Q&A: New physician finds equilibrium between academia, clinic, home

With a 4-year-old son, a 2-year-old daughter and a husband who is earning an MBA while working full time, 37-year-old Shannon C. Scott, DO, understands all-too-well the juggling act faced by new osteopathic physicians craving balance between their professional and personal lives. Employed by the Midwestern University/Arizona College of Osteopathic Medicine (MWU/AZCOM) in Glendale as a clinical assistant professor of family medicine and osteopathic manipulative medicine, Dr. Scott feels fortunate to have a manageable schedule that splits her time between caring for patients in the school’s multispecialty clinic and instructing and mentoring students.

As the first DO to fill the new physician in practice seat on the AOA Board of Trustees and the 2011-12 chair of the AOA Council of New Physicians in Practice, Dr. Scott fields concerns from other physicians recently out of residency, who are confronting a confusing onslaught of choices, changes and government and professional mandates as they begin their medical careers.

A native of Washington state, she graduated from MWU/AZCOM in 2004 and served an internship and residency through the Scottsdale (Ariz.) Healthcare Family Medicine Residency Program, which named her Outstanding Intern of the Year in 2005. For her achievements and dedication during training, she also received the Brazie Award in 2006 from the Arizona Academy of Family Physicians.

After completing her residency, accredited by the Accreditation Council for Graduate Medical Education (ACGME), Dr. Scott chose to obtain certification from both the American Board of Family Medicine and the AOA’s American Osteopathic Board of Family Physicians to enhance her career options and ability to serve the osteopathic medical profession.

Involved in the profession since serving as her class’s representative to MWU/AZCOM’s Student Government Association, Dr. Scott is an emerging leader in the American College of Osteopathic Family Physicians (ACOFP) and the Arizona Osteopathic Medical Association (AOMA), as well as the AOA. She was recently named the ACOFP’s 2012 New Physician of the Year and elected the new physicians representative to the AOMA Board of Trustees.

With so many career choices available to you as a family physician, what made you pursue an academic appointment?

After finishing my residency in 2007, I wasn’t sure of my next career step. I knew I enjoyed teaching, so I volunteered as a clinical instructor of OMM at MWU/AZCOM. And to test the waters, I joined a large family medicine practice, which gave me a solid grounding in the business of medicine. When a full-time position at Midwestern became available a year later, I knew it was the right choice for me because I feel passionate about teaching but also love patient care.

The job enables me to have more time for my family than most positions would. I’m able to work four days a week, so I have a day off besides the weekend to spend with my two kids. In addition, my time at Midwestern is equally divided between teaching OMM and family medicine and caring for patients in the clinic. I like the flexibility and variety of my job, which allows me to reach out into the community and mentor students in various venues. I’m the faculty advisor to AZCOM’s osteopathic family medicine club, the source of most of the students I mentor. And I always have a third- or fourth-year student rotating with me in the clinic.

How did you come to specialize in family medicine?

I always enjoyed my family medicine rotations. I was fortunate to work with exceptional family medicine preceptors and realized during my third year of medical school that this specialty was a good fit for all of my interests. Specifically, I am interested in women’s health issues and pediatrics, so being able to treat both adults and children is an advantage. I also enjoy doing procedures and incorporating osteopathic manipulative treatment into daily practice.

What do you say to students who are interested in family medicine but worry about being able to repay their student loans?

Students are very concerned that in family medicine and other primary care fields, they won’t make enough money to pay off their loans. I point out that many states and the National Health Service Corps have loan-repayment opportunities for primary care physicians willing to work in underserved areas.

But students also need to determine what kind of lifestyle and future financial goals are important to them. Of course, everybody’s definition of a comfortable lifestyle is going to be different. As a family physician, you can make money by incorporating a good business model into your practice.

But first and foremost, as I tell students, you need to be happy and enjoy what you do. Your loans will get paid back. But sometimes, your spouse or significant other will have to be employed, and your family will need to make smart financial decisions.

What drew you to osteopathic medicine?

I am from Washington, which didn’t have a lot of DOs where I was growing up in Tacoma or where I went to college in Bellingham. As a biology major, I thought I was interested in going to medical school, but I also was pursuing a minor in dance education. I am a big believer in doing what I love and keeping my options open. To fulfill the requirements for my minor, I taught classes in jazz and modern dance on campus.

