Dr. Nicole Outten: From nontraditional student to family med resident

Dr. Nicole Outten ’25 grew up in Florida and initially wanted to be a mother and teacher before deciding to pursue medicine at age seven after breaking her arm. She completed her undergraduate degree in interdisciplinary natural sciences at the University of South Florida, hoping to attend medical school.

Dr. Outten is passionate about primary care and family medicine, intending to become a comprehensive primary care provider who can care for patients of all ages, including the elderly. As a nontraditional student, Dr. Outten had to overcome challenges like a lack of confidence and family obligations, but she persisted in her dream of becoming a doctor.

She is excited about innovations in primary care like point-of-care ultrasound and procedures like PRP injections that can be done in the office, allowing family medicine doctors to provide more comprehensive care.

Dr. Outten encourages students to pursue their dreams in medicine and not be discouraged, as the rewards of being a primary care physician can outweigh the challenges.

UMHS spoke to this inspiring new doctor a few days before UMHS graduation at Lincoln Center in New York City this past June.

How UMHS made a difference

UMHS Endeavour: Please tell us where you’re from and what excites you the most about your residency?

Dr. Nicole Outten: I was born outside of Columbus, Ohio, but I grew up in Fort Myers, Florida, and I will be doing my residency in Fort Myers with the Florida State University Lee Health Family Medicine Residency Program. There are many things I'm excited about, but I think the peak or the pinnacle of this residency acceptance is that I'll be serving in a hospital and a community that has served me and helped to cultivate me as a person, and hopefully has added to the doctor that I'm going to be. And it is also within walking distance of my home, so that makes it really nice.

Did you have a favorite professor at UMHS? And can you tell us about any specific stories or perhaps some anecdotes about how they helped you make a difference during medical school?

It’s really hard to narrow down exactly one professor. I will say that there were several that really lent themselves to my style of learning: Dr. Jalan, Mrs. Jalan, and Dr. Mungli. I like to draw my notes. All of their teaching styles allowed me to draw and rewrite my notes in that way with pen and paper.

There was a specific situation, it was my second semester in my first physiology exam, and I just inadvertently thought there were 40 questions instead of 50. And time came up on the exam, and I realized I had 10 more questions that I didn't have time to complete. And I went to Dr. Gigi, and she kind of expressed some sincere sympathy for what I was going through, and then she said something that was very poignant and really kind of carried me through the rest of my med career. And she said, "Pull yourself together. You have other exams to take today. We will get through this and talk about it later." And those words were just kind of the advice I needed, and I wound up acing my biochemistry exam later that day and another exam. And I don't think if I had someone to really just kind of tell me to get it together, that I probably would've fallen apart the entire rest of the day.

 The fifth semester in Maine was a pleasant surprise

What was the fifth semester in clinical in Maine like for you? Can you tell us a little bit about the faculty, the Kaplan Prep course, and anything that helped you prepare to do well on the USMLE Step 1, and also your clinical rotations?

I don't have a problem saying this because I was pretty vocal about it, and I expressed my discontent with having to live in Maine or do a fifth semester at all. I felt initially that it was an unnecessary waste of my time. I didn't want to be in Maine. I am from sunny Southwest Florida, and so I was not looking forward to being in that area.

And that opinion that I had going in quickly changed. So, Dr. Kumar, Dr. Michaud, and Dr. Johansson all really kind of made an environment where we were given more space and time to just improve on our basic science skills to prepare for the step, but also to have an opportunity to become more confident in our clinical skills. My preceptor, Dr. Annemarie Pond, is now someone whom I kind of confidant. She was able to write a letter of recommendation for me, and so I built a relationship with her, and all of those things would not have happened without being in Maine.

And lastly, I think one of the important things was Dr. Turco, who was a Kaplan professor and gave us 10 tips that I wrote down and I have since really kind of shared with other friends and classmates— follow the “Turco Top 10.” They were all on my Step exam. And so, it made it essential for me to also feel confident when taking my exam, and I could reflect on things that I probably would've skipped over.

Is there anything else about your experience at UMHS that you want to share with our current and prospective students?

I think it's really important to just remember your purpose and why you are where you are. And there's going to be some days that are tough and you're going to kind of question and challenge whether or not you're in the right space, or if UMHS was the right school, or if the professors are for you. I will say with certainty that I think that happens in every medical school. I don't think that there was anything that we were shorted on by attending UMHS, and I think there's a big misconception about Caribbean med schools.

