The research-medicine-policy trifecta

Image by Vitaliy Strokous.

Image by Vitaliy Strokous.

Since my University of Washington General Internal Medicine job started a month ago, I have been loving my research assistant work. The studies – related to breast cancer and melanoma pathology, digital pathology slides, and patient access to electronic medical records – are inspiring. My day-to-day work is satisfying, and I am learning so much (both thematically and in terms of skills).

The Principal Investigator (PI) (my boss) is also inspiring, on a personal career path level for me. I have been trying to figure out for years just how much a person can do: can I develop and impact policy, work with patients as a clinician, and advance public health with research, or can I only do one or two of these things? I, of course, want everything. To me, the three can contribute to one another, enabling a life of health service. Here are some of the considerations:

  • Education: The degree options are MPH, MD, and PhD. Technically, other clinical degrees could also be useful, such as RN. With a MD by itself, I could practice medicine. With a PhD by itself, I could conduct research, teach, and/or contribute to policy. The MD/MPH combo would enable me to practice medicine, conduct research, contribute to public health policy, and teach (at least as a physician at a teaching hospital). The MD/PhD gives me similar work possibilities, perhaps with a larger emphasis on teaching and leadership (and definitely research). Of course, the financial and timeline impacts of these degrees are part of the equation; the MD is 4 years, the MPH is either 2 years by itself or 1 year when part of a MD-MPH dual degree program; the PhD is at least 3 years, if one already has a MPH/MS (or perhaps a MD?).
  • Level of analysis (individual vs. big picture) impact: As a physician, I would get to work directly with patients. In my prior one-on-one work, say with tutoring, I loved the satisfying feeling after a day of working with someone directly. Ideally, this is a feeling of satisfaction at having helped, but sometimes a day goes by without solutions. Still, I felt gratified at the end of a day to have worked on a problem with someone, even if we didn’t achieve huge gains. Thus, I would love to work individually with people. Still, I would like to work to better health at a group level, to see benefits across larger numbers of people. That is where research and policy come in. The room for innovation, for asking population-wide questions and finding answers, can be found at this level.
  • Possible level of advancement in each arena: I am looking to go as far as possible in a career and to reach a decision-making level. The more I exposure I gain in my jobs and internships, the more it seems like those with either a PhD or a MD and MPH/PhD become team leaders and decision makers in public health and health care. It appears that a MPH by itself is not enough. The clinical and practical application knowledge gained through a MD and practicing medicine seem to be extremely useful for research and policy, enabling one to emphasize practical application in research designs and policy decisions. The PhD and MPH enable better population-level considerations and research designs.
  • Personal life: I plan to work in a field that I love – to generally be happy and/or satisfied with the work that I do each day. Still, I also plan to have a family (of some sort) and avocations. Ideally, I can combine some interests, like travel, with work. Still, it can be challenging to have a family when working at the international level on-site. It will also be challenging to sort out when to have a child in the education and career timeline that I face: 4 years of medical school and 2-5 years of MPH and/or PhD add up to 6-9 years of education. Thus, I will be finishing my education in my late 20s – early 30s. Then, for medicine, there is residency, at least an additional 3-7 years.

Education + residency (if applicable) timeline:
MD: 7-11 years
MPH: 2 years
PhD (without prior MPH): 5+ years
MPH/PhD: 5+ years
MD/MPH (assuming not combined program): 9-13 years
MD/PhD (assuming not combined program): 10-14+ years

Essentially, were I to have children and get a MD, I would have to do so during medical school, residency, and/or immediately after residency when starting a new position – busy busy!

It is easy to be daunted by these prospects. I had thought that perhaps one would have to confine work areas to different career stages – working for a few years as a physician, then as a researcher, then as a policymaker, or something to that effect. However, I have now met someone who “does it all” – she practices medicine, does massive amounts of research, contributes to policy, mentors, and has a family. My new boss has shown me that it is possible to navigate between the micro-level of patient care and the macro-levels of research and policy, all while having a life. I love that with university positions, one gets to add teaching into the mix. I also met a Reed alumna at Working Weekend, a Reed networking event, who does research, practices medicine, and has a family at UCSF. Clearly, research and practicing medicine can go together quite well, with some degree of policy work added in. I suspect it is a balancing act to add in policy work, though physicians can of course serve on various national and state policy-making committees. I suspect that the time spent on research vs. clinical work vs. policy making vs. teaching varies throughout the years, sometimes with more of one work type than another. Whether this research-policy-practice trifecta is possible at the global health level, I do not know, but at least I work daily with someone who does so at a national level.

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