post by Corrine
Elizabeth walked into the clinic for her routine OB check. She was due any day. She had had a little cramping that day but felt fine. I decided to go ahead and check her.
She was 9 centimeters dilated! She hadn’t had any real pain, but she was about to have her baby! (Ten centimeters is when it’s time to push.) And this was not her first baby, either. There was no time to call an ambulance.
I quickly got her into my car yelling to my nurse to cancel my patients for the rest of the day. I drove her to the hospital. I dropped her off at the emergency entrance with a nurse telling them to get her upstairs STAT! I parked the car, ran upstairs, just in time to deliver her baby. Whew!
That is just one of the many fond memories I have from my 35 years as a family physician at the Tanana Valley Clinic in Fairbanks, Alaska. (Elizabeth is not her real name. I changed it due to HIPAA regulations.)
 |
| One of the many babies I delivered |
------
I’m a bit amazed and humbled as I look back and think about all that I have done and all that has changed in and around me. Sometimes it makes me feel old, but most of the time I feel like I have been an important part of a special community. You can’t really reduce a career down into a bunch of statistics, but just for fun, here are some interesting numbers. These number are estimates but are pretty accurate:
* 1900: Patients that consider me their doctor as I retire.
* 800: Babies I delivered before I gave up that part of my practice in around 2005.
* 25: Family physicians I have worked with in our family medicine department over the years
* 25: Clinical staff I have worked directly with at the clinic.
* 7: CEOs I have worked under.
I have seen a lot of changes during my time at the clinic. We went from being a small physician-owned clinic to being part of Banner Health, a large corporate-owned conglomerate, and finally to being part of Foundation Health Partners (FHP), a community nonprofit that owns several health entities in Fairbanks, including the hospital. During that time our clinic has grown from a being a stand-alone mom-and-pop clinic in a single building with less than 20 doctors to a multispecialty clinic of over 100 providers in various sites around town associated with FHP.
 |
| Group photo of many of the TVC doctors from several years ago |
Getting Started
I didn’t always know that I wanted to be a doctor. When I started college, I was going to be an engineer. I was good at math and science. But I wasn’t enamored with it and spent a year or two trying to decide what I wanted to be. A meteorologist? A physical therapist or athlete trainer? I realized I didn’t want to take orders from somebody else so decided I should be a doctor. I would be an orthopedic surgeon with an emphasis on sports medicine. But I quickly realized that I did not like being in the operating room. I also thought I would hate obstetrics but on my OB rotation, I realized I loved delivering babies.
 |
| Graduating from the University of Michigan Medical School |
Family medicine really is the best specialty for me. I’ve always been interested in many different things. In family medicine, I can do a little of everything, which keeps me interested. In one day, I can take care of a baby, biopsy a mole, treat a pneumonia, talk to a patient with metastatic cancer about end-of-life issues, and help another patient get their hypertension under better control. I really like the variety of family medicine. I also like having longitudinal relationships with my patients. Some have been with me my whole career.
I moved to Fairbanks, AK, in March 1990 just a few months after finishing my residency in Spokane, WA. I stayed there longer due to my boyfriend, who was a year behind me in the program. (And, no, that relationship did not last the move!) The month before I moved up, the temperature in Fairbanks never got above -20F. I wondered what I was getting myself into! I figured I would give it a year and see what I thought. That first year was hard, but then I found like-minded friends and the rest is history. I met my husband in 1991, we got married in 1992 and had our kids in 1994 and 1996.
 |
| Me with my class of family medicine residency doctors - Spokane, Washington 1989 |
Changes in Medicine – Some Nostalgia for the Old Days
Medicine was quite different when I started. There were no cell phones, and we didn’t use personal computers. When doctors were on call, they mostly stayed home or had to carry a bulky satellite phone. We carried beepers so the hospital or call service could notify us about calls or messages.
In the clinic, we made appointments with pen and paper in a big appointment book. We had a team of medical records people who spent their time locating paper charts for messages and patient visits. Often charts got lost. I remember having stacks of pink message slips on my desk. And stacks of charts to go with them. We dictated visit notes into a Dictaphone that would later be typed up by transcriptionists. Every morning there would be another stack of charts to sign off on these dictations. Although I have a love/hate relationship with computers, at least a patient’s information is now readily accessible, and chart notes are done quickly. (Although we have become our own transcriptionists, which is more time-consuming.) Instead of multitudes of medical records personnel and transcriptionists, we now have multitudes of IT people instead.
