By Georgia Kubic, MD
Like many of my peers, I pursued a career in medicine because of nebulous ideals–I liked to help people, loved learning, enjoyed being challenged, and wanted to give back to my community. Looking back, when I made the medicine career decision, I did not fully comprehend the complicated entity that medicine is or what a career in medicine meant. When I discovered this complexity, I needed to find meaning, a grounding point. A pivotal point in choosing my career path came as a result of reading an article “In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices” as part of my Practice Management Rotation. The article highlights practices that demonstrate that primary care can be about more than seeing thirty patients a day and endless charting. That is a big reason I took a position at an Indian Health Service facility in Alaska providing outpatient primary care and gave up the excitement of OB, ER, and inpatient medicine.
Let me tell you about my job. I have a predictable 8-5pm schedule four days a week and one extended-hours clinic day a week. Every four months I work a Saturday clinic. I do not take any call. Our team includes a nurse case manager, a certified medical assistant, and a scheduler. Together we manage a patient panel of a little over 1,300 patients. Each member of the team works to ensure that every one of our patients is up to date on pap smears, colonoscopies, screening labs, chronic disease management, and mammograms. In order to reach our goal of open access and same day appointments, my nurse case manager triages the schedule to manage refills, lab scheduling, paperwork, and approve overbooks. Rarely is my schedule booked out more than a day or two in advance. If I am not available there is a team of nurse practitioners and physician assistants in our clinic available for same day acute visits and ER follow up. Other in clinic resources include a lactation consultant, dietician, integrated PharmD and an insurance resource liaison.
I love it! The majority of patients are scheduled for thirty minutes. This affords me time to spend with each patient. I get the time to learn their stories and better understand their barriers to wellness. I have time to give them my undivided attention without feeling the need to document during the visit. I have three hours of desk time a week to complete paperwork, follow up on labs, consult with specialists and complete notes. I leave work with my work completed and do not take any work home.
The majority of my encounters are emotionally charged and riddled with complicated psychosocial issues. Fortunately, I work alongside behavioral health consultants in the clinic that are available to provide counseling to patients on an as needed basis. They are available for counsel regarding positive pregnancy tests, substance abuse counseling, weight loss, sleep hygiene, anxiety, depression, life stress, and the list could go on. My employer sees the value in focusing on relationships and ensuring that I receive training on how to manage these emotional encounters. In addition to training in motivational interviewing, every employee attends a three day intense conference on the importance of sharing story the Alaska Native culture.
Finally, after four years of undergrad, a year of working while I applied to medical school, four years of medical school and three years of residency I am a year into my first year of practice. I have arrived at my dream. I recognize that this practice type is not a good fit for everyone, but I feel extremely lucky to have a job that I feel passionate about and that allows me to continue to be idealistic that health care can be about people and not just about the bottom line. Mostly, I feel incredibly privileged to be practicing medicine in a way that my altruistic younger self would be proud of.
Georgia Kubic is a former graduate of the Family Medicine Residency Program at the University of Utah.