Internal Medicine / Family Doctor

‘Patient’ (tolerating difficulties) and ‘Patient’ (consults a physician) are the same word which may convey different meanings. Ironically, each meaning played a significant role in VF’s career: A patient high school chemistry teacher helped VF to understand chemistry. Later, a few medical instructors, who were not patient, led VF to a medical specialty and career satisfaction with many patients. 

FAMILY BACKGROUND / POSSIBLE CAREER INFLUENCE

VF is the youngest of two siblings. His father’s parents emigrated to the United States, where VF’s father was the first generation to be born in this country. VF’s grandfather owned and operated a ‘bar’ (selling alcoholic drinks and ‘light’ food to adults) to support his family. 

VF’s father paid his own way through college and medical school, becoming a surgeon. VF’s mother graduated from a university and trained as a teacher but after having children, devoted herself to taking care of the home and helping to raise the two boys. When VF’s brother, older by 10 years, headed off to college, VF felt like he was an ‘only child.’

VF recalls no specific directions from his parents to pursue a career, though his mother did mention casually, more than once, that like his older brother who became an obstetrician, “you could someday become a good doctor like your dad and brother, if you want to.” 

CHILDHOOD THOUGHTS OF AN ADULT CAREER

Looking back to his childhood, VF recalls feeling ‘adrift’ without any specific career thoughts (despite his mother’s subtle? – LOL – comments). He thought briefly about becoming a lawyer but not to the point of ever taking any law related courses. 

SCHOOL DAYS

Public high school provided the usual array of required courses spanning writing, languages, math, and science. ‘Good’ grades came easily to VF, who was self-motivated to study his courses from elementary through high school. A chemistry course was taught by a ‘low key’ teacher who provided a way of problem solving, using a method (‘factor label’) different from how chemistry was being taught to another group within the same high school. By using the ‘factor label’ method, VF was able to quickly understand the chemical process of converting one substance into another because it seemed to follow a certain logic. VF talked to fellow students about how they were being taught differently by another teacher, more highly regarded as a scientist / educator but VF concluded that he was fortunate to have a teacher who was both calm and logical. 

COLLEGE

VF applied to several ‘liberal arts’ schools – a mix in size from small colleges to large universities. He was accepted by all and scheduled interviews at two of them. VF had no early preference to attend either of the two schools so his mother – this time not so subtlety – suggested that he attend the college which was easiest for travel: only 2 hours from home and located close to the major highway exit. 

As it developed, VF was happy with ‘his’ choice of college; while the college offered no ‘pre-med’ curriculum track, VF easily made friends while focusing academically on his biology and chemistry courses. 

By now mentally committed to pursuing a career in medicine, VF took the required exam (MCAT) to be considered for admission to medical school. He applied to several medical schools but was admitted to only one, which he now attributes to possible favorable consideration as the son of an earlier graduate of that medical school. 

(Editor’s note – The admissions process to colleges and universities has always been – and likely will remain – a secretive, confidential process. Most applicants hope to be judged solely on their high school academic record – unless, of course, their GPA is not in the range from which the college has typically selected, in which situation the applicant then hopes to be admitted based on one or more other factors including teacher recommendations, SAT (or equivalent) score, athletic ability, ‘legacy’ (child of an alum) or a talent such as an award for having played a musical instrument or participation in a drama club or a debate team.  Several colleges and universities have pledged to avoid giving any favorable consideration to applicants merely because they are children of a former graduate. 

Some admissions personnel have admitted trying to ‘balance’ their incoming classes by choosing among qualified applicants (by way of high school GPA) to achieve representation within the school from different cultural / ethnic / religious / racial / gender / geographic backgrounds. Of course, it has always been illegal to bribe an athletics coach to recommend an applicant for admission – as some wealthy celebrity parents recently learned and have spent time in prison as punishment. 

From the Editor’s personal experience of having been rejected for all but two of his college applications, there is likely at least one college that will be a good fit for anyone willing to accept the academic challenge and finally pay more attention to course studies than to socializing and sports.

The ‘take away’ points are these: while a college degree is not required for everyone’s career satisfaction, if you apply and are accepted somewhere, you may never know the factor(s) which led to your admission to college or graduate school but such knowledge is useless; just take full advantage of your opportunity to pursue further education and at some point, you will likely find a potentially interesting career path to follow, learn more about and achieve career satisfaction. Then, of course, your school will hope you remember their role in your success by thanking the school through your financial support as an alum.)

