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Thursday Mar 18, 2021

Six Ways to Practice Family Medicine

(Editor’s Note: For Match Week, we asked our new physician bloggers to share how they practice family medicine and what they enjoy about their respective niches. Their answers offer a glimpse at the breadth of the specialty.)

[man choosing between three doors]

Health Policy and Politics

I still remember my Match Day in 2016, seated at a table with friends and family, waiting to find out where I would be traveling to start residency training. My entire focus was on the next three years, so I hadn’t thought much about what would come after my training was completed.

On the interview trail many people asked me, “What is your five-year plan?” or “Where do you see yourself practicing after residency?” My answers focused on what type of clinical care I wanted to provide. For the most part, I was right about that part of my career.

Five years later, however, I realize there are entire aspects of my work that I never imagined. I spend 50% of my time in clinical care and residency education; the other 50% is spent trying to fix the U.S. health care system.

After seeing the inequities and inefficiencies of our health care system firsthand during medical school and residency, I completed a one-year fellowship in health policy and politics. I still spend large portions of my time at the state capitol working with legislators to craft and respond to health care legislation. I work to find policy solutions to physician workforce issues and payment reform with the Farley Health Policy Center.(medschool.cuanschutz.edu)

I also teach medical students and residents about the intricacies of how health policy affects patient care and outcomes. During the pandemic, I have had the opportunity to run a telemedicine educational program that keeps primary care clinicians across Colorado up to date on COVID-19.

I never could have imagined a more perfect balance of clinical work, education and health policy. Have a five-year plan, but be ready for it to change and evolve.

Kyle Leggott, M.D., Aurora, Colo.

Taking the Lead

My first medical director muted her desktop notifications during our one-on-one meetings. She shared positive patient feedback with me and found stretch projects that interested me. She even sent me my favorite succulents on my work anniversary. She was attentive and caring, and she was the person who unequivocally supported my journey into leadership.

Physician leaders not only inspire their teams, they make individuals feel supported and heard. They unlock potential. They coach us to reach beyond what we think is our best.

Oh, the places you’ll go in family medicine!

Family medicine offers a diverse range of both patients to care for and practice settings. Additionally, the type of the work we do as family physicians can vary, and that includes leadership roles.

As family physicians, we are often best positioned to be leaders on a team. This can mean leading an office team, chairing a committee or serving as a high-level physician executive in a health system.

At my primary care organization, I serve as the regional medical director of our West Coast markets. In addition to direct patient care, I have the opportunity to drive quality care and service. I collaborate with cross-functional teams ranging from product, data analytics, access, operations, recruiting and even global supply chain. As a leader, I get to think about how to design processes to meet the needs of our patients and team members. At the highest level, I am always thinking about how we can provide the best quality care to more than 500,000 patients who depend on us.

But the most important thing I do as a leader is support others the way my first medical director supported me.

Congratulations to the candidates who matched into one of the most versatile and exciting specialties — family medicine!

Natasha Bhuyan, M.D., Phoenix

Full-scope Fulfillment

During my second year of residency, while I was in my HIV continuity clinic, a third-year resident told me, “Watch out or the only patients you’ll have are women, their babies and LGBTQ patients.”

I didn’t respond, but I was actually really excited at that prospect.

Seven years later, my panel is mostly women (and their children). I am the director of women’s health at a federally qualified health center and do the majority of family planning, colposcopy, ultrasound and prenatal care. I share the gender-affirming care panel with one other physician, and I’m the lead clinician for pregnant patients with opiate dependence in our outpatient-based addiction treatment program. My panel is diverse, and I get to speak two or three languages a day.

I am fortunate to be able to train Boston Medical Center family medicine residents in my clinic, as well as Boston University medical students.

When I’m not spending my 20 hours a week in my clinic, I am both a hospitalist and a laborist at Boston Medical Center. I cover labor and delivery for an average of one shift a week, and I do full-spectrum obstetrics, including cesarean sections and high-risk pregnancy care.

In some ways I feel like I’ve extended residency because I still get to do everything! I may still work longer hours than many of my colleagues who have chosen to narrow their career adventures, but they are hours that I enjoy.

In my third year of residency, a co-resident warned me, “You won’t be able to do everything forever!” She may be right, although I can’t imagine changing my scope. I get to work with so many teams at the hospital, giving me a larger practice community. I get to work with the most fun residents and medical students across a diverse scope of care. It keeps me engaged and excited to go to work, and fulfills my purpose of treating every patient to the best of my abilities.

The last 12 months have shown how important full-scope family physicians can be to an emergency response. At Boston Medical Center, family physicians were found in every corner, helping with hospitalist teams, palliative care teams, obstetrical teams, urgent care and our longer-term respite and recovery sites. Choosing family medicine was just the start of the adventure. Finding the right job has supported my scope and strengths and been key to maintaining my balance and happiness.

MaryAnn Dakkak, M.D., M.S.P.H., Boston

Power to Implement Changes

It started with a few email requests.

