In this episode of “DPC Pediatrician,” Dr. Phil Boucher and Dr. Marina Capella explore an exciting question for pediatricians: Can you teach while running a Direct Primary Care (DPC) practice? They share their personal experiences with teaching medical students and residents, discussing how they integrate educational opportunities into their DPC practices. Whether you’re passionate about educating the next generation of physicians or curious about how to stay involved in academia, this episode provides insights and actionable tips on making it work in a DPC setting.
Link to Podcast: Teaching in Pediatric Direct Primary Care: Is It Possible?
Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr. Marina Capella, two DPC pediatricians who are on a mission to share our love of direct primary care with you.
0:11
Welcome everyone to another episode of DPC Pediatricians. Today we’re going to talk about the question of can I teach in pediatric DPC? A lot of us have come from other practice settings, including academic settings where maybe we were involved with medical students or with residents. And we enjoyed that process of teaching the next generation of physicians.
0:34
And that’s definitely one thing that I thought about because I really like teaching. And I thought, you know, how can I incorporate it? Is it even going to be a possibility since I don’t have affiliations with big private practices or with an academic medical center? And Phil, I believe you also like teaching.
0:52
So was that something that was on your mind when you started?
0:54
Definitely. I mean, I think most of us, if we had good teachers, want to teach and we want to help to teach the next generation of medical students and residents and all of those sorts of learners that we don’t want to just not
1:06
have access to them anymore and not to get to share about DPC because that might not be something that they consider. And so, yes, that was definitely a consideration of mine when making the leap over to direct primary care. How did like what did you do?
1:18
How did it work out for you or what you found that’s been successful at being able to teach?
1:24
Yeah, well, I’ll say first, I did not have a clear answer. I had no certainty that it would work out when I first started, but I thought, you know what? Maybe a door will open and I’m just going to, you know, opportunities.
1:33
So what I ended up doing is I was doing volunteer work at my local medical school. I started out doing interviews for their admissions committee, and then I ended up getting a position on their main admissions committee. And in order to do that, I had to get adjunct faculty status.
1:50
Got it. Okay.
1:51
And so that gave me access, I guess, to the university in general and the medical school and connections. And then I was able to sign up to be a preceptor for third year medical students. So now I have third year medical students that rotate through my clinic. for their pediatrics rotation.
2:07
I had also done some volunteer work at a local free clinic and I needed that status in order to be able to do that too. So it’s unpaid work, unfortunately, but it’s very rewarding. I love teaching the next generation of physicians and I love also spreading the word about direct primary care as well.
2:26
I would say that all the students that have rotated through my clinic have some curiosity about the business medicine and about DPC. And it’s a delight to be able to share not just the pediatrics knowledge, but also the DPC knowledge. How about for you? How have you managed?
2:43
So before when I was in private practice in the group setting, we did have students and I will be honest, I maintained my adjunct professorship to get access to the medical school library journals. And I still do have that because then you can go look up the journal articles and
3:02
you just go through the library and you’re able to get to the journals without having to pay for them. Um, but I did want to keep doing that moving from private practice into direct primary care and maintained that. And so I do still have M3s that come shadow me.
3:17
Occasionally pediatric residents will even spend a month with me. That was something that we did before when I was in my private practice and we still do now. And honestly, the M3s are kind of like, yeah, that’s, that’s cool. That sounds neat. The pediatric residents are really interested because they have seen other side.
3:32
of the busy clinics and everything along those lines. And they’re like, wait, you have all this time for your patients and you’re leaving at a reasonable time and you’re not spending your evenings doing notes. Like this sounds pretty good. So easy to make a name for yourself is like a good place to teach.
3:47
I actually have this, I got it right over here that it came like during the pandemic. And so like they shipped it to me because we couldn’t have like in-person things, but I did win a volunteer faculty clerkship teaching award for the pediatrics department in 2020, which was really cool and inspiring to me.
4:08
And I don’t keep a lot of like crap in my office, but I do have that here as a reminder that like, it makes a difference. And you do inspire a lot of people just by showing them how you practice and having the time for students.
4:22
And so I think that that is something that is really important to me to continue. We do have a family medicine residency program in our town. We otherwise don’t really have residents in Lincoln, but there is a family practice residency. And so the family practice residents come and spend a week or two in our practice
4:39
for part of their pediatric training, which is another opportunity to get to teach somebody some specific pediatric things that they might not otherwise see. And to also, they all ask a lot of DPC questions too, and they come in. And then like just the other week, there was one that, and he was like,
4:56
How do you think DPC would work in the community that I’m already signed up and moving to? Because they’re like, whoa, this is kind of cool. This is much better. Like I have time to like do life and everything like that.
5:07
And so the long and short of it is I keep teaching M3s and residents as much as I’m able to and as much as they need, because I think it’s important and it’s fun. And I now just have more and more time to do it.
5:20
I think one of the things about DPC that that probably the med students and schools don’t even realize is like you have so much more time to let them go in and take a history and then present to you. And it’s not like, OK, really quickly, tell me what’s going on. OK,
5:33
just tag along med student and watch me, you know, take a history and examine them like you have the time to let the students know. do a lot more and your patients have more time too, because they’re not waiting for 30, 45 minutes to get seen.
5:47
Like you’re going to send the med student in right when they show up and they’re happy to talk to somebody and they have all that time. So I think time allows for so much more opportunity to teach and to have a good experience as the teacher and as the learner.
