Dr. Laura Fralich, MD: Sports Medicine Physician

Join me and Dr. Laura Fralich, a double-board-certified Family Medicine and Sports Medicine physician who currently runs her own private practice out of Spokane, Washington! Dr. Fralich and I discuss what drove her to sports medicine, her non-traditional medical school path, and what makes a great physician.  

Transcript

SPEAKER_00 0:01

Thanks for listening to In Practice: Becoming a Doctor, One Conversation at a Time, where we talk with different physicians at different stages in their careers about all things specialty, day-to-day life, and the choices we make on this journey. Welcome back, everyone, to another episode of In Practice. And I have another wonderful special guest with me today, Dr. Laura Frolic. Forgive me if I'm pronouncing that incorrectly. But I am super excited because Dr. Laura is a sports medicine specialist, and we are yet to talk to a sports medicine specialist on the podcast. So yeah, if you would like to introduce yourself and you know what you're doing now, and then we can get into what you did before and why.

SPEAKER_01 0:45

You bet. Thank you for having me, Mia. My name is Dr. Laura Frelick. I'm a sports medicine physician. And I actually own my own practice. I was in large healthcare systems for about a decade as an employed physician. And about two years ago, I elected to open my own uh private practice. It's a direct specialty practice, so really don't take uh any form of insurance. We're not contracted with any insurance company, so we're considered out of network. Um, I do take uh labor and industry, so Washington State L and I, just because I have a heart for those folks. They deserve they deserve access to high quality care in a reasonable period of time. So um, so that's what I do. I also have a uh podcast called What's Right with Healthcare, and um doing a little bit of speaking as well on podcasts and stages. So um yeah, uh I'm very, very busy learning how to be a physician entrepreneur, yeah, which is kind of like being an intern uh all over again.

SPEAKER_00 1:52

I'm sure.

SPEAKER_01 1:53

It's a lot of work, but it's fun.

SPEAKER_00 1:55

Yeah, that's great. Yeah, everyone should go give a listen to uh Laura's podcast as well. Thank you. Um how did you decide on sports medicine? Because I know that you're actually also a family medicine board certified physician. So I'm wondering if one of those came first, if you knew you wanted to do both at the same time.

SPEAKER_01 2:17

Yeah, that's a great question. I think everybody has their own reasons for going into the specialty that they go into. I was not planning on going into family medicine. I was thinking either orthopedics or ER medicine. And through some life circumstances that I didn't have a lot of control over, I ended up uh needing to stay in Spokane, where I was from after med school, and um did family medicine here because they had that residency and uh heard a sports medicine physician talk at one of the uh Thursday teachings at the residency while I was a med student doing a rotation. And I joke that I don't think I blinked the entire time he spoke because I was completely mesmerized and enamored with the stories he was telling about being a team physician and uh getting to practice musculoskeletal medicine, but also getting to treat uh dermatologic conditions in athletes and sports performance issues and dealing with mental health issues with athletes and just the gamut of being able to take care of the entire athlete, the entire patient. And so for me, it was more about um getting to be a part of that as opposed to uh just fixing bones and tendons and ligaments when they are injured, such as our wonderful orthopedic surgery call surgeon colleagues. So for me, I just like that full spectrum, but with that slant in sports medicine. So I did a family medicine residency and then did my sports medicine fellowship at the University of Massachusetts. Um, in the meantime, I still had that ER itch. And so I moonlighted my third, I think my second year, definitely my third year of residency in a small rural hospital, a couple of hours outside our our major city, Spokane. And um, and I did that for about six years, uh, moonlighting and then as a locums physician, and absolutely loved it. And it kind of gave me a good foundation for uh being a team physician. And so I was a team physician for um uh Western Hockey League team, the Spokane Chiefs Hockey Club here in town for a few years as well. So um I'm a team physician at Gonzaga Prep High School as well, which I love and um have supported a lot of our local high schools. So as a former athlete, I played Division I college basketball.

