Title:Care for the whole family

Family medicine alumni offer compassion, continuity, and community

Growing up in Richmond, Virginia, Aman Kapadia (M’25) spent weekends hanging out at the convenience store where his dad worked, in the nearby town of Petersburg. Over time he got to know many of the customers, and their stories had an impact on his interest in becoming a family physician.

“A lot of the folks I got to know from around the area were spending time rotating in and out of correctional facilities,” Kapadia recalls. “And that really piqued my interest, along with the national social issue of police brutality. That drew me to the question: why are so many folks being incarcerated? But then also, as somebody interested in medicine, how is their health now being impacted by incarceration? In a country where health is already in a pretty dilapidated state, I can only imagine it can get worse in such a setting.”

His curiosity and care led him to earn a masters in public health and then come to Georgetown for his medical degree. He was drawn to the specialty of family medicine, in part because of how it aligns with the university’s emphasis on cura personalis, addressing care of the whole person.

“You hear the phrase when you’re applying to Georgetown, and at the white coat ceremony, all the way until graduation. The family medicine faculty really lived up to that motto.”

One of eight students in his Georgetown class to go into the field, Kapadia is now in his first year of family medicine residency at The University of Virginia.

“Family medicine is one of the specialties that’s uniquely positioned to address components of health care that go beyond just the medicine itself,” says Kapadia. “We’re looking at the social determinants of health, along with the fact that we’re doing full-spectrum care, seeing all sorts of folks from different backgrounds.”

“Family medicine is where medicine remembers its purpose,” says Norman J. Beauchamp Jr., executive vice president for health sciences and executive dean of the School of Medicine. “It is where we see the whole person—their health, their story, their family, and their community.”

Why family medicine

Those who choose family medicine care for people across all ages and life stages, from prenatal care and delivering babies, to pediatrics and adult medicine, to geriatrics and palliative care. Many are motivated by the holistic approach, getting to know patient families over the years, and understanding community resources or limitations that may impact a person’s well-being. The broad and deep skillset is especially valuable in resource-poor areas, which may be busy cities or quiet farming communities.

“At its heart, family medicine is full-spectrum care like we see with the rural doctor,” says Yalda Jabbarpour (M’08), vice chair for research and associate professor of family medicine at Georgetown’s School of Medicine, and director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care. A leading voice nationally in primary care patient and policy research, she advocates for increasing student exposure to family medicine. “When students are able to go and rotate with a rural family medicine doctor, or even an urban doctor who does full-spectrum care, they say ‘Wait, you run the hospital, you deliver the babies, you do house calls, and you do an outpatient clinic? That’s so cool.’”

But around the country, in rural and urban areas, there continues to be a shortage of family medicine doctors, even as the need increases.

“Continuity and the relationship with your doctor is so important today,” says Michelle Roett (M’03), professor and chair of the School of Medicine’s department of family medicine, and clinical chief of family medicine at MedStar Georgetown University Hospital. “People are sicker, and their circumstances more complicated. They have a lot going on mentally, and to understand who they are psychosocially is really challenging.”

She notes that family medicine prepares physicians “to meet patients where they are and to understand what their community, personal, and family dynamics might be, and how that affects their health. Being able to balance that with what preventive needs might be for their age, and understanding how all of that plays together as a family and as a community–this is unique to the specialty. And it distinguishes us from other primary care fields in that we see everybody.

“All over the country, there are pockets where there’s only a family doc for 100 miles in what we call health professional shortage areas, where family docs tend to be the only people available for primary care, for mental health, for obstetric and women’s health,” Roett adds. “It’s why we train that way.”

Primary care specialties like family medicine are linked to building more healthy and equitable care in communities while saving costs. Its emphasis on preventive health care helps minimize issues like diabetes, hypertension, and maternal and infant mortality.

“It’s borne out well in scientific studies: if a community has more family docs, they are healthier because they have more preventive care” and fewer emergency department visits and hospitalizations, Roett says.

“When you look at patient outcomes like morbidity and mortality, studies done by our colleagues show that primary care including family medicine is the only specialty that when you add more of them to a place, life expectancy increases,” says Jabbarpour. “If we want to improve the health of the nation, we really need to increase the primary care workforce.”

