Careers in Family Medicine: US Department of State

We are continuing our blog series, Careers in Family Medicine. Each week over the next 3-4 months, I will highlight a family physician and their career path. Each one will share their pearls. So far, we have highlighted examples of Rural Practice, Value Based Care, and Academic Medicine. This week, we will focus on what it's like to travel the world to provide care to US Citizens with Dr. John Brewer, Regional Medical Officer, US Department of State.

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 PAs as well as the primary doctor for many retired Tricare for Life patients.

After this, I joined a rural practice outside my hometown in North Alabama and did the full scope of Family Medicine except for OB for 5 years. Outpatient clinic, home visits, 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 a different opportunity with new challenges and some benefits.

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

My role as a Regional Medical Officer has seen me serving in Ghana, Kazakhstan, Frankfurt, Peru, Dubai, DC, and soon 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 much deeper 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. I probably do 2 prior auths a year. I get to take care of patients across the lifespan and can see them as often as they need to and without productivity-dependent time constraints.

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.

Sometimes you are the best medical care for people in difficult situations, so you sometimes can get out of your comfort zone.

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

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 cycling to work in Virginia or Peru, that time exercising and being outside (sometimes 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 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, 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 impact American policy and leaders.

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

Again, there is much wisdom from this family physician's experience in a variety of practice settings. I'd love to hear from you what you found helpful.  

Next week, we'll dive into being a family physician in a multi-specialty group incorporating both clinical and leadership roles with Dr. Kelly Derbin. Don't miss any in this series; sign-up to have them delivered to your inbox. 

Until then, have a joy-filled week! Tonya