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Tuesday Jul 22, 2014

Like Father, Like Son: How I Raised a (Future) Family Physician

Like many small-town family physicians, I've volunteered over the years as a team doctor for our local school's athletic teams. On Friday nights, I often found myself on the sidelines, watching football and cheering on the local team (which often included many of my patients). More often than not, my son Brett would tag along, soaking up anything there was to learn.

On one particular fall evening, one of our players was badly injured, and I hurried onto the field to evaluate his condition. In retrospect, I probably should have paused just long enough to tell my son, who was about 7, to stay put.

Last weekend I represented the AAFP at the Nebraska AFP's board meeting. My son Brett, left, is a student member of our state chapter's board of directors.

As I kneeled next to the injured young athlete, I heard a small voice from behind me say, "Dad, there's blood."

That's Brett. Always eager to experience and learn something new. It wasn't the last time he got an up-close view of his dad trying to help someone who needed it. We've lived in a few small Nebraska towns that lack urgent care facilities and hospitals. So when people needed help in a hurry, they often call me directly. If Brett was with me I got one of those calls, he often came along to the office.

I remember one day when Brett was about 10, a young girl fell and needed stitches in her chin. Brett and I were out running errands when I got the call, so we went straight to my office to meet the girl and her parents. With the permission of the patient and her parents, Brett watched me clean the wound and stitch it closed.

Through these types of encounters, Brett learned not only about medicine but about the importance of building relationships with patients, families and the community.

As a high-school student, he participated in a medical interest group and expressed interest in becoming a family physician. He followed up on that by shadowing other family physicians in our area.

When he enrolled in a college halfway across the country, I thought he might come back with plans to become a subspecialist because although Brett has seen all the positive things that family medicine has to offer, he is aware of the payment issues and other challenges we face, as well.

He also knows the time demands of being a family physician. One year, Brett and I signed up for a father-son basketball camp. The night they were taking photos of the sons with their fathers, I got tied up at work and was late. The other kids got a nice memento to remember the fun experience they shared with their dads, and Brett got a photo of himself. Alone.

But Brett has stayed the course. Now in his fourth year at the University of Nebraska Medical Center, he is a student member of the Nebraska AFP Board of Directors. This past weekend, I represented the AAFP at the Nebraska AFP's annual meeting, and my son was there as a member of our state chapter's board. It was a proud moment, and Brett has given me plenty of those.

He's served as president of the Student Alliance for Global Health and in the student senate at UNMC. But the point of this post isn't just for me to say how proud I am of my son. It's to point out the importance of mentoring. Brett obviously got an early start, but if we expose students -- in high school or college -- to the broad scope of family medicine and show them the relationships we develop with our patients, they will understand and value what we do.

And some, no doubt, will follow.

Robert Wergin, M.D., is president-elect of the AAFP.

Tuesday May 20, 2014

Turn the Page: Saying Goodbye Not Easy for Graduating Resident, Patients

My residency is almost over. By this point in our careers, all graduating family medicine residents have spent four years in college, four in medical school and at least three years (sometimes four) in residency. You might think there would only be elation, joy and relief on the cusp of completing this grueling, 11-year process.

It has been years of 80-hour (or more) workweeks, cafeteria food (if you even have time to go there), missing your kids' school events, missing your spouse's birthday, being that relative who misses weddings, funerals and Mother's Day -- all while struggling to pay the bills. By this time in some other industries, we might have made a fortune by working such long hours, but instead we are in serious debt. Most of us owe more in student loans than we do on our mortgages.

The bond a patient can develop with his or her family physician is amazing. Here I am with a patient who is interested in following me to my new practice -- more than two hours away.

So why would anyone sign up for the not-so-enticing path I just described?

Three words: the patient relationship.

As a medical student, you get limited exposure to continuity of care because rotations are usually eight weeks long, at most, so the number of repeated contacts with a specific patient or family is limited. Family medicine residency, however, focuses on relationships and caring for a patient across all settings, whether that be at the physician's office, a nursing home, the patient's home, a hospital or a hospice facility.

I've delivered babies and handed them off in the delivery room to a grandmother who is also my patient. Moments like that give you more enthusiasm and energy than a venti coffee ever could.

What I'm realizing as I near the end of my training is that patients get more than quality medical care from our interactions. They develop a bond with us that has far-reaching implications. My patients feel like they know me as a person, not just as a diagnostician. We have conversations about their priorities and how their financial and logistical realities relate to treatment. We grow to understand each other.

I don't think most patients in a residency training program realize how much we appreciate them. They quite literally provide the foundation for our specialty training. Most of us can remember our first patient in the office, our first well-child visit and our first reading of a patient's obituary. We remember the cards and notes patients send us, but most importantly, we remember how they humbled us with their complex medical cases.

I recently added a little spiel to each patient encounter I have about how I will be leaving the program and transitioning them to another resident in July. This conversation fails to get any easier with repetition.

I have had multiple patients cry. Several have stood up and hugged me, and a lot have asked for directions to where I am going next.

Through this process, I have noticed a difference between two groups of patients. Those who I inherited from a former resident (or from generations of residents in my program) smile and say I better pick a good physician to take my place. In contrast, the patients I acquired from the emergency room or hospital and brought to this practice during my residency -- many of whom had never had a family doctor before -- tend to enter a brief panic. I explain that the same attending physicians who have been joining our visits occasionally are still going to be here to precept the residents, that the incoming class of residents is wonderful, and that the same nurses will answer their phone calls. Some of those patients say that they don't want a new doctor, and they will drive the 2 1/2 hours to my new office to see me.

I've heard over and over, 'I've never found a doctor like you,' 'You listen to me,' 'You know my whole family.' They say they like being able to come with their kids to one big, long appointment for everyone. They like to see a face they know if they get admitted to the hospital. And women have told me they want to have the same doctor take care of them during and after their pregnancy and see their new babies.

To all of these cares and concerns, there's really only one reply I can give, and it's a reassuring one: That's family medicine. I am a family doctor, and they will get the same care and have the same opportunities across generations with their next family doctor. I am nothing special within family medicine; it's family medicine that is special.

There are more than 3,000 family medicine residents who will be graduating soon. What tips do you have for other third-year residents who are preparing to say goodbye to their patients? If you've had a particularly gratifying goodbye, please share your story in the comments field below.

Kimberly Becher, M.D., is the resident member of the AAFP Board of Directors.

Wednesday Apr 30, 2014

Medical Student Advocates Make Big Impression on Legislators at FMCC

When I sat down at my state's table at the Family Medicine Congressional Conference (FMCC) earlier this month, I was quite surprised to find two of my Quillen College of Medicine students already sitting there.

Melissa Robertson, left, and Jessica White, right, seniors at East Tennessee State University's James H. Quillen College of Medicine, met with legislators from their state -- including Rep. Marsha Blackburn, center -- during the Family Medicine Congressional Conference in Washington.

