Family Practice

I am officially a week and a half into my newest rotation, family medicine. I like it a lot, which is good because this is the field that I think I am going to be going into initially. It's sooooo nice having normal work hours again (8-4 with Friday half days), compared to the 5:30-5:30s with 26 hour call every couple of days during OBGYN. I love being able to sit and chat with my patients, and actually treat everything. Throughout my entire clinical year, I was always told "Don't worry about that, that is their primary doc's concern, only treat the problem at hand." That was hard for me, to see such a blatant problem and have to ignore it because it wasn't within my scope of practice. Now that I am working with their primary doc, I've had to get back into the habit of looking at the patient's ENTIRE chart....all their recent lab work, their past few progress notes to see what issues they have been dealing with, their consuls, cardiology workups, etc; even if they only came in for a runny nose or med change. I feel like this rotation I'm actually using critical thinking skills, and I find myself that I'm able to counsel my patients more than before. A lot of times the doctor will ask me in the patient's room what I think is going on and what I want to do, which can be nerve racking because you don't want to look wrong in front of a patient. Thankfully I've been mostly on par with my diagnoses, and usually close with my plans. My biggest challenge right now is knowing what meds to choose and why. I generally know the classes of meds, but knowing which of them to choose can be a challenge. Especially diabetes medications and antibiotics. Thankfully I am doing an elective in internal medicine so I can get more practice managing hypertension, afib, diabetes, COPD, etc.

The one thing that I don't really like about this rotation is that the patient's entire chart is on an ipad that I use. I have to be very conscientious about making sure I'm not staring down at the ipad the entire time that I am with a patient, which can be tricky (usually because a lot of patients aren't very good at knowing their medical problems). I like the EMR that the office uses, but it is internet based, so I have to wait for the pages to load sometimes.

The other big thing that is going on is that I've had to start getting serious about looking for jobs and studying for the PANCE, the physician assistant certification exam. I graduate in less than three months (!!!!!!!!) and things feel real. My CV is done and being reviewed by a career counselor at school. I haven't registered for the PANCE yet because I don't know where I am going to be to take it....still deciding between Maine, Mass, and Philly (all places where I have significant ties). I have decided that I am going to take it three weeks after graduation. I'll use the first week to move and let my mind rest, then use the next two weeks to study. In terms of jobs, I am proceeding with going with the rural family practice route. If I do loan repayment through the NHSC, I'll either get 20k or 30k each year from the government (depending on how rural I am), tax free, to use towards my student loans. As someone who is pushing $150k in debt, this is a very appealing option to me. Plus I grew up in a somewhat rural environment, so it is not like it will be a big adjustment for me. I'll be looking primarily in the Northeast and Northwest...I think it could be interesting to live in the Washington/Oregon area for awhile.

But wow...I am graduating soon! I have been having conversations with classmates about how it does not seem real to be graduating. It seems like such a lonnnggg time ago I started the program. The didactic year is so tough, and when you are in it, you don't see an end in sight. Also, I'll have to learn what it's like to live like a normal human being again (and I'm serious about this). After two years of 90+ hour work weeks (including study time), I don't know what I'll do with that being halved and having all this free time to my hands.

Good things are happening folks!