Why I’m Optimistic About the Future of Primary Care


Previously published on AAFP.org. Click HERE to see the original article.

While shadowing me, a premedical student noticed that I entered the lot number of an IUD into my charting.

“Why do you have to waste time entering that?” she asked. “Don’t you think that IUDs should come with QR codes that can be easily scanned into any EMR?”

Ah, the voice of innocence. Working with premedical students is always an interesting exercise in questioning and clarity.

Every July, a new intern class or medical school cohort begins the journey into medicine. They are often met with a litany of well-intentioned wise words and lessons from seasoned physicians. (twitter.com)

Rather than doling out advice for new physicians — as my colleagues and I did in June of last year — in this post, I’d like to share what I learned from years of working with trainees and why they give me hope for the future of medicine.

Find Purpose in Everything You Do

Many young physicians and trainees don’t measure success based on hours logged. They measure it based on achievements and fulfillment of purpose. This is an interesting parallel to evaluating good health care based on outcomes rather than volume of visits. Millennials find broader purpose in health care through advancing social justice and improving the social, economic, and environmental factors that impact the health of populations. Yes, premeds still ask me about MCAT scores and personal statements. But they are much more interested in the work I do with LGBT populations or reproductive rights. They are engaged by stories about how primary care changes lives.

Collaborative Teams Are the Key to Care Delivery

I volunteer with premed and medical students at a homeless clinic, alongside nursing, physical therapy, occupational therapy, social work and audiology students. Working within a diverse, interdisciplinary team is natural for the students, who recognize medicine as a team sport. They understand that, as Atul Gawande, M.D., M.P.H., recently said, patients need pit crews, not cowboys(freakonomics.com) who want to do it all themselves. Students don’t succumb to traditional hierarchies of medicine, and they listen to and value their teammates. For example, I was once waiting for a medical student so I could precept a patient visit; however, she would not begin until her nursing student colleague returned from the restroom. Given that 44 percent of the millennials belong to a minority group,(www.brookings.edu) it’s no surprise they embrace diversity of backgrounds, experiences, and opinions.

We Need More Mentoring, Coaching, and Development

We used to call it “lifelong learning” — the innate curiosity drive that continually helps physicians grow in medicine. Traditional mentoring structures paired a senior physician with a recent graduate and involved a unilateral transfer of knowledge, ideas and best practices. New physicians still crave mentoring and development, although they expect it to look a little different. According to the 2016 Deloitte Millennial Survey,(www2.deloitte.com) 63 percent of millennials say their leadership skills are not being fully developed. It also found that those who intend to stay with their organization for more than five years are twice as likely to have a mentor (68 percent) than not (32 percent). Health care organizations should try creative approaches to mentoring — such as group mentoring, reverse mentoring, micro-mentoring or coaching — and give new physicians access to developmental tools. This requires a time investment, sometimes away from direct patient care.

Doctors of the Future Are Flexible

Think about how a hospital system implements change. Usually, change starts at the C-suite level after years of conversation and research, then middle management gets engaged, then lower-level champions are included to get buy-in from the field. The process is cumbersome, bureaucratic, and slow. It is often met with resistance. As a result, changes in health care have historically moved at a snail’s pace. But trainees have a different mindset. They are willing to try new processes or workflows in a rapid change cycle. They are happy to evaluate and course-correct. Unlike some of my colleagues, the premeds I work with are not rattled when they arrive at work and the inventory closet has been rearranged or a new EMR product feature has launched. Given their flexibility, we should give young physicians the autonomy to lead change.

Embrace Technology and Innovation

It’s so cliché I almost didn’t want to include that trainees are tech-savvy. Doctors of the future are immersed in technology and connections, with a variety of knowledge at their fingertips. In health care, this is particularly significant as Millennials and Generation Z members have the ability to embrace artificial intelligence platforms, blockchain for health care, the Internet of Medical Things, and more. Changes have historically taken years to take off in health care. As we usher in the digital health age, we need physicians and patients at the forefront of crafting solutions — not just techies.

With these future doctors poised to join the workforce, I’m optimistic about the future of primary care. This July, rather than focusing solely on giving advice, reflect also on the lessons that trainees can teach us.

Natasha Bhuyan, M.D., is a board-certified family physician in Phoenix.

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