DR. G CHOSE FAMILY MEDICINE. WHY DID OTHER DOCTORS CHOOSE THEIR SPECIALTY?

Over the past several weeks, I’ve written extensively about the factors and events that influenced me to pursue a career in Family Medicine. I didn’t start out wanting to be a family doctor. In fact, it was way down on the list. In my era in the medical education realm, “general practitioners” were treated with derision. Medical schools were centers where complicated patients were referred. They positioned themselves as the rescuers of the screw-ups caused by the local medical doctor (LMD). When Mrs. Smith was sent to the IU Med Center, her history always inferred that the LMD was in over his head, didn’t take proper care of his patient, and sent her to IU so their physicians could make things right.

This attitude was pervasive so medical students developed a negative opinion of the lowly LMD practicing out in the communities of Indiana. I have to admit, I developed a negative attitude and didn’t have much respect for them. In the 1960’s, IU’s emphasis was clearly directed toward training specialists and not family doctors despite the need for more family practitioners in Indiana. I started med school wanting to be an ophthalmologist, changed to orthopedic surgery my third year, and finally decided on Family Medicine five years later during my second year in the Air Force.

During that five years, medical educators and concerned family doctors conceived and developed Family Medicine residencies all over the country. Family Medicine was establishing its role as a specialty unto itself, and attempting to improve its image by requiring 3 additional years of postgraduate education. Respect for Family Physicians improved, and family doctors were treated as valued colleagues. Becoming a Family Physician was no longer berated.

They also began a process of board certification and re-certification to assure the public that family docs were knowledgeable and competent to care for their medical needs. The concept was successful, and now, residency-trained, board-certified Family Physicians are everywhere.

I’m not the only guy who ever went to medical school or chose Family Medicine. What about other doctors? What motivated them to go to med school? What was it about their specialty that influenced the decision to pursue that field? Did life events influence them? Were they happy with their choice? Once you commit 3-7 years of your life to a specialty, it’s hard to turn back.

My nephew is a urologist in Sioux City, Iowa. At the age of 12, he suddenly developed Type I, insulin-dependent Diabetes. He had to abandon his dream of becoming an Air Force pilot, and instead set out to find a cure for diabetes by becoming an MD/PhD. In college, he studied biochemistry, did research at the National Institutes of Health, and was heading for a career in pediatric endocrinology after med school. However, during med school he decided getting a PhD was not for him. He also ruled out internal medicine and began focusing on specialties that included procedures. That meant surgery. He wanted “to fix things” and “needed to use my hands daily.”

He considered orthopedics and ENT but found the personalities of urologists and the variety of “procedures” they performed were more suited to his liking. Also after completing a residency his training would be complete. He would not be required to take a “fellowship,” as many surgical sub-specialties demanded. In practice, he can do every procedure he was trained to do. He sees patients of all ages, takes care of acute and chronic problems, follows patients long term, and does procedures from simple circumcisions to complex robotic operations. He is very happy with his career choice. In this case, a major life event was the factor influencing a career in medicine. Not until he was exposed to the numerous medical specialties did he realize that as a doctor he wanted use his hands and fix things, and operating on disorders of the urogenital tract interested him more than anything else. He says, also, that almost every urologist he meets is a nice guy. I agree.

An orthopedic spine surgeon chose a career in medicine after growing up with a father who practiced Family Medicine in a small town. He decided against primary care early on, and ruled out pediatrics because he had “several siblings with chronic problems,” and these situations upset him. He didn’t like general surgery because “guts are gross,” and crossed off GYN because he respected the virtue of women. In orthopedics, he saw patients of all ages most of whom were in good health. Their problems improved, and he dealt with new problems every day. Limiting his practice to orthopedic spine surgery allowed him to control his life.

Dentists are doctors, too, and dental school is a 4-year commitment like med school. It’s always interesting to learn why a good student chooses dentistry over medicine. An Indiana man knew at an early age he wanted to enter the medical field in some capacity. His childhood dentist was a wonderful man who had a big influence on him. His Little League coach was an OB-GYN doctor who told him if he liked his free time he should go into dentistry. In college, he earned Phi Beta Kappa academic honors so after college he “could go anywhere.” He chose dentistry and dental school because he liked to work with his hands. After dental school, he completed a residency and practiced dentistry for 40 years. Two factors were influential in this case: the positive influence of a childhood role model, and the subtle negative comment made by another mentor. The effect of role models and people in positions of authority is significant, and sometimes off hand comments they make have more influence than imagined. This doctor credits these individuals with forming his opinions and influencing his decisions.

A med school classmate and south side colleague was similarly influence by people in his life. His family doctor was a close family friend who had a big influence on his college and career choices. He recommended Indiana Central College, now the University of Indianapolis. At Indiana Central, he took a course in Animal Biology, taught by Dr. William Morgan. On the last day of the course, Dr. Morgan called him to his office and asked what he planned to do with his life. “Major in history or go to Law School” was his reply. Dr. Morgan disagreed and suggested he consider medicine. He worked for Dr. Morgan in his lab and gained experience and confidence. He applied to med school, and four years later, his “impossible dream” came true when he received his MD degree. The influence of two important figures in his life instilled a confidence in that led him to a 40-plus year medical career. *

As an intern, he struggled to decide between orthopedic surgery and family medicine. He chose Orthopedics, but he soon came to the conclusion that ortho was limited in scope and not as it had been represented when he was a student. His one year as an ortho resident was “a miserable and disappointing year.” He dropped out of the program to enter a family medicine residency at Methodist Hospital.

