There are certain stories in life that are so consistently true they're retold ad nauseam: pretty people rule high school; first dates are awkward; working in a cubicle is suffocating to the human spirit; blind dates are awkward; most of college is spent drinking and trying to get laid; dating is awkward. These are the stories from our own lives that we laugh about with our friends and cry about when we're alone. While less prevalent in the world at large, all third year medical students have their own set of universal tales of woe. The two major themes are our clinical mishaps (the time I wanted to press the "nurse assist" button but instead pressed the "patient has no heartbeat" alarm) and general lack of respect for our status as a human beings (residents, attendings, and staff who either abuse us or treat us as though we do not exist).
And while I've found that many attendings are not necessarily inclined to take time out of their busy schedule to teach, they are willing to take the time and reinforce their superiority. For every time that I've been genuinely mentored by a physician and asked what I hope to do with my career, I've also been sneered at, "So, what do you want to do when you grow up?" At first the over-achieving part of every medical student wants to hedge their bets and attempt to make a good impression by reporting back the same exact specialty as the inquiring physician. You even probably convince yourself that it's a possibility so that you don't have to be a liar. But as my third year continues I've lost the heart to muster up fake sincerity. These days I just state, "family medicine." Usually I tack on a weak, "... but I'm keeping an open mind."
It's at this point that attendings seize the moment to share their wisdom. They all start with the cursory nod to family medicine, "Primary care is really important. They need good people." With those niceties out of the way, they then point out the various reasons why I'm about to make a mistake. Firstly, "Unless you're in a rural area, family practitioners don't get to do anything but refer people." And secondly, "Nurse practitioners and Physician Assistants are taking over outpatient care; it's best to specialize because you'll always have a distinct skill." This statement subtly implies that outpatient medicine is not complicated enough for professionals of our caliber. Sometimes they even appeal to my ego and imply that I'm "too good" to become a family physician. And though it's never explicitly stated, we both know I'm choosing a path that will pay far less than the overwhelming majority of other specialties. While I sit there politely and try to behave like the perfect mentee, my own mind is in a state of panic.
And while I've found that many attendings are not necessarily inclined to take time out of their busy schedule to teach, they are willing to take the time and reinforce their superiority. For every time that I've been genuinely mentored by a physician and asked what I hope to do with my career, I've also been sneered at, "So, what do you want to do when you grow up?" At first the over-achieving part of every medical student wants to hedge their bets and attempt to make a good impression by reporting back the same exact specialty as the inquiring physician. You even probably convince yourself that it's a possibility so that you don't have to be a liar. But as my third year continues I've lost the heart to muster up fake sincerity. These days I just state, "family medicine." Usually I tack on a weak, "... but I'm keeping an open mind."
It's at this point that attendings seize the moment to share their wisdom. They all start with the cursory nod to family medicine, "Primary care is really important. They need good people." With those niceties out of the way, they then point out the various reasons why I'm about to make a mistake. Firstly, "Unless you're in a rural area, family practitioners don't get to do anything but refer people." And secondly, "Nurse practitioners and Physician Assistants are taking over outpatient care; it's best to specialize because you'll always have a distinct skill." This statement subtly implies that outpatient medicine is not complicated enough for professionals of our caliber. Sometimes they even appeal to my ego and imply that I'm "too good" to become a family physician. And though it's never explicitly stated, we both know I'm choosing a path that will pay far less than the overwhelming majority of other specialties. While I sit there politely and try to behave like the perfect mentee, my own mind is in a state of panic.
For the most part, though I sound bitter and sarcastic, these conversations are usually quite sincere and kind. In fact, it's only the attendings who actually care that spend the time to discuss these things with me. The attendings that don't give a shit, just nod and continue ignoring me. Like all people, I respond well to people who care about me and want to agree with them. And though there are days where I think I know more than I'm given credit for, I still recognize that these are people with decades of experience as medical doctors. This, combined with the fact that that I actually have enjoyed all of my rotations, makes me long to want to follow their advice. What a happy coincidence it would be if it just so happened that I loved implanting pacemakers! Not only would my work be fulfilling, but I'd also be joining the ranks of a highly respected and specialized field. Oh, and I'd make bank while doing it. And though I can remind myself that there is a whole profession of doctors who have chosen family medicine and have not ceased to exist, I have to admit that it can be quite anxiety provoking.
