Students Optimistic About Future of Family Medicine

AAFP News: What do you wish your medical school peers understood about family medicine? How does family medicine align with your career aspirations?

Corey Boggs, fourth-year student at Ross University School of Medicine and AAFP student liaison to the Student National Medical Association: I wish my peers knew about the versatility of family medicine. A lot of times when I speak with people about family medicine, they think it’s a traditional 9-to-5 job in an outpatient setting. Those jobs are necessary, and they do exist, but family medicine can be anything you make it.

For me, advocacy is a big thing. I’ve found that family physicians really keep advocacy and empowerment of their communities at the forefront of what they do. It’s not preventive medical care and then kicking you out the door. Family physicians do a good job with wraparound care and trying to ensure patients get the social services and ancillary services they need to reach their health care goals.

Garrett Kneese, third-year student at University of Texas Health Science Center at San Antonio and Family Medicine Interest Group Network regional coordinator: When I figured out I wanted to do family medicine, I told my peers, “We should really all be friends now.” And my classmates asked, “Why?” I explained, “Because you have to work with me for the rest of your life.” I wish students understood the criticality of getting to know the future family physicians in their class. We are the people you’re going to be taking care of patients with from one level of care to the next. In this way, family medicine is a great specialty choice for those who want to serve within expansive interprofessional networks, which is a career aspiration for me personally.

Hannah Smith, fourth-year student at Brody School of Medicine at East Carolina University and national coordinator of the FMIG Network: From day one of medical school, my classmates knew I wanted to be a family doctor. It’s been a constant conversation ever since. When they say something about their specialty, I say, “Oh, family medicine can also do that, and …” They’re like, “Family medicine is pretty cool. We get it.”

We work with everyone. Family medicine is a holistic, team-based, multi-specialty approach to caring for a person. It’s been unique to see different residency programs that bring in ideas about working with social workers and behavioral health on the interview trail. I’ve told some of my friends who are interested in other specialties, “I talked to this really awesome person who is not a family physician but is an advocate for family medicine because it is so critical to what we’re doing in caring for communities.” It’s been an interesting experience sharing what this interview year has been like with classmates and giving them insight into what family medicine is and why it’s important.

Katie Yu, second-year student at George Washington School of Medicine and Health Sciences and FMIG regional coordinator: I chuckle thinking about my career aspirations when I first started medical school. All of my goals essentially described family medicine. I just didn’t know about family medicine yet. I wanted to do rural medicine, work with underserved communities and provide cradle-to-grave care. On a whim, I attended our FMIG’s first session, “What is Family Medicine?” It was a panel of D.C.-area family docs describing their career trajectories, and I felt the proverbial lock click into place: This is my path. Much like Hannah, I have since essentially become a family medicine saleswoman. There’s so much that I want my classmates (and everyone else) to know about family medicine. To list a few: the places we can go (literally anywhere; I was looking at family doc positions in New Zealand the other day); the procedures; the other clinicians and community partners we work with; and just the “family doctor” community in general.

AAFP News: The Academy recently had a webinar for students with Academy Vice President and Chief Medical Informatics Officer Steven Waldren, M.D., M.S., and other experts in health care innovation (including Lily Peng, M.D., Ph.D., product manager for Google AI Healthcare), who discussed ways primary care changed in 2020. What stuck out to you most about that conversation?

Boggs: Some of the physicians on that panel are not practicing clinical medicine, which again speaks to the versatility of family medicine. It shows the importance of clinical informatics and things of that nature. That session reaffirmed what we all understand: Medicine is developing rapidly and so is the technology to care for patients. When presented with challenges, we are able to rise to the occasion. There will be bumps in the road, but the effort is there and it’s understood that tech will be a major part of meeting the challenges. Artificial intelligence is going to be a standard of care.

In my third-year rotations, one of the family physicians I worked with documented patient encounters using paper charts. My hand would be about to fall off at the end of day from writing everything. But I also worked with a family physician who documented using an EMR. There’s definitely a shift there. We have to be innovative about what’s coming next.

Smith: Dr. Peng found a unique way to use her energy and story to advance medicine. Some of her story was about how it’s so hard for people in underserved locations to get access to health care. In family medicine, there’s a million ways to use that kind of energy. Do you want to go through policy, clinic or use AI and informatics to come at a problem from a different approach? All that’s possible in family medicine.