I was a professor of physician assistant studies, and so when I look at this from a perspective of not just being a student, but also being a professor, we were taught very high-class medicine. And having gone into my clinicals, I felt like we were not only prepared for our clinical rotations from a clinical standpoint, but from a basic science standpoint. I felt like we knew our sciences going in, and it made us stand out among other medical students in our third and fourth years.

Dr. Nicole Outten chats with a fellow grad before the UMHS graduation ceremony on June 6, 2025, at Alice Tully Hall in Lincoln Center, New York City. Photo: Andre Bolourian.

How a broken arm inspired a career in medicine

When you were young, did you always want to be a doctor?

Ironically, I was just going through some old pictures, and I always wanted to be a mother and a teacher. And then at seven years old, I broke my arm, and I sat in a busy ER with a very fractured, deformed arm. But I was just enamored [with the hospital]. I was overwhelmed with excitement, and I knew at that moment that I wanted to be a doctor. So I would say yes, I've always wanted to be a doctor. I accomplished the other two things of being a mother and a teacher as well. And so life is full for me.

Where did you complete your undergraduate degree, and what was your major? What was your undergraduate background?

So, my undergraduate degree was completed at the University of South Florida. My degree was in interdisciplinary natural sciences. Basically, I took science for four years, and so I studied every science there was, from ecology to cell biology, biochemistry, organic chemistry, physics, with the intention of going to med school at the completion of my undergraduate degree.

What are some of your goals for your upcoming residency?

So, I really want to just kind of hone in on some procedural skills. I want to really become a better practitioner and a better clinician, and gain some insight on how I can approach taking care of people in diverse communities. I'm really passionate about global health and public health, and so I want to kind of expand on that. And I really feel strongly about primary care and its importance in driving medicine. So I just want to learn how to be a comprehensive primary care provider, kind of taking it back to old school medicine where the family doctor did everything.

At UMHS, we are huge advocates of primary care because it's a field of specialties that a lot of people overlook, and they want to go into something more specialized, but there's such a need for primary care doctors in the US, especially now, just anywhere, whether it's urban or rural environments. So, we are very excited whenever somebody's as enthusiastic about primary care as you are. What about family, we’re medicine appeals to you the most? Can you talk a little bit about that?

I knew going to med school that I wanted to take care of people from zero to 99 and beyond. And I say beyond because I actually had a rotation where I was taking care of 105-year-olds.

Wow.

We have a community here in Fort Myers that is considered a blue zone, and they have 11 residents who are over a hundred years old.

That’s amazing.

So, zero to 99 plus. This is a long journey, and I think sometimes we do get caught up in the glamour of specialties, and maybe what income might be driven by that, or having prestige with having a certain name or title. But the reality is that being a primary care provider, you have to know everything about medicine. You don't get to slack, you don't get to stop learning about ENT or stop learning about cardiology. You have to know everything. And so that's probably what drives me the most, is that I have worked really hard to learn this medicine. I don't want to stop using it.

We have many UMHS alumni who are family medicine doctors. Many have told us that their favorite patients to work with are the very elderly, 95 to over 100, for so many different reasons. Do you have any thoughts on that?

One of my hobbies is reading historical fiction, and I just love history, although I don't think I liked it in high school or anything like that, but I love hearing people's stories, and so you just gain so much insight and perspective on life. It's humbling, but it also reminds me that there were moments where people lived and had experiences that we'll never get. And so you get that from them. And then being able to take care of those people who have done so much for other people, it's really rewarding to me.

Advice for nontraditional medical students

Dean Patrick McCormick mentioned that you are a nontraditional student, and we really value nontraditional students at UMHS. Please, tell us about your experience as a nontraditional student at UMHS.

I think it's important for me to first say why I'm a nontraditional student. Obviously, I chose to go to a Caribbean med school just because I didn't necessarily meet all of the parameters to apply to med school in the US at this stage. So, I often tell people, my prerequisites for med school are as old as most of my classmates and as old as most of my children. So I finished my undergraduate degree in 2002, again with the intention of going to med school, and I really just lacked the confidence that I needed to take the MCAT at the time, coupled with the fact that I was a mother of about to be three children at the end of my undergraduate degree.

