Maddie Turner
Rice University
Houston (29.7° N, 95.3° W)

featuring Rachel Solnick, Emergency Medicine Physician and Healthcare Research Fellow, University of Michigan, Ann Arbor (42.2° N, 83.7° W)

Dr. Rachel Solnick combines the high-adrenaline world of emergency medicine with the thoughtful consideration of health policy research.

Dr. Rachel Solnick is an emergency medicine physician and healthcare research fellow in the National Clinician Scholars Program at the University of Michigan. She graduated from Rice University in 2010 with a triple major in psychology, policy studies, and film. I was able to interview Rachel—who is currently based in Ann Arbor, Michigan—from Rice University’s campus in Houston, Texas. During our conversation, we discussed her experiences in medical school and residency, her decision to go into academia, and how she is bringing her research into her work as a physician.

Growing up in Washington, DC, Rachel had frequent exposure to the world of public policy, and she cultivated this interest through participation in student government. Her time in college allowed her to continue exploring the intersection of society and medicine: after receiving a foreign studies grant through Rice, she earned her master’s degree in social epidemiology in London before going on to medical school at Baylor. During her residency at Yale New Haven Hospital, she participated in a policy fellowship on Capitol Hill that allowed her to engage with debates surrounding health reform. Following residency, she decided to continue the work that she started during her master’s degree by pursuing a research fellowship and studying nationwide trends in cost, quality, and utilization of emergency medicine, specifically in reproductive and maternal healthcare.

As an attending in emergency medicine, Rachel works emergency department shifts in which she sees patients one-on-one and manages their course of treatment. She chose emergency medicine specifically because it gives her the opportunity to support a diverse range of patient presentations instead of focusing on a specific organ or body system. She explained, “You see everyone at the worst moments of their lives and through all segments of society…I liked that as a way to have a pulse on what was going on in the health of my community.” In addition to direct patient care, she takes classes on health policy, research methods, and experimental design with a cohort of students and applies those skills to her own research in reproductive and maternal health. Specifically, she wants to identify aspects of maternal healthcare that could be improved to reduce maternal morbidity and to provide access to long-acting reversible contraceptives through emergency room care.

Instead of entering a medical practice directly after residency, Rachel chose to go into academics in order to make a lasting impact on the structure of US health policy. She has the chance to work one-on-one with patients while simultaneously conducting population-based studies in emergency department care, giving her a unique combination of both microscopic and macroscopic perspectives on community health. For me, one of the big takeaways from the interview is that there is no single path to success through medical school and residency. Pursuing experiences related to your own personal interests gives you perspectives in multiple fields that other people do not have. In Rachel’s case, she brings her expertise in emergency medicine to the world of health policy, allowing her to address, at the government level, problems about the accessibility of healthcare, without losing sight of the people and communities at stake.

Although medical school was a big commitment, Rachel reflected that her clinical experience has affected her research and opened so many doors for her career. She told me, “It does bring a different lifetime of experiences to those questions that, I think, can really alter the research directions, the questions that we ask in general, the perspectives that we take. It’s undeniably going to be different for people who are not in a clinical setting.” She encourages students interested in medicine and healthcare to reach out and shadow medical professionals because hands-on experience is the best way to discover what you enjoy. I think that many students do not realize that there is such a diverse range of career paths available in the medical field; my interview with Rachel showed me that combining your interests in new ways gives you a unique skill set and allows you to better advocate for the causes that you believe in.

Highlights from the interview:

How did you got interested in your field?

When I first applied to Rice [University], it was the beginning of the path because I was a senior in high school, and Rice was like, “Hey, we’re going to accept you. But, also, if you’re interested, you can apply to medical school right now.” I said, “What?” That was not in my radar as something that was an option. I didn’t know that there were programs that had this joint acceptance, but it was actually a really easy application. I thought, well yeah, I have thought about being a doctor for a long time, so I might as well apply now. So along with the Rice offer came also an offer for Baylor College of Medicine. So, I was lucky enough to be on this path towards medicine…for essentially most of my adult life.

