Better known as "Dr. Z," Jeffrey Zlotnick, MD, CAQ, FAAFP, practices family medicine and sports medicine across state lines, in Bethlehem, Pennsylvania, and Phillipsburg, New Jersey. He's been in practice for nearly 30 years, and sat for the sports medicine Certificate of Added Qualification exam in 1982. Dr. Z became interested in sports medicine after working with a runner, who happened to be insulin-dependent diabetic, with a goal of completing a marathon. Dr. Z helped the runner to adjust his insulin, diet and fluid intake and complete the 26.2-mile race. From there, his interest expanded into taking care of local athletes, becoming the race physician for the Multiple Sclerosis Society's annual 150-mile bike tour, and teaching and giving lectures.
Q: What led you to practice of family medicine?
Dr. Zlotnick: 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, NJ, 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!
Q: What is the greatest reward you receive as a family physician?
Dr. Zlotnick: My greatest rewards are what I call small miracles. Many residents and students go into medicine with a sense that they have to save the world. After time, the reality begins to hit them that there is very little chance that they are going to be able to accomplish that rather lofty goal. That sense begins to translate into a feeling that they have somehow failed and they will never be the physician they wanted to be, and that they will never be able to help others. They can become jaded and it can become "just a job" that they go to, never realizing the impact they are having on a day-to-day basis.
Let me tell you the story about Ed. Ed was about five years old at the beginning of this story. Ed's family had lost part of their health insurance coverage courtesy of cost-cutting measures by the managed care company with which his dad's company contracted. Ed's father called me one evening because Ed had a rash he had never seen before, and was running a temperature. Dad was rather upset and wanted to call someone he knew. I was no longer their official doctor because of the changes, but he called me nonetheless. I told him to bring Ed in and we'd work out everything else later. One look at Ed and I knew something rather serious was going on. A few phone calls later and we had Ed admitted to the hospital and set up for an emergency bone marrow biopsy. The results were done stat and the news was what I unfortunately had expected: leukemia. A few more phone calls later, Ed was on his way to his initial bout of chemotherapy.
Ed is now the same age as my son, and has finished college. All it took was a little caring and a few phone calls.
Another story is about Jim, who was a star athlete for the local high school when he noticed some foot and knee pain. Jim wanted to be a track and field star, however, the pain was getting worse by the day. His father had taken him to see an orthopedic surgeon who just told him he'd grow out of it and to give him an over-the-counter nonsteroidal anti-inflammatory drug. When I saw him, I saw a very upset young man who wanted so much to be a good athlete. What I didn't know at the time was that he wanted to be that track and field star because he could earn a scholarship for college — for Jim and his family, it was the only way he would be able to go to college. I examined Jim and found what we sports med folks like to call, "miserable misalignment syndrome," a touch combination of pes planus, genu valgus, and patellar femoral syndrome. At first, we started an intense program of physical therapy combined with trying different types of OTC orthotics. However, we finally had to get him fitted with a set of custom-made orthotics. It took a few months, but the pain began to fade and his ability to run increased.
It wasn't until I saw him a few years later for a minor injury that occurred in college that I learned the full extent of what working with him had done for him. To me it was just the day-to-day business of seeing patients. It had never occurred to me until that moment how much impact that had on his life. What was mundane to me was a turning point in my patient's life. Keeping that in perspective has been one of the greatest rewards of all.
Q: Describe a typical day for you.
Dr. Zlotnick: Currently, I work in a multi-office practice. I start my morning in one office and may travel to another for the afternoon, although some days I'm in the same place all day. Practice varies, some things are routine, then there are the patients that just present a challenge, be it diagnostic or something else in their life that needs help. Paperwork is a constant that frankly annoys us all. Even with electronic medical records, there are still forms that need to be filled out or signed. It's part of the job and you just learn to wade through it.
As for lifestyle, contrary to rumors that family medicine will not allow physicians to have any free time, I've managed to maintain a very active social and family life. I raised two children who are now on their own, and had time to spend with them while they were growing. Yeah, I missed some things, but not a lot. I'm very involved in all sorts of public service activities. I have time for my favorite hobbies. I'm still a bit of an avid bicyclist and an admitted "mileage junkie." When the weather's good, you'll find me out there riding. I also have a motorcycle which I tour on.
I'm also very active in medical politics. I've been active in the New Jersey Academy of Family Physicians for more than 20 years. I had the honor of serving on its board and as its president. I'm not as active at the moment, but I still contribute using my experience in various forms of practice and still help develop educational and public service programs.
