Students, Residents Show Their Passion for Family Medicine


Yup, that was the headline. And it was probably true.  Why? Because medical students have been sold the fantasy of what family doctors used to do and they are still totally idealistic.  And because residents have a vision towards some loan repayment, a guaranteed salary from the hospital and real money in the bank, they also retain their passion.  This post is not to knock them.  This post is to point out what you won’t see.  You won’t see a headline from the AAFP stating “Family Docs in Practice for Greater than Ten Years Show Their Passion for Family Medicine”. It won’t happen and the AAFP knows that so they continue the propaganda.  Here is the ironic thing.  If they were to interview Direct Primary Care doctors, however, they WOULD be able to use that headline. The passion returns!  Hence, the inner conflict of the AAFP.  My fear, however, is that more and more medical students and residents are being bred into the present era of EMRs, meaningless use, unproven quality metrics and industrialized medicine.  They will think that it is the norm and learned helplessness would have already set in by the time they start.  Then there will be no one fighting back other than us old bastards with our gray hair, our cranky attitudes and our fists shaking in the air.  But that’s okay because I have a lot of fight left in me.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Students, Residents Show Their Passion for Family Medicine

  1. kurt
    August 13, 2015 at 10:03 am

    “Nursemaids, guardian angels, secretaries and gd health policemen”.

    That is what primary care medicine has been reduced to. We’re not paid enough to do the first two tasks and given an inefficient means to do the third.

    As far as the “health policeman” the insurance companies and ivory tower boys
    want us to be, nothing is going to change in this country until people are held accountable for their lousy health behaviors. They go out of the office and can do whatever they want.

    Case in point is I send a few diabetics to one of the best educational groups in the country (they have the coverage) and a fair number still have lousy glycohemoglobins due to a lackadasical attitude.

    Take a look around, obesity, diabetes and heart disease. MOC, CME EHR, none of it is or has changed the overall health in this country. Without the patients being held responsible, the status quo is assured. All the above does is generate a pile of money for the academic service groups and industry (AAFP, ABFM and a myriad of others) Yeah, when organizational heads get paid
    $600,000 more than me when I have to put in the uncompensated hours I do,
    I’m angry.

    I point this out to med students and they look shocked. I tell them to ask around for confirmation and I suspect they’ll hear more of the same.

    Oh, I hear nurse anesthetist is the hot commodity these days. Makes two to three times as I do now since I can no longer see as many patients and generate income for the group.

    Don’t get me wrong. I was perfectly content with what I made/make. Problem
    is the uncompensated time spent is degrading the quality of life. Kurt

    • Pat
      August 13, 2015 at 9:08 pm

      Uncompensated time is simply … degrading.

  2. Perry
    August 10, 2015 at 12:53 pm

    ” They will think that it is the norm and learned helplessness would have already set in by the time they start. ”

    They are also going to very unhappy.

  3. Pat
    August 10, 2015 at 8:56 am

    1. So this poor med student was excited over a project titled “Application of an Interdisciplinary Student Educator Model in Increasing Health Insurance Enrollment.” That in itself is one of the most depressing things I’ve ever seen, and the student has already fast-tracked himself for a masters in public health and eventual selection as the next non-clinical surgeon general.
    That he was so excited in fact, that he ended up ‘presenting’ his findings in the L.A. airport at 2:00 AM really makes me nostalgic for the old airport Hare Krishnas. How depressing must it have been in LAX if the bars were closed and all there was to do on a long-delay layover was to watch this weirdo getting lathered up over insurance enrollment? That must have prompted some suicide threats.

    2. Kansas City has some great museums and restaurants, the Power & Light District downtown is really cool, and burnt-ends BBQ sandwiches are a gift from heaven. Anyone spending time listening to lame AAFP lectures instead of pursuing those delights is beyond help.

    3. “Learned Helplessness” – Doug, you have encapsulated the entirety of the fuzzy, amorphous, gummy-sticky fog bank of modern medicine in that one phrase.

  4. Steve O'
    August 10, 2015 at 8:38 am

    Really, I’m moved by a few of the article’s examples of AAFP members:

    “On Monday, [Dr. X_] worked a cardiac outpatient clinic in the morning before moving on to the primary care outpatient clinic in the afternoon. She then worked the overnight shift — with five admissions — at the hospital before attending lectures Tuesday morning. Her 30-hour shift finally ended with a trek to the airport, and she made it into Kansas City late Tuesday night.

    In addition to the Emerging Leader program, Dr. X_ worked her residency program’s booth in the expo hall and served as an alternate delegate in the National Congress of Family Medicine Residents. She made it home late Sunday night — just hours before heading back to work on Monday.”

    Here’s another story that I find a little sad –

    Poor W.Y_ wasn’t as lucky. W.Y_, a student at the University of Southern California’s Keck School of Medicine scheduled to present his research poster in the expo hall at the conference, saw his flight from Los Angeles delayed. He was subsequently bumped from three alternative flights and could not make it to Kansas City. Waiting overnight at the airport for the city’s buses to resume running, W.Y_engaged in a long conversation with some airline employees and others about families, economics and health care.

    Although W.Y_ was unable to present his poster at National Conference, that didn’t stop him from presenting it at 2 a.m. in the terminal at the Los Angeles airport. During the past two years at USC, W.Y_ has worked to increase health care access by training interdisciplinary health professional students to act as insurance educators who provide consultations regarding Medi-Cal, Covered California and My Health LA to consumers at community health fairs. His poster chronicled those efforts.

    W. Y_, who won a scholarship from the California AFP to attend the conference, asked AAFP staff to post an email about his experience and photos of his impromptu airport poster presentation because he wanted to contribute “to the spirit of the conference” even if he couldn’t be there in person.

    The overwhelming thought that comes in to my mind in reading their story is, “lithium.” Each one seems to need a blood level between 0.6 and 1.2

    The myth that is being sold is “busyness.” W.Y_ and Dr. X_ are massively, immensely busy. Anyone with a sense of human physiology understands that they are too busy. Anyone with a sense of normal behavior knows that one does not present posters in the LA Airport at 2AM on “Interdisciplinary Student Educator Model of Increasing Healthcare Enrollment.”

    The transformative fantasy being sold is not that much different from what is sold by military recruiters. If you join the Marines, you will shine like gold. You can be immortal. You can be invincible. What is on the other end is often endless fear, hours upon hours of boredom, and being treated like a mechanical part, which is discarded if it breaks. Hooyah!

    Sadly, in medicine, those who have made it through the cruelty mill pay back in cruelty to others, their students in training and others. You do not become like gods when you are a doctor. All you are is a doctor.

    The AAFP cannot make money off humanity in medicine. It’s not a payer. So they sell the myth “To children ardent for some desperate glory,
    The old Lie; Dulce et Decorum est
    Pro patria mori.”

    Wilfred Owen wrote this story about the realities of World War I, and the old lie is ‘sweet and proper it is to die for your country.’ In a gas attack, he relates, there is nothing sweet and proper about death.
    Read ” Anthem for Doomed Youth” by Wilfred Owen if he speaks to you.

    When we permit inhumanity anywhere in our civilization, we are part of its cause. And we do permit it in medical training. We even admire it.

    We worship the Iron Cage of Bureaucracy, as Max Weber put it. To be busy, that is the greatest thing – to be busy criticizing others who actually do the work, all the better. The system locks up in ankylosis and dementia – what do WE care? The patients get no help. That is acceptable. WHY?

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