When it comes to making the case for family medicine, Dr. Brenda Fann knows what she’s up against. She knows family physicians suffer from a paucity of respect that rivals Rodney Dangerfield’s. She knows they tend to earn less money and enjoy less prestige than their colleagues in medicine’s burgeoning subspecialties. “You hear things like, ‘Oh, you’re just a family doctor,’” she says. “We’re not the heroes you see on all the medical shows on TV.”
What’s more, the number of students in American medical schools pursuing careers in family medicine has dropped by more than 50 percent since 1997, according to the American Academy of Family Physicians. Ten years from now, as the baby-boom generation ages, the nation will face a shortage of nearly 40,000 family practitioners.
“It’s a crisis,” says Fann, the director of the Family Medicine Residency Program at Rush-Copley Medical Center in Aurora.
The physician points to a stream of studies that shows that regular primary care produces excellent health outcomes at lower costs. She notes that some experts argue that the humble family doctor offers nothing less than the salvation of the American health care system, by emphasizing prevention, keeping people out of the emergency room, and helping them avoid costly interventions. The question, she says, is where to find all the family physicians we will need.
At Rush-Copley, Fann and her staff of attending physicians supervise a class of 12 freshly minted physicians who have deﬁed the trends and chosen a career in family medicine. Residency is the last step before physicians can begin independent practice, and Fann says her job is all about making sure her residents are ready. “By the time their residency is complete, I need to have a sense of comfort that, yes, I would send a member of my family to see them,” she says.
Over the course of their three-year residency, new physicians learn at the bedside, treating patients under the supervision of attending physicians, assessing cases and defending their diagnoses on rounds. As they advance, residents become more independent in their encounters with patients. “There’s no substitute for experience, for seeing a variety of patients and the full range of problems,” Fann says. “My job is to kick our residents closer and closer to the edge of the nest, so that when they graduate I know they’re ready to ﬂy.”
Carrie Nelson, a physician and former colleague of Fann, says the powerful bonds Fann forms with residents are key to her success as an educator and mentor. “Because the residents know she cares about them so much, she has the credibility with them to be a tough, honest source of feedback,” says Nelson, the medical director of Your Healthcare Plus, a disease management support program run by the State of Illinois. “She doesn’t shy away from being frank with them.”
Fann brings the same educational style to her work with pre-med students at her alma mater. The physician serves as a mentor to Elmhurst students through the Dr. Dennis J. Patterson Center for the Health Professions, which brings together students with varied but complementary career interests for pre-professional and research opportunities and more. In addition, students in the College’s medical humanities program work alongside Fann at Rush-Copley, participating in rounds with the doctor and her residents, conducting research and presenting their findings. “Our students see medicine in action,” says Cheryl Leoni, the Patterson Center’s associate director. “They come back excited. Brenda treats them like residents. That’s the best part. She’s a wonderful mentor for our pre-med students.”
Fann knows that it’s a daunting challenge to convince today’s medical and pre-med students to consider careers in family medicine. Top medical schools tend to promote subspecialties at the expense of family practice. Many, including Harvard and Johns Hopkins, lack separate family medicine departments. Moreover, medical specialists may earn three or four times as much as primary care physicians. With medical school costing as much as $200,000, such numbers become a crucial consideration for aspiring doctors. “Students get a little scared when they hear that they won’t be able to pay off their loans if they go into family medicine,” Fann says.
Family medicine also lacks a certain glamour. It’s no accident that television’s medical heroes tend to be specialists like brain surgeon Derek Shepherd, “Dr. McDreamy” on Grey’s Anatomy. To find a family physician on TV, you may have to go back to the 1970s and the not-so-dreamy Marcus Welby, M.D.
That is too bad, says Fann, because the work of family doctors, while admittedly less dramatic than that of specialized surgeons, is no less crucial to the well-being of patients. “I can do my best to prevent a heart attack—spending hours counseling a patient on diet and exercise and getting cholesterol down, helping him quit smoking, controlling blood pressure with medicine—and no one will ever know that we prevented a heart attack. We know that we kept chronic problems under control or minimized risk factors. But it’s not like auto insurance, where you get credit for an accident-free year.”
Fann found her way to family medicine 15 years ago at the University of Illinois College of Medicine, and she has never looked back. She was inspired by the breadth of the school’s emphasis on primary care. When the time came to choose a specialization, she was reluctant to leave behind any part of her training. “I didn’t want to be limited to a very narrow focus,” she says. “I wanted to use all I had learned.”
For Fann, family medicine has brought much more than intellectual satisfaction. She has been in practice long enough to see newborns she helped to deliver grow into grade-schoolers who come to her each year for their sports physicals. Stay with patients long enough, she says, and their problems become your problems, their stories part of your story. “Instead of seeing just a snapshot of the patient, you see the whole photo album,” she says. “I love the continuity you have with your patients.”