As the fugue continues it becomes harder to play along and it only becomes more clear to me that family medicine is my calling. However, it doesn't mean that there aren't uncomfortable truths that can be unsettling. NPs and PAs are quite competent and as we continue to scrutinize healthcare spending practices, I think it's clear that more and more basic clinical work will be delegated. In fact, a hospitalist once said that he suspected that all of outpatient primary care could be done by NPs and PAs. As the nation debates changes in healthcare delivery and the numbers of NPs and PAs grow, I can't help but wonder if I'm choosing to go into a field that will soon be obsolete. And an even more uncomfortable thought, "If I wanted to do outpatient primary care, did I go into the entirely wrong profession? Should I have become a PA? And if that's the case and I had known that to begin with, would my pride and sense of prestige have allowed me to do so?" Then again, how could a PA be interchangeable with a MD if we spend so many more years in training?
As the fugue continues it becomes harder to play along and it only becomes more clear to me that family medicine is my calling. However, it doesn't mean that there aren't uncomfortable truths that can be unsettling. NPs and PAs are quite competent and as we continue to scrutinize healthcare spending practices, I think it's clear that more and more basic clinical work will be delegated. In fact, a hospitalist once said that he suspected that all of outpatient primary care could be done by NPs and PAs. As the nation debates changes in healthcare delivery and the numbers of NPs and PAs grow, I can't help but wonder if I'm choosing to go into a field that will soon be obsolete. And an even more uncomfortable thought, "If I wanted to do outpatient primary care, did I go into the entirely wrong profession? Should I have become a PA? And if that's the case and I had known that to begin with, would my pride and sense of prestige have allowed me to do so?" Then again, how could a PA be interchangeable with a MD if we spend so many more years in training?
i am jealous of the brilliance of xkcd all the time
My girlfriend once made the comment that healthcare actually misuses PAs and NPs. All too often there are more MDs than PAs and NPs in a clinic and really it should be the other way around. And ultimately it was this comment and the world of business that has saved me. I was munching on three different types of macaroni and cheese at a soul food themed wrap up for the annual Net Impact conference and catching up with a friend from college that I hadn't seen in years. When she asked me what kind of doctor I hoped to become, my usual answer, suddenly flew off with enthusiasm. It occurred to me that as doctors, because our jobs are traditionally to cure disease, we're often in the mindset of overcoming obstacles. However, surrounded by progressive business people, I realized that to them, obstacles were opportunities. Suddenly I grew excited about the prospects of Family Medicine and the possibilities for change.
When studying social movements and why they take hold, the old school of thought was that people rose up together when the situation became so oppressive that it was unbearable. However, after further study, it's become clear that history has not followed that pattern. In fact, social movements ignite when people feel like there's a chance for change. In other words, optimism is required. And it finally dawned on me. The current turmoil of primary care, the changes in the way we practice and who practices, and the political landscape of healthcare reform scare me because my future is unknown. I'm selecting a profession based on what it looks like now even though it will probably be drastically different by the time I actually start practicing. On the other hand, for as long as I can remember, I've dreamed of starting a revolution. This might be my chance.
When studying social movements and why they take hold, the old school of thought was that people rose up together when the situation became so oppressive that it was unbearable. However, after further study, it's become clear that history has not followed that pattern. In fact, social movements ignite when people feel like there's a chance for change. In other words, optimism is required. And it finally dawned on me. The current turmoil of primary care, the changes in the way we practice and who practices, and the political landscape of healthcare reform scare me because my future is unknown. I'm selecting a profession based on what it looks like now even though it will probably be drastically different by the time I actually start practicing. On the other hand, for as long as I can remember, I've dreamed of starting a revolution. This might be my chance.
