Panelist #2 – Dr. Richard Bruno: Advocacy, Preventive Medicine, and Public Health
Dr. Richard Bruno Thank you. And thanks to Dr. Huhn. Always inspiring to hear your story, too. Thanks so much for sharing. I’m Bruno. He/him pronouns. I’m family medicine and preventive medicine trained. And I’ve come to you from Portland, Oregon, here in the harm reduction clinic. I’m so grateful to be able to chat with you about family medicine, one of my great loves.
I came to family medicine in sort of a roundabout way. I, as a junior high student, was volunteering at a camp for kids with disabilities in Little Rock, Arkansas (where I grew up), and I was taking care of kids with diabetes, cancer, spinabifida, autism and it was just wonderful to be able to provide assistance for their medical needs. I really started to think about going into the field of medicine at that point and got into the research angle as my way into medicine. I was a clinical trials coordinator for a while. I worked in the sleep lab hooking people up for sleep studies. And instead of going the research PhD route, I was like, “I want to do medicine. I want to take care of people and be present and helpful for them in their most vulnerable times.”.
Dr. Richard Bruno So I got into med school. One of my good friends from high school died of a brain tumor that probably wouldn’t have killed them if they’d had health insurance. And so, I started thinking about all the systematic and systemic problems in our medical system that really drive unhealthy behaviors and contribute as unhealthy factors in people’s lives. And being without health insurance was one of those. And so, I started devoting some of my work becoming a better advocate and ally for my patients, because I felt like if we could create a universal health care system, we could support people to be able to get access to health care they needed.
I got into the advocacy angle and became active with AAFP and started writing resolutions at National Conference (now FUTURE). And I think National Conference has an incredible array of folks there and really helped build up the profession. I really found my tribe, so to speak, in terms of just finding a way to be a better advocate and ally for my patients, and which I found to be actually burnout prevention, getting back to the previous points. I think when we can feel like we are doing something to change the system, we feel it can help counteract some of the burden day-to-day clinical work can sometimes give us.
Dr. Richard Bruno So I really focused on becoming involved in the AAFP. It became like a home for me. I became the National Conference chair, I became a member of the board of directors (resident). There’s always ways to get involved in whatever area or passion you have within family medicine through AAFP. So always, always a wonderful place to do that work.
I went to residency in family medicine/preventive medicine. It was a combined residency trying to train hybrid docs to be able to do primary care and public health interventions. It’s basically three years of family medicine residency and two years of preventive medicine residency into four years — we combined it together. You get your MPH as part of that. So, I’ll put a little plug for that and a combined program if you want to get super efficient with your training. It’s a great way to do that. And for me, it was, as former AAFP President Ted Epperly says, becoming the kind of doctor that your community needs. And I felt like my community needed a doctor who could not only provide medical care, but also help change the systematic factors that are influencing people’s health. So that was a wonderful way to do that.
Dr. Richard Bruno I finished residency, went out and started working for some federally qualified health centers and did the National Health Service Corps loan repayment program. I was working in some underserved clinics in Baltimore, where I really started cutting my teeth with HIV medicine and addiction medicine. Getting boarded, getting specialized in those things that I feel like my patients needed in the community I was serving.
And then I moved back to Portland, Oregon, where I’d gone to medical school, and I ended up working for a health care for the homeless organization. I was trying to find some of those under-resourced folks in the community to be helpful for, and I set up some programs that were designed to help people get access to buprenorphine in walk-in clinics — low cost, low barrier, immediate access to care through a walk-in clinic without an appointment. And just trying to streamline some of those processes, make it easier for people to get that kind of care that they needed.
And then about a year ago, I transitioned over to my county health department. So I worked for Multnomah County Health Department, which is about 813,000 people in the greater Portland, Oregon metropolitan area. The health department is really designed to help work on those larger population health interventions. And so, I became the health officer there, kind of like a health commissioner. And that’s my job now, is that I work on larger population health interventions. I oversee the medical examiner’s office, the emergency medical services, all the ambulances in the county and emergency preparedness.
And then I go to work a lot. I work on opioid overdose prevention and response. Recently, I’ve been working on some work with mobile vans, which I find is a really fascinating new angle, as well as bringing some good stewardship to some AI tools that we’re starting to use in public health and in medicine as well.
Dr. Richard Bruno And then I’m also able to stay clinical. I get to work in our HRD clinic. I’m here in our harm reduction clinic today. And I work shifts our SDI clinic and on our mobile van, where we can get out into the community and bring care to people where it’s most needed, and often to people who have trouble getting into traditional brick and mortars. Finding ways to get access to care by having to get on public transportation or other ways can be significant barriers for people.
Dr. Richard Bruno I’m here now doing what I thought I wanted to do: take care of patients but also work on some of the larger population health issues. And I always kind think back to some of the core concepts of family medicine as some of the big drivers for me. And if you look at some of the research of Barbara Starfield, she analyzed countries that had a robust primary care infrastructure and showed that they had better overall outcomes. And so, she came up with something called the “4Cs” of primary care. And I think family medicine is the most pure primary care. And so, those are like first contact, the coordination between multiple specialists, the comprehensiveness of family medicine. We can do a wide array of things, diagnostics and treatment and and other tools. And then my favorite is the continuity of care. It’s the longitudinal relationships that you develop with people over time. You talk to the people who have been able to deliver a baby and then take care of them as a child and then deliver their baby. There’s multigenerational, womb to tomb, cradle-to-grave spectrum that family medicine really embodies and really does very well.
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