SS 10 : A Private-Practice Family Medicine Doctor Discusses Her Job

Session 10

Dr. Noe is in a solo private practice seeing patients as a Family Medicine physician. She talks about Family Medicine and what you should think about too.

Full show notes coming soon

Transcript

Introduction

Dr. Ryan Gray: Specialty Stories, session number 10.
Whether you’re a premed or a medical student, you've answered the calling to become a physician. Soon you'll have to start deciding what type of medicine you will want to practice. This podcast will tell you the stories of specialists from every field to give you the information you need to make sure you make the most informed decision possible when it comes to choosing your specialty.
Welcome to the Specialty Stories Podcast, I am your host, Dr. Ryan Gray. If this is your first time here, thank you for joining me. If you don't listen to any of the other podcasts we do, or we publish, go check them out at www.MedEdMedia.com. That's www.MedEdMedia.com. Today I have a great episode with primary care, and a physician who is in a solo private practice, practicing family medicine. Let's go ahead and jump right in.

Meeting Dr. Sasha Noe

Dr. Sasha Noe: My name is Dr. Sasha Noe and I practice family medicine.

Dr. Ryan Gray: And you are in a private practice setting, correct?

Dr. Sasha Noe: That's correct. I actually am in a solo practice which I started straight out of residency.

Dr. Ryan Gray: Talk about that decision for a minute; the decision between family medicine in an academic center, in a community setting, or starting your own private practice.

Dr. Sasha Noe: Well as far as what the decision entailed for me, I think really it has to be about where you find your happy place. And for me I knew that the hospital setting was not exactly my happy place. I enjoyed academia, I spent many years in academia previously- this is my third career and we can talk about that some more. But I did know that my happy place would be in an outpatient setting primarily, even though I have seen my patients in a hospital, the outpatient setting for me was where I really felt like I wanted to spend the majority of my time. And in terms of determining whether I wanted to do that as an employed physician or as a solo- you know as my own practice which I owned, that had- we had a couple of factors that went into that. I really wanted to own my own time. As I'd mentioned a minute ago, this is my third career, I have a family, and I'm a bit- I was older when I started medical school. So it really meant that I had a bit clearer vision for how I wanted my time to be. And so when I went into residency I really focused on learning a lot about what it would take to start a practice and run a practice because I wanted to be able to determine my work hours, and my work load, and just have some flexibility there.

Dr. Ryan Gray: How long have you been practicing now?

Dr. Sasha Noe: Just over five years out of residency.

Dr. Ryan Gray: When did you know that family medicine was what you wanted to practice?

Dr. Sasha Noe: In my fourth year of medical school actually. Interestingly enough I went to medical school to become an emergency medicine physician. I had shadowed in an ER for the year prior to medical school while I was still in an academic position, and I loved the ER. I loved being able to take care of patients that came in, and that high acuity, and just the ability to feel like, ‘You know I'm really doing something here and helping patients.' And so when I went into medical school I thought yeah, ER medicine is what I wanted to do, and that is what my focus was. When I got to my fourth year of medical school, I actually had an opportunity to do ER rotations where I was following that schedule where you change shifts. You have a daytime shift today, and a night-time shift tomorrow, or this back and forth of sometimes working during the day, sometimes working overnight. And I really discovered that I actually am a work in the day, sleep at night kind of a person.

Dr. Ryan Gray: A normal person you mean.

Dr. Sasha Noe: So for me, that is what- that really is what made the decision for me. I actually remember telling my husband, I said, ‘I think I'm too old to do ER medicine. I don't do this whole like shifting of my sleep patterns too well,' you know? I was in my thirties and I thought, ‘Man maybe I'm too old to do ER- the shift, the shift work.' But really what it ended up turning out to be is just I am happier when I work during the day and sleep at night. So family medicine for me was the absolute next best thing because I can essentially have as much- deal with as much acuity as I wanted to, and take care of patients on a continual basis. The part about ER medicine that I knew I was going to miss was the continuity of care and family medicine really fills that gap for me in a way that's very fulfilling. So it turned out to be the best decision in the long run. Initially it was a choice of necessity for sleep patterns, but it's really been the best thing I could have ever done.

Dr. Ryan Gray: You mentioned the acuity of care. Can you just define that for somebody who doesn't know what that means?

