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 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.