September 19, 2023
Dr. Viera serves as the chair of the Family Medicine and Community Health Department at the Duke University School of Medicine, and earlier this year he became editor-in-chief of The Journal of Family Practice.
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That’s the phrase he still uses. It’s because when he was a young boy living in South Carolina, that’s the kind of doctor he knew about. “I grew up in a small town,” he says, “and the only kind of doctors I knew of were small-town doctors. Even the doctors I grew fond of on television, like Dr. Baker from ‘Little House on the Prairie’ and Bones from ‘Star Trek,’ were country doctors.” His boyhood dream was to become a doctor like them, even though he would have to be the first person in his family to attend college to do it. Attending Wofford College was the first step.
But there were more steps to come as Dr. Viera trained to become a simple country doctor. First, there was the gap year before medical school when he became a middle school science teacher and soccer coach. Then came his service in the Navy after he completed medical school on a Health Professions Scholarship: “I chose to do my residency at Naval Hospital Jacksonville, where Family Medicine was the only residency in the hospital,” Dr. Viera says. “We got to ‘do it all,’ as they say, which was exactly the kind of Family Medicine I wanted to be doing.”
This kind of full-scope Family Medicine continued when Dr. Viera served his overseas tour in Guam, where in another naval hospital he did inpatient work, cared for prenatal patients, delivered babies, and performed procedures including flexible sigmoidoscopy, vasectomy, exercise treadmill testing, and colposcopy. “I enjoyed delivering babies and also caring for their parents,” he says. “I had whole families under my care for several years while in the Navy.” While stationed at Naval Hospital Guam, Dr. Viera even flew on medical evacuation missions to take critically ill patients to the nearest U.S. tertiary care hospital in Hawaii.
All the while, he was moving toward his next unexpected step: a master’s degree in public health. “I loved evidence-based medicine and wanted to learn more about epidemiology, research, and public health,” Dr. Viera says. “You realize there is so much that’s coming into your clinic that you wish could have been prevented. Diabetes, hypertension, and the other chronic diseases we treat every day have so many of their roots in social drivers outside of the clinic walls.” His desire to do more for his patients led him to begin a master’s degree and fellowship program as a Robert Wood Johnson National Clinical Scholar at the University of North Carolina.
Dr. Viera left his rank as a Lieutenant Commander in the Navy to complete the fellowship, which he says required some adjustment. “I took a big pay cut,” he says, “and partly to help make ends meet during the fellowship, I also moonlighted in the Siler City emergency room, where I was the only doctor in the hospital overnight. And I’ll tell you, my full-scope training really came in handy in the emergency room of a rural area.” Once he finished his fellowship, Dr. Viera stayed on as a faculty member in the academic setting, an environment in which he has remained since then, with a research focus on cardiovascular disease prevention.
To be sure, he loved the research and teaching he took on at UNC. After 13 years there, Dr. Viera felt ready to try a new challenge as the chair of the Duke Department of Family Medicine and Community Health. “I loved all the academic missions — the clinical care, the research, and the teaching,” he says, “and so I decided it was time to raise my hand for a chair position.” He has now been in the chair role at Duke since 2017, and earlier this year he received the Leonard J. & Margaret Goldwater Distinguished Professorship (Dr. Viera is the first professor from the department to receive this type of award). Though he no longer practices the full spectrum of Family Medicine to include inpatient care and delivering babies, his work still supports that kind of care he has always valued. “We promote that type of full-scope training,” Dr. Viera says, “so that our graduates can be equipped to meet the needs of the communities they seek to serve.”
One concrete way Dr. Viera promotes full-scope Family Medicine training at Duke is through partnerships with Duke Regional Hospital, where Family Medicine attendings and trainees have an inpatient service, deliver babies and provide coverage of the newborn nursery. “We’re continuing to grow our prenatal care and obstetrical services there [at Duke Regional Hospital],” he says. Our philosophy for this training is that we want to train doctors to be able to go into their communities and help deliver the kinds of care the community needs.”
Dr. Viera is also doing what he can to educate family physicians through his new role as editor-in-chief of The Journal of Family Practice, which he began on July 1. “In this role, I’m able to mentor new as well as experienced authors who write about the many things we see in family medicine,” Dr. Viera says. “I’m passionate about helping others in their academic development. Now, I can’t be in classrooms or on the wards every day, but I can mentor these authors on their research ideas and papers. And that’s a good way for me to continue to teach.” Ultimately, his role as a journal editor helps to bring evidence-based care to people wherever their clinicians can access the journal online.
And what about Dr. Viera’s own patients? With the responsibilities he has taken on since first starting out to become a family doctor, he can’t participate in as much clinical care, but he still sees patients in clinic one day per week. “I’m less involved in patient care but still enjoying it a lot,” Dr. Viera says. “I look forward to catching up with my patients in my clinic, since those relationships are important to me. Building relationships with my patients, faculty, and learners over time is what I love most about all the care, mentoring, and training in academic medicine.”