6:00
Yeah, absolutely. You’re probably a little more trusting than I am with just sending them in. And sometimes I do depending on the student how comfortable they’ve gotten. I think with me being integrative pediatrics, it’s a little trickier because it’s like asking them to know the basic level of stuff plus the whole other world.
6:18
If you’re talking about diet, skip the nutrition stuff. We’ll talk about that when I come back in. Find out how their runny nose is.
6:24
Yeah, exactly. But still, it’s really fun. And usually what I do is have them observe in the beginning. And then after a while, once they get comfortable, I’m like, okay, I’m here also in the room with you. but you’re going to start asking the questions and then I’ll just fill in the gaps.
6:40
That way it kind of saves, I don’t know, it saves for me, it saves time, but you’re right. There is that time to teach. There’s more time to teach than there was before. And that’s one thing I really enjoy. I will also add that because of that adjunct faculty status,
6:55
I was able to get paid in order to teach a course as well. And so I teach Medical Spanish, the intermediate and advanced version. And it’s actually been really fun because I have the students come to my clinic and I cap it at like 15 because that’s how many students I can kind of fit in my clinic.
7:12
But I have mock patients in each of the rooms. And so they get practice dividing up into groups and sort of tackling a whole history and physical in Spanish. And then I kind of go around and I have a TA that kind of goes around and helps the groups. And then we kind of regroup.
7:29
But it’s really cool because it’s not just like dry classroom learning about medical Spanish. It’s like, okay, you’re going to Have these like either real or mock patients that you’re going to talk to in Spanish and you’re just going to get comfortable being uncomfortable in a different language. And and it’s really fun. They really enjoyed it.
7:47
I did it for the first time this last year and I’ll be doing it every spring. And so that’s something that I couldn’t have done in this unique way. Right. In my past fee for service life as well.
7:57
Right. There would be no way to get like the clinic time and to get the people and to get all the sign off. Like, oh, this is, yeah, no, we can’t do this. Like you can just be like, yeah, let’s do it and we’ll figure it out.
8:07
I think that’s one of the best parts about DPC is there’s lots of things where somebody asks you and you’re like,
8:13
yeah,
8:13
we can figure it out. Like we can figure out how to do that.
8:16
Exactly.
8:16
Amazing. That’s so cool. I’m glad that you said that. I didn’t know that.
8:20
So I guess if you live somewhere close to an academic medical center or a medical school, a DO or an MD medical school, they’re probably looking for pediatric preceptors. So just reach out and ask if you’re interested in teaching. Now, one concern I do hear from many DPC pediatricians is, well,
8:41
I don’t have the volume necessarily or some days I may have patients and some days I don’t. So that is a consideration to have is like if you if you really, truly don’t have the patient volume yet, then maybe it’s not a great experience for a student. But once you get there,
8:55
then I think the possibility is there if you’re near a medical school and you don’t have to be super close by. Some of them are desperate for people.
9:03
They’re desperate. Yeah. Like I say, usually the med school schools will pay for like a hotel for somebody if it means that they can travel somewhere and get their their clerkship done. So I would imagine that even if you’re not super nearby, you can figure out how to make it work.
9:19
Yeah, absolutely. Yeah. And it really is a pleasure. It’s a joy. I think teaching for me sort of rekindles that joy of even the mundane stuff of pediatrics, because for me, maybe it’s been my like 10,000th runny nose and viral URI. But for this student, it’s only their second or their third.
9:38
And so it takes something that could be really boring because I’ve done it so much. And it kind of makes it interesting again, because it’s teaching someone for their first time how to manage this condition.
9:49
And I think from a volume perspective, like, yes, there’s some value in seeing 40 patients in a day. Like you get to see a lot of volume of patients, but it’s pretty shallow. Like there’s only so much teaching that you can do when you’re seeing 40 patients a day. Yeah.
10:04
four or five patients there’s so much time to talk you can let the med student catch up on life be like hey i’m sure that you don’t have a lot of time for life at this moment so consider this like a little bit of a break from the fire hose that
10:19
you are usually experiencing they’ll have a much better experience and probably thoughts about pediatrics just based on the life management that they’re able to do while they’re on a less high intensity rotation And then you can really go deep. And even if it’s the runny nose, like, well, what should we do for RSV?
10:34
Do we need to test people for RSV? What should we be telling people when they come in and they’re four-month-old or they’re day-old or they’re four-year-old has a fever or runny nose and let the med students do a lot more critical thinking and research?
10:50
The other thing that I do if I’m feeling like, okay, this must be really boring. Let’s do something. is I’ll just have them pull up their USMLE world questions. We pull them up and we do some questions together and I tell them what I’m thinking
11:01
and they all know much more about hurler syndrome than I remember about like the really specific things. But I can tell them, here’s how I would answer this question or here’s what I am looking for when I’m answering this question. And those are actually fun for me. I mean, because my grade doesn’t depend on it,
11:17
but those are fun to kind of just go back and be like, okay, this is what they’re asking in this question or they wanted you to notice that the kid has a turtle When you’re looking at it for, for the answers here.
11:26
Yeah, exactly. Yeah.
11:28
I enjoy that. I think it’s a lot of fun.
11:31
I agree. I agree. So if, if teaching is in your wheelhouse, if you enjoy it, then there probably is a way to figure it out. It may not happen immediately, but definitely is a possibility for you in the future in pediatric DPC.
11:43
Yep.
11:45
Thank you all for listening until next time.
