New-In-Practice Family Practice, Anaesthesia and Palliative Care – University of Alberta – University of Calgary
My name is Alex Kmet and I specialize in Family Practice, Anaesthesia and Palliative Care Medicine in Whitehorse, Yukon. While my family moved regularly growing up, I’m originally from rural northern Alberta.
I completed Rural Family Medicine in 2013 at the University of Alberta, Family Practice Anaesthesia at the University of Calgary in 2014 and finished my Palliative Care Medicine at the University of Alberta in 2018.
I’d previously obtained my Bachelor of Medical Science from the University of Alberta in 2010. I completed four years of general Undergraduate Studies at the University of Alberta; my interests were so varied I didn’t have enough credits in a single discipline to qualify for a degree prior to starting medical school.
Why I chose Family Practice, Anaesthesia and Palliative Care Medicine and this location.
My scientific brain loves physiology and pharmacology, as well as the challenge of restoring health in the face of disease, and I find that satisfaction in my Anaesthesia practice. I’ve been fortunate to work with the independent humanitarian organization Médecins Sans Frontières in locations including Iraq and Central African Republic to provide emergency Anaesthesia services to people affected by war and neglect.
I chose medicine as a profession to be with people and hear their stories. Emphasizing personhood and dignity in the face of illness is the greatest responsibility of our profession.
Regardless of disease state, palliative medicine allows me to alleviate suffering, connect with people and their loved ones, and bear witness to the human condition. I love a quote I once read on a forum, and I’ve carried it with me ever since:
“…[I]n my mind, being a good physician has everything to do with being willing and able to sit and be truly present with patients and families during pivotal life transitions. Sure, we try to put out fires. But, if we can’t put out the fire, a good physician takes the patient’s hand and walks with him through the flames”
(ForamenMagnumPI, Student Doctor Network Forum; Sept 10, 2010).
Regarding location; Yukon is home to an incredibly diverse landscape and a beautiful mix of very special people. There is a calling to the North that cannot be explained unless you’ve been, and it’s reflected in those who live here.
Yukon is a territory of 35,000 people, providing full-spectrum care across cultures and vast territory is exciting I feel like I’m caring for the community than I do individual patients.
What does a typical day of clinical duties involve?
How did your residency program prepare you for practice?
Each residency program prepared me well enough for the scopes of practice I was expected to provide. Rotations in non-academic community hospitals – with community specialists and generalists – were crucial to building the skills needed to practice in a rural and remote location.
I was not given any significant practice management training and would say that was a gap in my program at the time. Luckily, I ended up with incredible colleagues who have been wonderful mentors.
Did you seek any resources outside of your residency training to help you prepare for practice?
I actually never thought about it and didn’t know of any resources. That may have been nice to know about.
Can you describe the transition from residency to practice?
I had no way of knowing the depth of responsibility that our profession bears for our patients until I was on my own.
The removal of a Senior who is always directly responsible can feel like a loss of security, and the weight of responsibility can feel overwhelming. I didn’t understand all the paperwork, follow-ups, and results that my attendings were taking care of behind the scenes. These significantly add to your day if you haven’t planned for it somewhere in your schedule.
Start with less work than you think you want to do and be deliberate and thoughtful about adding more. There will be no shortage of people asking or expecting you to do more work; regardless of how hard you work, people will always ask for more.
Set limits early and expand them slowly based on comfort and balance with personal life. Seek mentors and colleagues you can trust for support in the transition and nurture those relationships as you will need them for the times when you have unfortunate patient outcomes.
What are the best aspects of being in practice?
Having the ability to decide where and how and how much I get to work. Being your own boss is amazing.
What are the most challenging aspects of being in practice?
The unexpected sickness that can happen to a patient at times when you also have personal life commitments (ex. The really sick patient in clinic at the end of a day on Friday) can be difficult to balance.
Maintaining a balance between personal and professional life (especially in a small location) can be difficult; It’s hard not to see patients every time I go to the grocery store.
What is one question you’re often asked about being in practice?
“How do you manage doing both palliative care and Anaesthesia? They seem so opposite!”
I find them to be quite complementary, and I appreciate how the diverse nature of each specialty provides perspective for the other. The balance of life and death is made so much clearer by juxtaposing two very diverse fields of practice, and I think each one has transferrable skills that benefit the other. Also, I would get really bored doing the same thing.
Is there anything you would do differently in residency now that you are in practice?
Study less and play more. There is not enough study time that will prepare you for everything that you will need to know in practice, especially as a generalist. Solidify the basics and focus on a broad foundational knowledge base and fill in the specifics over time. Missing out on family and personal time is something you can never get back. When you are at work, devote yourself to devouring every scrap of knowledge and seeing every patient possible. The crux of this balance is that medicine is a game of volume if you want to be good: your mind must be uncluttered if you want to take it all in.
What are your colleagues like and how do you interact with each other?
I feel very honoured to work with such collegial and skilled colleagues. Rural medicine attracts like-minded people and I find that our medical community is very supportive. Working with people who are also genuine friends is awesome.
How do you achieve your CME hours (i.e. do you go to conferences, read journals, etc.)?
I attend one Anaesthesia and one palliative care conference per year. I read one family medicine, one Anaesthesia, and one palliative journal each month. Additionally, our hospital organizes a different CME session every Thursday over lunch.
What are your academic interests (e.g. leadership activities, research)?
I’m currently involved in a nation-wide palliative care research study and am involved in advocacy work for enhancing palliative care services in the territory. I also participate in some administrative hospital duties, like being part of the Clinical Ethics Committee.
What is your work-balance life like and how do you achieve this?
I make it my goal, except when on call for Anaesthesia services at the hospital, to be home in the early evening and am almost always successful so that I am able to spend time with my wife. I am lucky to be able to take 8-12 weeks of the year as vacation without too much hassle and we travel outside of Canada frequently together (we just finished a 3-week campervan trip through the southwest USA in October, and we are planning to spend the New Year in Peru). We play weekly Trivia every Wednesday night at a local dive bar and focus on maintaining close friendships over board game nights and dinners.
I really enjoy great craft beer and I love running (my wife says that I’m like a Husky in that I go crazy if I don’t get enough exercise). I run 5 days a week, usually before work starts in the early morning, and when the weather is nice (or just so long as it’s not too icy in the winter), I will often run the 10km to work at the hospital and then run home afterwards.
Are there any major differences in your non-clinical life now compared to residency?
I spend more time focused on non-medicine related things now in my personal life than I did before. I have more non-medical friends and we share more non-medical interests and I spend less time thinking about work when at home than I did before, which is so incredibly refreshing.