• Career Q&A with Family Physicians: Life and Work in Family Medicine

    "What is a typical day like for you as a family physician?"

    I have a blend of direct patient care, teaching, and administrative duties.

    "Today, my practice of medicine is an engaging blend of direct patient care with my own patients about 20 percent of my time, teaching about 30 percent of my time, and administrative duties as a department chair about 50 percent of the time."

    As I joke with our residents at times, I am on one long rotation known as family medicine.

    "As I joke with our residents at times, I am on one long rotation known as family medicine. I see patients three half-days during the week, four if you include the half-day that I spend at our affiliated community health center, Westside Neighborhood Clinic.

    The rest of the week is a mix of precepting resident clinic, administrative time and policy work, including multiple MemorialCare level meetings (our residency program recently became one of the practices to join the MemorialCare Medical Foundation)."

    I really enjoy the flexibility of an academic career.

    "I really enjoy the flexibility of an academic career. Every day is different. I see patients 1-2 days a week, teach medical students and residents, work on research projects, and contribute to national health policy discussions about primary care and workforce needs."

    I have a work hard-play hard mentality.

    "I work in my office practice four days a week for about 10 hours a day. I also see patients in our local nursing home. I utilize our hospitalist for inpatient care for my patients, although this is a relatively new change for me.

    I am active with my children's schools and sports activities, as well as with my church. I have a work hard-play hard mentality. I enjoy my work but I work hard, and then after work is my time to spend with my family and friends.

    I am also active with the AAFP and travel routinely for meetings and conferences. I usually take my family with me on these trips so they can enjoy the experience of new cities and reunite with friends in the medical community."

    I have clinic three times per week, teach medical students in five courses, and more.

    "My typical day is a mix. I have clinic three times per week, and I finish my notes soon after every clinic. I teach medical students in five courses -- two classroom-based, two clinical rotations and an elective in Honduras. I also teach residents that take an elective course I offer at the Family Medicine Center. I meet with medical student interest groups, community leaders and other health professionals or faculty members to plan health education activities in the community and to prepare overseas trips for global health experiences. I staff  and work on improving services at our student outreach clinic, as well as mentor and advise students, residents and junior faculty memmbers with interest in my areas of expertise. I work on research projects with students and residents preparing presentations. When not at work or volunteering -- which, believe it or not, happens a lot -- I spend time with my family and friends, playing with my 10-year-old son, watching futbol (soccer), and listening to music. We have two main vacations per year and take a 'stay-cation' for the Holy Days to celebrate Christmas at home."

    Treating patients in the clinic 

    "Each day for me starts around 6:30 a.m. in the clinic. We have unscheduled/walk-in or urgent care hours from 6:30 to 7:30 a.m., and the first scheduled patient on most days will arrive at 8:00 a.m. On Monday, there will be routine appointments until noon.

    There is typically a Monday afternoon meeting with clinical social workers, occupational therapists, patient attendants and nurse case managers, as well as other administrative staff, to discuss significant issues with patients extending beyond office-level clinical care. The meeting will encompass referral management and social issues impacting medical care and treatment for individual patients. Sometimes it will also involve coordination with affiliated hospitals and in-patient facilities and discussion with other providers, such as physical therapists, pain management physicians, surgeons and other sub-specialists.

    Tuesdays, Wednesdays and Fridays are usually reserved for adult medicine/flight medicine patient care until 4:00 p.m. After the morning schedule on Thursdays, however, I head to my church, where I lead a Thursday lunch-time Bible study in an afternoon men's group."

    I don't have a typical day.

    "I don't have a typical day. Mondays I have time to work on administrative and teaching tasks, as well as other official obligations, as medical director for an underserved training track for medical students. Monday evening, I am the primary medical attending at a teaching clinic where medical and pharmacy students see patients in teams as part of the medical students' introduction to clinical medicine. This clinic ends around 10 p.m., so I get Tuesday morning off.

    Tuesday afternoon and all day Friday I work in south Richmond seeing all pediatric patients, most of whom are Spanish-speaking. Wednesday and Thursday mornings are spent working, teaching and administrative tasks, while the afternoons are spent at the faculty practice.

    I try not to schedule anything work-related on the weekends, but we occasionally have community outreach events that take some time. I am trying very hard not to bring work home, though I don't do as well with this as I should."

    You have the opportunity to tailor your life to your values.

