Member of the Month:
Neelima Kale, MD, PhD, MBA
Dallas FP prepares the next generation of family doctors for the future
By Perdita Henry
Neelima Kale, MD, PhD, MBA, was interested in medicine early on, but being born in Washington, D.C., and raised in Mumbai, India, presented a challenge when it came time to pursue her medical degree. “At that time, all the schools in India were state schools and it was nearly impossible if you were a non-citizen to attend medical school,” Kale says. “It was very competitive. You had to get all kinds of clearances from the central government to go to school. I tried to obtain them but couldn’t, so I opted for pharmacy because my family was in the pharmaceutical business.”
In fact, her father was one of the largest manufacturers of metronidazole in Asia. “Pharmacy was the logical choice since I couldn’t go into medicine,” Kale says. “I went on to earn my bachelor’s and master’s in pharmaceutical sciences and decided to return to the U.S. to do my PhD.”
While wrapping up her PhD studies, it occurred to her that maybe she wasn’t through with medicine after all. “I realized I could take a non-traditional route into medicine,” Kale says. “As I finished my PhD, I took the MCAT. I earned my MD and then obtained an MBA with a concentration in health care finance and health care administration.”
After kicking off her career and establishing herself over the years as a physician in Ohio, Kale and her family were ready to make a change. Texas seemed like just the place. “Part of it was that I really got sick of the snow. I was looking to move some place warm,” Kale says. “My husband travels every week for work so we definitely needed to be near a big airport and middle of the country-ish. Dallas was perfect for both of us.”
Currently, Kale is a family medicine faculty member at UT Southwestern Medical School and director of the residency clinic, where she shapes the next generation of family medicine physicians. “My philosophy is that if you make an excellent education environment, then patient care will follow,” Kale says. “The two are not exclusive and you can do both at the same time. I run the clinic, make sure systems are in place to provide good education and great patient care experiences. I make sure that we create good doctors.”
Why did you choose family medicine?
I attended medical school at the University of Oklahoma College of Medicine, where they exposed us to primary care on the first day of your first year. I also had some really strong family medicine role models. I truly liked every aspect of it.
Every time I had a rotation, I would ask myself, “Could I do this for 8 to 10 hours for the rest of my life?” Family medicine was one of the few where the answer was, “Yeah, I could do this for the rest of my life.” You are doing so much and doing it in so many different venues. You are in the office, in the hospital, in the nursing homes, and in board rooms; you are in everything and that was attractive.
If you’re a specialist, you know the patient in your office is having a problem with whatever organ you specialize in most of the time. With family medicine, you never know room to room what you’re going to encounter. For a long time, I did full-spectrum family medicine, including obstetrics, and it was really rewarding and it felt like I was making a difference in people’s lives.
What is the most interesting/memorable experience you’ve had treating patients?
Many years ago, while I was in private practice, I had to make a home visit. This lady was over 100 years old, generally healthy, but I didn’t want her driving. I went to see her and brought along a medical student. As we were leaving, she grabbed our hands and said, “Now remember ladies, we need you to go vote.” We said, “Of course.” And she said, “Do you know why? Because I marched in the streets so that you could have the right to vote.”
She was one of the original suffragettes. I found that amazing.
What interests you about family medicine?
Right now, I teach and sort of create family physicians, which is a little different from being in private practice and seeing patients. The nice thing is I know what we are creating physicians for and I know where they are destined. I know what they have to be when they are done here.
The most important thing to me as a teacher is to be able to step back when I see a resident hesitating a little bit. Your instinct is to take over but you have to put your hands behind your back and say, “Let’s try that again,” or, “How about we look at it in a different way?” When they are presenting a case that’s perplexed them and you know the answer because you have seen it about five times in the past, instead of telling them what it is, you get to keep questioning them until they come to the right answer.
As educators we must learn those skills. You must let the learner come to the answer on their own. It’s the whole “give them a fish or teach them to fish.” You have to teach them to fish.
What’s one word or phrase that characterizes your style of family medicine?
Partnership. It’s a partnership between me, my patient, and their family. I think that’s how we get results. If one of the three is not invested in that journey, we are not going to see improvements.
We really need to move away from this concept of just ticking boxes to make everything count. We must work with the patient to see what their goals are and what can reasonably be achieved. We need to see patients involved with their care. I can set all kinds of goals but if the patient or the family have barriers to those goals, we are not going to achieve what we want.
After experiencing private practice, what led you back to academic medicine?
The first time around, I was coming out of residency and I wanted to practice the absolute full spectrum of family medicine including obstetrics and neonatal nursery. Academic medicine gave me the chance to hone my skills and get my confidence up.
The second time around, I found private practice financially rewarding but intellectually it wasn’t as stimulating as academic medicine was. When it was time to make a change, my husband and I knew we were going to leave Ohio for a warmer climate. I thought, “Do I really want to go back to another private practice or do I want to be somewhere I would be more challenged and stimulated?” I like to teach, I think I’m a good teacher, and it’s important that we create the next generation of family doctors in the right way.
What has your experience as a TAFP member been like?
TAFP is an incredible organization. I’m amazed at what TAFP does with their lobbying power in politics and with the people. There are so many family physicians that we can be a force for good. We can disseminate new knowledge rapidly because so many of us are frontline physicians, who see 30 to 40 patients a day. We are such an amazing group. We can collectively do a lot of good for a lot of people in a very short amount of time with little financial strain.
You’re the vice chair on the Commission of Public Health, Clinical Affairs and Research. Why is it important for you to dedicate time to the commission?
When I started on the commission, it was about getting to know people and getting to know what medicine in Texas is. When you are in liberal north Ohio, you hear a lot of things about Texas. For me, this was the opportunity to get to know the people and the issues on the ground level and to address those issues.
It’s also important to talk to other family physicians about what they are seeing and what their impressions are. As vice chair, I get to interact with family medicine physicians from across the state and across the spectrum in terms of years of practice. We have physicians who’ve practiced longer than I have been alive and they bring a unique perspective to the commission and to the conversation.
Family doctors are on the front lines of medicine. We are the ones who are dealing not only with patients but the fallout of policy, both good and bad. We know what works on the ground and what doesn’t.
It’s important that we have a voice and we make it heard. We all must do our part as family doctors. We all have to do a little bit to improve public health and family medicine research. Since there are so many of us, if we all do a little bit, I think we can make a change.
What’s the most important quality a family physician should have?
Humility and compassion. Compassion for your patients and the humility to know you will never know everything there is to know. Knowing what you know and what you don’t know is very important.
Family doctors often hear, “You can’t possibly know everything.” That’s true, but what sets us apart from other specialties is that we feel comfortable with it. We know how to deal with it. Every day in our office there will be one patient who will make us scratch our heads. That’s what keeps you young. It’s important for family doctors to be humble about it.
And don’t forget you choose to care for your patients. If you don’t forget that you will be fine, despite what’s thrown at you in terms of regulations, rules, policy, and politics.
TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting TAFP by email at email@example.com or by phone at (512) 329-8666. View past Members of the Month here.