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Interviewer: Thinking about getting an MD-PhD? Today we're going to talk to a guy who just completed an MD-PhD program, next on The Scope Radio.

Announcer: Navigating your way through med school can be tough. Wouldn't it be great if you had a mentor to help you out? Well, whether you're first year or fourth year, we got you covered. The Med Student Mentor is on The Scope.

Interviewer: Today we're going to talk to someone who has a very specialized degree, an MD-PhD. We're here with Ryan Craig. Can you tell us a little bit about how obtaining an MD-PhD is different than the four-year medical school degree?

Ryan: The way that our program works, and most programs, you do the first two years with your normal medical school class, go to all your classes, take step one, but whenever the rest of the class moves on to the clinicals, you go into the lab and start your project.

Most places can take two, three, four, sometimes even five years to finish your research, and then you get injected back into med school with third years in the clinics and the hospitals. So it's a little bit more of a time commitment, but in the end you come out with both your degrees.

Interviewer: So when you talk about doing research as an MD-PhD student, do you pursue a type of research that you're initially interested in, or is it something you're assigned?

Ryan: Well, it's kind of funny because my situation was a little unique. I started medical school after Hurricane Katrina came through New Orleans. A lot of the researchers didn't come back the year following, so we were a little limited on what we could choose. I originally wanted to go into cancer research, but at the same time found a great lab with a wonderful mentor and lots of resources doing HIV research.

I don't really think that the project itself is as important as the tools and information that you can learn, because my plan in the future is probably to go back to more cancer-oriented research using the tools that I did learn in my lab.

Interviewer: As an MD-PhD, do you get to choose what kind of topics or what kind of interests that you get a PhD in?

Ryan: Yeah, our program was really great in that you could pick from a number of departments; pathology, biochemistry, physiology, neuroanatomy, even chemistry. So whatever your interest is, you can kind of find a place that you fit in across all those programs. As long as it's a biomedically-related field, I think that most programs would allow you to pick and choose exactly where you want to be.

Interviewer: When MD-PhDs complete medical school and the PhD program as well, do all of them go on to complete a residency in a hospital?

Ryan: As far as I know, most probably do. It seems to me kind of like a waste to put yourself through the tortures of medical school and not actually use them. So for the most part I believe that most people do. A lot of times they have the research kind of in the back of their mind during residency and try to look for future careers that can allow them to do both. I do know some people that will go through the residency and then focus the majority of their time in research. But for the most part I think that these MD-PhD students come out as clinicians with an interest in research, or like they like to call them, physician scientists.

Interviewer: For a prospective MD-PhD student, can you think of any skills that they might have developed before going into graduate education, or maybe personality traits, or just in general interests that might push someone to pursue an MD-PhD?

Ryan: I think it's important to have a real attention to details. You know, when you're planning experiments you have to have a lot of insight ahead of time as to what you expect, and how to deal with failure is a pretty important thing because more often than not your experiments don't work or don't come out how you expect.

So to be able to persevere in those kinds of situations is important. I think just a curiosity to learn is a good trait to have. I would consistently read things in textbooks and kind of want to know more about things that maybe are glossed over or not thought of as important, and so with the background in research, you're able to go in and ask those questions and maybe even solve some of those questions on your own.

Interviewer: I think that the ability to experience failure translates into both MD as well.

Ryan: Yes, that's for sure.

Interviewer: What would the difference in everyday practice be like between an MD-PhD versus an MD?

Ryan: I do plan on practicing medicine as an MD for probably more than half the percentage of my time, but I also want to be able to be involved in projects that are going on in the hospitals, in the medical schools, and in the research labs.

One of the main reasons that I didn't just do a PhD is because the difficulties I saw in running an entire lab yourself, where you spend most of your time writing grants and writing papers, and not really a lot of time doing the research yourself, as an MD-PhD you bring a unique skill set where you have access to patients, you have the knowledge of the medical side of things and you also have the skills and tools necessary to do the research. So you're a very wanted piece of the puzzle.

To be able to have a little bit of extra time of your medical practice to put forth towards doing research, it makes it better to where you can kind of focus on the things you want to focus on and not necessarily be the bureaucracy behind running your lab and being a full-time researcher.

Interviewer: That certainly is a great point because throughout my medical education it comes up again and again how important evidence-based medicine is, and to have a good idea of how that evidence-based medicine is developed seems invaluable for an MD to have.

