There are many unique aspects to being a female physician. Being a female faculty member brings with it another layer of complexity to the relationships with female residents. As a mentor and role model for female residents, we have a unique responsibility to help shape their future. Like it or not, our residents look to faculty as not only teachers of medicine but teachers about life as a physician. And, a female physician at that.
The female residents in my program often seek me out to discuss issues not related to their education in family medicine but related instead to how they want their lives to look after residency or how they can balance residency with their current lives.
The residents want to talk about work-life balance. They want to hear how I do it. How I am involved in my children’s lives. What I do when my kids are sick. Do I cancel my clinic? They want to know how to manage life as a physician and as a mom. Should we treat our own children? How long did I breast-feed? Was I successful in pumping during the day without getting way behind in clinic? Do I work at home? How, oh how do I keep up with everything there is to do in academics? When did I decide to work part-time? How did my patients react to that? Do I sign out my OB patients? What do women think about that? These seemingly small things that we agonize over day to day are vitally important to our residents when they are deciding what kind of job to choose after graduation.
In addition to the mentoring that goes on about work-life issues, female residents want to talk about how to set up their professional lives to be happy and fulfilled. In this setting, we talk about whether to do OB or not, how to decide on part- or full-time status, or whether they should work in outpatient-only jobs.
We also talk about what their practices will look like as a new female physician joining a group and how to develop relationships with nurses and office staff. There are definite gender issues involved in those relationships that are distinct for female physicians, especially young female physicians starting in practice. As a part-time physician and full-time mom, I think that I have the credibility (and nonjudgmental attitude) that allows them to admit that maybe they don’t want to be an “old fashioned family doctor.” I am hearing more and more from female residents (and male residents too) that the vision of their life after residency does not include working all the time, and they feel a bit guilty about that.
Lawyers can look over contracts, but we, as their mentors, can make sure that our female residents negotiate specifically about maternity care, protected time for pumping, and flexible work hours. We can role model starting clinic early so that we can be home with the kids after school or getting coverage so that we can go to a school play. We can role model that it’s okay to say that we are not available to meet on Wednesday nights because of a yoga class. We can demonstrate to our female residents how to communicate our needs and the needs of our families.
As female faculty, we have a responsibility to our female residents to help them achieve their goals. I think our roles as mentors and role models can go a long way in terms of helping them design lives and practices that utilize their hard-earned skills while honoring their life principles.
Posted in Education, Family Medicine Stories, Group on Women in Family Medicine, Leadership
Tagged balance, education, Family Medicine, life, medicine, Mentor, mentoring, Residency, Residents, Sarina Schrager, Women in Family Medicine, work, work life balance
Joseph Scherger, MD, MPH
I attended a health care forecast conference recently and learned a sobering new reality. In the near future, Americans will be getting their primary care services in many different locations.
Walmart has announced that it soon will be offering comprehensive primary care in many of its stores. Walgreens, already the largest provider of immunizations outside the government, will expand its Take Care clinics and manage four common chronic diseases: diabetes, hypertension, hyperlipidemia, and asthma. A longtime colleague and family medicine educator recently went to work for Kroger’s new clinic system, The Little Clinic. Large employers are setting up workplace clinics to provide common health services while keeping their employees on the job.
Discount department stores have already started to dominate certain areas of health care. The most convenient place to have hearing and vision testing and treatment in our area is at Costco. The pharmacies in Walmart, Target, and Costco are gaining market share rapidly over the traditional pharmacy providers. What is to stop these institutions from offering primary care?
All of these nontraditional primary care services are likely to be at lower cost than through traditional providers and be delivered in most cases by mid-level providers. How will a patient’s medical record be kept whole? What is the future of the traditional family physicians’ office? How many of our residency graduates will take positions as medical directors or providers in these nontraditional settings?
There has always been a distinction between a primary care physician and primary care services. The primary care physician, especially a family physician, provides continuity of care through a relationship. Primary care services include preventive services, common acute problems, and chronic disease management. Ever since the emergence of Urgent Care centers in the 1980s, primary care services have expanded beyond the primary care physicians’ offices. Increasingly, the family physician has had to gather information from the patient about what and where they have received various services such as immunizations and procedures. The decentralization of receiving primary care services is likely to explode in the drive to deliver care faster and cheaper.
There are not many answers to this new reality of primary care. Only the patient will be able to keep an intact medical record. One thing that trumps care in a discount store is being available to patients online anytime from anywhere. Calling for the next available appointment will not suffice. The role of the family physician increasingly will be that of a health coach and advisor rather than the mandatory provider of primary care services.
Medical societies will fight against the expansion of primary care and other medical services to different providers, but it is likely that many new physicians will find that joining these convenience care teams is satisfying work. It may turn your stomach now, but your residency program may be giving out a Walmart award at a future graduation. How does family medicine education prepare us for this future?
Posted in Education, Family Medicine Stories, Public Health
Tagged education, Family Medicine, family medicine education, future of family medicine, health, health care, healthcare, medicine, Patient, primary care, Walgreens, Walmart