Choosing to Care
By Ann Mary Quarandillo
Among middle and high school students, a career in medicine has always been a top 10 choice. Yet today, many areas of the country face an acute physician shortage. Medical school is tough, and getting in is tougher, says Evergreen faculty member Paula Schofield, a chemist who advises students who are pursuing careers in medicine. But for the many Greeners educating the next generation of medical professionals, it is definitely worth the struggle.
"I was never interested in science or math in high school," recalls Higgins, who is in her second year of medical school at the University of Vermont. "I even remember asking a high school chemistry teacher if he thought I could go to medical school if I didn’t like chemistry. He wasn't very supportive."
It wasn’t until she started the sciences at Evergreen that she discovered her passion for medicine. "During my first science class, Introduction to Natural Science, I also worked at the Student Health Center training to be a medical assistant. Science at first was very difficult but I loved the interactions with patients at the health center. Evergreen’s hands-on approach made science less intimidating and more understandable."
The interactive, problem-based approach to learning in the sciences at Evergreen, as well as undergraduates’ opportunities to work with faculty on scientific and health-related research, prepares students well for medical school. "The problems students are going to have to solve as doctors are interdisciplinary in nature," Schofield explains. "They have to look at patient case history, look at other patients, research—use all this to solve their problem. Many medical schools are moving toward an Evergreen approach with students working in groups, using lots of different disciplines to solve problems. Having integrated knowledge of these fields is important."
An M.D. with a master's in public health, and professor of family medicine and adjunct professor in epidemiology at the University of Washington, Dr. Nancy Stevens ’73 finds her ability to work across disciplines critical to her work. “In medical school I was always curious,” she says. "I wondered why others weren’t questioning what we were learning. Couldn’t we do it better? Couldn’t we work with more kinds of people to make this better?"
Stevens now teaches and trains family physicians to be medical school faculty. She has spent the last 10 years directing a network of family physician residency programs, developing high quality clinical training in community settings for family physicians. One of the fastest growing needs in the medical field, especially as more people become part of the system, is for family doctors. But fewer and fewer medical students are becoming general practitioners or entering family medicine. One reason, of course, is that the pay scale for specialists is much higher.
But focusing on one specialty area is also appealing for students, many of whom are studying medicine to help solve patients’ problems. Learning the skills family doctors need to deal with the uncertainty involved in treating people with a wide range of health issues can be daunting. In general medicine, patients’ problems can’t always be solved.
“To be a family doctor, you have to deal with ambiguity. Balancing patients’ best interests with the possibility of lawsuits, or confidentiality vs. danger to the patient—those kind of gray areas are really hard for doctors, so they become more specialized to avoid ambiguity,” Stevens says. “Evergreen pushes people to see the ambiguity—to look at more than one point of view and look at information from many different perspectives. That makes people better able to deal with complex systems.”
Having a personal connection and level of trust between patients and health care providers affect the consistency and quality of care, according to the 2008 study, “How is a Shortage of Primary Care Physicians Affecting the Quality and Cost of Medical Care?” by the American College of Physicians. “Medical schools are looking for clinical experience—more than just volunteer work,” explains Schofield. “Shadowing a doctor, working as a student medical assistant in Evergreen’s Student Health Center, even earning your nurse assistant certificate—you want the most hands-on experience you can get.”
Evergreen senior Chac Franco-Vasquez has taken that advice, shadowing a local doctor and seeing what it’s really like to work with patients. Although he knew he wanted to follow a career in some sort of science and math, it wasn’t until his junior year that he decided on medicine. “I took a class on immigration, as well as Reproduction, Birth and Power, which focused on bioethics,” he says. “I saw a lot of problems with the current health care program in the U.S., particularly with marginalized communities.” This summer, he completed independent lab research with faculty member Andy Brabban, worked with Upward Bound students, and now serves as co-coordinator for the Evergreen student chapter of MEChA, a Mexican American and Latino/a advocacy organization.
