Family Medicine Vital Signs

At a recent conference for medical educators by the Society of Teachers of Family Medicine, Wanda Filer, a past president of the American Academy of Family Physicians asked how many of us in the room had been told we were “too smart for Family Medicine”? At a conference of close to 600 people, a little over half of the participants in the room raised their hands. Which leads me to ask, what are we, as a profession, doing to either bolster or harm the reputation of primary care among students?

Many medical students begin medical school interested in Family Medicine. It is not unreasonable that once exposed to the breadth of options in medicine they might choose another specialty, but how can we best nurture that interest?

We train in this highly populated valley, but we serve a much wider region given that so much of our state is geographically rural and less densely populated. Is there more we can be doing to serve the entire state’s needs? You might expect our school to turn out a high number of Family Physicians given that we are abysmally low at 49th in the nation for lowest primary care physician‐per‐ 100,000 population ratio by the AAMC. However, last year, the percentage of the class that matched in Family Medicine was 10%, and this year we were at 12%.

The medical school with the highest rate of graduates going into Family Medicine, based on three years of data, is at 20%. In a time when projections for primary care are dire, what are we doing to improve our numbers? What is it that pushes a student to choose Family Medicine?

In the last two years, our clerkship was expanded from four weeks to six; this change was driven by student interest. This has given us an opportunity to really showcase our specialty. In addition, many students are choosing to experience a rural practice for three weeks and a more urban experience for the other three weeks, further emphasizing the incredible breadth in our profession. Evaluations have been positive with students appreciative of the flexibility of this option.

Providing students experience through activities sponsored by the Family Medicine Interest group is another way to nurture a budding interest. For our program, this is another way for medical students to be exposed to our awesome residents. Becoming acquainted with residents, so close to their own experience as medical students, allows students to more realistically see what their future as a Family Physician could be.

I would be remiss if I did not mention those practicing Family Physicians that have influenced all of us. We all have those amazing mentors, inspiring leaders that rejuvenate us and remind us why we do what we do. For me, it was Heidi Shields.  When I was a third-year medical student, she showed me that a Family Physician can do it all – deliver babies, deliver excellent patient care both inpatient and outpatient as well as have a family. I will never forget going with her to the wedding of one of her patients in the hospital chapel as the woman was dying from cancer. This woman was emphatic that both of us attend, as we had seen her daily for the last few weeks in the hospital while we worked to manage her symptoms. I will never forget watching this patient stand as tall as she could, Foley catheter bag full of urine covered by the folds of her dress, her eyes fluid-filled as she walked proudly down the aisle. Throughout my powerful learning experience with Dr. Shields, she shone as an example of what I hoped to become. Each of us has the opportunity to be one of those influential people for a student and nurture this interest.

Rather than lament our own past experiences, it is time to move forward and truly spotlight Family Medicine. Let us stand up for what we do and what we believe in: caring for all people through all phases of their lives. I am lucky to be a part of an awesome team in medical student education at the University of Utah; our mission statement encapsulates a goal for us all, let’s “inspire and mentor students to champion Family Medicine”.

Karly Pippitt, MD, FAAFP is the Director of Medical Student Education and an Assistant Professor (Clinical) in the Department of Family & Preventive Medicine at the University of Utah.