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What Is it Like to Specialize in Family Medicine?

Hilton C. Ray, MDMy name is Hilton C. Ray, MD, and I’m a Diplomate of the American Board of Physician Specialties® (ABPS) and the medical director of Prowers Medical Center in Lamar, CO. I have been practicing family medicine since 1991. Although I have been interested in other medical specialties, I turned to family medicine as a way to continue serving a wide community of patients. As a family medicine practitioner in a rural setting, I see patients ranging in age from newborns to the elderly and can do much more than I could in an urban environment. Additionally, the specialty allows me to practice from a holistic perspective and impact health across generations of families.

Family medicine is a good fit for me because I like mental challenges, mysteries, and puzzles, and family medicine presents a variety of challenges for the physician. For instance, I see patients with conditions that span the practices of cardiology, orthopedics, rheumatology, dermatology, pulmonary medicine, and gastroenterology, just to name a few. This diversity keeps most days from being routine. I enjoy the different cases that come through my office as much as I enjoy the variety of people.

By far the most enjoyable aspect of family medicine is the relationships that I develop with my patients over time. The physician-patient relationship is at the core of traditional health care, particularly in the rural health care setting in which I practice. Seeing the same patients over a couple of decades or watching babies whom you have taken care of grow up and start families of their own is an amazing experience. While there are many things that I have done over the course of my career that I absolutely enjoy, such as teaching, I don’t think anything else compares to the long-term connection that a patient-physician bond fosters.

Currently, family medicine physicians face several challenges, many of which involve the changing nature of medicine and the requirements that we have had thrust upon us. Some of these have to do with electronic medical records and the need to report data to multiple health care entities including the government. While the benefits of these reports are being debated by legislators, lawyers, physicians, and pundits, the bottom line is that many of these activities have encroached upon the time that physicians can spend with their patients. This is in addition to the insurance companies that have their own set of requirements, including prior authorizations that take up physicians’ time and place further barriers between doctors and patients. The advancement of technology has been both a boon and a bane to medicine in general. These and other factors are changing the way physicians and patients interact, and not all those changes are for the better.

One of my more memorable experiences in family medicine occurred when I was working on Saint George Island, a small island with a population of 150 people located about 750 miles southwest of Anchorage, Alaska, in the middle of the Bering Sea. I went there to be the only medical provider for a planned two-week stint. I ended up staying on the island for nearly three weeks as the plane that was to take me back to Anchorage was unable to come because of bad weather. One day in my second week there, amid storms that made the seas very rough, a Polish ship arrived at the dock and called for the police chief. Because of the dangerous waves and a growing storm, the crew only had time to unload a sick crew member, and he spoke only Polish. He came to the clinic, where we quickly ascertained that he had peritonitis. The weather was too rough for a plane to fly in and evacuate him, so we kept him in the clinic. There was no hospital on the island, but the clinic did have a bed in the back room. We gave him fluids as well as ceftriaxone, the only IV antibiotic that we had in stock. Lots of phone calls and about 36 hours later, a plane was able to arrive and evacuated him to one of the major tertiary hospitals in Anchorage. According to a later report, he ultimately had surgery and did fine.

If I could give advice to a family doctor in training it would be, try not to listen to the noise. There is so much going on in health care today that it is easy to lose sight of one’s goal. Medicine has always evolved and will continue to evolve. The only difference is that, in this era, changes come with a lot of people shouting about different medically related topics. Between intrusion by insurance companies, pharmaceutical companies, and government agencies, there are many people who are vying for your attention as a new doctor. We must remember to focus on what is truly important – the patient. Do that and most of the noise will fade on its own.

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Medical organizations throughout North America understand that our rigorous certification standards prove that ABPS Diplomates are capable of delivering the best patient care possible.

