Family-practice physicians often are differentiated from their internal medicine colleagues by their skill sets in procedures.
“To the extent that a family-medicine physician may want to demonstrate that they can have a skill set that adds value in order to be hired or accepted, I think surgical assisting could have very specific application in specific places,” says A. Neal Axon, MD, assistant professor in the departments of internal medicine and pediatrics at the Medical University of South Carolina in Charleston. “I’ve certainly tried to market myself as a med-peds person, and as somebody who’s good at more than one thing.”
Dr. Axon concedes hospitalists as surgical assistants would not work at his institution. “In academic medical centers, the dividing lines between divisions and disciplines are very concrete,” he explains. “I think many people carry those cultural barriers or dividers—even if they are somewhat artificial outside the academic environment—when they leave and go into community practice.”
Those divisions are not felt as keenly in the Midwest, according to Dr. Frenz, where “family medicine has a long tradition.” St. Joseph’s Hospital has a family – medicine residency program, and more than half the credentialed physicians there are family- medicine trained.
“We think that family-medicine physicians have a skill set that is valuable in certain clinical settings,” he says. “For example, we do a lot of work on the behavioral health floors and are the principal medical providers on a 28-bed chemical dependency unit.” Dr. Frenz had a patient who was pregnant and alcohol dependent. Because of his expertise in addiction medicine (another of his self-described “insurgencies”) and residency training in obstetrics, Dr. Frenz is managing the patient without incurring an ob/gyn consultation.
How to Prepare
Every hospitalist’s path and skill set is unique, but for those medical students or residents who might be interested in combining some surgical work with hospitalist skills, Dr. Frenz advises adopting a calculated approach to electives. Besides taking as many surgical electives as possible, trainees should try to pick small community hospitals where they will not have to compete with surgical residents for time in the OR.
Although she thinks expanding into surgical assisting could improve recruitment (offering a varied hospital experience), Dr. Cereste also emphasizes that many questions regarding training standards, care standards, and expense hurdles would have to be addressed.
The bottom line, says Dr. Hoffmann, is that hospitalists “need to be able to play a lot of different roles. I think we’re like a utility infielder. If [surgical assisting] improves patient care, is a valuable service to the health system, and is viewed by consultants, specialists, and family doctors as an additional skill, it’s clearly going to benefit your program and your hospital. The key is to see what works in everyone’s little pond and try to be a team builder.” TH
Gretchen Henkel is a medical writer based in California