Nature vs Nurture: What matters more for student interest in Family Medicine?

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At a recent conference for medical educators by the Society of Teachers of Family Medicine, Wanda Filer, a past president of the American Academy of Family Physicians asked how many of us in the room had been told we were “too smart for Family Medicine”? At a conference of close to 600 people, a little over half of the participants in the room raised their hands. Which leads me to ask, what are we, as a profession, doing to either bolster or harm the reputation of primary care among students?

Many medical students begin medical school interested in Family Medicine. It is not unreasonable that once exposed to the breadth of options in medicine they might choose another specialty, but how can we best nurture that interest?

We train in this highly populated valley, but we serve a much wider region given that so much of our state is geographically rural and less densely populated. Is there more we can be doing to serve the entire state’s needs? You might expect our school to turn out a high number of Family Physicians given that we are abysmally low at 49th in the nation for lowest primary care physician‐per‐ 100,000 population ratio by the AAMC. However, last year, the percentage of the class that matched in Family Medicine was 10%, and this year we were at 12%.

The medical school with the highest rate of graduates going into Family Medicine, based on three years of data, is at 20%. In a time when projections for primary care are dire, what are we doing to improve our numbers? What is it that pushes a student to choose Family Medicine?

In the last two years, our clerkship was expanded from four weeks to six; this change was driven by student interest. This has given us an opportunity to really showcase our specialty. In addition, many students are choosing to experience a rural practice for three weeks and a more urban experience for the other three weeks, further emphasizing the incredible breadth in our profession. Evaluations have been positive with students appreciative of the flexibility of this option.

Providing students experience through activities sponsored by the Family Medicine Interest group is another way to nurture a budding interest. For our program, this is another way for medical students to be exposed to our awesome residents. Becoming acquainted with residents, so close to their own experience as medical students, allows students to more realistically see what their future as a Family Physician could be.

I would be remiss if I did not mention those practicing Family Physicians that have influenced all of us. We all have those amazing mentors, inspiring leaders that rejuvenate us and remind us why we do what we do. For me, it was Heidi Shields.  When I was a third-year medical student, she showed me that a Family Physician can do it all – deliver babies, deliver excellent patient care both inpatient and outpatient as well as have a family. I will never forget going with her to the wedding of one of her patients in the hospital chapel as the woman was dying from cancer. This woman was emphatic that both of us attend, as we had seen her daily for the last few weeks in the hospital while we worked to manage her symptoms. I will never forget watching this patient stand as tall as she could, Foley catheter bag full of urine covered by the folds of her dress, her eyes fluid-filled as she walked proudly down the aisle. Throughout my powerful learning experience with Dr. Shields, she shone as an example of what I hoped to become. Each of us has the opportunity to be one of those influential people for a student and nurture this interest.

Rather than lament our own past experiences, it is time to move forward and truly spotlight Family Medicine. Let us stand up for what we do and what we believe in: caring for all people through all phases of their lives. I am lucky to be a part of an awesome team in medical student education at the University of Utah; our mission statement encapsulates a goal for us all, let’s “inspire and mentor students to champion Family Medicine”.

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Karly Pippitt, MD, FAAFP is the Director of Medical Student Education and an Assistant Professor (Clinical) in the Department of Family & Preventive Medicine at the University of Utah.

 

How Did I Get Here?

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By Jake Whetzel, MD

Recently our residency program has wrapped up another interview season, meeting to review our applicants (and potential future friends and colleagues) to complete our rank list to submit for the Match in March. It is nearly impossible to meet and get to know each applicant as a resident due to rotation schedules limiting your availability to participate in the interviews, or you get caught up in a conversation with one interesting applicant and might miss out on the chance to meet another. Our process allows us to revisit each application and hear from others in the program who had a chance to interact with these future physicians and hear how diverse our applicant pool was, with people coming from all parts of the country, each with different backgrounds and experiences, all ready to become a Family Physician. Being only a couple years removed from going through a similar process, I can still relate to the stress and excitement of choosing my future career. Reviewing our most recent group of applicants has caused me to reflect on my journey to Family Medicine and answer the question – How did I get here?

 

This blog has included a number of pieces last summer/fall that asked writers to answer the question – Why (not) Family Medicine? This was a slightly different version of a question that always seemed to come up during the interview process – Why Family Medicine? To me, the answer is probably the same for both. A career in medicine probably first developed in my mind around middle school, and was based on some great interactions I had with providers early on in my life. I was so impressed with their knowledge and ability to reassure us if things were fine or “fix” things if they weren’t. Initially, I remember thinking Radiology would be kinda cool. It seemed that this just involved looking at pictures and trying to solve the puzzle. As life progressed through high school and college, my thoughts shifted and started to include more about what type of lifestyle I wanted, what would give me fulfillment in life and where I wanted to live. The first and last questions were easy. I knew I wanted to live in a small town, evident within about a week of moving to the “city” of Helena, MT (population estimated just over 30,000 in July 2015) for undergrad. I also knew that I needed to be located in close proximity to mountains that I could escape to when I would need to decompress. And Montana will always be home.

