The following is a posting that appeared on FAMILY - L , the American counterpart of GP-UK. 
It contains the text of a leaflet for high school children about being a physician. 
Mainly a physician as GP, or, as it is called in the USA; family practitioner or primary care physician (I am not sure what the distinction is.).
Among other things, it gives an impression of the views of  Robert Bowman about the future of the role of the doctor.
What I particularly disliked was the notion of the physician who has to argue with his boss (!!) whether or not to refer a patient to a specialist.

Dik Kruyt, MD
Netherlands

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From: 	Robert M.D. Bowman[SMTP:[log in to unmask]]
Sent: 	vrijdag 11 oktober 1996 15:25
To: 	Multiple recipients of list FAMILY-L
Subject: 	Rural High School Career Fair

I just returned from Chadron State College in rural western Nebraska. The college has had a career fair for some years and now attracts 500 students and teachers from 4 states. We had a similar program when I was at ETSU. The key elements are having health professions students and faculty and financial aid people present, finding the right teacher or counselor to contact in the rural high schools, holding it on a weekday, and communication with all involved. This career fair can address some major barriers to rural kids considering health careers. Rural kids just do not have the health career exposures. They often don't think that they are good enough or they think it will cost too much. The following is the handout I give and I also tell 3-4 stories to illustrate some of these areas. For those of you who have not talked to today's youth lately, don't take things too personally. Although generally the groups were attentive and some asked a few questions afterwards, most were not brave enough to do Q and A in front of strangers. Also they leave notes like "this really sux bad". Don't they know their teachers clean up afterwards? With two pre-teens... I don't want to think about it now. Beware, there may be a strong family practice and rural bias, where could that come from? We have a great and growing need for mental health, geriatric, and rural primary care and OB docs in our state and this may be reflected too. Adjust for your state and students and group, edit, revise, and use. Consider a rural high school fair to keep rural background admission applications up, a key resource is medical students and their groups.

Becoming a Physician             

What does a physician do?
        Physicians do patient care in offices, hospitals, and other locations. They generally work some 50-60 hours a week and make $100,000 or more a year. They take a minimum of 11 years of college, medical school and residency after high school. They must be willing to listen to and care for all types of patients. Physicians also manage programs, clinics, labs, and research projects. One translation of the word *doctor* is teacher and a physician continually works to teach patients better health practices, to teach students medicine, and to teach people in the community how to improve the health care in the community. 

What will physicians do differently in the future?
        There are many changes going on in medicine. Doctors are unlikely to be replaced by computers, but information searches and retrievals are becoming more a part of medicine. Physicians are more and more becoming employees and are less owners of their practices. This allows more time for patients, but presents certain challenges. When physicians saw the need to send a patient to a specialist, they just did it. Now they must provide some evidence for the need for the referral and sometimes must insist on this, even when their bosses initially say no! Physicians are doing more with wellness and people care, and are doing less *curing* of disease and other high tech stuff. They are doing more primary care and more geriatric (elderly) care. They will also be doing more behavioral and mental health care. 
        The role of the physician is changing. No more are physicians lonely captains of the ship. They work with other types of health professionals in teams to care for patients. Physicians also do more work with the community or groups of patients to identify sources of disease at the root level rather than wait to treat the diseases that result (alcohol, drugs, fatty foods, lack of exercise, teen pregnancy, educational failure, mental health, parenting skills, sexually transmitted diseases, AIDS). 

What are the main challenges of being a physician?
        It is difficult to be nice to patients when they are not nice to you or are very different than you, but despite these differences, a physician must do their best consistently. Sometimes caring for people can even cause physical (sleep), emotional (problems too close to home), spiritual (different beliefs), or financial problems. 
        It is tough to find a balance between knowing enough to do the best care, and not getting overwhelmed by what all there is to know. Remember it is more important to know how to find out what is necessary for patient care than it is to know everything. It is also tough to keep medicine from being so fascinating that it absorbs your life, your family, etc.
        It is also difficult to do painful procedures or ask invasive questions, even when you know it is in the patient*s best long term interest. It is tough to do self-examination to find out areas that you need to improve, and devote time to learning about these areas. Even those who cringe at the sight of blood can still be physicians. The trick is getting yourself and others involved in problem solving and helping people, not being overwhelmed at their problems.
        The main challenges of being a physician come later after you have withstood the challenges and your patients get the best treatment. Most times only the physician and the patient know when this happens; the recognition may not come.

