Rebecca A. Lubelczyk, MD, is a utilization review advisor physician for Massachusetts Partners in Correctional Healthcare in Westborough, MA, and associate clinical professor of family and community health at University of Massachusetts Medical School in Worcester. Lubelczyk received a bachelor’s degree in biochemistry from Vassar College (1992), and her MD from University of Massachusetts (1996). She completed a residency in general internal medicine at Brown University School of Medicine, Rhode Island Hospital (1996-1999), followed by a residency in post graduate year 2 and 3 at the outpatient community site at Rhode Island Department of Corrections (1997-1999). Dr. Lubelczyk also completed a general medicine fellowship at Brown University School of Medicine, Rhode Island Hospital (1999-2001).
Dr. Lubelczyk’s prior work experience includes medical director at MCI-Norfolk and Massachusetts Partners in Correctional Healthcare, associate program medical director at UMASS Correctional Health, assistant professor of family and community health at University of Massachusetts Medical School, medical director at Bay State Correctional Center and UMASS Correctional Health in Shrewsbury, and medical director at Bay State Correctional Center Correctional Medical Services in St. Louis. She sits on the Society of Correctional Physicians board of directors, and she has been published in multiple journals, including the Journal of Correctional Health Care, the Journal of Occupational Environmental Medicine, and the American Journal of Public Health.
When did you first decide to become a physician? Why?
My mother worked as a nurse, so I grew up with health care in the house. She always hoped I would become a doctor. When she was diagnosed with breast cancer before the age of 40, somehow I thought I could help her if I did become a physician. I really never considered anything else as a career.
How/why did you choose the medical school you attended?
I grew up in Massachusetts and we have a state medical school. I applied and interviewed at UMASS Medical, as well as several schools in Boston. I really felt comfortable at UMASS Medical during the interview and on the tour. I liked their primary care focus and the fact that if I worked in an underserved area for a period of time after graduation, they recognized that as payment for a majority of my school loan.
What surprised you the most about your medical studies/med school?
I realized that I hated hospitals. I had worked in an emergency room as a “runner” during my high school and college years and loved it, but as a physician, I hated inpatient care. I didn’t like getting to know my patients only when they were sick only to say goodbye to them when they got discharged. The cycle of admitting and discharging became boring and lacked challenge most of the time. I was equally surprised when I became a senior resident that I really liked to teach. I looked forward to teaching rounds and ended up doing a fellowship in primary care medicine.
Why did you decide to specialize in correctional health care?
During my second year of residency, I was invited to go to the state prison as my second clinic site by a colleague of mine that I didn’t know all that well (she wanted to start having residents rotate through the prison as an elective). I was reluctant at first, but I didn’t want to disappoint her and thought that after one year, I could bow out gracefully and do something different. I hadn’t been able to find a second clinic site that was interesting anyway and my primary clinic site was fraught with difficult patients with complicated social situations that I could never solve. I wanted a change…..a challenge, but where I could make a difference. I was slightly unnerved when I realized that I really, really enjoyed going to prison. I thought something had to be wrong with me. When I rationalized that it was okay, that there were positive aspects of working in the prison, I began to just accept the fact that I liked taking care of inmates. I didn’t want to tell my parents, as they aren’t terribly fond of the incarcerated population (like most of our neighbors and families), but they respected my decision and have supported me ever since.
If you had it to do all over again, would you still specialize in correctional health care? (Why or why not? What would you have done instead?)
I honestly don’t know what I would do if I didn’t work in corrections. I can’t imagine practicing anywhere else. Perhaps I would go into teaching. I did do some student interviewing teaching at UMASS Medical while I was on faculty, and I really enjoyed it. I think my students also enjoyed the small glimpse into the correctional medicine world as a unique environment that many don’t get to venture into and return home every night.
Has being a specialist in your field met your expectations? Why?
I wanted to be a good doctor. A really good doctor. I feel like I’ve been able to really understand correctional medicine as a specialty, allowing me to be a really good doctor for my patients. I do a lot of teaching with them about healthy behaviors even in an environment where they have lost a lot of independence and privileges. There are not a lot of individuals that my patients can find compassion in, living in a prison. It is a dark place sometimes, full of distrust. It takes a lot to earn their respect and their confidence. By trying to show that I care for them, at the same time being fair and mindful of the level of security I work in, I hope that I have been able to achieve some of their trust. Many of my non-correctional colleagues wonder if I feel safe. I remind them that many of my patients get released and go see them after release. Out there, they could be bringing anything to that appointment or ER. Where I am, I feel very safe. Many of my non-correctional colleagues wonder if I am constantly being manipulated or lied to for alternative motives. I remind them that many of our non-incarcerated patients come to our clinics for similar motives. At least in prison, I have the ability to verify their level of disability or pain, because of the higher level of monitoring for security purposes. I feel that I can take even better care of my patients who are incarcerated than I ever could on the street.
