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Ep 126: Tips on Science Funding, Communication, and AI (Listen)

Ecem Uluegeci
Harvard College
Boston (42.3° N, 71.0° W)

featuring Alican Ozkan, Postdoctoral Research Fellow, Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston (42.3° N, 71.0° W)

Many students go through the dilemma of choosing between the industry and academia especially as their graduation approaches. That was one of the highlights of my conversation with Dr. Alican Ozkan. I was especially excited about this interview because Dr. Ozkan is currently working at an institute that I have been following since I got interested in biotechnology.

Dr. Alican Ozkan is a post-doctoral research fellow at the Wyss Institute for Biologically Inspired Engineering, a cross-disciplinary research institute at Harvard University, which focuses on developing bioinspired materials and devices. He graduated from the Middle East Technical University – Northern Cyprus Campus, Turkey with a bachelor of science in mechanical engineering and received his master’s degree in mechanical engineering from Bilkent University, Turkey. He has recently obtained his PhD degree from the University of Texas at Austin. In our conversation, we talked about his research interests and what keeps him motivated to pursue them.

As a mechanical engineering student, he “did not have a lot of enthusiasm toward the incorporation of biology and [engineering]” before starting his PhD research. However, he still wanted to get out of his comfort zone and work on the technologies that can be applied to life sciences. In the first years of his PhD, he worked on the organ-on-a-chip concept in collaboration with the University of Texas MD Anderson Cancer Center and Dell Medical School. At Wyss, he is currently working on increasing the cellular complexity of these devices as well as discovering the interaction between difference compartments of tissues.

Something that fascinates him in his current workplace is having a team of diverse engineers, molecular biologists, and clinicians collaborating on the same project. He believes this makes the Wyss Institute a special research center, which brings people from different backgrounds working on the same problem while looking at it from various angles.

To him, academia provides enormous amounts of flexibility to pursue one’s interests. Being able to work on the scientific questions that he wants to find answers to is a great motivation source for him. I always thought one of the challenges of being in academia is keeping yourself motivated to do research on the same subject for a long period. Seeing the potential applications of his research keeps Dr. Ozkan motivated because he believes that his research will help improve the treatments of various diseases.

Dr. Ozkan’s advice to the undergraduate students interested in staying in academia is for them to experience what research is like as early as possible; if possible, during their undergraduate studies. He thinks that getting a master’s degree facilitates the transition from undergraduate to postgraduate research for those who plan to stay in academia or those who are uncertain about their future plans. He encourages students to get involved in the grant writing process and publishing papers at the early stages of their academic careers. Finally, he emphasizes the importance of finding self-motivation to pursue their research interests to overcome the challenges that they might face during their careers in academia.

Highlights from the interview:

Everyone’s family, their community, and their life circumstances create an initial role for them in society. What was expected of you and how did those expectations shape you into choosing your current career?

My parents are both chemical engineers in Turkey. My mom was in academia, and my dad worked in the industry. Becoming an engineer was never forced on me, but my strong interest in mathematics and physics led me to study mechanical engineering. However, I would like to note that my parents have always been supportive of me and have motivated to improve myself scientifically.

What led you to your current position as a researcher? And what does this position entail?

Ever since I started my doctoral studies, I have always wanted to collaborate more frequently with clinicians and life scientists. In the first years of my PhD work, we were making these devices called Organ-on-a-chip at the University of Texas at Austin. Our progress on the engineering side in the first years of our work helped us set up a collaboration with the University of Texas MD Anderson Cancer Center and Dell Medical School for our devices to be used as preclinical tools. In my current work at the Wyss Institute for Biologically Inspired Engineering, we have direct access to patient biopsies that can be incorporated into our microfluidic models and devices. These models reveal findings that conventional systems cannot, help us make a diagnosis and come up with new pathways and solutions to prevalent diseases.

Were you always interested in life sciences, or did you get interested later in your career?

Not in the first years of my academic career, but I later recognized the potential applications of microfluidics in the field of biology and this got me interested in life sciences. In my undergraduate years, I was working in the field of microfluidics, creating microscale channels that you can flow any kind of fluid like blood or cell culture media; or even water and air. Microscale channels have many different applications. I was using this technology to synthesize small nanoparticles that can be used for magnetic resonance imaging. But the major advantage of this technology was to create very fast reactions. In a batch, you can synthesize these nanoparticles in three days, but in these microfluidic channels, you can complete this process in just a few minutes as compared to hours. That’s a huge improvement. Microfluidics already has a lot of different applications; Organ-on-a-chip is one of them, circulation tumor cell isolation from blood and single-cell encapsulation and their genomic sequencing are other examples. I have always been interested in bio-related microfluidic approaches. Before starting my PhD studies, I did not have a lot of enthusiasm toward the incorporation of biology and [engineering], but I wanted to make another attempt in the biology field to get out of my comfort zone. Organ-on-a-chip is a perfect example of combining engineering and biology by incorporating blood flow or airwaves, airflow, and mechanical stretching motions, or even creating architectural complexity so that you can recapitulate complex disease models. I spent five years at the University of Texas at Austin, collaborating with MD Anderson, where we used patients’ cells provided by our clinical collaborators and incorporated them into our microfluidic devices and recapitulated the same disease model observed in humans. There’s a lot of new potential applications of these organ models as Organ-on-a-chip models. Right now, we are trying to increase the cellular complexity of these devices and are tuning the extracellular matrix that we put inside the Organ-on-a-chips. For instance, cancer has different stages, it progresses, and every patient is diagnosed at different stages. Some patients can be at the fibrotic or cirrhotic stage when the tumor tissue much stiffer than the earlier stages. The stiff tissue alters the chemoresistance of the cancer cells. We are able to calculate the stiffness factor so that we can incorporate this in our organ-on-a-chips and estimate the true response of the cancer cells to the chemotherapeutics. Stiffness not only controls chemoresistance but also alters the vascular barrier permeability, that controls the amount of nutrient and drug delivered to the tissue. We were able to capture this in my previous work as well.

What keeps you motivated about your work?

I think making a scientific discovery is the top one. Knowing that we might be one of the few labs that can make discoveries in these top-end engineered Organ-on-a-chips. Working with the actual biopsy samples to isolate cells, analyze extracellular matrix properties such as stiffness and components between different patients and to incorporate in our devices makes our work even more unique. These advances will improve treatments; we will get into more personalized treatments with these devices. That’s very motivating for me.

How did you decide to stay in academia instead of working in industry?

In academia, you have more flexibility on what you work on. I don’t have a lot of background in the industry; so, it might be wrong to make assumptions. However, in academia as long as you work on an issue that is of interest to you, and you are answering a novel, important, and impactful question, you can establish strong collaborations, get funding from large agencies and feed your enthusiasm to make a scientific discovery. When you have your own research lab, you can pursue your own research ideas and I think having that opportunity is invaluable.

How do you feel about the research funding process?

It is definitely concerning because if you don’t have any funding in your lab, then you cannot do any research. It’s the number one rule of the universities in the US. That’s something we need to swallow and keep working on because there are a lot of good researchers out there making a lot of progress in their work. It is a tedious progress, but the funding agencies don’t have unlimited resources to fund all the laboratories; they can only fund the most important projects that can answer the biggest and critical questions.

Do you think there are any misconceptions about your job, about being a researcher?

The most common misconception about people working in academia, especially in my home country, Turkey, is that academics work 40 hours per week. I don’t believe many people realize the extra work we put in our spare time, on holidays and weekends. I think academia is an underestimated field; people don’t see what goes on in the background, how much effort and time we’re putting in the laboratory, or how many nights we’re staying awake to solve the problems or to find reasonable explanations to the findings of our research and experiments.

Can you describe the team dynamics in your group in terms of structure, organization, and other characteristics?  