But I have always been interested in the intersection of society and medicine, and I’ve continued to pursue that throughout Rice. At Rice, I triple majored in all things not biology, essentially. I did psychology, policy studies, and film. So what I loved about Rice was that it gave me the option to do all these other interests that I had that were not directly related to [medicine]…From Rice—again, this is a very Rice specific, I’m trying to do that since I know you’re at Rice—Rice…really opens up the door to a number of opportunities you might not even realize are out there. They had a grant for a foreign studies opportunity after Rice…and I only found out about this from the people who were helping to judge the grant. But somebody told me about social epidemiology as a field to study. Prior to that, I had public health as a thing on my radar, but social epidemiology was a new thing for me. Once I learned about it, I felt like, yeah, this is something I’ve been interested in for a long time…essentially using science and different data methods to explain and help identify a number of the social causes for diseases.

I did a master’s program for a year in London with Rice’s help prior to going back to med school, where it was back to the grind, in a way. But I also, as a med student, had a lot of opportunities to get involved with physician organizations through the American Medical Association because that group was really good about giving avenues for leadership development and for getting involved in issues that doctor groups care about from a wider perspective. That also helped me realize that I really love working in organizations with other people and getting to work on projects, as a nice adjunct to the one-on-one of patient care. So, I ended up going into emergency medicine for my residency because it was the one that really clicked with me in terms of a professional standpoint. It was the interface with all variations of life out in the public. It wasn’t just you see this specific person because you’re a bone doctor, or you’re a plastic surgeon. It’s like you see everybody at the worst time of their lives and through all segments of society. So, I liked that as a way to have a pulse on what was going on in the health of my community, essentially.

I did an emergency medicine residency at Yale following med school, and while I was doing that, I was also still involved with physician organizations, this time through my specialty organization…which was the Emergency Medicine Residents’ Association. So that was a really unique opportunity to then explore what I was mentioning earlier, interest in health policy. And through that, getting again to work with a national selection of really motivated residents from around the country to advocate for things that we cared about. At that time, when I was in that position, there was also the most recent iteration of health reform debates. I know there’s always health reform debates. This was when they were trying to do the big GOP overhaul of the Affordable Care Act. So that was an exciting time to really delve into the issues and figure out, more from a structural and policy regulation standpoint, of how health delivery happens in the US.

And from there, finishing up residency, I was thinking about, well, what’s my next step? And this was…really challenging and continues to be a little bit of a tricky crossroads. The thing about going into medicine is that there are a number of different big decisions that continually happen every four years. And I was [thinking to myself]…you know you could just go into the community…as an emergency medicine doctor, and half of my co-residents did that…or you can switch into a different path and go into academics, which is where I’m at now, because I was really interested in what I had begun to do when I did my master’s in London. I wanted to delve a little bit more into that from a…more narrow perspective of emergency medicine as a way to hone those skills so I could make more…policy impacts, hopefully, in the future. And in terms of next steps from here…there’s two major options that people go from a fellowship like this, which is either into academics, where you’re looking for…funding, which is usually NIH funding, some way to support your research, which is health services research while you’re also doing shifts. Or, I’ve known a lot of people who, through this program, have gone more into the policy world or like a governmental world…So it’s still a work in progress, when I’m finally not a student anymore, what I’m actually going to do, but having done all of this education really does open up a lot of doors to different opportunities to really make a great impact both in…still getting to be a doctor one-on-one with patients, but also [on a] more population-based level, too.

I think a lot of people think that choosing to go to med school closes a lot of doors because it takes so long. It’s a really big commitment. But it sounds like it has actually opened up doors for you to pursue your other interests in health policy and things like that.

I really encourage everybody at that stage to continue to look around. I think what this project is doing is awesome because there are so many ways into what I want to do. My route is just one of them. I’m not going to say for 100 percent—I’m just being honest—that I needed to have done medical school and residency to inform the work that I wanted to do, because I’ve seen people in these positions who are MPHs or nurses. But it does bring a different lifetime of experiences to those questions that, I think, can really alter the research directions, the questions that we ask in general, the perspectives that we take. It’s undeniably going to be different for people who are not in a clinical setting.

You said that you knew you wanted to be a doctor for a while. Do you remember when you first saw yourself or envisioned yourself being a doctor? Did you also always know you were interested in health policy, or did that come later?

