Five Stories: Family Medicine Empowering Personal Mission
National Conference Main Stage Delivers Encouragement, Reassurance
Aug. 1, 2023, Scott Wilson (Kansas City, Mo.) — “How many here started medical school during the pandemic?” asked Jen Caudle, D.O., FACOFP, during her July 27 keynote at the 2023 National Conference of Family Medicine Residents and Medical Students.
Hands went up and hands clapped in the audience of more than a thousand students, residents and other members.
“Amazing,” she said. “I can’t imagine what that must have been like. Give yourself a lot of credit.”
That current of recognition and uplift ran through the two rousing, openhearted, sometimes vulnerable Main Stage events of this year’s National Conference, which assembled here July 27-29. Together, Caudle’s keynote and the next day’s Peer Stories panel offered five firsthand examples of family physicians who have not only embraced the specialty, but also personalized it to suit their own interests and goals while amplifying their passion for health care.
Real Connections With Patients
Caudle is a professor of family medicine at Rowan-Virtua School of Osteopathic Medicine, where she is the co-director for the third-year family medicine clerkship and a preceptor for the school’s family medicine residents. She’s also a familiar media presence to millions, having established a brand on TV as well as across social media as “Dr. Jen.” (The people talking about health in the media, she said late in her talk, “should be the people who do health.”)
But there was a moment when the pace and urgency of emergency medicine almost captured her, until she realized how much she hated not knowing what happened to the patients she was seeing. Twenty-three years after she made a referral to oncology for a woman who was living with the pain of a fungated mass in her breast, she still wonders what happened to the patient.
Likewise, Caudle said, a rotation through intensive care taught her that it wasn’t just a variety of maladies she sought; she wanted to see well people, too. And a surgery rotation kept her in basement operating rooms from before dawn until after sunset.
These turns through other possible clinical lives added up to something basic, she said: “I wanted to have a relationship with my patients.”
Here, she cited a very recent example: a patient whose cancer she’d recently uncovered and whom she had sent to the hospital in just the past few days. “No way I am not going to be there on this journey for this family, for this patient I’ve seen for 11 years. So, as I was on my way here, I was texting the son, asking if they need anything.”
Story Highlights
Best Care Anywhere
The four speakers who made up the conference’s July 28 Peer Stories panel each echoed Caudle’s innate sense of mission that found fulfillment in family medicine, starting with the twinned drives to serve expressed by Col. Laurel A. Neff, D.O., M.B.A., M.A., FAAFP.
Neff said her military and medical careers have made real a “child of the 1980s” dream of someone who “lived on reruns of M*A*S*H."
“What drew me about that show,” she recalled, “were the people and the purpose, the band-of-brothers mentality, the idea of being stronger because we’re doing it together.”
In middle school, then, Neff joined the Civil Air Patrol, learned Air Force planes and uniforms and spent winters taking family field trips to the Air Force Academy. Ultimately, though, she “took one trip to West Point and was hooked, but also knew I wanted to go into medicine.”
She rejoined the Army after medical school, returned in 2008 from deployment and began leading a clinic.
“I enjoyed advocating for doctors and nurses and working to improve system for patients,” she said.
Flash forward to today: Neff commands a 240-bed hospital center ready to go anywhere medical care might be needed and missing only a wisecracking Alan Alda.
“We’re 72 hours from putting down stakes to treating casualties,” she said. “Soldiers who join today’s Army inspire me every day to be stronger, make better decisions and learn as much as I can.”
Neff’s talk centered on the inspiration she’d taken along the way, naming several people who had helped guide her decisions and career. Among these, she said, has been Lt. Gen. Telita Crosland, M.D., M.P.H., FAAFP, director of the Defense Health Agency.
“I remember her from my state conference,” Neff said. “She’s an Army family physician and she is leading the way for me.
“I am the product of many mentors and many years of experience,” she said. “And so my advice is that you figure out your passion, put on many different hats to find your focus, find your mentors and lead with your heart. Be all that you can be.”
Stepping Back, Moving Forward
Aisha Harris, M.D., who owns and practices at Harris Family Health, a direct primary care clinic, told listeners how family medicine opened the door for her to perform public health outreach and advocacy work in her hometown of Flint, Mich. — a career she traced back to being “a Girl Scout who loved innovation and exploration.”
She was an undergraduate at the University of Michigan, aiming for a career in pharmaceutical engineering, when an oil company internship in New Orleans made her realize she wanted something different and led her to, as she put it, “take a step back.” At the same time, Harris had been volunteering for Project Lazarus, a nonprofit supporting people living with HIV/AIDS. Returning from New Orleans, she found herself talking a lot about that experience and wondering how to be, she said, “a catalyst.”
The answer: medicine. So she enrolled in Georgetown University’s medical school (engineering degree in hand), then decided that family medicine, with its “head-to-toe problems and generational connections,” was, she said, “exactly what I wanted to do.”
She moved back to Flint in 2020 after residency and immersed herself in patient care. Soon, however, she wondered what else she could do.
“I started thinking I needed to do more,” she said. “I was working in a chaotic place and tiptoeing around the idea that I wanted to do policy work. I felt burned out. I was taking care of people but wasn’t quite taking care of myself.
“So I stepped back again and realized I didn’t have to settle on burnout. And when I reflected on what I really wanted, the idea of opening my own clinic lingered. I dived into learning about medical business: billing systems, clinical management, absorbing what happens after I take care of my patients.”
Direct primary care, she said, “reminds me of the type of doctor I wanted to be when I entered medical school.”
Now, just seven months after opening her clinic, “every single day I am so happy for the change,” she said.
“I wake up with joy and peace, excited to have something of my own. Yes, I take care of my patients, adults and children, but I am able to write a column for a Black-owned Flint newspaper and have a podcast that addresses health disparities. I love sharing information and doing community talks.