What fascinates me about my workplace is that there are clinicians, molecular biologists and engineers from different backgrounds collaborating on the same projects. Furthermore, these team members have also specialized in the disease model that they have been working on. That is to say, every research member has their different expertise and perspective on how to tackle the problems that we are facing. Moreover, occasionally these disease models are combined to investigate the biodistribution and interaction between different organs. That’s the biggest novelty of our work, which at the same time makes Wyss a top-notch research institution. For those who are interested, I would like to invite you to check out our website and publications.

What advice would you give a student interested in staying academia after college?

After college, getting a Master’s degree would be a good transition to academia. Students can always turn their master’s degree into a PhD then if they feel like the research is what they want to do, and they can continue to build their academic career. During their undergraduate years, younger researchers should get involved with the research activities of one, maybe more laboratories, participate in publishing papers, and have a sense of what the research environment is like, what kind of sacrifices you need to make a good scientific discovery or progress. Having an internship at different companies is also valuable; it helps them observe the differences between academia and the industry. I would definitely recommend for them to attend workshops on grant writing, take active roles in writing proposals, and apply for scholarships/fellowships. Applying for scholarships/fellowships is going to be really minor compared to these big grants, but still, it’s going to be a good learning process for them. Lastly, self-motivation is very important. Like I said, a big portion of the experiments we are running fail because they’re very novel; there will be some problems to troubleshoot, problems you have never faced before or anticipated because you’re doing those experiments for the first time. So, you will feel down a lot during your academic career, but you need to have the self-motivation to keep moving forward because without that, you will not be able to get into the lab, work hard to complete your project and make an impact.

Interview excerpts have been lightly edited for clarity and readability and approved by the interviewee. This article only aims to share personal opinions and learnings and does not constitute the interviewee’s current or former employer(s)’ position on any of the topics discussed.

Zehra Karakılıç
Tilburg University
Netherlands (51.5° N, 5.0° E)

featuring Julie Walker, Navigation Engineer, Intuitive, Sunnyvale (37.3° N, 122.0° W)

Shvetali Thatte
Case Western Reserve University
Cleveland (41.4° N, 81.6° W)

featuring Harrison Nguyen, Dermatology Resident, Emory University School of Medicine, Atlanta (33.7° N, 84.3° W)

In life, you should be in no rush. Sometimes, it’s easy to get caught up in the whirlwind of life, with the next step always coming before you’ve even put your first foot down. This is a reminder to explore all your options, to take the chances you might never have thought of, and to let yourself enjoy the journey instead of sprinting and missing the details just to get to the finish line first.

My conversation with Dr. Harrison Nguyen, a dermatology resident at Emory University School of Medicine, reminded me that every experience we have ultimately gives us a new skill set that will pay dividends in the future.

Dr. Harrison Nguyen began his journey to medicine when he was accepted to the BS/MD program at Rice University/Baylor College of Medicine. However, Dr. Nguyen’s journey was not limited to medicine; he also pursued research abroad, expanded his cultural horizons, explored the world of football in his undergraduate years, and pursued an MBA at Yale University between his third and fourth years of medical school.

Each summer during his undergraduate years, Dr. Nguyen committed himself to finding a new opportunity that would allow him to explore a different intersection of medicine, research, and service. From studying the healthcare system in Norway to conducting public health research in Vietnam and Greece, Dr. Nguyen had a plethora of cultural insights that he now sees himself applying as a practicing physician.

Dr. Nguyen was always certain that he wanted to be a doctor, and as he grew up, he found a natural love for science, the human body, and helping others. In his undergraduate years, he researched a virus that plays a role in 80% of aggressive skin cancer cases. From his laboratory experiences, his drive towards dermatology arose, and today, he continues his journey as a dermatology resident and the leader of the Health Policy Research Group for the American Academy of Dermatology.

As a future physician, I was curious about how Dr. Nguyen believes the medical field is changing, and he brought up a relevant conversation about physician burnout. Even before COVID-19 hit, many physicians were finding themselves exhausted with the patient load, combined with the increased paperwork from electronic medical records, but the pandemic has further exacerbated their concerns with the number of patients increasing and physicians being caught in difficult situations.

In his opinion, the most important way to prevent burnout, at any age or stage in your career in medicine, is to remind yourself why you chose medicine. Recognize why a career in medicine makes you happy, and make sure that you are constantly feeling that joy. Each individual has their own reasons for going into medicine, but as long as you stick to your own reasons and embrace them, you’ll find that medicine is a very rewarding career.

There’s no doubt that the use of technology in medicine has also grown in recent years. I sometimes worry that technology will replace healthcare professionals; however, Dr. Nguyen reminds us that no matter how many algorithms or robots are created to assist doctors, the foundation of medicine lies in humanity. The new tools can augment the physicians’ skills when caring for their patients, but they will not replace healthcare professionals. Medicine is an art and a science, and if you take the art of human connection away, you can no longer reap the same benefits.

Our discussion on the humanity of medicine was an excellent segue for me to ask Dr. Nguyen about a personal initiative that I have started this summer. The early part of my summer allowed me to read books that explored the intersection of culture and medicine, including Black Man in a White Coat and Racism in Healthcare: Alive and Well. After reading these books, I spoke to various physicians, medical students, and other healthcare professionals about their personal opinion on culture in medicine.

Based on these insights, my friends and I recently submitted a proposal to the Association of American Medical Colleges (AAMC) and various undergraduate institutions. We are asking for the AAMC to make cultural competency a pre-med course requisite, and we are asking individual undergraduate institutions to begin offering cultural competency courses at the undergraduate level. Our literature review, the proposals we’ve submitted, and our petition can be found at this link. 

On this topic, Dr. Nguyen’s comments were very encouraging:

“As a physician practicing in a multicultural hub, I see first-hand the powerful impact that cultural competence can have on understanding a patient’s disease experience and on partnering with patients to devise an optimal treatment plan.  Data have consistently shown that cultural gaps can drive significant health inequity and worse clinical outcomes, and I believe that it is of utmost importance for trainees at all levels to receive robust training in cultural competence.”

I feel very fortunate to have had such a multi-dimensional conversation with Dr. Nguyen, and I certainly have many takeaways that I will carry with me as I begin my own journey to medicine.

The theme that resonated most with me from our conversation was that there is no timeline for your life or your career. You determine what you do every day, every month, and every year, and the more passionately you pursue goals, the happier you will be. You can never connect the dots going forward, only backward. So, do what fulfills your passion now, and you’ll find a use for it in the future, maybe in a totally unexpected way.

Highlights from the interview

Could you talk about how your background prepared you for your career?

I grew up in Detroit as the only child of immigrant parents who came from Vietnam and started from the very bottom. I mention this because it is very much a guiding force in my life. I had a strict upbringing. My parents had always dreamed of themselves of being physicians, but they weren’t able to be doctors because of their own life challenges. In my earliest memories, I wanted to be a doctor without really understanding what that meant. But, as I started to get older, I noticed a natural affinity to science and knowing more about how the human body works. In high school, I applied to 13 colleges and eight combined medical programs and chose Rice University and Baylor College of Medicine because of my family and Rice being located in the largest Medical Center in the world. I knew I wanted to be a doctor, I knew I had guaranteed acceptance to medical school, but I didn’t know what to really do with myself. I started doing research as a freshman in college in the laboratory of a well-known investigative dermatologist specializing in oncogenesis. Just six months prior to my matriculation, an important paper was published in Science showing that Merkel Cell Carcinoma, a rare but very aggressive type of skin cancer, was caused by a virus in 80% of cases. So, I started doing research on this virus and growing my experience over the years. As I started to build my own reputation as a researcher, my mentor got me involved in clinical research as a consultant.

In college, I  wanted to see the world because growing up, I didn’t have that experience. So, every summer, I would try to take an internship abroad that integrated my interests in medicine and research & service. After the summer of my freshman year, I did public health research in Vietnam. After my sophomore year, I did research in Greece, and the after my junior year, I met Ipek Martinez. She was a great sponsor and supported my proposal to study the healthcare system in Norway. Norway’s healthcare system is radically different from ours. They have a socialized healthcare system where everyone has healthcare provided to them, and they have great outcomes for the most part. So, I wanted to understand more about this, and I spent my junior year abroad in Norway. It was a very formative experience for me as I started to see different drivers of health.

