Family Physicians are
in High Demand
In a difficult
economic time when many people are searching in vain for
work, family physicians can count on having a job.
Family physicians, general internists and general
pediatricians are primary care physicians. Typically they
are the first physicians who people consult when they are
ill. Physicians who prefer to have long-term, meaningful
relationships with their patients often choose primary
care. Primary care doctors provide preventive services and
can care for most of their patients’ problems. If they need
to refer patients to sub-specialists, such as cardiologists
or orthopedic surgeons, they help coordinate their
patients’ care. Primary-care-oriented health systems around
the world tend to have lower costs, better health outcomes,
and greater health equity. Given the rising cost of health
care and the lack of equitable care provided over the years
to Native people, having primary care providers is
especially important in Native communities.
All primary care physicians are needed in underserved
areas, but family physicians are uniquely equipped, as they
are the ones who are able to deal with a broad scope of
problems and age groups. Pediatricians care for children
and general internists care for adults. In contrast,
Dr. Terry
Maresca, Mohawk,
says, “Family medicine spans the age range from very
young infants and women who are pregnant to children,
young adults, adults, and Elders. We care for the whole
spectrum. Our training is broad enough that we can
thrive within a rural community as well as in an urban
underserved community.”
In contrast to most medical specialties and subspecialties,
family physicians are taught to care for patients within
the context of both the family and the community. This
orientation fits well with Native communities.
The
Need for Family Physicians
There is a
critical and growing shortage of family physicians in the
United States. Dr. Joy
Dorscher, Turtle
Mountain Band of Chippewa Indians, says that Indian
communities are being hurt even more than non-Native
communities. She points to the 18% vacancy rate for
Indian Health Service physicians. Dr. Pat Rock, Leech Lake
Band of Chippewa, agrees with Dorscher and adds that
reservations have been hit even harder than urban
American Indian communities, like the one he serves in
Minneapolis.
Dr. Jack Colwill and his research team found that in less
than 20 years, the U.S. could face a shortage of up to
44,000 family physicians and general internists.
Drs. Dorscher, Rock and Maresca, who are all family
physicians, are eager to see more Native people enter
family medicine and medicine in general. Dr. Rock says, “As
with other ethnic and minority groups, Native physicians
are more likely to return to their community or practice in
another Native community.” Rock adds that even the Native
physicians, who don’t work directly with Native
communities, often serve Native people in some way.
Sharing a common heritage with their physician increases
the likelihood that Native patients will share information
that is vital to understanding their problems and providing
care that will work for them. Rock says, “Because of our
history, people have trouble with issues of trust. These
barriers are difficult, no matter what. When you’re telling
important personal things to another human being, you want
to be able to trust them. I think those boundaries are able
to melt away more quickly where there’s some commonality,
like sharing a wholistic way of looking at the world,
including spirituality. It’s easier to work with our own
people.” Rock adds that he feels that Native physicians who
choose to serve a broader community have a great deal of
value to share with non-Native people. Dorscher and Maresca
agree.
Unfortunately, however, the number of Native physicians
might decrease. Since 2005 there has been a 14% decrease in
the number of American Indians and Alaska Natives applying
to medical school.
Part
of a Family
Why should
students consider a career in family medicine? According to
Dorscher, “Physicians have a wonderful opportunity to touch
the lives of the people around them. As physicians we touch
our patients both literally and figuratively. I can’t think
of any other occupation, career or calling that allows this
kind of interface.”
Dorscher continues, “The biggest reward, which I think is
unique to family practitioners, is that you are part of
your community. This winter a young man came up to me in
Target and presented his child to me saying, ‘You delivered
him. He is such a wonderful gift.’ Who else gets that? It
warms my heart.
“When I was a resident, I took care of four generations of
a single family. What a phenomenal honor to care for
multiple generations of a family. To be allowed to be part
of a family in that way.
“If you’re a cardiologist, they remember you and they might
say, ‘Thanks for saving my family member’s life. We’re
forever in debt to you.’ But we have the honor of being
able to have a close relationship with a family. I don’t
think that’s a normal part of a sub-specialist’s practice.”
Dorscher also talks about the rewards of relationships that
are continuous over time. Such relationships are personally
satisfying but also make it possible for physicians to know
their patients well enough to provide care that is tailored
to their patients’ needs and resources. “You watch young
women build their families and grow into beautiful mothers.
You help them with that process. I’m not saying they’re
good mothers because of me, but now with families being
separated, some families need motherly support. You can
provide that. You watch these beautiful children and you
help get them ready for school. When they see you in the
community, they say, ‘Dr. Joy. What are you doing here?’
