Career Advisor's Background and Career Information

Background

Name: Michael B. Potter, MD
Career Advisor for: Family Medicine
Title(s): Associate Clinical Professor
Best way to contact (e-mail, phone?): potterm@fcm.ucsf.edu
Undergraduate & Graduate Degrees/Institutions:
AB, Harvard College1984; MD, Harvard Medical School, 1990; Family Medicine Residency, UCSF-SFGH, 1993.
Clinical Interests/Duties:
I am an attending physician at the Lakeshore Family Medicine Practice, where I see patients three days a week. Our practice includes adults and children of all ages, and we provide maternity and newborn care for our patients at Moffitt Hospital.
Research Interests/Duties:
I am Director of Clinical Research at Lakeshore and Co-Director of the UCSF Collaborative Research Network (CRN), which is a practice-based research network of primary care clinicians throughout Northern California. The CRN focuses clinical research relating to chronic illness care, promoting healthy behaviors, and the increase the delivery of preventive health services in primary care practices.
Personal Notes or Comments:
The thing I most like about family medicine is the opportunity to get to know patients and families over time in a variety of clinical contexts. I see patients of all ages, and from every walk of life, and I thoroughly enjoy each day's small surprises. I learn something new from my patients every day. After 10 years in the same clinical practice, I really feel as much like a trusted personal advisor as I do a physician to many of my patients, which is a great privilege. My research is increasingly focused on how we can make the most of this privileged position in the lives of our patients to assure that our patients receive the high quality care that they deserve. I live in San Francisco with my wife and two young sons, aged 4 and 6. My wife is Yeva Johnson, also a family physician. We met in residency, when we were assigned to be interns working in San Francisco General Hospital's Pediatric Clinic - the rest is history. Yeva works for the San Francisco Department of Public Health, and she has a rewarding career taking care of some of the most needy people in our city. Balancing our work and home lives is always a challenge, but we are making it work. Music is a big part of our lives - Yeva is a flutist, I play the cello, and our two sons are learning violin. It looks like soccer is going to be the next "big thing" in our lives in the year to come.

Career Information

1. What can students do in the 1st and 2nd years to explore and/or prepare for this career? First, I encourage each of you with an interest in family medicine to come and meet the family medicine career advisors. We are eager to meet you and would be glad to talk with you about opportunities to learn about our specialty. In addition, family physicians engage in a wide variety of work; we are always happy to help students connect with a family physician whose interests match yours.
Some students find that it is very helpful to spend some time seeing patients with a family physician in order to get an idea of what the specialty is all about. We can also put you in touch with some of the outstanding researchers in our department who would be glad to talk with you about academic careers in family medicine and share opportunities to become involved in family medicine research. Many family physicians are strong advocates for their communities; students interested in community activism can also be introduced to appropriate faculty.
UCSF has a Family Medicine Interest Group, and we encourage you to become an active member. The California Academy of Family Physicians has its office in San Francisco, and they often have roles for students who are interested in organized medicine. They also offer a limited number of summer preceptorships for students.

2. What common variations exist in the length/content of residency programs for this career? Board Certification requires 3 years of training. Although the first year of training includes a substantial amount of inpatient care, most residents do approximately 50% of their training in outpatient settings by their second year. Internship usually includes at least three months of adult inpatient medicine, two months of inpatient care of children, two months of inpatient obstetrical care, and a month working in the emergency department. In the second and third years, there are usually an additional three to four months of inpatient care of adults, children, and infants and an additional month or two of inpatient obstetrical care. Subspecialty training in orthopedics, gastroenterology, gynecology, ophthalmology, ENT, and other fields may also be included as formal rotations in the second and third years. Many programs offer international health electives. Throughout it all, you will develop your own longitudinal clinical practice, and will devote more and more of your time to caring for families in an outpatient setting.
There are variations in the family medicine residency training program that all students considering a career in family medicine should be aware of. First, there are part time residency positions in some programs, which allow students with small children or other personal needs and responsibilities to complete their residency over four or five years with a less demanding schedule. Second, there are combined residencies in family medicine-ob gyn and family medicine-psychiatry. These programs allow students to become board certified in both specialties after 4 years of training. There are also several programs that allow you to do an MPH as part of your training.