How do I become a physician?
        You must finish college and take certain science and other courses and apply to a public medical school (UNMC), private medical school (Creighton), or osteopathic medical school (Des Moines, Kansas City, Kirksville). Remember that many do not get in their first year and some come to medical school after ten or more years of different work. Admission applications are going up. 95% of public medical students come from the home state. Private medical schools are generally more competitive. Osteopathic medical school emphasizes primary care approach more and osteopathic graduates make just as good a physician with some advantages in the musculoskeletal and whole person areas.

What are the types of physicians?
        Basically there are primary care physicians who see patients mostly in office settings, and specialist physicians who see patients with more specific problems such as heart disease, stomach trouble, brain tumors, cancer, etc. Primary care physicians include family physicians, general internists, and general pediatricians. Sometimes obstetrician-gynecologist doctors do primary care, but mostly on the women that they care for. Specialty physicians often work with a specific body organ, or assist other physicians with lab tests (pathologists), putting surgical patients to sleep (anesthesia), or x-rays (radiologists). 
        In recent years it has become more difficult to find jobs for specialists. Primary care physicians have seen increasing need and salaries in recent years, especially those interested in rural health and geriatrics. There is a great need for psychiatrists and others skilled in mental health care (treating depression, behavior problems, substance abuse). There is a shortage of psychiatrists and child psychiatrists nationwide and especially in Nebraska.

What do medical schools look for?
        Successful applicants have good grades, especially in the science courses. They also have good scores on the Medical College Admission Test (MCAT). They do interviews at the medical school. The major function of the interview is to determine the ability of the hrs from home, important to me. It did not have 40000 people and lots of tempting entertainment, it also was not so academic that I would be stressed out all the time. This was a good fit for me, what about you?

What if my grades or scores aren*t that great?
        The interview will give you a chance to demonstrate improved performance in the later years as you settled down, applied better study habits, got more motivated, or whatever. Health experiences and job experience can count too.

Why don*t more rural people get into medical school?
        They don*t apply or they think that they are not quite good enough. This seems to be a rural trait because I got to thinking the same way when I left rural practice to go teach at one of the ivory tower medical schools. I found out that my problem solving skills more than made up for any lack of knowledge. 
        Rural applicants often have more extracurricular activities, more awards, and more work experience, but they worry that their grades or scores are not good enough. They sometimes do not have much exposure to health professionals as they are growing up. Some start in other health professions, and then choose medicine. Although this may cost them some loss of time in school, it is valuable in terms of what they later bring to medicine and patient care.

What challenges do I face in medical school?
        Medical school is challenging educationally and emotionally. You must practice good study habits, learn to prioritize important areas despite lots of information, and keep a good balance in your physical and emotional needs (exercise, good food, friends, family, church, etc.). There is much new information. Even if you took a lot of biology and chemistry courses, you would still have new material. People from small towns also face adjustments as well (feeling safe, less friendly folks, folks who might take advantage of you in rent, purchases, etc.). Others find it difficult to be as involved as they were in college or high school.

Areas for Consideration for Medical School Candidates

Middle school - science fairs, scouting awards
High school - visits to local doctors, hospital volunteer work, Eagle award, medical explorers, volunteer for EMS squad, 
scholarships, leadership in clubs and team sports, community work, volunteer/leader in community organizations, foreign language courses
College - make sure of good study habits, show ability to manage challenging material and courses at the same time in one
semester, establish connections with premedical club and premed advisors, do volunteer work as a leader (Habitat for Humanity, Christian missions, school or community organizations), cultural immersion experience of one or more months, visits to medical school campus, take medical school orientation or science course (contact Jody Rutt) or do research there or community project with the medical school (contact Dr. Bowman), prepare and take MCAT, take required medical school courses
Work - many work experiences tie in to medicine. My personal bias is in favor of waiters and waitresses and others who serve
(and put up with) people. Teachers and teaching are also needed. We could use more social workers and those with mental health interest and experience.

Remember that medicine is about serving people. If you enjoy serving and learning and problem solving, you could not ask for a better opportunity.







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