The sessions were very interesting, and are the cause of today's introspection. I think most went very well; the first three 30 minute interviews were more in depth, while the latter four only spanned 15 minutes (it was rapid fire, hence the title, "Speed Dating"). We were shuffled in and out of 14 different rooms with single or paired interviewers, who had just as long a day as we did, probably longer. Two areas of inquiry that kept coming up centered around my interest in health policy and my penchant for Emergency Medicine. The Asheville Pilot, which focuses on a "medical home," and a coordinated care learning model, has strong ties to rural health and outpatient care. I think EM and my political tendencies may seem to antagonize this structure. Being originally from Washington, DC, it is not unrealistic for people to see me as someone who intends to move back to the Nation's Capital with policy in mind. Originally, some of my classmates thought I had no intention of even practicing medicine (which absolutely can't be further from the truth), given my involvement in the Health Policy Interest Group. I reiterate here that my number one priority is to become a outstanding clinician, leaving policy as my second passion.
I believe that any time you can see the broader picture, that context begets knowledge. For many medical students (especially at UNC), that's what the Masters in Public Health is all about. One must understand the patient in the broader context of his or her disease. The idea is to be able to look more critically at the epidemiology. How does this disease manifest not only at the level of this patient, but also in the population as a whole? I have this same interest, but in a different scope. I think my DC upbringing, parents in public service, and political science background, have made me a "systems" person. I want to how we can become better patient care providers in the context of the current business model. What does the Patient Centered Medical Home and Accountable Care Organization look like? How can we implement a lasting model? These are the questions I want to be able to answer.
This interest in policy is not incongruous with rural medicine. We need more physicians who are leaders and patient advocates. Medicine in the United States is still practiced in the outpatient setting. Most patients are not walking up to major academic health care centers as their primary care facilities. I don't believe the health of this nation rests on the Harvards and the UCSFs. I think it rests on access, coverage, integrated care, and preventative medicine, which are some of the biggest problems facing rural medicine. What I'm trying to say is, I think the Asheville program would have an strong influence on how I view medicine in this context. I think this experience could only enhance my understanding of the system, and would encourage my advocacy for rural health, whether that be 10, 20, or 40 years in the future. Our lives are shaped by each day's experiences. I've been in DC for 18 years and Chapel Hill now for seven; there's more to the world than the big city and Blue Heaven.
I also realize that I need to take a step back, disconnect, and see the options out there. I really do enjoy what I've seen in Emergency Medicine; there's no question. But I also enjoyed my six weeks in surgery during undergrad, and my weeks in Pediatrics out in Boone, NC. I can't make any decisions until after third year, and I'll probably need some of fourth year to truly know what I want to do. I need my mind to be a blank canvas, letting each clerkship draw its own picture and make its own mark. But I understand my experience is in EMS and the emergency setting; I'm just not ready to be pigeonholed in one specialty just yet.
No matter what happens, I am going to get a fantastic education; it is important for me to remember that. A lot of amazing people applied for this program and it is competitive, but I will become an outstanding clinician in Asheville, Charlotte, or wherever else I'm headed. I've made a lot of choices in my life, and I've made a lot of mistakes. But when I choose to learn from my them, life seems to always work itself out. Two years ago, I thought that I really wanted to end up at Duke for medical school. Only now can I look back and see how silly that was. I remember trying to decide between Princeton and UNC for college; again, it should've been a no-brainer. Every time I've ended up in the right place, at the right time. Of course there are a few things I wish I had done differently along the way, but it all works out at the end.
I have much to look forward to in the coming weeks: the men's heath exam, Community Week #5, and spring break! Damn, time flies.
It does always work out, but this is a daunting time. Around the end of 2nd year, I started to feel like the clock was ticking down to the day my residency application (ERAS) is due, a little more than a year away.
ReplyDeleteI thought 3rd year would make it clear, but it didn't really for me. I made my decision after focusing on what was most important to me and my happiness. There are a lot of things to consider in addition to how you want to help patients: status and salary, personalities/ mindset of colleagues, environment (hospital vs. clinic), lifestyle, etc.
The good thing about medicine is it is vast, even within all specialties you still have a lot of variety and chance to reinvent yourself. Getting involved in policy is always an option, and you could do both clinical and policy work.
BTW, medicine is practiced in the outpatient setting for most, but ironically medical education focuses on the inpatient setting. There are still a large number of people who do rely on hospitals as their primary care unfortunately. Usually these are people with multiple problems (like poverty, obesity, addiction, mental illness, chronic disease and physical disability).
Did you read the latest Atul Gwande article? Hopefully this will change. I think the future of good medicine is better primary care. Much cheaper too! Good luck on your exam!