Member of the Month: Astrud Villareal, MD

Dallas resident physician reflects on the importance of self-care and travel

By Perdita Henry

posted 09.06.18

There are so many firsts in life. Your first word, your first step, your first day of school. There in those little bodies is so much nervous excitement. So much anticipation about what’s to come. As we age, those firsts get bigger and sometimes that excitement can wane. Now it’s your first day at college, your first day of medical school, your first day as a resident. Those firsts are still exciting, but the stakes have changed. You’ve grown. You are prepared. However, there is still a certain aspect integral to success in those firsts. Attitude. It’s all about how we see those next big challenges and how we proceed to tackle them.

Astrud Villareal, MD, a third-year resident at the University of Texas Southwestern Family Medicine program, knows those firsts specific to the journey of becoming a physician. However, her role as physician is a long way from her initial career choice. “My first official dream, according to my parents, was to be a food taster,” she says. “I still love food, but I didn’t go that route.”

Born and raised in the Philippines, as she prepared to make the leap from middle school to high school, her family made the decision to move to Texas. “We moved to Dallas and I started high school here,” says Villareal. “I went to Woodrow Wilson High School. I loved my time there.” She even tried out for the basketball team and made it, despite being a tad vertically challenged. “As short as I was, the team accepted me,” Villareal says. “I have no idea why, but sometimes they know that kid may not have the height, but she will run.”

It’s that attitude, the willingness to try different things and throw herself into them fully, that still drives her. From signing up for all sorts of random programs as a teen to get a better understanding of where her career passions may lie, to whole-heartedly embracing the idea of studying abroad during medical school, to making time for mindfulness and self-care during the hectic days of residency, when Villarreal chooses to take that first step, she does so with enthusiasm.

Why family medicine? Were you inspired by anyone?
Going into medical school, I thought I was going to do emergency medicine. I loved the variety and it was great. The shifts worked for me — and for a lot of people that’s a make it or break it. But after doing a few shifts, I realized I personally needed more continuity of care.

As a resident, my favorite aspect is being able to develop a relationship with my patients. It’s what drives our decisions as a team.

While in medical school, I had a chance to work with Nora Gimpel, MD, and Patti Pagels, MPAS, in the free clinics. They provide important care to the community and make sure medical students have access to that as well. They’re two of my biggest inspirations in the field of family medicine.

How can we attract more medical students to family medicine?
It’s tough because we have to fight the “Family medicine is for average students” and “You’re going into family medicine because your board scores are low” assumptions. It’s hard to break that down overnight. We can combat it by highlighting what family doctors do and the legacy of family medicine.

People don’t always know what we can do. Showing students that they can craft their career path is big. You may fall in love with sports medicine during your intern year, and in our specialty, you can continue to go that way. However, you aren’t locking yourself in if you change your mind. You can craft your career to match your desires.

One of the things I talk to everyone about is the financial aspect of family medicine. Addressing the concern, “Will I be able to have ‘the life’ if I choose primary care?” early on is important. We tend to address that once they’ve made up their minds or are deciding between two specialties. It’s a little hard to convince them otherwise at that point.

You were originally interested in health policy and spent a semester abroad to investigate that passion more fully. What did your time in Copenhagen teach you?
One of the best pieces of advice I got as a medical student was, “No matter what you do, don’t finish without studying abroad. It doesn’t matter where. Just go do it.” It sounded like good advice and I married myself to the idea.

I hadn’t decided on which aspect of medicine I was going into. I liked medicine, but I also liked health policy. The Copenhagen program had a great mix of that. Their health care system is completely different and that was intriguing. They had a slew of courses dealing with the international politics of the European Union. The program sang to me.

Regardless of what study abroad program a student chooses, being in a different country for a semi-extended period forces growth.

What were a few of your favorite things about the program?
One of my favorite classes was half lecture and half patient visits. What we learned in the classroom we were able to apply quickly. We went on home visits and saw how they did follow ups. It was a course in how their health care system worked.

In Denmark, a patient’s primary care provider must be within a certain distance of their home. It allows them to easily visit their physician when needed, and if they can’t get out of the house the physician can come to them. Patients don’t have to take a train or a boat to get to the doctor.

I was used to the idea that patients will make the trip to visit the doctor’s office. And it’s okay if we need to send them to another location an hour away. I never thought about transportation as a part of health care in general. You think of dispensing meds and lab findings, but there is this whole transportation side of medicine that really affects people.

How has that experience influenced your career?
It made me think more about the social affectations. When I talk to patients now I ask, “Did it take you a long time to get here? What is your transportation situation?” Even when I’m in the hospital admitting someone I ask, “Did someone bring you? Is someone going to be able to pick you up?” Sometimes those things are put on the back burner. If they don’t have a way to get the medicine or a way to get to the follow-up appointment, then all we’ve done is lost.

It’s affected how I practice and the way I teach. Now when I’m teaching medical students and I see a patient, I’m trying to connect the student to the patient immediately. I want to get that knowledge stored in their brain quicker. That way they have a face to go with the lesson rather than just a random fact. It’s one of the things I saw best demonstrated in Denmark. They linked things together and I learned it better that way.

I read that you enjoy traveling and going on adventures. What’s been your favorite travel experience?
My mom and I went to see Paul McCartney in concert and to see The Beatles Live in Las Vegas. I have never seen my mom dance that hard.

The most unexpected experience was with my best friend in London. They’d just finished building The Shard — the tallest building in western Europe — and they were hosting a silent disco. Gorgeous views of the city, and everyone was given headphones that lit up. There were three stations you could tune into and each station had a specific color, so other people knew what station you were listening to. If you took off your headphones it was silent, but everyone was dancing their hearts out.

And there was the last time I saw my host family in Denmark. We took a boat from northern Denmark, crossed over to Sweden, and had lunch there. It was a great reunion.

How do you see yourself as a new physician?
In my third year of residency, I realize I really enjoy academic medicine. The opportunities here match my goals. Then there’s the bonus that I’ve learned from faculty that I could end up practicing with. A lot of people have different interests and experiences and that’s a fun part of academic medicine. You get to learn and gain expertise just by working with people.

What is the best lesson residency has taught you?
One of the best pieces of advice I got from my current faculty advisor, Turya Nair, MD, was be grateful. We don’t do that enough. We think about the big things, but those little things add up too.

The other thing is self-wellness and kindness to yourself. We are our own worst critics, so the ability to forgive ourselves, and let it go, allows us to fully move on to the next day. It’s a different kind of wellness that allows you to be more present, give more of yourself, develop resiliency, and prevent burnout. At the start of each day, I choose to have a good day. I choose to forgive myself for the bad days, because they do happen. As a resident, there are a million things coming at you, but it’s a choice to be present and give your all to the patient you’re seeing.

In Harry Potter, Dumbledore says, “It’s our choices, Harry, that show what we truly are, far more than our abilities.” This is true in residency too.

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 tafp@tafp.org or by phone at (512) 329-8666. View past Members of the Month here.