The Journal of the Arkansas Medical Society Med Journal Dec 2019

COMMENTARY Tobias Vancil, MD Challenge Yourself I consider myself one of the fortu- nate ones in that I’m able to pro- vide medical education as part of my daily practice . I spend a significant amount of time delivering patient care side-by-side with trainees at both the student and resident level. However, the majority of this time is spent with third-year students who are rotating through the internal medicine clerkship at UAMS. During these interactions, I typically ask them, “What are you go- ing to do with your life?” Early in the third year, the answer is an under- standable “I’m not sure yet” as most of our stu- dents, including those coming from a family with some medical background, really have no idea what career field they will pursue. As students experience a few rotations, some start to narrow their choices but are still largely undecided. Mid- year and after, this question tends to cause some degree of panic as there are significant decisions to be made in order to set a schedule for the se- nior year and move forward with their residency match application. Recently, a student’s answer caught me off guard; he confidently said, “I came here with a plan to one day deliver primary care to those in the small town where I grew up.” Why was this such a surprise to me? Let’s just say I haven’t heard that response in a while. Years ago this would have been a very common answer, but of late, the tendency is for increasing numbers of students to elect a residency out-of-state. The concern, of course, is that once they leave their home state for training elsewhere, they’re less likely to return. This is not only an issue for us, as almost every state has seen this trend, but UAMS students matching into residencies inside the state has dropped to 42.9% from 52.2% over the last 10 years (JAMA Sept 10, 2019). In a state where we would like to see many of our trainees returning “home” to their small towns or underserved communities, we don’t really want to see this trend continue. Why is this happening? Speculation from the medical community suggests increased competi- tion for limited residency spots as well as some geographical drift in certain medical specialties. Social commentary regarding behavior of the millennial population shows increased pressure by one’s peers to “challenge yourself” in life by leaving home and living in different regions of the country throughout your career. The student I spoke with shared a different perspective and stated, “No one in my high school or hometown ever mentioned that a higher degree was a pos- sibility. The idea of leaving was sort of foreign to me until I met students in college with this plan. I wish someone had just stimulated me earlier to be more open-minded about career options.” Unfortunately, this is a common theme we hear when talking with students once they get on cam- pus. Another student once told me, “My guidance counselor told me a career in medicine wasn’t a very good plan because no one from this school has ever gone to medical school before.” Obvi- ously, these statements are generalizations and not meant to stereotype the attitudes of our entire education system, but it should be a reminder to all of us that our youth are impressionable. The lack of exposure to a new idea about career op- portunities can be very powerful. As a medical community, we should take these words as a challenge to ourselves to con- sider the potential in our younger generations, to avoid underestimating their insightfulness, and to encourage them to seek out goals they may have once thought unattainable. It stands to reason that it is easier to recruit physicians to small towns or communities if they already have a connection there, so we need to focus on reaching out to our adolescents in these areas. No one knows more about the rewards of a career in medicine in these communities than AMS members (and potential new AMS members) who provide health care in these environments every day; this makes them obvious mentors to our budding students. For those of us who deliver care in the larger “cities” of this state, it’s important to keep in mind the prospective benefit to our patients that having more providers in these more rural regions would mean: less travel, more direct access to care, less time away from work seeking care, etc. As a soci- ety, I feel we have an opportunity to stand behind our colleagues in the more outlying expanses of the state and assist with outreach to these would- be physicians not yet identified in our communi- ties. I know I am ready to help. 124 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY David Wroten Executive Vice President Penny Henderson Executive Assistant Journal Advertising Nicole Richards Managing Editor Jeremy Henderson Art Director EDITORIAL BOARD Appathurai Balamurugan, MD, DrPH, MPH Family & Preventative Medicine/Public Health Tim Paden, MD Family Medicine Sandra Johnson, MD Dermatology Issam Makhoul, MD Oncology Naveen Patil, MD, MHSA, MA, FIDSA Internal Medicine/Infectious Disease Benjamin Tharian, MD, MRCP, FACP, FRACP Gastroenterologist/Hepatologist Robert Zimmerman, MD Urology Tobias Vancil, MD Internal Medicine Darrell Over, MD Family Medicine EDITOR EMERITUS Alfred Kahn Jr., MD (1916-2013) ARKANSAS MEDICAL SOCIETY 2019-2020 OFFICERS Dennis Yelvington, MD, Stuttgart President Lee Archer, MD, Little Rock Immediate Past President Chad Rodgers, MD, Little Rock President Elect Seth Barnes, MD, Hot Springs Vice President George Conner, MD, Forrest City Secretary Bradley Bibb, MD, Jonesboro Treasurer Danny Wilkerson, MD, Little Rock Chairman of the Board of Trustees VOLUME 116

The Journal of the Arkansas Medical Society Med Journal Dec 2019 | Page 4