SPEAKER_00 4:51

Um yeah, that was my next question.

SPEAKER_01 4:54

Yeah, it kind of kind of filled a lot of different uh voids for me that I was looking for while practicing medicine.

SPEAKER_00 5:04

That's awesome. That's super cool. Um, so tactical question before I ask more about your experience. Sports medicine is not its own residency. You have to do a family medicine residency, and then the sports medicine would be a fellowship that you would do.

SPEAKER_01 5:20

That's correct, but you don't have to do family medicine. Um the sports medicine fellowship is usually one year. There are some programs out there that are two years, and I think that has more of a uh research slant to it, that second year. I just did a one-year fellowship, and you can have a background or do a residency in family medicine, internal medicine, PM and R, so physical medicine and rehab, pediatrics. Um, I believe there's even like a med peds. So any of those, you know, uh kind of foundational residencies need to be done first, and then you're eligible to do a sports medicine fellowship.

SPEAKER_00 6:12

That makes sense.

SPEAKER_01 6:13

How is sports medicine different from PM and R so typically sports medicine focuses on everything but does very little with the spine.

SPEAKER_00 6:30

Okay, okay.

SPEAKER_01 6:31

And so spinal cord injuries, as you can imagine, is its own very complex uh beast. And thank God for our PM and R folks because they do such a good job of helping those patients and they also deal with uh uh catastrophic or or traumatic brain injuries. And so while sports medicine uh fellowships can focus on concussion, and we certainly take care of people with concussions, physical medicine and rehab uh really knows how to take care of people with spinal cord injuries, and so like I don't know how to do spinal injections. We leave that to them, and they're very, very good at it, thank goodness. Uh and so yeah, there are just some nuances there that uh we just don't touch on very much, and so therefore we're not very good at. And um, but there's certainly a lot of crossover between PM and R and uh sports medicine, uh, whether you do family or internal medicine or what have you.

SPEAKER_00 7:45

Yeah. I'm just yeah, I'm just thinking sort of about why someone might do like do sort of your path of like family or internal medicine to sports medicine fellowship versus just a PM and R residency versus like orthopedics. And of course, orthopedics, I think, can have like you could do orthopedic surgery, so that's like sort of its own thing. But I wonder if you could you could like talk a little bit about why someone might go one versus the other versus the next, like what you would think about.

SPEAKER_01 8:11

I I can only speak to my experience. I just know that I started down the orthopedic surgery pathway. And I went into medicine when I was a little bit older. I'd had a few other careers before I went into medical school. And so for me, the that grind and lifestyle just did not fit with my my long-term goals personally and let alone professionally. I just I wanted to take care of the whole athlete and be able to treat, like I said earlier, a dermatologic condition or um work with them on how they can uh optimize their sleep hydration and nutrition. And I like working with athletic trainers and being part of a team. So I think from my experience in orthopedics, uh they're there to fix the bone, tendon, or ligament that gets injured, and then that's it. And so um certainly that's not the case uh for every orthopedic surgeon, but I think for me, I just wanted to be able to have a strong skill set where I knew how to take care of the whole athlete from emergent to non-emergent issues.

SPEAKER_00 9:31

That that makes total sense. And I hear that from like family medicine doctors and residents that I've talked to and like internal medicine, also, you know, the the res the fellowships and the specialties, and then just the the regular, you know, PCPs and stuff that the things that start with those foundational residencies, that's that's what I hear from a lot of people is like I just I wanted to be able to be with the whole person, take care of the whole person. Um, I think you also get a little bit more connection sometimes with patients because you're dealing with like a lot of different layers of of what they're experiencing. So it's very cool. Um, and it's given me a lot to think about actually personally, because I'm very interested in in like the brain and behavior, neurology, psychiatry. But I've wondered if I want to quote unquote narrow into that or if I would consider doing a more foundational, which I really like actually that word, foundational specialty. So I don't know, it's it's given me some things to think about. Um, but yeah, it's a very common thing. And I think it's a very noble is the wrong word, but like thoughtful and important role to have.

