Career Q&A with Family Physicians: Life and Work in Family Medicine
"Why did you become a family physician?"
I wanted my approach to medicine to include social determinants.
"Prior to medical school, I worked as a volunteer medic for a small non-governmental organization in post-war rural El Salvador.
It was a time that I had an opportunity to see how critically linked social determinants are to health. I was determined to marry the two in my future career and family medicine was the natural path."
I wanted a medical career that I could build around my family life.
"I originally began my medical career as a surgeon, however, after multiple military deployments, my previous medical lifestyle began to weigh heavily on my family. I entered the family medicine residency because of my desire to build my career around my own family life, not the other way around."
I found my fit in family medicine.
"My mentors were family physicians and pediatricians, so I always knew I would do primary care. I actually was drawn to peds, and even led PIG (Pediatrics Interest Group) in med school my second year!
My first clinical rotation was in family medicine, though, and I found my 'fit' on day one. I didn't expect to love all of the things that a family physician does, but with each experience I learned more about family medicine as a specialty and about myself as a provider."
I really enjoy the family rapport and making a difference in patients' lives.
"I knew from a very young age — in elementary school — that I wanted to be a physician. In college, I worked with the athletic department at the University of Alabama as an atheltic trainer, and our team physician was a family physician who specialized in sports medicine.
Through that experience, I knew I wanted to do the same thing. I really enjoyed the family rapport he has with his patients, the highly competitive athletes, the focus on wellness and exercise, and how much of a difference he has made in his patients' lives."
I knew that I wanted to work in a rural setting.
"When I entered medical school I was considering pediatrics or family medicine. My decision to enter family medicine had two major influences. The first was a desire to work in rural Virginia, where I felt that the scope of practice of family medicine would make me more valuable to the community.
The second was the influence of mentors who were family physicians. Two doctors in particular showed me the intellectual, personal, and community benefits of family medicine. I am proud to be working alongside them as colleagues today."
The holistic approach fit my global health career goals.
"I was led into family medicine after working with a family physician who I met while working as a general practitioner in a non-profit hospital in Honduras. It was clear that her training had provided her with a set of skills I wanted to have to practice medicine, both in my local practice at the time and my considering my dreams to one day participate in global health. It was holistic from every point of view and fit so well my career aspirations for academia and service to the community."
I wanted to care for patients across the lifespan.
"Family medicine engaged me early in my life. My family was privileged to have a wonderful family physician who encouraged me to go to medical school. The pivotal point, however, occurred for me during medical school in my second year when I was seeing patients with a local family physician in his office. His engagement with his patients and love of his discipline was inspiring.
As I began to plan my clerkships, I realized that I could not give up on my desire to care for all patients across the lifespan. Dr. Gabriel Smilkstein was one of the faculty at the University of California, Davis, at the time who supported me in this decision when I was being heavily recruited into other disciplines. His mentorship was invaluable. As students, we were encouraged to develop a migrant farm workers clinic to gain more experience and insight into our own interests. It provided us with another view of health care outside of the academic health center. It still exists today."
Being a clinical generalist is a real asset.
"I have always been motivated by the community, family, and patient-based perspective of family medicine. No other specialty embraces the systems-based approach to patient care. Plus, the nicest people I met in medical school were invariably family physicians.
I think of two pivotal moments – first was my sub-internship in Santa Rosa's family medicine program when I really experienced the excitement and fulfillment of community-based family medicine. The second was an elective at the CDC working on infectious disease outbreaks. Although I was interested in infectious disease, it became clear that being a clinical generalist was a real asset; I could feel comfortable talking about everything from HIV/AIDS to maternal child health to chronic disease care."
I enjoy developing relationships with patients and families over time.
"I consider myself privileged to have had the opportunity to pursue my dream of becoming a physician. I don't, however, think there was any particular moment in time when I knew I would be a family physician. I observed patient-doctor relationships over time. I witnessed family member interactions and how they were intertwined as they developed. The family as a whole provided more of a distinct and complete picture of how to provide comprehensive care for the family, and in turn, each individual. I enjoyed a much more satisfying and meaningful relationship treating families as a whole as the individual relationships grew strong and the requisite trust more profound. I have relished and appreciated the benefits of building trusting relationships with each member as they grew stronger, sincere, and more genuine.
