Book Review: "In Stitches" and myths about family medicine

I wanted to be able to write a positive review of In Stitches, the humorous medical school memoir written by plastic surgeon and frequent Rachael Ray show guest Tony Youn, MD. This generally enjoyable chronicle of Youn's coming of age as a physician and person in the mid-1990s through the trials of premedical and medical education produced many "I know exactly how he felt" moments for me, especially in its hilarious tales of his awkward attempts to find female companionship at Monday night post-exam parties. (For those who actually read the book, my own medical school experience wasn't exactly like Youn's. For example, he didn't take a series of post-call swing dance lessons in order to meet single women, or go to the same Italian and Chinese restaurants so many times with his best male friend that the waiters assumed they were a gay couple. But that's neither here nor there.)

At turns serious, heartwarming, and laugh-out-loud funny, In Stitches is a mostly entertaining read. So why give it two thumbs down? While Youn presents a less than flattering picture of every medical specialty other than plastic surgery, he unfortunately is especially harsh on family medicine, perpetuating several myths that have likely kept countless otherwise well-suited students from making this career choice. As a student, Youn's ignorance is a forgivable offense (though somewhat surprising, since Michigan State College of Human Medicine ranked a heady 6th out of 141 in last year's primary care-oriented social mission rankings of U.S. medical schools), but as a celebrity specialist who presumably receives referrals from family physicians for patients with body dysmorphic disorder and more serious physical conditions, it's not.

Youn's first error comes up when he decides to tell his father, a hard-driving immigrant obstetrician who wants his son to pursue a more fulfilling (read: higher-paying) medical career, that he is seriously considering the specialty of family practice (why, it's not really clear, as Youn never did a family practice rotation, nor did he seem to particularly enjoy his experiences as a student on internal medicine or Ob/Gyn):

I suppose I could go into family practice. It's so easy. Three-year residency, and the last year is a walk in the park. You're essentially done in two years, no pressure, and you're left with a ton of free time. I like to dabble. I can get more serious about my guitar, maybe join a band. ... Why not take it easy? I think I've found it. Family practice. Perfect for me.

As with most residency programs, the intern year in family medicine is the most intense and demanding. Other than that, though, Dr. Youn's information is all wrong (and it's a good thing he didn't actually choose family medicine, since he would have been sorely disappointed). My third year of residency was most definitely not a "walk in the park," and there is very little truth to the myth that students who go into family medicine are "dabblers" who can't make up their minds about what medical specialty they like best ("jack of all trades, master of none," as the misguided saying goes). If you loved medicine and pediatrics and can't make up your mind which to choose, I advise medical students, do a combined Med-Peds residency. Family medicine is a specialty that treats whole families, from birth to death, not pieces of families or particular body parts.

The other myth that begs correcting is Youn's father's exaggerated fear that his son will "go broke" and "have to move back home" because family physicians are paid so pitifully compared to other specialists. No doubt, my take-home pay is probably a small percentage of Dr. Youn's as a plastic surgeon, especially since most of his patients pay in cash and he can charge what he likes. But depending on the source of one's data, the median annual income for a family physician in various regions of the U.S. is somewhere between $150,000 and $180,000 - not exactly chump change, and an income level that Democratic politicians dueling over tax cuts recently defined as "billionaires" compared to most Americans.

For medical students who are considering going into family medicine and want to read a more balanced source of information, I recommend the article "Responses to Medical Students' Frequently Asked Questions about Family Medicine." (Full disclosure: I am an editor of the journal that published this article, and my wife wrote the accompanying editorial.) The article gives well-documented answers about my specialty that you won't find in Dr. Youn's otherwise interesting memoir.