Dr. Sasha Noe: Patients, if they have medical conditions that are life-threatening, or very, very serious requiring hospitalization, indicates that they're a higher acuity patient. A lower acuity patient is someone who doesn't require hospitalization or going to an emergency room or anything like that. It's things that can be handled as an outpatient in-office.

Traits of a Good Family Medicine Physician

Dr. Ryan Gray: What traits do you think lead to being a good family medicine physician?

Dr. Sasha Noe: I think the most important thing- or the most important trait is really having a sense of deep compassion and caring for someone as a whole. And it's not to say that other specialties don't require compassion, de-compassion. I think naturally as family medicine physicians, we attend to the entire patient. And I'm an osteopathic physician so the whole mind, body, spirit approach is very important, but we really also encompass a lot of what's going on not just with that person, but with their dynamic that's going on in their lives be it with other family members. And so I think a level of- really a desire to want to help someone beyond just a particular set of medical problems, or symptoms if you will. You really have to desire to want to have a follow-up and this continuity of care that- at a different level. You know it's really about relationships, really anything we do is about relationships, but I think more so with primary care you're really building deep relationships with your patients, and that can be very impactful to them. So I think you really have to desire those types of relationships, and that I think is probably hugely important. I also think that you need to desire to know a lot about a lot, because family medicine takes care of all body systems. So if you want to know a lot about a lot, I think it's a great field for you. I think it can be overwhelming for some people because it really requires knowledge about multiple systems, the depth of which depends on the individual, but I think not being afraid of complexity of multi-organ systems if you will. Because you're going to be faced with it, you know? You don't just deal with one body system. Not to say that that's not complex in and of itself, but understanding to a level of how it all plays together, and what you really need to address, and what needs to go to a specialist is huge. So I do think it requires a broad depth of knowledge and you've got to like that.

Dr. Ryan Gray: What types of patients are you seeing, or is a family medicine physician seeing in a typical day?

Dr. Sasha Noe: So of course with it being primary care, we do see a lot of chronic illnesses. You know things that from a cardiac standpoint, or a pulmonary standpoint, you know your hypertension, your heart failures, your COPD patients, your chronic kidney disease patients. A lot of the patients that I see because a pretty significant population of my patients are older, they're really pretty complicated in terms of having diabetes with heart failure and/or COPD. You know what I'm saying? With chronic kidney disease, like I have a lot of patients that are 65 and over so they're pretty complicated. A lot of my day is those types of patients. I really enjoy geriatrics so because of that, a lot of my day is taken up with seeing these individuals who really have multi-organ system medical conditions. And then probably the rest of that is really on an urgent care sort of a basis. Not just your coughs and your colds but we'll see your typical like rashes, or cuts, or bird attacks, or chest pains, or whatever. You know I mean we do get a smattering. I do a lot of surgeries in the office in terms of dermatology surgeries, and so we'll do that. Because I've really enjoyed procedure driven environment in the past, I really do a lot for my patients from an urgent care standpoint. So it's a combination really of your routine chronic medical condition patients in addition to whatever- you know whatever urgent situations come through the door, and we get quite the variety of those.

A Day in the Life

Dr. Ryan Gray: Describe a typical day in the life of a family medicine doc. Maybe not specifically for yourself, but in general what a family medicine doc's day would look like.

Dr. Sasha Noe: So really as you look at your patients that you have for the day, you're really looking at- you're going to spend time before your patients come in just really looking at who's coming in, and why are they coming in, and what issues do we need to address today, what preventative type things do we need to do for this patient, what things do we need to have close follow-up on? You know so there's the preparing for your patients, there is seeing your patients, and then there's documenting on everything that happens which I don't think is unique to family medicine, but a lot of what we get into as well, it's a lot of- we do face a fair amount of social issues in family medicine which was something that was a little bit more surprising to me for family medicine when I started realizing that in my training. But a typical day really involves preparing for your patients when they come in, taking that time to think about really what all of their needs are that you might need to address while they're here, and just ensuring that they have proper follow-up for coming back and making sure that their chronic needs are being taken care of. And so you know, you're seeing patients, and then you are documenting as you go really. And in addition to that there's a lot of paperwork that comes around my desk for coordinating care really. You know whether it's referrals to have procedures done, or referrals to specialists, or calls to specialists to coordinate care. That was another thing that we do quite a bit of as well is just doing that quarterbacking of care for the patient. So if I needed to speak to a patient that I'm sending to a cardiologist, and I talk to that specialist to let them know what's coming down the pike for that patients, and that's something that I do so it's a combination of all those things.

