Member of the Month: Troy Fiesinger, MD

Past TAFP president considers the evolution of his career and where he’s headed next

By Perdita Henry

posted 07.11.17

Troy Fiesinger, MD, has experienced a very fluid career in family medicine. He graduated from Baylor College of Medicine, completed his residency at East Carolina University School of Medicine in Greensville, North Carolina, but returned to Texas because “the chili didn’t taste right, their barbecue is just wrong,” and he missed his home state. Upon his return, he began working with Scott and White practicing family medicine and obstetrics in Waco, switched his focus to training residents at the Conroe Family Medicine Residency program in Conroe, and then decided to return to the Houston area joining the Memorial Family Medicine Residency program in Sugar Land. A few years ago, he decided to return to private practice and set out with the specific goal of joining “a group that was looking far down the road to where family doctors need to be to adapt to all the changes in health care including the payment environment.” He found that group and joined Village Family Practice.

During our conversation, Fiesinger keys in on the things that drew him toward family medicine and how that passion has kept his career journey evolving. In a health care environment that involves change and uncertainty, Fiesinger is involved with a practice that is unafraid of the future. “We are heavily involved in the next generation ACO, Medicare advantage plans, and have multiple insurance contacts whose payments are based in part on quality performance and cost effectiveness,” he says. “It’s very exciting to help build a new clinic in another part of town for this group but also to be a part of a group that understands where family doctors need to be and how they need to change to be successful in the future.”Whether working with large medical organizations, residents, or private practice groups he never compromised his love for family medicine and knows the best is yet to come.

“When I was a young resident, I thought no one would listen to me and it’s the opposite, they pay more attention.”

Why did you choose family medicine? What’s your favorite aspect of it? Were you inspired by anyone?
I chose family medicine because in medical school I liked everything. I was going to be an OBGYN for six months, then decided on internal medicine, and then realized the only way to do both was to choose family medicine.

I was inspired by Drs. Judith and John Edgerton who lived in Friendswood. She and her husband rotated with medical students in their practice, so I went to work with them for six weeks. They made family medicine look like a whole lot of fun. They would take you home for lunch, they knew their patients well, they lived in the same community as their patients, their children went to school with their patient’s children, and they really showed me family medicine could be a very satisfying career for many years.

My favorite aspect of family medicine is the variety. I love that I’m still seeing seniors and teenagers. I can treat chronic illnesses, which I really enjoy doing. I can treat anxiety, depression, ADHD. I can do office procedures and all of these things are a part of family medicine. There’s really no limit on what you can get the training to do.

You’re an active member of TAFP. What is it about membership in AAFP and TAFP that inspires you to participate?
Feeling like you’re playing a role to make our profession better and preserving what has always been great about family medicine inspires me. My father would tell me you can’t complain if you don’t go do something about it. It’s natural for me to be involved with AAFP and TAFP because there are issues I am concerned about. There are things we need to make better. We need to preserve what has always been good about our profession. I think membership to AAFP and TAFP is essential to accomplish many of those things because we have strength in numbers. When we have 6,000 plus family physicians, residents, and students coming together, we’re listened to. When we have over 100,000 physicians nationally, we are listened to. For almost a decade we have seen the government, large insurers, and corporations pay attention. We are finally seeing the impact we have worked for years to make.

Whenever I’m frustrated, going to AAFP and especially TAFP meetings, helps me recharge. The people attending these meetings are pushed by the same things I am and are trying to make the same changes. Interacting with them inspires me to keep going. I’ve made some great friends participating in these organizations. We all know that if a patient moves to another city finding them a great doctor is just a phone call away.

“Whenever I’m frustrated, going to AAFP and especially TAFP meetings, helps me recharge.”

What is the most important resource TAFP offers you?
For me it is political advocacy and CME. TAFP does a very good job advocating in Austin for family physicians and I try to help with that. As one physician, we don’t have much impact at the state level but when it’s multiple family doctors all saying the same thing, politicians listen.

We’ve played an effective role working on bipartisan and non-partisan levels. We had statewide and local help to increase funding for the Texas Family Medicine Preceptorship Program for medical students, to increase funding for our residency programs, to increase loan forgiveness programs for physicians working in underserved areas, and to generally enhance the specialty. These things only happen through the resources TAFP provides its members. The CME is fun, it’s great to see friends and colleagues, it’s great to see good lecturers come back year after year, and we all need to learn how to improve the quality of care.