    "I spend roughly three days per week in clinical care in corrections: Tuesdays, Thursdays and Fridays. On these days, I spend about half my time seeing patients, 25 percent doing paperwork and the other 25 percent charting and in administrative responsibilities. Since we have built an interprofessional practice in corrections, time for scheduled meetings and regular communications are central to a successful program. Also, since corrections is a nurse-driven program — they are the primary caregivers practicing at the top of their games, armed with protocols and standing orders, and above all, their clinical judgment and experience — I have quite a few nursing notes to sign off daily.

    I also precept our family medicine residents in their community medicine rotation. My two-plus days a week on campus are spent teaching first-year medical students, teaching in our interprofessional education program, mentoring and advising students in our service and community engagement programs, and performing other duties related to my position as the AHEC medical director.

    I work a lot, but I do so by choice. I liken myself to a light switch, either on or off, while my partner, Scott, is more of a rheostat. He winds down with hobbies; I wind down with a nap.

    I take my responsibility as role model seriously, although I don’t always take myself that seriously. In doing so, I remind students you don’t have spend as much time as I do in work-related activities. For me, folding my avocations and vocation into my work time is a good fit. Other people need more boundaries between work, service, fun and other stuff. That’s part of the joy of family medicine, academic medicine in particular: you have the opportunity to tailor your life to your values."

    In a typical week, I see about 100 patients.

    "On a typical day in my office (if any day is truly 'typical'), I arrive at 7:20 a.m. My first patient is scheduled at 7:30 a.m. My day is scheduled so that I finish seeing patients around 4 p.m., though I usually run about 10-15 minutes behind. I have one late night when I stop seeing patients at 7 p.m., and one half-day when I finish at noon.

    Although I answer messages, review and comment on labs, tests and consultant notes and fill out forms throughout the day — either between patients or during my lunch hour — I am usually in my office for one to 1.5 hours past when I finish seeing patients to finish the paperwork of the day. This includes reviewing and signing-off on my mid-level's notes and changes, performing administrative duties, and answering my personal and professional emails. In a typical week, I see about 100 patients.

    Outside my office, I find that it is important to spend time with my family and friends and just enjoy the rewards of my hard work. I am very active in raising my three wonderful children and in teaching them the finer aspects of cooking and using power tools."

    My time is split between practicing medicine and teaching residents and medical students.

    "I'm currently transitioning from private practice into academics, so every day is a new and different one. My time is split between practicing medicine and teaching residents and medical students.

    Due to a strong interest in health care policy and clinic-based research, a moderate amount of time is spent meeting with other organizations and people trying to improve the health care process in our community."

    My days include soul-searching, meaningful interactions.

    "I arrive at the office around 7:30 to start the day, review paperwork, and look at lab results and messages that have arrived overnight. My first patient is scheduled at 7:50 a.m. My practice brings in a variety of insured and uninsured patients. My morning generally starts with about 10 patients: physicals, follow-ups, and acute visits.

    The eighth patient of the morning is a heartbreaker. My 40-year-old female with severe cardiac and anxiety comorbidities. She has a 15 percent ejection fraction after a massive myocardial infarction (MI), is homeless and has been for about eight months, lost her job due to her illness, experiences much anxiety over her health, and has multiple episodes of chest pain during the week. She comes in for a visit and explains how she has eaten her last meal and will have nothing until her disability check arrives in six days. We discuss her homelessness and how she cannot save enough to rent an apartment. I visit our social worker to determine what services I can provide information on, shelters, food pantries, and free community meals. I also meet with our outreach manager to obtain grocery gift cards from our Project Bread program.

    I do this while EKGs and labs are being obtained. This allows her time to rest and lie down instead of sleeping upright in her car. I finish seeing my morning patients, over lunch more paperwork, discuss cases with my two nurse practitioners, then the afternoon begins. Another 10 patients in my schedule.

    My 3:00 patient is an uncontrolled diabetic. He is so depressed he cannot control his diabetes, nor does he care about any treatment. Instead of discussing the diabetes, we discuss what to do about his life and how his family would view his outlook on his decisions for lack of treatment. This is another soul-searching, meaningful interaction with a patient while developing and maintaining the physical patient relationship.

    I finish seeing patients and then complete the paperwork of the day. I am the medical director, so I complete emails and administrative work and finally leave for home about 6:15. I live close by and on my short drive home, I look back at the day and feel good that I was able to listen and help my patients make educated decisions about their health care. I am able to have dinner with my kids and then I finish up paperwork and try to read a journal article or two. I usually fall asleep while reading an article, and my 12-year-old removes my glasses, tucks me in and then he heads off to sleep."