Taking Call as a Primary Care Physician

Dr. Ryan Gray: Do you have to take a lot of call? I know for you in private practice it might be a little different, so maybe a little more general.

Dr. Sasha Noe: Because I'm a solo physician of the practice that I'm at, I take call all the time. I'm on call 24/7, and you might think, ‘Oh my gosh that's crazy. Like don't you ever sleep?' But actually it's not. It's I will go weeks without a call after hours, and then I'll have a weekend where I'll get six calls. I don't really get a- I think because I set a lot of expectations for my patients when I see them in the office and when they establish with me, we make sure that we take care of everything as much as we can during regular office hours, and they know for like emergent care they can absolutely call me after hours anytime, and I can help them if I can, otherwise I'll refer them to an urgent care or an ER, but for the most part a lot of the patients are- I've had for quite some time, so they're well managed. In the beginning there was a lot more call I think because patients were new, and I hadn't quite gotten them all stabilized to where they were a well-oiled machine if you will. So I took a lot more call in the beginning, and then really as the years have gone by I've really seen the call being very, very manageable. I really mean literally weeks will go by and I don't get a call after hours.

Achieving Good Work Life Balance

Dr. Ryan Gray: Do you think you have good work life balance?

Dr. Sasha Noe: So I think that that ebbs and flows for me. You know as a mom, as a wife, as a business owner, as an entrepreneur always doing other things, that really ebbs and flows for me. There are seasons where I feel like I'm doing pretty good at it, and there are seasons that I feel like, ‘Oh my gosh, this is horrible,' you know? When I started my practice, obviously that was a very intense time for us, and I put a ton, a ton of hours in, probably fourteen to seventeen hours initially a day for a good year. But I knew what I was building, so we make the sacrifice to do that. However right now, and for the last three to three and a half years really, I do feel like I've achieved a lot better in terms of work life balance. You know I'm usually gone. I mean today was a late day for me. I'm usually done seeing patients between 3:30 to 4:00 and then I get to go home because I structure my administrative work in a way that allows me to get a fair amount of it done while I'm here and if there's anything left I'll do it after my kids go to bed, or I get up- I'm an early riser so I get up early. So I do really get an opportunity to spend a lot of great quality time with my family most of the time. It's not 100%. Like today it's a later day in the office, even if I wasn't going to be doing this podcast, there are things that happen in medicine that you can't prevent, but for the most part I feel like I get to spend a ton of time with my family, it just feels at times I think as a mom that can be a little bit challenging because you always want to do more.

Residency as a Family Medicine Physician

Dr. Ryan Gray: What does residency look like for family medicine?

Dr. Sasha Noe: So it's a three year residency. I think the first year is probably the most difficult, and the first six months is even the most intensive part of the entire three years. I think it takes about six months for a resident to really get in the groove of being a physician, and being the one making the call for patient care. But after that first year in family medicine, after your intern year in family medicine, to me it really became more routine because I don't know, maybe it's a confidence level thing. Like you weren't as stressed out, you know you had a little bit of experience under your belt. If you wanted to do more outpatient rotations you can. I actually did as much inpatient as I possibly could because I knew I wasn't going to be spending a lot of time inpatient, and I wanted to make sure that I had as many of those skills to be able to manage my patients as an outpatient if that makes any sense. I don't know if that makes any sense to you. But I just knew all the things that I wasn't going to get to spend a lot of time with once I got out of residency, I tried to make sure I focused my time on those as well in residency. So I think the first year is intense, the first six months, very intense, but the last two years are more manageable, and I think there is a light at the end of the tunnel. I think after residency if you choose to go into your own practice, then I think you'll have some intense work for a couple years, but even after that things settle down. So it's not this crazy intensive constantly stressed life that you experience as a medical student or as a first year resident.

Dr. Ryan Gray: What should a student be doing to be a competitive applicant for family medicine residency?

