Doctors: The Next Generation

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With droves of physicians poised to retire—nearly one-third are expected to wave goodbye to their patients in the next decade, according to the Association of American Medical Colleges—it’s time to say hello to the next generation of doctors. We recently sat down with three residents from UC Davis Medical Center to ask their thoughts on the future of health care and what they hope to bring to the table.

CHRISTINE OSTERHOUT, M.D.
Age: 29
Specialty: Psychiatry
Hometown: Danville, Calif.

Why psychiatry?
I’ve always been the kind of person who is interested in not so much the “what,” but the “why.” As an athlete—I came to UC Davis on an athletic grant for soccer—I initially thought I might do sports medicine or orthopaedic surgery, but as I went through med school I found myself really drawn to talking to the patients in terms of their psychological issues. About halfway through [med school],  I was absolutely sold that I would do psychiatry.

What are some of the more interesting populations you’ve worked with as a resident?
I worked in a jail as part of my rotation, and working with inmates was fascinating. There are a lot of stereotypes about them, but the reality is they have incredibly rich stories, and there’s a lot of pain and suffering there—probably more than in the general population. I thought it was so interesting to learn about their life choices, and why they made those choices. Pediatrics was another interesting rotation. Being in a room full of adolescents or children who had cancer led to this epiphany, where I thought, “These kids shouldn’t be here in the hospital—they should be at the prom!” It was a life-changing experience.

Is there anything that has surprised you about medical school?
I don’t think it’s any different than any professional school in that the demands are quite high. I think what’s underestimated is the amount of dedication it takes to show up every day and be in a room with a sick patient. Those lessons are harder to learn, and more challenging than sitting with a thick textbook, memorizing information. It takes a lot of professional dedication to sit with patients and listen to their stories. I expected to sit in a room with a sick patient, of course, but you never think about what it will be like to sit in a room with a patient who is dying.

Medication is a big part of psychiatry. What are your thoughts about that?
Medication will always be a staple of psychiatry, I think. But I do think it should be approached in a multidisciplinary way, from giving people resources to psychotherapy to medications. A lot of times patients don’t want to take meds, and that’s when I ask questions to find out what exactly bothers them about the medication. Sometimes they just want to learn more about it before they take it. But if they’re not willing to take meds, but they’re willing to talk to a therapist, or their clergy at church, I’ll tell them it’s great. If you have a good therapeutic alliance with the patient, some sort of compromise can usually be reached.

What do you see as the future of psychiatry?
In my opinion, it’s already really starting to blossom. Several years ago, everything was based primarily on theory. We had to do a lot of experimental trials because we didn’t know that much about the brain. But now, technology is so advanced that neuroimaging is huge in psychiatry. Now we can answer questions such as: Where is the problem in the brain? Can we see it? Can we treat it? Can we define the origin of these illnesses? I think that’s really exciting, and that’s where psychiatry is going.

What are you personally hoping to contribute as a psychiatrist?
I don’t have lofty goals of saving the planet or anything, but I would like my patients to know they have somewhere to go for help. I would like to improve their quality of life in some way and to help them to achieve their goals, whatever that means. I think mainly it’s about being a stable figure—a resource for them to come to.


JOEL WILLIAMS, M.D.
Age: 29
Specialty: Orthopaedic surgery
Hometown: Clarkston, Mich.

Did you always know you wanted to be a doctor?
Initially I thought about engineering, but it lacked the human connection. My dad is an orthotist, so that’s the direction I thought I’d go in. But my dad, while very supportive, didn’t want me to do it just to be following in his footsteps. So he arranged for me to job shadow a physical therapist, orthopaedic surgeon, occupational therapist and a physician assistant. The surgical room was what really drew me to medicine.

How so?
It’s a very straightforward approach to fixing a problem. While psychiatry, internal medicine and some of the other specialties are intriguing to me, surgery, in general, is a very mechanistic approach.

What has your residency been like so far? What kinds of surgeries have you done?
The first year was general surgery—mostly abdominal and GI (gastrointestinal) surgeries, like hernia repair, taking out gall bladders, appendectomies. The second year was trauma—mostly people who are in car accidents, bicycle accidents. They usually come in through emergency. That’s actually what I want to go into: trauma.

Isn’t it scary?
It can be, but not as much as it sounds. Everybody who comes in to ER is treated first by other doctors, so we’re the second line of care, which hopefully means it’s more controlled.