The days were longer and busier back then. As family doctors, we saw our scheduled patients plus any patients that walked in wanting to be seen. This could make for some very busy and long clinic days. We admitted patients to the hospital and rounded on them daily before or after our clinic days (sometimes both!). We often saw our own patients in the emergency department and some of us delivered babies. (Which come on their own schedule, so everything else had be rescheduled around them. But not sleep, unfortunately.)
 |
| In spite of being busy, our family medicine department always had fun -especially dressing up for Halloween |
Some days and weeks were even busier than normal. We took call once a week, which involved phone calls from patients and sometimes admitting family medicine patients to the hospital at night. Sometimes we could go in early the next day to see the patient and sign paperwork, but often we had to go in whenever the call came in. For those of us who delivered babies, it often felt like you were on call most of the time. There were definitely a lot of sleepless nights. I remember multiple times getting off the phone in the middle of the night, cursing about having to go to the hospital, but getting up and going anyway. By the time I got to the hospital, my bad mood would be gone. Patients weren’t wanting me to lose sleep, they were just sick. And being up at night, I got to see the aurora borealis a lot more. Often, I would leave and come back, and Eric would never realize I had been gone!
Over time, many of those duties got taken over by others. TVC developed the urgent care walk-in clinic, hospitalists took over the hospital care, emergency physicians started seeing our patients and, eventually, we all stopped delivering babies. Now, I’m just in clinic every day seeing scheduled patients every 20-30 minutes. We still take call, a week at a time, but that involves only phone calls from patients and often there aren’t many. Although it's nice to have more down time when I’m not a work, I miss the variety of my first 10 years.
 |
| Susan on the right, Joanna on the left and I ran the family medicine department together for several years. We are wearing tie dye to celebrate my 60th birthday. |
Besides taking care of patients, I have been involved in the administrative side of medicine, too. I was the first medical director of family medicine when our department got big enough to need a director. In the seven years I was director, we started up our controlled substance clinic (to safely take care of patients on chronic opioids), started an integrative behavioral health program (which we had to stop when UAF cut their PhD psychology program), came up with a better way of taking call with more doctors, and came up with better scheduling templates. I was also in charge of the hospital family medicine department for two years and was the chair of the hospital Ethics Committee for around 15 years.
Some Grumbling for the Current Days
 |
| The majority of the family medicine team on my last day of work. We all wore Tie Dye to celebrate! |
I can’t talk about all the changes in medicine over the last 35 years without complaining about some of them. Now it feels like insurance companies run everything. I can’t prescribe medication without a prior authorization even for inexpensive medications for which there is good evidence that they are needed. Prior authorizations require too much paperwork and are often turned down the first time. Uggh!
Almost every expensive diagnostic test is denied coverage until I do more paperwork justifying why it needs to be done. I wouldn’t order it if it wasn’t necessary! Insurance companies want to cut down on waste and fraud, but it has gotten out of control. And sometimes it’s clear they are doing it just for the profits. All of this causes more administrative burden for us physicians, and we don’t get paid for that time. Double uggh!!!
 |
| My fellow family doctors and I may complain but we also have fun together |
You’ve probably heard about the nationwide shortage of health care staff. That’s happening in Fairbanks, too. It has gotten harder to get and keep enough staff to help physicians do their jobs, so we end up doing more work that nurses or medical assistants used to do. And, no, we don’t get paid for that work either.
Something that hasn’t changed but is still annoying and unfair is that the health care industry in the United States has always compensated more for procedures than for talking to patients. But spending 30 minutes discussing end-of-life issues with a family is just as important as doing a cataract surgery and can save insurance companies (and all of us) more money in the long run. But physicians are not paid the same for this important work. I’ve never been motivated by money, but it does sting that I can work as many hours as an orthopedic surgeon but make only 25 percent of what they do. That is not right.
So Why Did I Stick with It?
The main thing that kept me in family medicine all these years has been the relationships with my patients. I love getting to know them and finding out about their lives. Many have become friends. Many have been with me the entire 35 years. For some, I’m the only doctor that they have had. I have taken care of many families. In some, I take care of up to four generations. I have taken care of babies of women who were babies that I delivered. (That really makes me feel like a family doctor). I have been through good and bad times with them. We have laughed and cried together. It has been an honor and a privilege to have such intimate relationships with my patients and to help them on their health journeys. It is bittersweet knowing that somebody else will now take on their care.
What’s Next?
But it’s time. I’m ready for the next stage of my life. As to what that will look like, I’m not sure yet. I want a chance to be bored. (My husband thinks that will take about two weeks.) But I want to be thoughtful about how I will spend the next phase of my life. For now, we have some outdoor adventures scheduled in March (the best winter month for getting outdoors). I plan to do a long self-supported bike race, Bike US Nonstop, in June that will go from the Pacific Ocean (Oregon) to the Atlantic Ocean (Washington, D.C.). Eric and I will then spend another month or so making our way home, camping and exploring along the way.
After that, who knows? Maybe something different in medicine? Maybe I’ll get more involved in our local outdoor clubs or help bring back some biking events. Anybody remember the Tour of Fairbanks or the Chena Hot Springs Ride? Or maybe I’ll do something completely different. I’m not one to sit at home binge-watching Netflix (although I plan to do a little of that, too) so I’ll be busy doing something. I’ll miss my family medicine practice but it’s time to move on.
 |
| Our practice manager, Susan, and I try not to take ourselves too seriously! Halloween 2016 |
No comments:
Post a Comment