A family physician shares her inspiration [PODCAST]

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“Why else should a person become a doctor?

Because there is always something to learn. Because holding someone’s hand when they’re scared is a profound gift that feels as good to give as it does to receive. Because your job will call on you to be brave, honest, and the best human you can be. Because you can work with people who are as devoted to and optimistic about our fellow humans as you are. Because you can choose your patient populations, your clinical settings, the procedures that you do, and the way that you practice.

So, yes, good luck, young friend. Keep your focus on what brings you joy, and pursue that. You’ll be great at it.”

Rebekah Rollston is a family physician.

She shares her story and discusses the KevinMD article, “So you want to be a doctor? Here are 10 truths.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Rebekah Rollston. She’s a family physician, and she co-wrote the KevinMD article “So you want to be a doctor? Here are 10 truths.” Rebekah, welcome to the show.

Rebekah Rollston: Thank you so much. I’m glad to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you just share your story and journey to where you are today?

Rebekah Rollston: Like we just mentioned, I’m a family medicine physician. I am currently based in Boston, but I’m actually from East Tennessee, the rural Appalachian region. So I went to medical school at my state university, East Tennessee State University, and I was part of the rural primary care track there. It actually took me a while to find family medicine, even though it was a pretty prominent specialty at my school. And luckily, I eventually came around to find a family medicine residency, and I’m pursuing that up here in Boston.

I moved to Boston really so that I could find a family medicine residency that really addressed the social determinants of health, public health, and family planning, which are some things I’m really passionate about. And so I ended up here. I’m now an attending physician, and I do a lot of different things. I do have a public health background. I did my master’s of public health during my medical school experience, actually, at George Washington in D.C., and so that’s a really important part of my practice.

So these days, as an attending, I am a hospitalist at Cambridge Health Alliance. It’s a Massachusetts-based, publicly funded hospital that’s Harvard-affiliated. So I really love doing that. A lot of our patients are non-English speaking. We really get to serve a very diverse and underserved population, which is something I’m very passionate about and really love doing.

I also do telehealth for addiction medicine. I’ve been really involved in a digital health startup that’s actually based here out of Boston. I did some consulting work with them, and then I am also helping to lead the research and community engagement arm of that initiative. And then I’m also working on a family planning clinic that’s also here in Massachusetts, working with men, women, transgender, non-binary folks, really anyone who’s seeking sexual and reproductive health at our clinics here in Massachusetts. So those are some of the main things that I’m involved in now, and really centering that public health and population health that I’m very interested in.

Kevin Pho: Wow, it sounds like you’re wearing so many different hats and doing so many different things. You have hospital medicine, you work with that startup, you work with telehealth, and there are just so many things that you do as a physician. Now, you have a background as a family physician. So tell me how your background in family medicine has prepared you for all the different things that you’re doing today.

Rebekah Rollston: Yeah, that’s a great question, and that’s actually a large part of why we wrote this KevinMD article. As a family physician, like I said before, it took me a little while to find a specialty, even though it is a very prominent specialty at my medical school. But as a family medicine physician, you really train in everything. We train in residency from obstetrics and delivery all the way to the end of life. And so, as part of that, and especially in my training, where it was very public health and health equity focused, we were able to have that vast training in outpatient and inpatient primary care. But then we were also able to learn and train in a lot of things like addiction medicine, family planning, geriatrics, or palliative care.

So something else I’m really interested in and think is really important is being able to engage with families, which I see especially on the inpatient side, but also on the outpatient side when I was in residency, in goals-of-care conversations and as we start thinking about end of life. And I think those are so many things that, as family medicine physicians, we just really have the wonderful opportunity to do and help serve our patients in those ways. And it’s really within family medicine that you get that sort of broad training, and then you have the opportunity to focus it in whatever ways you’d like.

Kevin Pho: So most family physicians I talk to on this podcast and who write to my site have a relatively linear track. They do the family medicine residency, and they do primary care. But I think what’s unique about your story is that you’re in so many different tracks. So talk about how you got interested in so many different tracks that branched off from your family medicine training.