Dr. Sasha Noe: Well I think- you know family medicine residencies aren't- they're not very competitive, only because there's a lot of them- many of the slots really go unfilled which is sad because it's really an amazing field. However I think we are seeing a shift in terms of a focus for the need for primary care, we have been seeing that for years. So really they're able to really look for the cream of the crop and I do think it's a combination of competency and just really affability really. You know you have to be competent and likable, you're able to work with other people. So you know everyone will say, ‘Well you need to have great rotations, good- what are they called, audition rotations with the place that you want to attend. I would really recommend that if you want to be the most competitive for a slot in family medicine or any, but really for family medicine it was very helpful to have an audition rotation. And that's recommended for any medical student; if you know where you want to go, you need to do an audition rotation there, you need to get in there because they need to see you, they need to work with you, they need to learn what kind of person you are. It's unlike- you know obviously the board scores, that's kind of like the first cut, right? What are the scores, that's step one, but really it's about who you are as a person, how well you work, how hard you're willing to work, and that's best demonstrated when you do an audition rotation. So I think to be the most competitive, that's something that students should really be doing.

Bias of DOs

Dr. Ryan Gray: You're a DO. Do you see, or have you seen or felt personally any bias towards DOs in family medicine?

Dr. Sasha Noe: I can tell you what I find are patients that come looking for me as a DO because they've had experiences with DOs before. They're looking for someone who they perceive as having a different approach to patient care. And so if they've had that experience with a DO before that they come looking for me. Then I have patients that come and have no clue that I'm a DO, so they're just looking for a physician and then they find out kind of along the way. So I don't know if that answers your question about- can you repeat that again? Let me see if I-

Dr. Ryan Gray: What about from a residency maybe perspective? So as a DO student applying for residencies, did you see any bias of residencies that were only looking at MDs?

Dr. Sasha Noe: I actually have to say that certainly when I applied to the ER residency, which is what I thought I was going to be doing, I personally felt that pressure because you hear. You're like, ‘Oh maybe they don't have a lot of DOs in their program, maybe it's harder to get in,' but actually I ended up having- they brought me in, they interviewed me, I actually had to call them and tell them- it was really sad actually, I had to call them and tell them that I needed to withdraw from that because they had interviewed me, and they were really pleased, everything I had done was to get into this one ER residency, and actually that was the month that I realized I really did not like the changing of the shifts despite the fact that I loved my life when I was there, working in the ER at the time. So you know I didn't sense that from them, I think a lot of that was some of the pressure that I put on myself. As far as for family medicine, I applied to an osteopathic residency so I didn't have to worry about that. I do know that there are some of my colleagues that that is a valid concern for them because of the sheer numbers. ‘Am I going to get in? Are there any biases there?' I think the hope would be that that has changed, and certainly with some of the changes that we're seeing with the merging of accrediting boards and stuff, I think the hope is that that would be less of an issue for some people. I'm not going to really get into that right now because that's a whole other topic on its own. But I didn't feel that for family medicine, if I could just put it that plainly.

Opportunities to Sub-Specialize

Dr. Ryan Gray: Yeah, okay. What opportunities are there to sub-specialize as a family medicine doc?

Dr. Sasha Noe: So you know you can sub-specialize in terms of things like sports medicine, you can choose to sub-specialize and do OB. We see a lot of that. You can sub-specialize with neuromuscular medicine which my- actually my specialty is family medicine and osteopathic manipulative treatment. So I'm actually sub-specialized not just in family medicine but in osteopathic manipulative- OMT. So I have the opportunity to be able to help patients with that sort of therapy when they're here in the office unlike other individuals that just do family medicine. So those are the ones that I can think of right off the bat, there may be others but those are the ones I'm aware of right off the bat.

Taking the Boards

Dr. Ryan Gray: What do the boards look like?

Dr. Sasha Noe: To me they were essentially just more of the clinical aspects of things that we did compared to say step one and two where it was more of the basic. You saw more basic science with some clinical, with the boards for family medicine it was definitely much more of an application of the knowledge. So did you have to know the basics? Of course you do but it was more of how are we going to formulate a treatment plan for this patient? Or understanding what the guidelines are for managing different common illnesses be it from a cardiac, pulmonary, GI standpoint, et cetera. So obviously very much across the board, so in the sense that when we took our step one and two, you had to know a lot across the board. Family medicine, your boards are very similar to that, but it is geared a little bit more towards clinical practice, so that's different.

Dr. Ryan Gray: Do you know what pass rates look like?

Dr. Sasha Noe: Honestly I don't have statistics on that lately. I would imagine that the pass rate would be pretty decent, but that's just me guessing.