As I started to prepare for medical school, having that experience in Norway and also working with pharmaceutical companies in a more advisory consulting capacity, I began to think about pursuing supplemental education and training to my medical degree. So, I took the GMAT prior to starting medical school. I wanted to do an MBA between my third and fourth years in medical school. Baylor had a combined MD/MBA program with Rice, but I wanted to see something new and expand my network beyond Rice. I went to Yale University to get an MBA and MPH between my third and fourth years in medical school. Taking the time off from medicine to focus completely on building a skill set in finance, economics, and strategy in operations was really special. I also focused on health policy at Yale School of Public Health. I developed a skill set in statistics to apply it to concepts in medicine and business. I wanted to do this in a global context. So, I began doing consulting work for an Israeli pharmaceutical company.

Business school brings together folks from all different walks of life, different backgrounds, different paths. My path was considered relatively unique, but I was able to learn so much from my classmates from the nonprofit sector and the finance sector, and those who had worked in Teach for America. It opened my mind to the problems in the world and different approaches to solving them. It allowed me to study problems in other sectors and industries and apply them to my areas of interest in healthcare. During that time, I also worked as a consultant for the Food and Drug Administration. I worked in developing regulations for the cosmetic industry and that led to more work through the American Academy of Dermatology, which is the main professional organization that represents dermatologists. I was interested in the evolving landscape of health policy and how it impacts dermatology. So, I started and am now leading the Health Policy Research Group for the American Academy of Dermatology.

After Yale, I came back for my fourth year in medical school, applied for residency, and ultimately chose to go to Emory University in Atlanta, which is adjacent to the Centers for Disease Control and Prevention and close to the American Cancer Society. I saw this opportunity to advance collaboration. Most interesting problems and solutions happen at the intersections between fields, between industries, between researchers and collaborators from different perspectives. I think of myself as sitting at the intersection of dermatology, health policy, and innovation, trying to design and advocate for regulations that support safe and effective innovation in dermatology. I’m currently a second-year dermatology resident; I have two more years of dermatology residency, and then I intend to do a fellowship in dermatologic surgery. Moving forward, I intend to focus on advancing initiatives in health policy and innovation from the perspective of a dermatologist.

What do you think about medicine becoming a field of mixed feelings lately? 

It’s no secret that there’s a lot of burned-out people in medicine. I don’t have a solution myself, but personally, something that I remind myself is that, we have the great privilege of being able to take care of patients. They put their lives and their family’s lives in our hands. There’s no other opportunity like that. You should remind yourself on a regular basis why you went to medicine and what motivates you. If you recognize that you are more motivated by money, for example, acknowledge that, that’s not a bad thing. In medical school, people will discourage you from talking about lifestyle and money. That’s such a shame because although it may not be particularly relevant in medical school, these are important factors in your future happiness and so I encourage you early on to recognize your preferences, your tendencies, and your desires and then to make decisions based on what you want without concern for what other people think.

On the first day of medical school, I said I wanted to be a dermatologist. I stumbled on that field for the wrong reasons. This burned-out doctor had told me that he wished he had gone to dermatology just for the lifestyle and the money. As I came into it, I realized that dermatology has a great impact on our patients’ quality of life. We don’t save lives as other doctors do. But, patients will take their dermatology medications before they take their heart failure or diabetes medications. Data show that skin diseases have a significant impact on a patient’s quality of life. So, I feel like I am making a difference every day. Don’t let other people’s narratives shape your own. Gather as many opinions as you can, and then reflect and acknowledge your own characteristics and desires, and ultimately make the decision that is in your own best interests.

What would you recommend students in terms of navigating research opportunities, ways to build up their resume for medical school applications?

You should be in no rush because every opportunity you have early on to advance your career, to build more skill sets will pay dividends in the future. You only go through college once. Your opportunity to take different classes may not come again in the future. You will never have the opportunity to be around so many individuals and opportunities of diverse nature. So, as much as you have to focus on checking the boxes and jumping through the hoops of getting into medical school, push yourself to do things that you otherwise will never have the opportunity to do.

Broaden your horizon and recognize that college is a very special time with where you have free rein to be whoever and explore whatever you want. Once you get to the medical school, those opportunities dissipate, you’re told what to do and you have to go through a very structured path. That’s even more so the case in residency.

From when you started medical school and your residency to the present day, how has the field of medicine changed overall?

One of the most salient changes that I have noticed is the increasing integration of technology into our workflow. In dermatology, we rely on the tools of telemedicine to be able to care for our patients in the times of COVID-19. This is an example of technology being more integrated not to replace physicians but to assist physicians in caring for patients. I expect that to continue to grow.

We can use tools such as machine learning on a regular basis to make informed decisions on management. In dermatology, there are algorithms that are being developed to guide the physicians to decide whether a pigmented lesion is benign or malignant. Some physicians are resistant to these changes. They’re worried that technology will replace their role, but medicine at its core is grounded in humanity. I don’t ever see a world in medicine where physicians or healthcare providers are replaced, but rather where tools are developed to augment our skills in caring for our patients.

Do you think we will go back to face-to-face appointments or people will still opt to stay for telemedicine as a preference?

We’re finding that telemedicine offers many benefits in different scenarios. I think telemedicine is here to stay. The COVID-19 pandemic has accelerated and catalyzed the changes required to be able to implement and operate telemedicine services. For example, for Accutane follow up, we usually need to see patients every month in person to run labs and ask questions, but that’s something very conducive to telemedicine visits. Telemedicine is a great platform for following up with patients who are doing well on treatments. It has also expanded access to patients who live far from a hospital and allowed us to connect with them more easily.

This is a question that’s not pertaining to the reflection that I will write but I wanted to ask your opinion. We put together a cultural competency petition to the Association of American Medical Colleges (AAMC) and individual undergraduate institutions to begin offering a cultural competency course for pre-meds and make that course a pre-med requisite. Could you share your thoughts on this initiative and the importance of cultural competency in medicine in general?

That is an extremely important initiative. I applaud you for having that insight. I couldn’t speak more highly of the importance of cultural competence and caring for patients, and being able to recognize different walks of life, connect with your patients, and understand the different drivers of health disparities. As a physician practicing in a multicultural hub, I see first-hand the powerful impact that cultural competence can have on understanding a patient’s disease experience and on partnering with patients to devise an optimal treatment plan.  Data have consistently shown that cultural gaps can drive significant health inequity and worse clinical outcomes, and I believe that it is of utmost importance for trainees at all levels to receive robust training in cultural competence as early in undergrad and in the pre-med program. We as residents are now integrating this more formally into our curriculum. The Accreditation Council for Graduate Medical Education (ACGME) is starting to develop initiatives to formalize this. Let me give you a few examples from dermatology. We see different types of hair loss disorders, one of which is a type of scarring called cicatricial hair loss that is common in African American patients. The skill to understand cultural haircare practices and integrate that into our counseling and patient management is truly night and day. When I use the terminology that our patients are familiar with, their eyes light up because they realize that their physician understands them. There are some cultures who have faced a lot of adversity in the past and have developed some skepticism to physicians who are not from the same background; so, to be able to understand where they’re coming from, their desires, their preferences, makes a huge impact on the outcomes.

Interview excerpts have been lightly edited for clarity and readability and approved by the interviewee. This article only aims to share personal opinions and learnings and does not constitute the interviewee’s current or former employer(s)’ position on any of the topics discussed.

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

featuring Jonathan Jackson, founding director, CARE Research Center, Massachusetts General Hospital, Boston (42.3° N, 71.0° W)

Jonathan Jackson is a cognitive neuroscientist at Harvard Medical School and Massachusetts General Hospital, as well as the founder and director of the Community Access, Recruitment, and Engagement (CARE) Research Center at Massachusetts General. During my conversation with Jonathan, we discussed his passion for neuroscience, his decision to found the CARE Research Center, and the many twists and turns of his unconventional career path.