Does your MD-PhD degree qualify you to do anything that an MD can't do?

Ryan: That's a good question. It's not quite as specialized as one might think. As an MD, you can actually run your own lab if you wish. I've known people that have quit practicing but kept their MD degrees through continuing education classes and retaking boards and whatnot, but that use their full time towards running labs.

So it's not that you can't, it's just that the MD-PhD training program really puts you in the position to know how to do those things and not necessarily wasting a lot of time later on in your career trying to figure out how to write grants, how to write papers, and what projects you may or may not be interested in.

Interviewer: Do you have any advice for a pre-medical student who is considering obtaining an MD-PhD?

Ryan: Yes. Find a lab to work in, whether it's volunteering over the summer or getting involved in a big project, or even as much as just preparing materials for projects. To be able to be in that environment, to really see if that's what you like, because it is a pretty big commitment to do an MD-PhD program, and if you find out a couple years into it that you don't like it, you might have wasted a good bit of time.

Experience is a plus no matter how you can get it, and like what happened to me, it doesn't necessarily even have to be the thing that you're most interested in as long as you can learn something from it. Meet some professors, meet some researchers and see what their lives are like.

Interviewer: Last question. Would you do it again if you had the option?

Ryan: Yeah. The benefits that I see now looking back, it made me a much better public speaker, it made me much more confident about my work. This program in most places will pay your tuition and a stipend as well, so I came out of this program a few years behind but with no loan or debt out there. I think that is one of the biggest advantages, too, is that I don't have that hanging over my head right now when I look towards the future.

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Interviewer: Today show is all about how med students can get involved with health care policy because health care policy is going to affect the way that we practice medicine as future physicians.

Announcer: Navigating your way through med school can be tough. Wouldn't it be great if you had a mentor to help you out? Well, whether you're first year or fourth year, we got you covered. The Med Student Mentor, is on The Scope.

Interviewer: We're here with Nika Nour. She is the Digital Director for the Internet Association and a former Staffer for the House Committee on Energy and Commerce.

When you have a conversation with a congressman and you want to get something specific done, what is the best way to go about doing that? I mean, is it just saying, "If you don't do this then I'm not going to vote for you," or like is there a better way of getting the change that you want to see?

Nika: One thing is, when you come to the table and you meet with congressional staff or when you visit an office or when you talk to member of congress, come prepared with your point of view, with some information to back up what you're trying to convey. Really try to come up with three things that you would want their office to have in terms of a takeaway. Remember that, depending on the public policy or the topic that you're trying to get across, information and education is key.

Medical students are the experts in their industry. It's really important to find a way to reiterate what needs to be done and how it needs to be said.

Interviewer: Are there ways that medical students can get involved with lobbying or being on a campaign? Is that a more effective or is that another avenue to affect change?

Nika: As a citizen and a med student, any form of civic engagement is going to influence. Even something as simple as voting and being an active voter and really making those key decisions is a way that you can impact public policy because ultimately, you are deciding who's going to sit in that seat and who's going to go up to bat for you.

In terms of the lobbying front, there are a lot of third party groups out there and there's a lot of people that you can get involved with that are already up here in Washington. It's up to you guys to be able to find a local chapter or even reach out to them and kind of let them know that you want to help, you want to get involved, that you would like to dedicate some of your time and key knowledge to help whatever issue you're trying to advocate for.

Interviewer: With advocating for different issues, is it better to join lobbying organizations like American Medical Association or big organizations like that, so that way you have a lot of people behind you?

Nika: Any time that you can put in, any form of activity and as long as you're joining up with others that are aligned with your cause and your point of view, is going to be helpful.

If you feel that you're not getting your voice across or your point across, then sometimes these third party associations or organizations are a way to go. It really depends on what the topic is and what impact you're trying to make.

Interviewer: You mentioned before, timing. Timing is really important.

Nika: Right.

Interviewer: When is the best time to get involved and what should you do when you feel like it's time to get involved?

Nika: As early as you can, as established as your relationships are.

Once a bill gets to the House floor, it's already gone through committee, it's already been considered by a multitude of people. That doesn't mean that you can't change it. I'm just saying that the time that... it's more of being proactive versus reactive and what you'd want to do is to create that long lasting relationship.

For example, there's a big difference where you had already established a relationship that you've been informed that there are certain bills are being written and you are a part of it from day one. Or that you have already voiced your opinion early on and that you're constantly touching base with that office every few months, then you're more likely to see something on the floor that was a product of you.

