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Interviewer: So you're interested in a career in medicine but you don't know what's your area yet. We'll talk about if family medicine might be right for you next on The Scope.

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Interviewer: With so many different fields in medicine, it can be a challenge to decide which one will be right for you. We have Dr. Kirsten Stoesser, a family physician at University of Utah Health Care to explain what it's like to work in family medicine. First of all, Dr. Stoesser, what is family medicine?

Dr. Stoesser: So family medicine is one of the primary care fields, and we take care of patients from babies to seniors.

Interviewer: So you're really seeing everyone and everything?

Dr. Stoesser: We see everyone and everything, that's exactly right.

Interviewer: So why did family medicine appeal to you?

Dr. Stoesser: I realized when I went through my rotations that I liked everything. I loved pediatrics, I loved psychiatry. For a while, I thought I would be an ENT surgeon. I wanted to go into OB-GYN. And every time I did a new rotation, I thought, "Here's my new career." I couldn't just pick one thing. I was fascinated by everything.

Interviewer: So ultimately, what made you choose family medicine? What was the final criteria?

Dr. Stoesser: You might laugh at this, but, for myself, I realized I was not passionate about getting up at 3:00 a.m. to take out a gall bladder, but I had learned that the family physicians, a fair number, deliver babies and I could be passionate about getting up at 3:00 a.m. to deliver a baby.

Interviewer: So what are some of the other advantages of family medicine?

Dr. Stoesser: Well, not things that I had thought about at the onset, but what I've seen now having been in this career for 15 years or more and with my own career as well, observing colleagues and prior residents that I've had, there is just enormous potential to do so many interesting things within the field of family medicine and to reinvent yourself and to change your career as your interests change.

I actually did a fellowship in obstetrics after residency so that I could do operative obstetrics. And I did that for a number of years, and then I decided it was time for the . . . I did not want to do that anymore. And now, my practice has turned in a way that I could have never envisioned. I'm actually doing hepatitis C care in the clinics, and I have an LGBTQ practice and I'm helping patients transition with transgender care issues. So those are things that I had no idea I would be interested in 20 years ago but are a really big interest for me now.

I know of other family physicians who've gone on to do some amazing things, who've been the medical care providers on wilderness expeditions. We had prior residents who've been working in Alaska and others who have been in Antarctica working as the medical care providers. People have just done all sorts of things with this career.

Interviewer: And what about disadvantages?

Dr. Stoesser: So it is true what they say, you know kind of a little bit about everything but almost a lot about nothing unless you choose to sub-specialize. And you have to learn to become comfortable with that feeling of discomfort. And you have to know what your limits are.

Interviewer: So what type of person do you think should go into family medicine?

Dr. Stoesser: I'm sure there are a lot of different people who go into family medicine, but again, somebody who always wants to be learning their entire lives, who wants to be challenged, who doesn't want to be bored, and who likes a variety of things.

Interviewer: And what does your typical week look like?

Dr. Stoesser: So my typical week, I truly do see a lot of variety in that. I see adult men and women patients. I see seniors. I see a fair number of geriatrics. I see a lot of psychiatric patients. I see a fair number of pediatric patients and still delivering babies that brings in more pediatric patients.

Interviewer: So how does this particular field of medicine impact your personal life?

Dr. Stoesser: You know, all medicine impacts your personal life. And if you're going to go into medicine, you have to be committed to the "Patient comes first." It really depends. You can be in family medicine and you can be in a potentially 9:00 to 5:00 job, although those are getting harder to come by. And you might have somebody who's covering for you on nights and weekends, but still patients have issues. And even if you have a "day job," there's still somebody who needs to answer those phone calls. So you'll still probably be at least doing part of that.

Then there's the other extreme where you have somebody who's doing a lot of calls with, they might be doing in-patient hospital medicine as a family physician. They might be delivering babies, and they might be on every three to four nights. Or especially if you're rural, you might be on call all the time because you're the one doc in the town. So there can be a huge variety.

Interviewer: All right. So I'm still not sure if family medicine is right for me. How would you make a case for why family medicine is a good practice to go into?

Dr. Stoesser: Well, I'd never want to tell somebody that they should go into family medicine. I mean, one disadvantage of it is that you certainly don't make as much money as you do in the specialty fields. And for some people, that is important. But you still do make a fair amount of money. And one of my preceptors had said, "You know, even though you may be one of the lower paid physicians, you're still making more money than the majority of people in the United States and certainly in the world." And I think that's a good thing to keep in perspective.

And you really want to do what you love because I know somebody who's a cardiothoracic surgeon who's making a lot. But they're on call every second to third night for their entire life, meaning that they have to be working in the hospital, up at night every two to three nights. The most money in the world is not going to be enough to make you happy if your work hours make you miserable. And maybe that person loves being on call every second to third night, but I can tell you that would not be for me.