The AAFP provides two scholarships for students and two for residents to attend this annual advocacy event in Washington, which trains family physicians (and future FPs) to advocate for their patients and for family medicine. The AAFP Foundation also awards a student scholarship, so I thought perhaps these students -- Jessica White and Melissa Robertson -- had earned scholarships to attend. But as it turns out, they decided to make the trip from Tennessee at their own expense because they thought it was an important learning opportunity.

In fact, 55 students and residents from around the country attended FMCC this year. Their spirit and efforts give me great hope for our future.

FMCC provides a remarkable blend of advocacy education and skills development along with the chance to immediately put those learnings into action. On the first day of the conference, we heard from advocacy experts, representatives of federal health agencies, congressional staff and two legislators.

On the second day of the event, more than 200 students, residents and practicing physicians took what they had learned on day one to Capitol Hill to talk with legislators and staff about issues such as physician payment, education and workforce. One of the best parts of this conference is the opportunity to share personal stories with our legislators. There is no question these conversations have a big impact and are one of the reasons face-to-face meetings have such potential to make a difference in promoting our interests.

Legislators and congressional staff hear from the AAFP Board several times a year, but stories from members can be so important because they speak directly to legislators who are elected to represent their state and district and tell them how constituents are being affected by the various challenges family physicians face.

For example, Jessica and Melissa, two seniors who have matched into family medicine residency programs, were able to talk about important education issues during our visits. As we reviewed the key points from the previous day's advocacy training sessions, we realized their presence was especially serendipitous given their paths to family medicine.

Jessica matched in Asheville, N.C., just across the mountains from Quillen. She will join the family medicine residency at the Mountain Area Health Education Center(MAHEC), which is a teaching health center. These centers provide creative approaches to training family medicine residents based in the communities that most need them.

Under the Teaching Health Center Graduate Medical Education (THCGME) program established as part of the Patient Protection and Affordable Care Act, GME funds go directly to the centers. However, the THCGME program, which started in 2011, is only funded through 2015.

The program is now completing its third academic year, graduating its first cycle of residents and sending almost 300 primary care physicians into the workforce. It should come as no surprise, then, that extending funding for the teaching health centers program is one of the Academy's top legislative priorities during this congressional session.

Without such an extension, Jessica's residency program cannot guarantee her salary for all three years of her training. Accepting this offer represents a remarkable leap of faith on her part. It also provided a great example to the people we talked with about the importance of extending funding for these programs.

Melissa is a nontraditional medical student and former elementary school teacher, so she brings a critical, real-world perspective to both medicine and medical education. She came to the AAFP's National Conference of Family Medicine Residents and Medical Students two years ago and got the advocacy bug there. During that conference, she was elected to the Society of Teachers of Family Medicine's Board of Directors and now is serving her second term.

Melissa, who matched to our East Tennessee State University residency program in Bristol, has a real knack for asking common-sense questions that help cut through administrative layers. Her particular path has made advocacy issues such as student debt and the primary care salary gap extremely important in her world.

Together, the three of us considered the day's congressional visits and how to tell these stories in meaningful ways. First up was Tennessee Tuesday, which is a weekly breakfast during which Sens. Lamar Alexander, R-Tenn., and Bob Corker, R-Tenn., welcome everyone visiting from our home state to Washington. They are always excited to meet their constituents and were especially eager to meet these medical students.

Next, we met with Rep. Marsha Blackburn, R-Tenn. Jessica's family lives in Blackburn's district, so this connection immediately lent relevance to our advocacy stories in a way that had not happened in my previous conversations with the congresswoman. Our legislators certainly pay attention to their constituents, and we were able to get some unscheduled time and a photo opportunity with Blackburn.

Moreover, during a subsequent meeting with Blackburn's health aide, we were able to talk about topics in a totally different light because of the students' circumstances. This latter meeting also showed Jessica and Melissa the critical role legislative aides play in setting agendas for elected members of Congress.

We then met with Rep. Phil Roe, M.D., R-Tenn., who represents Quillen's district. Originally, we had been scheduled to meet his legislative aide, but when he heard there were two medical students from his district present, he immediately made time to meet with them. In fact, their stories were so compelling that he asked if we would walk to the Capitol with him because he had to vote, but he did not want to cut short his discussion with Jessica and Melissa.

Jessica’s story about her uncertain financial situation at the residency program in North Carolina grabbed Roe’s attention in a way my previous discussions with him could not, in part, because Christ Community Health Services in Memphis is one of more than a dozen residencies that are expected to start receiving THCGME funds beginning in the 2014-15 academic year.

As a nontraditional student who made a huge financial sacrifice to become a physician later in life, Melissa's story also sparked his interest immensely. He specifically asked her about her medical school debt and how that influenced her and other classmates in their specialty choice.

Roe also took notice when Melissa addressed another of our advocacy points -- the need to renew and increase commitments to GME, such as through Title VII funding, and to consider how we can increase the number of students choosing primary care specialties.

As he prepared to walk to the Capitol, Roe asked Melissa and Jessica whether they would come back to his office after he returned from the vote because he wanted to talk more with them.

After we finished talking with Roe, I left for a media interview and then headed out of town for the Minnesota AFP meeting. By this point, Melissa and Jessica were seasoned advocates, and I knew our messages were in good hands and would be heard in powerful ways. They went on the next visit on their own and later went back to Roe's office.

The three of us texted about the overall experience later, and we made plans to improve how we present the need for advocacy to students and our residents. In fact, Melissa is meeting with the Quillen Family Medicine Interest Group this week to talk about how to prepare for the Academy's resident/student conference scheduled for Aug. 7-9 in Kansas City, Mo. That is the "pay it forward" concept in action.

So, what can you do to pay it forward? In addition to the scholarship opportunities mentioned above, the Association of Family Medicine Residency Directors sponsors 10 scholarships for residents to attend FMCC. But we could do more. Family medicine residencies, departments of family medicine, state chapters and even individual practices can help send students and residents to FMCC. Exposing students and residents to advocacy, a critical part of how we can improve the care of our patients, can pay huge dividends for those FPs-in-training and for our specialty.

Reid Blackwelder, M.D., is president of the AAFP.

Wednesday Apr 16, 2014

Chance to Shape FP Training, Education Prompts Career Move

I've lived my whole life in Indiana. My children -- like the three generations before them -- grew up here as well. Those children, now adults, still live near us here in Indianapolis.

My education and training -- from Ball State University to the Indiana University School of Medicine and the family medicine residency at Community Health Network -- all happened in the Hoosier State.

I'll be leaving my home state of Indiana behind next month to start a new job as the AAFP's vice president of education at the Academy's offices in Leawood, Kan.

