Medical students, especially those with little exposure to careers in medicine, have great difficulty imagining a career in medicine other than what they see and experience through their rotations.
And shortly after rotations, they are asked to make choices that place their careers on certain trajectories. And while the scope of someone’s ideal practice will grow and change, the choice of specialty defines us in a way that is undeniably powerful and far reaching into our professional careers.
As I wrap up my third year of medical school, what has become apparent to me is that there are two often unnoticed—and often under-promoted—qualities that influence whether a student chooses one specialty over another.
These two qualities are physical and metaphysical. Physical describes the more brick and mortar/billable procedure/patient population aspects students are exposed to during rotations, such as “Is the preceptorship in a small town or a large urban setting?” and “Does this rotation expose students to a wide variety of patient presentations, procedures, and demographics?” The metaphysical is a bit harder to quantify but importantly demonstrates how happy employees are with their chosen line of work. It speaks to the culture of the rotation environment, which, to the student, serves as a representation of the profession as a whole.
Before I began my family medicine rotation, I was most interested in practicing in an urban setting and was excited to be placed in a clinic that served as a safety net for a county hospital population. For reasons related to cost effectiveness, care within this huge county hospital system was streamlined to specialty clinics, and I didn’t get the same exposure as other students rotating in either more rural locations or at an unopposed site.
For example, patients needing a gynecologic exam within this hospital system were referred to a large network of clinics that were staffed by obstetrics and gynecology residents. As a result, I didn’t gain experience in women’s health care during my family medicine rotation. I practiced the gynecologic exam and procedures during my Ob/Gyn rotation only. This differed from the experience of other students in more rural sites, who not only provided well-woman exams, but also participated in special clinics like colposcopy clinics. Based on my family medicine rotation, I would not have believed family medicine offered great opportunities in women’s health.
My family medicine clinic site saw a lot of adults and newborns but didn’t cater as much to children. Since I enjoy working with children and adolescents, I found myself considering a career in pediatrics instead, because I would have not believed family medicine offered great opportunities working with children and adolescents.
I had to take a step back to recognize that although my specific family medicine rotation didn’t give me exposure to certain populations, family medicine as a specialty could still offer me the potential for caring for all my populations of interest.
So how many students go into Ob/Gyn, pediatrics, or internal medicine because their family medicine rotation doesn’t expose them to the full breadth of opportunities family medicine offers? How do we make sure students understand that programs and sites are very different and the scope of practice can vary widely?
The Medscape 2016 Physician Compensation Report shows that 73% of family physicians surveyed would still choose a career in medicine after all their years of practice. No other physician specialty surpassed this continued commitment to their career.
During the third year, I was turned off by internal medicine and Ob/Gyn at my institution, as both of those programs offered poor work-life balance. And in my rotations, Ob/Gyns and surgeons actively told us they were unhappy with their career choices.
But the family medicine residents I encountered at my site were all bright, interested in their work, and always demonstrated compassion toward their patients. I thought, “Okay, these are my people.”
In the metaphysical category, family medicine does extremely well. Yet this metaphysical quality is often overlooked by medical students and under promoted by faculty when students are making a career choice.
Rotations and preceptorship sites should flex both their physical and metaphysical muscles when trying to recruit students into a field with huge growth potential and proven job satisfaction.
great story. i still love going to work 25 yrs into my career. definitely in the metaphysical
Mark Cucuzzella MD, FAAFP
Professor Family Medicine
West Virginia University Department of Family Medicine
Couldn’t agree more. My partner and I just celebrated 40 years together in Family Medicine. The continuity of care and being regarded as a trusted friend and advisor to my patients has been most rewarding. I had never wavered from my desire to be a Family Physician since entering medical school. Luckily my medical school, Creighton, actively promoted family medicine and also I was lucky enough to be accepted to the Santa Rosa Family Practice program which prepared me for a rewarding life in private practice. It may not be the most lucrative of specialties, but the life experiences have been wonderful. I would definitely do it again.
Robert Heckey, MD, FAAFP
Santa Rosa, CA
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I’ve been a family doc for 27 years now–military, small town, small city. Everything from prenatal to hospice and in between. Deliveries, broken bones, minor surgery, ER work. Currently I’m in a small city, working quite a bit with refugees (that’s a carryover from visiting a refugee camp during my military time). I absolutely love it! The medical part is fascinating, but the best part is that I hear stories firsthand that most people read in magazines.
Every day I go home glad to be American and glad to have a chance to serve those who are eager to become Americans.
Great read! I am not a doctor but, having worked with medical students for some 15 years and then spent two years in surgery and more recently joined the Family Medicine team, I most certainly enjoyed your write up. Working with family docs is a whole different world vs. working with stressed out surgeons. It takes a unique person to be a family doc.
Thanks for your commentary, after 37 years i don’t do everything i used to such as ob, neonatology, scrubbing in on my own patients, colonoscopy, vasectomys ect as i have moved to a more urban area although i seem to do much more than my younger counterparts. I will certainly make more of an effort with my med students i precept to try to enlighten them on the wide variety of practice that is avail in a less urban setting. thanks again
David Wheat md
Family Medicine is Comprehensive Medicine – the epitome of primary care medicine!
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I hope we lead.