What are you hoping to achieve as an orthopaedic surgeon?

I’d like to model my practice after Dr. Mark Lee’s (orthopaedic surgeon at UC Davis). I’ve been doing research for the entire past year, and he’s been my mentor the whole time. The experience made me realize I want to keep research a part of my career. Dr. Lee typically spends two to three days a week operating and in the hospital, but he still has time to do research—usually one day a week—and spends another day in clinic, seeing patients. That’s what I’d like to do.

What do you see as the future of orthopaedic surgery?
Historically, orthopaedics is very mechanically oriented—like a piece of wood splintered in two pieces that needs to be screwed back together. The whole biologic side of things was overlooked. But now there’s great excitement over biologic agents and stem cells, which have great potential. We are trying to establish that if you use these cells in the right scenario, it will help with healing difficult cases.

Do you think complementary medicine has a role in orthopaedics?

The truth is, I don’t know enough about it to say. So far my training has been very traditional, very Western medicine-based. That’s not to say complementary medicine doesn’t work—there’s all kinds of anecdotal evidence that says it does—but there’s not enough data, not enough literature to know whether it works. Sometimes I get asked these questions in clinic—“Should I continue to see my chiropractor?”—and the truth is, I don’t know enough about it to advise them. I certainly find it interesting, though.

What’s it like to have the initials of M.D.?
It’s definitely exciting, and I feel really lucky to be in this position. I don’t mean to sound clichéd or cheesy, but it really doesn’t feel like work.


EFRAIN TALAMANTES,  M.D.

Age: 32
Specialty: Internal medicine
Hometown: Norwalk, Calif.

You are the son of Mexican immigrants. How did that affect your choice to become a doctor?

I grew up doing manual-labor type jobs—working as a gardener, helping my family run their business, helping them make ends meet. It helped me to appreciate the value of hard work, and taught me that there had to be a better way to take care of oneself. A lot of the folks I was around didn’t have a formal education, and they really pushed me to go to school. But it wasn’t really until high school that I was able to understand the power of education—something that was revealed to me through an outreach project called the Puente project. Through the project, 30 disadvantaged students were given our own college counselor, who helped us understand the steps it took to get to college. The program really helped me to think, “How can I help other people just like me who are first generation, having these struggles?” At first I thought I wanted to be a high school teacher, but after getting involved in a pre-med group in college that was focused on helping to translate for people who needed medical care, it really magnified my interest in medicine.

Why did you choose to specialize in primary care?
I think the field of primary care—which is probably the most important for patients in many ways, as we’re the ones who first encounter the patient and have to figure out how to get them where they need to go—is undervalued and under-resourced. In the community where I grew up, a lot of people didn’t have a doctor. I see myself practicing in a working-class community like the one I grew up in, helping poor folks who need a doctor and need to take care of their families.

I hear you’re involved in helping needy patients through a program called TEACH (Transforming Education And Community Health). Can you tell me about it?
It’s a partnership between UCD and Sacramento Primary Care Clinic. We take care of patients who don’t have any form of insurance. They come from all walks of life—Russian patients, Latino patients, homeless. In these situations, you have a huge responsibility to help the patient in front of you, but also to have an understanding of the world they’re coming from. Some of them can’t even refrigerate their insulin because they live out on the streets.

What kinds of challenges do you see ahead in primary care?
I think one of our biggest responsibilities is to figure out ways that we can serve patients’ self-care. These patients spend most of the time at home—not with me—so it’s important to know they can take care of themselves. Physicians need to provide patients with the tools to be able to do that.

What do you see as the future of primary care?
I think it’s going to be a field that’s valued because time and time again, studies have shown that if you have a good primary care foundation in your system, you’ll save the system money and make a real difference in your patients’ quality of life. I think most of us fear there will be a decrease in services. But I’m hopeful that I’ll see a world where we can focus on primary care and provide that to our patients, our children and families. I think it’s the American way.

What, if anything, has surprised you about being a med student?
Probably I didn’t expect there to be so much responsibility to your country—to the world. You think, “OK, I want to be a doctor and take care of patients.” But in becoming a doctor you realize what a huge responsibility you have, not just to your patients, but to your community. You could say, “Poverty isn’t really my area,” but when you see patients day after day, you can’t help but think, “What can I do to help our community?”