What do you like most about being a specialist in your field? Explain.
I can concentrate on my practice of medicine. I can worry about their diseases and not how are they going to afford that medicine, that specialist, that MRI. I can practice good medicine, really good medicine. My patients can focus on themselves a little bit more instead of the stressors of their life situations back home. That stress may be there, but they are no longer buried under it. They no longer have to find child care to come to their appointments, or take the bus, or pay for parking. I work in their home, essentially. I come to them. My “no-show” rate is nearly zero and I quickly hear if they refused a test or an appointment. Their blood pressures, blood sugars, are all taken by licensed nurses. I don’t have to wonder if the numbers are real or not, no longer slightly altered by a patient who doesn’t want to go on insulin quite yet. I get good reliable information about my patients, helping me to tailor their care.
What do you like least about being a specialist in your field? Explain.
There are headaches of the job that you don’t lea
rn about in medical school. The culture is one of survival in a world of uniformity and routines. Anything that differentiates one from another is coveted. Patients seek items of identity and comfort that aren’t really all medically related. Requests for better mattresses, better blankets, better pillows, better shoes, bottom bunks can take up some time that could be spent managing someone’s HIV or Hep C or diabetes or cancer. Legal issues can be annoying too. Unfortunately when a patient disagrees with your management of their care, it is not uncommon for them to file a grievance, complaint or suit. I don’t think it is good medicine to make everyone happy for the sake of making them happy, but I document what I chose to do and not do with sound medical rational and it has served me well so far.
What was it like finding a job in your field–what were your options and why did you decide what you did?
Finding a job was really easy. I called up the statewide medical director and got an interview. This was my first job out of residency and fellowship, and I’ve been here over 12 years. I wanted to work part time and have been able to up until about a month ago. Most prison and jail systems have opportunities for full and part time physician employment. Most of us didn’t go to medical school thinking that they want to become a prison doctor. Most of us didn’t even know that physicians worked in correctional facilities. I am pleased to say that really good doctors work with the incarcerated population, not because they have to but because we want to. I have been able to host medical students in the prison as a preceptor to try to get more potential doctors exposed to correctional medicine.
Describe a typical day at work–walk me through a day in your shoes.
In the morning, I make sure that my attire is professional and not inappropriate to work in a men’s prison facility. I pack my lunch and make sure there is no metal or glass in my containers. I arrive at outer control to get my set of keys that open the doors/gates of the medical department, and I go through security to make sure I’m not bringing in anything I’m not supposed to. I check in with my nurses to see if there were any events overnight (ER send outs, patients that require an urgent follow that morning), pick up my paperwork (labs, ekgs, consults) from my box and go to the exam room to start my morning line of patients. The patients arrive on their own (it is a medium security facility), not escorted by officers, and sit in a holding cell until I am ready for them. I see about four acute visits an hour; I get 30 minutes if it is a physical or a chronic disease visit. Between 11 a.m. and noon, we stop clinic for a major count (where all the inmates go back to their cells to literally be counted to make sure everyone is where they should be) and start an afternoon line around 1 p.m. I use lunch and time after my last patient to chart, review labs, consults, etc. I bring no charts home because they are property of the Department of Correction and they need to stay at the prison. Sometimes unexpected events happen like a fight, a fire drill, a medical emergency and the normal operations have to be put on hold until the disturbance is identified, stabilized and everyone is safe and accounted for. One has to be a little flexible since you never know what may happen in the course of a day.
On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?
I worked between 24 to 28 hours when I was part time. I recently accepted a 32-hr position that is now mixed between clinical and administrative. I get about eight hours of sleep at night if I am not on call. After 5 p.m. Monday through Friday, all day Saturday/Sunday and holidays, my pager is off unless I am on call. The physicians and advanced practitioners take call for the state of Massachusetts prison system (about 10,500 inmates) for overnights, weekends, and holidays. Call is three to four times a month, usually shared with an advanced practitioner who takes the first line of calls. When I am on with an AP, I rarely get called as they are very skilled and competent. The advanced practitioner calls for questions or support on a clinical issue if they need it. When I am on call by myself, it can get busy with about a call every hour on average, two to three overnight hours. I have had the fortunate night when I had no calls after 11 p.m. As a full-time physician, my benefits package gives us four weeks of vacation, as well as time for CME education. I take as much as I need and save the extra for unexpected leaves of absences.