But really, if somebody's thinking that they're interested in family medicine, the best way is to do just do rotations in family medicine more so than just the required medical student longitudinal ones come in and do an extra month or two with a preceptor you enjoy who sees patients that you're interested in.

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Dr. Stoesser: Hi, my name is Kirsten Stoesser, and I am a family medicine physician. A question that a lot of new parents have is whether or not they need to supplement breastfeeding with formula. In most cases, this is not necessary but in some cases it can be helpful.

One of the times where we recommend that somebody supplement with formula is if the baby is not gaining weight appropriately, especially in those first few days to the first week. If we see that a baby has lost more than 10% of its birth weight and is not able to gain that back adequately enough and quickly enough with breastfeeding, then we will recommend to do supplementation with formula.

This doesn't mean, though, that you have to do a bottle feeding. There are actually some ingenious ways to be able to administer formula. One of my favorite ways is what's called the "Supplemental Nursing System," or the SNS system, and this involves sort of a drip line. There's a line that's taped over the mother's shoulder and then this line comes down and is taped across the breast and the nipple.

So a baby can still breastfeed and even if they're not getting much while breastfeeding, they are getting the formula that drips in and baby is still getting practice with breastfeeding so they're not losing that skill and mothers are still getting the stimulation at the breast, which helps to promote further breast milk production. Usually, when babies do the SNS system, they just need to do this for a few days and then they're able to catch up the growth and the weight that they need and are able to go back to breastfeeding.

There are different ways to supplement. Sometimes it can be because the baby's not getting enough nutrition, and sometimes it's because the mother's not producing enough milk. And so if the mother's not producing enough milk, having ongoing stimulation at the breast is important. So in addition to having the baby feed, one thing that I'll recommend to moms to do is to get a breast pump and after baby feeds to actually pump for five to ten minutes on both sides so that the breasts are getting adequate stimulation.

Another thing that's really important is for the mom to get plenty of sleep, which I know is hard, to make sure that she's eating regular meals, to drink plenty of fluids and to try to relax as much as possible. Another thing I'll recommend is that sometimes if just even one feed in the middle of the night, if somebody else can do that feeding, they can do a bottle feeding with either formula or with pumped breast milk, then that can allow mom to get a few hours more of uninterrupted sleep and sometimes that can help with breast milk production during the day because mom's not as exhausted.

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Dr. Stoesser: Hi, my name is Kirsten Stoesser, and I am a family medicine physician at University of Utah Health Care. One of the common questions I get is, "How do you know if your newborn is getting enough to eat?" So there are a few ways to be able to assess if your baby is getting enough to eat. One is just does your baby seem relaxed and happy right after a feed? Does your baby seem content and going back to sleep or relaxing? Although babies can be irritable a lot, and cry a lot, and crying doesn't always mean that they're hungry.

So there are a few other things that you can look at as well. One is, how many wet diapers are they making? In the first day after they're born, they should make one wet diaper in 24 hours, and then you add one diaper a day for the next few days. So, by two days, they should have two wet diapers, by three days three wet diapers. And from the fourth day on, they should really be making about four to six wet diapers per day.

In addition to the number of wet diapers, you can also look and see what does the urine look like? If the color of the urine is pretty pale, that means that they're getting enough liquid. But if it's a dark yellow, or if it's even a pink-orangish color, that can mean that they are dehydrated and that they need to get more fluid in.

In addition to the number of wet diapers, looking at the stools, it can be really helpful. These also change in their character and number within the first few days, first few weeks. Initially right after a baby is born, the stool will be black and tarry, that's the meconium, and then it turns to a greenish and then a brownish color. And then, with breastfed babies, the stool then transitions to being a yellow, what we call a mustard-yellow color and, kind of, a seedy consistency or like a cottage seed consistency. In the first week to first month, they usually make about two to three stools a day with breastfed babies. And after one to two months, there can be a large variation. They can make one stool a day, or they might go a few days without having a stool, and that again can be normal.

And then the other thing to look at, to make sure that your baby is being fed well, is weight gain. And although that's a hard thing to do at home, when you bring your baby in for clinic visits at three to four days after they're born, and at their two-week, and their two-month visit, we will check their weight and then look at that on a graph to see how they are comparing to other babies of the same age, and are they within the normal weight. And a lot of times, parents worry that their baby is not feeding well, but when we can show that they're gaining weight normally and appropriately, that shows that they are getting enough nutrition.

Sometimes we will have parents come in more frequently if we do have a concern about the weight, so that we can check it a few days or a week later, just to make sure that a baby is gaining appropriately. And normally they should gain about an ounce a day, or about four to seven ounces per week within those first few weeks, first few months. Although most babies, they will lose some weight in their first few days. That's normal. By two weeks, certainly of age, they should be back to their birth weight.

Again, the things to look at are how many wet diapers are they making? What are their stools like? And are they gaining weight? And if you have any concerns, certainly calling into the clinic, or make in an appointment to come in. And we can always check your baby, and be more than happy to figure out what's going on, and how we can help.

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