My career started in rural private practice in the small town of Flora, Ind. -- population 2,000 -- before I came back to Indianapolis as faculty at the residency where I had trained. I stayed with Community Health Network for more than 20 years as residency director, vice president of medical affairs for two of its hospitals, chief medical officer for the entire eight-hospital network and, most recently, as the network's chief academic and medical affairs officer.

So what would it take to get me to leave my home state? Nothing less than a chance to make a positive, lasting difference in the education and training of medical students, family medicine residents and our active members on a national scale. That, of course, goes hand-in-hand with enhancing the quality of care delivered by our specialty.

I'll be leaving my position on the AAFP Board of Directors on May 3 (after the Board meets during the Annual Leadership Forum and National Conference of Special Constituencies). Nine days later, I'll start a new journey in Leawood, Kan., as the Academy's vice president for education.

I feel as though I have been training for this role for the past three decades. The majority of my career has been devoted to medical education and improving quality of care, so it's a natural fit. For example, for the past five years, my job responsibilities have included oversight of medical student education at our network's hospitals, our residency programs and the CME offerings we produce.

At the AAFP, I will be responsible for the Academy's efforts related to medical education and CME, including the education and training of medical students and residents; student interest in our specialty, including federal policies that affect it; and CME curriculum development, production, accreditation and regulations.

Many challenges await, but I'm excited to lead the AAFP's excellent staff who work in these areas, including those who support two commissions -- the Commission on Continuing Professional Development and the Commission on Education -- composed of family physicians who volunteer their time to address these vital issues.

We must ensure that medical students have top-notch exposure to family medicine and that they have good experiences when they do. That can be difficult, in part, because practicing physicians who enjoy teaching have competing demands for their time. But there is no doubt that good role models help build student interest in the specialty.

We are facing a shortage of primary care physicians that likely will worsen because of an aging population, a sizable number of physicians nearing retirement and a large number of patients gaining access to insurance as a result of health care reform. More -- and more targeted -- funding for family medicine residencies is needed to meet this demand, and GME funding and reform are high on the list of the Academy's legislative priorities.

Family physicians want to keep up-to-date with evidence-based CME, and the Academy will continue to improve and expand its offerings to ensure timely and convenient access to high-quality CME. We will build on the strong programing currently offered, and we always appreciate input from our members on how to better serve their CME needs.

On a more personal note, the challenges of this role also include succeeding the immensely accomplished and respected Perry Pugno, M.D., M.P.H., who is retiring after 40 years in family medicine, including 15 years of service to the Academy.

The challenges are great, but so are the opportunities. The key to improving health care in this country is to make it more primary care-oriented by placing greater emphasis on prevention and wellness. Family medicine is the specialty that does that better than any other. I am proud to have this opportunity to further strengthen our specialty through continuing efforts to enhance medical education at all levels.

Clif Knight, M.D., is a member of the AAFP Board of Directors.

Wednesday Mar 26, 2014

I Matched! And It's Good News All Around

I knew I wanted to be a family physician before I ever made it to medical school. As a college student with an interest in medicine, I shadowed an anesthesiologist and an orthopedic surgeon before our family physician suggested that I shadow one of his partners. It was that experience that set me on this path.

I was impressed that this family physician had patients who had been in his care for 30 years. He knew entire families and had a deep connection with the community. I spent time at that practice during my Christmas breaks and summer vacations, and it wasn't long before I realized, "This is who I am, and this is what I'm supposed to do."

Friday I got the good news that I had matched at the University of Alabama-Birmingham's Huntsville Family Medicine Residency. My classmates Libby Van Gerwen (who matched in internal medicine-primary care at Tulane University School of Medicine) and Brittany Holley (internal medicine at the University of South Alabama College of Medicine) also had reason to celebrate.

One particular patient encounter stands out in my memory. The physician had to inform a woman that she had cancer, and it was inoperable. Despite the horrible news, he was reassuring and told her that she wouldn't leave that day without a plan. The level of trust she had was clear. She valued his opinion and wanted his advice. It was a defining moment for me.

Fast forward a few years to last Friday when I -- like thousands of other medical students around the country -- received my National Resident Matching Program letter. I had hoped to stay at the University of Alabama-Birmingham's Huntsville Family Medicine Residency. I've been here two years for
clinical training, and I wanted to stay here for residency. I know the faculty, the community and the hospital. It's a good school and a
good fit.

I felt good about my chances of staying, but you don't know where you're going until you open that envelope. It's a big moment after four years of medical school and four years of college. This is your career, the rest of your life.

Fortunately, I got the news I had hoped for, and I'll be staying in Huntsville. Nearly 10 percent of my class matched to family medicine, and news was good for our specialty nationally, as well. The number of medical students choosing family medicine increased for the fifth year in a row, and the number of U.S. seniors matched to family medicine also increased.

Although the numbers were encouraging, we have a long way to go. Our country is facing a shortage of primary care physicians. And it's projected that within a few years, we will be graduating more medical students than the number of residency spots available. The system clearly needs work.

One thing that would help would be having more family physicians such as the one I shadowed back in my hometown. If you're a family physician with a passion for what you do, reach out to students in your area or from your alma mater and show them what you do. You just might give a future family physician their defining moment.

Tate Hinkle is the student member of the AAFP Board of Directors.

Friday Feb 21, 2014

Building the Family Medicine Pipeline

When I was running for AAFP President-elect, I said during a question-and-answer session at the Congress of Delegates that I would try to say yes to every opportunity that came my way. This can be daunting because there are so many opportunities to represent the Academy each week.

However, being president truly is a once-in-a-lifetime experience, and I have tried hard to follow through on my promise. I do everything I can to jump at invitations from state chapters, to medical student functions and other opportunities to meet with AAFP members all over the map.

Family Medicine Interest Group advisers discuss ways to increase student interest in our specialty during a recent meeting in Nashville, Tenn.

I recently had one such opportunity on my way back from the Nevada AFP meeting. I was invited to stop in Nashville, Tenn., to be a part of a dynamic workshop for Family Medicine Interest Groups (FMIG) faculty advisers. This leadership summit was an opportunity to bring together medical school and residency faculty and staff from all over the country who serve in adviser or support roles to the student-run FMIGs at their own or an affiliated medical school. One of the most important reasons for doing so is to develop relationships and create a sense of family in this group.

There is a significant turnover in this group because the role of student group adviser often falls to the newest faculty member in a department. In fact, many of the folks present had been involved with their FMIG's for less than a year. This makes it important for us to bring people together so we have an exchange of information as well as support systems for this incredibly important work.

FMIG's are remarkable. There is a great deal of direct student leadership involved for each medical school's group, with a select group of medical students elected or appointed to serve in roles to connect and coordinate between FMIGs. The AAFP recently selected its 2014 FMIG Network Regional Coordinators, who hail from Arizona, Illinois, Missouri, Pennsylvania, and Washington, D.C. These dedicated students work tirelessly to share information with FMIG student leaders at each institution and to provide opportunities for those leaders to connect and share best practices, much like what was done at the FMIG Faculty Adviser Summit.

