While waiting for permission to enter the nuclear lab at Emory Heart Center, students, left to right, Brandon Bringuel, Kalie Deutsch, and Michael Webber pay attention as Samuel Church, M.D., M.P.H., delivers a quick lesson on diagnosing chest pain.
Medical students gather around the nuclear lab technician at Emory Heart Center for a closer look at patient images.
Midway through his six-week family medicine rotation with Samuel Church, M.D., M.P.H., medical student James Eames is very comfortable examining his patient Margaret Hedden.
In the middle of Lake Chatuge, with a boat full of medical students in swim suits and his son onboard, Samuel Church, M.D., M.P.H., center, cuts the engine and leads a discussion on finances.
In a common occurrence at Synergy Health Inc., clinical team members gather in the hallway to share information about patients; shown here, left to right, Julia Murray, P.A.-C; Jessica Grooms, C.M.A.; medical student Lara Smith; and Samuel Church, M.D., M.P.H.
Family medicine needs to recruit medical students to the specialty -- lots of them -- to stave off dire predictions of primary care shortages. And it's family physician mentors like Samuel Church, M.D., M.P.H., who hold the recruitment key.
Church doesn't just tell visiting medical students how much he loves practicing family medicine in Hiawassee, Ga., a rural community nestled into the North Georgia Mountains.
- Family medicine needs to recruit more medical students to the specialty, and Samuel Church, M.D., M.P.H., of Hiawassee, Ga., has a precepting style that draws students to the specialty.
- Church is a solo family physician with a large clinical team; he sees 20 to 30 patients a day and added two student apartments to the second floor of a new clinic he opened early in 2014.
- Students call Church a community advocate and a role model, and those who have switched their specialty to family medicine credit Church for changing their minds.
Rather, he opens up his life as a small-town family doc and invites them in. What students see after a very short time in this town of about 1,000 people (in the summer, the county population swells to nearly 10,000) is the impact that one family physician can have on a community and the joy that comes from serving the people who live there.
Underlying Church's soft-spoken demeanor is a passion for the specialty that has led more than one unsuspecting medical student straight into the arms of family medicine.
Count Lara Smith among them.
Catching the Passion
This spring, Smith, a third-year medical student from the Georgia Regents University - University of Georgia (GRU-UGA) Medical Partnership campus(www.medicalpartnership.usg.edu) in Athens, learned that she was headed to Hiawassee for her six-week family medicine rotation.
Smith told AAFP News she was not happy about being sent to "the middle of nowhere in Georgia," and questioned her clerkship director's wisdom in sending her there.
"She was worried that I wouldn't find critical care medicine as rewarding as I thought I would …and she was right," said Smith. "Halfway through my rotation, I could feel my passion turning toward family medicine -- where nothing else had moved me like that."
Smith credits Church's teaching style for her change of heart.
"He doesn't force any of it on you -- he just turns patients over to you, and at that moment, you walk in and they are your patients.
Patients Betty Anderson and Jerry Anderson finish up a clinical appointment with some friendly banter between medical student Lara Smith and Samuel Church, M.D., M.P.H. "Have a good bedside manner, talk to patients, spend time with them and you'll be fine," Jerry Anderson tells Smith.
"It was the first time in my third year that I felt that autonomy and responsibility," said Smith, as she recounted the joy of partnering with patients to create care plans around a diagnosis she had come to -- with Church's oversight, affirmation and course correction when needed.
"I finally felt like I was doing something," she said.
Watching the Magic
AAFP News traveled to Hiawassee in early June to watch the magic among Church, medical students, patients and members of the medical team.
Brett Magner, M.D., knows all about that magic. He called his six weeks training with Church "crucial" in his final decision to pursue family medicine.
"He is a community advocate and role model," said Magner in an email. He called rounding in a nursing home the "most memorable experience" of his family medicine rotation arranged through the GRU-UGA Medical Partnership in Athens -- as were rotations for all of the medical students in this story.
After calling on the patients needing attention that day back in 2013, the last stop for Church and Magner was the facility's cafeteria.
"Dr. Church sat down at the piano and played old-time bluegrass tunes that the residents sang, danced and clapped to. The happiness in that room was contagious," wrote Magner. "I remember thinking, 'Who is this guy?'"
Magner soon will begin training at the Cascades East Rural Family Medicine Residency in Klamath Falls, Ore., but he won't ever forget watching his mentor carry a sick child straight to the ER from the clinic or chat with patients about events in their lives that seemingly had nothing to do with high blood pressure and bad cholesterol numbers.