If you wait, then you're getting into a much more reactive territory.

Again, it's a lot easier to build a house from the ground floor up than to remodel it.

Interviewer: Sure and you mentioned that there were websites that let you know about bills before they hit the floor. Do you know of any specific websites for health care policy?

Nika: Go to Congress.com and you could view the top 10 most viewed bills. You can look at committee reports, nominations, all sorts of legislations, sources. And you can even, for example just type into the Search, type in health care. If you actually go to Congress.com's website, it's an example of what you can type in to the search bar, is health care. It's evident that people are really actively using it.

Interviewer: Do you have any last thought?

Nika: I just encourage everybody to know who their representatives are from the local to a federal level and to understand the process.

Education works both ways. You can't impact public policy if you don't know how it works. The same goes for Congress, you can't write good comprehensive legislation if you don't understand the industry. It's really a helping of both hands that makes good legislation happen.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: What does it take to become an infectious disease doctor? That's next on the Med Student Mentor.

Announcer: Navigating your way through med school can be tough. Wouldn't it be great if you had a mentor to help you out? Well, whether you're first year or fourth year, we've got you covered. The Med Student Mentor is on The Scope.

Interviewer: Today we're going to talk about what it takes to become an infectious doctor with Dr. Andrew Pavia, Chief of the Division of Pediatric Infectious Disease here at the University of Utah. Thank you, Dr. Pavia, for joining us today. We're very excited to have you.

Dr. Pavia: Well, thanks for having me.

Interviewer: So first of all, can you tell me a little bit more about your path to infectious disease as far as your residency and fellowship? How did you get here?

Dr. Pavia: Well, I followed a somewhat nontraditional pathway and it's nontraditional in many ways. I did my residency in internal medicine and was a chief medical resident. Then I did my fellowship at the Centers for Disease Control in something called the Epidemic Intelligence Service. But that doesn't include a clinical component. I worked on problems that affected children and adults but predominantly children. I decided at that point that I was really interested in pediatric problems as well as adult problems. So when I finished my three years at the CDC, I was in Utah at the time and I did my clinical fellowship training in both adult and pediatric infectious disease.

But as a fair warning, that is not the way most people are going to go through their training. And it's certainly not the order they're going to do their training in. What it does point out though is that there are many pathways. It also reminds people that in medicine you can keep reinventing yourself. And you can keep doing things that you're interested in and adapt as you go. Don't think that a decision you make as a second-year medical student is going to determine where you sit at 45 years old.

Interviewer: And that's good to hear especially as a second-year medical student. It's really stressful and we constantly get asked "What will you go into?" and "What will you specialize in?" So I feel like it's good to hear that there are different paths and you don't have to decide everything right away. But there are those students that are 100% sure that they want to do infectious disease. So what would you tell those students? How can they prepare in the first four years of medical school to become infectious disease doctors?

Dr. Pavia: Well there are two main pathways to infectious disease fellowship, really three. One is to do an internal medicine residency and then do a fellowship in adult infectious disease. The second is to do a pediatric residency and do a fellowship in pediatric infectious disease. And the third is to do med-peds and then you can either do one or both of the infectious disease sub specialties. Probably the most important thing though if you're really thinking about infectious disease is to start to get your feet wet early on. There are a lot of ways to do that.

It may be to do global health. It may be to spend time in Africa and see the clinical impact of infectious diseases and see not only how much of an enormous impact they have on people's health but what a difference it makes when you have effective treatments. It may be to get involved in the laboratory and to see some of the incredible new tools that are available. For instance, we can now sequence the entire sequence of a bacteria in under a day and learn things about it that took a lifetime, a career to determine. We can even find bacteria that you can't grow in the laboratory through sequencing.

And the third pathway—the one that most reflects what I have done—is to work on what we call clinical and translational research. That is, research that is really much closer to the patient that either looks at what treatments work best or what features help you determine what kind of disease a patient has or to compare outcomes. Where can you get the best outcome for the least resources and the least risk for a patient?

Interviewer: And those all sound like great opportunities. I also think that med school is very stressful and there's so much going on and it's hard to narrow down what extracurricular activities to do, just because our time is so limited. So if you had to pick something that you feel best represents infectious disease from the standpoint of a second year medical student, what would it be? What activity do you think would be best?

