California AFP Teams Up With State's Family Medicine Residents to Spotlight Specialty

It started out as a simple idea -- hold a social get-together for residents at two different residency programs -- but before they were done, Alisha Dyer, D.O., Charlene Hauser, M.D., M.P.H., and Randi Sokol, M.D., M.P.H., had created a bona fide workforce pipeline program operated in conjunction with the California AFP that could change the very face of family medicine in the Golden State and beyond.

"The three of them are phenomenal," said Callie Langton, M.P.A., the California AFP's associate director of health care workforce policy, about the pioneering residents. "The pipeline program would not have come together as nicely as it did without all of their work. Having two residency programs working together was really something special."

The program the three physicians formed in conjunction with the California AFP is called the Future Faces of Family Medicine, and it brings medical school residents together with high-school students interested in medical careers.

The program's first foray included 20 Sacramento High School students and residents from Dyer's Sutter Health Family Medicine Residency Program and Hauser and Sokol's University of California-Davis, or UC-Davis, Health System Family Medicine Residency. Residents in the two programs led 10 educational sessions for the high-school students during a four-month course on primary care.

"The students learned a ton about primary care and what their options are," Langton said. "A lot of them didn't know what family medicine was going into the program. Coming out, they have a really good idea of what they can expect, the breadth of family medicine and all the possibilities they have if they decide that they want to go to medical school and into primary care -- or, specifically, family medicine -- as a career. I think they really had their eyes opened to what it means to be a family physician."

Hauser said the students -- coincidentally, all young women -- earned CPR certification, visited a simulation lab, attended an obstetric delivery workshop, learned how to perform a physical exam and heard a lot about primary care.

Students in the program, who also had an opportunity to shadow residents at a health clinic, were required to develop a presentation for their high-school health class about issues relevant to teenagers, such as nutrition and depression.

"I was surprised at how eager they were to learn and how excited they were to see very basic things that we see every day and probably take for granted, like a CPR course," said Dyer, a third-year resident. "They were excited to get CPR-certified, even though they spent a whole Saturday of their spring break doing it. We gave them a fair amount of extra work, like writing reflections and presenting a health topic to their class, and they did a wonderful job."

The students, many of whom are from underprivileged backgrounds, also heard the residents' personal stories of how they made it through college and medical school.

"Part of the stigma is the financial barriers students assume they will face and won't be able to overcome," Dyer said. "A lot of residents in the (pipeline) program came from disadvantaged backgrounds and explained how they found funding and that it's not something to hold you back from what you want to do."

Jennille Fleming, who will be a senior at Sacramento High in the fall, said the program gave her and her classmates valuable insight.

"It's important for students to have one-on-one time with doctors who are already doing what we want to do. It really helped me get some perspective. I've always wanted to be a doctor. That's always been my dream."

For Dyer, her dream of becoming a doctor unfolded when she was a high-school student in Santa Rosa, Calif., and participated in a yearlong program that allowed students to shadow physicians in a variety of specialties, including family medicine. She said being exposed to such a program at a young age influenced her decision to pursue a career in medicine.

Sokol said her journey toward primary care really took off when, as a medical student at Tulane University in New Orleans, she began researching barriers to getting medical students into careers in primary care and working with the Louisiana AFP on a mentorship program that linked first-year medical students with preceptors.

"(Students in the Louisiana mentorship program) got early exposure to primary care while they were in med school, so I had the seed planted before I got here," said Sokol.

"Our ultimate goal (for the Future Faces of Family Medicine program) would be to document successes or failures and use this as a model for other residencies to encourage them to collaborate with each other in other cities and do similar types of programs."

Langton said the California AFP was so encouraged by the results that the chapter plans to repeat the program in Sacramento during the coming school year and expand it to an as-yet-unnamed community in southern California. The chapter also will be preparing a toolkit for distribution to other AAFP chapters that may be interested in emulating the program.

Dyer, Hauser and Sokol plan to stay involved, at some level, when the course returns to Sacramento High in 2011-12.

"We want the next group of residents to take over," Hauser said. "We'll be there with support and the idea that this is something that is handed down through the residency programs."

The original group of 20 students isn't done with the program yet either. After completing the course in April, students have been paired with area family physicians who will allow the students to shadow them in their practices.

"I think this is a wonderful opportunity to get students who have an interest in medicine an early taste of it," said Gold River, Calif., family physician Warren Brandle, M.D., M.S., who is mentoring Fleming. "I think there's a lot of value in continuing this program and expanding it in other areas."

