By Bruce D. Greenberg
Condensed from article published
Winter 2008, California Family Physician
Reprinted with permission
I was inspired to write this article after hearing about the upcoming 60th anniversary of the California Academy of Family Physicians. When I was a medical student, family medicine was in its infancy. The first FP residencies were just beginning, and doctors were starting to take the initial exams given for board certification in our new specialty.
I still remember the day in 1971 when I was accepted into UC Davis School of Medicine, which was a fairly new medical school at the time. I was excited to enter an institution employing "the organ system approach" and "early clinical exposure," which, at that time, were considered innovative teaching methods.
After graduation, I began my residency at Natividad Medical Center in Salinas. It was a lot of hands-on experience and patient care responsibility with minimum supervision.
Near the end of my last year of residency, the local doctors in southern Monterey County offered me a full-time job. It was exciting to think about going into a practice where I could finally put all of the skills I had learned in residency to use.
I joined a wonderful group of dedicated physicians comprised of six FPs, a general surgeon, a pediatrician and an internist. Initially, we didn't have an ob-gyn, so the FPs did all of the deliveries, and the surgeon and some of the FPs did c-sections. We operated as a private practice for the first 20 years of my career, after which rising overhead and falling revenues led us to be "acquired" by the local hospital as self-contracted employees.
Many of the original doctors began retiring within a few years of my arrival. A certain core group had stayed for their entire careers, while many others had come and gone in short fashion, often citing inability to cope with factors of rural living, such as a lack of shopping, shortage of employment for spouses, and the perception of a sub-par school system. Not surprisingly, that pattern has continued.
From nearly my first day in practice, I decided that I wanted to be active in teaching medical students. What stuck firmly in my mind from my years of training was who had been especially nice to me (and, thus, served as a good role model), and who had not. I decided that I had a unique opportunity to try to emulate the good ones and to try to personally spare as many students as possible from "the bad." Initially, I precepted a couple times a month at my old residency program, but as my own practice became too busy, I began to invite students and residents to join me there.
Over my years in practice, medicine has certainly changed. At the beginning of my career, we had a very limited choice of antibiotics and only a handful of agents to treat hypertension and diabetes. However, while technology has advanced and the population in our service area has more than doubled, we still have just about the same number of local primary care doctors as in the old days. And, the patients are still looking for that same type of old-fashioned, personal attention from their family physicians.
I can only hope that one day I can leave the profession on my own terms, knowing that I did the best I could for my patients with the tools I had available, and that I attempted to pave the road for the generations of physicians to come.
Full text of the original article is available at http://www.familydocs. org/communications/cfp_magazine/ family-medicine-1978-and-now.php