Such an honor!
“It’s fun to see the strengths of the families. Even the
most dysfunctional families have strengths that they bring.
That’s pretty cool.
“When very difficult times hit, people will ask you to help
them with very difficult decisions. As difficult as that
is, it’s an honor to be there in that way.”
Identifying with the Patient
Family
physicians make a good living but typically don’t get paid
as much as subspecialists. This doesn’t bother Rock who
cares for patients at the Indian Health Board of
Minneapolis where he also serves as medical director and
CEO. “I guess I am a living testimony to the non-financial
benefits of family medicine. This is my eleventh year, and
I continue working here. I love the job as much as the
first day I walked in here. It’s challenging and never
dull.
“People are so
grateful, like the single parent mother who’s appreciative
that we saw her daughter quickly. She couldn’t get in
anywhere else. And there’s the Elder who is grateful that
we saw and treated her grandchildren.
“I’ve never doubted the value of my work here. It’s
positive even when there are negative outcomes – things
that break your heart. In fact negative outcomes cause me
to put more energy into my work.
“Today I saw a 50-year old Native American man. He has no
health insurance. He lost his job in manufacturing a few
months ago. His wife was just diagnosed with pancreatic
cancer. He was in tears in my office. I told him I had to
send him to the hospital because he’s neglected his health
for a long time, in part because he doesn’t have insurance
and thought he didn’t have access to services. Today he was
so sick he had to come in.
“I told him ‘I’m glad that you’re here today.’ He said,
‘I’m glad I’m here today too.’ I said, ‘If you come back to
see me I’ll work hard for you to get you feeling better and
work to give you the necessary help. Don’t give up yet.’
“I see this [type of situation] every day. I identify with
the people I work with. I feel like I’m part of the
community. I’m not an outsider coming in. It’s very
rewarding.”
Valuing
Relationships
Dr. Maresca
finds family medicine rewarding to people who enjoy people
and their stories and value rich, long-term relationships.
She also says it can be rewarding for people, like herself,
who enjoy variety. “On a typical day I might see someone
with an ingrown toenail, a person with a lung clot, a
person with a new pacemaker, an Elder whose fractured hip
was missed in the emergency room, and a child with BBs in
his nose. I am never bored!”
Maresca also appreciates being able to practice in a
variety of settings. “Family medicine is a flexible
profession,” she says. “I’ve been in many different areas.
I’ve worked in everything from urban underserved, to
reservations with IHS, to tribally-based communities. I
actually tried private practice for two years.
“Family medicine is intellectually stimulating. By the time
that patients get to a specialist their problems are likely
to be narrowed down. They might even already have a
diagnosis. But since patients typically bring their
problems first to a family doctor or another primary care
provider, you get the first crack at trying to figure out
what’s going on. That means you need to be a good puzzle
solver and be persistent. But you don’t need to know
everything. We have consultants. Help is available.”
Maresca continues: “We have opportunities to be able to
change the health system. We advocate not only for our
profession but also for patients who have less voice in the
health systems that we serve. There’s a strong social
justice piece in family medicine that is very satisfying to
me.”
Characteristics
Needed for Family Medicine
As Drs.
Dorscher, Rock and Maresca implied, family physicians need
to value people and their stories, be empathic and be good
listeners. They need to be able to build and sustain
trusting relationships with their patients, families,
colleagues, and community members. They need to be
intellectually curious, able to tackle and follow through
on difficult issues, and enjoy problem solving. Because
family medicine includes a broad scope of issues, family
doctors need to be dedicated, life-long learners. Not only
do they need to increase their medical knowledge and
skills, but they also need to continue to grow as people so
they have the self-comfort and knowledge that enables them
to invite and help patients deal with tough problems,
including sensitive personal issues.
Preparing to be a Family Physician
Drs. Dorscher,
Maresca, and Rock recommend getting involved in a pre-med
program, such those offered in conjunction with the
Association of American Indian Physicians. They say that
even if students who are interested in family medicine are
not able to be involved in a structured program, they can
do such things as search for information on the Internet,
ask a local family doctor for permission to shadow him or
her, and/or talk with a local family doctor about what it
is like to be a family physician.
The
article above was originally published in the Spring 2009
issue of
Winds of Change. The cover
artist is Joe Maktima, Laguna Pueblo/Hopi. This piece
entitled "Chanting Wind" and the rest of his work is rooted
in the culture of his pueblo ancestry. For more information
visit the artist's website: joemaktima.com or email him
at: jmaktima@infomagic.net.