Why is it important for family medicine physicians to participate in advocacy? 
Politicians listen to the people who come and talk to them and they pay close attention to the physicians who make the effort to travel to Washington and speak with them about issues. So, when we as a specialty want to improve the training of future family physicians, we best accomplish that by reminding our political leaders what’s important to the family physicians in their district.

When I was a young resident, I thought no one would listen to me and it’s the opposite, they pay more attention. The greatest impact is a physician in training, a family medicine resident, or a brand-new family physician saying directly to a politician “I am why you need to support medical education. You want people like me to be your constituent.” When they see that young face representing the issue in person it has a much bigger impact than the rest of us who are in the middle to late stages of our careers. It’s the opposite of what I thought years ago. Your impact is much greater than you realize it is.

What one word or phrase characterizes your style of family medicine?
I would say relationships. I am most effective in caring for my patients when I can establish a trusting relationship where we have mutual confidence in each other. That’s when my patients are most satisfied with their care, I am most satisfied caring for them, and we trust each other to do what’s right. I always tell the students I work with, the first goal is to establish the relationship, because without that you can give the best advice in the world and accomplish nothing. When your patient trusts your advice, they’ll not only listen to what you have to say, they’ll be patient with you when you have an “off” day. They’ll not only come back to you but they will tell their friends to come see you too. Now that I’ve returned to private practice I’ve lost count of how many people come to me because, “my neighbor, my brother, my sister, my dad, or my mother sees you.”

Do you have something you always do to establish a trusting relationship between yourself and a new patient?
It’s hard to put into words because it’s something you learn to do over time and automatically do, but I always begin with asking questions. I want to get to know the patient, I want to know what their concerns are, what they are worried about, or what did their parents tell them to make sure to ask me. For example, when a patient comes in for a physical I know there is always something on their mind. The company may have made them do it but more often someone told them, “you need to get that checked out.” That’s really why they’ve come in. So, I’ll ask a variation of, “I’ll do your physical today, but what do you want to make sure I cover?”

What is it about family medicine that interests you?
I love that every day is different. Sometimes I think it’s like a game show and the question is “what’s behind door number three?” You never know what is behind door number three. It’s the variety that keeps me in it. Your career changes and evolves. I’ve gone back to what I started out doing in the same profession.

“I am most effective in caring for my patients when I can establish a trusting relationship where we have mutual confidence in each other.”

What do you do in your spare time that helps you stay refreshed and inspired?
I love to be socially active. I have always run, biked, hiked, and camped. Doing those things keep me refreshed. I also love to read. I have been a big reader since I can remember. Disappearing into a science fiction novel is a great way to stay refreshed. I also like listening to podcasts that feature different perspectives or feature topics that have nothing to do with medicine. I listen to a great podcast out of the University of Houston where they talk about inventions and it has nothing to do with medicine but it’s fascinating to listen to these people talk about how they did what they did.

How do you champion family medicine?
I champion family medicine on three levels. One, is be the best family doctor I can be for my patients. To me it’s how you demonstrate the value of family medicine. We can’t just tell people what it is, we must show it.

Second, it’s not just about taking good care of our patients, it’s being aware and savvy about quality measures and how to provide high quality, reasonably-priced, health care to our patients. It’s about how to make the health care system better, how to do that on a daily, and all the little ways that are critical to achieving it. The national policy means nothing unless a whole bunch of family physicians with their patients do the little things to make that happen.

And third, is getting involved outside of my office. I am active in TAFP and AAFP, the Harris County Medical Society, the Texas Medical Association, and other community groups. Being out in the community in whatever way you personally find satisfying is a great way to champion family medicine because then they see what you do. For example, I’ve been on multiple scouting trips with my son and we have a young man on these trips with serious health issues. The parents know that a family physician is on the trip, they can tell me how to handle special issues, and I can assure them that whatever happens I can take care of their child. Thankfully, nothing usually happens on these trips but these little ways outside of the office are great ways to champion family medicine and all of them are important.

TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting TAFP by email at tafp@tafp.org or by phone at (512) 329-8666. View past Members of the Month here.