Expanding interest… and paychecks

Out of 200 fourth-year medical students at Georgetown this year, 15 plan to apply for a residency in family medicine, up from eight the previous year. Growing the pool is a priority for the medical school, and with the specialty’s emphasis on relationships, lifelong patient care, community support, expanding the greater good, and building health equity, family medicine aligns well with Georgetown values.

So what are the challenges students face in choosing the field?

Medical students spend their last two years learning about and rotating through the different specialties, and in September of their fourth year, apply to a specific one for their eventual residency after graduating. Conversations about the pros and cons of various specialties take place among classmates and with medical practitioners and faculty they meet along the way. Friends and family members weigh in too, of course. People have advice to share based on their own lived experiences, and those opinions naturally come with biases.

In looking at the specialties, each student brings their unique needs and personal preferences to their decision, including types of patient interactions and settings they like, average workload, and projected compensation. At a competitive school like Georgetown, there can be increased pressure for students to choose what might be perceived as the most prestigious specialties. And with the average graduate debt close to $250K, many look to pursue the most lucrative fields.

Family medicine as a specialty is not always topping that list.

“Anyone going through this process thinks about earnings potential, which in family medicine is not as high as it is in other specialties,” says fourth-year medical student CJ Rooney (M’26), who applied family medicine this fall. “I don’t think anybody at Georgetown is doing it solely for the money, but if you’re coming out of medical school with a significant amount of debt, from undergraduate as well, it’s definitely going to be a factor.”

Several years ago, family medicine professors Jeff Weinfeld and Katye Hart started a program at the School of Medicine called the Specialty Respect Campaign, offering presentations, posters, and social media intended to counter misperceptions and help dismantle stereotypes in medicine across all the specialties. Notably, they surveyed students and found them not only less likely to choose any disparaged specialty but also any specialty where doctors are speaking negatively about other specialties.

Roett emphasizes the importance of doctors working across differences for the good of the patient, too. “Family medicine physicians see themselves as partners with other specialties, and mutual respect between specialties impacts the quality of care patients receive.”

There are reasons why medical providers might elevate their own specialty and criticize others, says Beauchamp. “An individual’s specialty becomes a core part of their profession and personal identity, and to protect that identity, they may draw negative comparisons to other specialities.

“But as we guide students in discerning their paths, it is important to distinguish competitiveness for a specialty from calling,” he notes. “Calling centers on purpose, presence, and the privilege of being invited into the lives of patients and families. Family medicine resonates so deeply with many students because it reflects why they came to medical school in the first place: to accompany, to listen, to heal, and to serve.”

In recent years, several medical schools have begun offering tuition-free education made possible through philanthropic donations. “There’s growing recognition that this debt piece is really hindering medical students from making the choice that they want to make because they understand how much debt they’ll be facing,” Roett says. “At Georgetown, we’re in the 95th percentile among all medical schools for how much debt students graduate with. In the philanthropic space, we do well in terms of attracting donors for scholarships, but we still have a long way to go, especially to impact the students with the most need.”

Beauchamp underscores how community support becomes transformational. “At Georgetown, we are committed to ensuring that passion—not financial burden—shapes the paths of our graduates. Continued investment from our community is vital to empowering the next generation of physicians who serve with compassion, curiosity, and courage.”

As for pay, primary care providers (including family medicine, pediatrics, and internal medicine) tend to receive lower compensation than the surgical subspecialties. But family medicine salaries are rising.

“For the last 20 years, family medicine has been the number-one recruited specialty, which drives up demand and drives up salaries,” Roett says. “What’s challenging for every specialty is figuring out how to pay off student loans and decrease the burden of debt. If we can make a difference in student debt, could we free students to choose their calling based more on what they’re passionate about doing and their desire to serve versus the pressure they feel to make the most money?”

Increased exposure

“The Department of Family Medicine does an incredible job at laying the foundation for the value and the importance of family medicine,” says Lois Wessel, DNP, FNP (G’97), who has the unusual distinction of being an associate professor in both the School of Medicine and the Berkley School of Nursing, teaching family medicine and care to future doctors and advanced practice nurses.