Jonathan graduated from Rice University in 2007 where he majored in Cognitive Science. While he came to Rice knowing that he was interested in studying the brain, he didn’t have the opportunity to explore either cognitive science or neuroscience in high school. It wasn’t until his junior year of college that the metaphorical lightbulb went off, as he was studying abroad at the University of Otago in New Zealand. “One of my classes was on neurodegeneration. When I saw a picture of a normal brain next to an Alzheimer’s brain on the slide projector, it hit me like a bolt of lightning. I knew that that was the problem I wanted to solve.” After returning to Rice the following semester Jonathan was able to work with a psychology professor studying aging and Alzheimer’s disease, and decided to pursue a PhD in Psychological and Brain Sciences at Washington University in St. Louis. “It really seemed like a problem of justice,” he told me, explaining his fascination with Alzheimer’s and neurodegenerative brain diseases. “Somebody can make it to 70 or 80 and lose the one thing that is more valuable than anything else, which is their memories and their sense of identity.”

Justice has remained a key element throughout Jonathan’s career in academia and healthcare. After earning his PhD, he completed a postdoctoral fellowship in Neuroscience at Brandeis University, before moving on to his position at Harvard Medical School and Massachusetts General. He discovered that he had a love for teaching during his time in graduate school, and he channeled this passion into community engagement, giving talks that explained science to “non-scientists” in understandable terms. “We are gatekeeping our science,” Jonathan said in our conversation. “You can’t even read the papers that we publish without paying an arm and a leg. Some of that’s not really our fault as scientists but it is part of the system we operate in and support. What led to my career shift is that science should not be for the scientists; it should be for everybody.” Since 2014, Jonathan estimates that he has given around 400 talks to his community explaining the biology behind Alzheimer’s disease and the steps to developing a cure. His passion for expanding science and healthcare accessibility ultimately led to his founding of the CARE Research Center, which seeks to expand and diversify clinical trial recruitment through community engagement.

The CARE Research Center has four main goals: health disparities research; community funding; direct community engagement; and advocacy through policymaking. Such a broad mission requires a lot of delegation and collaboration, and Jonathan credits his team with handling much of the hands-on work as he works to bring these disparate spheres together. Some of his daily responsibilities as director of the research center include writing papers and grants to secure funding, holding meetings with foundation representatives, and creating policy guidance for state and federal governments that improve equity in intersectional communities. Jonathan explained that especially during the current moment where there is renewed focus on Black Lives Matter movement, he wants to use his platform to give voice to groups that are typically marginalized or disenfranchised. His team recently held an event called Rest and Reflect, which aimed to give trans-identifying people of color a space to process and express what they are feeling about everything going on in the world today. 

What struck me most about my interview with Jonathan was that in every aspect of his career, he strives to expand the accessibility of science and healthcare to a wider and more diverse group of participants. Historically, clinical trials have always been conducted with predominantly white, predominantly male subjects, which is harmful not only for minority groups but for the credibility of medicine and the health of our world at large. “If you run [a trial] on people who look the same, and then when you try to sell that medicine out in the world, it will have a very different level of effectiveness than you think it has,” Jonathan explained. Expanding access to new treatments and actively seeking out participation in clinical trials from underrepresented groups makes us better scientists, and better equips us to serve the people around us. 

I also found it surprising that when starting out, Jonathan never would have predicted the path that his career would take. Originally, he planned to delve more deeply into a specific field of neuroscience called attentional control–which studies the ability of patients to maintain sustained attention–and how it relates to the onset of Alzheimer’s disease. Instead, over and over he found himself pushed into health disparities research, a result of “well-meaning but misguided racism.” He described how frustrating it was that people expected him to go into the field of health disparities despite having no experience or initial interest in the topic. However, as time went on he realized how much the research in this area was lacking, and saw concretely how he could make a difference. “I thought about it for several months and realized that I could have the chance to do some of this work the right way. And if I was going to do disparities work I would do it with high-quality science and I would do it on my own terms.” Thanks to support from Massachusetts General, as well as some entrepreneurial spirit of his own, he was able to start the CARE Research Center, a very unconventional and risky move for a junior researcher who is not yet established in a particular field. For Jonathan, the risk paid off. “Although the moves and the jumps that I’ve taken have been very non-traditional, this was the best way to support the science and the communities that are so often left out of these conversations.” 

Looking to the future, Jonathan explained that technology is rapidly changing the way that we conduct research and practice medicine. Clinical trial recruiting has become much more centralized and corporate, increasing efficiency but often overlooking patients from marginalized communities, decreasing the heterogeneity of trial participants as a result. In medicine (and especially during the era of Covid-19), tele-health is on the rise as a faster and more convenient option for doctor-to-patient interactions. However, this platform privileges those with good internet and access to technology; communities without widespread internet access will be left behind. Although technology has the potential to improve healthcare, Jonathan says that we must remember it is a double-edged sword: “Bringing technology into any sort of transaction conversation, process, or model only serves to amplify the biases that you are carrying with you. If you have the tiniest bias towards working with white people, for example, and you build a technology to help you with your process, you cannot expect technology to eliminate that bias. It will instead amplify it.” Technology will not solve any problems for us: as a product of our society, it inherits our weaknesses as well as our strengths. In order to use it effectively we must constantly strive to amplify voices that are traditionally silenced.

Jonathan’s advice for undergraduate students looking to get involved in science and healthcare, especially those looking to go into independent research, is to embrace the entrepreneurial spirit. While he wouldn’t necessarily recommend his own career path to students, he acknowledged that “every scientist has to be a little bit business savvy.” The first half of his career, a very traditional progression of PhD to postdoctoral fellowship, gave him the extensive knowledge and research experience required to found and support the CARE Research Center despite not yet being a full-fledged professor. Jonathan wouldn’t have been able to begin this venture without support from colleagues at Massachusetts General, but had he shied away from taking a step off the beaten path of academia, the idea would have never come to fruition in the first place. His passion for neuroscience, commitment to science accessibility and community engagement, determination to conduct credible research, and entrepreneurial hustle all coalesced to give him a unique perspective and skill set to tackle the problems of science and healthcare accessibility in the research community.

Highlights from the interview:

Can you tell me a little bit about yourself and when you first envisioned yourself going into the healthcare field and academia?

When I was accepted to Rice University, I selected cognitive science as one of my academic interests, not really knowing what it was. By the time I formally declared my major in my freshman year, I knew that I wanted to study neuroscience and the brain, and I wanted to help people. What really set my current path was when I studied abroad in my junior year at the University of Otago in New Zealand. One of my classes was on neurodegeneration. When I saw a picture of a normal brain next to an Alzheimer’s brain on the slide projector, it hit me like a bolt of lightning. I knew that that was the problem I wanted to solve. In my senior year, Rice brought in its first professor into the psychology department who studied aging and Alzheimer’s disease. I worked very closely with her. Then, I went to the graduate school in St. Louis where I really started studying the early detection of Alzheimer’s disease. Next, I did a post-doc at Brandeis University for a couple of years and then moved on to Massachusetts General Hospital where I did a post-doc for one year and then joined the faculty as an instructor. 

Do you enjoy making science more accessible for people that are in science? We cut off science from people assuming that they won’t be able to understand it, but do you think that’s not the case, we just need to work on communication?

I’ve given so many talks to community audiences or even professionals that don’t have scientific training. What I learned was exactly what you said, we are gatekeeping our science. You can’t even read the papers that we publish without paying an arm and a leg. Some of that’s not really our fault as scientists but it is part of the system we operate in and support. What led to my career shift is that science should not just be for the scientists; it should be for everybody. We need to do a better job of communicating and explaining. We also need to do better work about empowering non-professional scientists to be good at science. We should teach and empower individuals to do everyday science at home and in their communities. Doing that, we can improve the quality of our work by making sure that it is relevant to the experiences and needs of the communities. 

What led you to found the CARE Research Center? Was it difficult to transition from strictly academia to entrepreneurship?

