The Power of the Preceptorship
By Travis Bias, DO, DTM&H
In middle school, I aspired to become a DJ. Because this required me to take the least amount of math. Despite this original goal, I started my time at Southwestern University as a pre-med student and headed to UNTHSC Texas College of Osteopathic Medicine to begin my medical education. A career as a physician stood perfectly at the intersection between intellectual challenge and service to others.
I was drawn into medicine to make a difference. The calling of a medical career can be heard as young as 18. It requires determination, a selfless heart, and compassion no matter the situation. Between the ages of 22 and 26, however, a young physician-in-training must decide which specialty he or she would like to be practicing from age 30 until retirement. This decision shapes career options and powerfully influences the future lifestyle, and thus capacity for relationships, growing a family, and personal balance and well-being. This choice in path, like in other careers, also affects potential lifetime income. Thus, specialty choice is not to be taken lightly, especially given the growing burden of educational debt that young medical graduates face.
Given the great public investment in medical education and a looming shortage and worsening maldistribution of all health providers, a young medical student’s choice of specialty has far bigger implications.
Like most medical schools, TCOM emphasized early clinical exposure. These brief rounds and observerships during our first couple years of basic sciences started to plant the seeds of what our future could look like. Did I want to be the pulmonologist in the well-pressed suit and tightly tied necktie, citing recent research, rounding on the most complex cases in the hospital? Did I want to be the energetic, sometimes fatigued general surgeon in scrubs, solving life-threatening problems sometimes in a matter of hours? Did I want to be the family physician or pediatrician dressed in khakis and a button-down shirt, building relationships with the entire family, managing their chronic illnesses with varying levels of success, while treating acute exacerbations and illnesses?
Enter our formal preceptorship requirement, placing first and second-year students into clinical settings to observe a primary care physician for a total of four days. I had entered medicine to make a huge difference, a significant impact, so I figured a surgical specialty would satisfy that goal. But, this was just four days in observing primary care, and it was required anyway.
I had enjoyed the teaching style of one of our former family medicine clinical faculty, Dr. Richwine, so I spent my time with him. He graciously volunteered his time to show me what true community family medicine involved. He had an electronic health record before many practices had adopted them, and his patients loved him. Dr. Richwine and his established patients already had a relationship built on mutual respect, so they could dive right into the current issue. He knew his patients and they trusted him enough to talk of details so intimate they might not share them with their own family members or significant others. He managed hypertension and diabetes, treated acute respiratory and urinary infections, diagnosed sleep apnea, and managed depression and anxiety. In addition to his outpatient work, he had chosen to add on a diverse and bustling weekend work schedule in the nursing home, emergency department, and local hospice. Family medicine was so much more than I had previously imagined, and I just had to see it for myself.
I am now board-certified in family medicine, after being fully educated and trained in Texas, and my career has taken me down an exciting path of work in developing areas, the study of tropical medicine, and contributions in advocacy, public health and policy. All of these possible, with my role even stronger, thanks to the broad education in family medicine.
A physician-in-training may just need a straight-shooting mentor or model to paint a real picture of the lifestyle, complete with the beautiful and the ugly of primary care. A preceptor can have the honor of passing on traditional pearls that cannot be learned in textbooks, gathered from years of experience, to secure the future generation of family docs. Finally, the policy maker may need simple anecdotes to show the complex process that underlies why medical graduates enter certain specialties or choose to practice in certain geographic regions, in addition to the encouragement to invest a relatively small amount in a preceptorship program that could bolster our primary care base in a time of family medicine residency program contraction and poor access to health care in our great state.
Our health system is in the midst of change, but one element that stays the same is this: the importance of the primary care physician. While the diverse set of payers is slow to come around to this, a strong health system relies on a foundation of primary care. And the beginnings of a primary care career start early. Sometimes it requires simply a four-day glimpse into that challenging, versatile, and rewarding everyday life to guide that vision of what an impactful life in medicine can look like.
TAFP is currently looking for physicians for the Texas Statewide Family Medicine Preceptorship Program. As a former medical student who chose family medicine after completing a preceptorship, I urge you to sign up and mentor medical students questioning specialties. To sign up, visit www.tafp.org/preceptorship or contact Juleah Williams at (512) 329-8666 or jwilliams@tafp.org.