These long-term relationships provide a healthy environment and approach to practice family medicine and provide care for the entire family. The term 'family history' suddenly meant much more than a few lines on a chart for reference; it became a dynamic link that brought the family members full-circle as I treated them, their children, and hope to care for their children's children. I have enjoyed developing the long-term relationships that challenged both the mind and soul as I participate in my patients' health care."
Working with people in their communities was a more natural fit for me.
"As I entered my fourth year of medical school, I used elective time to create a family medicine rotation. We had no family medicine department at Saint Louis University at the time. I had been leaning toward family medicine or med-peds. I had already started realizing one of my professional mottos: I don’t love medicine; I love what I can do with it.
During my two family medicine rotations — one at a Federally Qualified Health Center (FQHC), one a private practice — I came to realize I was much more comfortable working with people in their own communities, whether that was an ambulatory care center or a homeless shelter. Working with people in their communities, with their own concerns that they identified, was a more natural fit than 'doing to' people in the more patient-passive hospital environment.
The day that this hit me viscerally was a day I stayed late working with my preceptor. His schedule was packed. He knew me and my skills at the time, and he knew I had been a high school teacher prior to medical school. We did a lot of tag-teaming that day, with me reinforcing care plans with patients after he made the diagnoses and plan. Time flew by, I realized I was genuinely having fun, and I found that I already was on my path."
I enjoyed the clinical patient interactions.
"When I first decided to dedicate my life to the practice of medicine, I had all intentions of becoming a surgeon. Orthopedics and plastics, in particular, held my attention. I even started my first year of training as a rotating intern in an osteopathic surgery program.
However, after spending my first few months tending to pre- and post-operative patients on the floors and then going through a rotation in the family medicine clinic, I enjoyed the clinical patient interations even more. It was then that I explored, and obviously changed career paths toward, family medicine."
I like knowing my patients on a personal level.
"I was a firefighter/EMT (emergency medical technician) before going to medical school and expected to go into emergency medicine. However, when working in a family physician's office in college, I discovered the satisfaction of relationships that come from knowing my patients on a personal level.
In emergency medicine, I took action and got immediate feedback, but never knew what happened to the patients. Family medicine gave me the emotional fulfillment of knowing the rest of the story."
I knew from the beginning that I wanted to be in primary care.
"I grew up in a small town in southern Arizona and knew from the beginning I wanted to be in primary care. During my first year of medical school I went to a dinner hosted by the Arizona Academy of Family Physicians. Several Arizona family docs spoke, but the one I remember specifically was Dr. Carlos Gonzalez. At the time, he was working in a small community in Arizona and the life he described was what I was looking for, especially the relationships he had with his patients. After that, I got more involved at my school and nationally with the AAFP and just felt like it was the right fit for me.
During medical school I tried to keep an open mind, but just never felt quite at home during other rotations. I would get bored seeing the same things all the time or just not feel welcomed like I did within the family medicine community. I knew it was what I wanted to do and that I wanted to practice in a rural area with a broader spectrum of practice."
Family medicine's humanistic approach is what I believe medicine should be.
"I recall being very confused in medical school as to where I wanted to go. I was looking at internal medicine, pediatrics, and even ophthalmology. At one point I was feeling very disillusioned because medicine was not fitting with my personality and humanistic approach. Then I heard of the 'radical' emerging specialty called family medicine.
I would travel from my school in Newark, New Jersey, to New Brunswick to attend an interest group for students interested in family medicine. From there I took an elective rotation at a family medicine residency and I was hooked.
It had everything I was looking for and was what I imagined medicine should be. It wasn't the pneumonia in room 400 — it was Mrs. Smith who had pneumonia, and also had some personal issues with her family. It had variety, it was challenging, and it had a humanistic approach. I knew this was my niche and I have never looked back!"