Any scientist that ends up becoming an independent researcher has to embrace a little bit of the entrepreneurial spirit. I’m not a business major, I’m not strongly interested or invested in the business world. My area of expertise was attentional control, which is the ability to monitor how somebody’s paying attention or not and whether that is related to their chances of developing Alzheimer’s disease. I tried to bring that to my group but they kept repeatedly asking me why I don’t do disparities work; why I don’t start to look at risk factors for black people versus white people.  So, I reluctantly embraced the disparities research. It was not something that I wanted to do, I was not interested at all. Over time, I realized that the way the [disparities] work was being done within this group was just bad science. They didn’t have a good appreciation of how these constructs were measured or how to incorporate them into a model. If I stayed in this group and did disparities work, my career was going to blow up. If I tried to push the attentional control research, I would get no support or funding. At that point, I realized that I couldn’t stay there. I had to do something else. I thought about it for several months and realized that I could have the chance to do some of this work the right way. And if I was going to do disparities work I would do it with high-quality science and I would do it on my own terms. So, I started my own research center. I was lucky enough to get some support from the Massachusetts General Hospital to start the center, but it was not a smart idea. Usually if you’re going to start a research center, it’s because you’re a full professor in a particular field and you are world-renowned for a specific topic. Instead, I decided to do it as a junior scientist, not having really done this work but knowing what needed to be done. I set off to start a new sub-field of science. That was fairly risky, but now I have a better and broader ability to do good work than I previously did. Although the moves and the jumps that I’ve taken have been very non-traditional, this was the best way to support the science and the communities that are so often left out of these conversations, research, and the therapeutic benefits for something like Alzheimer’s.

Could you talk about  your day to day responsibilities at the CARE Research Center?

I’m the executive director of the CARE Research Center. Thus, I don’t get to do as much science as I want to in any given week. Most of my duties are administrative. I have a small staff of about 10. I don’t only have junior scientists in my group. I also have administrative staff, a program manager and a staff assistant. We also have community organizers. We have a board of trustees that we have to answer to. My main day to day job is to bring in money to keep the center open. In any given week, I have six to seven meetings a day about advising, consulting, or collaborating with researchers all over the world for getting people into research trials, keeping people in research trials, or thinking about diversity in our work. I also give talks to colleagues about the work I do. The way that we are doing clinical trials and curing diseases is changing. Instead of a clinical trial being conducted at one site or maybe five sites where every site has to run a clinical trial, there are these franchises that are owned and operated individually but all do the same sets of work. On the one hand, this makes running clinical trials more efficient; on the other hand, it makes it more centralized, which may introduce some problems later. So, much of my day-to-day work involves working with these large clinical trial networks to bring back some of the local flavor because that is really necessary for the trial to succeed. I’m also writing papers and grants. I help different organizations learn to be consciously anti-racist and allow themselves to be publicly accountable for that work.

What really exciting about CARE is that even though we are a research center, we do four sets of things. We do research, community work, policy work, and direct advocacy work. We work with local, state, and national governments to develop white papers and policies to help them understand how to be more equitable. Last month, for example, I was working with the Attorney General’s Office in Massachusetts about environmental justice, thinking about how pollution disproportionately affects black lives.

I also wanted talk about the disparities in the clinical trials, specifically the way the whole system is changing and becoming more centralized. Is that a problem that’s going to get worse? Or is there a risk that more people will fall through the cracks?

If people are not careful, and they only prioritize efficiency at all costs, which is what corporations do, then marginalized groups, minority groups, will definitely slip through the cracks. What I am trying to do with the structure is to have adequate representation. If you run a trial on people who look the same, and then when you try to sell that medicine out in the world, it will have a very different level of effectiveness than you think it has. So, it’s a good business practice to diversify the clinical trials. And so far, most of these new clinical trial networks have been responsive to that.

What advice would you give to students who want to get into healthcare advocacy work to actively include those disenfranchised groups? What is the best way to start making that change as they’re moving up?

Make sure that as you move forward, no matter what you look like, no matter what background you came from, you have power and privilege. Even if you are new or young, it is your duty and responsibility to bring others up with you. So, anytime you offer an opportunity, anytime you look for a collaborator, make sure that you’re looking for those voices that are usually silenced. Look for the choices that allow you to work with those voices that are usually missing from this space. Usually, you have to look for them. It’s not that they’re not there, it’s not that they’re not as talented as the other voices you’ll hear, but they’re made to be quieter. So, being very intentional about the spaces that you enter is the best way to center the groups that are more likely to have a tougher time than you.

Could you talk a little bit about how evolving technology is shaping both healthcare and advocacy work as we move forward? Do you think it is changing?

This is one of those things where we have to acknowledge that technology is just a double-edged sword. There are many aspects of technology that are good and that make the work easier, but we have to get out of the mindset of thinking that technology will solve the problems that we have created. Bringing technology into any sort of transaction, conversation, process, or model only serves to amplify the biases that you are carrying with you. If you have the tiniest bias towards working with white people, for example, and you build a technology to help you with your process, you cannot expect technology to eliminate that bias. It will instead amplify it. For example, in the medical space, with the COVID-19  pandemic, many providers are turning to telemedicine for the first time. That has made it much easier for many people to keep their appointments without worrying about taking off time from work. However, telemedicine is really good for people who have reliable internet access and can afford to take an hour out of their day. So, we have to keep in mind that using technology can make some parts of the work easier but we are building more barriers to healthcare by demanding that people have access to this technology. Technology can make things easier, but without making sure that everybody can access and really use that technology, we’re just going to make the problem worse for people who need the most help. 

Is there anything else that you would like to mention?

There’s one thing that I wanted to say about my time at Rice. I always remember and really appreciate the help that I got from the student financial services, people in the admissions department, my college masters, the RAs, and the dean of students during my time at Rice. I would absolutely not be where I am today without their support and it is so important to me that I wanted to share that here. 

Interview excerpts have been lightly edited for clarity and readability and approved by the interviewee. This article only aims to share personal opinions and learnings and does not constitute the interviewee’s current or former employer(s)’ position on any of the topics discussed.

Ecem Uluegeci
Harvard College
Boston (42.3° N, 71.0° W)

featuring Matthew Sprinkel, Marketing Manager, PROCEPT BioRobotics, Redwood City (37.4° N, 122.2° W)

Recent innovations in medical device technologies have been changing the future of healthcare. I have been interested in this industry since I was in high school, which is why I was excited about speaking to Matt Sprinkel.

Matt Sprinkel is a marketing manager at PROCEPT BioRobotics, which is a privately held surgical robotics company in Redwood City, California. He graduated from Rice University in 2015 with a major in international relations and minor in biochemistry. Then, he received his master’s degree in translational medicine from the Department of Bioengineering at the University of California, Berkeley in 2018. I had the opportunity to interview Matt, who is currently in California, while I was across the globe in Turkey. In the interview, we talked about his previous plans as a pre-med student in college, his career path in the medical device industry, and what keeps him motivated about his job.

Matt has been working at PROCEPT BioRobotics since 2015, but he originally became interested in medical devices early on during an internship at a start-up company. This led him to alter his original plans in college for becoming a surgeon and instead pursue a career in medical devices, starting with his first role in the clinical research department. He was so fascinated by the current project of an autonomous tissue removal robot that he ended up more involved with quality assurance and research and development. This involvement led him to come up with an idea of a surgical drape, a project he took from concept development to prototype and manufacturing.

During his master’s program, Matt decided to navigate toward marketing even though he had not envisioned himself as a marketing manager in this company early on. As a marketing manager, he benefits from his multidisciplinary background, especially the clinical and medical expertise that helps him understand his product well. Matt also said that his political science degree has been helpful in his success as a marketing manager since some of his main tasks are simplifying the terminology and communicating the message clearly to the market.

