The kind of revolution we want to join

by Christina on April 22, 2011

Yesterday I posted this on KevinMD. It’s been fascinating to see people’s comments (and a good exercise in non-attachment/ not taking things personally — see some of the highlights below).

It never surprised me when my medical school classmates said they would “never do family medicine.” I knew exactly how they felt: why would we choose to go into a field where physicians are undervalued, underpaid, buried under administrative paperwork, and where patients do not get the time or attention that they need?

Despite the warnings against it, I am pursuing family medicine as a career. And I am not alone: more medical students are doing the same — the numbers matching in family practice went up 11% from last year.

Why? Because we know primary care needs to be better and we want to help change it.

Primary care challenges us to master the full breadth of medical knowledge. With humility, intelligence, and an appreciation for physical, emotional, and spiritual health, more medical students are aspiring to be complete physicians for their patients. Primary care is difficult to access in our current system, and patients want a doctor who understands them and can be “their” doctor.

The residency interview trail provided me with an opportunity to talk with leading family physicians across the country. As I went through this process, it became clearer to me that family medicine is on the brink of an exciting revolution. There is an unsaid manifesto in family medicine that motivates many of us to join the field, and it includes the following:

  1. Change. Family medicine will be leading the implementation of vitally needed changes ahead. As primary care becomes central to our healthcare system, family physicians will be part of new and more effective models of care, such as the patient-centered medical home (modeled by systems like Kaiser Permanente and Geisinger), accountable care organizations, and the growing numbers of direct-pay practices popping up across the country.
  2. Prevention. The focus of our healthcare system must shift away from costly procedures and treatments and towards simple and cost-effective lifestyle changes to prevent many of our modern afflictions (cancer, heart disease, obesity). Primary care physicians are leading the effort to emphasize prevention over cure.
  3. Innovation. New technology and social media tools have the potential to radically improve communication, medical treatment, and patient-education. While the current model is failing in many ways, primary care is thirsting for new ideas and innovations to facilitate their work (such as virtual doctor visits and smartphone apps to monitor patients’ blood sugars and weight).
  4. Relationships. Family physicians create and sustain the health habits of our country through the relationships they cultivate with individuals, families, and communities. Despite the exponential growth in technology, effective doctoring starts with the basic human-to-human relationship, and changes happen through these relationships.
  5. Health-equity. Family physicians are deeply committed to caring for vulnerable and underserved populations. Our challenge lies in designing a system that provides accessible, equitable, and affordable health care to all people, from inner city refugee populations to remote Native American reservations.
  6. Value and centrality to system. As the value given to primary care increases, family medicine will no longer be a field people go into because they don’t have high enough board scores to take the “R.O.A.D. to success” (Radiology, Ophthalmology, Anesthesiology, Dermatology). Rather, family medicine will be what medical students go into because they are at the top of their class. They are drawn by the responsibilities and challenges of handling a medical career central to the healthcare system.
  7. Teamwork. Family physicians get to interact with a large team of people to improve patient and population health: nurse practitioners, physician assistants, health educators, policy-makers, researchers, nutritionists, physical therapists, and more.

Through consistent and long-term relationships with patients, primary care physicians see changes over time, determine when to refer patients to a specialist, and provide preventive treatments that limit future costly procedures and hospitalizations. The entire medical system relies on them.

Many of us came to medical school driven by ideals and passion. Family medicine allows us to transform our idealism into reality. That’s the kind of revolution we want to join.

———-

Here are some favorite comments (check out the post if you want to see more):

“Oh to be young and idealistic. Reminds me of myself 20 years ago. I hope you do not become disillusioned like I have.”


Why would top medical students go in to family medicine when it is also a job that apparently can be done by NPs and PAs, who have a fraction of our education and training? That makes no sense… Yes, unfortunately the FM doc has become the paperwork bitch of the medical system. I don’t see why that would be a reason to go into it.”


“Hat off to you for the idealism and enthusiasm. Ideally, all you said, if implemented, would bring the desire outcome. Nevertheless, we live in the real world, where policy changes, no matter how beneficial it’s impact on society, would not happen unless the key and leading groups are incentivized.”


“Enthusiastic idealist – there are worse things to be called. Make a difference in one life, one interaction at a time. Go for it, Christina.”


“Usually the people talking the loudest like this in medical school are the ones who end up with the ritzy suburban botox and bariatrics cosmetic practices in ten years.”


“German philosopher, Arthur Schopenhauer, “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” Hats off to you being ahead of the curve. Ignore the “Preservatives” (i.e., those protecting the status quo) if you want to effect change…”


I’m having deja vu. Back in the late 70s, when I was in training, there was great enthusiasm for family practice, and I had a number of friends who were just as committed to this way of practicing medicine, looking forward to providing care for underserved smaller cities in my state.

After twenty years, only one was still doing it. The others had moved to the big cities, or gone into a second residency.

I’m not sure we’ve set up the right environment for both patient care and career satisfaction. It sounds like we’re re-cycling the old ideas, and not changing the system that caused it to wither.”


“Best of luck. Live your dream. Provide longitudinal care. Don’t end up pushing paper in a patient centered medical home or ACO where others do the hands on contact and report to you.”

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