We expect some things to go in and out of fashion, like shoe styles and tie widths. Tom Greer, Jr., MPH ’79, professor of family medicine, co-director of the family medicine clerkship, director of medical student programs and co-director of TRUST, says students’ choices with regard to medical professions go in and out of style, too.

“We have societal periods of a decade or more where people are more interested in service,” he says. “An example that most people understand is how popular the Peace Corps was when John F. Kennedy was president.”

James E. Davis, chair of the Department of Family Medicine, agrees. “Interest in primary care goes in surges,” he says. “There was a surge in the 1970s; there was a surge in the early 1990s. But the [current] decline has been going on since the late 1990s.”

Greer offers a hopeful note, though: he’s noticed an increase in interest in family medicine. “I don’t know if it’s a blip or not. This year, we’ve seen enormous changes, like doubling of the students who show up for some family medicine events…we’re excited. We hope it’ll be a trend and not a one-time occurrence,” he says.

Why they like primary care

Trends may come and go, but the students, doctors, teachers and administrators interviewed for the magazine all have their own reasons for choosing — and/or sticking with — primary care.

Our students

Small-town medicine.
Mo FitzMaurice
writes, “When I decided to pursue medical school, I knew I wanted to be a family physician. I was born and raised in Grangeville, Idaho, and I was delivered by our family doctor. I’m drawn to the continuous and personalized nature of the care that he and other physicians provide to patients, and I’m passionate about providing the same kind of care to a small community in Idaho. I feel like the UW School of Medicine has provided me with an excellent foundation to become a good family physician.”

Patient advocacy.
Margaret Onwuka
writes, “I am drawn to family medicine because of the opportunity to provide care to entire communities. As someone who enjoys learning about and witnessing firsthand the various stages of human development — from birth, to adolescence, to adulthood — choosing family medicine was a natural fit. Being trained in a field that practices social medicine is also appealing. I have been inspired by family medicine doctors in the greater Seattle community who are just as passionate about patient advocacy as they are about patient care. I would like to incorporate this trait into my own practice.”

Breadth of knowledge.
Micahlyn Powers
writes, “In my first year of medical school, I worked with a doctor who cared for primarily middle-class, well-insured patients in beautifully equipped rooms, using state-of-the-art electronic medical records (EMR). In my second year, I worked with a family physician in the small fishing town of Westport, Wash., who was struggling to convert from paper charts to an EMR. We cared for elderly and low-income patients. I was struck by the contrast between these two environments and awed by the flexibility and knowledge of both physicians. Then, after my third-year rotations, I realized that I enjoyed providing continuity of care because it gave me the opportunity to develop relationships and educate others. As a future family physician, I will have countless opportunities to educate patients about the importance of a healthy lifestyle, as well as provide practical tools to translate advice into action.”

Our interviewees

Trying everything.
As a medical student, Greer was good with his hands, but he didn’t want to be a surgeon. He loved little kids, but he also wanted to treat their parents. In short, he liked a little bit of everything, and he became a family medicine practitioner. “The thing that I think is so wonderful about family medicine is that when the nurse brings me a chart, I see whoever is behind door No. 3,” says Greer. He may need to refer people on to a specialist, but he feels confident that he can help the patient who’s waiting for him.

Loving the job.
Roger A. Rosenblatt, Res. ’72, ’73,
professor and vice chair of the Department of Family Medicine and director of the Rural/Underserved Opportunities Program, says that his job is immensely fulfilling. “If they didn’t pay me, I’d still do it. I love what I do.”

Finding role models.
It took a while for Amanda Keerbs, acting assistant professor of family medicine, to find her role models. “When I entered college, my older sister became ill with acute myeloid leukemia…watching her experiences in the medical center, I was somewhat disillusioned by the practice of medicine and how impersonal it felt,” says Keerbs. Later, she worked on homeless medical outreach projects in the Los Angeles area, and received a completely different view of medicine. “I was really impressed by the physicians who worked with the project, with their ability to connect with patients,” Keerbs says.

Laughing with patients.
Jennifer L. Brunsdon, M.D. ’96, Res. ’99,
grew up in Montreal, Canada, with “fabulous socialized medicine.” Her favorite part of the job as a family physician in Helena, Mont.? “The best part is the stories. You get to hear about people’s lives…it’s rare that we don’t share a laugh at some point during a patient encounter.”

Finding the right lifestyle.
Before becoming a doctor, Sharon Dobie, Fel. ’89, professor of family medicine and a member of the Colleges faculty, was a social policies urban planner. One of the founders of the Rural/Underserved Opportunities Program (R/UOP), which places students in a clinical setting for four weeks in the summer, Dobie believes in giving students eye-opening experiences. “I think some students imagine that their lifestyle might be better if they didn’t work with an underserved population or in a rural community,” she says. “I don’t think it has to be that way. I think R/UOP can show them that physicians in a variety of settings can have quite meaningful lifestyles.”

Shaping health policy.
Jim Davis,
chair of the Department of Family Medicine, recently chose between two job offers: working with a senator or congressman in Washington, D.C., through a two-year Robert Wood Johnson Health Policy Fellowship, or becoming the chair of the Department of Family Medicine at UW Medicine. “The Dean argued that if I came here, I would have the strength of the five-state region, which clearly has primary-care workforce needs,” says Davis. He chose Seattle as the faster track to shaping health policy.

The excitement around the medical home.
A number of interviewees mentioned the promise of the medical home, a new, team-based approach to primary care. In it, doctors take more focused care of fewer patients. Patient and physician satisfaction is high, says Davis, and the Washington State Department of Health has asked 33 practices — including three from UW Medicine — to test the model.

Students and Debt


A number of people interviewed for our primary-care story mentioned reducing student debt as an incentive for students considering the field. Why? Medical school is costly (approximately $171,000 for a four-year education, including tuition, room and board and other expenses), and many students take out large loans to complete their education. The result is that they have a great deal of loan debt when they enter practice.

In 2009, approximately 93 percent of UW Medicine’s graduating M.D. class had medical-school debt; 72 percent had more than $100,000, a figure that does not include debt accrued as undergraduates. Another thing these figures leave out is interest payments. Over the years, many students pay many thousands more in interest on their loans.

We asked Thomas E. Norris, Fel. ’89, vice dean for academic affairs, and Sharon Dobie, Fel. ’89, professor of family medicine and a member of the Colleges faculty, what they would do if the School received a windfall for primary-care education. Among other things, both wanted to reduce students’ debt loads.

“I would provide financial support to the students so that their debt load was mitigated — so that they would be less influenced by the economics of going into primary care,” says Dobie. “Primary-care physicians make plenty of money. None of us is hurting. But relative to what our specialty colleagues are making, it’s often quite a bit less. If you’re leaving school with a several hundred thousand-dollar debt, that influence [a specialist’s potential salary] is going to be greater.”

Norris, a member of UW Medicine’s Scholarship and Student Support Committee, also would like to provide more scholarships for students interested in primary care. Scholarships help reduce the debt load and make it easier for medical students to consider going into primary care, especially in rural and underserved areas, and raising funds for scholarships is one of UW Medicine’s top priorities.