As part of our “Meet Yale Internal Medicine” series, today’s Q&A is with Justin Belcher, MD, PhD, assistant professor of medicine (nephrology).
Q: Why did you go into medicine? Were you one of those children who knew they wanted to be a doctor when they grew up?
A: Just about. I knew I wanted to be a doctor since high school. I didn’t always know that I would be a scientist (I was a history major in college) but took the basic prerequisite courses. I love to read and write. One of the things I enjoy about doing research is actually writing the papers – most people don’t like writing papers. But I’ve had to focus more on science writing rather than some of the more expressive writing I’d done in the past.
Q: What brought you to Yale School of Medicine (YSM)?
A: I came as part of the research fellow track. I did one year of clinical training and then embarked on several years of research. I was fortunate to be able to expand my research project into a thesis and obtain my PhD. I was very lucky when I was applying for my fellowship. For a few years before the official match started, you would apply wherever you want, interview, receive offers and actually choose for yourself where you wanted to go a few months later!
I had a choice of many places besides YSM, but what swayed me was the people. I know this is always a little tough to judge because on interview days, everyone is putting their best foot forward. Everyone is smiling. But everyone here seemed genuinely nice and not just putting on a show. It seemed like a very collegial group of people.
I am from Easton, Conn. originally so I was looking mostly in northeast for my fellowship. Yale has roughly the same sort of training as other schools in Boston or Philadelphia, but the people here seemed like a nicer group. Thankfully that has been the case.
Q: Why specialize in nephrology?
A: I wanted to do internal medicine and specialize in something. I was definitely not a surgeon or a proceduralist. I thought about cardiology and gastroenterology but the challenge of the physiology of nephrology won out. I was fairly sure by the end of medical school but a great renal elective as an intern sealed it for me. I knew I wanted to do something in-patient. I really like the hospital, the academics and the teaching.
Q: Tell me about your work at the VA Connecticut Healthcare System.
A: I work full time at the VA. I work in the outpatient clinics seeing patients myself and also precepting fellows in their clinic. Additionally, I do a lot of telenephrology. Some outpatient VA clinics throughout the state have primary care physicians but are without specialists. Rather than driving from New London to West Haven, we will have a tele session - there's a television screen and I see them and they see me. I also do telenephrology for Manchester, N.H., which doesn't have nephrology. I am also about to roll this program out in San Antonio, Texas, which also doesn’t have nephrology.
When I am the inpatient nephrology attending, I teach the medical students, residents, and fellows. In addition, I attend a few weeks a year on the general medicine inpatient services. At YSM, everyone rotates at the VA. I also do a lot of noon nephrology conferences, morning reports, affiliate hospital lectures and teach in the medical student nephrology course.
At the VA, you can have more time with patients than you do at Yale New Haven Hospital. Vets can have the reputation as being a challenging population, but just hearing their service stories is incredible. I saw someone two days ago who's 95. He played the bugle at the ceremony when Japan officially surrendered to end World War II. A story like that is remarkable to hear.
Q: What do you like about teaching?
A: Nephrology is fun to teach because it's something you need to work through, it's cognitively challenging, but it's also something you can understand and don't have to memorize. In nephrology, the upfront investment is more; to understand the process of it, the physiology of it, but once you do, it's incredibly gratifying to be able to think your way through pathophysiology. I think a lot of people can be intimidated by it for that reason. When you are a student first starting out, it can be complicated.
I try to break it down and make it relatable, interesting and fun. I like when I see the light go on in people and actually enjoy nephrology. Teaching is fantastic and is my favorite part of medicine. You are always learning. There's always new physiology to know.
Q: What can you tell me about research that you are working on?
A: A big study at the VA right now is looking at opioid use in dialysis patients. We are working to wean these patients off opioids using a couple of different modalities. We are also looking at monitoring interoperative urine output in response to diuretics to guide real-time fluid management. Additionally, I did my PhD thesis on acute kidney injury in patients with cirrhosis so there are a few projects that I would like to get started related to that.
Q: Where do you hope to be in five years? Ten years?
A: Hopefully here! I came to Yale hoping that my impression of the people here was accurate, and it certainly was. I love the people in the department. Everyone is very supportive and friendly. I love the teaching aspect of my job so I hope to get more involved with the medical school nephrology course.