Careers in Family Medicine: US Department of State

We’re continuing our Careers in Family Medicine series, highlighting the diverse and sometimes surprising paths family physicians take. So far, we’ve explored rural practice, value-based care, and academic medicine.

This week, we go global. Dr. John Brewer, Regional Medical Officer with the U.S. Department of State, shares what it’s like to serve Americans posted overseas—combining the breadth of small-town family medicine with the reach of international diplomacy.

John, give the readers an overview of your career in family medicine.

Well, I have run quite the gamut! After completing my residency, I served four years in the Air Force as a Family Doctor in Charleston, SC, at a busy outpatient clinic, supervising a number of NPs and PA, as well as serving as the primary doctor for many Tricare for Life retirees and spouses and also running a local free clinic.

After this, I joined a rural practice outside my hometown in North Alabama and did a pretty full scope of Family Medicine (except for OB) for 5 years to include outpatient clinic, home visits, a nursing home panel, endoscopies, inpatient care, ER shifts, Medicaid clinic director and a weekly Wound Care clinic panel.

When I ran across the US Department of State, I was intrigued and felt like it was an altogether new and unique opportunity I couldn’t pass up.

What are the benefits, both personally and professionally, of serving with the State Dept?

As Regional Medical Officer (the title for MDs in the Department of State) has seen me serving in Ghana, Kazakhstan, Frankfurt, Peru, Dubai, DC, and London.

The job is to manage all the health care needs of American staff and families officially posted to the Embassies and Consulates for a region (usually 5 or 6 countries).

My family has been able to experience the world in a much deeper way than any tourist (one daughter is German fluent, and another is a Spanish chatterbox).

And I have gotten to practice medicine in a way that often makes me pinch myself. We don’t bill insurance or collect fees. Prior authorizations are much less a burden than in private practice. I get to take care of patients across the lifespan, can see them as often as they need and without productivity-dependent time constraints. And we have finally deployed our first ever EHR….both a challenge and a great way to improve care for our very mobile population.

I have an entire globe of colleagues and a support network, including medical evacuation transport, at the ready. And as I am often many patients' only medical care resource (like a small town practice), the zebras do appear sometimes, and I get to work with the host nation’s medical colleagues and resources to provide care.

What have been the challenges?

Moving isn’t easy. We do it about every three years. My wife is a pediatrician, and she has had difficulty maintaining her practice over the years. When parents struggle, it is hard to be far away. We have missed some funerals and weddings too.

Sometimes you are the best medical care for people in difficult situations, so you sometimes can get out of your comfort zone and have to constantly use your resources and strive to find the level of care that they need.

This can be a hard job for those who require professional distance from their patients as I share community life with many of them...similar to being a small town doc.

We don’t have an EHR, and while that may sound dreamy, it makes providing care more complicated. Hopefully, this is resolved in the next couple of years!!

What specific approaches do you take to enhance your personal and professional fulfillment and joy?

There are boundaries to when and how available you make yourself. Ensuring your colleagues know you care and will be there in an emergency generally leads to a healthy clinical relationship. And ensuring that local medical unit staff are empowered to make me less essential helps with the community.

As expected, the job lends itself to various travel that would be difficult in other settings. We make use of these opportunities. Learning some local language creates a sense of belonging and acceptance. Trying different foods and experiences is something my family loves, and I like to bicycle wherever I may be. Whether commuting to work in Virginia or Peru, that time exercising and being outside (even in a polluted, crowded place, yes) is very centering.

Any tips for those looking at their first job (or those who are looking to pivot) on how to decide?

Try something interesting. We are eminently employable, so if you have a wild idea, go for it. DOS requires 5 years of clinical practice prior to application, so it is not a first job out of residency (and shouldn’t be; you do need a base of experience to do a good job). Otherwise, if you want to get paid to live and work overseas and get to be as close to an old-time family doc as I figure is possible nowadays, this job might be for you.

Are there any tips or perspectives you'd like to share with readers about a career with the State Dept?

If you are adventurous and fairly comfortable in managing a broad range of medical conditions and you are under 59 and a half, complete an application on USA Jobs. 

The pay is not quite at par with an average salary, but you aren’t dependent on productivity, and there are a number of financial benefits beyond salary.

Any other things you’d like to share?

It’s an amazing opportunity to practice medicine, make a difference in people’s lives, and sometimes even intersect with decision makers and decision making on important US Foreign Policy.

Great! Thank you for taking the time to share your wisdom with the readers. How can people find you if they want to learn more?

Feel free to email me at [email protected] or [email protected] or https://careers.state.gov

Dr. Brewer’s journey shows how a career in family medicine can open doors you might not have imagined—sometimes to the other side of the world. I’d love to hear what you found most interesting or inspiring.

Next week, we’ll meet Dr. Kelly Derbin, a family physician working in a multi-specialty group that blends clinical care and leadership roles. 

Until then, have a joy-filled week,
Tonya