BY LESLIE CHAMPLIN
Your potential peers are in your waiting room. They're at medical conferences. In restaurants or at dinner parties. In line for the movies or baseball games.
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"A bad role model is worse than no
role model." |
So, when you're discussing long hours and low pay, you may unwittingly dissuade medical students from embracing family medicine. At least that's what some students suggest.
Three students from Temple University School of Medicine, Philadelphia -- Sandy Green and Heather Kovich, in their third year, and Priya Mammen, in her fourth year -- described why they considered other specialties despite their initial interest in family medicine. Speaking at the Society of Teachers of Family Medicine Annual Spring Conference May 12 - 16 in Toronto, they offered their perceptions.
Where's the passion?
"When I talk to family practitioners, I hear them say they work hard, don't make a lot of money and don't have any respect," said Kovich. "I want to work in a career where people love their job."
Green agreed. "On the plane coming here, I met family physicians and all I heard was, 'We're not respected, we're not this, we're not that,' instead of what's being actively done," he said.
Every family physician should work to change that perception, said Joseph Blonski, M.D., director of the St. Cloud Hospital/Mayo Family Practice Residency Program in St. Cloud, Minn., after he attended the students' presentation.
"Those of us who love what we do need to help students see why they should choose family medicine instead of why they shouldn't," he said. "We need to see family medicine as a privilege instead of as a burden."
What about intellectual rigor?
Though family medicine rotations are difficult, the students said their residents and faculty showed little interest in evidence-based medicine.
"Family medicine doesn't foster the same culture of academic curiosity as the other specialties," said Kovich. "On my family medicine rotation, I was … told, 'Here are the books, but you won't need them.' I didn't see family medicine residents going home to read at night; if they had an extra hour, they played video games."
Green agreed. "I'd ask a question, and the internal medicine resident could cite guidelines or refer to the most recent research in the Journal of the American Medical Association. If I asked a family medicine resident why he prescribed one drug over another, he'd say it was because that was the way they were taught. If they (the family medicine residents) said something like, 'I know the guidelines, but this choice is better for the patient because it's less expensive', then I would understand that they knew the guidelines and were considering the patient."
These words bode ill for family medicine, said John Smucny, M.D., associate professor of family medicine at State University of New York Upstate Medical University, Syracuse.
"We're in a bad downward spiral if the residents we have turn students off," he said after the students' talk. "We need more information on how students view family medicine residents and (need to) get a sense of how widespread this problem is.
Research seems soft
Family physicians study "soft" topics, focusing more on patient-physician relationships than on medicine itself, said Green.
Patient-centered research makes sense for a patient-centered specialty, according to Charles Christianson, M.D., a family physician in the office of medical education at the University of North Dakota, Grand Forks.
"We're proud of rebelling against the academic establishment and of focusing on patient care, but we do need research for academic legitimacy and intellectual growth," he said after listening to the students' presentation. "A good benchmark is the extent to which other primary care specialties, such as general internal medicine, conduct research."
More may not be better
Family medicine educators say students need more exposure to FP role models. But quality, not quantity, counts more, the students said.
"In my encounters with family physicians, I hear a lot of whining," said Green. "I don't want to spend my time with them in practice if that's the attitude that comes across to me as a student."
True, said seminar attendees. "Departments are judged by their weakest link," said Rick Ricer, M.D., professor of family medicine and vice chair for medical education at the University of Cincinnati. "A bad role model is worse than no role model. Predoctoral programs need to go weed out the bad role models. We cannot have the worst role models in our predoctoral education."
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
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Copyright © 2004 by
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