MEDICAL SCHOOL

Medical school courses are a combination of requirements and ‘hands-on’ learning while experiencing general categories of medicine through participation in ‘rotations,’ which are an opportunity for medical students to apply what they have learned in the classroom and develop their clinical skills by treating real patients while under the supervision of experienced physicians and ‘residents’ (recent medical school graduates with real-world experience less than a licensed physician but more than a medical student). During the rotation, students carry out various tasks, including patient interviews and examinations, monitoring vital signs and lab data plus team discussions. The rotations may involve, separately, Internal Medicine, Obstetrics and Gynecology, Pediatrics, Neurology, Surgery and Psychiatry.  

Rotations are important in helping each medical student figure out how to choose a medical specialty for themselves. At this point in a future physician’s career, the following advice has often been provided for how to choose a medical specialty: Reflect on your interests; Procrastination is not your friend; Keep an Open Mind; Forget about Prestige; Think about the Day-to-day activities you’ll be doing; Determine how involved you want to be with your patients; Think about what sort of work environment appeals to you (for example: in a hospital or in a clinic or in an office); Get significant clinical experience in specialties you are considering; Decide how long you are willing to commit to a residency program; Be honest with yourself. 

Rotations are challenging because medical students are expected to – concurrently – manage their academics, plus patient responsibilities and all the emotions that come along with taking care of patients for the first time, plus think about the next step in your medical education: what type of residency to apply for and in what setting and geographic location. 

During rotations, many students report getting little to no sleep between 12-hour shifts and studying for exams. Medical school administrators note that it is common for students to start their rotations without already having a firm opinion for their eventual, medical specialty career path. 

Like life outside the world of medicine, the people you deal with in school or on the job, may have a significant impact on how you perceive that career. VF’s experience within his surgery rotation is an example. By random scheduling, VF’s first assigned rotation was surgery, considered by many medical students to be the most challenging / stressful among all the rotations. Like the other medical students within the surgery rotation, VF and his classmates all started with zero experience in surgery (even though VF’s father had been a surgeon and occasionally discussed his career activities at home). Waiting to greet the new students, were residents and physicians who had just finished training an earlier group of medical students during the previous rotation and now had to deal with the next, inexperienced group. While some residents and physicians demonstrate extreme patience during this introductory phase, others are impatient with inexperience, becoming brusk and rude. Unfortunately for VF, he and his classmates were subject to the impatience of their surgery rotation supervisors, which left a negative impression on each of the students, toward the medical specialty of surgery. (Editor’s note – This is the same situation sometimes encountered by others outside the medical career path, in any school or workplace, where a mean-spirited teacher or manager can discourage students from pursuing that otherwise potentially interesting and useful career path.)

VF’s other rotations, including obstetrics, pediatrics and psychiatry, were less stressful but not sufficiently interesting to VF until he experienced the issues within Internal Medicine, where the residents and physicians were both competent and patient, helping the inexperienced medical students to appreciate the daily activities involved with internal medicine: dealing with the prevention, diagnosis and treatment of internal diseases, such as arthritis, cholesterol disorders, colds and flu, diabetes and back pain. In contrast with his other rotations, VF felt most comfortable handling these types of issues and chose his residency applications accordingly. 

MEDICAL RESIDENCY

A ‘Residency’ is the stage of medical training for recent medical school graduates, who have by now selected a medical specialty, which is likely their future career path although no binding commitment is required. 

VF’s Internal Medicine rotation assignment was, by coincidence, within a community hospital setting. He liked such a setting, which seemed less competitive and more focused on teamwork, than working within a large hospital. So, he applied to a residency program in the same community hospital and fortunately, was accepted. 

VF’s favorable impression of working within a community hospital setting was based on his rotation experiences within both a large hospital and a smaller, community hospital, where he found the physicians to be focused more on taking care of people by recognizing their illnesses and providing appropriate care, than engaging in competitions such as publishing medical research or jockeying for promotion to the Chief of the department at a prestigious medical institution.