As a freshman, he took the Introduction to Natural Science program, but also served as a resident advisor, where he realized he wanted to care for people. “I loved being with people at their worst times—not thinking about who’s who or what status they have, but just taking care of them,” he says. “Physicians look at symptoms and physiology, but the psychology of the person is also part of it. What I learned at Evergreen is that a lot of different things need to be integrated when you go into medicine—and that it’s healthy to have uncertainty. That’s how we discover new things."
Teaching students to deal with ambiguity reaches across all the sciences at Evergreen. “Faculty here show science students that not everything has an answer,” says Schofield. “Otherwise, why would we do research? Be honest about what you don’t know. You can use your skill set to solve problems as far as you can, but sometimes you need to try a different approach.”
That openness to different approaches encouraged Laura Zeidenstein ’76 to pursue her goal of becoming a midwife, and continues to influence her current work as a certified nurse midwife and director of the graduate Midwifery Program at Columbia University in New York City. “Evergreen allowed me to stay in the world and integrate my academic experience with a world experience—that’s crucial,” she says. “It influences how I teach, work with students and work with patients.”
Many paths are available to students in the medical field. Dr. Jon Geffen ’94 decided to go to osteopathic medical school, and received his D.O. from Missouri’s Kirksville College of Osteopathic Medicine in 2000. But when he started at Evergreen, he didn’t even know the field existed. “I wanted to be a medical doctor, but I also wanted to be a healer,” he says. Today he specializes in non-surgical treatment of spine and muscle pain at Puget Sound Orthopaedics in Tacoma. With a new osteopathic medical school recently opened in Yakima, Geffen sees new opportunities for Evergreen students interested in medicine. “Osteopaths are fully licensed physicians,” he says, “and along with M.D.s can perform all the types of surgery and prescribe all the same medications, but also focus on a holistic approach that treats whole patients, not just symptoms.”
Evergreen also prepares students for the challenges they’ll face as health care professionals. Programs address health care reform, bioethics, major diseases and epidemics, and the politics of health care—in addition to science. Maternal health is a perfect example of people’s needs competing with the current system. “Midwifery has always been in survival mode in the U.S., and there are many misconceptions out there about what midwives do,” Zeidenstein explains. “Every other industrialized country uses midwives as primary providers for childbearing women. So we train students to serve women and their families, but to be aware of the challenges they’ll face as outsiders in the health care system. We want them to maintain their optimism and idealism, but they will not be successful if they are not very reality-based.”
For Stevens, the key is providing care that gets people closer to a better life, rather than spending large amounts of money on marginal health improvements. She worries that there will not be enough primary care doctors to meet the growing need. Many family doctors have reduced their practices, and there are currently not enough faculty to teach family medicine. But it’s an ideal fit for students who truly want to help people. “It’s a great idea to have real doctors who see you, know you and follow you over time,” she says. “You can’t make rational decisions about your own health on your own. Patients need someone knowledgeable to advise them—someone who understands them as well as the options available.”
Chac Franco-Vasquez is “a bit nervous about med school, but also pretty confident,” he says. His senior year, he plans to focus on history and a critical analysis of health care, trying to find out how people who are not being helped today can be, and where he can best fit in. His Spanish language skills are critically needed in the field, where he’s interested in primary care as well as emergency medicine. “Emergency requires good sense and the ability to think on your feet, taking risks and helping people in that critical state. It would be very fulfilling to be that person,” he says. “But I’m still very open to other ways of doing medicine.”
When Sara Higgins entered medical school, she was convinced she wanted to go into family medicine, and is a leader of her medical school’s Family Medicine Student Interest Group. But now she finds she’s also interested in pediatrics, oncology and surgery. “I love learning and I have Evergreen to thank for that,” she says. “It opened my eyes to the world and made me excited to be a part of it. As a doctor, I will continually be learning the science behind diseases, new innovations of technology, and most importantly, I will get to be a part of people’s lives.”