The opportunity for continual learning and the exponential impact medical devices have on patients’ lives are great motivations for him and why he enjoys working in the medical device industry. The field is “very dynamic,” which encourages him to learn and grow. He is also grateful for the learning environment at PROCEPT BioRobotics, where he is surrounded by experienced mentors. He said, “It is great to be part of a team that’s on a mission of trying to do something greater than personal achievement and knowing that I’m making a difference.”

Matt’s career journey resonted with me. Many people have mistaken my passion for biology and healthcare as an interest to attend medical school. But, as Matt’s experience proves, however, one does not have to have a medical degree to work and make an impact in the healthcare field.  Matt recommended that new graduates interested in the medical devices industry lead by example, take pride in their work, and put themselves in a position where they will continue learning new skills.

Highlights from the interview:

What shaped your decisions into choosing your career?

I boldly stated in my high school resume objective statement I wanted to work at the intersection between medicine, business, and technology. I always thought this meant I would need to go to medical school. My mother was a doctor, and growing up I always wanted to learn more about what she did all day. In high school, I really enjoyed my science classes, which further cemented my path towards healthcare. I applied to internships, I shadowed, and by the time I graduated high school, I knew that I wanted to be pre-med. In college, I majored in political science/international relations and minored in biochemistry for my pre-med requirements. Then, one summer I took an unpaid internship at a small pre-clinical stage medical device startup and discovered that the medical device industry aligned more with my interests. This ultimately influenced my decision to take an unpaid internship at another medical device startup after graduating college. Those three months passed by in a blur and at the end of it I accepted their offer – I knew I’d found my path.  

What led you to your current position? What does this position entail? 

The route I took to my current role as a marketing manager was very circuitous. I started out in the clinical research department and assisted with our Phase II clinical trials. Over time, I wanted to learn more about our technology.. PROCEPT BioRobotics manufactures a robotic surgical device that can autonomously remove tissue, specifically forbenign prostatic hyperplasia. The disposable portion of the device is inserted [into the body], and the surgeon creates a customized treatment plan, essentially on a computer screen. Once complete, the surgeon presses on a footswitch, and the robot will autonomously remove the tissue according to the plan. I was completely enthralled by this, and I ended up helping the engineers in the research and development (R&D) laboratory. At first, I helped out with quality assurance testing, but then I became more comfortable with the device and traveled with our clinical research team for our phase two and phase three studies. Over time, I started to help build the device onsite, test it, and make sure it was ready for procedures. I also came up with a small idea for a surgical drape, which was a novel drape that improved the ergonomics and usability of our device during the procedure. That’s how I learned about design controls and R&D project management because I was the main person doing all of that. I took the project from idea stage to prototype patent to manufacturing, and finally, to FDA clearance through the 510K pathway. After I completed the project, PROCEPT offered me an opportunity to train surgeons on how to do the procedure for our commercial launch. I traveled all around the world the first three years of my career and spent 18 months in Europe training surgeons how to perform our procedure. Then, I came back and completed a master’s degree in translational medicine at UC Berkeley. After my master’s, I was thrilled to have PROCEPT offer me a very multidisciplinary role as a marketing manager. In this role I’ve worked with a lot of different departments: regulatory, quality, sales, and professional education. Because I had already jumped around in a couple of different roles and departments I had already started to develop the ability to look at problems and projects from multiple perspectives, which helped me acclimate to the new role.  

Did you ever envision yourself as a marketing manager?

When I first started at PROCEPT, I didn’t have that much of a plan. I was the 17th person in the building. At that point, there was so much work to be done and not enough people to do it. I just started taking on more work, and I didn’t have time to take a step back and think about the direction that I wanted to go until a couple of years in. Over time though, as I gained more experience and jumped to different roles, I started to gravitate towards marketing. I’ve found that navigating career paths in industry are very different from following the medical school path where you can almost project out what you’ll be doing for the next decade. Things get even more complicated in smaller, early-stage companies, because things change very fast. Every three to six months, the needs of the business change and new opportunities open up.  

It wasn’t until I was about two years into my career that I knew I wanted to work in marketing. I began to see how involved marketing was in every aspect of the business, and I liked the idea of being able to lead projects that involved so many different departments, while at the same time trying to figure out how to best communicate to surgeons the unique value of our product.

What are the skills you find yourself utilizing the most in your position now? How did your college years prepare you for that?

There are two skills I find myself using quite often. First, in marketing, it’s important to be able to distill something that is complicated into something that is simple and memorable. You can have a list of 50 features, but those features need to be turned into benefits that will actually resonate with surgeons (your customers).  Building on this example, your messaging should resonate not only with surgeons, but also with patients, hospitals, and insurance companies. As I mentioned before, my political science degree helped me to communicate clearly with all these stakeholders. The second skill I find myself using often is analysis and critical thinking. It’s hard to make decisions without information. It’s even harder to make decisions with information that doesn’t make any sense. I spend a lot of my time analyzing different metrics and looking at how our marketing programs are performing, because I can then figure out which programs work (and why), and which ones aren’t performing as well as they should be (and why).  

What keeps you motivated about your work?

If I had the choice today between working in the medical device industry and being a surgeon, I would still pick the medical devices industry. Not to sound cliché, but I’ve always wanted to make a difference. But more than that, I’ve always wanted to make a big difference. Working in medical devices has taught me an important lesson about scale. One medical device can improve tens of thousands of patients’ lives. It’s tougher to do that as a single surgeon in a practice. Another source of motivation is a sense of responsibility to not squander the great mentorship and advice I’ve received over the years. I’m very lucky to be able to learn from the experienced people at PROCEPT that have been willing to trust me by putting me in positions in which I might fail. I find it rewarding to conquer that initial fear of failure as I tackle a project or problem that I’m unsure if I’ll be able to complete or solve. I owe a great deal of my success to the people who have been there to help me and teach me. And lastly, it is great to be part of a team that’s on a mission to try and accomplish something we all wouldn’t be able to do as individuals.

What advice would you give a student interested in your field?

I have three pieces of advice. The first isn’t specific to the healthcare field and it’s to judge your work as if you were your manager. If you were the manager, would you like whatever output was just submitted to you? When I ask myself this question, it helps me anticipate things I may not have thought about, and make edits or additions that I otherwise would’ve missed.

The second piece of advice, which is a bit more relevant to the healthcare field is to never forget that patients’ lives are on the line. Whether you work in the Quality department or the Professional Education department, patients’ lives are impacted by your work. Whenever I find myself unmotivated to do the boring administrative work, I try to remind myself of this fact. It helps me stave off procrastination and continue to do good work, when it would otherwise be easy to let it slide.

Lastly, it’s important to ask for what you want in your career. What I mean by this piece of advice is that in order to even be able to ask, you have to put in the time to figure out what you want out of your career and why you want it. You can apply these questions to the short term (ie. to your current role), as well as to your long-term goals (ie. your dream job or goal). Once you have figured out where you want to go, be it a different role within your company or even changing industries, it makes it easier for other people to help you get there.

Interview excerpts have been lightly edited for clarity and readability and approved by the interviewee. This article only aims to share personal opinions and learnings and does not constitute the interviewee’s current or former employer(s)’ position on any of the topics discussed.

Shvetali Thatte
Case Western Reserve University
Cleveland (41.4° N, 81.6° W)

featuring Judy Huang, Therapist, Telehealth, Los Angeles (34.0° N, 118.2° W)

Values. Although a vague and often ambiguous term for many, values are critical to finding a worthwhile career. As my conversation with Judy Huang showcased, understanding our values helps us determine our priorities, after which we can reconstruct our perspective and reevaluate our happiness.

Judy is a marriage and family therapist associate at the Asian Pacific Counseling and Treatment Center in Los Angeles. With a BA in Psychology from Rice University, followed by an MS in Marriage and Family Therapy/Counseling four years later from Fuller Theological Seminary, Judy’s educational and career path has been unique, allowing her to gain valuable experiences.

In between getting her BA and MS, Judy worked at Deloitte Consulting, where she focused on learning business skills through the strategy and operations sector. Early on, she realized that a business background was critical because any issue in the world, even one in the therapy industry, requires knowledge in business to develop a solution. However, while Judy learned a great deal from her career as a consultant, the profession didn’t fit with her values.

