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How did you first get interested in science?
My first life was in the music business. I've always liked science since I was a little kid, but I got into the music thing having a parent, my mother, who was an artist and musician. I trained in classic bass guitar my first two years of undergraduate education. That's what I was focused on because my original foray into organic chemistry wasn't exactly the most pleasant and positive experience.
I went out to Berkeley and did the pre-med but finished with my undergraduate degree in psychology and a minor in music/mass communications. I went from the playing part to the engineering business/ recording part. By the time I graduated from Cal I had a Friday radio show on a Jazz station, I was program director at UC Berkeley's radio station, I was spinning records at clubs, I did the booking and promoting at the UC Berkeley jazz festival. I felt I could do both, at least for the time being, so when I went out there I felt I wanted to go to medical school because I thought that was going to be the career thing.
So I applied my first year after graduating, and I think the combination of 'are you really serious about this stuff?' and I had a good gpa but I didn't do the greatest on the MCATs because I'm not one of those superlative standardized test takers- I have, this is my excuse, I call it 'adult attention deficit disorder', in that I get easily distracted by the a, b, c, d choices, and I tend to second-guess myself. Thank God my son hasn't inherited that- my daughter may have.
I didn't study for the MCATs- I figured that I had done all my pre-med requirements in the last two years, so it's all fresh. That didn't work- so then I worked in a lab for a year and a half, still did my music thing on the side- and I kind of felt that was my primary activity. The lab was just to say: 'OK, look, guys, I am going to really do this thing'- and I actually ended up getting a few publications. I re-took the MCATs after Mr. Stanley Kaplan- not that that taught me anything more. What it did teach me was test-taking technique. I think that's what all those courses do. Those graduate-level tests are only about half knowledge- the rest is just how well you take tests.
There are some people who do well at those- but I've always had to struggle with them. I could always blow away a test given at the end of a course, and that happened in medical school too.
I started medical school in '83, after working that year and a half, and I worked all the way through my undergraduate education as well. I was part of the pdp program at Berkeley- which is for minority students and underprivileged students. They had a summer program for high school students in the Bay area, and then they had a tutoring program for students in the sciences; engineering and premed. I tutored in organic chemistry.
By the time I left the bay area- I probably did most of the music at the majority all of the east bay and most of the north bay high school proms. This was in '82 and '3. It was funny because all the faculty who had some involvement with the kids in setting up the proms, would say: 'oh man, the DJ's cool, everybody knows him- and he's going to medical school- he'll be great to talk to the kids.'
Then I went back to the east coast, to D.C., because all of my family is from the East Coast originally, to George Washington. I picked George Washington because the second time around I got in pretty much everywhere I applied to- I picked George Washington partly because it had a very diverse class. The mean age was almost 28. We had a guy who is now an orthopedic surgeon who was a fourth-string tackle for the Dallas Cowboys, a couple pharmacology/physiology professors, and one woman who was 45 who had been a pre-med counselor at the University of Pittsburgh for twenty years and then she said: 'geez, I'm telling all these young kids how to do it- I need to do it myself.'
It was an interesting class. I kept doing my music thing, in terms of working clubs and stuff like that, all the way through my residency, which I did down here. When I went up to Toronto things kind of slowed down. I came to Atlanta to do residency- so I was here at Emory '87 to '90, and then I went to Toronto for fellowship training, at the hospital for sick children, in pediatric GI.
I think part of the reason I went into medicine is that I like science- I've always been interested in that kind of thing, and I like working with people, I like being challenged, and I thought, although I was very busy and I enjoyed doing the music thing, I wasn't getting pushed up here. [points to head] That was why I never saw it as a career- I have to be juggling five balls at once to feel like I'm being stimulated, and I didn't think I was getting what I needed in terms of intellectual challenge, so that's another reason why medical school.
In pediatrics, one of the things I try to tell medical students when they're trying to decide- and I have advisees at Emory, I'm an adjunct member for the admissions committee, so I interview applicants. It's funny, because someone working in one of my labs, an undergrad at Emory, started to write her personal statement, and she said: 'do you have any tips?' And I said: 'Be honest, be yourself, and it's the hardest piece of writing you'll probably ever have to do.' I had a real hard time, especially having done these really different things in my life. That was tough, because you have to put you on paper, in an 8 by 11 box. Now, sitting across the table from this side, when I read those things, you can tell who isn't totally frank. I feel like, c'mon, I'm not too far from where you are, give me a break- what do you really mean? And you didn't want to be a doctor ever since you were two months of age.
