As I read the article from the January 4th, 2012 Journal of the American Medical Association, "A Doctor Goes to Washington … And Safely Returns", I couldn't help but compare my experiences to those described in the article. While the author of that article had spent over thirty years in medicine, I am fairly new in my career, but intent upon mixing clinical medicine with policy and public service. I am a health policy fellow at the State Department, where I am serving as an advisor to the office of International Health and Biodefense. In this role, I have had the privilege of witnessing policy making in action while I try to navigate the exceedingly complex bureaucracy of our federal government. I recently graduated from Yale’s psychiatry residency program, but the issues with which I deal on a day to day basis in this position sometimes have little to do with mental health specifically, but instead with developing policies and procedures related to larger systems interactions and the role of the federal government in the regulation of health care delivery systems and medical research.
My State Department experiences are rewarding, as they have allowed me to taste a non-clinical side of medicine, and I would encourage other medical students, residents, and junior physicians to avail themselves of such opportunities early in their respective careers, as these may become trajectory changing. Prior to my departure for D.C., I received confused looks and quizzical responses such as, “what does that have to do with medicine?” My answer is that I believe that this exposure to the workings of our government would indeed add to my clinical repertoire, and offer a unique perspective to those making medical and science policy decisions.
In my role, I have been fortunate to sit at the table for high profile discussions at senior levels of our government. The issues are related to important questions, including the oversight of dual use research that has attracted significant attention of late. While there are certainly no easy answers, understanding the process by which policies are created to address fundamental ethical questions--for example, limiting access to scientific information--is an invaluable experience.
I find that as a young doctor recently out of training, I too can contribute meaningfully and learn by listening and making the most of each interaction. With my background and interest in mental health, I have taken advantage of the opportunity to approach other offices in the State Department and within our larger government to collaborate on ways to increase access to psychiatric care, particularly for those suffering after disasters and from other traumatic experiences. While I don't expect major changes overnight, I have been pleased to find that there exists an eagerness for healthy discussion and brainstorming of how to expand our limited resources to those who may need them most desperately, both within the United States and around the world. The World Health Organization has predicted that by 2020 depression will be the second leading contributor to the burden of disease, and currently depression is the leading cause of disability. Given these sobering projections, I hope to highlight the acute need for mental health care, and begin to expand our government’s efforts to increase outreach efforts.
The State Department, in particular, is especially dedicated to promoting the cause of women, especially by encouraging women in the sciences globally. I hope that I can, by example, show young students and trainees that women scientists not only have a role in the government, but their voice is critical in making foreign policy decisions, which are linked to health stability and economic security.
As a physician, I often found myself working in a virtual silo. The practice of clinical medicine is tremendously rewarding to me, but it can be lonely at times. My stint with the government has given me an opportunity to collaborate with other professionals from a huge number of diverse backgrounds. These interactions have been eye-opening, and they give me a chance to learn how other agencies are working together for the promotion of our better health. When I return to the practice of clinical medicine on a more regular basis, I believe I will have a greater understanding of the nuances of policy making and the tremendous complexities of negotiation. These skills will be helpful in any setting, whether in clinical practice, hospital management, or academia.
I am certainly enjoying my time with the State Department, and I would strongly recommend a non-traditional experience such as this to other young doctors as they navigate their careers and find their niche.
The views expressed in this article are those of the author, and do not necessarily reflect those of the U.S. Department of State or the U.S. Government.