Samuel Church, M.D., reassures a patient being prepped for a nuclear diagnostic procedure as medical students Brandon Bringuel, Kalie Deutsch, Mike Lou and Michael Webber take it in.
Ditto for Brandon Bringuel, who along with three other third-year students spent an "academic half day" in Hiawassee on the same Friday in June that AAFP News was in town.
A few days later, Bringuel reflected on a morning in Hiawassee that began with discussions about stress tests and EKGs and patient encounters at the nuclear lab at the Emory Heart Center. The morning ended back at Church's clinic with a sobering session about the prevalence and prevention of child abuse.
Bringuel also recalled an afternoon packed into a ski boat with Church at the wheel and medical students eager to try wakeboarding. But even during a recreational break, Church found a teachable moment. He simply cut the boat's engine, pulled out his laptop, and began a lesson on finances.
"Not many of us will remember most of what we learned sitting in a dimly lit lecture hall," said Bringuel. "But I would bet money that most of us will remember talking about the financial aspects of (our future careers) in medicine on a beautiful afternoon in the middle of Lake Chatuge."
Keeping It Relevant
Suzanne Lester, M.D., the insightful family physician and clerkship director back in Athens, Ga., told AAFP News she wanted medical students to have the most robust family medicine experience possible.
"There are a lot of misconceptions about what we do (in family medicine) -- and it's much more than students realize," said Lester. She first learned about Church from a colleague, and what she heard piqued her interest; a trip to Hiawassee followed.
"I saw everything he was doing up there and I thought, 'This is the guy,'" said Lester. "He's such an enthusiastic role model. I like to send him my students who are interested in primary care but don't know what type.
"If they come back from Hiawassee and they haven't chosen family medicine, then I know they really aren't family doctors," said Lester. Of the 11 students Lester has sent to Church for rotations, four have committed to family medicine. For a few others, a single day with Church was enough to clinch a decision for family medicine or at least open their minds to the possibility.
Lester noted that even students who choose another specialty learn an important lesson. "They walk away from their clerkship with an engaged rural physician knowing that it's a hard job and it's a rewarding job," said Lester. "Those students have much more respect for the specialty."
Teaching and Learning
Church's enthusiasm for precepting -- for which he receives no monetary compensation -- hasn't waned one bit, even with a hectic schedule that has him receiving a new student every six weeks. His wife, Nancy, and their four children also welcome students to town and immerse them into the family.
"I'm teaching students how to stay happy, have fun and practice medicine," said Church. "The beautiful thing is when we inspire someone to go into family medicine."
Church anticipated lots of visitors when he planned the construction of a new building for Synergy Health Inc.;(www.synergymd.org) it opened early in 2014 and includes two apartments on the second level that accommodate eight people. Students appreciate a good bed, study areas with a view of the mountains and access to a large kitchen they share with clinic staff members.
As a solo physician with a patient panel close to 4,000, Church sees 20 to 30 patients a day with the assistance of a strong clinical team. He's also on call 24 hours a day, every day. "It's an honor, not a burden," said Church.
As for patients, their acceptance of doctors-in-training has been remarkable. "It's cool how the patients embrace them," said Church. "Patients feel like they're contributing to the students' medical education. Patients say they're getting a little something extra."
Training students does take time, especially at the beginning of a rotation. "The first week, they follow me to see the style; after that, they see patients on their own and then present cases to me," said Church.
Patients with unusual conditions or difficult personalities often find their way onto a medical student's schedule, said Church. Those kinds of situations provide "extra learning" that will serve future doctors well.
"Most private practice folks are afraid of precepting because of the time commitment, but I would challenge them to try it," said Church. "Having students around expands my knowledge every day."
Changing Hearts and Minds
Church knows he can't turn every student he meets on to family medicine. But when he does, it is memorable. Take third-year student Joey Krakowiak, who when he started his family medicine rotation with Church, was primed for a career in pediatric neurology.
"In Hiawassee, I got to experience the joys of small-town, rural family medicine with a great physician who showed me the feasibility of running a practice in that setting," said Krakowiak in an interview.
"Dr. Church also immersed me in his life outside the clinic. I saw how involved he was in his community -- with the youth at his church, the high school wrestling team, the nursing home and hospice care."
In short, what Krakowiak saw in Hiawassee was a vision of his own future. And just like that, family medicine gained another recruit.
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