I should say this- and this may help the pre-meds out there. A lot of what pre-med and med-school students are forced to do once you get into that med track is based on sheer ignorance. Let me qualify that: If you think about it, when you are an undergrad, when do you have to apply for medical school? In your junior year. For a lot of people, you might be 21, you're barely out of high school, you haven't lived, and all of a sudden you're committing yourself to a year-long process where you're then supposed to tell people this is what you want to do for the rest of your life. So it's not based on experience- it's based on what you think you might want to do. Then, when you get into medical school, when do you have to start applying for residency? Third year. For a lot of people, they haven't gone through all their core rotations- and now you've got to decide what it is you really want to do for the rest of your life. So if you decide that you want to do a sub-specialty, so I did a three-year residency in pediatric GI, you have to apply for fellowship training during you second year of residency, if you want to get into a good program.
So again, you haven't gone through all your core components of pediatrics, so again you've got to make a decision based on no experience. And it doesn't stop- because once you're in your fellowship, if you want to do academic medicine, you've really got to start applying for jobs during your second year. If you want to do research, a lot of people have to start applying for funding in the second year of fellowship.
I don't say this to discourage people, but to give perspective- we're asked to make a whole lot of very important decisions that impact on you for the rest of your life based on no experience whatsoever. At least the Clinton administration helped those of us who have loan debts recoup some of that- but it's not a cheap process. Unless you know you've got a parent who's a sheik and lives in Saudi Arabia and can pay them in cash- you're talking minimum graduating loan debt, coming from medical school, of about a hundred thousand. At Emory, you talk to some of the students who finished here, and, I mean, it's a second mortgage I'm paying for the rest of my life.
Would I do it differently? No, because I love what I do. But at least I lived a little bit and I had mentors and teachers I turned to along the way, and I think that's the most important thing. One of the things I ask, which we don't get taught a lot about, but when I'm doing medical school interviews or even people who are thinking about medical school, I ask 'who are your mentors? Who do you look up to, talk to?' It doesn't have to be a literal mentor, but you go through life and you meet people who tell you what to do or help you shape what you are and what you do.
In my stage right now, I still have people I call my mentors. They are mentors to me in different areas of my life- you can have personal mentors, mentors who are professional, and they know you in different ways, but all of them together help you steer.
I'm one of those people who will sometimes do things impulsively, but for the most part, when it comes to life-decisions, I like to have experienced it or at least talked to as many people as I can run my mouth to, and hear them run their mouths about what they do about whether they like it or whether they don't.
There are a lot of my colleagues who aren't very happy about what they do, but that's probably because they didn't think too hard about what they were doing when they were doing it. And medicine has changed- from when I was in medical school in the 80's to now. It's changed- the pressures are very different. I think, because I'm one of those eternal optimists, that it's going to get better. But I think that you have to be flexible and you have to be able to deal and handle all the things that are going to happen.
So, multiple factors led to my decision to go into medicine. I had a ball in medical school- it was tough, and I busted my butt, but I also had an outside life, did other things as well. I know a lot of people in my class, when I graduated, said that I lived two lives, because I'd be studying in the library until 11:00 on Friday nights, and then when they library shut down I was in the club working, because I had to work. I did it Friday and Saturday nights, year-round.
I love what I do, but when I talk to undergrads or residents, even, you learn a lot of stuff along the way- book stuff. But it doesn't teach you common sense and it doesn't teach you how to apply it. When you finish your pediatric residency, you can take care of a whole lot of very different disorders and a whole lot of very sick kids, but do you know how to change a diaper, or what to do when your own kid is crying? Now- it doesn't teach you practical issues.
It's funny, because I almost think that it would have been nice to have a child before I started residency, because I would have appreciated some more of the anxieties and concerns of parents coming in. That gets back to the issue that we decide a lot before we've had the experience- so we don't have a context in which to put these children.
I think there are some people who are extremely mature at a very early age and very goal-oriented. And for reasons that I don't think anybody will ever be able to explain, these people have common sense and practical skills. So, for some people, they can go through the program the way it is. But I think a lot of us need some ups and downs and some rocky trails- it's important to do that, because, in the end, this is a tremendous commitment.
When my wife and I were thinking about getting married, one of her first reality checks was, 'god, everything you do is planned out in these three and four and five-year blocks,' and even thinking about when we would have kids fell under that. I think medicine almost forces you to do that. Once you get into it, the work never stops. It will always be there, so you have to live kind-of rationalizing the fact that you can't always clear your desk every day. There are always going to be patients, if you're solely clinical, and if you're in academics you've got to juggle even more than that. There are always people who are going to need your attention. So if you want a life you're going to have to be able to say, 'y'know, there are other things to do.'