Primary care patient and policy research like that done by Jabbarpour is “embedded in the first year of medicine when a lot of things are discussed, including social determinants of health, why we have disparities in health care, the value and the importance of understanding families and where you live and what you eat and where you have access to food,” Wessel says.

She has taught an interprofessional education course for nursing and medical school students called Families in Crisis, looking at incarceration, homelessness, immigration, and infertility. Her presence in the medical school classrooms “helps future physicians understand our role as advanced practice nurses in the health system.”

The value of prevention

Finding rotations for students to get experience in family medicine can be difficult compared to hospital-based specialties, says Jabbarpour, in part because many of the practices are underresourced so preceptor availability is limited.

“It’s hard for students to get robust exposure to clinical family medicine. If you’re not exposed to it, you’re not going to choose it.”

At the crux of the financial challenge for out-patient primary care is the health care payment system, Jabbarpour notes, with the fee for service system making it difficult for family physicians to do what’s required in today’s average medical office compared to specialists doing high-reimbursement procedures. The heavy administrative load includes insurance filings, prior authorizations, prescription management, recordkeeping, billing, and more. And family medicine visits often cover multiple issues in one appointment such as an annual physical.

“If we’re picking one barrier to going into primary care, I think it’s the payment system because it all trickles down. It leads to poorly resourced offices, relatively poorly reimbursed physicians. And then the money also matters in terms of how we train.”

Medicare is the largest funder of residency training, with the funding disproportionately supporting residency slots focused on treating hospitalized patients, where primary care is not a focus. Since most students get their rotations at hospitals, they get used to working with specialties such as cardiology, orthopedic surgery, and internal medicine, with less exposure to outpatient primary care, Jabbarpour explains.

“We’re working on ways to redistribute Medicare training money to help train people in outpatient community type sites where we see these shortages nationwide, such as in rural areas.”

“We have to reform how we value medical services,” Jabbarpour explains. “Right now it’s over-inflating the payments for procedures and under-counting the value of prevention.”

Following the heart

Currently Georgetown offers students family medicine placements in multiple outpatient clinical settings in the DC area. In addition, a new longitudinal integrated clerkship in DC matches one in Baltimore which began in 2016 and allows students to experience more outpatient family medicine in underserved settings.

“I became drawn to family medicine during my rotation in it last year in a medically underserved area,” says Rooney. “I realized that I wanted to have that connection with the patients over time, tracking their progress and helping them figure out what barriers they might be having.”

The rotation included three weeks of outpatient at the MedStar Family Medicine Fort Lincoln clinic just outside DC in Prince George’s County, and one week inpatient at MedStar Southern Maryland Hospital Center in Clinton.

“In family medicine you’re able to establish real rapport and trust with your patients,” Rooney notes. Patients would come in with uncontrolled diabetes, “and then six months later I’m seeing them after diet and exercise changes, and new labs come back with their diabetes much more controlled and they have a much better quality of life. Those are the appointments when I knew I wanted to keep doing family medicine,” Rooney says.

“Dr. Roett does a great job of listening, and making patient care priority number one,” he adds. “Like, what’s this patient coming in for? I know on my note it says high blood pressure follow-up, but what do they say? Is there anything that’s bothering them that they want to talk about? It’s not just about getting through the patient list quickly to stay on time.”

Many students develop an interest in the field by working alongside family medicine faculty during community outreach and electives such as HOYA Clinic, health fairs, and work at homeless shelters and correctional facilities.

From the outset of his time at Georgetown, Kapadia became involved with Correctional Health Outreach, a student group working in health education at the Arlington County Detention Facility. They study health disparities that may be affecting the incarcerated population, and develop professional relationships with incarcerated persons and corrections facilities. At the facility, the volunteers share information and hold open discussions on chronic health issues like diabetes and high blood pressure, as well as broad topics like nutrition and injury prevention.

“I hope that my future is serving the overlooked population, continuing to get experience within a setting, whether that’s a jail or prison, delivering health care to these folks who deserve it,” Kapadia says.

When choosing a specialty, Roett encourages her students to listen within.

“The majority of family physicians would choose the same specialty again, but I meet many others who ultimately regret not choosing what sparked their interest, their true calling. I advise students to go with your heart and your values, what aligns for you and what’s making you feel good every day and not what somebody else is telling you you should do. You want to be happy in your career.”