Dr. Pavia: Well I think you have an opportunity as a fourth-year student to do a clinical rotation elective to give you an idea of the day-to-day life in the hospital. But as a second-year student there are a couple things that could be much more fun.

First, would be to look for research opportunities. We've had a number of medical students work with us over the years on projects that often resulted in their publishing a paper. A number of them have ended up in infectious disease or have done something else academically that was closely related.

Another would be to take advantage of some of the great opportunities we have here at the University of Utah to do work overseas. If that's something that excites you and if you have a language skill and a passion for working with people in less fortunate circumstances, they're great opportunities to pursue.

I think there are people in adult infectious disease and pediatric infectious disease who would love to talk to you. There's a Dean for International Affairs, Ty Dickerson, who would love to talk to you about things like that. Of course, there are opportunities that you'll hear about in med school.

Interviewer: That sounds very exciting. Just a couple more questions. Every time I ask people what should I go into, what do you see me doing, they always say "Just follow your heart and go wherever you think your personality fits." And that sounds like a simple response. But it's actually really confusing because I find myself thinking, "Well, what does that mean? Where will my personality fit in?" So what kind of personalities do you think best fit in infectious disease?

Dr. Pavia: Well, there's a joke I like to tell about infectious disease doctors which is they have to be the consummate clinician and really be good at almost every part of medicine. They have to really care about people and understand problems in society. They have to have a great interest in science because things are constantly changing and they should probably marry a wealthy partner. I say that facetiously. You will not starve as an infectious disease doctor, but if your goal is to have a 140-foot yacht and to drive a new Mercedes every year, you probably should look elsewhere.

But if you're curious and interested in your patients and like to be around a group of people who are excited about what they do, infectious disease fits well. We really have to dig into patients' lives because understanding in an individual clinical encounter, understanding what somebody has, may hinge on really understanding where they have been traveling, what their hobbies are, the interactions they have had with animals or with food. So you really have to be a good clinician and curious about people.

You may be working with a lot of people whose lives are very different than your own. Maybe they're a war refugee from the Sudan. Maybe they're an IV drug user. And so, you have to really be able to get inside their lives with them a little bit. And if these are things that match with your clinical personality, I think ID is well suited to you.

If you want to sit on the other side of a computer screen and use technology to understand your patient, there are opportunities for that in infectious disease. But that's not what most of us are like. Now, that's not to say that many people don't work with big data or aren't experts in everything ranging from genomics to data visualization, to designing diagnostic tools that let you put in what information you have and generate new probabilities that guide your diagnostic thinking. But in the end, infectious disease is really about people and the societies they come from.

Interviewer: It sounds really exciting. I know you've gotten me excited about it and I feel like I have to find out more about it.

Dr. Pavia: Well good.

Interviewer: It definitely sounds exciting and I think that's fun just to have something that's constantly changing. You're like an investigator and that's what infectious disease sounds like, so that's very exciting. Do you have any additional advice for someone who wants to succeed as an infectious disease doctor?

Dr. Pavia: Well, I think many people go into medical school with kind of a public health bent. They want to make a bigger difference in society rather than one patient at a time. That's really my background as well. Infectious disease is one of the fields where you have the skills to do that. There are other areas -- birth defects, maternal health. But in infectious disease, if you're interested in improving the health of populations in society, then that training is really useful for it. At most health departments, at the CDC, at the WHO, infectious disease doctors are in great demand because after all, infectious diseases remain the number one killer in poor countries and in the top five even in the wealthiest places.

Interviewer: Great. Well thank you Dr. Pavia once again. It was a pleasure and it was great talking to you.

Dr. Pavia: Well thank you and I hope we've excited a few people about a field that I'm constantly excited about.

Interviewer: Definitely! You excited me, so that is one person.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Maria: Why should consider specializing in infectious disease? That's next on the Med Student Mentor.

Announcer: Navigating your way through med school can be tough. Wouldn't it be great if you had a mentor to help you out? Well, whether your first-year or fourth-year, we gotcha covered. The Med Student Mentor is on The Scope.

Maria: Today we're going to explore specializing in infectious disease with Dr. Andrew Pavia, Chief of Division of Pediatric Infectious Disease here at the University of Utah. Thank you, doctor, for joining with us today. We're really excited to have you.

Dr. Pavia: Thanks for having me.

Maria: So first things first. What is it like to be an infectious disease doctor?

