In response to student opinions about careers and FP faculty concerns about bashing FP.
Face it, medical school is about as foreign an environment to FP as possible.
It is not a surprise that those staying with FP are (choose your characteristic)
older, more mature, married, etc., and other indicators of having set their own
course.
It is also no surprise that those who are taken out of the usual curricula and
environment as much as possible, by their choice and ours, chose FP (preceptorships,
missions, community experiences, projects)
I have mixed emotions about current attempts to find "anyone who will do fp"
just as the managed care pressures influenced many to become FP for the wrong
reasons. Those who allow themselves to be talked out of FP by
just might not make good FP docs.
Bob Boyer is one of the best fp and rural speakers you could ever have. It was
my pleasure to work with him at his presentations. No one I know could influence
students and residents in a one hour session better than he.
One of the saddest commentaries we regularly got when the AAFP allowed us access
to students and residents at the annual student resident meeting was from
graduating fp residents. 1 - 2 a year would regularly state something like, "now
I remember why I got into medicine in the first place." Medicine and family
medicine training had all but extinguished their purpose
I do not know where the "missing FP doctors" are now, the ones that we should be
having in our programs and towns and communities, but I suspect some are still
in small towns having returned after a few years of college or even a degree.
Many were so interested in people and service that they chose other careers, not
knowing how family medicine might be a stellar way to serve. Others are in law,
law enforcement, teaching, or counseling.
Many sold themselves short early and did not get encouragement or shadowing or career advice, since they did not happen to have parents that were professionals like many if not most of what would have been their medical school colleagues. Others were on alternate lists at medical schools. Some were cut out when medical schools decreased class size as Fahey, Bauer, and Sachs demonstrated in their article years back.
Those who became FP docs overcame obstacles. Those who would have been fp
docs somehow overcame only some of the many financial, social, educational, and
other hardships that they might have overcame.
Some were stopped by decisions decades ago that led to poor education in inner
city and rural areas. Some lost the opportunity to pursue medicine when their
small colleges folded pre-professional training in the effort to stay open and
survive. Others were discouraged by college health advisors who told them their
grades or scores were just not good enough. Of course they were only responding
to medical school admissions policies that favor the intellectual over the
emotional and spiritual.
Others cared more about their families and other needs. Their awareness of the
messed up world of medical training and practice was far greater than their
potential colleagues who charged in oblivious, and much better than mine. This
is perhaps most sad, because this insight might have translated into needed
reforms, whereas the admitted oblivious are more likely to defend and ignore the
current situation.
I am tired and need to get home. I still think that family medicine is the best career and I am proud and fortunate to be in a state and department that honors this. Like everyone else I wished we had better morale (personally, departmentally, etc.), but sometimes we just need to keep on going despite the turmoil. Those who are repelled by our situation need not apply. May we continue to attract and support those who like challenges and the long term rewards that come with overcoming them.
We should not feel alone however. The challenges facing FP are similar to those facing teachers and other public servants, who also have little support for the sacrifices that they make.
Robert C. Bowman, M.D. rbowman@unmc.edu
See what some thought about transitions to an academic career: