The Front Line of Medicine
It is easier to build strong children than to repair broken men.
The words of abolitionist Frederick Douglass resonate for Juan Jose Ferreris, a pediatrician and assistant clinical adjunct professor at University of Texas Health Science Center. He sees a straight line between the public funds allocated for children’s care and their well-being as adults.
“Kids receive less than 20 cents of every health care dollar. Meanwhile, 80 percent goes to adult end-of-life care. Why aren’t we spending those funds on people when they’re young, when it could make a genuine difference?”
Ferreris contends that money also shapes health in less obvious ways. Salaries of primary care physicians are well below those of more “glamorous” specialists. Some fledgling MDs, burdened with medical school debt, reason that they can’t afford not to specialize. Consequently, he says, only 3 percent of medical students choose primary care.
For Ferreris, who is both humbled and inspired by his young patients, building a Culture of Health necessitates recalibrating priorities.
“Nobody’s concentrating on the whole; they’re only looking at one part. And they’re not paying attention to the human—the brain, the spirit, the soul.
“We overlook that aspect…but it’s where I believe the primary care doctor has irreplaceable value.”
Feeling, Not Finances
Ferreris was encouraged to make a flashier career choice than pediatrics. As a member of Alpha Omega Alpha (AOA), the world’s only medical school honor society, he was in the top 10 percent of all medical students in the country—an open door to any specialty.
Yet pediatric medicine appealed to him at a level that other fields did not, he says, acknowledging that his decision was based more on feeling than on finances. “I can’t imagine that anyone would choose pediatrics for any reason other than it’s where their heart is. It isn’t money or fame, that’s for sure!”
His appearance was a factor as well. “I’m short. Very short!” he says, laughing. “And I’ve always looked much younger than I am. Kids are less scared of me.” During his pediatrics rotation in medical school, parents often marveled at the level of ease their children displayed with Ferreris. “They would say, ‘Wow, he’s never like this with other doctors,’ or, ‘You’re the first doctor she talks to.’ Kids just seem to feel comfortable with me.”
His respect for his patients is palpable. “The best thing about my work is the relationships, the friendships I’ve developed. I get to know people I wouldn’t otherwise meet—their personal and social challenges, their demons.”
“Regardless of their backgrounds, these moms want to take care of their babies,” he explains. “They don’t always succeed, because they carry baggage from the past, but on the whole, they want to do it right.”
He feels honored to serve the people who place their trust in him—even on a bad day.
“I see these kids grow up from a baby in diapers to a kid who’s scared of you to a kid who wants to see you,” he says. “To have them recognize me, even after they get older, and run down the hall to give me a big hug, bring me handmade cards…really, how bad can my day be?”
Ferreris confesses that his job is humbling, and sometimes overwhelming.
“You feel this responsibility to be perfect, and you know you’re not. We’re all human,” he says, adding, “But they make you up your game. They expect better, so I have to do better.”
Finding His Place
Originally from Puerto Rico, Ferreris is a military brat whose father is an Air Force officer. “We moved around a lot,” he says. Texas was the last stop before the family moved back to Puerto Rico, where he finished high school; he decided to return to the Lone Star State for college.
As one of the few racial or ethnic minorities at Baylor University in Waco, a quiet West Texas town, he felt like an outlier. “It was 1986, and I may have been the only minority in the dorm,” he says. “Plus, the school was Southern Baptist, and I was a Roman Catholic boy. I was not a part of the whole, and that was a little unsettling.”
Ferreris excelled academically, earning pre-med honors. It was at Baylor that he met his future wife, and also came across the Minority Medical Education Program (MMEP, now SMDEP), which was accepting its first cohort of students under the auspices of the Robert Wood Johnson Foundation. Baylor College of Medicine, located in Houston, hosted one of the program’s inaugural sites.
“My wife is from Houston, and I was considering Baylor for medical school. So going there for MMEP seemed like a way to explore the city as well as the school,” he says. Classes were held in nearby Rice University’s lecture hall, which Ferreris recalls almost reverently. “It looked, felt, smelled like you might imagine a lecture hall at an Ivy League school would be.”
Describing that summer as “motivational” and very different from his undergrad experience, he remembers finally feeling like he belonged. “What was nice about the program was the exposure to lots of different kinds of people, from all types of ethnicities and ancestries.”
“Patients make you up your game. They expect better, so I have to do better.”
At MMEP, he also benefited from proximity to one of the most famous cardiothoracic surgeons in the world. “We had lunch one day with Dr. [Michael] DeBakey, who in many ways was the founder of cardiothoracic surgery. To have lunch with him, talk with him, was something I couldn’t have done anywhere else. It was awe-inspiring.”
By the time he left Houston, Ferreris had made a crucial discovery about his future. “Spending time in the neuroscience laboratory made me realize I couldn’t be in a lab,” he says. “Don’t get me wrong, they were great people—brilliant people! But the personal part of me yearned to have contact with patients.”
The die was cast: he would focus his training on pediatric primary care.
Reality Sets In
Still, Ferreris is troubled by the direction primary care, and medicine in general, has taken over the past decade, particularly with regard to costs. “Everybody is expected to do more with less, but the truth is that primary care was already doing that,” he asserts. “And now we have to do even more with even less.”
In his view, the imbalance places undue pressure on family physicians, whom he calls “the front line.” He says, “I think it affects quality of care in that its wears down those doctors, both physically and at an emotional level.”
Equally concerning is the decline in primary care practitioners. “When you ask students on the first day of medical school what they want to do after they finish, 30 to 40 percent of them say primary care,” he notes. “But check again after they’re done, and it’s less than 3 percent.”
Some of that attrition can be ascribed to faculty advisers who urge students to pursue more prestigious fields. But a large part of it, says Ferreris, is cost.
“You come out of medical school owing close to $200,000. You’ve been in college for a decade, you’re almost 30 years old, and you’re just starting your life. That $200,000 is the cost of a house, which you’re trying to buy. You need to replace your old car, you’re starting a family, and now you’re paying off your loans. Reality sets in. ‘How do I do this while working the crazy hours that primary care docs work, making only slightly more than a nurse practitioner makes?’”
Ferreris raises the dual dilemma facing young physicians from underserved communities.
“We want them to go back to those communities, because it makes more sense to deliver care in a way that is understood—culturally, linguistically—by the people being served. But how do you convince Juan Jose—if he’s an AOA grad and can be a specialist, work in a nice part of town, and make $700,000—to take on $200,000 worth of debt to become a family doctor in an underserved community? Is it right for us to push him to go back?”
“I think that’s why a lot of people don’t choose family medicine,” Ferreris concludes. “But in their defense, there are times when I think, ‘Gosh, it sure would have been nice to be that interventional cardiologist who makes a ton of money and drives a beautiful car and doesn’t have to work as many hours.’”
“But then a little kid comes running down the hallway to hug me and says, ‘Hey, Dr. Ferreris, how are you!’ And I think, ‘Never mind. This is why I’m here.’”