Five survival tips for a career in family medicine

On June 26, I put a “Wednesday Cake” in the oven. Every few weeks I bring homemade cake or muffins to the teaching room. I try to do it often enough so that it becomes a tradition but not so often that it becomes an expectation. For the past 40 odd years on July 1, I have welcomed new family medicine residents to their practices. I have been doing clinical supervision for around forty years. That June 26 was something of a Swan Song.In the afternoon I participated in one of the best workshops I have ever done in my many years of teaching. My colleague, the beautiful and talented Dr. Jenny Wu, who is responsible for setting up the resident teaching sessions at CLSC Parc-Extension, asked three veteran and soon to be retired family docs to give tips on how to survive and flourish during a long FM career. The three of us, Thomas, Juan-Carlos and myself, have very different personalities, interests and career paths. Yet it was remarkable that much of our advice was the same. What we have in common is that we are all academic family docs, working with underserved populations and dedicated to teaching; so, this might not be relevant to people with other priorities.To summarize, here is some of the advice we gave our students and our younger colleagues: TimeWhen transitioning from Resident to practicing physician, resist the temptation to load yourself up with full time work. Your first year in practice is a huge jump. Every patient is new. Every job is a challenge because you have a new level of responsibility. Don’t set yourself up for an early burnout! With the current shortage of GPs everyone is clamouring for your time. Resist! It is easier to add than to pull back. At the beginning, try to work only three or four days a week. Being on call counts as a workday. Make sure you book paperwork time into your clinics or try out an AI scribe. Set up vacations every three to four months right from the beginning. When you start to really know your patients and your job, you may or may not want to add a day to your work week. Remember, a medical career is a marathon not a sprint, pace yourself!MoneyMoney is a good thing, but it is not the only thing. One of my great regrets is that I never worked rurally or did locums in the North. It would have allowed me to pay off my debts more quickly and the experience would have made me a better doctor, faster. My colleagues who did work rurally gained tremendous insights, and skills which can only be acquired when the buck truly stops with you! Also, when your children are young is a good time to be far from the city. When thinking about your work balance, you do some work for love, some for money and some for career advancement. If a job provides the opportunity for two out of three, it’s worth doing. If all three at the same time, you’re golden!Make sure to do good medicine. It is fine to do walk-in clinics as part of your practice and it’s a good way to make money. But a completely McMedicine practice is soul destroying. The most miserable family doctors I know are those who do high volume, low contact, low follow-up medicine. They are continually angry at the patients who need more than they are willing to give. Longitudinal practiceWe spoke about the joys of longitudinal family practice. How helping people move forward in their lives, playing that small but important bit role in their movie can be deeply fulfilling. There has been much talk about how this generation of family docs are abandoning longitudinal care for more lucrative and less burdensome aspects of practice. This is something that we should all work against, by removing the administrative burdens and nonsense from the role. Honestly, this is where the real power of family medicine lies. This is where the most fulfilling part of the practice really happens!Dealing with the governmentThe main message that we gave to the residents was surprisingly similar from all three of us. Don’t be afraid to change, as you change—this is the gift of family medicine. Try to manipulate the system for yourself, fit the rules to what you want to do rather than the other way around. In general, don’t take the government too seriously. Their policies will change repeatedly. Just stay the course, try to fit into what they want without compromising your soul.FamilyThen, being me, I spoke about balancing career and family. Firstly, I acknowledged my debt to my long-term housekeeper and nanny, Theresa Polydore. For 20 years, her work allowed me to work with the security of knowing my children were safe and my home would not descend into chaos. I advise all physicians to get help in the house. As my mother said to me when I got married, “Perle, marriage is hard enough, get a house cleaner!” As my father used to say, “some problems are best solved by throwing money at them.” Almost nothing causes more strife in a relationship than different levels of tidiness. Despite feeling burdened with debt, pay for someone to help with cleaning. In that same vein, I strongly advise keeping gender roles in the household fluid. Accept differences in parenting styles. Different people parent differently, they are not necessarily wrong. We have a problem, as physicians: because we spend all day telling people what to do, we think we can keep doing that at home and in our intimate relationships.My last piece of advice to my residents was, don’t marry a jerk! More importantly, try not to have children with a jerk. My marriage has been the most important support to my career, and the most consistent contributor to my joy. Marrying a jerk, as I have seen with many of my friends, not only destroys your happiness, but is a real career killer. I gave the residents a few examples of red flags and green lights which help separate the frogs from the princes. The final part of the workshop was, to me, the most thought provoking. The residents asked us questions that were on their minds. These were deep, and wide ranging and impossible to capture in this essay. It made me grateful that the future of healthcare is entrusted to these thoughtful, intelligent and dedicated young people. We talked about dealing with death, medical error and guilt. I confessed my regrets at my own failings, notably my terrible temper, something I have excused in myself as righteous indignation. I spoke about how I have struggled over the years to control it. We discussed how to deal with feelings of helplessness in the face of the overwhelming bio-psycho-social challenges facing our patients., How to find a balance between the courage to do what we can and despair that we can’t fix what needs to be fixed. I quoted my old mentor, Dr. Michael Klein, “If you are not God, you don’t have to take responsibility for natural disasters.”As the workshop ended with cake and hugs, I am happy to move forward into my retirement with a sense of a job well done.

Five survival tips for a career in family medicine

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Perle Feldman

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