The advisers all play different roles in this process, depending on their institution, environment and engagement of leaders. They have the responsibility for finding ways of sharing the excitement and passion for family medicine with students during their first two years of medical school, through the FMIG and other department efforts.

Most FMIG's are mainly made up of, and led by, first- and second-year students. Third-year students are on their clinical rotations and have less free time, and fourth-year students have often already committed to specialties. The group of advisers focused some of its discussion on how to keep third- and fourth-year students engaged in FMIGs to help support a family medicine specialty choice among the third-years and to use the fourth-years as mentors for the junior students.

This is a huge and critical aspect of addressing our pipeline challenge. The more we can tell medical students about the joys of family medicine, the more we may maintain their interest as they begin choosing specialties. In these challenging times, the message that our country truly needs primary care physicians is one that medical students need to hear, alongside the message of what's in it for them, which is the opportunity to have the greatest impact on population health and a specialty that provides variety, excitement and deep patient relationships.

This meeting allowed us to discuss the frustrations and the opportunities of a rapidly changing health care system and environment. I promised to take what I heard from the advisers back to the AAFP Board of Directors to help inform our deliberations related to developing our workforce pipeline.

I hope all of our active members work with medical students when given the opportunity. When students are early in their training, they are eager to see true patient encounters. At the same time, we have to recognize how impressionable students are. We need to make sure that our love of our patients and our thankfulness for the opportunities to answer our calling is what comes through. The more we do this, the more students will see that no other specialty creates the opportunities to get to know patients, make a difference and to truly impact families the way family medicine can.

Active AAFP members who would like to be connected with an FMIG faculty adviser at a medical school in their area may contact student interest strategist Ashley Bentley. Thanks for being a part of the learning process.

Reid Blackwelder, M.D., is President of the AAFP.

Friday Jan 31, 2014

Support for GME Reform Exists; Agreement on How is Lacking

The Council of Academic Family Medicine (CAFM) recently released a report outlining its four pillars -- pipeline, process of medical education, practice transformation and payment reform -- for advancing primary care physician workforce reform. The article also emphasizes the importance of advocacy moving forward.

In an interview with AAFP News Now, AAFP Vice President for Education Perry Pugno, M.D., M.P.H., the Academy's liaison to CAFM, said the biggest barriers to implementation of these concepts are "the tremendous need for change in how U.S. graduate medical education (GME) is financed" and resistance to reform by people who benefit financially from the flawed system already in place.

Although there is widespread recognition of our nation's need for more primary care physicians, there is not agreement in Washington on how to meet that goal. Two bills have potential to greatly enhance efforts to increase the family physician pipeline, but the lack of progress in moving either bill forward illustrates how difficult -- and frustrating -- the political environment in Washington can be.

In 2011, Reps. Cathy McMorris Rodgers, R-Wash., and Mike Thompson, D-Calif., introduced a bill that would establish a pilot project allowing a portion of GME payments to go directly to non-hospital, community-based primary care residency programs. McMorris Rodgers and Thompson reintroduced the bill, which has support from the AAFP and other physician organizations, in the current session of Congress, but no companion bill has been introduced in the Senate. AAFP staff members are working with Senate staff members to try to find a sponsor for the bill in the Senate.

Meanwhile, Sen. Bernie Sanders, I-Vt., has introduced legislation to reauthorize the teaching health center program, which is set to expire in 2015. Republicans historically have been supportive of community health centers (federal funding for the program doubled under President George W. Bush), but thus far, Senate Republicans have been reluctant to put their names on a bill that specifically supports teaching health centers, a concept initiated as part of the Patient Protection and Affordable Care Act. To date, Sanders' bill has nine other co-sponsors -- all Democrats.

Family physicians might not give GME a second thought once they leave residency, but the way GME is funded affects the types of physicians we produce. Funding an outpatient residency through an inpatient facility doesn't work. And the proof that the existing system doesn't work can be seen in decades of failing to adequately increase the primary care workforce.

Providing GME funds directly to residencies would be a more efficient and more logical process. For example, CMS pays resident salaries in my program based on how much time the residents spend at our local hospital. Thus, residents have to work enough hours in the hospital to get paid, regardless of whether the training they need is hospital-based. Does that make sense for a specialty where the majority of physicians are more likely to practice in an outpatient setting?

In the teaching health center model, residencies are funded directly, and an education committee -- not a hospital -- dictates how residents are trained.

Indirect medical education payments also are an issue because CMS leaves distribution of those funds to the discretion of hospitals. Hospitals have legitimate claim to some of that money -- which is roughly $40,000 per resident -- because they provide residents with meals, sleep rooms and more when they are working at the hospital. Although some hospitals are good about sharing those funds, others are not. In my case, our residency receives no money from indirect payments. With 20 family medicine residents (including our first-year residents pictured with me above), imagine what we could do with a fraction of the $800,000 going to the hospital.

The federal government invests $13 billion a year on GME, but those funds need to be used appropriately to produce the workforce the nation needs. The family physician pipeline once again will be one of the key topics during the annual Family Medicine Congressional Conference, scheduled for April 7-8. I hope to see you in Washington.

Daniel Spogen, M.D., is a member of the AAFP Board of Directors.

Tuesday Jan 21, 2014

Chemical Spill Puts Resident, Hospital to Test

Jan. 9 was like any other Thursday. I worked a full, busy and ordinary day as a family medicine resident at my hospital in Huntington, W.Va. Then I drove 30 minutes home to Culloden, W.Va.

It's worth noting that A) Huntington and Culloden are served by two different water treatment plants, and B) I didn't listen to news radio in the car.

On the way home, I stopped to buy groceries for the coming weekend. Although busy grocery stores are nothing unexpected, what I saw on this night was different. It was a new level of frenzy. Still, I didn’t think much of it. Many people in my community had been without power for a few days because of a recent storm. I thought maybe they were restocking their freezers and refrigerators.

I finished my shopping and went to the check-out line. That's when another shopper said to me, "You don't have any water. Why don't you have any water?"

I'm not accustomed to having my shopping cart critiqued, but I was willing to play along.

"Why do I need water?" I asked.

That is how I found out that an estimated 7,500-gallon spill of 4-methylcyclohexane methanol -- a chemical used to treat coal -- had been detected in the Elk River, less than two miles upstream from our area's water treatment plant.

At that point, I was too late. There was no bottled water left on the shelves in that store or any other store in town. I went home to a weekend without water -- me and 300,000 other people.

A state of emergency was declared for a nine-county area that includes Charleston, the state capital and West Virginia's largest city. We were told not to use tap water for any reason, which meant no consumption, no bathing and no cleaning anything.

Schools and businesses closed. The West Virginia National Guard was activated to distribute drinking water and assist residents affected by a chemical spill. Volunteers, like the Poca High School students in the photo above, handed out cases of bottled water to people in need.