Rebekah Rollston: Yeah, so I think it actually really started with my experience, my life experience, growing up in East Tennessee. As a young person, as a high school student I would even say, I started seeing a lot of these sort of social inequities, or poverty, in my region. And so I felt really motivated to be able to help in a certain way. That ultimately led to me going to medical school.

But as part of that, I think this interest in family planning and gender and sexual and reproductive health really stemmed from my experiences being a woman in what’s often considered a more conservative geographic area. So there weren’t quite as many women; my medical school class was far below the national average. And even just within my region, it was not totally normal, I would say, for someone like me to be pursuing such a long professional path, rather than sort of the more, what some people would consider, typical path of having this more adult life earlier on, in terms of houses and kids. So I think that really sparked my interest in family planning, sexual and reproductive health, and the role of women in medicine.

And then also in terms of addiction, which is really a major part of my practice now, that started in medical school. I’m from East Tennessee, like I said. That is one of the hardest places hit by the opioid epidemic in America. And I have to say, I was embarrassed to figure this out in medical school, that this was such a dramatic and sad thing in my community that I hadn’t previously been aware of. But during my rural primary care experience in medical school, we actually engaged in a community-based participatory research project where we really worked with our rural community. Mine was in Hawkins County, Tennessee, and the main thing we addressed was the opioid epidemic.

As medical students, you can’t address the full opioid epidemic in a community, but this really gave me a foot into the breadth of this epidemic in America and how we can actually, there are so many things we can do to help, and there’s still a long way to go in what we’re doing. So all of these things have really sort of shaped my experience, and really, I would say, who I am as a person and also as a physician, and led me to where I am today.

Also, my public health experience. Like I said, I did my master’s of public health at GW between my third and fourth years of medical school, and I am extremely passionate about population-level health and health equity. And so as we start thinking about, well, just primary care as a whole, but any of these more niche subjects like family planning, addiction medicine, or palliative care, any of these things really also at their heart are addressing social determinants of health and health equity. And so that is really a core part of my public health training, and then also what I hope to really contribute throughout the course of my career.

Kevin Pho: All right, let’s transition into the KevinMD article that you co-wrote, titled “So you want to be a doctor? Here are 10 truths.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to co-write it?

Rebekah Rollston: Yeah, exactly. I wrote this article with three of my other colleagues from the Harvard Center for Primary Care, which is one of my main affiliations, and we wrote this article actually in response to another KevinMD article, which talked about 10 myths debunked about if you want to become a physician. We read that article and understood where the author was coming from, but our experience as family medicine physicians has been very different and very positive. So as we wrote this article, we really went through the 10 myths that were debunked in the previous article, and then really rebutted that in terms of what our experience has been like and is as family medicine physicians.

So there are things like “You’ll be rich.” I think that is the first point that we talked about. That myth was debunked in the first article that we were responding to. But really, as family medicine physicians, who honestly are some of the lowest-paid physicians in the country, as primary care is not quite as valued in this country, the average salary is $200,000 to $230,000 a year. And so, with the average medical debt being $200,000, we still make a very good living, and we’re very happy with that. So that was the first point.

There are a lot of other points about how you’ll change the world. We talked about how we are actually able to really walk with our patients over the course of a lifetime in a lot of cases. And actually, maybe you don’t change the whole world, but you do actually change the worlds for some people in some very specific ways. And then there are also other points like “Everyone will want to date you” or “Everyone will be really thankful.”

And so really, I think the main message of that article is that, at least within our experience as family medicine physicians, it is such an honor to be in this field, and we’re really able to serve so many patients. Maybe every day is not always the most glamorous day, but especially as you see patients over the course of months to years, sometimes even a lifetime, you develop very important relationships, to the patient but also to the physician. And so we really get to know our patients, and that in and of itself is something that we really love and love about our field.

And I would say I am doing a lot of other things right now. I’m not in primary care specifically. Very interestingly, at my hospital, I stayed at the same hospital that I did family med residency at, and with the sort of more vulnerable or underserved population that we work with, we do actually get to know a lot of the patients. So we work very much within a community. It’s a community-based hospital just north of Boston. And so a lot of the patients we do get to know over the course of months and years. They return to our hospital. Their family members return to our hospital. I’ve met some of them in my primary care experience. So even though I’m not doing the traditional primary care track right now, I still actually have that sort of longitudinal relationship, not with everyone, but with some of these patients, which I think is a really neat experience.

