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When one career isn't enough

Yale Medicine Magazine, 2019 - Autumn


Most people attend medical school to become physicians; some, however, use their degrees to pursue other goals.

For some MDs, a commitment to medicine extends beyond the exam room or the lab bench. “I often advise students that the first career they choose isn’t necessarily what they’re going to be doing forever,” said Lisa Ide, MD ’89, MPH, the chief medical officer of Zipnosis, a virtual health care technology company. This mindset might not surprise millennials, who are increasingly likely to anticipate having a series of different careers rather than a single lifelong one. For most medical students, though, the standard postgraduate path is residency followed by academia or clinical practice. Some alumni of the Yale School of Medicine, however, have managed to use their MDs in unorthodox ways.

“I’m struck by the zigs and zags,” Rob Kolodner, MD ’74, vice president and chief medical officer of the telehealth company ViTel Net, said of his own journey after medical school. Neither Ide nor Kolodner, both of whom appeared on an alumni panel on career transitions in June, intended to pursue the work they ended up choosing. Ide recalls a pivotal moment during an overnight shift in the emergency department, when her patient—a mother with a young son in tow—waited hours to receive treatment for an uncomplicated ear infection. Ide’s frustration with clinical inefficiency shifted her focus from individual patient care to improving population-wide access to health care. She pursued an MPH degree and a second residency in occupational health, which equipped her for employee health leadership positions at General Mills and Fairview Health Services.

Yet another pivot brought her management expertise back to the problems she’d encountered in the emergency department: at Zipnosis, she and her team of software engineers strategize ways to streamline care delivery. “I love coming to work, knowing that my job is to prevent that mom and her son from sitting in the ED.”

Kolodner was also drawn to data that improve patient care and came to medicine with a basic understanding of computer programming. During his residency in the 1970s, he was one of the few psychiatrists who used a computer to manage research references. “Looking at this data made me realize that there was an awful lot coming out of the literature that the practitioner wasn’t using.” He accepted a position as the director of medical information resource management at the Department of Veterans Affairs (VA), and proposed providing each VA hospital with a computer. Despite initial bureaucratic pushback, Kolodner’s team implemented the world’s first large-scale electronic health system. As the national coordinator for health information technology, he continued advocating for health information systems. At ViTel Net, he now uses technology to empower individuals to control their own health care.

Connecting people from different disciplines has been a defining component of each role he’s occupied. “The type of innovating I do is combining existing things in new and exciting ways. It requires adaptability.”

The flexibility of Yale’s curriculum may prepare alumni for unconventional occupations, and for the uncertainty that comes along with them. “The Yale system taught me how to learn and keep learning,” Ide said. “With each pivot, I felt comfortable jumping in and developing new skills.”

Alumni like Ide and Kolodner trained for their nonmedical pursuits on the job, but other students seek dual degrees in preparation for unconventional paths. Yale offers a number of joint degree programs in areas like policy, law, business, history, forestry, and theology, among others. Barbara Kazmierczak, MD, PhD, the director of Yale’s MD-PhD program, said that students pursuing nontraditional scholarship bring distinctive insights and goals. “Compared to other physician-scientists we’re training, these students are often drawn more explicitly to shaping the way in which medicine is practiced or perceived.”

Marco Ramos, MD ’18, PhD ’16, pursued a PhD in history of science and medicine alongside his medical training. His historical research, which focuses on health activism in the Global South, was informed by his clinical interests in psychiatry. His own engagement with social justice in medicine is bolstered by rigorous historical evidence. “It was an opportunity to deliberately blur the lines between the sciences, humanities, clinical work, and political action.”

While YSM offers and encourages interdisciplinary pursuits, it also emphasizes clinical leadership. “It makes a difference when health companies have a practicing physician on their team,” said Ide. “They understand what it’s actually like to be responsible for a whole panel of patients or struggle with electronic medical records.” Howard Forman, MD, MBA, the director of Yale’s MD/MBA program, said that the joint degree prepares students to work in a variety of fields—its graduates are leaders in politics, technology, and global health—but, only three students in the program’s 20-year history have opted out of matching into a residency. He’s proud of these numbers—in peer programs, the proportion of students leaving medicine is closer to one-third or one-half.

Preparing for an unconventional trajectory implies a willingness to pursue interdisciplinary work. Kolodner suspects that these alums will be surprised by their paths. “They’re laying a rich foundation and acquiring skills earlier on, but they’ll likely follow the same zigs and zags, the unanticipated things that push us in different and exciting directions.”