Fortunately for me, my hospital and residency program weren't affected. I was able to shower at the hospital and fill water bottles to take home. My fellow residents were wonderful, watching my 6-year-old during his unplanned vacation while I was on call, and they also allowed my husband and son to shower or bathe at their homes.

In the bigger picture, it was fortunate for others in the area that the hospital was unaffected because without water, other health care facilities in the nine-county area were unable to care for their patients.

To transfer patients from one facility to another, you have to have an accepting physician on the receiving end. Although other academic and private admitting services at my hospital declined to accept transfers from the affected facilities in Charleston, our family medicine service did. If we hadn't taken these patients, they would have been sent to facilities in Ohio or Kentucky, and we didn't want that to happen to them.

And although I feel good about the care we were able to give, we were quickly overwhelmed. In addition to patients transferred from other hospitals (after being admitted for reasons unrelated to the spill) we also treated numerous patients who were exposed to the tainted water and were suffering with nausea, rash, headache, diarrhea and vomiting.

We also experienced a surge in patients suffering from influenza. Without access to water, people couldn't wash their hands, and the flu spread rapidly within a few days.

Soon, our hospital was full. People were admitted with no bed to go to, so gurneys were set up in the hallways with makeshift bed numbers taped to the walls.

People pitched in and helped out because in a crisis situation you have to adapt and be flexible. Residents who weren't on call offered to help. We stepped up and took care of patients who needed help.

Finally, on Jan. 15, patients from Charleston started going back to the facilities they came from.

This past weekend, people in my community were allowed to flush their pipes -- running faucets and showers, dishwasher and washing machines -- to clear the tainted water from the system. The process made the house smell, and the stuff coming out of the pipes was awful. But it's progress and a step closer to getting back to normal.

Would you be ready if a crisis affected your community? The AAFP has resources available to help families, medical practices and communities prepare for disasters.

Kimberly Becher, M.D., is the resident member of the AAFP Board of Directors.

Editor's Note: Photo is courtesy of Staff Sgt. De-Juan Haley via Wikimedia Commons.

Wednesday Dec 11, 2013

Student Audience at Vanderbilt Gives Hope for Primary Care

As I have often said, one of the great joys of being an AAFP Board member is the opportunity to attend chapter meetings and talk to members from across the country. Every now and then, however, I receive an even more special invitation.

I recently was asked by the family medicine interest group (FMIG) at Vanderbilt to come speak during the medical school's Primary Care Week. It is nearly impossible for me to turn down a request from students, especially those from one of the 11 target schools that lack a department of family medicine.

Although Vanderbilt does not have a family medicine program, there are a number of family physicians in the region who have worked hard to give its students role models and mentors in our amazing specialty. I was honored to add my name to that list. Some students from Meharry Medical College -- another Nashville, Tenn., school -- also were  present, but the majority of students were from Vanderbilt.

This was an outstanding experience. We had almost 100 students (including student leaders Eszter Szentirmai, Josh Hollabaugh, Allison Umfress and Ashlee Hurff, who are pictured here) who were interested in primary care and the role that it will play in the future of health care. I took the opportunity to tell my own story, which began at a time when my own alma mater -- Emory University -- lacked a family medicine department. My path was similar to theirs.

I was able to talk about the excitement of finding family medicine while at Emory and nurturing that experience to become a small town family physician. One of the messages that I gave students was to make sure they keep doors open and consider all possible career choices.

We talked about some of the challenges that stop students from picking primary care. For example, at some schools, students interested in primary care sometimes are told they are too smart for family medicine. That is an interesting comment. If anything, someone choosing family medicine is recognizing his or her ability to see everything broadly and doesn’t feel the need to be limited to a particular organ system, body part or group of diseases.

There is no question that these students made a choice and followed a calling into medicine because they want to help people. No specialty can help people as broadly and as immediately as family medicine.

They also were interested in advocacy. We talked about some components of the Patient Protection and Affordable Care Act and how it has provisions that provide incentives for primary care.

We talked about the need to come up with different payment models to support this transformation. We discussed the real need for hospitals to change their structure to be part of new models of care such as accountable care organizations, instead of focusing on keeping their beds full to maximize profits.

We talked about the role of physician-led teams in taking care of all patients and meeting the depth of their needs in this changing time, especially as patients with multiple chronic diseases become more complicated to manage. More patients than ever are presenting with comorbidities. As family physicians, we are at the front lines of managing this care, and we have the ability to make the greatest impact in patients' lives by managing their health at the earliest stage possible.

This also was a great opportunity to talk with students, many of whom are graduating in 2016 and 2017, about the disparity between the number of U.S. medical students who will be graduating and the number of residency positions that will be available. There was no question that reality is starting to sink in, and these students were interested in how they could advocate for change.

I told them that as medical students, it is critically important for legislators to hear their voices, and I assured them that representatives with medical schools in their districts will want to hear from them. I challenged them to reach out to their legislators, whether by email or a personal visit to their offices.

I am confident that Tennessee's representatives in Congress will be hearing from some of these students.

Having students from both Meharry and Vanderbilt created an interesting point of comparison.  Here I was talking about primary care in a target school that ranked at the bottom of medical schools in an Annals of Internal Medicine article that evaluated schools in terms of addressing the social mission of meeting a community's needs. On the other hand, Meharry ranked second in that report, which considered the percentage of graduates who practice primary care, work in health professional shortage areas and are underrepresented minorities. 

Based on the AAFP's annual study of family medicine residency matriculation rates, Meharry ranked 23rd in 2013 with 13.8 percent of students matriculating to family medicine residencies, and Vanderbilt ranked 126th (last) with 0.3 percent of students matriculating to family medicine residencies. These figures are based on a three-year rolling average calculated annually by the Academy.

The fact that we had students from both ends of the spectrum expressing an interest in primary care gives me hope that we can continue to open doors and make inroads. Family medicine is all about relationships with patients, but it also should also be about relationships between students in different schools sharing a culture and philosophy, and between students and those of us who are in regular practice. The more we can create and nurture these relationships, the more likely our students will recognize the path to family medicine is truly the one that allows them to follow their heart and fulfill their dream of helping people and changing the world.

Family physicians interested in reaching out to their local FMIGs to see how they can support those groups may contact AAFP student interest strategist Ashley Bentley

Reid Blackwelder, M.D., is President of the AAFP.

Wednesday Oct 16, 2013

Residents Can Attest to Demand for FPs

I recently served as a panelist during National Primary Care Week activities at my alma mater, Marshall University's Joan C. Edwards School of Medicine. During our session, one of the medical school students asked me how family medicine might change in light of more mid-levels providing primary care. Specifically, the student wanted to know if demand for family physicians might fizzle.

My response?

Absolutely not.