It's one of the other reasons that I'm in academic medicine, because I have a life. I want to be a parent- I mean, you can see what my walls are decorated with. [gestures to walls full of crayon drawings drawn by his children] My parents divorced before I was ten, so I didn't really have a father-figure in my house. So, for my Christopher, I want him to know me.
So if they've got a program at school, at least this job allows me a little flexibility- if I were at another job, I would still find a way to get there. I have my one clinic day, and it's chock-full on Fridays. And because I only have my one clinic day on Friday, if I cancel a clinic it's a domino effect in terms of putting patients back. I think, on the whole, it would probably be better if people took some time [before going to medical school.]
I think particularly for the thing that I do, being a clinician-scientist, we are at a disadvantage to the Ph.D.'s. There is all t his rivalry between Ph.D.'s and M.D.'s, and I'm one of those people who thinks that there are always ways to work with other folks. Society and the institution itself has, I think, set up a lot of that animosity. For instance, the NIH will routinely fund an M.D. at a higher dollar rate than it will fund a Ph.D. Part of their rationale is the idea that the M.D. is going to take it back to the bedside, whereas the Ph.D. can't. But I think there's benefits to working together.
The Ph.D., by the time they get to my level, or even when they start as an assistant professor, has worked on their Ph.D. for five to seven years, has done one, probably two post-docs, and then come on as faculty. That's a tremendous amount of experience, time, and skill development in terms of their area of research, that a Joe like I, who has come out of four years of medical school Ðand it's a professional training; it's a skill- and medical-school residencies don't teach you how to think critically, and that's what fellowship teaches you how to do. And we come out of fellowship with three years of fellowship training, and only two of that, and most of them don't even have two years, despite what the boards say, have two years of research.
So this is someone who is coming in as an assistant professor and is supposed to be able to balance seeing patients, teaching, and get funded and run a research program with only two years under their belt versus the guy who has had five to seven as a Ph.D. and one or two 2-3 year post-docs, and then come in. There are lots of interesting things that the institution creates. It would enhance somebody if they spent a little extra time, either after undergrad or when they got a graduate degree or whenever, if they're thinking along that path, at least to live so that they know that this is something that they're going to be committing their lives to.
These colleagues of yours who are unhappy in their careers- why do you think that is?
I think that there are multiple reasons. I think that there are those who are unhappy because they probably didn't think a lot in terms of why they went in what they went into. I think the majority of people in medicine are unhappy because, well, because everyone's got different thresholds in terms of handling change, and change can be very anxiety-provoking. Medicine right now is in a tremendous dynamic place.
The security that you used to feel when you had an M.D. behind your name- ain't there anymore. That's why the AMA is talking about unionizing. Because it's not the last bastion of, once you've finished residency and you're in practice, you're fine.
We have to be held accountable like everybody else does. And then there a lot of things that relate to the dollar. It happens in academics and happens in private practice, where we have to acquire additional skills and knowledge to do what we have to do. For a lot of the older generation, it's hard.
That's why, for instance, the highest number of enrollees in the executive MBA program here at Emory are M.D.'s. It's not necessarily that they are doing it to add some credentials to their name- they're doing it because they have to understand all the nuances that are out there. I just talked to an old friend who had a life similar to mine- we used to DJ at a lot of parties together. He went to Hopkins and did his M.P.H. there as a pediatrician. He did his fellowship at Harvard, was running a level two NICU, he was a neo-natologist, and now is completely out of it and is consulting.
He's loving what he does, but he took the last two years off and got his M.B.A. and now is in a consulting firm. I thought that was pretty impressive- because here was a guy who basically made it, had tremendous credentials, and decided to stop and go back, with additional loan debt because he went to business school.
I think that's the important thing to realize- is that there isn't one way to do it. Medical schools would like you to think that there is one way to do it, but there are lots of ways to do it and be successful.
What do you currently teach?
I give a few clinical correlation lectures. I'm going to be involved with June Scott in terms of some graduate courses in immunology and microbiology, but haven't been doing any formal teaching. I give standard lectures to the residents, and the clinical core lectures to the students, but don't actually teach an entire course.
The teaching is daily, but it's in lots of different contexts. I teach in clinic because I've got residents and medical students and sometimes pre-meds who just want to shadow me. Or when I'm in the hospital on service, my month on service at Egleston on the inpatient service, and I give core lectures to the residents. And teaching in my lab. So Pat Barnes, who is a SURE student this summer, when she's presenting her stuff, I use her as an example to talk to the rest of the lab, and I also teach her how to be critical of her results, how to design her next set of experiments, how to think about that sort of thing. Teaching is fun to me, and you can do it in lots of different contexts.