3. What common variations exist in this career after training? The opportunities are very broad. Most graduates decide to go directly into clinical practice. Clinical practice settings can range from urban to rural and from large multi-specialty settings to solo practice. Some people choose settings with underserved communities, such as an urban clinic or a clinic on an Indian Reservation. Others choose to practice in settings with mostly managed care patients or even in settings where managed care patients are not accepted. Still others pursue careers in international medicine. Nationally, about half of graduates initially include obstetrical care in their practice, and a large proportion of graduates also continue to do both inpatient and outpatient care. However, there are also a large number of graduates who prefer to practice exclusively in an outpatient setting. Many graduates work part time in a variety of settings until they decide what type of practice setting suits them best.
Some graduates choose academic or public policy careers after training in family medicine. While no additional training is required to pursue this path, many students choose to do additional training in a research or teaching fellowship, or to get an MPH. Some will do an additional training program in Preventive Medicine, Occupational Medicine or surgical obstetrics. Sports Medicine, Adolescent Medicine, and Geriatrics are other specialties sometimes pursued by family medicine graduates who wish to pursue additional training. Teaching the next generation of family physicians is a high priority for many graduates, and there are many opportunities for graduates to participate in family medicine training programs, either as core faculty or as volunteer preceptors, no matter what path you have chosen for yourself. While most family physicians choose this specialty for the opportunity to work directly with patients, there have been some impressive national and international leaders emerging from the specialty in the last ten years. Family physicians have been deans of medical schools, president of the American Medical Association, US Surgeon General, head of the Centers for Disease Control and Prevention (CDC).

4. What is a typical work day for you (or someone else representative)? The typical work day for a family physician in clinical practice will vary quite a bit, depending on your work setting. The average clinician may come in to their office early to answer patient messages or prepare for a busy day with their office staff. In a typical day, most family physicians will see more than 20 patients of all ages. These visits may include some common acute illnesses such as viral infections or minor injuries; chronic illness visits, such as asthma, diabetes, or congestive heart failure; or others types of visits, such as prenatal visits, well child checkups, and new patient visits. We try to take time to assess our patients' needs for preventive services such as immunizations and cancer screening, and we try to make time to promote healthy behaviors, such as healthy diet and exercise. We also try to pay attention to our patient's mental health, since a large proportion of our patients seek our help first when they are depressed or anxious. We also do a variety of minor procedures in our office, including endometrial biopsies, IUD placement and removal, skin biopsies, and joint injections. Some family physicians also offer other procedural services in their offices, such as flexible sigmoidoscopy or coloscopy. In my own clinical practice, I am sometimes on call to manage laboring patients or to care for newborns in UCSF's well-baby nursery. In many other settings, family doctors may make rounds on their other hospital patients or schedule visits with their nursing home patients or homebound patients. There are even some family physicians who have decided to focus their practice on caring for patients in the hospital setting, as "hospitalists", and others still who have spent most of their careers working in urgent care and emergency department settings.

5. What is the "culture" of this career? Family Medicine is first and foremost a career that attracts people with a strong interest in people. More than any other specialty I think of, family medicine really has a strong belief in the holistic nature of medicine. We do not so much see ourselves as caring for disease as we se ourselves caring for people and their health needs. We recognize that, if we are going to be successful in helping our patients to lead healthy lives, recover from an acute illness, or cope successfully with chronic illness, we need to be both on the cutting edge of knowledge and we need to understand, appreciate, and accommodate the values and priorities of our patients. These twin values are at the core of the family medicine culture.

6. How compatible is this career with raising a family? How is this different for men and women? Family medicine can be a demanding specialty involving long hours. However, most practices and work settings are willing to accommodate family doctors who want to work part time. Family medicine residencies, in general, are accommodating of pregnancy and family demands. Some of us have worked part time while raising small children and expanded our schedules when we felt we had more time to devote to our careers. Family medicine has traditionally attracted many women, and there are many women faculty in residencies and academic programs. Currently, slightly more women than men are joining family medicine.