Judy recognized her privilege in having the choice to do meaningful work. She had the desire and responsibility to give back to the community, and she wanted to find a profession that would better enable her to do so.

Given her interest in psychology and therapy, Judy pivoted to graduate studies for her masters in family therapy. After completing her degree, she began her training and is now a full-time employee for a counseling center, where she works with families, from adults to kids.

The recent pandemic has given Judy a new perspective, as she has begun working in telehealth. For some, telehealth is a far better alternative compared to in-person visits, as it is more affordable and accessible. Unfortunately, no solution is perfect, and while telehealth addresses some needs, it effectively creates separate problems. For people facing unemployment or a lack of income, access to therapy is still not possible, regardless of whether it is in-person or online. For those lacking technology and Wi-Fi or the means to acquire it, telehealth creates issues of access. And for the most vulnerable, an online connection simply does not compare to in-person.

Judy says that the transition towards telehealth has been interesting but not easy. She’s learned new ways of forming connections with her patients and is constantly looking for new methods that can facilitate the therapy process.

Therapy is the “on the ground” work that Judy was looking for. With each session, she can see herself making a tangible impact on families.

In light of being asked what advice she has for current college students, Judy’s keywords were, “Be open to different opportunities and experiences. Know what your values are and stay close to them. You can be in any role, any industry, as long as you stay true to your values. Be happy, wherever you are.”

Being a college student myself, I recognize how easy it is to lose sense of your values and priorities in the face of what your peers and the rest of society may deem more valuable. What you choose to do with your free time, your summers, and the opportunities at hand is up to you.

When choosing clubs to join, leadership positions to take on, and internship or research offers to accept, we must continuously check in with ourselves to make sure that is what we want. Take the time to identify your values before deep-diving into a field that may not truly pique your interest. Everyone requires different amounts of time to discover themselves, and it’s okay if you learn your values and choose your career at a later time than someone else.

Most importantly, Judy reminds us that no decision is final. As we grow older, we will change, and perhaps so will our values. Our perspectives will broaden and what once made us happy may no longer be the case.

We have to accept that such a change is okay; we can always choose differently as long as we keep our eyes open.

Highlights from the interview:

What took you on your career path, which took you from consulting to therapy?

I was always really interested in something that had to do with social impact and social justice. Earlier on, I tried to do an internship in microfinance, and it just felt like the main messaging in industry was pretty much that you have to learn business skills to make any impact. Which is why I joined Deloitte, I thought that I could make changes from the top down. But part of what I realized that in consulting was I was a bit disillusioned with the skills I was learning, and disillusioned with kind of where I was spending my time and where I was actually helping, and it didn’t feel like I was making an impact. And it felt more like guilt-appeasing than impactful.

So then I transitioned into looking for more on-the-ground type of work. Psychology and therapy had always interested me. Then I pivoted to graduate studies to learn therapy and counseling. And that’s what helped me go down the path of graduate school, and down the path of working with the most at-risk and lowest income families just to feel like the things that I was doing was actually making a difference. So yeah it’s been a whirlwind, it’s been very different. And it actually utilizes a lot of the same skills of building trust and rapport, and listening and solving problems. It just feels more meaningful and on-the-ground.

How do you think passion has played a role in choosing your career path and sticking to it?

It’s been a huge motivator for me. I think working just to work is something that I’ve had the privilege to not have to be confined by. And beyond working to put food on the table, I’ve been able to be like, “I want a choice in what work that I do. I want choice in my work to be meaningful.” And I recognize that it’s a privilege, and part of that privilege comes with feeling the responsibility and the want to kind of give back and to make sure that there’s more equality in the playing field for everybody to be able to pursue something that’s interesting, something that’s meaningful, something that feels purposeful.

I wanted to do something that felt more meaningful for me, and I think for me, I also needed to see more immediate change and more concrete change. So that was a big driver for me to know that, “Okay, I’ll actually be working with individuals on the ground, I’ll actually be making a difference in people’s lives, and I can actually see the changes happening while it’s happening, rather than working on something vague and more higher level. So all these things have been big motivators for me.

It definitely sounds like you’ve been following what you value and what you care about the most, and not being sucked up into the work place itself, which is inspiring.

Yeah! It’s hard to stay true to values. Because there’s a lot of temptation of other things, and so yeah, I think knowing your values and reassessing how your life is aligned to them every couple of months, and keeping yourself accountable, is a good way to check in with yourself. Because I think that I probably stayed too long in my first career. I got to a point where I was like, “I need to either make a decision or I’m going to be stuck in this forever, because I won’t be able to get out.” And so that’s something that I had to do, but only because I know myself. It might be different for other people, but that’s my own journey.

Given that you’ve kind of transitioned to virtual therapy, how do you find that different from in-person. What obstacles did you have to overcome?

I mostly did in-person through an agency. So I either went to schools, or homes, or they came to the office depending on what their situations were like. There’s something about connecting in person that allows you to be present and sit with people in their emotions. And there’s that heaviness and tenseness in the room that it’s nice to have somebody physically in the room with you. And I do miss that part. I think part of the transition is I’m now on a platform that’s more affordable for people, but it’s still expensive for people without income. There are needs that are met for the low-income folks because those are covered by Medi-Cal and the government will pay for services through that. So those people are covered. There’s the people with private insurance who can pay out of pocket, or who have good insurance who will pay for access to healthcare or mental healthcare. And those people are covered. And then there’s these people in the middle who make too much to qualify but they don’t have enough to actually pay for services cause they usually run $150 to $250 per hour. And so, it’s been more about being open to taking a pay cut to be on a platform that allows for access for more people. It’s enough and fairly paid enough for me to be like, “Okay, this is fair, this is okay.” And I am more available, more accessible to more people, even if they’re not the lowest on the totem pole, they’re still people who are getting lost in the cracks. And so I can meet them here.

What changes do you think could be made to telehealth to mitigate the difference that arises from the shift from in-person to virtual?

I think part of it is that it just takes a little bit longer to build that trust and that connection of, “I’m here with you.” Cause when I’m physically there with somebody, then I’m already physically there. Whereas virtually, I might have to be more explicit, like “I feel your pain,” or “I hear you,” and be more explicit in what I say or how I breathe and things like that. So I think having more awareness of my own body cues and how I communicate with the other person so that they know. So that they feel as supported as if they were in-person.

I think there’s a lot of access, and that’s great, that more people are willing to try it and able to actually use it. I think there’s a big gap for the people who don’t have Wi-Fi, who don’t have access to consistent internet, things like that. So those people will kind of be left behind. Because if we go only virtual, then it will be less access for them. A gradual transition will be helpful and for those who might fall through the cracks and put things in place so that there are still agencies that kind of can go in person.  

Do you have any last words of advice to share for college students?

I think the advice I would share is to be open to different things and opportunities, be open to different experiences, and all the while, know what your values are. Stay close to your values and check in with yourself because you can be in any industry, you can be in any role, you can be in any job. As long as you hold your values, I think you can be happy wherever you are. And so just to make sure your values stay consistent, your identity feels consistent, and that you’re able to check in with yourself every couple of months.

I think another thing to remember is that no decision is final. That you always have the opportunity to change, always have the opportunity to take a different path. And just because you choose one path today doesn’t mean you’re locked into it forever. And so to give yourself the freedom of always reassessing, of like, “Do I want to continue down this same path still or do I want to try something different?” and to make it an intentional choice rather than a passive choice.

Interview excerpts have been lightly edited for clarity and readability and approved by the interviewee. This article only aims to share personal opinions and learnings and does not constitute the interviewee’s current or former employer(s)’ position on any of the topics discussed.

