Balancing the Many Hats in Academic Family Medicine

Christine K. Jacobs MD, FAAFP Professor and Chair Department of Family and Community Medicine Saint Louis University

This week…

• I taught a medical student to lower her voice an octave and speak more slowly to communicate with a hard-of-hearing patient. She countered by asking me an anatomy question that sent me off to do research.

• I learned hepatitis C protocols to treat my safety net patient.

• A senior resident and I strategized our upcoming week on call on the COVID Service.

• Our clerkship director, faculty, and I met with 3rd year medical students to plan 4th year and application to family medicine residency.

• My research colleagues and I grappled with whether we had the bandwidth to participate in a multicenter project on a tool to assess suicide risk.

• I worked on a plan to help fund family medicine initiatives in the community.

This variety, intellectual challenge and impact on future physicians and community is why I and my faculty colleagues are committed to academic medicine and find it deeply rewarding.

Academic family medicine stands on 3 pillars; education (of medical students and residents), scholarship (in education or research) and clinical practice (in a teaching environment). Academic careers follow different paths. Some academic physicians move from faculty into program directors to department chair roles, while others become master teachers, channeling intellectual inquiry and talent into education. Regardless of the path, academic physicians generally spend 5-7 years at each stage from Assistant to Associate to Full Professor.

Education of Medical Students and Residents

Family physicians are natural educators of patients. Academic medicine takes education to the next level with medical students and residents to grow our profession and strengthen the evidencebased practice of medicine.

Medical students often matriculate with a vision of medicine that looks a lot like family medicine. Students tell us that they want to form relationships with patients. They want to engage in their community. They have broad interests and they are captivated by the intellectual inquiry of diagnosis and treatment. So why do relatively few students choose family medicine? In good part, it is because of their exposure to specialists. Academic family physicians play a critical role with medical students, demonstrating the intellectual rigor and rewards of primary care.

The academic physician’s toolkit includes skills in clinical teaching, small group case-based learning, and physical diagnosis teaching. Some offer elective experiences in areas such as sports medicine, preventive medicine or community health. Some faculty develop expertise in classroom teaching of evidencebased medicine. For example, at Saint Louis University School of Medicine, the academic family physicians lead courses in Epidemiology and Biostatistics, Clinical Interviewing and Clinical Diagnosis. Even if medical students decide to match into other specialties, these early experiences engender respect for primary care physicians.

Family Medicine Residency faculty must adapt their teaching methods for adult learners. Being residency faculty requires a strong dose of humility as residents present the newest evidence that faculty may not yet have encountered! However, residency faculty enjoy and appreciate the climate of intellectual inquiry. Faculty are most often seen precepting residents and medical students in clinic and the hospital. But behind the scenes, they are planning residency lecture series, planning and ensuring rotation curriculum, evaluating and advising residents, and producing scholarship or research.

Scholarship and Research

The desire for a climate of intellectual inquiry drives most faculty to academic medicine. Very few family physicians enter academic medicine with significant research expertise. However, most university departments of family medicine have research divisions and faculty often “catch the research bug.”

Scholarship that informs clinical practice and medical education is critical to the future of family medicine. Research spans the breadth of our specialty. Health promotion and disease prevention, clinical best practices, social determinants of health and health equity are common themes, as well as innovation in medical education. We are uniquely positioned to understand what knowledge is critical to primary care. Recent investigations in our department include the relationship between HbA1c and depression treatment, effectiveness of opioid treatment protocols, and relationship of socioeconomic status to pain treatment. Academic physicians frequently collaborate with researchers or faculty from other disciplines to study these questions, and seek external funding for larger research investigations.

Clinical Faculty Practice

Academic family medicine often allows faculty to work with patients who fall into the healthcare safety net, supported by the mission of a university or FQHC. That practice particularly appeals to physicians who enjoy patients with multiple complex medical issues and social stressors, and who are committed to making systems work better for those patients. Medical students, universally present in the academic practice, reward faculty with a multitude of enthusiastic clinical questions even as they challenge them with time management.

Sometimes academic settings allow faculty to explore practice or learning in areas that are harder to find in community practice. Obstetrical practice, for example, is less limited by insurance constraints in an academic setting. Academic departments or residency programs may support faculty to train and practice in areas such as point of care ultrasound, colposcopy, or medication assisted treatment for opioid use disorders.

Rewards of Academic Medicine

So why do I love academic medicine?

• Intellectual stimulation in clinical practice and education

• Working with faculty colleagues who have different but overlapping interests

• The ability to do projects that impact the health and healthcare of our patients and community

• The opportunity to contribute to the knowledge base of medicine through research and scholarship

• The joy of teaching and mentoring the physicians of the future

Academic medicine can be entered at anytime. Strong physician educators have often spent years in practice. Those years provide a foundation for clinical teaching and can lead to an interest in a particular area of academic medicine. For family physicians considering academic medicine, the Society of Teachers of Family Medicine (STFM) is a valuable resource.

The payoff of academic medicine is not financial. Academic physician salaries are usually significantly below market salaries. But there are many satisfactions: great intellectual challenge and social engagement, the knowledge that we are contributing to evidence-based clinical medicine and improving the health of communities by training a new generation of physicians. I could not imagine doing anything else.