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Friday May 30, 2014

Family Medicine: Make It What You Want

Editor's Note: More than 85 percent of new physicians are employed, compared to 63 percent of all active AAFP members. This is the fifth post in an occasional series of blogs that will look at the different roles family physicians can play.

One of the factors that attracts many of us to family medicine is the diversity of practice settings. This can manifest as having the freedom to choose a particular practice location or a certain practice model, but it can also mean choosing to focus on a patient population that shares a common background or set of diagnoses. Yet even though I knew about these variations, I never anticipated being in the type of practice I’m in.

I have learned more about psychiatry and neurology on the job because caring for patients with developmental disabilities required it.

I work at the Neurobehavior Healthy Outcomes, Medical Excellence (HOME) Program in Salt Lake City. It is a novel patient-centered medical home (PCMH) that provides care for individuals with developmental disabilities (DD). We provide primary care, case management and full-spectrum mental health services (psychiatry, therapy and behavioral interventions) for people of all ages who have developmental disabilities. We are an official Utah Medicaid HMO, meaning that individuals have to be accepted into the program, and we receive a per-member per-month capitated payment for each of the nearly 900 individuals who are enrolled. We spend one hour with each patient to allow us the time to address their many needs and to better coordinate with other members of the care team.

I always envisioned myself working with an underserved population, but I never would have guessed that I would be working with this particular group of patients. I did not have any specific training that covered the unique health care problems individuals with developmental disabilities face. In fact, I have had to learn on the job the past couple of years to properly care for them. I applied for the job after it was suggested to me by a residency faculty member who saw an interest and ability that I was unaware I had. He recognized that the way I interacted with patients and the way I thought about medicine in general would be a good fit with this population.

At first, I was more curious about the model of care then the population itself. I had wanted to work in a PCMH so I would have the proper team in place to care for patients, so the idea of working with psychiatrists, therapists, case managers and others strongly appealed to me. But now that I have been working for some time in this setting with oftentimes challenging but always interesting and rewarding patients, I have grown to love it and wouldn’t trade it for any other practice.

My story is not unique in family medicine. Many of us end up in a niche practice based on a specific population need or personal interest. It is obviously a challenge to be an expert in all areas of family medicine, so many of us naturally gravitate to a certain area. And this change often comes about a little more organically than deliberately. But that’s the great part of family medicine -- you make of it what you want.

In some ways, a practice like this narrows my skills. I do not practice obstetrics because that is not a common issue faced by my patients. I do fewer procedures than I was trained to do because many of my patients require sedation in the operating room. I have decided that this is an appropriate trade-off because working with this population has increased my knowledge and skills in other areas. There are few physicians around the country who have a deep understanding of the health care needs of individuals with developmental disabilities. I likely have learned more about psychiatry and neurology than the average family physician because caring for my patients required it. These added skills are an asset I use to teach residents, students and others. If I end up in a different practice setting in the future, these skills can be used to supplement those of others in the practice. I can also retrain in specific areas at a future time if I choose to do so.

There is often some anxiety that accompanies a decision to narrow one’s practice after having received such broad training, but we should not be afraid to tailor our practice to our needs or interests. This is one of the great beauties of family medicine – you’re free to make it what you want.

Kyle Jones, M.D., is a faculty member at the University of Utah Family Medicine Residency Program. He is the director of primary care at the Neurobehavior HOME Program, a patient-centered medical home for those with developmental disabilities. You can follow him on Twitter @kbjones11.

Posted at 03:13PM May 30, 2014 by Kyle Jones, M.D.

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