opinion

Clinical experience is the essence of a career in medicine

A message to all physicians from Robert M. Wah, MD, chair of the AMA Board of Trustees.

By — Posted Jan. 23, 2012.

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In recent weeks, two sets of parents I know asked me to speak to their children, undergraduates interested in careers in medicine.

This was a real treat for me -- both to talk with bright young people about the profession I love, but also to take a step back from the political conflicts over the future of U.S. health care. As we struggle in the political and policy arena to improve medical practice and health care for our patients, it is all too easy to overlook other things that are really important.

Both students had asked for my advice. Both are attending prestigious universities and both graduated from Thomas Jefferson High School for Science and Technology in Fairfax, Va., where my daughter is a freshman. TJ has been ranked by U.S. News & World Report for the past three years as the No. 1 public high school in the United States.

Of course, I was flattered to be asked by their parents to talk with these very intelligent young people. The two of them had very different questions.

One has been doing neurobiology research starting in high school at TJ, and the other is considering acceptances to multiple medical schools. The researcher is trying to decide if going to medical school is the right path, and the other is very interested in a possible career involving health care policy.

My advice followed several lines. I pointed out that after the decision to enter medicine, they each have decisions to make: specialty; mode of practice (solo practice, group practice, academics, etc.); geography of where they want to live; choosing between clinical medicine or "other," such as administration, research, entrepreneur, policy, etc.

I see many students anxious to get degrees in addition to their medical degree, such as an MBA, JD, MPH or PhD. I suggest that this is better done after gaining mastery, expertise and a reputation as skilled clinician.

This is possibly seen as "old-fashioned," but as far as I am concerned, clinical practice is the essence of what being a physician is all about.

Most physicians go into medicine to do clinical work. It is very, very rewarding, and I advise that everyone make sure to take the opportunity to have the special experience of taking care of people as a clinician before looking at the "other" box of work opportunities. It is possible that they will fall in love with patient care as most all physicians have done. They may never seek to work in the "other" box.

Get your clinical training and experience. No one can ever take this away from you, and it will hold you in good stead in whatever area you go into further on.

After 16 years of full-time clinical practice, I applied to business schools and was accepted at Harvard Business School, Wharton and several others. My clinical experience and perspective likely helped in my being selected for admission.

During this time, I met a young woman who was getting her MBA and MD degrees at the same time. She told me she was frustrated when applying for residencies. Most of the residency program directors were not enthusiastic about taking her in their program. With her Wharton MBA, they did not see her as a likely candidate to have a clinical career, and they would prefer to train future clinicians.

In talking with the two young students recently, I was again reminded of the fact that a career in medicine is filled with unlimited opportunity, and I always seek to maximize opportunity. In telling them about my career, I realized all the many great opportunities I have had:

  • I have seen tens of thousands of patients, delivered thousands of babies and done thousands of surgeries.
  • I have taught and learned from hundreds of medical students, residents and fellows.
  • I am fortunate to help lead the development of health care information technology and policy at the local, regional, national and international levels with past positions as associate CIO for the Military Health System, then as the first deputy national coordinator for health information technology at the Dept. of Health and Human Services. I was recently interviewed on nationwide TV in Australia in 2011.
  • My experiences enabled me to lead a business division with a profit and loss responsibility for $150 million.
  • Currently, I am honored to serve in my position as chair of the American Medical Association Board of Trustees.

Throughout my career, I have continued to see patients, do surgery, and teach residents and fellows. My clinical experience and perspective has made me more effective in all of these nonclinical settings.

The "other" box is vitally important to improving health care for our patients and our profession.

However, I believe that to be maximally effective, doctors working in the "other" box will be best served if they can bring experience as clinicians who take care of patients. When talking about health care, they will stand out among all those who may have other backgrounds such as finance, economics, law or health policy.

I am doubly inspired by the interest of these two students. They affirm that the best and brightest students continue to see medical careers as full of opportunity and worth pursuing. It is vitally important for our patients and the health care system that we continue to attract smart, accomplished young people.

The fact is that the physician population, like the rest of Americans, includes an abundance of baby boomers. With their upcoming retirements, we face a looming manpower crisis in the medical world:

  • The Assn. of American Medical Colleges estimates that, in the next decade, nearly one-third of physicians will retire, and America will face a shortage of more than 90,000 physicians. The projected deficit by 2025 is more than 130,000 physicians across all specialties.
  • As an example, in my home state of Virginia, 43% of the state's practicing physicians are over 50, an age at which surveys have shown many physicians consider reducing their patient care activities.
  • Even in the retirement mecca of Florida, there are only 14 practicing physicians per 1,000 Medicare beneficiaries, well below the national average, and nearly half -- 49% -- of Florida physicians are older than 50. The situation is similar in most other states.

And so, especially at this time, seeing these young students is very heartening for me. As we push to improve medicine and health care for our patients and seek the elimination of the Medicare sustainable growth rate, greater medical liability reform and more flexibility with things like the Medicare Patient Empowerment Act, those students' interest in medicine provides the broader context about our great profession and the privilege we have to care for our patients.

I am encouraged that they see the same great opportunities in a medical career that we saw and have been blessed to have.

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