I think it was always both. I was one of those kids that was always interested in student government and the idea that people who organize and try to structurally address problems would have a lot more success than people mumbling about how the status quo is. So, I’ve always had a policy mindset…but I also have really been interested in science and just fascinated by the human body. So, I’ve been so, admittedly, very lucky to be able to pursue both of these interests for the entirety of my life, essentially.

During your time at Rice, did you have any doubts about whether that was still the path you wanted to go on when you were exploring all these new things, like majoring in film and so many other majors as well? Or did it just cement your feeling that you wanted to go to med school?

It’s a great question because it’s so hard to know what a day in the life of a doctor is unless you actually shadowed. So, I would encourage people who are interested in medicine to spend some time in whatever specialty they think they’re interested in. People would totally be happy to let undergrads shadow. When I was at the Yale emergency room, we would have undergrads coming in, and fairly often they’d have to get some approval for it. But I think that is…you can’t really explain what it’s like unless you’re there….I didn’t actually do that much when I was at Rice because it was something that was always there for me. I think more of what I was doing was seeing if there was something else out there that I could not live without. And these are things I did at Rice, I liked them, but I’m happy to pursue those things outside of my professional career, and still keep it an important part of my life, and not something that is what my job is going to be.

What does a typical day look like for you? Going through med school and being a fellow.

Med school is rough. Personally, I felt like it was rough because of how it’s designed. The medical world, similar to the academic grad school world, is structured in a very hierarchical way, where the people at the bottom of the hierarchy, which is either the master’s students or grad students, are really oftentimes…It’s a stressful place to be, existentially, because you don’t have a job. You’re spending a whole bunch of money to be there. The med school wants you to do well, but ultimately, you are responsible for…everything that happens to you. There’s a lot of stress. Also, further complicating it, as a med student, you don’t have any final decision role to play. So, there’s a lot of those things going into it.

But on the flip side, as a med student, it’s the time in your life where you’re going to have the most freedom of learning. Not really time, because med students are really busy, but people are there to teach you. As a resident, as an attending…if I want to learn something, that’s on my own time now. Whereas a med student it’s like, “Oh yes, med students come learn. I have this interesting patient. You are here to learn.” So that was an awesome thing about being a med student. It was very busy. The first two years of med school are spent—or it’s a year and half—spent in classes, basic sciences. I never even took biochem at Rice, so I was learning that. Sort of all basic things you need to be a doctor—anatomy, a cadaver lab, those sort of things. A lot of PowerPoints and a lot of what’s common now is to just watch the streamed lectures. Some people went to class, but other than that, it was stream lectures, take the test…That was the first two years, and then after that, you go into rotations as a med student where you’ll have two weeks, up to two months, on different kind of services. There’s a core of services that everyone has to do, and then you have to choose different electives. That was a hugely different way of life than, obviously, just being a student. It was a lot of fun. Just get to see what you might be interested in going into for residency.

And then residency applications…a match system, which is interesting. You just put your application out there and apply to as many places as you want, essentially, spend a lot of money, and go and do all these interviews. And then you find out where you match. And then residency begins, where it’s very different depending on what specialty you go into, like how intense it is…That being said, every resident is working a whole bunch. And that’s also punctuated by weekly educational activities, too, so it isn’t all about patient care and services. It’s still educational. And what’s cool about residency for most residents I know is that there’s such camaraderie between you and the class of coresidents you’re entering with. That was one of my favorite things about residency was the 14 other residents I was with…In this whole saga of medical education…there is so much movement between one location to another to another, so it’s amazing to go to a whole new city, and state, and region of the country, and to have this built-in residency family, and the residency leadership who is there to make sure they’re invested in you as their residents to make sure that they make you a good doctor. So I felt like there was actually a little bit of a transition from med school, where you’re just like one of very many and you hope that you can make it—people care about you, but also you really need to make it—to this is your residency family. And we’re all going to become good doctors together while we’re busting our balls and working really hard for all these patients we have to see.

