In this first of a series of posts, I would like to discuss the lack of mentorship that community-bound specialist MDs receive during their time in medical school, Internal Medicine residency and subspecialty fellowship. Unlike our academic colleagues, who are generally university affiliated and research oriented, those interested in working in the community (ie. private practices with hospital affiliations that may not be formally linked to a university) are unlikely to receive good mentorship, unless they seek it out themselves.

By definition, 99% of clinicians that we encounter in medical school, clerkship, residency and fellowship are academics, since they are in a university teaching position. If you were to ask these clinicians if they have ever stepped foot in a private practice or a community hospital, you could expect a “no” from the vast majority. This is unfortunate, since community work has a different mindset than academia; there is more focus on patient care, informal teaching of fellows, clinical research, and business, as opposed to nonclinical basic research and committee work. There can be a misguided perception from academic mentors that those who can’t handle a large research component ‘drop down’ into community practice, where in reality it is a different skillset. I believe that this is a disservice to the more than 50% of graduates who practice in the community.

It can also be challenging to arrange a community elective. Electives are an effective tool to help decide your career path and can lead directly to a job offer. As a Respirology fellow about 20 years ago, I encountered resistance from my program director and education committee when I asked to do a community elective; no one had ever requested one before, and the committee questioned if it “would be an appropriate use of my time”!

They eventually agreed, and I had a great month in a private practice in Ottawa; in fact, I ended up joining the practice after my fellowship and worked there for 18 years.