When Dr. Waldren was talking, he said, “I’m almost jealous of you guys.” That really stuck out to me. Can you image being in his shoes and being jealous of us? He has a great point that we get to see this exponential growth in something that he’s only seen the beginning of so far. He said that currently the speed of artificial intelligence computation doubles every three months, so before I’m a doctor — in five months — it will double again.

Kneese: I have a slightly different angle on this question about how 2020 changed the future of medicine. So much damage was done to our information ecology over the last half-decade. It’s all coming to a head with the COVID-19 pandemic. We’re seeing how disinformation is so widely accepted. That’s concerning to a lot of people, especially in health care, who are seeing how difficult it is to work against. We’ve taken for granted what we expect patients to believe about what is healthy or unhealthy. It’s put family physicians at the front line of being the gentle educator who can hopefully reduce and repair some of the damage that’s been done and regain public trust in health care. There’s more doubt about that trust than we thought.

AAFP News: You’re training at a time of rapid technological advancement, and we’re also seeing health care policy evolve and be debated at a speed that is unfamiliar. Did these environmental factors influence your specialty choice? If so, how?

Boggs: It didn’t influence my choice because I was gung ho about family medicine for a long time. It does make me happy to know that I have the support of technology to better serve my patients. In family medicine, we are gatekeepers of health care. Unless you go to the ER, you’re probably going to see a family physician, who might refer you to another specialty if needed.

Smith: Don’t forget that even if you go to the ER, you could still see a family physician because we work there, too.

When I was on rotations in every other specialty, I would see patients who were battling something that seemed like a systems failure instead of a medical failure. I was like, what is the AAFP doing on this issue? What can local family doctors do? What policy can we change to help this person? Family doctors are well equipped to juggle the needs of anyone in our communities without being limited by thinking, “I don’t know how to address that need,” be it a medical failure or system failure.

AAFP News: In what way do you hope family medicine will change most by the time you finish residency?

Boggs: I hope our payment model is turned upside down. Right now we have a contradiction. People say, “Family medicine and prevention are super important, and that’s what we need.” But the system in place doesn’t support that. Right now people come in with a heart attack and then the patient is managed with cardiac meds after the fact. There isn’t a focus on prevention. I hope in the future, policy and payment will align with health care in the United States, and we practice preventive medicine instead of being reactionary.

Kneese: I would like to see change at the GME level with improvement in training for family physicians pertinent to their integration in the public health sector, whether through partnerships with Area Health Education Centers or better regulatory incentives to take on community health programming. I think that starts with capacity-building at the resident level.

Smith: I think sometimes we struggle with other specialties not understanding family medicine or not being supportive of student choice in family medicine. That’s one thing I’d like to see change.

Yu: My school doesn’t have a family medicine program, so we have amazing community doctors come in and talk to us regularly. One family doctor’s anecdote really resonated with me. We’re in a major urban center where a lot of people don’t understand the value of family medicine. We have specialists literally around the corner for every conceivable illness or issue. This doctor went to medical school knowing she wanted to do family medicine. After acing her board exam, she had a mentor ask why she was doing family medicine with that board score. She said because family doctors should be the smartest people in the room, given all the knowledge we’re supposed to have. That’s so true and has been my mantra as I battled my way through pre-clinical and prepare for my own board exam.

Although a lot of doctors do know how important and how vital family medicine is, I would like to see a broader industry-level recognition that family medicine and primary care are the foundation of our health care system. We have a real sense of pride in our specialty, but as Corey said, I think it’s time that our health care system acts on its rhetoric on the importance of primary care. I hope we can take steps toward actuating this in the next five years.

Smith: It makes it a better experience when you go into a rotation, and they’re instantly accepting with what you want to do. I remember being on my burn rotation and transplant rotations. They were like, “Heck, yeah do family medicine and come learn about burn and transplant.” It allowed me to be a more effective part of the team. That’s how we’re going to help each other in the future.”

AAFP News: You recently went through orientation training for the national FMIG Network. What did you learn, or what deepened your understanding or appreciation about family medicine?