“When you grow and change, you adapt to things you didn’t expect to be interested in. I’m a family doctor, an engineer, an advocate, a business owner. The unknown of the future is OK with me.”
Leap of Faith
Tate Hinkle, M.D., M.P.H., M.S., FAAFP, picked up Harris’ thread of embracing uncertainty. He, too, radically shifted his work in recent months.
Last fall, Hinkle went from practicing in a rural clinic to joining Main Street Health in Alabama as its chief medical officer. The company, Hinkle recently told AAFP News, helps practices transition to value-based care.
After his family medicine residency at the University of Alabama Medical Center–Huntsville, Hinkle practiced in Alexander City, Ala., for more than five years, building strong relationships with his patients.
“Jane came to see me one day,” he said, recalling one such person (but changing her name). “Like a lot of rural patients, she was on a fixed income and had multiple chronic diseases. She was distraught. Her insurance had changed, and now her meds would cost so much that she had to decide between eating and affording care.
“I had to do something. So we researched together right then what she could do, what resources might be available, and we made a plan to get her help. Of course, patients were backing up, and that’s the huge conundrum we face sometimes: You want to help them, but it takes time.”
Hinkle’s awareness of this dilemma led him to consider the recruitment offer he’d gotten from Main Street.
“So many things that happen outside the four walls of your clinic impact your patients on a daily basis,” he said. “But it’s hard to address the social determinants of health on top of your day-to-day work. Last year, I was asked to join a startup working in rural America. What we do is work on addressing some of those issues and supporting clinics and taking care of Medicare patients.
“It was gut-wrenching for me because it meant leaving full-time clinical practice. My patients could see in my face the agony of deciding.”
Yet the opportunity to help more patients reminded Hinkle of how he’d arrived at family medicine in the first place.
“I’m from a blue-collar, small, industrial town,” he said. “My family had been there for generations. My grandfather was the first postman in that town. When I was in college, my family physician suggested I shadow one of his partners. I saw someone who really knew his patients, and I was amazed at the breadth of his knowledge, the relationships he’d made over years and years.
“It’s a rare moment when you realize what you are meant to do with your life.”
The recruitment offer had brought another rare moment, Hinkle knew. “I ultimately decided to take a leap of faith and try to do something to affect change. So far, I have worked in my own state plus Georgia and South Carolina, and I’ve been able to help physicians and about 40,000 patients.
“I hope you all understand: Being a family physician can open so many doors for you. We need family physicians in small communities, and we need them in education, government and anywhere else decisions happen. We heal communities.”
Hinkle said he’d seen Jane again since he joined Main Street, and the reunion was emotional.
“Jane and I had both had incredible impact on each other’s lives,” he said. “She springboarded me toward trying to fix the system. Life is like that every day if you’re a family doctor.”
Puzzling Through
When Lalita Abhyankar, M.D., M.H.S., FAAFP, left her first job out of residency two and a half years ago, she told the audience, “I felt like I’d jumped off a train barreling at 100 mph.” That sudden change, and the path she found to eventually becoming clinical director at Carbon Health in San Francisco, formed her story, the session’s finale. Along the way, she solved a big puzzle.
Specifically, she put together a 500-piece jigsaw puzzle she’d picked up while on a walk through her Brooklyn neighborhood shortly after quitting her job at the federally qualified health center where she’d spent the first leg of her career.
“Every piece I put down,” she said, “I heard myself voice a negative self-belief: What are you doing? Why are you doing this? Who said you could leave this job? I stayed up until 3 in the morning to finish that puzzle.”
Crucially, above the static of that doubt, Abhyankar also remembered a 2018 New York chapter meeting where a guest speaker warned, “If you guys don’t do something, artificial intelligence will take your jobs.”
“People stood up and argued passionately that he was wrong, but on the train back home I thought about what I’d witnessed,” Abhyankar said.
Soon, she had begun exploring software design and engineering. “I cold-called tech people and went to meetups and even participated in a design competition,” she added. These steps taught her that the developers shaping health care technology need family physician partners.
“By February 2020, a month before lockdown, I knew I needed to start exploring something different, helping out with some of the tech innovations,” she said. A year later, burned out by the pandemic and temporarily jobless, she found her next phase. As she told AAFP News last week, Abhyankar produced a six-part podcast series for Health Affairs on consolidation in health care and its impact on independent primary care.
“I was scared to jump into uncertainty,” she said. “Medicine had felt safe because it was such a linear process, school to residency to attending.”As was the case for her co-panelists, though, embracing the unknown proved to be the way forward.
Having moved from Brooklyn to the Bay Area, Abhyankar is now a district medical director for Carbon Health, a primary- and urgent-care company operating in more than a dozen states. She also is chair and co-founder of the AAFP’s Technology Empowered Clinical Optimization member interest group and has made a podcast with MIG vice chair Kelly Nieves, M.D., of Temple, Texas, that summarizes the key points of the MIG’s meetings. And she still mentors medical students as a volunteer assistant clinical professor for the University of California, San Francisco.
“I know I can do hard things, make critical decisions, persevere, manage a team,” she said. “And I’ve learned that putting out something energizes me. When it comes to technology: As problem solvers ourselves, sometimes it’s better to define a problem than to find the solution. That leads to collaboration that can get us something more beautiful. Self-trust and self-belief are everything, and it’s a daily practice.”
Abhyankar’s conclusion recalled part of Caudle’s message the previous day.
Family medicine “is one of the hardest specialties,” said Caudle (who has already told her social media followers about her National Conference experience). “We know a lot about a lot, and that matters.”
From the back of the room, a single person’s clap ignited loud applause.