7. How important, individually, are each the following for admission to a competitive program:

a.Extra-curricular/volunteer work? Helpful, but not required
b. Research/publications? Helpful, but not required
c. Honors in third year? Helpful, but not required
d. AOA? Helpful, but not required
e. A sub-internship? Helfpul, but not required
f. An externship? Helpful, but not required
g. (Other important elements to the application?) It is helpful to have been involved in activities that demonstrate that you are interested in people - either by volunteering on a community project that involves outreach to a community that interests you, or by volunteering in a clinical setting where you can test your interest in family medicine. Organizing activities for the Family Medicine Interest Group at UCSF is another way to demonstrate your commitment. Admission committees want to see that you are a well-rounded person who has been thoughtful about your career choice - your extracurricular activities are a way to demonstrate that.
If you are interested in pursuing an academic career in family medicine, and you are looking specifically at programs with outstanding research opportunities, it can only be helpful to start early and get involved with research projects of our faculty at UCSF. That said, most residency programs are realistic about the amount of time that you will have in medical school and in your residency training to do substantive research. Research can help get the attention of the admissions committee at a competitive program, especially if it involves topics that are important to our specialty. However, it is not required or expected of family medicine applicants.
AOA also can get the attention of the admissions committees at competitive programs. However, most programs are much more interested in whether you are an honest and reliable person who is both easy to work with and who brings enthusiasm and commitment to the task best family physician you can be. As a graduate of UCSF, your academic capabilities are already going to be well regarded, whether or not you are AOA.
Finally, it is helpful to have letters of recommendation that show you are adept clinically in diverse clinical settings. One letter should be from someone in family medicine who has gotten to know you and your abilities well. Other letters from specialites such as internal medicine, pediatrics, ob/gyn, or psychiatry can also be very helpful if they are strong.

8. What are the most important qualities or character traits for a person in this field? You don't have to be an extrovert, but you do have to be a good listener and genuinely interested in people and their stories. It helps if you are the kind of person who notices what is unique about each patient who comes to you for care. Another important trait is a desire to be at the center of your patient's care, since the role of the family physician often involves coordination of a broad range of specialty or community-based services.
The knowledge base of the family physician is about the same size as it is for any other medical specialty. However, medical students trained under what often seems to be a necessarily reducitionist medical school curriculum often feel intimidated by the breadth of our specialty. In fact, learning the details of one area of medicine (i.e. obstetrics) can aid in learning the details of another (i.e adult medicine) since similar principles are often involved. While family medicine is not well suited to everyone, you should be aware that literally thousands of us started out just like you and have become happy and successful family physicians, doing outstanding clinical work in communities large and small. At its most basic level, our role as family physicians is to help patients identify the needs of our patients and to do our best to see that these needs are satisfied. To be successful in this role, you should be the kind of person who is always eager to learn more, but recognizes your own limits. You should also be the kind of person who likes to work collaboratively with colleagues and can appreciate that each member of the health care team has an important role to play in the care of patients.

9. How competitive are the residency programs in this field? There are over 400 family medicine residency programs in the US. While it is relatively easy to get into many of these programs, there are many programs that are highly competitive. Some of these programs may have over a hundred applicants for five or ten slots. With a solid record and a good interview, however, any program should be within your reach as a graduate of UCSF.

10. How competitive is the job market after residency? Nationally, there is a shortage of family physicians, especially in rural and underserved areas. In urban areas where there is a relative oversupply of physicians, it may take more time to find the ideal job. However, even in the bay area, there are almost always good job opportunities for family physicians, especially if you are a UCSF graduate. With UCSF credentials and a good residency training under your belt, you should be able to find a job almost anywhere in the United States.

11. What programs would you consider to be in the 1st tier, 2nd tier, and 3rd tier? Programs in family medicine vary substantially, and it is usually better to think of this in terms of your own interests and the environment in which you learn best. Some students will find then academic medical center to be the most exciting and stimulating place to learn to be a family physician, whereas others will feel they learn best in a program set in a community hospital where family medicine is the only training program. If you are looking at programs in academic medical centers, it will be important to look at the relationships between the family medicine department and other departments to be sure that family medicine is highly valued and integrally involved in providing you with the most important parts of your training. If you are looking at programs in community hospitals, you will want to make sure that the opportunities to gain cutting edge training across the breadth of family medicine is up to your expectations. No matter what program you are looking at, you should see if the people who are part of the program share your values and look for role models that you would like to emulate.
In no particular order, the residency programs affiliated with the University of Washington, the University of Oregon, UCSF and UC-Davis are mostly outstanding. In Southern California, UCSF graduates have reported that the program in Ventura is also outstanding, and the programs in Santa Monica, Long Beach, and at Kaiser have solid reputations. The programs affiliated with the University of Arizona, New Mexico, Colorado, Minnesota, and Wisconsin also have outstanding national reputations. In the east coast, the Dartmouth and the University of Massachusetts and University of North Carolina programs also have excellent programs. The Mayo Clinic has well-regarded family medicine residencies in Minnesota and Florida. We are less familiar with programs in other parts of the country, but there are outstanding programs throughout the United States, and we are prepared to work individually with student to help choose programs that are best suited to them, regardless of where they might want to move.

12. What resources (web, books, etc, besides the AMA and AAMC sites) would you recommend for students interested in learning more about this field? Please see Bill Shore's response to this question. And please come ask us if you have questions!