 

Next came the decisions to find a career in medicine that allowed me to return home, a lifestyle so that I could enjoy it, and provide fulfillment in my life. This is where I came to Family Medicine. I would argue basic healthcare is a human right and that any small town community without a provider is underserved in this aspect, whether the next physician is only twenty miles away or one hundred. Without a local provider, chances are people just won’t go to see one until it’s an emergency. This may be due to inconvenience of travel, lack of funds or lack of trust in an outsider. The reason most of us are in primary care is to prevent these “train-wrecks” from occurring. To be truly beneficial to a community like these, I believe you have to be a local. They want someone who is a member of their community, a familiar face they can trust and turn to when they need it the most. When choosing a career, I felt that Family Medicine gave me the best chance at filling this void for a small town. I wanted to be able to take care of all the community members and develop those trusting relationships so that when a patient needs their care to be escalated, they can believe that the decision is in their best interest and consistent with their wishes.

 

One of the greatest things about Family Medicine is that no two paths are the same. Your career can lead you to urgent care, to academics, or to a hospitalist position. Family Medicine provides you with a base to mold your own choice that allows you to hopefully find that dream job that not only gives you the opportunity to make a major difference in other people’s lives, but also gives you a sense of fulfillment in your life. To the future physicians waiting for the Match, I wish you luck and hope that you are able to find that path to your own version of professional success.

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Jake Whetzel, MD is a second year Family Medicine Resident in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.

Why (not) Family Medicine? – Patrick Courneya, MD

Why (not) Family Medicine? is a series of posts from health care thought leaders, both inside and outside of Family Medicine. These will be posted every Friday. The participants were asked to focus on whatever they wanted in response to this question. We are glad that so many of these impressive leaders were willing to participate, and we hope that you enjoy their responses!

The Future of Family Medicine

I practiced medicine as a family doctor for 25 years, in the same clinic, in the same suburb of St. Paul, Minnesota. I saw my last patient 4 years ago and by that time, I had been at it long enough to be delivering the babies of babies I delivered. I enjoyed that style of full spectrum family practice that put me in the maternity unit, the emergency room, the halls of the medical and surgical wards and in the familiar trio of exam rooms I used to sit with my patients and listen to them talk about their lives, their worries, their illnesses. I had been there for them when they truly needed my help.  I finished my clinical practice knowing that the style of primary care I had enjoyed was fading away.

 

During the course of those years, I also learned how to really understand quality, to face the truth that measurement and transparency showed me about how well I was doing, and I got better.  We got better.  My colleagues, the teams that supported us, and the systems, information, and tools we used all improved.  We saved limbs and kidneys and hearts and vision and birthdays, anniversaries, seasons, and moments that otherwise would have failed to happen. Without measurement and improvement we never would have known the additional good we could do.  And we learned as well, what we couldn’t do.  We learned, or came to accept, that so much of health and well-being was beyond our skills, in the hands of our patients, in the choices they made, in the families where they were raised, in the communities where they lived, in the classrooms where they learned, and in the societies that they built. We learned that so much of health is beyond the expensive, invasive, amazing innovations we have seen in these last few decades.  And we learned that for all the objective measurement we can do to judge our effectiveness, health finds its real meaning in the subjective. Joy, passion, love, connection, and purpose all are beyond the specificity, sensitivity, confidence intervals and double blind, placebo controlled certainty we value in medicine.

 

And that, I believe, is where the future of family medicine and of primary care in general sits.  We will, in fact we must, continue to improve in the hard, evidence-based, high reliability care that we know will give people longer, healthier, more active lives. Family medicine, in unique ways, gives us the chance to apply our skills, lead our teams, and execute on the kind of high quality, evidence-based care we know is our obligation, while being present in our patients’ lives sharing their joy, fear, triumph and passing. The future of family medicine rests on our ability to find joyful, satisfying and sustainable professional and personal lives while we practice our profession.

 

A little over two years ago, my wife and I pulled up stakes and moved to California. My job now, as a physician leader for quality at Kaiser Permanente, has taken me a long way from the exam room but I still feel connected to the lives our caregivers touch. I still find joy as a physician because of what I can do to assure improved health for our members, our patients, and the communities we serve.  Joy is the key to the future of family medicine.

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Patrick Courneya, MD is the Executive Vice President and Chief Medical Officer with Kaiser Foundation Health Plan and Hospitals