Talking about how I didn't follow the rules is teaching, in a way. I've never been accused of being P.C.
What would you change about the institutions in which you teach and work?
Traditions. I think there are too many traditions in medicine. When I matched at Emory in 1987, and they don't like me saying this too much, we did the worst that we've ever done in the department of pediatrics. There were only four of us that matched out of the 17 slots, out of first-year residents.
Matched is when you are applying to a residency out of a med-school program, the majority of the core residencies: O.B., surgery, emergency medicine, pediatrics, participate in a program called the national residency matching program. So what you do is, you put in your application, you've interviewed, and then you rank your programs from one to ten in terms of preference. Then you send that list to the NRMP- the National Residency Matching Program.
This year, for the first time, I was on the residency selection committee for the department, so I was able to see how we went through the process. We rank all the applicants that have come through here, and we send that in, and then the computer goes through an algorithm, and it favors the medical student, rising resident, and they go to their first choice and then they go to the program, and if there's a match, you are bound, legally, to go to that program.
We call it black Monday. It's always the third week in March. And on Monday, the dean of students at all the medical schools will get a list of all the graduating medical students who have not matched, who have not filled a position. So you have to be by your phone, wherever that is, by 6:30 that day. You shout if you don't get a phone call, because you matched. If you get a phone call, you've got to go to the Dean's office the next morning, and then he gets on the phone and he schmoozes his friends, to try to get them in.
It's even more difficult if you're a foreign medical graduate because they don't have a dean to do that sort of thing. The match is becoming more and more biased against foreign medical graduates. The bottom line is tradition- one of the reasons that Emory didn't fill that year is that residents were getting killed. They were on-call every third night, and they were leaving this program tired, bitter, and angry.
I was doing elective down here in adult G.I.- I was a fourth-year medical student, and I remember being steered away from certain residents who were on rotation, because they were so pissed off and angry, and they didn't want us to see them. So myself and a couple of other interns sat down at a computer and we completely revised the entire call schedule, showed that it could be done. The chiefs were very open to any type of change, as was the department chairman of the executive committee for the department, and the next year we started filling and it's been getting better ever since.
Tradition is good to understand history, but tradition that's not working needs to be changed. I think there are a lot of traditions in medical school. In medicine, you can see that there are certain personality types that go into different specialties. For instance you can see why surgeons went into surgery.
I think that there's still a lot of bias, still an old-boy's club in medicine. I think there are still a lot of people who would be phenomenal doctors, and whose communities need them to be physicians who can't become a physician, or don't have the access or the means because of the institution, and that needs to be changed.
But, for example, Dr. Robert Lee came on as the associate dean for minority affairs, and Emory's medical school's face has changed, which is nice, but ten years ago it wasn't that way.
I don't think that medicine understands cross-cultural way of healthcare practice- there are different cultures that look at their health and well-being in very different ways, and I don't think there's enough of that being taught to medical students. In Vietnam, your blood is your spirit, and if you draw even a drop, a finger-prick, part of your spirit has been taken from you.
And if you've got a sick kid in the emergency room whose parents are Vietnamese, first generation, and you know that kid needs to get labs drawn, you may not understand why they are objecting so vehemently to you doing something to their kid. So that's not taught very well.
There are a lot of people who said I was stupid to do the clinician-scientist thing because funding was supposedly tight. But I'm in a good area- health and human services wants to fund things addressing child health issues. The problem is that there aren't a lot of pediatricians in academic medicine who have had the training or the background to get funded, or even carry out the project once it's funded.
If I could change anything, it's getting the medical institution to realize that the care for children is much different from the care for an adult. And the majority of medical schools, and departments of pediatrics, unless they're really strongly affiliated, or integrated within a children's hospital as their cash source, then they get the kibble while everyone else gets the steak. And Emory is the same way- I think the department of pediatrics gets second-choice. That's why I've got one lab at the CDC and one lab at the VA.
I came to Emory with three quarters of a million bucks from the CDC to set up an anti-mircrobial resistance and surveillance lab for H. Pylori, which is the organism that I'm working with, and, well, they said: 'Great job- but we don't have space.' There are only two pediatric investigators who have space in what I call the high-rent district over in the Rollins building. Only two- and that's not good.
I feel that acutely as a pediatrician- they expect us to be the warm and fuzzies who don't fight for our rights, so we don't get certain things. We're not the big money-makers like the neurosurgeons or the cardio-thorassic surgeons, or the cardiologists.
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