I did all of my undergraduate work with two children, and I didn't do it by myself, so I don't want to take all the credit. My husband has been my biggest supporter and cheerleader and has been there from the beginning. But anyway, so we had a family, and I just decided to come back home. There was a need for science teachers, and I had studied science. And so I taught science for a couple of years and realized I still really loved medicine. And Nova Southeastern opened a satellite physician assistant program in Fort Myers, which meant I didn't have to leave my family. I could study medicine and become a provider. And so I attended Nova Southeastern University, obtained my master's degree in physician assistant studies and medical sciences. And prior to starting at UMHS, I worked for 13 years as a physician assistant with 12 of those years spent in the emergency room.

Maybe longer—14 years as a physician assistant, 12 of them in the emergency room. But I constantly had the regrets and the doubts and all those things. And so I would Google, going to med school, going to med school. And my husband actually became critically ill during COVID, and it was a really tough time. I was working in the ER, and I was watching people die. It was just a weird time to be living in. And then my husband became critically ill. My daughter also suffered a pretty significant illness. She developed osteomyelitis after surgery, and all this happened within six months.

Oh, my gosh.

And I thought, I'm either getting out of medicine, or I have to make a change. And I was sitting in the hospital with my husband. I had just a special privilege to be able to sit with him at a time where there were no visitors, and I was praying and nothing, and I don't mean to impress this upon, but nothing but divine intervention was like, you either live life with no regrets or you don't live. And I said, I'm going to go to med school, and I applied, and here we are. So that's my non-traditional story. And I think aside from all that, moving to St. Kitts was the first time I ever lived by myself, and I was 42 years old, so that was the first time I ever lived alone, which was my greatest challenge.

That's quite a story. Very inspirational. We have a lot of women who have children who are deciding whether or not to attend med school. And you're just really living proof that it does pay off in the end. It sounds like you really had a rough time with your family. I'm sorry to hear that.

That's okay. Everybody's okay.

Now, what advice would you have for prospective students who may not be in their early twenties, but they have a desire to go to med school? Men or women who are in their late 20s, early 30s, 35 to in their 40s. What advice would you have for them?

If you have a passion or a dream, we are all here for some specific purpose, and so, we develop a dream because it's been embedded in us that that's part of our purpose. And so we strive for those dreams because it's something we want to work towards. And so I think if you have a dream or there's somehow you've been inspired to go into medicine, I think you push through. And it's not going to be easy. Every day is a challenge, and there are peaks and valleys within this whole journey, but if it's truly what you want and you desire, then it's worth pushing through and it's worth climbing to the peaks, and it's worth living through the valleys in order to get to the other side. Nothing for me is worse than living with regret, and nothing is worse for me than someone telling me I can't do something. I'll show you how.

There is an ongoing primary care shortage in the USA and what are some of the misconceptions that you think people have about primary care, and what would you say to people out there just to stress that it's such an important specialty, especially now?

I think we're living in an era where, this is going to show my age also, but where AI is taking over, and I'm not quite ready for that. Like I said, I used to draw my notes with a pen and paper. My other classmates were like, "You know you can use your iPad?" But yeah, so technology is coming in to take over. But what I realized is that even though technology is taking over, medicine still requires a human element.

And so, one of those places where we can continue to insert is primary care and in family medicine, or just in a primary care setting, where you become the go-between, where people don't know what to do. We may learn everything about medicine and what has to happen and how people should be cared for, but really, lay people don't know, and being that voice and that advocate for somebody is really important.

I also think there's a big misconception about how much you can make in primary care and that it's the bottom of the totem pole. And I would say two things to that. Either one, you're not in medicine for the money, you're in medicine because it's your passion, it's your dream. You have a service to provide, and so the money doesn't matter, or it will come from somewhere else.

The other, I would say, is that there's a whole advent of primary care in looking at other ways of performing more procedures, doing direct primary care and building memberships, and building a patient and having quality of life. I just spent the last four weeks with, or six weeks with, a provider who worked for corporate medicine and left because she had seven minutes to see a patient, and she was on a wheel, and she left and started her own practice, and she caps out at 600 patients. She has the best quality of life. She travels the world, her patients love her, she loves what she's doing, and she's not burnt out doing it. And she's a primary care family medicine doctor. And I think people need to look at other avenues.

I also spent time with someone who is a family medicine doctor but specializes in sports medicine, doing PRP injections and joint injections. And so you can have the luxury of procedures and innovative medicine in a primary care setting. It doesn't have to limit you, and you don't have to be at the bottom of the totem pole.