The other not-so-typical hobby I have is I go out 2-3 times a week and play blues guitar at various jams. I've been given the stage name of "Doc Z," and it's rather humorous when some of the other jammers realize that I really am a physician. In fact, after being inducted as president of the New Jersey Academy, I have the distinction of being the only state chapter president to play guitar in the band at his own induction dinner.
Q: What advice would you give your medical school self?
Dr. Zlotnick: Learn more about the business end of practice. I started in solo practice and really knew very little about running a business, so I had to learn on the fly. Not really the best way to do things. I made a lot of mistakes, some taking a long time from which to recover. I always enjoyed the medicine side, but the business side was like a foreign country to me. I would recommend learning as much as you can so even if you go into employed practice, you will be more aware of how things work and be able to be more of an active participant on day-to-day decisions.
Also, don't write off a type of practice just because you think it may be too difficult or time-consuming. When I started residency I never thought I would go into solo practice or in a rural area. So what did I do? I started a solo practice in one of the few rural areas of New Jersey. It was nowhere near as all-consuming as I thought. I was able to set limits on how much time I spent and how I delt with patients' off-hours needs. For someone who is independent-minded, I would recommend looking into this form of practice. I only left because I wanted to teach and had an offer I just couldn't refuse.
Q: What would you tell an undecided medical student who is considering familiy medicine?
Dr. Zlotnick: Think about where you want to find yourself in five years, 10 years, 25 years. Family medicine may not be the best payer, but I feel it is what medicine is really about. It's challenging, rewarding, and very adaptable to whatever lifestyle you want.
Q: What is your most vivid memory from medical school?
Dr. Zlotnick: The day I knew I wanted to become a family physician. I had finished my rotations in internal medicine and pediatrics and was very disillusioned. I then did a rotation in family medicine in a local residency and suddenly felt that feeling that I had when I first started medical school return. I knew at that moment I had found my niche.
Q: What has been the greatest challenge you have faced as a family physician?
Dr. Zlotnick: Dealing with some specialists who don't consider family medicine as an equal specialty. It was a matter of standing my ground and not giving in when it came to what privileges I was comfortable with in the hospital, and what type of things I would deal with in my office. Starting in a rural area, there was not a lot of specialists available for referrals, so I had to learn how to treat many things myself. Turned out it wasn't as daunting as I thought it would be.
My other challenge has really been myself and my personality. Having been in solo for many years and just my upbringing, I'm rather independent and have a tendency to speak my mind. This has made dealing with my employers difficult at times. It's not a challenge that I have conquered yet. However, I have to be true to myself.
Q: What community service are you involved in and what motivates you to do this work?
Dr. Zlotnick: When I lived in Sussex County, New Jersey, I became involved in the United Way, acting as the doctor for their bicycle tour fundraiser. I also rode part of the tour and then set up a small medical area for the riders. From there I became involved with the Multiple Sclerosis Society of Northern New Jersey. I rode the tour and was tour doctor for 10 years. I rather enjoyed the challenge of being able to increase my skills to be able to ride 150 miles over two days. I was also responsible for helping set up the rescue crews at the rest stops, informing the hospitals of what we were doing so they'd be prepared, and helping coordinate with the amateur radio groups.
However, the thing I am the most proud of is the program I created for Special Olympics New Jersey. The New Jersey Academy was approached about 9 years ago by the Special Olympics of New Jersey about developing a program to do pre-participation exams for students at various schools that were not able to see a doctor to be certified. After about 6 months of research I developed a program that made it possible to do station exams for Special Olympics. I had to develop a teaching program — which I took on a road trip to all the residency programs in New Jersey — spoke to legislators about liability issues for the physicians that participated, and worked with the Special Olympics of New Jersey on how to get the students to their facility and get them through the exam chain. This is now what is called MedFest. The primary tenant of MedFest turns the normal pre-participation on its ear: nobody fails! What we do is document the problems and limitations and let Special Olympics design an event that the athletes can participate in using their "Adaptive Sports Program." This has been an incredible success. For the participating residency programs it fulfills the requirements for sports medicine training, participating in community service, and working with a special needs population. We just completed MedFest 12 and to date we have certified almost 800 athletes who otherwise never would have had the chance to participate. My proudest moment was while volunteering at the Special Olympics of New Jersey games in Trenton, NJ, seeing a number of athletes we certified participating and seeing some get ribbons. It's an amazing feeling. The program has been so successful that the concept has been adapted by Special Olympics International, U.S. Division.
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Medical School & Residency
In Their Own Words: Family Physician Q&As
Dr. Jeffrey A. Zlotnick