A minor obsession with the word, “pipeline”

In family medicine, there’s a minor obsession with the word “pipeline.” The term makes me want to scream. Just think about a pipeline. The “line” part is superfluous. A pipeline is actually just a pipe. Our goal is to stuff prospective mission-driven family physicians into a big pipe, confine them there and apply large amounts of pressure to push them through this pipe as quickly as possible, lest the pressure drops and there’s some opportunity to escape the pipe by leaking out. Perhaps leaking out into anesthesia. Or neurology. Or — let’s be honest — commercial real estate development.

Is this the imagery that we feel best describes our efforts to grow our community medicine workforce? Likely not.

I’ve actively tried to replace the term “pipeline” in my own vernacular. Admittedly, it’s not easy to do without a good replacement term. (I was vaguely reminded of a time in middle school when I tried — unsuccessfully — to stop saying “cool” and start saying “verve.”)

So if not “pipeline,” then what? I thought back to when I decided that family medicine was my calling, the thing I couldn’t see myself not doing. I realized that for me, there was no pipeline. There was, instead, an airport runway.

As an undergraduate, I started to doubt that I was suited for medical school. I questioned if I would ever get in. I questioned if I would be able to keep up if I were accepted. I had gone from being the valedictorian in high school to scrounging (desperately) for Bs in my more rigorous science courses.

When I met Dr. Brandon Zabukovic, I was pretty much headed out of the airport entirely. Perhaps to test myself on this, I joined a weekly shadowing program at his full scope family medicine practice in South Bend, IN, as a senior in college. I showed up weekly and followed him around his office while he treated every person with the dignity and respect of an old-fashioned small-town GP, albeit in the basement of an inner-city homeless shelter.

If my goal was to rule-out medicine, I failed miserably. I was exposed to clinical medicine at Dr. Zabukovic’s office, but I didn’t have the scaffold to learn and retrain the actual medicine. Instead, I was taken aback by how the relationships — even as removed as I was — drove me to want to master the clinical. Prior to meeting Dr. Zabukovic, I had not made the connection between my mastery of my relevant coursework and my care of future patients. I saw how his clinical acumen made his patients feel at ease, made them let down their guards and engage.

I spent a half a day a week with Dr. Zabukovic for a year. It wasn’t a lot of time, but it was certainly formative time. I think about that experience now as whole preparation and take-off sequence. I hauled my bags back into the airport and figured out where I was headed. I needed fuel for the journey, though, and a flight plan to follow.

Dr. Zabukovic helped me with both. His mentorship set the standard for me in terms of what to seek and expect throughout my medical education. He recognized in me a kindred spirit and empowered me to envision a health care delivery model where folks living at the margins received high-quality care imbued with dignity and respect. If I showed up to his office to shadow, I left it ready to serve, and my tank was completely filled.

At first, I tried to make his exact flight plan my own, like some creepy little clone. I don’t think that’s uncommon. The thing about a runway, though, is that it’s not as confined as a pipeline. At the end of a runway, there’s the entire atmosphere just waiting to be sliced a pair of fresh family medicine wings. My flight plan looked similar enough to Dr. Zabukovic’s, but it better reflected my own passions and family circumstances.

When I meet new learners — especially ones who are passionate about providing full-scope family medicine in underserved communities — I’m tempted to convince them to do everything exactly as I did and then re-join me in in four to six years to be colleagues on the frontlines. I fight this temptation. Instead, I try to fill up their tanks a bit. I make sure their luggage is onboard. I help them create a flight plan, and then, I watch as they gain altitude and start their journeys.

Patricia Martin is a family physician.

Image credit: Shutterstock.com

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