    The afternoon patients required extra TLC today, so I didn't finish up until about 6 p.m. -- late for me!

    "Today was a pretty typical day for me. I started at 6:00 a.m., getting kids up for school and getting ready for work myself. I had a labor induction at the hospital, started last night, that I knew was waiting for me to come in and rupture her membranes, so I felt a little rushed. But, it was my daughter’s eighth birthday, so having donuts and grape juice for breakfast (a ritual in our family) was a must before leaving! I did get a call from the hospital at 7:30, just as I was walking out the door, that my OB’s membranes had ruptured spontaneously and that she was in active labor — hooray!

    I drove to work (about 10 minutes away), dropped off my bag at the office, and headed down the hall to the hospital to check on my labor patient and an observation patient admitted last night for dyspnea and near syncope. I spent the next hour writing hospital notes and planning for discharge of the obs patient. Office hours started at 9:00 a.m. with a full slate of patients, but in the middle of my third or fourth appointment, the hospital called to let me know there were complications with the laboring patient.

    My awesome staff appeased patients in the office and called patients who hadn’t arrived yet that morning to reschedule them as I jogged over to L&D. The baby was showing some signs of fetal distress but a series of interventions led to an improved strip, and the patient was making change quickly. I stayed with my OB patient since the situation was a little concerning and ultimately she delivered a healthy baby boy shortly after noon.

    Next stop was our group’s monthly business meeting to talk to the rest of the providers about financials and practice operations. We managed to finish 5 minutes early and I took the opportunity to take a quick power walk outside (sunshine!) before ducking back to the hospital to check on my mom and baby and make sure the obs patient made it out the door.

    The afternoon patients started at 2:15 and several of them required extra time and TLC today — sometimes that happens — so I didn’t finish up until about 6:00 p.m., late for me!

    My message box is pretty full right now, but nothing urgent, so I headed home for dinner and waited to log back in to the EHR later in the evening to clean out the backlog. I will spend an hour or so catching up on paperwork (actually, computer work) before tomorrow."

    It's hard to predict work hours, so it is a time sacrifice I have decided to make.

    "Currently, I work 8 a.m. to 5 p.m., Monday through Friday. I have an hour scheduled for lunch and an hour of administrative time scheduled each day. However, there are days that I see patients through much of that time or am doing charting, paperwork, etc., through at least part of my lunch hour. As I have gotten more proficient with our electronic health records (EHR), though, I am finding I need to use less of my own time to get work done.

    Although I am not currently working in the hospital, I was until recently still doing some low-risk obstetrics, which takes up more time, especially hours on call. I am hoping to start doing this again soon. It is hard to predict those hours though, so it is a time sacrifice I have decided to make."

    I start my morning in one office, and may travel to another for the afternoon.

    "Currently, I work in a multi-office practice. I start my morning in one office and may travel to another for the afternoon, although some days I'm in the same place all day. Practice varies, some things are routine, then there are the patients that just present a challenge, be it diagnostic or something else in their life that needs help. Paperwork is a constant that frankly annoys us all. Even with electronic medical records, there are still forms that need to be filled out or signed. It's part of the job and you just learn to wade through it.

    As for lifestyle, contrary to rumors that family medicine will not allow physicians to have any free time, I've managed to maintain a very active social and family life. I raised two children who are now on their own, and had time to spend with them while they were growing. Yeah, I missed some things, but not a lot. I'm very involved in all sorts of public service activities. I have time for my favorite hobbies. I'm still a bit of an avid bicyclist and an admitted "mileage junkie." When the weather's good, you'll find me out there riding. I also have a motorcycle which I tour on.

    I'm also very active in medical politics. I've been active in the New Jersey Academy of Family Physicians for more than 20 years. I had the honor of serving on its board and as its president. I'm not as active at the moment, but I still contribute using my experience in various forms of practice and still help develop educational and public service programs.

    The other not-so-typical hobby I have is I go out 2-3 times a week and play blues guitar at various jams. I've been given the stage name of 'Doc Z,' and it's rather humorous when some of the other jammers realize that I really am a physician. In fact, after being inducted as president of the New Jersey Academy, I have the distinction of being the only state chapter president to play guitar in the band at his own induction dinner."