“Hey, do you think you could add this line to this template?” or, “Can you move this text box a little higher?” were the frequent types of questions I would pass to the “provider champion” of our EHR system. I could tell she was weary of my requests after a while, but she sensed that I wanted to make our EHR work better for everyone. When she left our organization, she happily passed the “champion” baton to me, and so began my foray into clinical informatics.

Like many others who end up in this field, it was a process of either volunteering or being “volun-told.” In the early days, when hospital systems were transitioning from paper to electronic records, they would often assign a physician to have some clinical guidance in the migration process. Out of this, the titles of “EHR provider champions,” “information officers” and then “chief medical information officers” were born. The responsibilities of these positions vary among organizations, but the essential purpose is the same: to serve as a bridge between the clinical and technical worlds.

My humble beginnings as an “EHR provider champion” has progressed to CMIO, which has opened up new ways to enrich the clinician experience with our EHR. Honestly, it’s been a lot of fun. I have balance, still helping patients as a family physician, but I also get to use a different part of my brain to think more broadly about how our health care applications make an impact.

So if you find yourself frustrated with your EHR, rather than yelling at your computer screen, why not consider diving into clinical informatics? From here, you not only have a voice to recommend much needed changes in these systems, you have the power to make them.

Luis Garcia, M.D., York, Penn.

The Joy of Teaching

“What’s your typical weekly schedule?” is a common question I get from medical students who shadow me in clinic.

“It’s such a fun mix! Let me tell you about it,” is my common reply, prepared to demystify what academic medicine truly is.

My morning could be spent discussing patients with residents who are scheduled for behavioral health clinic while the afternoon involves catching up with my own clinic patients. Sometimes the precepting sessions involve supervising clinic procedures like joint injections or skin biopsies. Certain half-days, labeled academic time on my calendar, I consider blank canvases. Whether it’s meeting with my resident advisee and discussing their fellowship application, preparing a mystery case for the didactics conference or participating in a research Zoom meeting, this gives me dedicated space for education, research and administrative tasks. It is not as neat as it sounds on paper — there are plenty of workdays that stretch past 5 p.m. (sometimes even late nights when I’m on the inpatient service), but it’s worth it.

I pursued academics because it gave me a chance to experience all the aspects that I love about medicine — variety in patients, practice setting (inpatient and outpatient) and schedule; the privilege to teach and learn from others; and unique leadership and mentorship opportunities. I have enjoyed watching interns transition to senior residents, balancing patient care with teaching responsibilities. I look forward to discussions about how to improve rotations, residency wellness and competencies with other faculty members. I relish watching medical students take ownership and make plans for their patients. I found joy in work as an academic physician and it has continued to gift this joy even as the pandemic continues.

To all the students who are about to find out where you will train, cherish the moment and celebrate your accomplishments. Be open as you go through your rotations and take note of what you love most about medicine. Family medicine provides a path for everyone. I hope you find yours and that our paths cross in the future.

Astrud Villareal, M.D., D.I.M.P.H., Dallas

The Autonomy of Self-employment

I didn’t choose family medicine so much as it chose me. I have always been passionate about everything pertaining to health beyond the actual patient-physician encounter. I love thinking about health systems design, about the communities in which people live, and about the daily behavioral decisions that impact 99% of a person’s long-term health.

In that vein, I was also somewhat judgmental of specialties with high prices and limited scope. (It seemed almost wasteful to spend a decade training someone who couldn’t provide a breadth of services to help society.) Solidifying my specialty choice was the fact that I was able to secure a loan early in my training that allowed for complete forgiveness of the cost of my medical schooling; I just had to work for four years in an underserved county in Kansas after residency.

With the relative freedom from my loan burden, I was able to design my career upon residency graduation. I started moonlighting in various rural ERs and hospitals across the plains states. I opened a direct primary care practice in the urban center of Kansas City. I developed connections that spanned from the neighborhood in which we’re based to tech companies on either coast who are trying to make health care better.

My career path has also given me something unexpected: the autonomy of self-employment. For better or worse, I am in charge of what I do on a daily basis. I get to make the decisions — in the moment — for what is best for my patients, my community, the health care system, my family and myself. I don’t have to negotiate with — or work within — large bureaucratic systems. If a vendor or entity misbehaves, I am able to leave that relationship. I don’t have to waste time with the broken status quo, and I have eternal (but guarded) optimism that we can make health care better for all by starting from the bottom up.

Do I work hard? Yes, every day.

Do I work long hours? Yes, often.

Is being a doctor hard? Of course.

Do I find my work rewarding? Yes.

Do I love that I have created a clinic where physicians can have actual work-life balance? Yes.

Am I honored that patients love our clinic? Yes.

Do I enjoy lending my expertise to make our communities better? Of course.

And even though family medicine picked me more than I picked it, would I pick a different specialty if given the chance? Never. Not a chance. I love what family medicine lets me do.

Allison Edwards, M.D., Kansas City, Kan.

AAFP Resource
2021-2022: Strolling Through the Match Guidebook

Posted at 06:00AM Mar 18, 2021 by Kyle Leggott, M.D.

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