and succumb to the barriers facing them and their patients. Those who will question everything. Although they may not succeed each time, they refuse to accept barriers as insurmountable or immovable. There are "I will" physicians in every specialty and in every corner of the world, but you will find no field with more of these physicians than in developmental medicine.

Over this past summer, a 36-year-old patient with cerebral palsy, autism, and a genetic microdeletion syndrome who communicates non-verbally came to my office with a rapidly growing breast mass. One breast was remarkably larger than the other with a visible and palpable mass. It doesn't require a medical degree to raise red flags about breast cancer in this situation. A few weeks later after ultrasounds and biopsies, she was diagnosed with breast cancer. She was fortunately able to see the breast surgeon quite quickly and underwent a unilateral mastectomy.

Reviewing the breast surgeon's notes, I was surprised to find that they were not planning to do a PET scan to appropriately stage the cancer nor any chemotherapy as "the patient would not be able to tolerate it." Without staging the cancer appropriately, it was by nature near impossible to get appropriate care. Care for very advanced and metastatic cancer is very different from localized disease. Although she had not been successful previously in obtaining routine labs and imaging, I strongly felt this was a situation that required more effort than normal. After speaking with the family and the surgeon, I was able to arrange a PET scan with sedation, allowing everyone to make more informed decisions about her care.

Having limited experience with people with intellectual and developmental disabilities, the breast surgeon is someone I do not expect to readily have solutions to obtaining imaging in patients such as mine. However, I have noticed that some hear "the patient can't tolerate that," and ask no further questions and investigate no further solutions. On the other hand, there are numerous (albeit fewer) clinicians out there who think, "I have never dealt with this before, but I will figure it out." I work at a clinic for adults with intellectual disabilities, and that attitude is a requirement. In the ideal world, we might hire all clinicians with extensive experience with adults with intellectual disabilities. Unfortunately, those clinicians are incredibly rare. Having been involved in the hiring of a few of our staff, I have instead started to look for the "I will" attitude, and it hasn't failed yet. In a medical system where "we can't do that," is nearly a daily reality for many of our patients, I feel lucky to provide an environment where we do our best to provide tangible solutions.

PURSUING A CAREER IN DEVELOPMENTAL MEDICINE

For the medical student who is motivated and excited by the idea of being one of the physicians to creatively problem solve, I encourage you to pursue a career in developmental medicine. You will likely find that your first puzzle comes with determining how to pursue your training. It takes no more than a google search to determine that there is no developmental medicine residency and perhaps one fellowship.

As a student, I endlessly debated physical medicine and rehabilitation, developmental and behavioral pediatrics, and neurodevelopmental disabilities. All are needed fields serving those with dis

abilities, but I was committed to providing a medical home and being a primary care physician for adults with intellectual and developmental disabilities. I ultimately decided to pursue family medicine training, with plans to later determine how to get the specified training I needed. I perused many residency websites without a single mention of developmental medicine. Later, I attended a residency expo and went around, booth to booth, describing my career aspirations, asking each residency how they could provide training in caring for adults with intellectual and developmental disabilities. After visiting dozens of booths, I found maybe one or two residencies that had something concrete to offer instead of blank stares. I would ultimately end up at Tacoma Family Medicine, where I cared for many adults with intellectual disabilities in the hospital, a primary care clinic, and a specialized developmental clinic

"I wish I was able to give you a clear-cut guide to how to become a developmental physician with a list of the best medical schools, dental schools, or residency training programs. Unfortunately, the path to developmental medicine is not that simple. At the same time, following such a road less traveled comes with countless benefits."

My chosen path was ideal for me, but there are countless paths to developmental medicine, and people with intellectual and developmental disabilities need good physicians in all fields. Similar to a search for staff at our clinic, a search for a residency should focus on one with a cando attitude. Unfortunately, you are unlikely to find the perfect training program through a google search. Instead, it typically requires talking to friends, residents, and programs directly to determine what program can fit your needs. Those programs exist, although are hardly widespread. Though it takes diligent work, the beauty is that there is no single correct path to developmental medicine.

A DEEP DIVE : DEVELOPMENTAL MEDICINE RESOURCES

THE AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE AND DENTISTRY, Including the Student Resident Committee www.aadmd.org

AMERICAN ACADEMY OF FAMILY PHYSICIANS National Conference of Family Medicine Residents and Medical Students www.aafp.org/students-residents/medical-students/fmig/lead-fmig/meetings.html

TACOMA FAMILY MEDICINE AND ADULT DEVELOPMENTAL CLINIC multicare.org/tacoma-family-medicine multicare.org/services-and-departments/adult-developmental-clinic