Pub. 4 2020 Issue 1

occurs. Last week I gave a talk to our residency on this. These discussions are via advance care planning (ACP), a broad term that includes discussions about what matters most in life but also documentation with advance directives and POLST forms. We are having honest and difficult conversations about what we’ve learned about COVID-19, first globally and now within the country. Mortality rates for older people and those with comorbidities are soberingly high. The conversation you have is not “if your heart stops do you want us to restart it,” but more along the lines of “if you were to become sick with COVID-19 and required heroic efforts, such as CPR at the time of your death, your chance at survival is exceedingly low.” Long story short, these discussions are of the highest impor- tance, not only for goal-concordant care, but also to reduce exposure of our medical personnel to high viral loads during code scenarios, and also to preserve PPE and ICU resources. Again, you do not need a geriatrics fellowship to deliver quality care to older adults. Something we are concerned about at UAFP is the short- age of family physicians in Utah and in many other ar- eas in the U.S. We know that one of the problems is lack of residency programs and not enough spots in those that ex- ist. Do you have any thoughts on what Utah and the U.S. should be doing to encourage more students to go into fam- ily medicine? A healthy medical system has a foundation in excellent primary care. We need to create a culture in U.S. medi - cine where that is, in fact, the paradigm. To encourage more students to go into family medicine, we need to model for them what successful family medicine looks like. That modeling means we need to be supported and celebrated within medicine. One of the ways we could be better supported is through an exploration of alternative payment models, allowing us to take more time with our sicker patients. We could also use more support with documentation, either by increasing our training and tools for efficient electronic medical re - cord use or, in some cases, considering hiring scribes. Being a generalist is one of the hardest specialties. You need to have comprehensive knowledge, insight into your limitations, and tailored communication skills. This breadth of knowledge can be intimidat - ing for students. For more exposure, I think medical students need to spend the majority of their MS3 rotations in generalist fields, such as family medicine, rural medicine, pediatrics, internal medicine, emergency medicine and general surgery. You should not be an accredited medi - cal school if you are not able to offer these generalist rotations. Where do you hope to practice once you have completed your fellowship? I could not be happier to be in Utah for my residency and fel - lowship, but afterward, I’m looking to head back to Oregon to be closer to family. In addition to the sunshine, I’m hoping to bring back skills as a clinician-educator, teaching medical stu - dents and residents about primary care and geriatrics. Resident Spotlight | Continued from page 17 A healthy medical system has a foundation in excellent primary care. We need to create a culture in U.S. medicine where that is, in fact, the paradigm. www.UtahAFP.org | 18