Boggs: I can’t say it changed my excitement or motivation because that was already there. Orientation for me just affirmed my choice. I’ve known through my work with the AAFP that there are thousands of students and physicians who are passionate about family medicine. To be surrounded with so much passion and all these great ideas made me happy.

Yu: Talking about, “What do you love about family medicine” instead of, “Why do you love it,” was an awesome conversation to have. And it was incredible to see all the different ways people want to practice family medicine. In terms of the organization itself, I didn’t realize the scope of resources the AAFP has just for medical students. I’m excited to be a piece in that puzzle.

Kneese: I loved how relationships permeate every aspect of the organization. Everybody knows somebody that someone else knows in family medicine. The AAFP as an organization is so welcoming, and the specialty reflects this relationally-dependent dynamic. That’s something to admire about us.

Smith: I went through orientation last year, and this year I was kind of leading it. What made me appreciate family medicine this year was just how truly diverse family doctors are. We all came to the same conclusion on the topics we wanted to address. We all love the same specialty and are here to support it, but the conversations look so different. The backgrounds everyone has really influence how they want to change, impact and improve medicine for students. It made me appreciate the differences we see in each family doctor and each student.

AAFP News: In that orientation meeting, AAFP EVP and CEO Shawn Martin mentioned the recent fee schedule updates and the largest increases in primary care payment in decades. What does that mean for students considering their specialty choices?

Boggs: I don’t know if the increase is substantial enough that there’s going to be a wave of students who want to be family physicians, but I think it shows promise. If we can continue that momentum, I think we’ll see a change commensurate with the number of people choosing family medicine. As one of our colleagues said, if family physicians were paid as much as orthopedic surgeons, we wouldn’t be having this conversation.

Smith: It’s not going to create a big influx of people, but I do think it allows people to feel more confident in their choice. A lot of times the conversation is, “My student loans are so high. It could be until my kids are in college before I pay them off.” This means we have one more burden relieved with student load being able to be paid off, with the larger focus on payment reform.

Kneese: For undecided folks going forward, this signals momentum in the right direction. I don’t think there’s ever going to be a hungry doc, but I do think there’s some catching up to do for primary care. If you want to answer the call of your community, go into primary care.

Yu: It’s more about recognizing our own worth and the value of services we provide. What you’re paying for in family medicine isn’t procedures — although family physicians can do procedures — it’s the relationships that happen over a lifetime. Unfortunately, relationships are difficult to bill. I hope it eases the psychological and financial burden that many medical students and doctors bear, but I think we still have a ways to go before it seriously impacts specialty decision-making.

AAFP News: What motivated you to take on a national leadership role to help build the workforce for family medicine?

Boggs: I had leadership roles in SNMA, which focuses on the needs of minority medical students. It’s not specific when it comes to medical specialties. It was an opportunity to engage with two organizations I love — the AAFP and SNMA.

Kneese: I got my first real taste when I applied for the Pisacano scholars program last year. Meeting family medicine leaders through the process revealed how small the world of family medicine can be, even at the national level. During my interviews, I learned so much about the relationships held between mentors of mine I’d thought were disjointed. The interconnectivity was palpable, and I loved that feeling. Thus, when the call for national leadership came, and I said yes knowing I was joining a family of practitioners.

Yu: As an undergraduate, I was a geology major. I loved learning about the planet — and still do — but the real draw was the incredible camaraderie and support between faculty, staff and students. Coming to medical school, that sense of community was something that I really looked for. I found it with my school’s FMIG and I wanted to make sure that feeling was scalable. When our MS4 leader told me about her experience as a regional FMIG coordinator, it seemed exactly like the type of opportunity I was looking for.

Smith: I had pleasure of meeting (AAFP Manager of Workforce Development and Student Initiatives) Ashley Bentley and (AAFP Board Chair) Gary LeRoy when they came to my medical school. They were so inspiring and cared so much about what was going on with students. I knew taking on a leadership role wouldn’t be something that overwhelmed me or added to the stress of medical school but would be something that filled my cup.

I was so inspired by leaders in my state who championed student voices and advocated for things that were important to students and their ability to choose family medicine. When I went to National Conference, I saw that times 100. Everyone there at the congress was sharing their opinions and were so well spoken and inspirational about the specialty I already loved. I wanted to be able to do that for someone else. I’ve loved every day since.