What Dr. Noe Wishes She Knew Then

Dr. Ryan Gray: Okay. What do you wish- now that you've been out in practice for several years, what do you wish you knew going into your family medicine residency?

Dr. Sasha Noe: I don't know that you can really know this until you're actually there, but the weight of the responsibility that's on your shoulders when you're the one that is actually in charge of taking care of these patients. So you know as a student curer, you always had a resident, or an attending that was ultimately signing off on things, and making that final decision. When you start residency, that's it, you're the one. I remember on day three of my internship year, I actually did the house officer month, which is where you are the resident on call for the hospital. If anyone on any of the floors or the ICU needs something, and they need a physician to help out be it with codes, or with orders, or a patient's having a hard time, that's the house officer. And so I did that my first month and so your first night you're having to run codes, and you have to manage patients in the ICU, and I remember my third day driving over to my hospital and I think it just really kind of hit me. It was like, ‘Oh my gosh, like I'm really responsible for these people's lives.' You know? And I actually remember crying because I was like, ‘Oh my gosh, this is for real.' And I remember praying, ‘Okay God, just please don't let me screw up,' you know? And just the weight of that, you know? I feel like that was something I wish I could know before but I don't think it's possible until you're actually there. I think it's kind of like motherhood. People can prepare you all you want, but until you're there you don't really know what that means. And so in that regard I think the weight of what the expectations are of you is something that I wish I knew more of in terms of preparation for residency. It's a- no matter how much anybody tells you it's going to be hard, it's hard. But it's part of the process and I loved it really, at the end of the day. Like I loved- well I went home exhausted but I just loved what I was doing so that just kind of made up for all of it really.

Choosing a Residency Program

Dr. Ryan Gray: What should a student be thinking about or looking into when deciding a residency program to apply to?

Dr. Sasha Noe: So I think they need to consider first and foremost where- really the type of training that they want. There are different types of institutions that offer training. Do you want to be in an academic setting? Do you want to be in a community setting? What type of environment do you want to learn in? That's one, and then I think from a location setting- standpoint, it's important to kind of think about that. Now if you're a student- and most students don't have families. I had two kids and a husband, so you don't really have to- most people don't have to think about that, but for me, I needed to consider where I wanted to be because I didn't want to have a bunch of shifting of my family. So I think if you have a family it's important to consider where you want your family to be, because if you have to move you're going to probably be there for a while, and you have to consider the quality of your life that your family's going to have because you're really not going to be around very much going through your residency. So in that sense, location for someone who doesn't have a family and they're single, they can go anywhere as long as they're getting great training. So that opens things up. But I do think considering what kind of environment do you want to really learn in; a big hospital, a smaller hospital. I personally wanted to stay locally because I had a home, and my kids were in school, so I stuck to the surrounding areas that was drivable for me. But I really think quality of training and location of training I think are the top two.

Working with Other Specialties

Dr. Ryan Gray: What specialties do you work the closest with?

Dr. Sasha Noe: Cardiology, pulmonary, and GI. I think the majority of things that I see on a regular basis involves the needs for those top three specialties. And I think probably after that would be nephrology and then neurology, but cardiology, pulm, and GI. I work with those groups constantly.

Dr. Ryan Gray: What do you wish those specialists knew about your job to make your job a little bit easier?

Dr. Sasha Noe: Because I take care of patients who really are limited in terms of their income, I think it's my job to really ensure that they're able to afford their care all the time all year round. And so when a specialist goes to pick treatment modalities for their patients, that the newest and best drug that's out may not necessarily be practical for a patient because they have to be able to afford that medicine all year long. And so I think really just being more mindful of having a conversation with your patients and saying, ‘Is this a drug you can afford?' Because we see patients coming to us where they were put on a medicine that they're simply not going to be able to afford, I mean they're going to be lucky if they can afford it through August, September of that year based on their medical budget, on their budget for their prescription drugs. And I think that's probably my biggest challenge is because I have to coordinate their entire care it means making sure that it's affordable to them, and so I will often pick up the phone and speak to a specialist that a patient comes in and says, ‘Dr. Noe, this medicine is like-‘ Like I had a patient yesterday, her medication for her psoriatic arthritis was $1,600 a month and she has like a $4,000 drug benefit. She's going to hit her dollar whole with the one drug by April, if not before. And those are real issues that we face, and she's diabetic, she had all these other things going on that she needed medications for. So those are real discussions. So I have to pick up the phone and speak to the specialist and say, ‘Hey what can we do? What else can we try that my patient can afford that can be as effective for her?' We don't always have that option because sometimes the medications that they're put on is really the best thing for them, but I think communicating with the specialist, that's probably something that I wish that they would be more mindful of because I'm trying to make sure that they can take care of all their other body- all their other systems the entire year long. But I work with great specialists and I can always pick up the phone and call them and say, ‘Hey can we talk about this? And let me know is this something that we have some other alternatives for? Or is this something the patient absolutely needs? And what are our options? Can you provide more samples?' Whatever it is we need to do to try to help the patient out if they really do need to be on those expensive meds.

