Whitney LeFevre, MD
During most of my adult life, I’ve felt called to help close the achievement gap that exists in our country. So I deferred medical school to teach middle school math and science in inner city Baltimore with Teach For America. During my 2 years of teaching, I found that while I loved my students and I loved teaching them algebra and life sciences, I felt called back into the field of medicine. I saw that the best way for me to close the achievement gap was to return to medicine to find ways to address the many social determinants of health that kept my students from success.
In medical school, I was the education director for the MedZou Student-Run Free Clinic. The clinic both teaches medical students the joys of primary care and provides health care to the uninsured. My time at MedZou not only inspired me to become a family physician but also gave me the opportunity to create new programs to teach medical students while providing quality care to those in need. It’s at this intersection—the intersection of helping those in need while also stimulating medical students to be future family doctors for the underserved—where I truly feel I am able to fulfill my calling to close the achievement gap in our country.
In residency, I worked in an urban underserved environment with a predominantly Spanish-speaking population. Our patients had many social issues, including homelessness, addiction, food instability—the list goes on. In a place of great need like Lawrence, MA, I was motivated by how much family medicine was valued there. My patients deserved doctors who are full-spectrum trained and committed to quality, access, and patient-centeredness. And that’s what they got.
Dan Nguyen, MD
I think it’s time for family medicine to rock the boat. Family physicians, and especially family medicine residents, are uniquely qualified to promote quality improvement by standardizing patient care processes.
As a family medicine intern at an urban academic institution, these past 6 months have been a blur of rotations. Every 4 weeks, we start a new service and drink from a fire-hose of learning the intricacies of “how-to-be-a resident.” Our intern training is the most diverse; we rotate through inpatient services in OBGYN, pediatrics, family medicine, internal medicine, general surgery, intensive care, and the emergency department.
For inpatient services, there are common tasks that all residents perform. We answer pages, place admission orders, write progress notes, discharge patients, sign-out the patient lists, etc. We have access to the same electronic medical record, the same resources, and are unified by an academic institution.
What dawned on me is that every service seems to coordinate patient care completely differently. Every 4 weeks, I would re-learn how to do the same types of tasks but with different methodology. The most glaring disparities I noticed were in how different services handle transitions of care, especially patient sign-out.
Kathleen Rowland, MD, MS
Change is here, and more is coming. In medicine, we often perceive change, especially external change from hospital systems or payers, to be a threat. We feel a loss of control, which can lead to anger, resentment, and burnout.1 A survey of 3,000 US physicians done by a staffing company found that 58% of physicians who left medicine in 2013 reported doing so because they didn’t want to practice in an era of health care reform. This is more than stated they left because of economic factors such as malpractice insurance or reimbursement concerns (50%).2 The changes we face can feel overwhelming, and we have to take measures to make the changes less daunting.
Being resilient does not mean that we become pushovers. The goal of teaching resilience to change is to increase the sense that we are able to react to, triage, and adapt to changes while maintaining the core of who we are: physician teachers and healers. We can fight unwinnable battles or choose good ones. We can hold out on changing until the demand to do so is punitive, or we can adopt the change at a comfortable pace. We often do not choose the changes we face, but can choose the way we respond. As we restore that independence, we can reduce our risk of burnout and increase our satisfaction with practice.