A day in the life of an ER resident is basically—you go to your shifts, they start exactly when they start, they end sort of maybe when they should end, and you just see a bunch of patients the whole shift through. And that can be of varying activities in the ER. Sometimes, depending on how the emergency department is set up, there are the lower acuity side versus your very critical care side where you’ll also be getting patients from traumas that are happening on highways or assaults or falls. And then, also, your critical medical patients who are coming in short of breath or having abdominal catastrophes, all sorts of things. So it’s a very frenetic, fast-paced environment, being in the ER.

A day in the life of research fellowship. So now I’m sort of entering back into where I was in between Rice and Baylor College of Medicine, where part of this research fellowship is to get another master’s. So, three days out of the week, I’m in a classroom in a cohort of people taking classes on research design, methods, health policy in the US. And the other part of the time is spent…I work one day a week in the ER where I’m now attending. I’m no longer a fellow, so I get to be the one that makes the last call on a lot of these decisions…I’m mostly just agreeing with plans or changing plans where I feel like it’s appropriate….And then the other part, of course, is doing the research that I’m here to do, which for me, right now, I am developing a niche within emergency medicine in terms of reproductive health and maternity health. So, I’m looking into the big national datasets that we have to try to extract out—identify points in maternity health care that we could potentially be doing better. Like, if we’re dropping the ball on anything that can try to help improve US maternal morbidity and mortality, as well as other factors of reproductive health care.

How do you feel that science and technology is reshaping the medical field—and even the research field as well? Do you foresee any big changes in the work that you’re doing based on that development? 

Telehealth seems to be the next trending thing in medicine, just as a delivery tool, because access is one of the major issues that we deal with. Semi-related to that would be, I would say, improvements in how electronic medical records can help us better treat patients. So a lot of the interventions that people do research on—how/when you use clinical decision support—those sort of tools that can help physicians by extracting data in the background to nudge us one direction or to flag certain things that we might not see otherwise. So I like to almost think about these ways to get the EMR, electronic medical records, to work for us as almost an augmented brain. And I’m hopeful, because of all the billions of dollars that US health care has poured into electronic medical records, that we can actually get some patient benefit out of it in the future. So that’s another way. So semi-related to that, too, there’s been a bit more interest that has, at least, come on my radar now…ways that we can use machine learning to try to predict risk factors, trends in patients’ health…to either identify who is going to have bad things happen to them or who is going to be good candidates for certain kind of interventions or pharmaceuticals. 

There’s some really cool things being done for pathology and radiology—having trained machine learning algorithms try to detect problems in different diagnostic images to help flag the radiologist into…they are just always being flooded with images to look at. But to help assist them in making sure that they don’t miss things. For instance, for pulmonary embolism, that’s actually something that they were using at Yale. It would re-sort which patients [were] going to be at the top of their queue by way of—in the background being like, “I’m going to flag this because it looks a little bit suspicious for pulmonary embolisms. Maybe the physician should look at that next.” I would love to see how that could happen in the more clinical, direct, patient care world. For images, it’s easy, it’s like, “I’m going to look at this static thing,” but for the very dynamic world of the emergency departments, I know people are trying to develop things like that, that are taking combinations of information from telemetry, from heart rate variability, to also help us with the more patient, direct care atmosphere. 

Is there anything I didn’t ask you that you wanted to mention or any advice that you’d have for a student interested in med school or emergency medicine or research? 

I think really—and this is advice that has been given to me as well—it’s what you’re doing…reaching out to people. People are always happy to talk about their story if they feel like it’s going to help somebody develop their own path. I wouldn’t hesitate to do that. So that’s one thing. I know that I have, and maybe I didn’t actually intend to, but I’ve pointed out a lot of the drawbacks to the path that I have taken, but I’ve also—just being semi-familiar with some literature that shows that underrepresented minorities or lower-income students might be less likely to pursue these fields, just because of awareness of the debt that they have to take to do that. I want to just highlight that because I think that awareness is important. A big problem with American medicine is its lack of socioeconomic diversity as a major thing. And it’s tough going that much into debt, but doctors in America, at least in the foreseeable future, are still going to make a lot of money, and I would hope that we can make sure that the debt alone is not a reason that people from diverse backgrounds are not applying into this field.

Interview excerpts have been lightly edited for clarity and readability and approved by the interviewee.