FIRST CAREER JOB

Physicians who have successfully completed their residency programs have many options for employment, such as within a hospital or a clinic or a business or ‘hang your own shingle’ (practicing your profession by yourself). This latter option was VF’s first career choice. As a result, VF didn’t initially have a lot of patients seeking his services but soon, due to referrals from fellow physicians and patients recommending him to other patients, VF was taking care of patients in his office, in hospitals and nursing homes. Later, he participated in academic programs at a nearby medical center, teaching residents. 

CONTINUING EDUCATION

It is important to the success of many careers, not just medicine, that the worker who chose a specific career path, continuously seeks to learn the latest developments within that career. While physicians want to know the latest developments for the problems which the patients bring to them, it’s also true that patients want to know that their doctor is paying attention to ‘breaking news’ of medical developments. Patients are unlikely to ask their doctor, at each visit, “Are you sure you are up to date to understand my situation and treat it accordingly?” But there is an option for physicians to pursue, to assure both themselves and others, that they are dedicated to continuous learning: it’s called “Board Certification.” Physicians who stay current and are willing to take – and pass – a test administered by a group of senior professionals for their specialty, are called “Board Certified.” 

VF is Board Certified in Internal Medicine. 

A CAREER PATH MAY BE MODIFIED BY FACTORS UNRELATED TO YOU

When VF began his medical career, specializing in ‘Internal Medicine’ (also known as ‘General Practice’ or ‘GP’ or ‘Family Medicine’), the GP saw his (female physicians were then rare) patients in his office or traveled to patients in hospitals and nursing homes. (Editor’s note – I have vivid, childhood memory of our family dr., with big, scary eyebrows, being led by my mother, into my bedroom, to check on my aching stomach, which he diagnosed as appendicitis). Now, GPs only treat patients in their offices, for several reasons: (1) medical science continued to learn more about how to diagnose and treat different diseases, which led to some doctors specializing in only one disease, to whom the GPs refer their patient to obtain the most advanced diagnosis and treatment; and (2) it is more time and cost efficient to let patients come to you, rather than traveling to see them.

CAREER PATH MAY BE MODIFIED UNRELATED TO YOUR PERFORMANCE

After more than a decade as a ‘solo’ internal medicine specialist, VF was solicited by an older physician to work together as the third member of a (small) group of internal medicine specialists. They would not be ‘business partners’ dividing revenue and expense pursuant to an agreed accounting formula; each would remain essentially a ‘solo’ but working together, they could substitute for each other during planned vacations and unplanned emergency priorities. 

Eventually, this group of 3 internal medicine specialists was solicited by a large healthcare ‘system’ (a teaching hospital plus many other medical facilities, staffed by physicians practicing virtually every possible specialty) to become employees of that system. VF was at first reluctant to transfer allegiance from his small group (having first transferred to it from just himself) but the other two decided to accept the system’s offer (for reasons unique to themselves) so VF agreed, to avoid returning to his ‘solo’ status. 

Looking back, VF is glad he made the transition. He didn’t become a doctor to earn ‘big bucks’ so, affiliating with a large medical system provided a steady stream of patients, while the employer (aka the ‘system’) takes care of all administrative details such as providing office space, hiring staff, and making sure the required technology is always up to date and in working order. 

TYPICAL DAILY ACTIVITIES OF AN INTERNAL MEDICINE SPECIALIST

Of course, not all the following ‘typical’ medical issues are presented to every internal medicine specialist every day, but the following are examples of problems which VF discusses, diagnoses, and treats or refers to specialists: 

Acne, allergies, anxiety, arthritis, asthma, athlete’s foot, back pain, blisters, blood pressure screening, bronchitis, burns, camp physicals, cholesterol disorders, colds, depression, dermatitis, dizziness, indigestion, earache, fever, headache, health screening, hypertension, migraines, nausea, pneumonia, preventive medicine, rosacea, shingles, sleep apnea, sprains, ulcers, urinary tract infections and weight problems.

CAREER SATISFACTION

Treating patients – VF appreciates his daily opportunities to meet with patients who are experiencing, and perhaps suffering from, medical issues and with people who are hopeful that their periodic medical exam will find no problems. Using his medical training, VF tries to understand not only what the patient is saying but what else may be going on with that patient, without his or her realization. VF will either commence treatment or refer the patient to a specialist. VF then looks forward to following the (hoped for) progress of each patient.

Working with others within the medical profession – Aside from having to work with difficult supervisors during one of his medical school rotations, VF has sought – and been very fortunate to find – work settings which are mutually supportive and respectful.