SPEAKER_01 10:39

Um I think if if if people are interested in taking care of the whole person and having to know a lot about a lot, I don't like the adage that you have to know a little about everything. I think primary care sports medicine, you have to know a lot about a lot. Yeah. And so I, you know, I have patients who are type one diabetics and they play football.

SPEAKER_00 11:03

Yeah.

SPEAKER_01 11:04

Uh I have uh 18-year-old freshman college runners, females who have stress fractures. I have uh rowers who have asthma. I deal with master's athletes who like to play pickleball and have patellar tendinitis. I have patients who are mid-season in the basketball uh in their basketball season and have Achilles tendinitis or elbow issues. And we have to figure out how to keep those people on the court or on the field safely. Right. Um, because I've always said that athletes have a finite amount of time to have a great experience, particularly at the high school and college level. They can't wait six weeks to be seen by somebody, and then nobody, especially those folks, want to be told you're you're gonna have to rest, you just need to stop playing. Like that's just that's a death sentence for a lot of them. Yeah, they shut down. So we have to get very creative in sports medicine with our patients. And it really starts with having a relationship where they know, like, and trust us. And we have to work together uh as a team with their athletic trainers, with their coaching staff, with their strength and conditioning coach. A lot of these teams now have nutritionists or dietitians on staff. So the really cool part about sports medicine is oftentimes it's a very collaborative effort, especially if you're a team physician, which I love doing.

SPEAKER_00 12:43

That's amazing. I'm curious. Um, you briefly mentioned you had other careers before medical school. I'd love to hear. Um, I I wonder if you would consider yourself a non-traditional applicant um or not. Um, and then like what you what you were doing before med school.

SPEAKER_01 13:03

So I would say when I applied to med school 20 years ago, I was very non-traditional. I was, I think I was 28 years old. Okay. Yeah. And I knew that I always wanted to go to medical school, but once you go to med school, you're kind of committed. I joke that it's kind of like getting a tattoo on your face. Like you're in it, you're in it for the long haul. Like there's no turning back. And I knew that I wanted to do some other things before I committed to that. And so I was uh I got a master's degree in teaching, and so I was a high school math and science teacher for a while and a basketball coach. And I enjoyed that, but also knew that uh I always wanted to go to med school. So that was always on the uh in the back of my mind. Um, I worked at a lab, a pathology lab here locally for a few years, and that was really invaluable. I learned about uh, you know, hepatitis testing. And so I felt like while my my med medical school classmates and even in residency were kind of struggling to understand do I get a hepatitis antibody, hepatitis surface antigen? Like, what do I order? I knew that stuff because I had seen it in the pathology lab, which was so cool. Um, I knew that a B12 and folate had to be kept frozen, so I couldn't draw that lab and then let it sit. Um, so those types of intangible experiences, I think, helped me uh thrive in medical school and residency.

SPEAKER_00 14:42

Yeah.

SPEAKER_01 14:43

Gave me an advantage for sure. So worked in the lab, uh, taught for a bit, and then I was also a firefighter. So I was a hotshot uh firefighter out of Montana and then for one of the county fire departments and provided a lot of medical care. About 80% of our calls were medical, but certainly we had our share of uh wildland fire structure fires, urban interface type stuff. We just had a massive fire here in Spokane uh that was really, really, really devastating. And um thank goodness for the evolution of fire science and the people that uh do that job. But yeah, it uh reminded me how much I love doing that. I I'm a little too old for that now, but um it definitely tugged at me. I wanted to go out there and be on the fire line with those folks. Um, so yeah, I had a few other careers before I went into medicine and then finally decided I'm not getting any younger, I better do this.

