My Kind of Medicine: Real Lives of Practicing Internists: Alex Foxman, MD.
Dr. Alex Foxman is not one for sitting around waiting for things to happen. For example, he opted to attend medical school at the American University of the Caribbean instead of waiting for admittance to one of the more crowded U.S. schools because he “wanted to move ahead.” His idea of a “hobby” is launching a business. In an interview, he answers all of your questions before you have the chance to ask them, and on the subject of internal medicine—its strengths, its challenges, its future—he is equally tireless. His progressive viewpoint is energizing; while some may furrow their brows or wring their hands over the future of the profession, Dr. Foxman paints a brighter picture, one filled with promise. His view of internal medicine ten years down the road is more than optimistic—it’s exciting, and the best part about it is that you don’t need rose-colored glasses to see it.
Supply and Demand
According to U.S. Department of Labor, the need for internists and family practitioners who care for all of a patient’s needs is growing. The 2006-2007 Occupational Handbook published by the U.S. Bureau of Labor Statistics projects that the employment of physicians will grow faster than average through 2014. Dr. Foxman explains that given the trend over the last several years of medical students flooding other specialties, he feels it is inevitable for the pendulum to swing back in the other direction.
“The issue of compensation has been guiding a lot of people in their decision to not pursue internal medicine,” he says, “but what is happening is that some of these other specialties are getting saturated, and when that happens, the demand goes down, and then the pay goes down. It’s happening right now in anesthesiology.” He believes the downward trend in internal medicine is beginning to reverse, and not just for the short term, but for good. “There is a lot more attention focused now on primary care than there has been in a long time,” he explains. “We are in the front lines of the future of medicine.”
Being in the front line of medicine is one of the reasons why Dr. Foxman loves being an internist. He says being limited to one small area of medicine would bore him. “One of the benefits of internal medicine is the range of work. I’m comfortable doing everything from a biopsy to a knee injection. The work is intriguing and interesting.” Another central belief of Dr. Foxman’s is the importance of doing things yourself. This conviction goes hand-in-hand with his role as an internist. “I’m not a gatekeeper,” he says, “I rarely consult out. Because of my training I can handle 90% of patients on my own.”
For medical students searching for their special niche, he says residency is the key time for decision making. “Residencies and rotations are good because they give you the opportunity to see what something is really like. I believe you cannot make that decision until you actually work in a field. I made my decision during my residency. For me, I love being around people and I want to have long term relationships with my patients. I wouldn’t enjoy performing a procedure never seeing the patient again to see how it turned out or how the patient is doing.”
A Worldly View
For medical school, Dr. Foxman journeyed to the Caribbean for his core studies, then to England for his electives, and finally to California for his selectives. He was then accepted into the internal medicine residency program at the University of Southern California Medical Center in Los Angeles. Working in the English health care system required him to adopt a different approach to patient care, one centered more on clinical evaluation and skills and less on testing. It would become his blueprint for patient care. Dr. Foxman explains that in the U.K., where resources are fewer than in the U.S., physicians rely more heavily on evaluating and examining the patient. For him, it is the only way to practice medicine, the opposite of what he calls the “shock and approach” system currently used in the U.S.
“In England, any time they order a test they ask themselves, ‘Why am I doing this?’” he says. “One of the biggest issues in medicine right now is the cost of services. I’m willing to bet there are more CT scanners in the city of Los Angeles than there are in the entire country of Britain. As a resident, I was taught to rely on my education and training. It’s something I’ve carried with me throughout my career.”
Dr. Foxman finished his residency at the University of Southern California Medical Center, a Level 1 trauma center with a very busy ER. What he experienced there fueled his passion for prevention, a common thread of everything he stands for today. Much of his job working at the trauma center involved treating patients with advanced chronic conditions, and it was a sobering experience for the young doctor.
“I saw the worst of the worst,” he said, “the advanced diseases I treated and witnessed were mostly due to a prolonged period of either undiagnosed or poorly managed co-morbid conditions. These were people who had suffered large strokes, had advanced cancers and renal failure, who were blind … I would say 95% of these conditions could have been prevented or significantly delayed if preventive health care and screening were utilized.” It was an experience which resonates throughout his career and shapes his decisions.
When it was time to begin his professional career as a practicing internist, he decided to open a practice near the Russian housing projects in L.A. While it may have been an overly ambitious choice for some, for Dr. Foxman is made perfect sense. Of Russian Jewish decent, he spoke fluent Russian, and because of his most recent experience as a resident, he did not shy away from heavily populated urban areas with high demand.
Of course, no matter how many things you have going for you, a new practice doesn’t build itself. As he puts it, “medicine is a business too, and you can’t run a business by sitting around waiting for patients.” So the determined Dr. Foxman built his business by marketing himself within the community—giving educational presentations, running various projects and establishing a reputation for himself through word of mouth referrals. Once again his industriousness paid off. When he started out, he had three patients; today after moving the practice to Beverly Hills, adding a partner and expanding services, he has over 2,000.
Like most people who are fiercely passionate about what they do, there is not much about Dr. Foxman that can’t be traced back to his main goal: making preventive medicine a permanent part of health care. When you ask him what he does in his spare time, he talks about his involvement with several health care businesses. One business he is particularly interested in is an outpatient care facility for seniors. The program, which offers a wide range of preventive services, from nursing support to social work services to exercise programs, is centered on the goal of keeping seniors out of nursing homes for as long as possible. It encourages active patient involvement and a better quality of life for seniors. It also mirrors Dr. Foxman’s beliefs about what the health care system should look like and how it should operate, down to the last detail. “I firmly believe that aggressive preventive care can be the savior to the United States health system,” he says. For this doctor, there is little time to waste.
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