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 paperwork.

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 awesomeÂ…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.