When practicing medicine runs in the family

When she was 12 years old, Ashley Smith Lane remembers putting on her father’s white coat and walking around his Alabama clinic as though she were a doctor. Now, at the age of 28 and in her second year of residency, she’s no longer pretending.

Growing up as a doctor’s child, you see the best part of it, and you see the time constraints,” Lane says. “I grew up going to house calls with my dad, going to the ER [emergency room] when he had to admit a patient. It’s definitely a lifestyle that you have to choose.

Lane is the third generation of physicians in her family, following in the footsteps of both her father and grandfather. Through the years, they have witnessed the transformation of healthcare firsthand, along with the advent of new technology and changes in private practice.

Her grandfather, George Smith Sr., MD, began his career as a pharmaceutical representative, where he says he gradually found his calling to pursue medicine. He began practicing on July 1, 1966, a day that dramatically changed healthcare when Medicare became available.

His son, George Smith Jr., MD, says he respected his father’s job from an early age. “I used to carry [my father’s] bag on house calls when I was a little boy,” he says. “A lot of patients came by the house, and he treated people in our living room. I saw the respect and the admiration that my daddy’s patients had for him.”

In April 1986, a month before his daughter Ashley was born, Smith Jr. joined his father’s practice. Today, they still work together at Clay County Medical Clinic in Lineville, Alabama, and they marched side-by-side with Lane in the processional as she received her medical degree from the University of Alabama.

Next: The transformation of medicine

Small-town medicine

While growing up in Milford, Nebraska, Brett Wergin recalls that when walking around town with his father, Robert Wergin, MD, FAAFP, it seemed as though he knew everyone.

He recalls one evening when several neighborhood kids knocked on their front door. The kids had just been in a bike accident, and they had recognized his father’s car parked in the driveway. His father immediately rushed the kids to his practice and stitched up their injuries.

It was seeing those interactions between his father and patients that influenced his decision to pursue family medicine.

“At an early age, I was with my dad if he had to run to the clinic for something, or if he had to go to the hospital to do rounds, he would to take me with him,” Brett says.

“I got to observe the way he spoke to [his patients] and the way they spoke to him. It was like he was a part of their family. Patients felt very comfortable confiding in him. It was amazing to witness.”

Brett is now a fourth-year medical student at the University of Nebraska Medical Center in Omaha, his father’s alma mater. Robert, meanwhile, is now the president of the American Academy of Family Physicians.

“Watching my dad growing up, he was definitely working hard and he certainly had limited time. But it never really seemed like it was a job,” Brett says. “It looked like he enjoyed what he was doing every day.”

Witnessing medicine’s transformation

Through three generations, the Smiths say they have seen the evolution healthcare has undergone. Smith Sr. says that for him, the biggest advances have come through new medical technology, including the widespread adoption of electronic health records (EHRs).

“When I started, we kept patient records on a five by seven card in a file box, and we pulled them out when the patient came in. You wrote down what the problem was, what you found, and what you did about it,” Smith Sr. says. “You could write that all on one line. An office visit was around $4, and there was no such thing as third-party reimbursement.”

Smith Sr. and his son agree that EHRs and quality metrics have added documentation headaches for physicians that often distract from patient encounters.
But Brett says current medical students have an advantage when it comes to using this new technology.

“I don’t think people in my dad’s generation could have ever imagined having a phone that they carry around with them in their back pocket that has the name of every medicine. All that information is right in front of you,” he says.

“My generation grew up with this technology, and we’ll be getting trained only on electronic medical records. We won’t know anything else.”

Next: Future generations

Future generations

With all of the regulatory changes and new administrative burdens in healthcare, some physicians say they are reluctant to encourage their own children to follow that career path.

In an exclusive survey by Medical Economics, 43% of physicians say they would recommend their child or a friend’s child pursue a career in medicine, while 33% say they would try to dissuade their child from pursuing that career path. That’s down from 46% recommending a medical career to their child in 2011.

Other surveys have reached similar conclusions. A 2012 survey from The Physicians Foundation found that only 42% of physicians would recommend medicine as a career to their children or other young people.

In that same survey, however, nearly 67% of respondents said if they could do it all over again, they would still choose a career as a physician.

“Sometimes when you go to a doctor’s lounge, there can be a lot of negativity. Most of it pertains to all of the rules and regulations, meaningful use and those sort of things,” Robert Wergin says. “But if you ask the doctor, ‘Do you enjoy the time you spend with your patients?’ I don’t think you get much variance in that response. They’re still very satisfied with that experience of taking care of someone.”

Smith Jr. says that at first he did have mixed feelings about his daughter’s decision to pursue family medicine.

“There’s a great deal of satisfaction about doing family medicine in a small town. But there’s a difference to it now, especially lifestyle wise, and I just wanted to make sure that she was ready for that,” he says. “Medicine has changed a lot since 1966, and it’s changed a lot since 1986. There are so many other demands on our time other than patient care.”

After seeing many of his colleagues suffer burnout, Smith Jr. says it will be important for the next generation of physicians to pace themselves.

“I think Ashley’s generation has a better idea in what they want in terms of lifestyle and how they want to approach piecing together their career with the rest of their life and their family,” Smith Jr. says. “I’m confident that this generation understands their priorities and will get it right for them. There are some generational differences in how we approach the practice of medicine, but good patient care hasn’t gone out of style.”

As medicine continues to evolve, Brett says he’s optimistic that one aspect will always stay the same.

“There’s one thing that I hope never changes about medicine–that will be the same 100 years ago and 100 years from now: The physician-patient relationship,” Brett says. “Those meaningful interactions you have in the room with your patient.”