How Point-of-Care Ultrasound is revolutionizing primary care

You’ve mentioned that family medicine covers many different areas of medicine. Do you know of any new treatments or medications that you think are really going to help family doctors improve treatment for their patients in the relatively near future, or things that are happening now?

One of the things that I'm most interested in outside of just starting residency is the use or integration of point-of-care ultrasound. And so I am super excited, and anybody who's thinking family medicine should look at this residency program I'm going to because right now, Lee Health has provided a grant for the last three years where everybody gets a handheld POCUS machine, a butterfly ultrasound, which connects to an iPad or a cell phone. So that means that I can do bedside ultrasounds for patients in a primary care setting and get information from a device. It's non-invasive; it's safe. It's not exposing them to radiation, but it can provide a ton of information for me, being able to check for abdominal aortic aneurysms, checking kidneys for cysts, and checking even cardiac function. And so it has this ability to be integrated and limit maybe some referrals that are unnecessary to specialists, but also allowing primary care providers to do more.

I mentioned PRP, which is plasma-rich platelet injections that family medicine doctors can be trained to do for joint injections for people with severe osteoarthritis who are not surgical candidates. And so that is something you can do in the office, again, not to emphasize the financial side, but it generates a lot of money, and it really provides a really innovative way for people to treat a diagnosis when they aren't a candidate for surgery because of X, Y, Z, different conditions.

And then I think there's just the basics: take out your stethoscope and do the basics, and take care of our patients in preventative medicine, which means people live longer.

The point-of-care ultrasound is an ultrasound that can check people's kidneys or various organs.

So, the POCUS or point of care ultrasound is that. It's called a butterfly. It's a handheld ultrasound. I really would love to see ultrasound education in med school because I just think it's great for teaching anatomy, but it's a great bedside thing that, again, it's not invasive. It's not exposing people to radiation, but it is a handheld ultrasound, and then it connects to an iPad or a phone, so that's your screen, and you can check literally anything. You can use it to do better IV insertions. You can use it for abscess drainage, but you can also use it to look at specific organs.

 That’s amazing.

It has a ton of functions.

I know that normally if you have to go for any kind of ultrasound, you have to go to a radiology center, and that's a separate appointment, separate copayment. And also, especially for more elderly people who have mobility issues, they have to get to the radiology place to do that. That's a really exciting and useful new tool for primary care doctors.

You can use it to rule out DVTs quickly in the office. I mean, the capacity is really endless. And I'm going to get one for free at my new residency program.

Dr. Nicole Outten '25 outside Alice Tully Hall at Lincoln Center in New York City on June 25, 2025, just before the graduation ceremony. Photo: Andre Bolourian. 

Benefits of primary care as a specialty

Is there anything else you want to say?

Just to reiterate that, don't turn your back on it [primary care]. If there's a question at all, whether or not you're considering family medicine or a primary care specialty, use your elective time strategically to really find out if there's an area of family medicine that you like, and just keep an open mind that there are a lot of possibilities within family medicine.

I think the other thing that's important, as a physician assistant, is the luxury of I don't have to be board-certified as a PA in any specific specialty. So tomorrow I want to do dermatology, the next day cardiology, you have that flexibility. The same applies to family medicine. And so once you become a doctor and you're board-certified in XYZ, you're kind of stuck in that place. But in family medicine, if you're board-certified, you can go anywhere and do anything. And there are tons of fellowships for people who want to get a bit more specialized within family medicine.

I think if I'm talking to students, it's just, don't get discouraged. I had moments of doubt and times where I would get discouraged or I'd want to give up, but you have to go back to the reason why you chose to do this in the first place and why you chose UMHS. Whether UMHS was out of the convenience of location, UMHS was convenient in cost. UMHS was the only place that accepted you or whatever. Or, UMHS was where your family graduated from. Whatever the reason, you have to go back to the reasons why you're at UMHS and why you're studying medicine, and those are the things that will bring you sort of back into your base and say, okay, I can keep going because of these reasons. This is why I'm here, and this is why I'm doing it.

Email Dr. Nicole Outten at 4Outten@gmail.com

(Top photo): Dr. Nicole Outten at UMHS graduation in New York City on June 6, 2025. Photo: Andre Bolourian.