The Calling of Family Medicine

By Annie Koempel, PhD, MA, RDN, LD

The path to joining the specialty of family medicine can often be winding and complex. Countless physicians who intend to join another specialty instead find themselves serving their communities as a family physician. I’d like to give you three examples.

With two younger brothers prone to injuries – anything from bruised knees to broken bones – it was no wonder Sabrina* chose to pursue medicine. She was always nearby when a push, shove, or trip sent someone sprawling, and she found herself applying pressure to their wounds. She was fascinated by how their bones were set and foreheads sutured. The tables turned when she was a teenager and tore multiple ligaments in her leg that put her on the operating table. Her experience working with a physical therapist and orthopedic surgeon convinced her that medicine was in her future.

At three years old, Phoebe was already familiar with the operating table. She had life-saving heart surgery while her peers were learning to ride their tricycles. While her memories of her own experience were obviously unclear, the trust her parents had in the surgeon profoundly impacted her. They placed the life of their only child into the hands of a stranger and trusted them without question. By the time she was a teenager, Phoebe couldn’t imagine herself in any other role.

Ashley’s family moved to the United States from Southeast Asia a few years before she was born. Throughout her childhood, she watched as her grandmother navigated chronic conditions, including advanced diabetes, and her parents struggled to navigate the healthcare system amidst a language barrier. When she was in high school, her grandmother died, and Ashley’s path to medicine became clear. She wanted to help families like her own and knew her unique perspective could prove transformational to patients and the broader healthcare system.

Despite these life altering experiences with specialty care, Sabrina, Phoebe, and Ashley would go on to choose Family Medicine over surgery, emergency medicine, or endocrinology.

In less than two years as an anthropologist for ABFM, I have interviewed dozens of family physicians and heard so many variations on this theme. Surgery and endocrinology may pay more, emergency medicine may be fast paced and exciting, but family medicine offers unique opportunities the others do not.

“Why choose family medicine?” I always ask after hearing one of these stories.

The first answer I typically receive is that family medicine provides the chance to build lasting relationships with patients. Family physicians are overwhelmingly attuned to the physical, psychological, and social health of their patients. While assessing a strange rash, they are simultaneously screening for signs of depression, listening to stories of grief, and noting any needs for housing or food. The family physicians I talk to are overwhelmingly concerned with issues of social justice and social determinants of health, because they understand how inequities contribute to or worsen the health of their patients.

The second answer is related, but different. As one physician told me, “There’s nothing more deadly boring than a subspecialist clinic where they’re seeing the same five diagnoses over and over all day.” The steady variety of family medicine keeps it interesting. But it also allows for a more holistic view of the patient, which in turn supports the development of a trusting relationship.

There are, of course, a thousand other reasons why someone may choose to pursue family medicine. And the picture is not all laughing babies and thankful grandparents. Keeping up with a broad array of medical information is challenging, on top of managing patient messages and meeting quality metrics. And its common knowledge that primary care is under-resourced. There seem to be as many barriers to practicing as there are reasons to practice.

Society has largely lost faith in the healthcare system to prioritize patient health and wellbeing. Family physicians can play a key role in transforming our health care system and rebuilding the doctor-patient relationship, one relationship at a time.

*All names are pseudonyms.

Annie Koempel, PhD, MA, RDN, LD, is an anthropologist and qualitative scientist for the American Board of Family Medicine.