Kevin Pho: So I’ve done over 300 episodes of this podcast, and I have thousands of articles on KevinMD, and one of the prevailing themes, of course, is physician burnout. If you look at the numbers, 50 percent or more of physicians today are experiencing burnout, and the pandemic is only adding more and more stress on physicians. And this is against the backdrop of increasing regulation, time pressure, and pressure to see more patients and increase productivity. So I guess my question is, through all of that, how do you remain positive, and how do you maintain your ideals as a physician? And how do you remember the reasons why you went into medicine, against the backdrop of everything that’s going against a lot of physicians today?

Rebekah Rollston: Yeah, that’s a great question. I do want to preface this by saying I am younger; I’m sort of at the start of my career. So I definitely don’t want to discount the experiences of, and the burnout of, people who’ve been in this profession a lot longer than I have. But I think it can be really tough.

Personally, I find a lot of energy and optimism just with my coworkers, my patients, and, I think most importantly, the mission of my hospital system. Within our hospital, Cambridge Health Alliance, it is a publicly funded hospital where our mission is really, truly to serve our patient population. Everyone is there for the same reason. So we really rally around each other and support each other in that mission.

I have had experiences in productivity-based jobs. Very interestingly, I’m moonlighting at a facility. It’s an LTACH and an IRF, which is like a short-term rehab or step-down facility after people get out of the hospital, which is more productivity-based, or actually completely productivity-based. I think that can be a really difficult experience, and that has been a very short experience for me. And I think this sort of push or pressure on physicians to produce and see more patients in a shorter amount of time, often with EMRs that providers find less efficient or less helpful, can be really, really hard.

I think that, as a person, in my personal life, I’m not perfect at this, but I definitely try to focus on things that relax me. So I’ve done yoga, meditation, I run, and I have a very supportive partner who I can talk to. But at a systems level, which is really sort of my passion, the systems-level change, I think as a system we really need to move away from productivity-based care so that physicians and other providers can really provide the best care possible to our patients. And I think that when we all have the same mission, when we address this at a systems level, the things that are actually burning physicians out, then I think we can really start to meet that change.

Kevin Pho: We’re talking to Rebekah Rollston. She’s a family physician, and she co-wrote the KevinMD article “So you want to be a doctor? Here are 10 truths.” Rebekah, for those medical students who may be a little bit burned out, or even those premedical students considering a career in medicine, now, they read my site, and they have a lot of kind of cynical articles, articles about burnout, and kind of taking a more negative tone towards medicine. But I want you to share that flip side. What’s your message to these students just entering the profession?

Rebekah Rollston: Yeah, that’s a great question. I think as a physician, you have the opportunity to really make a difference in people’s lives. And I know that sounds so cliché, but it’s actually so true. As physicians, we’re given so much respect by our society, and I think that we really have the opportunity to use that platform to actually really improve the lives of people and our communities and even our larger-level populations. That can be done in other fields as well, but I think as a physician, it can be a really positive experience if you really want to impact the lives of people, but then also social determinants of health and health equity.

I think it’s important also to sort of find your group. Make sure you have support people, people you can talk to, in order to try to help relieve some of this burnout. But I do think that we’ve been given this awesome opportunity as physicians to really impact society in a positive way.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Rebekah Rollston: So I think my take-home message really goes back to the KevinMD article that we wrote, in that family medicine is such a vast specialty, and it’s one of the main primary care specialties in America, and I would just hope that more people start going into family medicine as we start valuing primary care more in America. And for those people listening who aren’t family medicine physicians, just partner with the family medicine physicians in your communities or your hospital systems, as you can really partner with family med physicians to help impact patients’ lives even further. And so when we work together and when we collaborate, I think that platform we have becomes even greater.

Kevin Pho: Rebekah, thank you so much for sharing your time and insight, and thanks again for being on the show.

Rebekah Rollston: Thank you. It’s a pleasure being here.

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