Do you feel that you are adequately compensated? Why or why not?
I feel adequately compensated. My understanding is that we have a good pay scale if looking at what family physicians make, and about equivocal for internists. We round on weekends at certain facilities that require 7-day provider staffing, which gets paid at an hourly rate.
If you took out educational loans, is/was paying them back a financial strain? Please explain.
Fortunately, the prison population is designated an underserved population in Massachusetts and I was able to pay back the majority of my promissory note to the medical school with my service. I did have some student loans that I was able to pay off without too much difficulty, thanks to the reasonable tuition at the state medical school.
In your position now, knowing what you do – what would you say to yourself when you were beginning your medical career?
I would tell myself that I received an excellent education, great training, and I have a real skill in communicating with patients which serves me well in helping them understand what they need to do to keep themselves healthy and what responsibilities I have to them to help them keep healthy. I would acknowledge that I have good instinct of when to accept opportunities that will improve me professionally, and likewise to politely decline opportunities that I recognize may not be in my best interest in the long run. Correctional medicine has opened many doors for me as it is a small field that a talented physician can excel in. I feel very fortunate to have had the opportunity to teach medical students, work on projects to improve the health care of our inmate population, become the president of the Society of Correctional Physicians, and be seen as an expert in correctional health care.
What information/advice do you wish you had known when you were beginning medical school?
I wish I had known that you don’t have to have a private clinic or be a hospitalist to be successful as a physician. There are so many careers one can have with a medical degree. I am very lucky I happened to find the right fit for me, almost by accident. When I talk with many of my colleagues, they also note that they found correctional medicine “by accident.” I’d like to change that. I’d like to have medical students begin to see correctional medicine as a viable career choice.
From your perspective, what is the biggest problem in health care today?
The non-incarcerated U.S. population is one of entitlement and instantaneous results, I fear. Patients would rather take a pill to make something go away than to work at it with diet, exercise, physical therapy, etc. Physicians have drifted away from practicing what is evidence-based and prescribe more of what will make the patient happy when they leave the office. We use too many antibiotics, order too many MRIs, do too many surgeries, and prescribe too many narcotics, when a more conservative approach may be the best medicine. Unfortunately, it is a hard conversation to have with a patient when you have to tell them that you aren’t going to do those things because that is probably not what will help them the most. I have learned through correctional medicine how to use my resources wisely and not order unnecessary tests or medications just to make someone happy. Correctional medicine has challenged me to continually practice the best, evidence-based medicine and I think our healthcare system would be greatly improved if it followed some of the practices of our correctional systems.
Where do you seecorrectional health care in five to 10 years?
I am working with national organizations whose goal is to make correctional medicine a recognized specialty by the ACGME. It is currently recognized by the AOA. A correctional certification exam for DOs has been developed and its first sitting will take place within the next year. I see the ACGME adopting the exam (or something similar) to provider certification for its MDs. There are only a handful of correctional medicine fellowships at this time, but I see this number growing as correctional medicine becomes increasingly more accepted as a profession through specialty recognition and certification programs. I see correctional medicine becoming an elective choice in more medical school curriculums.
What types of outreach/volunteer work do you do, if any?
I am a volunteer faculty member for the Department of Family and Community Medicine at UMASS Medical, currently acting as co-faculty advisor for a student-run elective on correctional healthcare. I am the current president of the Society of Correctional Physicians and serve on the clinical guidelines committee for the National Commission on Correctional Healthcare. I am a cubmaster for a local cub scout pack, a volunteer parent for a local Boy Scout troop, the Lego Club coordinator for an elementary school, and volunteer at the local historical society.
Do you have family? Do you have enough time to spend with them? How do you balance work and life outside of work?
I do have a family and feel that working part time in corrections gave me the financial ability to spend a good deal of time with them. I have been able to participate in their activities, help them with homework, and take them to places to learn and explore. I feel like I have achieved an excellent balance between home and work and am very fortunate to have done so.
What is your final piece of advice for students interested in pursuing a career in your field?
Don’t be intimidated by the razor wire, the high fences, and the locked gates. Behind those barriers lies a tough but vulnerable population that needs our help. They may have been abused, they might have mental health disorders, but they did something that they shouldn’t have done. They are already being punished for their crime –ignorance of their medical conditions is not part of their sentence. Taking care of this population can be challenging, but is very fulfilling, and as many of these patients will return to our communities, we are improving the general public health for all of us.
Juliet Farmer is a writer with over 19 years of experience in various industries and a contributor to numerous consumer and trade publications and websites.