Updated: Feb 21, 2019
Trying to figure out what kind of doctor you should become? Wondering what specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Flock chose the field of Family Medicine and why Family Medicine is a great field for women.
It should be noted that I am writing this from inside a community hospital in Wilmington, North Carolina as we go into our 4th night of shelter in place due to hurricane Florence. I still think that I have the best job in the world.
There is a shared theme among my Family Medicine colleagues that describes our love for the specialty. In medical school I enjoyed each rotation and considered every one of them for a future career. When it came time to deciding, there was nothing I wanted to give up. Now as a board-certified Family Physician, I still feel the same way. I specialize in people- all ages, any disease, all genders and in any setting.
My favorite things about Family Medicine:
Continuity of care! It is really rewarding to see patients over a long period of time and watch their chronic conditions improve under your care. Something as mundane as assisting a patient to quit smoking becomes gratifying when the patient looks forward to their follow up to excitedly proclaim they remain tobacco free. There is also nothing as special as seeing a baby you delivered that you have known since they were a heartbeat in utero for a preschool physical. Speaking of babies…
Family care. My favorite visits are newborn appointments coupled with a postpartum check of a mom that I delivered. Invariably once you take care of a mom and baby dyad you absorb their siblings into your practice and while you’re at it you become dad’s primary also. Families love the one stop shop for the majority of their health care needs and they are easy visits for you because you know their history well. Many seasoned Family Physicians share stories of caring for multiple generations of a family.
Variety. An average day in clinic may include a well child check, a routine obstetric visit, an incision and drainage of an abscess, a well woman exam, a discussion about end of life care and a diabetes follow up. There is never a dull moment. In my current practice, my day may have started rounding in the hospital on a mom and newborn or ended with a middle of the night delivery. If you think family medicine means back to back visits of hypertension, colds and diabetes, I cannot tell you how far from the truth this is (at least in my experience).
The challenge. Some people say you must know a little bit about everything. Really, you have to know a lot about everything. A large part of being a good physician is practicing evidence based medicine. Family Medicine encompasses multiple specialties and therefore we must stay up to date on their current practices. I actively stay up to date on guidelines published by the professional organizations of pediatrics, obstetrics, cardiology and endocrinology - just to name a few. Anyone can memorize guidelines but the real challenge is applying them to the person in front of you. For example, I once had a patient with underlying HIV, depression, hypertension and tobacco use who was hospitalized for acute coronary syndrome and ultimately diagnosed with coronary artery disease. The consulting cardiologist recommended placing the patient on a statin as one of several recommendations. At our post-hospital visit I was able to select a statin that did not interact with their antiretroviral therapy because I had taken care of many HIV patients in residency and was familiar with the pharmacology and guidelines for medication selection. I also knew that with the addition of another chronic medical disease, the patient was at high risk for relapse of depression. I was attentive to the patient’s PHQ-9 (Patient Health Questionnaire) scores, an evidence based tool for screening and monitoring of depression over the next several months. This led to detecting depression relapse and the patient was referred for cognitive behavioral therapy- an evidence based non-pharmacological treatment. Mood disorders can impact adherence to medication which is extremely important in the treatment of HIV. It would be several weeks before the patient followed up with their infectious disease specialist so I checked blood markers and sure enough their viral load had crept up and their CD4 count was consistent with AIDS. Based on infectious disease guidelines, I knew to start the patient on additional antibiotics for prevention of opportunistic infections in the interim. Eventually, the patient’s depression went into remission, their CD4 count improved, their viral load was undetectable and their cardiovascular risk factors were well controlled with a safe statin and hypertension control. This is just one example of integrating numerous practice guidelines to provide optimal care for a patient in collaboration with specialists.
Opportunity for niche practice and flexibility. Family Medicine training is broad allowing you to practice in any number of positions. There are a variety of fellowship options for continuing certification. However, you don’t always need formal training to refine your scope of practice. Family doctors hold a variety of positions in medicine. You will find family docs that are hospitalists, professors, outpatient only, providing HIV care, palliative medicine, sports medicine, nursing home medical director, the list goes on. From personal experience, my job is constantly evolving. I practice part time in a community health clinic where I see all ages and provide prenatal care. I have developed a role there as one of the women’s health providers which means I do a lot of reproductive health, contraceptive procedures and gynecologic care. Additionally, I have an expanding population of transgender patients who are receiving gender affirming hormone therapy. On top of this I am an adjunct faculty for NHRMC Family Medicine Residency program where I supervise residents in the clinic as well as inpatient and obstetric hospital care. Lastly, I am working on a statewide grant funded initiative to improve maternal health. So, when I say that you can do it all as a Family Doctor, it is not hypothetical. The hardest part of my job is saying no, because there are so many exciting things to engage in as a family doc.
In the immediate aftermath of Hurricane Florence I was deployed out to a neighboring rural community to bolster the efforts of a makeshift hospital set up in a parking lot. I was very useful to the team because I could see patients of all ages and any condition. Parents were reassured when I evaluated their newborns who had missed their weight checks due to widespread clinic closures and I informed them I regularly saw infants in my practice. I treated a patient with diabetic ketoacidosis and educated him about his new diagnosis of type 2 diabetes as well as arranged local follow up. Most notably I delivered a baby when the roads were blocked and her birth was inevitable. These experiences are a testament to our broad training and remind me how valuable family doctors are. I am humbled by the ability to care for my torn community during this natural disaster and for this, I have my specialty of Family Medicine to thank.