Medical school was a difficult adjustment for me. Coming from a blue-collar background and lacking a medical pedigree, I did not relate to most of my classmates, and I made very few friends.
That changed when I met J., a second-generation physician-to-be without the competitive guile or sense of entitlement implicit in most of the medical students I had met. With a generous personality undoubtedly sculpted by the experience of motherhood, she came across to me as someone who generally cared for others. I could tell that she opted for this career with pure intentions in mind. She modeled what I had thought this calling was about, and she reaffirmed my decision to become a physician. I don’t know if I would have made it beyond the early stages of medical school had fate not placed us in the same training group.
Frustrated with the mission of my school’s specialty-centric approach to treating disease, I opted to complete my clinical clerkships at the other major city in the state where I became part of the first class of a new community-based medical curriculum. This was a unique curriculum in which supervised medical students managed a cohort of uninsured patients with chronic disease using cost-effective medications and largely donated diagnostic services. Emphasis was placed on public health, social factors contributing to disease, and lifestyle associations with diabetes and hypertension.
It turned out that this was an ideal environment to learn the basics of medical practice. Unlike working in the hospital which is how medical education has traditionally been centered, I got to see my patients get better rather than merely treating disease. I didn’t know it at the time, but my preceptor was a former trustee of the American Board of Internal Medicine and had served on the committee in charge of policing internal medicine residency training throughout the United States before eventually becoming the dean of the medical campus. He was effectively donating his expertise to the uninsured in a way uncommon among similarly renowned academic physicians, and I never saw him in clinic without a smile on his face.
On graduation day, it was obvious which students were in the community medicine track, as our handshakes were replaced by hugs from our dean as we walked across the stage. Somewhat bittersweet was the fact that it would be the last time I would see J. in many years.
I later decided to continue working in free clinics during my residency back in my home state. J. completed a surgical intern year and a family medicine residency at the school of community medicine I had once called home. Her family has since grown, and she now works for a not-for-profit center which contracts as an Indian Urban Clinic.
J. and I met for lunch recently. We hadn’t seen each other since graduation. Based on the anecdotes of others of other primary care physicians I know in private practice, I expected to hear a tale of frustration, stressful time constraints, and uneasiness over the future of clinic medicine. In contrast, she was happy to sacrifice a more lucrative private practice career for one oriented more toward public service. The same welcoming disposition that once helped me through medical school is now helping patients in the city where we both once trained.
When I ponder the key to career satisfaction in modern medicine, the term balance comes to mind. I find that few doctors truly achieve this balance between work and life. Too focused on financial gain, we all-too-often become cogs in a taxing conquest for personal financial gain whereby patient encounters get shorter and work hours get longer.
A telling moment of our lunch was when J. opted for a vegetarian entrée. She could have easily afforded a few extra calories since she appeared just as slender as I remembered her early twenty’s self to be. “I can’t exactly tell my patients to eat healthy if I don’t do the same,” she explained. She is clearly still the same thoughtful individual I met so many years ago. I hope that her patients know how fortunate they are.
What is it that J. and my former dean of the school of community medicine have in common? I sense that both have found that serving the underserved can generate personal rewards while allowing for a more reasonable work-life balance. That’s a win-win for the community and the doctor.
Cory Michael is a radiologist.
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