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Wednesday Sep 13, 2017

One Good Look at Vast Scope of Family Medicine, and I Was Hooked

A strange thing happened on my son's path to becoming an orthopedic surgeon. During Kevin's final year of medical school, he decided to do a second family medicine rotation. His first had been unremarkable, and he had no intention of following in my footsteps.

[AAFP President Michael Munger, M.D., on-stage as his son, Kevin, graduates from medical school]

Here I am behind my son, Kevin Munger, M.D., who, just like me, embraced family medicine when he saw the whole picture of how our specialty works to improve the lives of patients.

But during his second rotation, he was paired with a preceptor who practiced full-scope family medicine, and he saw what actually was possible. It was the best experience of his training to that point, and he's now a third-year family medicine resident.

Oddly, I had a similar experience some 30 years earlier.

I knew I was going to be an ER physician from the moment I entered medical school. There wasn't any question. I was so certain of my path that I spent every other weekend working as an orderly in a local hospital. It was valuable exposure to health care, and I was learning things my peers weren't.

But it also was there that my career path turned. The hospital had several physicians who moonlighted in the emergency department, including some family medicine residents who made a life-changing impression on me. These doctors were the smartest, friendliest and most compassionate physicians I had encountered. They cared about me as a person. And because they knew I was a medical student, they often included me in their discussions and showed me what they were doing.

"Michael, come look at this case," was something I heard frequently. It helped me immeasurably, and it was fun.

But what really got my attention was the fact that these family physicians knew a lot about everything. It seemed there was nothing they couldn't handle -- trauma, critical illnesses, orthopedics. You name it. For a young medical student, it was impressive and powerful.

Of course, the other physicians were good at their jobs, too, but their approaches were far different. When confronted with a complex patient, the goal of the emergency department physicians and residents was to take care of that patient and get them out of the ER. The family medicine residents took a broader view. They didn't just want to stabilize the patient. They were thinking about what needed to happen next for that patient. What sort of followup would the patient need after being discharged? They weren't just looking at the patient's injury or disease. They were thinking big picture.

As happened with my son, my first family medicine rotation had failed to make an impression on me. But I was so impressed by the family medicine residents at the hospital that I did a second rotation. And just as with Kevin, my second preceptor made a difference, and I saw that family medicine offered everything I loved about medicine: ongoing care, management of complex chronic disease, procedures and more. I was hooked.

In three decades of practice since, I've looked at family medicine through a lot of different lenses. I've worked in independent practice and been an employed physician. I've been a preceptor, taught in a residency and worked in health care administration. Those varied experiences have helped shape who I am.

So, as I take the role of AAFP president today, I can relate to our members' individual circumstances and concerns, regardless of their practice setting. There is much work to do in the year ahead on issues such as payment reform, administrative burdens and more, and I'm honored to represent you.

I was fortunate to have former AAFP President Jack Stelmach, M.D., as my residency director. One of the many lessons he instilled in us was the idea of giving back to our specialty. One of my first advocacy issues involved scope of practice. In my first year after residency, I was on staff at a community hospital that wouldn't allow me to hospitalize patients in the ICU without a cardiologist consult. I was outraged and vocal. I wanted everyone to know that family medicine is a specialty with the ability to manage a wide range of patient care in any setting.

I learned that lesson more than 30 years ago from those bright family medicine residents. In my year as president, I'll continue to tell our specialty's story and do my best to ensure that payers, policymakers and patients know the vast scope and expertise that family physicians offer.

Michael Munger, M.D., is president of the AAFP. His term begins today.

Posted at 12:00PM Sep 13, 2017 by Michael Munger, M.D.

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