SPEAKER_00 15:42

Yeah, that is super cool. Um, and I can actually, I can only imagine, you know, now it's super common for everyone to take at least one year at a minimum. But I can only imagine, you know, 15, 20, even 10 years ago, it wasn't most people just went straight through, and that was sort of the idea. I actually remember talking to a lab PI from a couple of years ago from like a summer internship, and she had been an advisor on a med school committee like 25 years ago. And she was like, Oh, I don't think you should take more than one gap year. I don't think it's a good idea. And I was kind of, I left that meeting, I was kind of like, that's sort of outdated advice, but I knew I knew where she was coming from because you know, at that time, 10, 15, 20 years ago, it didn't look good almost if you if you took more than a gap year. It it looked to medical schools like you weren't sure or something. So I actually find it really cool that you were like, no, I I have these other things I want to experience, and just you just went for it. Of course, now that would be like not not still not the norm, but reheared and admired. Um, but that's super cool that you did it when it wasn't.

SPEAKER_01 16:49

Yeah, I think you're right. That's the norm now. I I taught and still teach at two of the medical schools here in town. I just yeah, kind of I will, I guess I could say I retired after seven years uh as um part of the teaching faculty at uh Washington State University's College of Medicine. And it was the norm, like you said, where a lot of students were in their late 20s, they'd been in the military or they'd had other careers before they went into medicine. And I actually think that's a feather in their cap because they have these experiences that help them relate to patients of all ages, all backgrounds, um, all professions, those types of things, as opposed to coming right out of college, going right into med school where you're kind of a professional student, but you have no life experience. And so it helps, I think, medical students who are more mature be able to relate to and have more organic, natural conversations with patients because they've had some life experience. So, and I think that's what a lot of medical schools are looking for now. I remember when I applied, it was almost like I had to explain why there was a gap in my in my training. It's like, well, I wanted to go do some other things. But now, I mean, that's the norm. And um, I think, like I said earlier, a lot of medical schools are looking for that.

SPEAKER_00 18:23

Yeah, definitely. Um, and I'm finding that as I'm in a gap, like my first gap year of two. I'm working in community health, and I just feel like it's, you know, you're meeting so many different people. I'm like learning what it means to be a person that isn't in school. And you it's it's good. You have a job, you you have things to do and responsibilities that aren't just homework assignments. And then you talk to a lot of different patients and people and you understand what just on a bigger scale, what people's lives are like and what goes on. And I feel like then if I go into medical school now with this experience, I've talked to a lot of different people. And so I've I've seen a lot of different walks of life and different like personal struggles people are having. And that's just not necessarily something you can get being only in school ever. Um so yeah, I actually think the push to do more gap years, it has pros and cons, but that's a huge pro, is that I think it's it encourages students like me to get life experience before going and interacting with other people's lives, essentially, is what you're doing in in med school and beyond.

SPEAKER_01 19:41

That's correct. I mean, I can think of multiple times when I was a resident where uh we had to, you know, tell a patient, like, you're gonna have to take some time off after this procedure, and they'll tell me, I can't take time off. I'm the sole breadwinner in my family. I or you know, I'm in a job where I don't have benefits, or yeah, if I don't work, I don't get paid.

SPEAKER_00 20:09

Yeah.

SPEAKER_01 20:09

And or um, you have patients that have to decide between paying for medication versus paying their rent. Yes, which should never be a choice, in my opinion. But here we are. Yeah. And having empathy for those people, which is really walking in their shoes, right? There's a difference between empathy and sympathy. I think we grow that, we grow that muscle, that empathy muscle by having life experiences and it helps us relate better to our patients. So I'm a huge fan. Um, that's not to say that people who go right through college and then into medical school aren't good med students and don't turn out to be good physicians, but there's something to be said for having life experience. I'm a big fan of that.

SPEAKER_00 20:58

Yes, yeah. That's and I yeah, it's very cool that you have these different careers. Um, do you feel like you've brought that teaching desire through um through into your like physician life?