Family physicians are in demand more than any other specialty and have been for seven years running, according to Merritt Hawkins. The health care search and consulting firm said in a report last month that the growing demand for family physicians stems from the need for employed FPs in hospitals and health care systems.

The number of medical students choosing family medicine increased for the fourth straight year in the 2013 National Resident Matching Programand more U.S. seniors matched to family medicine than in any year since 2002.

Despite those positive signs, the supply of family physicians is nowhere near balanced with the demand. Researchers estimate that the country needs 52,000 more primary care physicians by 2025.

The fact that family physicians are in demand should come as no surprise to family medicine residents. I receive solicitations daily from recruiters, despite the fact that I'm not looking for a job. I signed a contract more than a year ago for a position that will start in August 2014. Most residents don't sign that early, but I found exactly the kind of practice I wanted to join. The federally qualified health center is a patient-centered medical home with a physician friendly electronic health record. Its reimbursement model includes per-member, per-month fees.

The practice is continually pursuing, and receiving, innovation grants and trying new things, so I'm happy with my choice. I'm not circulating my resume. I don't even have a LinkedIn account. And yet, the calls, e-mails and snail mail keep coming at home and at work every day.

One of my fellow third-year residents -- who is looking for a family medicine job -- said she receives more than a dozen e-mails a day from recruiters.

So what did I tell that student during our panel discussion?

I said that nurse practitioners often specialize, so they can't necessarily improve access to primary care in areas of need.

I said family physicians should work to appropriately incorporate mid-levels into our practices because they can play a vital role on our health care teams.

And, I pointed out that many patients prefer to see a physician, and some will switch practices if they don't think they have proper access to their doctor.

We are in demand by patients and employers, and that isn't likely to change.

Kimberly Becher, M.D., is the resident member of the AAFP Board of Directors.

Tuesday Oct 01, 2013

National Event Can Open Students' Eyes to What Primary Care Is Really About

I came to medical school knowing that I would become a family physician. That goal was driven, in part, by the diversity and complexity of the work family physicians do, caring for patients from birth to end of life. I want to take that comprehensive approach back to rural Alabama, where I'm from, and family medicine is the specialty that allows me to do that.

The choice isn't as clear for many medical students, who often aren't exposed to primary care in their first two years because family medicine and other primary care faculty are underrepresented in most medical schools during the preclinical years.

So, how do we get students more -- and earlier -- exposure to primary care and family medicine?

Next week offers one opportunity to do just that. National Primary Care Week will be celebrated at medical school campuses around the country Oct. 7-11, giving students an opportunity to learn about, and experience, primary care. It's also an opportunity to highlight primary care physicians in leadership positions. For example, family physician and State Health Commissioner Cynthia Romero, M.D. -- pictured here with family medicine interest group leader Penelope Carter -- was the keynote speaker at the University of Virginia School of Medicine's Primary Care Week last month. (UVA celebrated a bit early).

During my second year at the University of Alabama, Birmingham, I was responsible for planning National Primary Care Week activities on our campus. Each day, we brought in a speaker from a different primary care specialty -- family medicine, internal medicine, OB/Gyn and pediatrics -- who talked about why primary care is the foundation of patient-centered care and how each specialty plays an important role.

There is a myth perpetuated in some academic settings that family physicians treat coughs and colds and refer everything else, but family physicians do so much more than most students realize. It's a powerful experience to have a physician from the community come to campus and describe a typical day in practice, which could include seeing patients in clinic, making hospital rounds, doing procedures, delivering babies and practicing broad-scope primary care.

Although I knew about that extensive scope of practice early on, I had numerous students come to me throughout the week, saying, "I didn't know this about family medicine," or, "I didn't know that about internal medicine."

The upcoming nationwide event has the potential to open students' eyes to what primary care really is about and what it looks like outside of an academic medical center.

So what's on tap for this year's National Primary Care Week? We've heard from family medicine interest groups around the country, and some obvious themes stand out. Students want more information about health care reform, and several schools are featuring speakers or panels that will look at how the Patient Protection and Affordable Care Act will affect primary care. Academy resources available for National Primary Care Week include a PowerPoint presentation with facts and analysis of the Affordable Care Act.

The AAFP also has presentation materials designed to educate students about the patient-centered medical home, which is another common topic for National Primary Care Week activities.

Team-based care and interdisciplinary panels also appear to be popular choices. Other intriguing offerings include residency fairs, flu-shot clinics and clinical skills workshops.

I encourage my fellow medical students to seek out activities on your campus during National Primary Care Week (and bring a friend) and throughout the year. Your colleagues have worked hard to design programming that will give you key insights and understanding you will need to make an informed specialty choice within the next few years. Regardless of whether you choose family medicine like me, we're all going to be working together in an evolving health care system characterized by an increasing demand for family physicians to carry us to better patient health outcomes, better patient experience of care and lower health care costs.

So, what is your medical school doing?

Tate Hinkle is the student member of the AAFP Board of Directors.

Monday Sep 16, 2013

COGME Report Puts Family Medicine on Priority List

In family medicine, we've known for years that the United States isn't getting the proper return for its $13 billion annual investment in graduate medical education. Federal funds paid to hospitals for training purposes too often result in the expansion of the subspecialty residencies hospitals need to maximize their own bottom lines -- cardiologists, radiologists and a slew of other "ologists" -- instead of producing the balanced workforce our health care system actually needs.

If legislators haven't already heard this message from the AAFP, the Council on Graduate Medical Education (COGME) -- which was created by Congress to provide assessments of physician workforce trends and training issues -- has recently spelled it out for them again.

Three years ago, COGME released a report that highlighted the worsening shortage of primary care physicians and recommended addressing the shortage by narrowing the gap in incomes between primary care physicians and subspecialists and reforming medical education.

In a new report released last monththe physician-led panel continued its call for more primary care physicians. In doing so, COGME was critical of Congress for underinvesting in GME. It also took aim at teaching hospitals for not emphasizing primary care and offering curriculum that was inadequate in related areas, including population health, care coordination and team-based care. COGME also questioned why national accrediting organizations have not taken the lead in bringing about these necessary changes.

      There are numerous recommendations in the 28-page report, and we will have a more detailed report this week in AAFP News Now. But here are a few highlights:

  • COGME recommends that Congress should continue funding existing GME positions and increase funding to support 3,000 more graduates per year.
  • The report recommends that overall GME funding be prioritized based on workforce needs, specifically calling for family medicine and other "high priority specialties" and for programs whose graduates go on to practice in underserved areas.
  • The report also recommends that any increases in GME funding should be directed toward training programs that produce a high proportion of physicians who continue in one of the prioritized specialties, which also include geriatrics, general internal medicine, general surgery, pediatric subspecialists and psychiatry.

COGME's recommendations are well timed. The Institute of Medicine is expected to release a review of the governance and financing of GME early next year. That report, which was requested by Congress, should prompt legislative reform.

