Anyone that has been through the medical gauntlet—college, medical school, residency, and then that final test: employment—understands that finding your tribe is crucial to your success. When I say “tribe,” I mean that special group of people whom you find along the way and know will be with you forever. It’s the group of friends that you woke up at 7 am to study with in medical school, spending long days and nights together because they understood you, made you laugh and happened to be pretty smart too. It’s the co-residents that worked and learned alongside you for those 24-plus hour shifts—all of you wearing wrinkled scrubs under a stained white coat packed with pocket-sized books, a half-full caffeinated drink and the granola bar that was supposed to be lunch if only you had remembered to eat it. So what happens to those tribes after graduation, as you start your new job? Most of my med school and residency friends reside in different states. Although they are only a phone call or text away, once I experienced the joy of being physically surrounded by similarly-minded friends for so many years, any sort of distance feels like a new kind of isolation.
In current family medicine practice, many of us are employed by a health system and situated in outpatient offices of varying sizes. It already felt weird to make the transition from resident to attending physician, knowing that no one was directly supervising my work or checking for errors. But even stranger to me was that in my first two jobs, no one discussed cases or even asked one another questions! After such rich and rigorous residency training, I remember thinking: This is not how medicine is actually practiced, right?!?! My partners kept their office doors closed and sprinted out the door at the end of the day. Where were the healthy debates over tough clinical questions, help with EKG interpretation, or the quick consults to a partner about a kid’s puzzling rash? Where was the tribe that stayed with one another until the work was done? My clinical curiosity and physician’s soul longed for the education that resulted from unique personalities examining a case from totally different perspectives. I sorely missed the “what if’s” and “have you thought of’s” that sharpened my skills during training. Because without those challenges, the efficient demands of office life and lonely hours charting after work drained the heart out of medicine for me.
You used to hear how physicians would hang their shingle and stay in a community for their whole career; now over 50% of physicians change jobs with the first five years of employment, with half of those changing after just two years. With non-compete clauses and every-expanding health systems that cover entire regions and states, many young docs make big geographic moves for that second job, sacrificing whatever local support they had previously found.
Of course, many of us in medicine have families, and families are certainly a tribe too. A family shares one another’s highest highs and lowest lows and still offers unconditional love. However, if I spend ten hours of my day at work and after rigorously training for medicine as though it’s an elite group sport, doesn’t it make sense that I’d want a work tribe too?
One of the biggest blessings in my life was finding academic medicine. There are tribes on tribes on tribes, especially in family medicine. I have found an entire department of faculty, staff and residents that push themselves and challenge others to become better people, more committed community members, and stronger physicians every day. In this tribe, we debate guidelines, analyze cases and remain invested in patient outcomes. I love this environment where everyone is continuously teaching and learning. No matter how far out of medical school you may be, you’re invited to the table if you want to share or receive knowledge.
I wish everyone who graduates residency could experience this same camaraderie at outpatient offices. I wish we were not so focused on individual metrics and pushed to the limit of efficiency. I miss all of my friends that have been, and are being, pushed out of jobs and relocating because a health system was not listening. We, as their physician colleagues, are listening. I love the current tribes in my life and I hope everyone out there does not have to change jobs twice to find their tribe too.