Seeing a family physician at work is valuable for medical students

I recently headed off to a reception for students from the new Pacific Northwest University of Health Sciences in Yakima, WA who are spending their third year of osteopathic medical school in Puyallup, WA doing rotations with the physicians in our community.  I’ve had a student with me recently, and it brings back memories of my third year in med school, and how things have changed.  It also leads me to mull over why I’m choosing to take on this uncompensated work.

In my third year of med school at Tuft’s University School of Medicine in Boston I opted to spend my whole third year at Maine Medical Center in Portland, ME.  Looking back this was one of the defining decisions I made.

It let me see how medicine was practiced in a smaller community than Boston, and in a far more progressive environment.  In Boston third year students were first and foremost unpaid labor, pushing patients to and from procedures on gurneys and in wheelchairs, drawing blood, starting IVs.  They stood on the fringe of large groups of student, resident, and attending physicians hoping to be noticed when they knew something and not noticed when they didn’t.   In Portland there were no 4th year students, so we got to do many of the things the fourth year students did in Boston, and because there were relatively few students, there was staff hired to do the simple tasks like getting patients to places and drawing blood each morning.  I came back to Boston to start my fourth year far ahead of my fellow students who spent their third year in the mecca in many ways, but far behind in understanding the politics and pecking order that existed in the city hospitals.  I felt I had a far better ability to make diagnoses, decisions, and do procedures.  I often was chastised for overstepping my unwritten boundaries finding that students “don’t do that” here.

I have a third year student with me in the office now.  She’ll stay for 4 weeks studying family medicine. It seems odd to have a student so green working in an outpatient setting. In my third year I really never left the hospital for any training.  I met my first outpatients in the few electives of the fourth year.  The experience for my student will be vastly different.  She will have spent most of her time under my direct observation, watching me, presenting cases to me, and hopefully learning from me.  I spent the majority of my time independently seeing patients, checking back with interns and residents, only occasionally with attending physicians, and feeling primarily overwhelmed.  She is protected from this type of learning by immersion, and has far closer supervision than I experienced.

The experience for me was so overwhelming that then I lost about 15% or my not overweight body mass in the first 2 months of my third year, until I realized I’d need to make time to eat and sleep to survive.  The work was simply never done, and there seemed so much to learn that the days and rotations seemed too short.  My student comes to the office at 8 AM, and leaves by 6 PM.  I rarely showed up after 6 AM, and never left before 6 PM.  I was on call every 3-4th night, and so far I don’t see that she will be on call at all, at least on the FP rotation.  Was my experience more intense?  Definitely.  Will her experience give her a better idea of what primary outpatient care is all about?  Definitely.

She will get to see a practicing family physician at work, and hopefully leave respecting that we can do a good job, see lots of patients, and play a valuable role in the medical care of our patients.  I chose family medicine really on faith and a gut feeling that it was the best career for me.  I had never really seen a civilian, non-hospital based FP work. She will have seen family medicine up close and for real.

Edward Pullen is a family physician who blogs at DrPullen.com.

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  • http://michael.benjamin.moore@gmail.com Michael Moore

    Preceptors like this, and the fresh look at medical training is why I chose this school! From the videotaped encounters with simulated patients (with evaluations from the patients and review of the video with a clinical professor), the integrated basic medical science/clinical skills, to preceptors like Dr. Pullen…I feel like I am getting the best medical education possible.

  • Dave Miller

    Ditto what Michael Moore said. It is experiences like this that convince us that we are among the charter members of one of the finest up-and-coming medical schools in the country.

    Dave Miller
    OMS II
    PNWU

  • alex

    Um.. are there any allopathic schools that don’t have a family practice rotation like this? I’m pretty sure it’s required.

    For ours they tried to send us out into private practice when possible, which I thought was a nice exposure to the real world. The only drawback was the low acuity, but it wasn’t a bad educational experience.

    • http://futureoffamilymedicine.blogspot.com mdstudent31

      Depends on what family medicine experiences the allopathic school has set up. There is the community component, but the community component could be an outpatient facility part of the major academic center that does not adequately value/fund its family medicine department. So, yes, allopathic (and osteopathic) schools have the required experiences, but they are not uniform and are limited to the sites and preceptors that are willing to take their medical students. My school does not have an “AHEC”/required rural and/or community family medicine experience.

    • http://abnormalfacies.wordpress.com/ Jim

      I would have to agree – my school requires us to work in outpatient settings during our second year, and requires an FP rotation the following year.

      I thought it was a great experience.

  • franky

    You guys got it easy…back when I was in med school…God I hated hearing war stories like that when I was training. I think it’s great to see office based practice. Most FP’s don’t admit to the hospital anymore, at least not around here. The hospitalists do all the inpt stuff. If FP is your calling, you should get early exposure to the reality of it and not be a total scut monkey all year. hats off to your school and good luck.

  • soloFP

    I did a 6 week rotation in med school and a 4 week rotation with a community FP. I also became an FP, despite seeing the long hours, endless refill requests, increasing prior auths for meds, prior auths for all CTs/MRIs/stress echos, incoming phone calls from patients/nursing homes/hospitals, and increasing stress from his employer to see more patients to make overhead. Days usually were 8 am until 6 pm on average, with one day a week until 7:30 PM. The same doc would go in on Sat and Sun to complete paperwork, review labs, and go through charts. It is a long schedule but rewarding in the end to directly care for the patients despite a lot of free work outside of the visits.

  • http://drpullen.com medical blog

    Glad to see mostly positive comments. I have another student now and continue to enjoy the bit of teaching I get to do. DrP

  • http://www.TheMedicalEntrepreneur.com Steven Hacker, MD

    Medical Students and Medical Residents should have as part of their training exposure to their preferential specialties in the private practice setting. As I write in the book, The Medical Entrepreneur, too often doctors are disappointed with their career choice because they really didnt understand what their post residency career would entail. There is no better way for medical students and residents to get a good understanding of this then by spending time in private practice.

  • Helena Vidaurri

    I am an attending dermatologist at a public hospital and also a professor in dermatology for 3rd year Med students
    I think a very important way of learning the real world medicine is This very close look a student can get when he/she spends learning time with an attending. It gives deepness and texture to The very abstract concepts of ethics, empathy, adherence and disease burden