From the Midwest to Africa, Arizona, and Oregon: Family Medicine for Nearly a 40-Year Career

As we recognize the critical role that female doctors serve in the world, we turn to the start of one career that began with a van, six medical school students and a trip to Philadelphia. "We borrowed the van from one of my classmate's family members," says Dr. Nancy Elder, who graduated in 1983 from the University of Minnesota Medical School, Duluth Campus. 

"We were going to attend the national AMSA meeting. We stopped in New York City on the way, and since we were poor medical students, we stayed in a dicey part of Manhattan. Somehow, we jammed the six of us into one hotel room, but we had a great time,” Dr. Elder says.I do not remember much about the AMSA meeting, but the trip surrounding it, the people we met and the adventures we shared – they were quite memorable."

Dr. Elder has had several clinical and academic medicine positions in her almost 40-year career, but it all began at the Medical School, Duluth Campus. Dr. Elder recalls an impactful event when she was a student on a three-day preceptorship in Hibbing. The full spectrum of medicine deepened the horizon of her learning in the most profound of ways, "The morning started with a code blue while rounding in the hospital," she says. 

"A patient coded in the ED, and I participated in the unsuccessful attempt to revive her. This was the first person I had seen die in front of me. My preceptor was caring and understanding and went out of his way to sit and talk with me while I tearfully processed what had happened," explained Dr. Elder. Afterward, Dr. Elder continued to see patients as she accompanied her preceptor at the clinic. 

"Later that afternoon, we were called back to the hospital for a delivery. The preceptor let me do the delivery. It was quick and uncomplicated, so I basically just caught the baby. But the emotional high? It was unbelievable,” states Dr. Elder. “I was seeing a new life come into the world. I still remember the baby's name. To me, that day encapsulated all of family medicine. The extremes of life and death with all the in-betweens that define this profession."

After Dr. Elder completed her Family Medicine Residency in Phoenix, AZ, she spent two and a half years as a doctor at the south rim of the Grand Canyon. She then spent a year in Africa in Lesotho as a family physician. "I did everything from delivering babies and doing C-sections to outpatient medicine and care of hospitalized patients as well as traveling to remote villages to work with health nurses," Dr. Elder says. 

Following these experiences, she spent two years completing an Academic Family Medicine Fellowship at the University of Missouri-Columbia, where she developed educational and teaching skills and competence in research and public health while continuing to practice family medicine.

While the platform of her experience continued to deepen and widen like tree roots near a river, Dr. Elder spent seven years as a faculty member in the Department of Family Medicine at Oregon Health & Science University (OHSU) where she helped lead the family medicine clerkship. "I was also full scope family medicine at that time," she adds. "Including outpatient, inpatient, OB and precepting residents. I also co-founded a new primary care clinic for OHSU in a disadvantaged part of town while dabbling in a bit of research."

Around this point in her career, Dr. Elder’s primary focus was transitioning to being a mom and caring for her two children while staying connected to family medicine as a part-time urgent care doctor. 

"I then spent 18 years as a faculty member in the Department of Family and Community Medicine at the University of Cincinnati (UC). I led the research division for over eight years, focusing on practice-based research, did OB for about five years, then moved to a Healthcare for the Homeless FQHC where I practiced for almost 15 years, serving as Chief Medical Officer for several years," Dr. Elder says.

After "retiring" from UC in 2018, she moved back to Oregon and took a new position directing the Oregon Rural Practice-based Research Network (ORPRN) at OHSU. "I lead a successful, statewide practice-based research network (PBRN) that works with over 400 primary care practices across the state. We have over 50 faculty and staff, and we do research, and education primarily through the telementoring Project ECHO platform, practice facilitation and assist practices with improvement and transformation," explains Dr. Elder.

Dr. Elder recounts how ORPRN navigated that seismic shift that occurred in 2020 with the start of the COVID-19 pandemic. "We moved from being a research network that thrived on working with, and in, primary care practices to an entirely virtual workplace in just a few weeks," she says. "When Covid hit, we had not only to find out how to re-vamp dozens of funded research and improvement projects, but we also had to find a way to help the practices in our state as they tried to figure out how to care for patients." 

Dr. Elder collaborated in efforts to help primary care weather the pandemic. "One thing we did, of which I am quite proud, was create and start a COVID ECHO for Frontline Clinicians, which began in March 2020,” Dr. Elder shares. “We built on 20 years of relationships with practices and with the Oregon Health Authority to quickly create a telementoring program to educate and support primary care and other frontline clinicians who were overwhelmed by COVID and the rapid changes occurring in primary care. Over 750 clinicians joined our first session, and we continued the program for an entire year."

The results of the ECHO telementoring program are discussed at length with Dr. Elder as a key author in the following publications: 

Dr. Elder and her colleagues also recognized that the country, and healthcare system, we're going through many nuanced and profound changes. "There was social unrest and calls for justice," she says. "These impacted our work, stirring us to move quickly and purposefully towards our goals of increased diversity and inclusion and health equity across our state."

Throughout her professional experiences, Dr. Elder has maintained a steadfast belief in the value of family medicine. "While I am now in the glide to retirement," says Dr. Elder.. "I remain convinced, now more than ever, that Family Medicine is the backbone of all health care. It is the key to better health outcomes and increased health equity. It has been my privilege to be a Family Physician for almost 40 years."

 

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