Special Opportunities Outside of the Clinical World

Dr. Ryan Gray: Are there any special opportunities outside of clinical medicine for family practice?

Dr. Sasha Noe: Absolutely. It really depends on the individual and what their interests are. I know that I've been approached on many occasions to be a medical director for different facilities. I've been talked to about doing- reviewing charts to earn extra income. I really feel like as a family medicine physician, I have the ability to gear my practice in ways that I can diversify how I want to serve my patients, and make it my own if you will. So there are business opportunities that they can pursue, but it really depends on what their interests are. You know, I mean- you know here you are Ryan, doing this great service to medical students, it's an opportunity for you to serve in a different way outside of your field. And so I think for family medicine it's very much wide open field for students, or for people that go into that field because you're able to diversify as much as you want really. There's a lot of ways to serve be it politically- I'm very involved in my profession, I'm the President of our county organization here, I'm just involved locally, nationally. I'm able to be an entrepreneur in things, not just in the running of my practice. I have a PhD in molecular immunology with [Inaudible 00:36:00] so that's something that is allowing me to have some diversification in terms of opportunities for myself to educate be it physicians or the community. So really it depends on what an individual wants to do, how driven they are to go after it. But I love that with family medicine there's such a diverse knowledge base that you can pick the areas that you want to make it work for you in ways outside of the clinic walls really.

Best and Worst of being a Family Medicine Physician

Dr. Ryan Gray: What do you like the most about being a family practice doc?

Dr. Sasha Noe: I love my patients. You know I love that I get to really know my patients and know their families. I have three generations of families that I see because of family medicine. I can see kids, I can see young adults, all the way up to patients in their eighties and early nineties, and I love that I get to have these types of relationships with my patients where I really feel like they've entrusted me with their care and once- because I've earned that trust, they will tend to be more compliant in their response to what's needed for them to stay healthy. But I also love just the fact that we can laugh, and I can be silly with them, they know me so well, they know that ‘Dr. Noe, she's hilarious,' and they know all the faces that I make. I mean it really is a family medicine, I mean I love it. I've had the opportunity to have monthly birthday celebrations with my patients where we just get together, have cake and snacks, and just hang out for an hour once a month. And you know I get to do those types of things with my patients to get to know them outside of the room where we're having deep conversations. We get to have a once a year Thanksgiving dinner that we do for all of our patients, and celebrate just a time of gratitude, and I love that I get to do things like that. And I think family medicine has really allowed me to build great relationships with my patients. I live in a small community so I like that. I like that I get to just have great relationships with them.

Dr. Ryan Gray: What do you like least about it?

Dr. Sasha Noe: What do I like least about it? You know the day when you have like a full schedule, and you've got the patient that keeps going, ‘Oh and I have this, and I have this, and I have this.' You feel the pressure of, ‘Oh my gosh I really want to take care of those needs, but I can't because I have other patients that I want to stay on top of and not let my schedule run crazy late and behind,' and I think that's my least favorite part of things, is just really not being able to take care of as much things as I can when they're here. I think some of that too is dictated- a lot of that actually is dictated by patients' insurance. You know like I can take care of all of this but I'm not going to get paid for it, you know? As primary care, we want to take care of as much as we can while they're there, but sometimes we have to make them come back and that's really frustrating in those scenarios where I do have the time but I know that I'm not going to get reimbursed necessarily for what I'm doing if I do that. So that's two-fold; it's the inability to really take care of everything while they're here because I have to keep moving on to keep my schedule moving, as well as a lot of the bureaucracy that it takes to really get the care for my patients that they need. I think those are the two frustrating- the biggest frustrations for me.

