As family medicine was being formally recognized as a medical specialty in 1971, three young physicians were preparing to enter the field. Family Practice News, an Elsevier publication, sat down with the 2nd-year family practice residents at that time to find out what they thought of their training, their newly recognized specialty, and what their careers would hold.
Now, 40 years later, we invited them to look back on how their expectations stacked up to the reality of clinical practice.
Although the three physicians came into the specialty in much the same way, their subsequent career choices led them down different paths.
A Call to Geriatric Care: Dr. Alva S. Baker
Courtesy of Dr. Alva S. Baker
Dr. Alva S. "Buzz" Baker began in family medicine before switching to a successful career in geriatric medicine.
Dr. Alva S. "Buzz" Baker was a 2nd-year resident at the University of Maryland in 1971. He spent several years in general family practice before deciding that he wanted to concentrate on geriatric medicine. Today, Dr. Baker serves as director of the center for the study of aging at McDaniel College in Westminster, Md., and teaches in the gerontology program. "A major emphasis of my life in the last several years has been on education of physicians and health professionals," he said.
Question: In terms of your work in geriatrics, how do you feel your medicine training prepared you for that – or did it?
Dr. Baker: It absolutely did not. Forty years ago, medical schools had very little emphasis on geriatric medicine. I have been involved in the care of people in nursing homes since 1972. As it was structured then, the training for geriatrics was really not sufficient in many residency training programs. I know that residencies now have more emphasis on geriatric medicine and taking care of older patients. The doctors who are coming out of residency now are going to live their lives in large part taking care of older persons.
Question: When you look back to when you were a resident, are you surprised by the path your career has taken?
Dr. Baker: Absolutely. I grew up on a farm in a rural area. I went to college and to medical school with the goal of becoming a small-town physician, as my family physician had been when I was growing up. I was very comfortable with that into residency, because the folks who were faculty in the residency program and served as teaching mentors were basically physicians who were in small towns or had been in small towns.
When I went into practice in 1976, it was in what was then a relatively small town of 10,000 people. That town is now home to about 30,000 people, part of a bedroom community of Baltimore. So my goal to be the "country doctor" was never fully realized.
Even in that small-town environment, the writing was on the wall that family doctors as we had known them over the previous half century needed to evolve into a different kind of physician, one who was much more science based, one who was constantly interacting with other aspects of the medical community. Not that the country doctors over the previous half century didn’t do that – but it really became a necessity to do that.
Question: With that in mind and especially in light of some of the teaching activities that you still do, where do you see the specialty going as you talk to young physicians and as you look at how family medicine has changed over the past several decades?
Dr. Baker: Family medicine is still family medicine. So the physician who is going to practice broad-based family medicine still needs training in all the specialty disciplines in order to do that and to do that confidently. If somebody is going to take care of children and newborns and adolescents and young adults and middle-aged adults, as well as older persons, the different aspects of caring for certain age groups are constantly evolving and changing.
I think it is a lot harder, actually, than when I was in residency for somebody to be able to put together and achieve a sufficient level of education and skill level in the 3 years that the residency comprises.
Question: Do you have any advice for today’s residents – especially if they have an interest in geriatrics – about how to approach that and have a meaningful career?
Dr. Baker: If they are interested in geriatrics, they need to get a better understanding of what practicing geriatric medicine is all about. My advice to them would be to try to find a true geriatrician who is just doing geriatrics and try to spend time with that person and learn what his or her life as a geriatrician is all about. The second thing that they could do is to get involved with a nursing home.