What Exactly Is A Family Medicine Resident?

I get the sense that not everyone knows what it is that I do. I mean, there is the vague sense that, yes… I am a doctor… but I think most people still think I’m some kind of a student or not quite a doctor. But that’s not really accurate.


So I thought I would use this particular update to give people a better idea of what exactly I do.

Once you graduate from medical school you enter into a training program for whatever specialty you decide to go into. How long that training program is depends on your specialty. Most are 3 years. Family medicine is a 3 year program. Your first year of residency is called your intern year. You are working with a training license, and a large hospital or program has agreed to be responsible for what you do. Your intern year is different depending on the specialty. But for most programs, it’s usually the toughest year of the 3. For us, we work approximately 80 hours a week. I say approximately, because this just needs to average out over a 4 week stretch. So you can work 85 hours one week as long another week you work less than 75. I was also on call every 4 days. Being on call involves you do a full day of work in the hospital and then continuing that work into the night and into the next day. It’s 30 straight hours of working. Sometimes you get some sleep. Often you do not. And this “sleep” is a very loose definition of the word. Because you are usually in an uncomfortable bed that has been slept in by hundreds of other people of varying body sizes and shapes and having your pager go off every 2-15 minutes for requests for Tylenol or assorted other remedies by your nursing staff. You get a total of 4 days off in a 4 week stretch. But how those days are distributed does not feel remotely like 4 days.

80 hours is a lot of hours. In the old days, I know that physicians often worked longer than that. And when I was working in the army with Basic Trainees, I worked 100-110 hours a week. I also know that there are other jobs where people routinely work that many hours. I think the only difference is that most people don’t work in jobs in which a small careless error can result in someone dying or being maimed. It’s a little brutal. Congress actually just passed a law that has changed this rule and now interns cannot work more than 60 hours a week, and they can’t work more than 18 hours in a row.

During our intern year, we are completely in-patient. That means I worked in the hospital the entire year. As a family doc, we basically have to know a little bit of everything. So I did Internal Medicine, ICU, CCU, Surgery, OB, Pediatrics, & ER. I actually did very little Family Medicine. It was a really tough and challenging year. I learned a LOT. I thought I had a sense of what being a doctor was going to be like when I was in medical school. Turns out I really had no idea. The more I worked, the more I realized how much more there was to learn. It was also extremely tiring and lonely. It is a wonder I made it through.

Different family medicine programs do this differently. Basically a committee decided that to be a well-trained family medicine doctor, you need to do a certain number of hours doing all of these different things. Different programs will try to integrate these different hours in different ways. Ours puts almost all of the in-patient hours in our first year. For our 2nd and 3rd year of residency, we are almost completely outpatient. This means every day I spend at least half of my day in the office seeing my own patients. What I really like about this is that for 2 years in a row, you are working in the office like a regular family doctor would.

Every so often, we do something a little different from just seeing patients in the office. We will either do an elective somewhere else in a different specialty or we will see patients of the practice who are in the hospital, or we will see newborn babies for the underserved. This is usually limited to a half day and the other half is spent back in the office.  I love the fact that I get to mix things up and do different things, but still continue to see my patients. And make no mistake about it… these are MY patients.

In my 2nd year, we get our license to practice medicine. Not a training one, but an actual one. The Board of Medicine says that as long as you pass your step 3 of your boards, you can request a license to practice medicine. So for our program, we start off our 2nd year of residency, as actual practicing doctors. Initially, in our 2nd year, we have to discuss each of our patients with an attending physician. This is a good thing. It ensures that you are making the right decisions. It gives you a chance to hear different opinions and techniques. It gives you a chance to start developing your own style and technique for managing patients and most cases. After a month or so, you are no longer required to discuss each patient. An attending physician is still there to talk to, but you don’t have to discuss each patient. So since August, I have felt like a practicing family medicine doctor. I see my own patients. They identify me as their doctor.

It’s funny because I have a lot of friends that tell me to "let them know when I’m done" so that they can start to come see me. I think there’s some confusion about my role exactly. I am actually a licensed physician. I have my own license. I am not board certified in family medicine yet. But if I wanted to, I could just work at an urgent care and practice medicine. Most places want someone who has completed a residency training program, but still… I am a practicing physician. And the way our program is set up… I see my own patients.

So what exactly does a Family Medicine doctor do? Pretty much everything. We see newborn babies, little kids, teenagers, young adults, middle age adults, older adults, and geriatric patients. We literally see everyone. We don’t do much in the way of deliveries anymore, due to insurance issues. However, we do Pap smears and Gynecologic Care. We do in-office procedures. We do a little counseling and therapy. We literally… do everything. This obviously… makes the job very hard. You really have to learn to be good at everything.  But I think that it's a big reason why I like being a Family Medicine Doc so much. 

I don’t always talk about how much I love my job. It’s hard to get yourself to admit that most of the time, because you’re usually so tired; and you tend to get very resentful of the fact that your personal life suffers so much. But really… I have to say… I am very happy to have chosen family medicine. Actually, to be more accurate, I guess I’d have to say, I’m very glad that God chose me to be a family doc. It's a job that involves so much variety.  It's a job that involves long-term relationships with your patients.  I love it.