Dr. Ryan Gray: If you had to do it all over again, would you?

Dr. Sasha Noe: Absolutely, absolutely. I walk into my clinic some days still, even five years down the road- five years out, and sometimes I sit in my office and I was like, ‘Wow I can't believe I get to do this.' I love that I can just sit in my office and revel in the fact that I've been so blessed to build my practice, to take care of my patients, and to just kind of do it my way as much as possible, you know? I would absolutely do it all over again. It's not been an easy road but a lot of times things that are worthwhile usually aren't, so I really am grateful that I get to do what I do. So it's not always a bed of roses, there's a lot of frustrations that you can have, but that comes with any job. It doesn't matter what job you have, there are challenges. But that question of would I do it again? Absolutely, in a heartbeat.

What the Future Looks Like

Dr. Ryan Gray: Do you see any major changes coming to family practice whether it be technology, or medications, or just the way it's practiced?

Dr. Sasha Noe: Well I think that there are major changes that have been happening with family medicine for the last ten years, and I think those changes are going to continue to be perpetuated. And what I mean by that is as a family medicine doc, you're really that quarterback for the patient, you know? Trying to coordinate all their care be it specialist care, ancillary care, be it PT, OT, whatever-skilled nursing, home health care. You are really coordinating a lot of the patient's care. Now what we see with the way healthcare is really moving in this country is that that's really the way that we can work towards helping to ensure that the patient gets what they need, and also that that coordination of care is happening in a way that's not- that there's not a bunch of disconnect, you know? Really as there's more communication, or an attempt to achieve more communication between physicians and institutions like hospitals to be able to make sure that there's greater coordination of care, and not a bunch of waste, but just really having someone who's on top of what's really going on with a patient. I think the stress for that type of healthcare has been more of the focus and is where we as a country is moving more towards. So I think that we're going to be seeing a lot more of that. I think that so much of the value-based care that is being said and touted is really being coordinated by primary care which is huge, and that's been the way that I was taught to practice in residency, to really take on that role and do the best thing for the patient. And so I'm really grateful that that was the focus of my training so I'm not having to figure out how to make the dots connect. But I think that individuals that are going into primary care, there's going to be more of a requirement for you to actively really manage that patient's overall care, and you've got to really want to do that in order to do a great job by your patients. So I see that really shifting.

Words of Wisdom

Dr. Ryan Gray: Any last words of wisdom for the premed or medical student out there thinking about family medicine?

Dr. Sasha Noe: You know when I was going through my rotations as a medical student, I had a lot of people tell me a lot of things about different specialties, and there were a lot of people saying, ‘I think you should do this because- you should do allergy and immunology because you have a PhD in immunology. Or you should do infectious diseases because you have a microbiology background. Or you should do this, or that, or no family medicine, don't do family medicine. You're too smart to do family medicine.' I had people tell me that. And there were a lot of people giving me a lot of input about what they thought I should or shouldn't be doing. And at the end of the day I really had to stop and block out all of those voices and say, ‘Sasha what do you want? What do you want that you think will make you happy? Not what other people want of you or what other people expect. Where are you going to be most happy practicing medicine and helping people? Where do you see yourself in ten years still really engaged in patient care- ten, twenty, thirty years down the road? What is that for you?' And I would say to them at the end of the day you have to make the decision that's best for you and your family. Just try- I mean obviously we want to get the advice from our mentors and our preceptors when we go through our rotations, but at the end of the day you really have to feel great about what you're going to be doing. So take some quiet time and do some soul searching, and figure that out for yourself because if you're true to yourself you're going to be happy and you're going to be doing this profession for a long time.

Final Thoughts

Dr. Ryan Gray: Alright that was Dr. Noe, and she again is a solo private practice family medicine physician, and she just shared her thoughts on what you should be doing if you are interested in pursuing family medicine. Great specialty, a very much needed specialty. I think primary care is where we need to go as a country to help improve our outcomes here in the US. Our outcomes are pitifully low compared to most other industrialized countries that have great health insurance, healthcare. Ours is lacking. So I hope you take a look at family medicine and seriously give it a thought.

If you want to interact with Dr. Noe more, go follow her on social media @DrSashaNoe. I hope you learned a ton today, and I hope you join us next week here at the Specialty Stories and Med Ed Media.

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