Far too often, medicine is led by less than 5% of non-practicing physicians taking away and replacing the voice of the 95% of physicians practicing and placing patient safety and care first on the front lines every day. The American Board of Physician Specialties has raised the standards in physician board certification not only in the quality of their boards of certification, but in hearing and allowing for the voice of those active physicians caring directly for patients. Having been a part of the ABPS over the last 28 years has allowed me to grow as a woman leader in a field often wrought with challenges. It helped me and others raise the bar of the standards of care in my specialty, Emergency Medicine, through their Board Certification in Emergency Medicine (BCEM). ABPS also helped raise the standards of care for 21st century medicine through their certifications in other specialties, particularly in Integrative Medicine & Disaster Medicine. Having physician voices heard matters to medicine and is essential in the betterment of patient safety and care.

Sarah E. Gilbert, MD, FAAEP
Sarah E. Gilbert, MD, FAAEP
Emergency Medicine
On October 18, 2007, President George W. Bush released Homeland Security Presidential Directive 21 (HSPD-21), calling on our nation, among other initiatives, to “collectively support and facilitate the establishment of a discipline of disaster health”. It is a great testament to the wisdom and foresight of the American Board of Physician Specialties that it immediately set to work and created, within the short span of only one year, an educational blueprint and set of certification examinations, both written and oral, for a new subspecialty of disaster medicine—and it is why I chose to be part this vital initiative and this wonderful organization. This is but one of the many innovative programs initiated by the American Board of Physician Specialties over the years, and why I am proud to support its work on behalf of our nation’s public health.

Art Cooper, MD
Disaster Medicine
When the American Board of Physician Specialties offered to host the American Board of Integrative Medicine, ABPS became a landmark organization working to move medicine into the twenty first century. Certifying physicians who have completed rigorous academic training in Integrative Medicine ensures that the field of Integrative Medicine will continue to develop academically, clinically, and professionally. The leadership of ABPS continues to impress me - they are diligent in constantly innovating to provide certifications for physicians who want to advance their careers and their areas of expertise. I am honored to be a part of this organization.

Ann Marie Chiasson, MD
Integrative Medicine
There are many ways board certification advances a physician career. ABPS Board examination verifies your accuracy, precision, and reflects your mastery of your residency training verifying your expertise. ABPS Board certification demonstrates your level of expertise beyond your practice experience, primary education degrees, and training which are necessary for insurance reimbursement and practice privilege requirements. Attaining your ABPS Board Certification will clarify your purpose, secure your practice growth, and expand into leadership positions. Board certification can serve as an indication of a physician’s commitment to medicine, beyond the minimal standards and competency of training, their measurement to quality of care, and attaining an award for excellence.

Chris Kunis MD
Internal Medicine
When I think historically, advancement in medicine and patient safety and care has been driven by the diversity of people and scientific thought. That’s what I found at the ABPS and more. For over 60 years that is just who we are. I found a physician certifying body that provides a choice and voice to all physicians ensuring that patients are always placed first.

Jerry Allison, MD
Emergency Medicine
When I decided to pursue a full time role as a physician executive it was important to me to obtain additional professional training, education and work experience. Board certification through the ABPS in Administrative Medicine is validation of my efforts and a demonstration of dedication to professional development. We need more physicians to become full time health care executives, knowing there is a board certification option in Administrative Medicine encourages physicians to take the leap from full time clinical practice to healthcare organizational leadership.

Richard Paula, MD
Administrative Medicine
The American Board of Physician Specialties has provided me with the opportunity to demonstrate mastery of internal medicine through board certification. As a hospitalist, board certification is an expected credential, and hospitals recognize the American Board of Physician Specialties (ABPS) as one of the three standard credentialling bodies for Internal Medicine. Additionally, the ABPS has helped me develop leadership skills as a Board member and Committee Chairperson. ABPS has also helped me sharpen critical thinking skills as a test question developer and reviewer. The Allopathic (MD) and Osteopathic (DO) physicians in the ABPS are lifelong learners and frequently pursue multiple board certifications. I enjoy the camaraderie of my peers in ABPS.

Loren Jay Chassels, DO
Internal Medicine
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