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A student’s road to medicine and health policy

When Charuta Gavankar applied for admission to START@Yale, a program that gives incoming medical students an early introduction to research, she listed her interests in order to be matched with a mentor. Her list included access to health care, determinants of quality care, and the effect of socio–demographics on quality of care. “Research questions at the intersection of science and economics fascinate me,” Gavankar said. “You don’t always know what’s happening on the front lines of care, and what the implications of policy are.”

If anyone’s in a position to explore these topics, it’s Charuta Gavankar, a 21–year–old first–year Yale medical student with an economics degree from Harvard and firsthand experience of the limitations of the U.S. healthcare system. When she was seven, her mother was diagnosed with thyroid cancer. It was the first of many bouts with cancer, followed by 16 surgeries and more than a decade of treatment. Her father moved from academia to the corporate sector to pay for medical care, but he lost jobs—and health insurance—because of economic downturns.

When asked if these experiences influenced her research interests and decision to go to med school, she answered, “Absolutely. There were times when we would go to the pharmacy and couldn’t even afford the co–pay. I wanted, and still want, to understand why this happens and what we can do about it.”

Her mentor in the START program, where she looked into hospital readmission rates, is Anees Chagpar, M.D., associate professor of surgery and director of The Breast Center at Smilow Cancer Hospital. “Charuta comes with a very great background in economics from Harvard, so we really wanted to capitalize on her interests,” Chagpar said. “We started to look at readmission rates because there is a focus now on quality and access and how can we best utilize health resources.”

“We used the national cancer database to isolate factors associated with readmissions, particularly after surgical treatment,” Gavankar said. “We were then able to put together an abstract and submit to a journal and a conference. We’re now analyzing data from Yale-New Haven Hospital to see how we stack up, what the other significant factors are here at the hospital, and how we can hopefully prevent readmissions or target populations particularly susceptible to being readmitted within 30 days after breast cancer surgery.”

In October, at the annual meeting of the American Society of Clinical Oncology, Gavankar presented a poster of her research.

Her road to Harvard and Yale began in Kingsville, a small south Texas town of about 25,000, where Gavankar was born. Her parents had immigrated from Mumbai, India; her father taught mechanical engineering at Texas A&M while her mother worked at a wastewater treatment plant. When her mother’s first cancer diagnosis required her to stay at home, Charuta’s father moved to bigger cities with better jobs to pay for the decade of treatment to follow. This left Gavankar, the only child, as the primary caregiver for her mother.

By the time she was in her teens, Gavankar’s frequent visits to the hospital had set her on a path to medicine. “When my mom would go into the examination room, I saw what it was like to be vulnerable, to be in a room with a stranger who was basically your last line of defense,” she said. “I admired her doctors—their knowledge, their kindness. I wanted to be one of them.”

The family relocated to Dallas for better access to medical care, where she attended the local R.L. Turner High School. Her freshman class had 1,600 students. Her graduating class had 800.

“It was an incredible place to go to school,” she said. She remembers “teachers and administrators that went above and beyond,” but also that “79 percent of students qualified for government ‘free or reduced–price meal’ programs.”

Corporate sponsorship supported a science academy at the high school and paid for students to take classes at a local college where Gavankar studied linear algebra. After graduation, she went on to Harvard where she did research on health reform and the health insurance market. “I had seen the very real costs of a serious illness, which made my research especially relevant,” she said. “I also knew I wanted to be a doctor and that this would be one of the only times to immerse myself in something else.

When one of her teaching assistants learned that she was working on a dorm cleaning crew, she offered Gavankar her own job as a research assistant. This led to another job with a business school professor who worked on health care reform in China. “I think that’s why I did economics—it would allow me to have interdisciplinary research interests later.”

Gavankar continued to explore her health policy interests throughout her undergraduate education, even during summer and winter breaks. Back home in Texas she interned at Parkland Health & Hospital System’s Center for Clinical Innovation (PCCI).

“At PCCI, we were looking for ways to improve quality and access to care at Parkland, Dallas’s public safety-net hospital. For example, long hospital wait times and lack of access to transportation often require patients to take the day off from work to come in, prompting most to put off seeking care until it’s almost too late. This prompted us to find ways to reach out to Dallas’ poor by directing them to Parkland’s outpatient community clinics and managing their care remotely with technology. We were also working on a program that, using mathematical and statistical modeling, sifts through the hospital’s electronic medical record in real-time to predict patients most likely to incur a readmission.”

Although she’s still not sure where her career will take her, she wants clinical care to be part of it. Her experiences have inspired her to become both “a compassionate physician who understands her patients’ burdens and a researcher striving to diminish economic barriers to care.”

“My dream is to work in a children’s hospital one day,” she said, recalling her volunteer experience at Boston Children’s Hospital. “My first day, I met a little boy disfigured by third-degree burns that covered his body. A year later, he walked in with his fourth-grade girlfriend to say “hi” to his doctors. That really stuck with me—it was a truly humbling glimpse of the transformative power of science and medicine.”

For more on START, see the video A head START at Yale