The need is clear. Despite the fact that more than half of patient visits are for primary care, only 7 percent of U.S. medical school graduates are choosing careers in primary care. A study published last year in the Annals of Family Medicine stated that the United States will need more than 50,000 additional primary care physicians by 2025 -- 33,000 to account for population growth, 10,000 to accommodate an aging population and more than 8,000 just to care for people who will be newly insured because of health care reform.

Additional residency positions also are needed to keep pace with number of new medical schools and expanding medical school class sizes. In fact, by 2016, the United States likely will have more medical school graduates than residency slots!

Tax payers are investing billions of dollars each year in physician training as a public good. For this level of investment, shouldn't we expect a physician workforce that meets our country's needs?

Jeff Cain, M.D., is President of the AAFP.

Friday Aug 16, 2013

Medical Students Need Washington to Do More

As a recent medical school grad, I spend a great deal of time thinking about my educational debt. I owe $234,000 (and the total is increasing even as I write this). There are many ways I can pay off this debt: National Health Service Corps (NHSC), Public Service Loan Forgiveness, arrangements with future employers, escaping to Mexico, etc.

But what about those who are unable to secure a NHSC slot or a job that qualifies for loan forgiveness? For many students considering careers in medicine, the high cost will be a burden or even a barrier.

The Student Loan Certainty Act cleared the House and Senate last month, and President Obama signed it into law Aug. 9. The Academy supported the legislation because interest rates on federally subsidized student loans had doubled from 3.4 percent to 6.8 percent on July 1. The new legislation ties undergraduate and graduate loan rates to U.S. Treasury notes and retroactively lowers them -- for now -- to 3.86 percent and 5.4 percent, respectively.

The new law, however, isn't perfect, which is why the AAFP is continuing to advocate for related measures. Specifically, the Academy is asking lawmakers to

  •  expand funding for federal loan programs targeted to support family medicine and primary care,
  • allow deferment of interest and principal payments on medical student loans until after completion of postgraduate training, and
  • grant tax-deductibility for interest on principal payment for such loans.

The potential problem with the law is that federally subsidized student loans now will be tied to 10-year U.S. Treasury notes. If bond rates rise, so will the interest rates on this type of loan, which accounts for roughly one-fourth of federal student loans.

The rates are capped at 8.25 percent and 9.5 percent for undergraduates and graduates, respectively, but those potential rates would be significantly higher than current rates and could make education more expensive and more unattainable for some low- and middle-income students.

That scenario could present a problem for our already unbalanced workforce because we know that students with lower income expectations are more likely to choose family medicine as a specialty. Today, our workforce stands at roughly 70 percent subspecialists and 30 percent primary care physicians. What will the workforce ratio be in the future if interest rates approach double figures, making the cost of education an even bigger hurdle?

Three-fourths of medical students come from the top two quintiles of parental income.

Without scholarships, low- and middle-income families disproportionately feel the hit of tuition. A 2002 study from the U.S. Department of Education found that high-achieving, low-income students were five times less likely than high-achieving, wealthy students to enter college in their first two years after high school.

I was fortunate enough to earn a full-tuition scholarship to Saint Louis University as an undergraduate. Without that scholarship, there is no way I could have afforded the $36,000 annual tuition. My parents did not earn the "big bucks." My mom is a speech pathologist and my dad is an economics professor at a community college. The scholarship award was much needed.

So what's the bottom line for family medicine? A 2009 study by the Robert Graham Center evaluated what influences specialty choices and found that as long as debt did not exceed $250,000, students were not deterred from a family medicine career. What we don't know, however, is how many students who are interested in primary care careers are deterred from even entering medical school because of the high cost.

Exposure to the NHSC was one of the strongest predictors of careers in family medicine in the Graham Center study. I know several students who have no medical student debt because of the NHSC's Students to Service Loan Repayment Programwhich provides assistance to fourth-year medical students dedicated to working in areas with physician shortages.

It's worth noting that the Academy has a Web page devoted to debt managementAs for me, I will enroll in the Public Service Loan Forgiveness program. As long as I work at a nonprofit organization, my loans will be forgiven after I make 10 years of qualifying monthly payments -- if the program is not discontinued, that is. Signed into law in 2007, this program soon will start to see its first wave of enrollees apply for loan forgiveness. My fear is that the program could be discontinued before I have the chance to apply, and then, since I was able to enroll in a discounted payment plan, I will have significantly more interest to pay. I feel very uncertain going forward.

And if I'm feeling uncertain, what are students from low-income families experiencing? When parents discuss undergraduate and medical school debt burden with their children, what are the results of those dinner table conversations?

Lowering the interest rates on student loans, at least temporarily, was a first step, but more work is needed to create a physician workforce that is diversified and represents the population. The time is now to let your voice be heardTalk to your House and Senate representatives about the importance of a strong primary care workforce. Talk to them about how education should be valued just as much as a home purchase. I encourage you to act.

Aaron Meyer, M.D., is the student member of the AAFP Board of Directors.

Tuesday Aug 13, 2013

From Classroom to Med School and Back: Why I Love Teaching

I recently started a job that combines two things that I love: teaching and medicine. Although I've known for a long time what I wanted to do, it took me a while to get here. 

More than 13 years ago, I decided to leave graduate school at the University of North Carolina to pursue admission to medical school. At the time, I was three months into a master's degree in linguistics when I realized pursuing my doctorate in the field just wasn't for me. Although I needed the opportunity that graduate school had afforded me to be analytical and thoughtful, I didn’t see myself sitting in an office pouring over transcriptions of computer-mediated communication (i.e., Internet chat -- the topic of my master's thesis) for the rest of my life.

I was ready to turn around and head back to Kentucky when my mother, in that way that parents do, mentioned that medical schools might be less likely to admit a student who already bailed out of graduate school.

Best advice ever. Not because I loved linguistics, which I did, but because it made me stay at UNC. During my second year there, I became a teacher, and it changed my perspective completely.

The first time I stood in a class of my own, in front of 22 college freshmen, I sweated bullets. I felt insanely underqualified and unprepared despite hundreds of hours of education pedagogy and at least three weeks of completed lesson plans. Considering that I was teaching English composition, one of the classically hated requirements of college, the great triumph of that first day was capturing the attention of every student by correctly identifying that the Nigerian student in my class spoke Yoruba.

I loved spending that first semester learning to disseminate information, but also being a part of the development of my students' lives.   

After realizing that my teaching style really could include me sitting on a desk in the front of the room, answering students' cell phones that rang during my lecture and confiscating anything that didn't explicitly pertain to that day's subject matter, I never questioned that teaching is where I belong. 

But I did question what I should be teaching.

I started medical school, four years after finishing that master's degree, knowing that I would graduate looking to return to education. So, this past year, when the job search was finally upon me, I looked exclusively for academic jobs. 