After an 18-month residency, he spent two years in the U.S. Army at Fort Bragg, NC, where he was “asked” to establish a Family Medicine residency. He accomplished the task and succeeded in attracting 18 residents in training. After completing his military obligation, he considered joining the faculty at the University of North Carolina, but a phone call inviting him to join a new practice in Indianapolis, changed his direction. He started practice on January 2, 1975.

In this doctor’s case, a specialty he chose turned out to not be what he anticipated, and he changed to a field that suited his personality far better. He was also influenced by the two individuals who invited him to join them and knew practicing with them would be a good opportunity.

Another colleague found high school science “intriguing and interesting.” This interest segued to the desire to be a doctor because he “wanted to help people.” After high school, he chose Wabash College for its high rate of students being accepted to med school. He was accepted to IU med school and excelled academically. Indiana needed intelligent, well-trained family physicians so he chose that field, but in a unique way—he created his own residency program. Being an influential member of his class, and wanting a university-based residency, he approached the IU faculty about starting a residency program himself. They agreed.

He completed one year of residency at IU Med School, then his last two years were at Methodist Hospital. He also created a Family Medicine residency at Methodist, and was the lone Family Medicine resident. He had trouble finding a specialty he liked well enough to do all the time, but his love of science and desire to help people, led him to choose Family Medicine. Along the way, he was helped financially and emotionally by many people, and expressed his gratitude by working hard to effect change and improve the quality of care given at St. Francis Hospital. He did, indeed, achieve that goal many times over. *

Another colleague entered emergency medicine. It was a decision that came after many years of uncertainty and evaluation. His grandfather had been a doctor in Tennessee, and because he “loved sciences,” he applied and was accepted (“to my surprise”) to medical school at Vanderbilt University. “I liked…all the services and had no definite plan as to which clinical direction I would take.” By the end of his internship he thought about family practice, but the military draft forced him to choose Internal Medicine. His brother-in-law was a resident at Methodist Hospital in Indianapolis and influenced his decision to go there.

The U.S. Navy deferred him to complete his medicine residency, and during active duty he served as Chief of Internal Medicine at a sub base in Groton, Connecticut. He did in-patient and out-patient care and quickly decided out-patient care “left something to be desired,” ie. It was boring. He moonlighted in an ER in Rhode Island and found he liked “the action,” and variety of patient problems he saw. Emergency medicine quickly became his passion, and after discharge in July, 1973, he was hired to work in the ER back at Methodist. By then, his brother-in-law and 3 other doctors had formed a group contracted to run the ER so the transition was easy. Emergency Medicine was becoming a specialty, and after a lot of planning and effort, he became Director of Emergency Medicine Education at Methodist Hospital. *

A love of, and aptitude for, science, and a grandfather who was a doctor influenced a career in medicine, and the relationship with his older brother-in-law led him to the specialty of emergency medicine. This specialty suited his lifestyle and allowed him the leeway in later years to practice missionary medicine. After many short mission trips, primarily to Africa, he and his wife made a five year commitment to run a hospital in a remote part of Tanzania. For five years, he was the only American doctor at this hospital, and quite often he was the only doctor period. He continued medical missionary work until he was in his mid 70’s.

In spite of denying that his career choice was motivated to “save the world through medicine,” he has definitely done that very thing. Five years in Tanzania, many return trips for a month or more, time in Zambia, Honduras, and Nigeria, as well as other third world countries has proven without question he has “saved” a lot of people in this “world” who would have died without his care.

In the 8th grade, a south side cardiologist spent 8 months of his life bedridden with Acute Rheumatic Fever. This life event and the influence of the two doctors who took care of him were the encouragement he needed to pursue a medical career. In college, he lacked the confidence for pre-med so he entered the pre-veterinary program. He credits a counselor at Purdue for suggesting he might be more suited for medicine and for convincing him to switch to pre-med. He also credits Drs. Charlie Reed and John Graham, his physicians during his bout with Rheumatic Fever, with being excellent examples of professional demeanor and impressive interactions with patients. He began thinking of a career in medicine

Four years at Purdue were followed by 4 years at IU Med School, one year of internship, three years of Internal Medicine residency, two years in the Navy, and a 2-year cardiology fellowship. All this time, he remembered the two doctors who were “classic models of what doctors should aspire to be.” He started practice in 1978, and was co-founder of Indiana Heart Physicians where he practiced for forty years. His respect for two good physicians and a major illness were reasons his life focus centered on medicine and a long, successful career in cardiology. *

Every doctor has a story. These are just a few. What stands out to me is these folks:

1. Loved studying science
2. Wanted to help people
3. Were influenced by role models in their lives
4. Had a life event that ignited their desire to enter a medical field
5. While thinking they knew what specialty they wanted to practice, the decision came only after experiencing the daily activities of the field.

I hope you found these brief biographies interesting. I learned something from each story.

* A more detailed account of these physician’s careers is published separately.