One of my dance students happened to be an osteopathic physician: Anne T. Mishica, DO. One day, she came to class wearing a T-shirt promoting osteopathic medicine. I actually asked her, ‘What is a DO?’ She explained that she is an osteopathic family physician, and she talked to me about osteopathic philosophy and her practice. Dr. Mishica invited me to shadow her in her office, which I did for the next year and a half. I had to drive about an hour to get to her office, so I would do this three times a month for three or four hours at a time.

Dr. Mishica was a great mentor to me, which I appreciated so much. I could see that medicine was the right career for me and I loved osteopathic principles and practice. So I decided to apply to osteopathic medical school. My experience being mentored led me to do the same for others.

While you mentor MWU/AZCOM students, you also reach out to help other new physicians in your roles on the AOA Board and the Council of New Physicians in Practice. What is a key concern of new practicing physicians that you’ve dealt with in the past year?

Board certification is definitely a big concern. A lot of new physicians in practice who have completed ACGME-accredited residencies are wondering whether to become certified by the AOA or the American Board of Medical Specialties or both. One of the best pieces of advice I ever received was, “Take any board exam you are qualified for because you never know what you are going to need in the future.” So when I completed my residency, I got certified by both boards. I’m very glad I did so because it has opened a lot of doors for me and leadership opportunities.

Certainly, being ABMS-boarded enhances your employment prospects with allopathic institutions and organizations. But to be a leader in the osteopathic medical profession and in osteopathic medical education, AOA board certification is a must. So I considered the investment in time and money to be well worth it.

Today, however, those who become dually boarded face two sets of processes for continuing their certification: ABMS maintenance of certification (MOC) and osteopathic continuous certification (OCC). The AOA specialty certifying boards are developing pathways to have their diplomates’ participation in MOC apply to OCC, but much uncertainty remains. To what extent will there be reciprocity when it comes to continuing medical education credits and programs for measuring practice performance and improvement? If there isn’t a lot of overlap between the two processes, that will be a disincentive to becoming dually boarded or to maintaining both certifications.

What other issues are on the minds of new practicing physicians?

The face of medical practice is changing so rapidly that new physicians often don’t know where to turn for practice resources. While younger physicians may be more technology-savvy and comfortable with the concept of electronic health records than their experienced colleagues, they are having trouble sifting through all of the new laws, regulations and programs proliferating in our evolving health care system.

As new practicing physicians, oftentimes we don’t know which government programs require our participation, which will compensate us for our time, and which will penalize us for not participating. We are in the dark about many of the Medicare and other quality-improvement and performance-measurement initiatives coming out. As new physicians, we may not be able to stay on top of everything as it unfolds due to lack of time, finances or staff support.

Our residency training programs may not have prepared us for all of these new programs. Many physicians find that they have to hire more staff for data entry and invest money in new processes. Often, as soon as we’ve implemented a system, another program emerges. In the face of rapid program changes, physicians often become discouraged and resistant to trying new things.

On top of everything else, ICD-10, which will be implemented in 2013, is going to change how we code and bill. Then we are going to have to send our coders back to classes or hire coders or go to classes ourselves in the midst of updating our electronic medical records and complying with performance-measurement programs.

Is that why many physicians today seek to be employees rather than be self-employed?

Yes, I think many physicians coming out of residency say, “I might as well go work for others and let them work out the details.” Most new residency graduates want to focus on patient care and paying back loans.

I recommend that new physicians get experience in the business of medicine before striking out on their own. They should test the waters and see what’s out there. They can join a group practice or become an employee of a large, busy practice for a year or two to get their feet wet and glean some experience from that environment. This is the best way for physicians to see what they might want to do in the future.

What is the next step in your career?

I have applied to the Osteopathic Health Policy Fellowship program, which begins in August. My interests include policies related to medical education. Many of the health policy fellows I’ve spoken with said that their long-term goals have changed upon completion of this program. For now, I am excited to pursue this opportunity, hopeful that it may lead me further in a direction where I can best serve the osteopathic family in the future.