Jen has more expertise in, like some difficult neuro-ICU or stroke patients, I call her to get her opinion. And when I see an unusual case, like the recent patient with MELAS syndrome [mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke] and another with anti-NMDA receptor antibody encephalitis, I call my father,” he said, adding, “I think of them as my ‘pocket consults’; they give me great advice.”
THE NEUROLOGY TODAY FAMILY SERIES
- Avitzur O. In Practice: A Family Affair: Neurology is in Their Blood. June 16, 2011: http://bit.ly/kkSvsf
- Stump E. A Tale of Two Hendins: A Father-Daughter Neurology Team, Nov. 20, 2008: http://bit.ly/iMsHQS
- Shaw G. A Mutual Excitement for Understanding Neurologic Disease: Lisa and Joshua Shulman. Dec. 2004; http://bit.ly/jdj9Ki
- Shaw G. A Long Line of Neurologists: From Morris Bender to Adam Bender and On. May 2004: http://bit.ly/mlYxgH
- Shaw G. In the Footsteps of Giants: Isabelle Rapin and Anne Louise Oaklander. Jan. 2004: http://bit.ly/lDgvgA
- Shaw G. The Life of the Mind: the Gomez Family, Oct. 2003: http://bit.ly/kcKQ7T
- Shaw G. Speaking the Same Language: Austin and Charlotte Sumner, Aug. 2003: http://bit.ly/lK2ZXC
- Shaw G. A Shared Passion for History: The Tylers. July 2003: http://bit.ly/k1WvXP