SPEAKER_01 21:12

I think that's what physicians do. I think we're educators.

SPEAKER_00 21:15

I agree.

SPEAKER_01 21:16

Yeah, uh, I think at heart we have to be educators. Not everybody's very good at it, but uh, you know, there's so many layers to being a good uh educator as a physician, from using proper language that patients can understand to having biases where let's say you're taking care of a physician colleague of yours and perhaps using doctor speak when they just want to be a patient. They don't want you to talk to them in this more pragmatic way. They want you to talk to them just as a patient. What does this entail? Don't assume that Because I'm a physician, uh, that I understand everything you're talking about now that I'm a patient. So those types of uh I think experiences and and understanding lend themselves to us being better educators. Now, I have the luxury of having a master's degree in teaching, and I think as a uh former college athlete and then being a coach, coaches are teachers as well. So I kind of grew up in that or was raised in that just by default. And so I think I do a pretty good job of that, but I'm always learning. Just when I think I've got it figured out, uh, I learned something new. I think that's one of the really cool things about being a physician is not only are there new technologies coming out all the time that we have to and new recommendations we have to stay up on, but our patients teach us so much. Just like I said, when we think we've got it figured out, we we don't, and it's very humbling.

SPEAKER_00 23:04

Yeah, but that's I think also the beauty of it. There's always something to learn, and there's always a new type of experience to have to be had and a new patient. And um, yeah, I think so it can be hard, but it can, I think that's kind of the whole point.

SPEAKER_01 23:19

Yeah, I think the best physicians are those that reflect or take time to reflect because we're very, very busy and it can be hard to do that. But if you take time to reflect on an interaction, I think med schools and residencies are pretty good at uh allowing students to debrief after patient interactions. And once you get out there on your own as an attending or you're in your own practice or what have you, it can be hard to take a step back and pick your head up and kind of look around and think about how that went, how I could have done it better. What can I learn from? What did I do well? What are some opportunities for growth for me? And I think, like I said, the best physicians are those that take that time to reflect and um work on themselves as educators, as communicators, let alone as clinicians.

SPEAKER_00 24:17

Yeah, 100%. Thank you for for sharing that, for talking about um your experience through med school. And I think this is a great place for us to end. I think this is really important insight. Um, and I certainly love, you know, as someone I I've done a lot of tutoring with young kids and and high schoolers. And I I love that the educational desire that I have is is not just going to be brought into medicine, but is necessary in medicine. And I just, yeah, it's it's wonderful to hear that um you work on it, that uh that you feel it's so important, um, because I I really think it's super foundational as a physician.

SPEAKER_01 25:01

There's so many resources out there for patients, right? The internet is probably the primary one, and it can be difficult for patients to really know what's legit, valid, trustworthy, and what's not. And so um yeah, if we can be kind of that uh source of reliable evidence-based information, that's really important, I think, for them.

SPEAKER_00 25:29

Yeah, 100%. Well, thank you so much, Dr. Falek, Laura. Um, it was so great to hear about your experience, about um your untraditional journey. I I like to hear when when it's not a straight line. Um, I think it makes people more interesting people, more interesting physicians. Um, and I think it's encouraging for people at the beginning of their path, like me, to hear that it doesn't have to be one and then the next and then the next. Like you can go and explore other things and it'll only make you a better physician. It's not gonna stunt you, it's not gonna hold you back.

SPEAKER_01 26:04

So not at all. I would in closing say that if somebody's thinking about going to medical school and they feel like they're too old, uh, I can remember saying, Well, God, I'm gonna be like 40 when I finally kind of get my feet on the ground and have a career and whatnot. And somebody told me, You're gonna be 40 someday anyway. Why not be a doctor? Exactly. So go do you, go do your thing, get the experiences you want, and then go to med school and give it a shot. Yeah. And uh, it just might work out, and it certainly has for me. I'm very fortunate.