December 22, 1997

So You Think You Want to Be a Doctor?

David Napier believes the first thing an incoming
college student interested in pursuing a career in medicine should
do is to find out why it may not be such a good idea. Napier,
a professor of anthropology at Middlebury College in Vermont,
wants young people aspiring to careers in medicine to know, before
sinking $160,000 - $175,000 into medical training, how very demanding
things can be for a doctor. Napier also wants those same students
to consider the advantages of someday setting up a medical practice
in a remote, rural area of the country where the services of a
dedicated physician may be especially needed.

Conflict? How can students who go out and experience
directly the harsh realities of a small-town, primary care physician's
life, be persuaded to both maintain interest in medical careers,
and, beyond that, set their sights on careers in rural medicine,
known more for its frustrations than its advantages?

Napier is convinced that students who are allowed
to spend time with doctors practicing medicine where "the
lights are not as bright," are more likely than most to follow
a similar career path. That's why he's sending a group of soon-to-be
Middlebury College students out this January to live with Vermont
doctors, to get a taste of medical practice as it is experienced
in some of the most remote, rural areas of northern New England.

Bolstering his case are comments by students like
Jody Carroll, a first-year student at Middlebury during the 1995-96
school year when she participated in Napier's first internship
program for premed students. Ms. Carroll, like the other 14 students
in that program, spent four weeks living and working with a Vermont
doctor. Students sat in during office hours, accompanied physicians
on hospital rounds, home visits, and in the emergency room. Physicians
received students' help in everything from examining issues of
quality of health care in their communities, to completing routine

Ms. Carroll learned that work for a doctor begins
early in the day and keeps up a steady pace. "Nancy (Dr.
Nancy Scattergood, of Bennington, Vermont) and I usually leave
the house no later than 7 a.m.," she wrote. "We go to
her office, park and then walk to the hospital to do rounds...
We then walk back to her office and she begins seeing patients..."

Eric Larson, a first-year Middlebury student who
worked with Dr. Timothy Cope, a family practitioner in Middlebury,
Vermont, now understands some of the less glamorous aspects of
a doctor's work. "I probably doubled my knowledge about medicine,"
he said. "I also have a better understanding of the medical
system, medical insurance, and coverage."

One of Napier's first internship participants, Middlebury
student Laura Parmalee, reflected on the serious illness of a
patient of Dr. Peter Harris, a doctor practicing in a small Vermont
community near the Canadian border. She said, "To see a
woman with cystic fibrosis hanging onto the last months of her
life and praying for a donor to become available that will give
her a second chance was hard. I realized that my life is awesome…because
of my health, my youth, and, most importantly, the love I receive
from my friends and family."

Because students in the first program generally reported
that their views of the medical profession had been shaped in
significant ways, Napier decided to run a second program, this
time getting students involved even earlier in their lives, before
college. "I invited 15 students accepted to Middlebury College
who had expressed interest in medical careers to show up here
three weeks early. Then we gave them a crash program in contemporary
health care issues," he said. That was the first part of
the program which continues this January with internships.

Napier's unique program grew out of his longtime
interest in the education and training of doctors. As a social
scientist, he worries about undergraduates struggling to complete
the heavy load of science courses required of premeds. He fears
the heavy emphasis on hard sciences may discourage or prevent
students from taking courses in the humanities and social sciences
which Napier believes are invaluable for providing skills needed
for the medical field. Some of his best students opt out of medicine
altogether because stringent premedical requirements are too difficult
to complete within the normal four years of undergraduate education.
Napier is also concerned that, among students who do go on to
medical school, few seem interested in working in rural areas.

Keen interest in finding ways to address these issues
led Napier to a research project in which he surveyed over 200
physicians to find out how they felt about the quality of their
personal and professional lives as medical practitioners. He focused
on doctors with rural practices in Vermont. Napier found that
life for the doctors offered frustrations and hard work. Many
of them complained that Medicare/Medicaid payments were too small
to compensate for the time needed to treat patients with lifestyle-related
illnesses such as alcoholism, obesity, and smoking-related diseases.
Much of the time spent with patients, he learned, was social
work, confirming his belief that more exposure to the social sciences
benefits those heading for careers in medicine.

One of the study's findings was particularly fascinating
to Napier. Many of the same doctors reporting high levels of frustration
also said they were very satisfied with their decisions both to
become physicians and to practice in rural areas. "In virtually
every case in which doctors reported they were happy with their
career decisions," said Napier, "they linked that decision
with an important experience that happened at or before the age
of 18."

Napier concluded that if a young student about to
enter college could spend time working with a physician in a rural
practice, it might accomplish two things: show them the kind of
life they might be headed for in medicine, and offer a life-defining
experience that could motivate them to follow in the footsteps
of these doctors, and choose medical careers in rural locations.

As the second program heads into the internship phase,
Napier believes it is accomplishing its goals. In addition to
exposing his students to the difficulties of the medical profession,
he says the program also empowers them. "By being there through
the often mundane situations that physicians encounter every day,"
Napier says, "these students learn that health is a state
of well-being that often requires as much social work on the part
of physicians as medical knowledge." He says students also
learn that the role of a physician is often to be an advocate
for his patients. In this regard, Napier's program helps to humanize
medicine by instilling those concepts at the undergraduate level
before students begin their intensive medical training.

David Napier's program is small, and he is under
no illusions that it will change the face of medical practice
or produce a whole generation of doctors who flock to remote areas
to set up rural medical practices. What he does hope to accomplish,
however, is to demonstrate the value of showing students early
on in the process of preparing for medical careers what lies ahead.
He hopes he has significantly enhanced the education of some
young college students who will one day be caring physicians,
who will not be shocked when they find they have entered a field
short on glamour and long on commitment.