An Update on AGS Fellows-in-Training

Fall 2001

Paul Tatum III, MD
2^nd year Geriatric Fellow, Dept of Family &
Community Medicine, University of Missouri, Columbia
University of California, San Diego

As I dropped my daughter off at the school playground this morning for her first day of school, I stopped for a few moments and pondered her future. Thanks to Title IX and the women's rights movement, she will know few limitations in life. I thought about her progression through school and how she will eventually choose a career. Hopefully, her career decision will be clearer than mine. It is amazing to me that as I begin my fourth decade of life, I still can't answer the fundamental question of "what do you want to do with your life?" Doing a geriatrics fellowship has created a wonderful dilemma for me. I am now faced again with another career choice that has the potential to send me off on a new and totally unanticipated career trajectory.

I entered medical school because of a desire to care for patients. However, through the course of a fellowship, I have found a new interest in research and in teaching students and residents. Although the academicians around me say that it's easy to be the "triple threat" of clinician, teacher, researcher, I am struggling with what to do. I wonder if I am the only fellow struggling with this, or are there others also trying to find the right balance?

One of the issues that I am struggling with is that being a "triple threat" means time away from clinic. Initially, one of the reasons I went into a family practice residency was because I wanted as much time in outpatient medicine training as I could get. I loved being in primary care and relating to my patients. The thought that some residents only had one day of clinic a month astounded me. As I move into a research position, will I need to give up too much of my clinic time? Will I be available often enough to my patients? Is having three days of clinic enough to be a good doctor for them?

On the other hand, research allows time to solve important problems that may have a more broad impact on the overall population. I would be helping many individuals at once rather than just one individual at a time. I like the academic processing behind research formulation. I love working on problems with a group of dedicated colleagues. But do I really want to play the game of grant funding? Do I want to risk spending the hours of work, only to get rejected? Do I have the skills to do important research in geriatrics? And will the research get in the way of my love of individual patient care?

I have finally decided that there is no better way to answer these questions than to try! With this decision comes another set of questions. Is a two-year fellowship really enough time to get started on a research career? Do I dare ask my wife to try stay for a third year of fellowship?

My daughter's teacher snapped me out of my meditation for a minute when she wished me a good morning. She has all of the qualities I respect in a teacher. She is a good listener, understanding, and a motivator. Am I capable of being all of that to a group of adult learners?

These were the insecurities that flashed through my head as I watched my little girl run to play. And you know, of all of the challenges about how to balance the three areas, none is as important as figuring out how to balance my time to be with her.

I suppose most of the fellows in geriatrics have answered a lot of these questions. Many of you may already have found jobs and satisfaction. As for the rest of you still struggling to decide who you are, I want to reassure you that you are not alone in your confusions. I wish you luck in your decision.