Why I love being a primary care physician

As I was reading an old copy of the Medical Society of New Jersey Journal, I stumbled upon an obituary of a doctor I had met as a teenager. My life was changed forever by knowing this humble country doctor. When I read about the plight of primary care doctors and their widespread dissatisfaction with their profession, I remember Dr. William Vroom.

Today's medical students no longer value primary care as a career choice in large part due to the perception of poor salaries and a lack of respect by fellow medical practitioners. I wonder what nonmedical people think when they read that as a group, physicians commanded the highest wages of any profession for the past 20 years? The starting salary of a newly minted family doctor is more than two hundred thousand dollars. Do primary care doctors work hard? No doubt, but so do UPS Drivers who work twelve-hour days and people who work two full-time jobs that pay minimum wage, both of whom earn far less than 200,000 dollars. At his 100th birthday party Dr. Vroom was quoted as saying, "In my day, Medicine was a great adventure. Of course, we had to make a living, but our practice was the big thing. The practice of Medicine must always be an adventure. A good doctor must always be a pioneer with spiritual fire and dedication."

The problem is that many physicians feel exploited by the system. They don't feel respected. As a result, they have lost the spiritual fire that brought them to Medicine. Respect, like love, is something you should never expect; it is only something you can give. If you expect that you will be respected because of your good deeds, you will be sorely disappointed. You can only respect yourself by doing the right thing, keeping your promises, and working hard because there is virtue in work itself. It may not make you popular, but if you don't ask for what you want, you will get what you've always got. There is only one word for loyalty that goes one way: Stupidity. Hospital administrators and insurance companies have long known that physicians will work hard to care for their patients even when mistreated because working hard at patient care is part of our nature. However, it does little to bolster self-respect, and resentment is sure to follow.

Dr. William Loveridge Vroom was born in 1866 and died in 1967. You probably never heard of him, but if your family has lived in New Jersey for a generation or two, it is possible they were brought into the world by Dr. Vroom, who was said to have performed over 3000 deliveries, including several calves, colts, and puppies.

His father was the pastor at the Reformed Church of Paramus N.J, and young William was visiting after graduating from medical school in the winter of 1888. At the ripe age of 22, he was a newly graduated physician waiting for his final grades from NYU. He was reportedly not a great student but was praised for his keen interest in Medicine, curiosity, and compassion for patients.

Ridgewood's only physician at the time, Doctor William Francis, decided he needed a break after practicing continuously from 1872 to 1888 without a vacation. He asked Vroom to cover while he took a short respite. Unfortunately, Dr. Francis didn't tolerate not working and died unexpectedly while on holiday, leaving Dr. Vroom no choice but to continue his practice for the next 77 years! He continued to see patients into his mid-90s when he was hailed as the nation's oldest active physician.

Dr. Vroom was curious and passionate about Medicine and life in general. He built his own telephone from cigar boxes and spare electrical parts. He even strung the telephone wires which he was forced to remove after two years by Bell Telephone. He reportedly wore out 22 horses making house calls, so he built a horseless carriage by converting a railroad steam engine into one that could be mounted into an old Ford and drove a makeshift- car. It was the first automobile in Bergen County. His only lawsuit resulted from his horseless carriage spooking a horse pulling a sled and throwing an older woman out into the snow. Though she suffered no damage, she was awarded $5,000 dollars for her trauma. Some things never change.

In 1910, Dr. Vroom and his young associate, William Craig, organized Ridgewood's first hospital as an annex to his Ridgewood home. The two doctors bought or made their surgical instruments, did the electrical wiring, and compounded their own medicines. Vroom commented, "In those days we were allowed to do a great many things. I could go to New York and have the run of the hospital. I could see any of the big doctors."

When World War I broke out, Vroom enlisted in the army at the age of 50 and turned the hospital over to the town of Ridgewood to run. Upon his return from Europe he helped raise enough money to build a modern hospital in Ridgewood, then a small rural village. He was one of the first doctors to administer Tetanus antitoxin, and to routinely recommend the use of aspirin. Vroom knew early in life what his calling was. Although he was known as somewhat of a maverick the state medical society named him General Practitioner of the year in 1949, according to N.Y. Times.

When I met him in 1964 at a family party, I was just a teenager. He was having a "snootful" and talking about his beloved medical career. Despite being a small-town physician, Dr. Vroom was chosen to pioneer the newly discovered insulin by the Rockefeller Institute in 1923. After listening to him speak for a few minutes, I knew I wanted to practice Medicine.

Dr. Vroom was asked by President Woodrow Wilson to go to Mexico to persuade the Mexican outlaw Poncho Villa to stop invading Texas. (Which had been forcefully annexed from Mexico in 1845) At their meeting, Villa was suffering from a kidney stone, which Vroom treated, but it didn't dissuade him. Later, Wilson sent a more forceful request thru General Pershing and the seventh Cavalry, who were equally unsuccessful at negotiating with the Mexican patriot.

Dr. Vroom saw thirty to forty patients a day, both at home and in his office. He told me many of his physician colleagues became alcohol-dependent because it was customary for the families to offer spirits and food to doctors making house calls. He worked hard, trying new treatments and often failing.. All men are not created equal, but all are born with unique talents within. Sadly many never discover that talent because they are afraid to fail. I doubt he cared what anyone thought of him. He said, "You can never get someone to like you. Besides, it's none of your business to know what other people think about you. Just follow your heart and do the right thing."

Primary Care training gave Dr. Vroom many unique skills and opportunities. (Dr. Vroom was not a provider, a vendor, or "your prescriber"; he was a doctor) Being an Internist has given me the same opportunities, and I've kept the spiritual fire for Medicine burning by trying many. I have had my share of failures, but when one door closed, another one opened. Sometimes I regret not being a better parent, or husband, and not saving more money, but that can't be changed. I believe having regrets is good for your soul, as long as they don't overwhelm you. It is a spiritual axiom that we learn more from our failures than our successes. I carry in my wallet a coin that says, "Above all else, remain true to yourself."

At his hundred-year birthday party, Dr. Vroom recalled one of the last patients he treated. She had been hospitalized at Greystone (A former N.J. mental hospital which was as dreadful as the name implies) for a "nervous condition,". She had been released for a short "vacation," and her mother had called the old doctor out of desperation. He agreed to see her. When she arrived at his office/home, he sat on a ladder, pruning a tree in his garden. He climbed down, listened to her story then invited her to help him tend to his garden. She agreed to do so and returned for several weeks to help him work in his garden. They had switched roles in a sense where she was helping him. In doing so, they formed a bond of trust that gave her more self-confidence. He eventually helped her find a job in a veterinary hospital, and she went on to become a health care professional helping others with anxiety disorders. When she attended his 100th birthday party, he pointed to her and her new baby and said, "That's the best thing I ever did."

Primary care physicians are the backbone of our medical system. Becoming an Internist didn't make me wealthy, but I can pay most of my bills. More importantly, it gave me the privilege of knowing and interceding in the lives of my patients in ways that specialists never can. For me, that's the best thing I ever did.