Family Medicine - Evolution and Rewards

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Surgery was my passion. I worked very hard to earn a position with a surgical residency at a top-100 hospital. Six months before I was to start my own odyssey (a la Grey’s Anatomy), I learned that my first child (unplanned) would arrive at the same time. I couldn’t give both my all. It was a no-brainer; I chose my son and family medicine, and I found more fulfillment and adventure than I’d imagined. In many ways, more than I would have found in surgery.

There was a time when family medicine was the poor and battered stepchild of the “real” specialties. The medical establishment opposed creating a new specialty that would fill the need left by the rapidly dwindling number of general practitioners (physicians can be stubborn and territorial, just like any other animal). Students were concerned that the broad body of knowledge required was too great. Family medicine was devoid of prestige, even ridiculed. However, with hard work, determination, and lots of documentation, it was demonstrated that family medicine and family doctors achieve better health outcomes at lower costs.

In 1969, Family Practice became the 20^th designated specialty. In 2005, the specialty was renamed Family Medicine. The American Board of Family Practice became the American Board of Family Medicine. “Family practice” is no longer in use, although you’ll see it in the literature, records and resources generated prior to 2005.

If you genuinely, in your heart and head, care for the people who put their wellbeing in your hands, you will be at home in family medicine. If you have doubts that family medicine is the right specialty for you, your patients’ loyalty, blind trust, admiration, faith in you, and invitations to share their most intimate moments and rites of passage will quickly convince you that you chose the right specialty.

The breadth and variety of practices make family medicine a unique specialty. Family medicine physicians:

• Are the only specialists qualified to treat most ailments and all ages.
• Are in the greatest demand. Enjoy being pursued.
• Work an average of 50.8 hours per week.
• Incomes are climbing faster than any other specialty; average salary is $160,000 – $180,000 annually.
• Can practice almost anywhere. About 2000 people can support a family medicine practice. Other specialists need about 10,000 people, and subspecialists need 50,000 people to sustain a viable practice.
• Have flexibility in scheduling – work full or part-time, or share a position with another provider.
• Create a medical “home” for their patients.
• Can branch out into special interests: sports medicine, pediatrics, geriatrics, obstetrics, addiction medicine, preventive medicine, occupational medicine, alternative and complementary medicine, ethics, public health policy, international medicine, travel medicine, authorship, or a special interest of the doctor’s creation.
• Can work in many settings: research, academia – with family medicine residencies and/or medical schools, administration, the pharmaceutical industry, urgent care centers, emergency rooms, cruise-lines, and many others.
• Can find fulfillment in serving the underserved, full-time, or in missions of a day to a year or more.

These facts and statistics are attractive, even persuasive. Why, then, are more physicians than ever before saying they wouldn’t choose the medical profession again? The complaints are valid. Overhead is rising – reimbursement is falling. Then there’s liability, malpractice insurance, and an exploding body of knowledge to absorb. Electronic health records aspire to be one touch and on you go, but I can’t find the menu with “Patient suffering anniversary reaction, one year post teen son lost to cancer. Rendered supportive counseling.”

I can’t think of any profession or occupation which is free of aggravation and uncertainty. I also can’t think of another profession in which you get to hold life in your hands.

I was providing prenatal and obstetrical care for 18-year-old newly-weds, married because their baby was on the way. Discouragement and shame were heaped on them, even by their families. Dour predictions of inevitable divorce and lives ruined were spoken over them, aimed at their youth. I confess that I had similar thoughts, but as I got to know them, I felt a deep peace, a mutuality, between them, rare for couples of any age.

Within minutes of birth, I was seated at the business end of mom, surgically repairing the episiotomy. The nurse asked if they had a name for their daughter.

“Faith Ann,” she told the nurse. “Dr. Coleman believed in us. We’re naming our daughter after her.”

For a moment, a holy moment, I forgot what I was doing. The nurse saw my reaction, and asked if I had known. I opened my mouth, but had no words. I was humbled to my soul; I had not earned such an honor. Through a mist of tears, I finished the mending. Thank goodness the public wouldn’t see the cosmetic result.

It has been said that “Life gives us moments; for those moments we give our lives,” (anonymous). In family medicine, you get to have lots of those moments. Keep plenty of tissues handy - you’ll laugh until you cry, too.

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