Nitin Agrawal
Medical Student
Texas A&M University College of Medicine
Board Member, Longitude.site

Graduating medical students early is not a completely novel concept. During WWII, there was a significant physician shortage, and various medical schools initiated a 3-year accelerated MD program to produce more physicians. These programs were eventually discontinued in the late 1970s and early 1980s. In 1918, the influenza pandemic created a similar situation. Third- and fourth-year medical students were enlisted to help treat the overwhelming number of patients, both those with influenza and those without. Today, COVID-19 resurfaces the question of graduating medical students and other trainees early. Italy, one of the hardest-hit countries, decided to cancel the final exam for its medical students and called upon 10,000 students to help with triage, to perform tests, and to support general practitioners’ clinics.

In the United States, there have been significant discussions of graduating fourth-year medical students early in order to help buffer the front lines. Many medical schools have initiated processes to allow students to voluntarily graduate early, but this is not the nationwide standard. The debate has now centered on whether more schools should and need to do this, especially as different parts of the country face different waves of the pandemic.

Pros

1. Fourth-year medical students can fill the need for providers immediately

By April, most fourth-year medical students have finished their required rotations. Many had vacation or were scheduled to complete online or other electives when the effects of COVID-19 became widespread in the US. For most fourth-year medical students, the amount of new knowledge gained from those electives may not be as critical to their future success. Therefore, fourth-year medical students can fill the need for providers immediately if they are allowed to graduate early. Many fourth-year medical students are currently quarantined at home, and if healthy and able, they can be quickly mobilized to immediately provide relief in critical areas.

2. Fourth-year medical students generally have fewer comorbidities

As COVID-19 continues to drain resources (including able health care personnel), there has been a push to bring retired providers into the front-lines. However, many of our retired providers have comorbidities that put them at a higher risk for more serious complications of COVID-19. While no one is exempt from COVID-19 and its potentially lethal complications, at this point, fewer comorbidities tend to indicate a better prognosis. One could then hypothesize that students with fewer comorbidities are at a lower risk of COVID-19 complications.

3. Fourth-year medical students can help free up more experienced providers

A brand-new intern is not ready to take care of a critically ill patient. However, a brand-new intern can help take care of common “bread and butter” cases (congestive heart failure, COPD, non-COVID-19 pneumonia, etc.). The majority of medical students should have encountered these cases on their internal medicine rotation and other electives. With proper supervision, a new intern can help manage these patients and help free up more experienced providers to treat critically ill COVID-19 patients.

Cons

1. Social distancing would be broken in many cases for fourth-year medical students moving for their residencies

Social distancing is one of the most important weapons to fight the virus. However, by graduating early, potentially tens of thousands of students (and possibly their families) will be required to move to different areas of the country. Additionally, as it is known that COVID-19 can rapidly transmit through asymptomatic carriers, this could lead to the unintentional spread of the virus. This mass movement also puts fourth-year students and their families at risk.

2. Introducing new interns into the front-line would further deplete dwindling PPE [Personal Protective Equipment] resources

PPE is critical in this fight, and unfortunately, we still do not have an adequate supply for all health care providers at risk. While new interns may not directly be the primary doctor for COVID-19 patients, they will undoubtedly need to use PPE for other cases or COVID-19 rule outpatients. While it is absolutely necessary to protect everyone with PPE, an influx of health care providers may put a new strain on an otherwise dwindling precious resource.

3. Fourth-year medical students will be brand new interns and therefore need a lot of oversight

While the July Effect (the idea that teaching hospitals in July have more mistakes/medical errors because new interns start in July every year) has been variably supported and contradicted, it is without a doubt that new interns need close oversight at the beginning of their careers. In a typical environment, upper-level residents provide months of close, individualized oversight until interns are able to take on more and more responsibility. However, additional oversight will reduce the overall time upper-level residents have while they continue to juggle complex patients, including COVID-19 cases.

A fourth-year’s perspective

As a fourth-year medical student, I can see both perspectives and do not know the right answer. A big part of me wants to help and be part of the front-lines. I went to medical school to ultimately provide care, and there is no better time than the present. However, a part of me understands that there are more complex issues at hand. Could I be doing more harm than good by rushing into residency? Would my presence create an extra burden? In this time of great uncertainty, these decisions cannot be taken lightly. However, due to the evolving nature of the pandemic, it is critical that medical schools nationwide discuss this internally as well as with their local hospitals, academic institutions, governing bodies, and the CDC in order to be ready when a decision must be made. As COVID-19 permeates the country, the need for health care workers on the front-line becomes ever more pressing. Should fourth-year medical students fill that void?

Article originally published on KevinMD.

Photo by National Cancer Institute on Unsplash

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.

Grayson Best
University of Texas
Austin (30.2° N, 97.7° W)

featuring Andrew Tessmer, Counselor & LGBTQ+ Therapist, Eddins Counseling Group, Houston (29.7° N, 95.3° W)

Andrew Tessmer is a professional counselor who is a member of the LGBTQ+ community and currently specializes in eating disorders and LGBTQ+ concerns. He works at Eddins Counseling Group in Houston, Texas. Andrew graduated from Texas A&M University with a psychology degree in 2010 and then completed a master of education in counseling at University of Houston in 2013. Andrew discussed interesting and unique aspects to the counseling field with me.

Andrew’s parents encouraged him to follow whatever path he cared for as long as he maintained his academic standing. When it came to the decision to become a counselor, it was not until the fall of his senior year that Andrew felt sure about his decision on what he wanted to do. There was no grand switch or leading cause that influenced his decision; rather, small experiences scattered through his development showed him who he was and what he liked to do. For instance, in late high school, Andrew discovered his interest in psychology; through volunteer work in college, he learned of his preference for one-on-one interaction. He then refined his interests in graduate school.

Finding a keen interest in exploring forms of anxiety, Andrew studied the ins and outs around eating disorders during college, as it gave him a good opportunity for research. During college, Andrew had unique working experiences, some of which included bartending and being in service work. He explained how he thinks working in a service position helps develop important skills that are very useful in counseling. According to Andrew, a service position develops your social skills and helps you build a resistance to less-than-ideal social situations. Along with this, it is important to have a job you need to stay “on” for, one where you cannot choose not to assist people because you don’t feel like it or they are being rude. Since therapy is more than just listening to someone, a service position is a solid introduction to some of the skills that are used in counseling, such as how to handle people.

When it comes to counseling, many areas do not have a counselor who has in-depth, specific training and expertise on LGBTQ+ concerns, which leaves a huge gap in the counseling field where many people may not find the connection they are looking for in their geographic area. This puts Andrew in a unique position to help people, who might otherwise not be able to find such a connection, using video calls. This is one of the things Andrew enjoys about technological integration in the counseling field. For example, one of his clients is only able to visit him in person for several months out of the year. With weekly video calls, they are able to continue their sessions and the relationship they have built. Andrew made a point of specifying how not every innovation is a good one, though. The sudden influx of mobile applications that attempt to regulate your breathing or make you feel calm are not replacements for counseling—but they are sometimes treated as such. It is an easy entry point for self-care and lowers the accessibility bar, but a mobile application or the process of texting your problems cannot replace the human connection built in counseling.

While he touched on many issues in therapy, such as accessibility and affordability, he felt the lack of standardization is the biggest issue in the industry right now, due to how it can limit the work a counselor can do and the help they can provide. Each state has its own requirements you must meet in order to become a counselor. This means you have to go through many hours of training in whatever state you would like to practice in in order to become licensed and then work in only that state. While it is possible to transfer your LPC (licensed professional counselor) license to another state, it is a cumbersome process. The lack of standardization creates an inconvenience for counselors and adds extra hoops to jump through in order to help people.

I find it incredibly interesting to think about the specificity of Andrew’s position in what he can offer as a counselor to another person. When thinking about counseling, I had not previously considered how your personal story or characteristics can affect the clients you bond with. When I hear people talk about looking for a counselor and things not working out, usually the reason is something along the lines of “just not connecting.” After talking with Andrew, however, it seems that being more open about personal aspects of your life, as a counselor, may allow clients to select a counselor fit for their lifestyle and connect more effectively with them. This is also a reflection on how counseling uses more than just a degree and practice experience; it uses your own life experiences as well.