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Now and Then


Nancy Baker2017.JPG

Nancy J. Baker, MD

We travel
in two dimensions,
living in time and place
experiencing life and death.

Now and here
or then and there.
What about now and there
and then and here?

Pancreatic cancer
means then is now,
there is here

Old age
implies then, not now,
remote from here
and unimaginable.

What if we live
as if today is our last?
Is now forever
and there everywhere?

The paradox of
now there and then here.
Impermanence means
take nothing for granted.

Heaven on earth
now and then,
here and there.

The Joy In Family Medicine


Anthony Tam, MD
University of Michigan FMR

When I look back and think about who I thought a doctor was when I was a kid, I imagined that person taking care of kids, adults, and even pregnant mothers. I saw them as a primary responder for minor injuries and illnesses or even for acute processes. And I looked up to these role models and hoped that, some day, I could be that doctor and role model for others. It wasn’t until medical school that I figured out the role model I looked up to was a family medicine physician.

After doing my clerkship rotation in family medicine, I knew this was the field I wanted to enter. A specific patient I had talked to at the clinic was “Mary”.  Mary had come in for a follow-up on her thyroid medication. Routinely, I went in before the resident I was working with to talk to “Mary” and discuss any issues she had. She suddenly burst into tears about how she has been feeling sad and giving up on life. However, after a long discussion about how much good she had done for her family, kids, and community, she came to the conclusion that she deserved to be alive and should continue helping others.  When my resident came in to review what we had discussed, the first thing “Mary” said was, “Will this be the doctor that will replace you when you are gone?  I felt so comfortable talking to him about my troubles in life and really hope that I can continue seeing him in the future for my care.”  It was this moment when I knew that family medicine was the career path for me. I wanted to be that doctor that builds trust in relationships and provides the care that any person needs, regardless of their economic or social situation.

Family physicians present themselves with great confidence, leadership, and sincerity.  They exude confidence by helping patients make informed decisions on preventive care.  They show true leadership in working with not only other doctors, but also the staff that helps run the clinic. And most importantly, they show true sincerity in making sure each patient feels as though they are being seen by a doctor that cares about them.

How do I know that I chose the right profession?  Fast forward now to my second year in a family medicine residency where I am looking forward to the days I have clinic so I can see the patients I started seeing as an intern. The staff I work with make me smile every day I’m here and I enjoy the time I spend in clinic.  I exit each room with my patients laughing and catching up with their lives as I walk them out to checkout.

The great, long-lasting relationships and trust developed with a patient and the continuity of care are priceless. I am so happy to have matched into an amazing family medicine residency that helps me become the doctor whose hand patients can hold in a time of sorrow, the one who encourages them to make the right lifestyle choices, or maybe even the one who takes care of an injured athlete on the field. I am more than eager to continue my time here with Michigan Medicine.

Top Ten Tips for Getting Promoted


Sarina Schrager, MD, MS

I can still remember charging my old PalmPilot in order to page through week by week, trying to find the dates of all of my lectures. I was preparing for promotion and felt overwhelmed because I had not kept track of all my work each year. Now I had to collate years of academic projects and lectures, from memory! I knew I was not alone as many of my colleagues were lamenting about the same collection process. The Women in Family Medicine Collaborative has recently collected some tips for promotion which form the basis for this blog post. These tips are geared for people at medical schools, but many will also be applicable for community program faculty as career development. Thank you to everyone who contributed to the list.

I tell the junior faculty in my department that the members of the promotion committee are nice people, people just like you and me, and they want to help you get promoted. No promotions committee gets together and sets a goal of denying people promotion. They want you to succeed. That said, it is your responsibility to be productive, keep organized, and prepare all the materials necessary.

#10—Read the promotion guidelines for your institution. I am calling this number 10, but in reality it should be the first thing that you do after you get hired. Every institution is different. Every tract is different. You need to know exactly what is expected and required for you to get promoted. And re-read these every few years, as medical schools will periodically revise the promotion guidelines

#9—Get organized. After reading the promotion guidelines, get organized! You don’t want to be like me, paging through your calendar to see when you have given presentations and handed in projects. Many people have both paper and electronic files to keep all evaluations, feedback forms, innovative curricula, PowerPoint slides, etc. You may want files titled: clinical, research, teaching, QI, curriculum design, mentees, etc.

#8—Find mentors. Many departments or programs will assign you a mentor or mentors. This is very helpful as you navigate the local system and infrastructure. You may look for mentors in other departments or disciplines, or even look outside your institution for mentors who have similar interests. The STFM Collaboratives and conferences are wonderful places to find mentors as well. Many people have formal mentors (ie, those assigned to them by their department or program) as well as informal mentors (those people you talk to in the hall, or have coffee with a couple of times a year). The Collaborative on Women in Family Medicine has provided me with many mentors through meetings and the listserv—people with whom I have written, presented, and served on committees. Mentors can also be very helpful when you are deciding whether to say yes or no to requests for your time.

#7—Develop two or three areas of scholarship. As family doctors, we all have many interests. But, in order to develop a story about yourself for your promotion, having a few themes makes sense. When you are early in your career, it helps to focus on two or three areas of scholarship. That way, you are able to develop a portfolio of work on each of the areas and demonstrate that you are an expert. Once you are promoted, there is nothing to say that you can’t change your focus and develop two or three different areas.

#6—Make everything count twice. Promotions committees look at quality of work as well as quantity of work. Don’t let your work get lost. Using the same background research, you can transform your presentation into a publication. If you do grand rounds, consider turning it into a review article. If you are working on a QI project, get pre- and post-data for comparison. You may be able to present or write about it.

#5—Keep your CV updated. Some people update their CVs as soon as a paper gets accepted or they do a presentation. Other people have a scheduled time every month, or every 6 months to add new activities. You may want to keep more than one CV—one that is long and includes everything (including students mentored and community talks and activities), and another that is more streamlined. Another suggestion is to make sure to date each CV, so that you always know the most recent one. Some people keep a CV saved on a Google drive so that they can update it from any computer.

#4—Find collaborators who can help increase your productivity. Many of us work with residents and medical students. Take advantage of their requirements for scholarly activity. Also, working with colleagues on research or a clinical review will make the work go faster and be fun. Have an idea for a presentation? Send a message to the STFM Collaboratives looking for co-presenters. It is a great way to meet people who have similar interests (see #2).

#3—Promote yourself locally and nationally. You need to demonstrate that you have a reputation outside your institution. One way of doing that is to volunteer to participate on working groups, committees, or conferences. You can go to your local AAFP chapter or join a national advocacy group. Pretty soon, you will be given more responsibility in the organizations.

#2—Network and build relationships. No matter how introverted you are, networking is a part of our jobs and vitally important for promotion. Most institutions will require you to have at least one “arms length” letter of recommendation for promotion. This is a letter from someone outside of your institution who doesn’t have a vested interest in your promotion. It should not be your residency faculty, or someone you worked closely with at a previous job, but someone you may know peripherally from your time on a committee, or a work group.

#1—Do your job. Do a great job. Follow your passion and successful promotion will follow. Be diligent about scholarly productivity and it will be obvious to the committee that you are a committed, energetic, and valuable member of the faculty.