Hollywood producers take note: The Hinsdale Family Practice Residency program of Hinsdale Hospital may be a hit television series waiting to be videotaped.
There are enough white-knuckle crises and heart-wrenching climaxes to fill stacks of scripts. And there’s even an outspoken central character, the program’s official guru, Dr. Gerald Lofthouse, who regularly erupts with quote-worthy conviction.
As director of the only such physician training program in DuPage County, every year Lofthouse takes 10 shiny new doctors fresh out of medical school under his wing and polishes off their rookie rough edges with three grueling years on the front lines of community-hospital medicine. The residents’ 70-hour-plus work weeks that prepare them for a career as a medical jack-of-all-trades are punctuated by real life-and-death dramas.
Lightweights need not apply. Ideal candidates for the Hinsdale residency “must have a good work ethic; work is not a punishment to be avoided,” stipulated Lofthouse, who graduated from the program in 1980 and joined the faculty in 1981, the same year he opened a private practice in Bolingbrook.
As chief mentor to the program’s current crop of 28 first-, second- and third-year residents (this is the first year for a 10-student class), Lofthouse is part mother hen, part patriarch, part Norman Rockwell family doctor and 100 percent dogmatic about the virtue of humility.
Doctors who take an imperial approach to plying the Hippocratic trade and dictate care to their patients rather than educate them so they can make informed decisions make Lofthouse’s blood boil. Venomous doctor bashing, now popular grist for best-selling books and TV and radio talk shows, is not entirely without cause, he said.
“I think a fair amount is deserved,” said Lofthouse. “Too many doctors have allowed themselves to be set on a pedestal over the past 30 years. Doctors are people, but when they allow themselves to be treated as gods, they soon come to believe they are gods.” Too often new medical school graduates think, “I’m going to act like those gods of medicine who taught me everything I know,” he said. Their role models are “the people who live in ivory towers of medicine, people in academia. They teach great knowledge, but they don’t teach the principles my residents need to cope with real, everyday medicine.”
One of the toughest lessons Dr. Jennifer McGowen, a first-year resident, learned on the job “was how to deal with the deep issues of life and death. I wasn’t prepared for that. In medical school, we didn’t talk with patients about dying.”
A defining moment for third-year resident Dr. David Reinhard happened about a year ago. A woman patient who gave birth to a son he delivered without complication became seriously ill a month later. She developed kidney failure and severe anemia unrelated to the pregnancy and required intensive care. Reinhard credits the support he got from his resident colleagues and specialists for the woman’s full recovery.
During her hospitalization, her baby was brought to her bedside for a visit. “I’ll never forget sitting there in the intensive care unit and watching her hold her son,” said Reinhard. “It made me happy to see her getting better, but at the same time it made me really anxious to have that much responsibility, to realize how many lives I affect when I care for a patient.”
The Hinsdale program, which dates back to 1974, receives 400 applications a year from medical school seniors for 10 first-year class slots. The demand for well-trained primary care physicians is being driven by managed care organizations, which use family practitioners as referral agents or “gatekeepers” to specialized services, said Kenneth Miller, residency program administrator. “A lot more is being expected of a primary care physician than ever before,” he said.
“A good family practitioner ought to be able to manage 90 to 95 percent of the cases he or she sees,” said Dr. Judy Frigo, chairwoman of the department of family practice at Hinsdale Hospital and a 1987 graduate of its residency program. In practical terms, that means a family practice resident needs plenty of in-the-trenches clinical experience.
The Hinsdale program is fully accredited by the Accreditation Council for Graduate Medical Education, which reviews 7,300 U.S. physician speciality and subspeciality training programs.
“The Hinsdale residency has enjoyed continued accreditation since it was first reviewed in 1975,” said Mary Alice Parsons, executive secretary of the council’s review committee for family practice. “It has an unbroken record of meeting high standards for faculty and curriculum in adult, adolescent and child medicine,”
The home base of the residency program is the Hinsdale Family Medicine Center, a family practice clinic owned by Hinsdale Hospital where residents see the full gamut of patients who typically populate a private practice. But they get their trial-by-fire training at the hospital as on-call house doctors, making rounds and responding to emergencies.
What makes the Hinsdale residency program special, say residents and graduates interviewed, is the absence of other residents in medical specialties who traditionally get the lion’s share of critical training resources. Consequently, Hinsdale residents have unopposed access to challenging patient assignments and get special attention from experienced physicians in a host of specialties, including cardiology, surgery, pediatrics, obstetrics, urology, psychiatry, internal medicine, plastic surgery and ophthalmology.
“Here it’s just us and the attendings (physicians),” said McGowen. “At a university hospital, it’s more hierarchical. I’d be expected to learn from a senior resident who may have been in my shoes just two years ago instead of the attending who has been out practicing for 20 years and has a big knowledge base.”
The average annual salary of area family practice doctors is $100,000 to $130,000, reported Miller, about 50 percent less than their specialist counterparts earn. But family medicine pays big dividends in emotional satisfaction, said practitioners.
“I started medical school saying I was going to be a surgeon,” said Dr. James Carsten, a 1991 Hinsdale residency alum who practices in Wheaton. “I like doing surgical things, and family practice lets me do that to some degree. But I really enjoy the patient contact, the rapport that goes with being an advocate for my patients. People need more than a pill or a test result from me. They expect me to help them cope with, and understand, their illness.”
“I like making a diagnosis,” said Frigo, “I like doing the follow through, and I like taking care of whole families that span several generations. And I like that I can’t remember a Thanksgiving when I didn’t get flowers from a patient saying thank you for being my doctor.”
Persuading residents to stick around after graduation and affiliate with the hospital is a top priority. Residents are seen as a potential decades-long revenue stream for outpatient tests and services, inpatient diagnostic studies and treatments, and for referrals of patients to specialists also affiliated with the hospital. “We have a goal-it’s outlandish, really-of retaining six residents from every class,” said Lofthouse. “Typically two or three stay.”
Reinhard plans to be one of them. He has accepted an offer to join an established Hinsdale practice next summer, after he completes his residency. It wasn’t an easy decision; there was no shortage of recruiting letters from other practices.
Lofthouse had a very different experience some 14 years ago, near the end of his residency, when he made plans to return to his home state of Washington and open a practice in a small agricultural community. After ironing out most of the details with the local hospital, he visited the town, intending to get the ball rolling.
“I was wined and dined and it was great until two local doctors discovered I was not interested in joining their practice and feeding their pension fund,” he recalled. “They said, in essence, if you come here, we’re going to take all our patients down the road 20 miles to the next hospital. We’ll boycott you.
“I was scared and disillusioned. So I came back to Hinsdale and stayed to teach.”
Lofthouse has no regrets. Many of his proteges are the medical backbone of the communities they serve. “I’ve got guys in little towns in southern Illinois doing all the Caesarean sections for four counties,” he said. “There are a lot of wonderful physicians working out there that I’ve been a piece of.”
How’s that for a made-for-Hollywood happy ending?