Fleming shadowed Brandle for the first time July 22 and is scheduled to visit his office again July 28.

"It's a good first step for students who have an interest in medicine -- ideally, family medicine," said Brandle, who is president of his local California AFP chapter. "We can get them exposed to the different facets of medicine and give them goals to work on and show them what it's like to be a doctor.

"They've all been to see a doctor. I think this is a great opportunity for students to see what it's like on the other side. They can see the joy we have in providing care for families and communities."

Of course, the high-school students have a long path through college, medical school and residency before they can begin their own practices.

"For 20 of them to end up in primary care is very unlikely, but if we could get even one student out of a class of 20 to end up that way, it would be excellent," said Sokol. "Our goal is to make it a program that's done at a lot of different residencies."

Hauser said the residents and the California AFP are reaching out to area colleges for opportunities to help the students with financial aid, admissions processes and finding mentors at the university level.

"I'm excited to see where the girls go," she said.

But that's not all the state's family medicine residents -- and the California AFP -- have been up to lately. What started last year as two residents selling T-shirts with catchy slogans has morphed into a full-fledged movement. Some are even calling it a revolution.

In February 2010, Rachel Friedman, M.D., and Nicole Mohlman, M.D. -- then residents in the Santa Rosa Family Medicine Residency program -- were attending the California AFP's Family Medicine Summit, listening to a speech about the future of the specialty and the need to get more medical students in the pipeline.

"Someone from the audience piped up and said, 'We need to increase the hipness of family medicine,'" said Friedman, who recently completed her residency and will become Santa Rosa's integrative medicine fellow in December. "I wasn't paying attention after that. I was scribbling on a napkin."

By the time the speaker finished, Friedman and Mohlman had five T-shirt designs, and Mohlman wasn't shy about sharing what the two had come up with.

Friedman recalled what happened next: "Nicole stood up and said, 'We haven't really been paying attention,'" she said with a laugh. "We've been at work because we have an idea to increase the hipness of family medicine. We want to launch a family medicine T-shirt revolution. Everyone clapped and was excited."

Several people were ready to buy the T-shirts on the spot -- despite that fact that they didn't yet exist.

"With the amount of energy created at that moment, we knew the time was right," said Mohlman, who graduated from the residency last year and is working in a community health center in Petaluma, Calif. "It's a very infectious idea."

Before the California AFP's Congress of Delegates a month later, the residents had invested more than $300 in their first two T-shirt designs. They nearly sold out during the March event.

Although Friedman and Mohlman wanted to do more than sell shirts, finding time to expand the business during residency was difficult.

"We reached out to them at the same time that they were looking for a way to make this happen and developed a partnership with them to promote Family Medicine Revolution," said the California AFP's Langton. "We turned it from just a T-shirt revolution to a bigger concept."

The chapter launched a website dedicated to the initiative, offering information and resources for students and residents. New products -- including more T-shirts and coffee cups -- have since been introduced, and proceeds from sales go back into the Family Medicine Revolution budget, Langton said.

Jay Lee, M.D., M.P.H., of Long Beach, a member of California AFP board, took things a step further when he created the Twitter hashtag -- a way for Twitter users to search for tweets that have a common topic -- #fmrevolution and urged other family physicians to use it.

Physicians in California, as well as those in numerous other states, have picked up on the hashtag, which makes it easy for them to find family medicine news on Twitter.

"We've got a pretty good range of people who are tweeting with that hashtag," Lee said. "It makes the world a smaller place. It makes you feel like you have buddies who are cheering for you and are proud of what we do and what we bring to the health care system."

Another bonus of using Twitter as a communication venue, according to Lee: "It raises awareness among the general public in a way that Facebook doesn't," he said. "On Twitter, most accounts are wide open."

All of which ties directly into what Friedman and Mohlman had hoped to accomplish when they partnered with the California AFP. Friedman said there are three goals for the revolution:

"We're trying to reverse that notion that medical students are still told that, 'You're too smart for family medicine,' which doesn't make any sense because you need to know more to be a family doctor than to be a (sub)specialist," said Friedman.

And just to be sure the revolution doesn't go the way of the dinosaurs, the California AFP made the initiative one of its strategic priorities this year.

"I'm very excited that our point of view is shared with CAFP," Mohlman said, "and shared at that level."