I had been bombarded by countless job solicitations beginning in my first year of residency promising no call, no weekends, no OB, no inpatient, exotic parts of the country, the possibility of loan repayment. And, believe me, a future of no late-night awakenings and uninterrupted Saturdays had a certain appeal, but by the end of residency, I loved the hospital, labor and delivery, late nights, early mornings and the satisfaction of the breadth of what I can do.

The search began late for me; it was November before I started looking and March before I interviewed anywhere in person. I know many residents who did substantially more interviews than I did, who cultivated contacts for years, keeping up with hometown doctors who might be their ticket to a perfect job. I went to three in-person interviews, having done a few more phone interviews, but I knew I was not the right match for those places. I found two really wonderful job possibilities in interesting places, both very different from Milwaukee where I had been living.

I'm excited to start anew, finished with medical school and residency (and any other degree programs for a while!) as an assistant professor in the Department of Family Medicine at the University of Kansas School of Medicine. I’m excited to be able to continue in as full a spectrum of practice as I can and to teach and learn from medical students and residents.

Sometime close to the end of my intern year, I was contacted through Facebook by a young man who had been in one of the last English classes I taught. He wanted to tell me that he had decided to become an English teacher based, at least in some part, on his experience in my course. He added that he was still in contact with many of those classmates and that during a number of years of discussion, they all felt that my classroom had become a community. That conversation, and the hope that someday I might be honored with another like it, is why I continue to teach, to help students find that community, whether in medicine, linguistics, or life.

Sarah Tully Marks, M.D., is the resident member of the AAFP Board of Directors.

Friday Jul 12, 2013

First-year Residents Set Expectations for Themselves

A new academic year started this month at family medicine residencies across the country. The new year means a new crop of first-year residents, who bring with them a great deal of energy, excitement and -- of course -- nervousness about their new roles.

As chair of the Department of Family and Community Medicine at the University of Nevada School of Medicine, Reno, I recently sat down with our new residents and asked them how they are adjusting.

It's worth noting that four of our seven interns are from Caribbean medical schools. I asked them if they felt any disadvantage compared to our American medical school graduates. They all said no and added that their rotations in U.S. hospitals had more than adequately prepared them.

Here is what they all had to say. 

Q: Do you feel confident? Are you appropriately prepared for internship?

A: Meghan Ward, M.D.

I just feel pretty ready to start. I wouldn’t say that I'm overconfident, however, and I know that I have a lot to learn. I do feel that my training has prepared me well. I am sure there will be times when I feel inadequate, but I realize that this is a learning environment and there is a lot of support to make sure I am successful. I am up for the challenge. 

Q: As you become an intern, it can be nerve racking. How would you rank your level of nervousness being an intern? Do you think this is a lot of responsibility to take on, or do you feel ready for it?

A: J. Kevin Daniels, M.D.

I'm pretty nervous about it just because being responsible for all these patients is a big deal, and you are doing it for real the first time. It will make you kind of nervous. I think that I'm ready for it because I feel that I'm well supported on the rotation. The senior residents and faculty are here and seem very willing to help and make sure I succeed. I'm not just out there by myself, so that makes me feel a little more confident.

Q: What have you learned so far that has taken you by surprise in the first two weeks of your internship?

A: Benjamin Hansen, M.D.

I think the most profound thing to me is that we understand that family medicine's emphasis is on treating the whole patient. Treating the social aspect of the disease -- not just the diseases themselves -- is important, but I never realized just how important that really is in terms of promoting wellness. People have a real desire to just have a conversation with you, to interact with you on a personal level. If you can get to understand people in that regard, they are little bit more passionate about taking care of themselves, a little more passionate about getting well. And I think that it promotes wellness a little more than antibiotics can do alone or whatever you are treating with. 

Q: Internship takes a lot of time, and a lot of interns have trouble with time management and getting into their personal life with this year of heavy study.  How do you plan on managing your time?

A: Umar Nasir, M.D.

First year is a huge transition from medical school to being a doctor, so it's basically a huge learning curve. The first priority should be learning new stuff and getting more comfortable with practicing family medicine. It can get difficult to manage your own personal life along with working; however, I think our first focus should be just learning medicine and becoming better. I think that you can have time for personal life; however, it all depends on individuals and how they manage time between their work and how efficient they are. I think it is different with everyone. 

Q: When you start a new training program and you are thrown into a hospital where a lot of people are accustomed working together and you're the new kid on the block, sometimes people don't get treated the best. How do you feel like you're being treated?

A: Kyle Baron, M.D.

I think that I've been very fortunate since I've only so far been working on the pediatric floor. All the staff up there -- from the nurses, MAs (medical assistants) to the techs -- have been very helpful and incredibly friendly. There are times when you get ignored a little bit. What I found is a lot of times when they do not know who you are, they don't make the effort to figure out who you are. Sometimes they think you are just a medical student and were given a task, so they don't need to help you or talk to you or it might be some other similar situation. As soon as you make yourself known, introduce yourself to everyone and be polite with everybody, they will get to know who you are. What I have experienced so far is that everyone is very friendly and helpful, and they know we are all there for the same reason. Even though I wouldn't say they go out of their way, I have found that if you ask for help, they will give it. I have not experienced any situation where someone wasn't willing to give help.   

Q: Why did you choose family medicine? Also, how do you balance internship and personal life?

A: Stephanie Reinhardt, M.D.

I chose family medicine mostly because of my experience at medical school. I just loved being able to see an adult patient with multiple chronic diseases, then pediatric kids that weren’t well and then going in and seeing a pregnant patient. I just loved the variety and being able to be good at a lot of little things. It's kind of what I envisioned doctors being when I was growing up, so it is kind of neat to have all the variety that we get in family medicine and all the prevention that we get to work with. I'm pretty passionate about preventing the long-term diseases that we treat, and I think that family medicine definitely does the best job with that over all the fields that I have seen. The first week is a little hard because we are working so much, but I've managed to always have dinners together at home every night. It is just something we do. My husband and I decided to make dinner together every night so we just have time together, and then we take the dogs for a walk. I think it's just making priorities. For me, my priority is medicine and my husband, so when I have free time, it's just where it goes. You have to have balance in your life.

Q: Are you happy you chose family medicine? How do you see that evolving during the next four years?

A: Satu Salonen, M.D.

I am happy that I chose family medicine. Well, I started on family medicine wards so I'm actually getting to see what family medicine really is. I like the fact that we see newborns, then we see pediatric patients, the obstetrical patients and then adults, so you really do get the whole scope of medicine, which is what I wanted. Hopefully, I will become more confident and comfortable.  As you know, just as you're starting out, it can be a bit overwhelming trying to tackle all the different patients from newborns to adults and multiple different situations. I feel pretty good now. I have a great senior resident, who is helping me out a lot, and I see myself growing as I go along.

Daniel Spogen, M.D. is a member of the AAFP Board of Directors.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.