As I have mentioned in previous posts, I am a member of my medical school’s Physician Shortage Program. The program, which does not involve any long-term primary care commitment or loan repayment, is made up of a group of students, primarily from rural hometowns, who are interested in pursuing medical careers in undeserved and/or rural communities. We meet as a group and discuss our personal experiences growing up in rural areas, the challenges faces by community physicians, and the proposed and impending legislature that will affect the practice of medicine in these areas. As part of this program, I was able to participate in a community medicine rotation, something few students at my institution get to experience during their third year.
Before I can elaborate on my experiences during this rotation, I would be amiss if I didn’t mention the structure of my institution’s third year clinical clerkships as a whole. Normally, students are expected to complete six-week rotations each in Pediatrics, Family Medicine, OB/GYN, and Psychiatry. We are also required to complete 12-week surgical and medical rotations, which include time spent in neurology as well as two other electives. All of these required courses must be completed at institutions affiliated with our teaching hospital, a large, urban academic center in Philadelphia primarily serving inner city patients. As a rule, “away” rotations at hospitals and practices not affiliated with this hospital are not allowed until fourth year.
My family medicine rotation, however, took place at a community hospital and its associated resident clinic located about 2 hours away from the familiar bustle of Philadelphia. While my peers would spend six weeks together, completing an entirely outpatient-based rotation, I would be the only student from my class of 250 on this particular rotation, and had absolutely no idea what to expect. As it turned out, the rotation was the most thoughtfully organized and coordinated clerkship that I have completed thus far.
The outpatient program’s main strength came from its small size and large geographic coverage. The hospital and its associated resident clinic provided care to patients from all walks of life – the insured, uninsured, wealthy, and those in need. My six-week schedule was divided between outpatient and inpatient services, so I learned very quickly how busy these services were. In fact, because of the number of appointments scheduled a the resident clinic, I was able to take on my own patient load during the outpatient portion of my rotation; I saw and precepted these patients as if I was one of the residents myself! Additionally, during the outpatient portion of my rotation, I was able to work at a private family medicine practice a few miles away from the hospital, and got a glimpse of life in community family medicine after residency.
The inpatient service was equally as hectic. While there was a respected OB/GYN practice in the area, when it came to obstetrics care, many of the woman wanted their family doctor to be there with them in the delivery room. Likewise, emergently-ill patients expected to see a familiar face when they arrived in an ambulance. As if the service those factors alone didn’t keep the inpatient service busy enough, an expertly run EHR system allowed us to coordinate and plan follow up appointments in the resident clinic after discharge. This coordination of care was the epitome of “patient-centered.”
The most striking observation I made about medical care, particularly within this community, was the lack of support from psychiatrists. Even patients desperately in need of this type of care were forced to wait months for a cancellation so they could be put on a psychiatrist’s schedule. The family practitioners were forced to single-handedly manage conditions that I had only imagined I would see during a psychiatric rotation. It was truly the physician shortage at its finest.
I still have two more weeks left on my community medicine rotation, but I feel like I’ve already been exposed to so much more than my peers who have spent the last few weeks in an entirely outpatient-based, urban practice. While I’m sure many of the same challenges exist for family practitioners across both settings, I feel as though my rotation has given me a better handle on what my life will be like both as a resident and as a practicing physician. I am fortunate to have been given this opportunity so early in my medical education, and would recommend this type of elective to any medical student, particularly if he or she is considering it as a career choice.