The past month, I have had so much variety, that it has served as constant reminder of why I love this field. For 3 weeks, earlier in the month, I spent my mornings at a Pediatric Clinic for the uninsured/Medicaid patients. Our population there is predominantly Hispanic and lower income… and it's so great to be able to work with them. My office is 99.9% insured and fairly well off. But we get these little pockets of opportunities to work with the uninsured. Once a month, we go to a free clinic where we work with the uninsured and every so often, we have pockets of working with this pediatric clinic. I love working with the underserved populations. I don’t know if I’d want to make it all I did, because I love seeing my patients; but getting the chance to work with uninsured patients every so often really makes me appreciate healthcare and the things we get to do for people.

I’ve also picked up a couple of newborn babies in my own practice. Many of the babies are with first time parents. Working with first time parents is extremely rewarding. I love being able to talk to them about all the ways that their baby is weird to them, but normal for their age. I love being able to prepare them for changes to their baby. It’s such a fun thing to be able to do.

I’ve also had the chance to do a ton of procedures lately. I put in earrings in a baby for the first time. It’s a little scary, but oh so cool to do a procedure that instantly results in such a beautiful thing. I’ve cut out some cysts. I’ve shaved off some simple moles. I’ve punched some moles out. I’ve put in some stitches. I’ve burned off some skin lesions. I freeze stuff off all the time. Procedures are probably one of my favorite parts of family medicine.

I’ve had some of my patients with depression/anxiety come back to see me and tell me they are doing much better. I’ve had some people come to me because I took care of their family members. I’ve taken care of some patients who had been bouncing around from doctor to doctor and cleaned up their care plan to good results. I’ve been managing a TON of sinus infections without antibiotics. I’ve been helping people work out insurance issues. I’ve talked to some troubled teens. I’ve talked to some overwhelmed parents. I’ve done some worrisome paps. I’ve also counseled some teens & young adults on good gynecologic care and STD risks.  I really get to see the whole breadth of health care, but in the context of continued relationships.  It's such satisfying work.

It's not all roses though.  I still have to take care of some difficult patients.  This usually doesn't mean medically difficult.  It's usually in reference to their personalities.  We live in a very entitled area, where people think they know better than their doctors sometimes.  I also am on call every 5-6 days.  When I am on call, I have to see patients in our immediate care clinic in the late afternoon into evening.  At night, I have a call phone in which I have to answer any calls from patients, from any of several nursing homes that we cover, and for any of our patients in the hospital.  This can be a few calls or it can be a non-stop process.  I also have to admit any patients that are coming through Fairfax or Fair Oaks Hospitals.  So if any patients from either our practice or any of the 10 total branches needs to be admitted to one of those hospitals, I have to drive in and examine them and do all the paperwork to get them properly evaluated and treated.  This means that at any one time I may get multiple people coming in to Fairfax and Fair Oaks hospital at once.  This has happened.  This is stressful.  It's a tough process.  When no one needs to be admitted, I can just relax at home.  But it is very rarely that easy.  The next morning, I still have to come into work and see patients. 

And my work isn't just limited to what I do in the office.  For every patient I see, I have to document the entire visit.  What they said, what I saw, what we decided to do.  It's an important, but VERY time-consuming process.  And I don't have enough time to document everything as I see them.  So I have to bring some of that work with me.  I end up working 55-60 physical hours in the office.  And a total of 70-80 hours a week outside of all of that.  Work can end up being all-consuming.
So this is one thing I really hate about things.  I hate being on call.  I hate bringing work home.  I hate not having enough of a personal life and always feeling tired.  I hate the fact that I can't seem to get my personal life and my homespace in order the way I'd like, because I either have too much work to do when I get home or just want to complely veg out.  So there is a lot that I hate about the nature of my life right now. 

However... the truth of the matter is... I really love my job. I am so glad I get to contribute to people’s lives in such a meaningful way. I love the feeling that I am able to be part of people's story.  I love being able to solve problems.  I love bringing comfort to people.  It really does make it all worthwhile.  I want to try and remember that more often and not get lost in my fatigue and weariness.

I'm Back to the Show

I haven’t updated my blog in almost a year and a half. I have thought about posting so many times, but it’s been difficult to do for a number of reasons.

1) Time – when you only have 24-48 hours of total off time a week there’s not a lot of wiggle room for chill time.

2) Dominoes – the longer you go without posting, the more you feel like you need to catch people up with and so the idea of an update seems more and more insurmountable.

3) The Law – 90% of my life now involves patient care. Federal laws prohibit discussing details of patients unless it is directly related to their care. So it gets really difficult to talk a lot about my days without revealing information that will get me fined or put in the pokey. It’s doable. It just requires a LOT of careful concentration and thought, which causes the most difficulty. See #2.

4) Whine & Cheese – Most of the time you usually feel like you need to unload emotions, it’s in the setting of significant emotional stress or significant emotional uplifting. So your posts become awful self-indulgent whine-fests or disgusting cheese-filled outpours that make you nauseous months later.

But recently, I had a bad week/few days of work and I went looking through my old blog and found a post that really made me smile, because it took me back to the end of my 3rd year of medical school and was filled with a sense of excitement at finding a sense of where the next few years of my life could potentially be. And I loved that I could see myself filled with that kind of excitement.

So I got convicted. And I’ve decided to get back to it. And I figure I’ll just have to put something up as often as I can.

Happy Birthday to Eleanor Kang and Deborah Choe! I love you both!