Dr. Pavia: Well, there is very little in medicine that's quite as exciting. You never know what you're going to see any day or any year, and if you think about the headlines just from this year, we're dealing with outbreaks in diseases that we never thought about. We're dealing with Ebola, we're dealing with measles outbreaks, enterovirus D-68, and that's just on top of taking care of some of the sickest people. If we do our job right, we're really helping them get better because the cool thing about infectious diseases is that they can kill you quickly, but many of them are curable.

Maria: Tell me more about what opportunities you've had professionally as an infectious disease doctor?

Dr. Pavia: Let me go back to the beginning of my career. When I graduated medical school, it was 1981 and nobody had ever heard of a disease that was affecting young gay men. My first night as an intern about a week after the CDC had first described the outbreak of pneumocystis and CMV, I took care of a guy with what turned out to be pneumocystis and CMV.

That shaped an early part of my career, and I think that gave me this drive to be involved in working with these new and emerging infections. AIDS really shaped my career and my life because it was something that many other people didn't want to touch, and yet every day we were learning something new. What we were learning was both scientifically incredibly complicated and fascinating, but we could take it to the bedside and help our patients who at the time had very little hope.

Maria: That sounds very exciting. It sounds like you were able to just take the lead and say, "I want to make a difference," and you went for it. Was there someone that helped you along the way, and was there someone that you looked up to at the time that helped you make that decision to just jump into something maybe others hadn't done in the past?

Dr. Pavia: Well, there were probably a lot of people who inspired me. I had two terrific Infectious Diseases Professors in medical school, although ironically back then they said, "Well, there's not much new in infectious disease, and there's not much money in the field." Well, they were wrong on the first point.

The other big career changer for me was a friend of mine found out about a program at the Center for Disease Control. He went down and served as an academic intelligence service officer, which is a job in which usually young ID-trained physicians who are people who are interested in infectious diseases, go down and they're involved as the disease detectives for the CDC. So after I finished residency I went and did that.

But there's another little story that connects the two there. When I was a third-year resident I took care of a young man who was about 16 who came in with bloody diarrhea and went on to get severe renal failure and he had low platelets. He turned out to have hemolytic-uremic syndrome, a disease that back then people knew very little about. Nobody drew any connection between that blood diarrhea and the hemolytic-uremic syndrome. In fact, they thought he probably had Crohn's disease incidentally.

When I got to CDC I had a chance to work on E coli 0157, and so there was another aspect in which something that just two years ago we knew almost nothing about we were able to work on, and now understand what's way more important, foodborne diseases. I think my friends and colleagues in infectious disease could all tell stories like this about ways that new discoveries really change the face of what we do in medicine. It's hard to find many other areas in medicine where you get to do that on such a regular basis.

Maria: And that was something that I was actually going to ask you about. I think that a lot of us go into medicine with this feeling that we want to go in and make a difference and change things, and we want that empowerment to really help. I was going to ask you how you feel that infectious disease helps you with that mission and helps you continue that mission throughout your career?

Dr. Pavia: In medicine, we try and make a difference in all sorts of ways. We try and make a difference for the patient in front of us, one-on-one. We try and make a difference by adding new knowledge that's really going to change things for a group of patients. We try and do things that might largely affect the world at large and people who have so much less than we do here in the United States.

In infectious disease you got to do all three because so many of the infections that we think about and that we worry about are global killers as well as big problems at home. So people who choose infectious disease can work in the clinical arena in the United States, they can do research on new and exciting scientific problems, they can work in global health. You can combine all of them, and all these things are a chance to really make a difference.

Maria: So it seems that there are different paths and different opportunities for you to take once you graduate and you're done with your fellowship and you're done with all this education. Is there a traditional route that people usually go through once they're done with fellowship?

Dr. Pavia: Well, I think that infectious disease practice these days breaks up into a number of different things that a typical infectious disease doc, if there is a typical infectious disease doc, may be hospital-based and may work with very sick patients such as transplant patients or hematology/oncology patients. They may also work on containing the spread of hospital infections. That's another major branch of our field, and that's something of a specialty in and of itself. There's a whole new area of quality improvement in antimicrobial stewardship which is continually improving the way all of us as a team practice medicine.

Other people go into practice and predominantly take care of outpatient problems. Others go into public health and work for state health departments or CDC or international agencies, and still others work in the field of global health and may work on problems like malaria, dengue, Chikungunya or Ebola.

Maria: That sounds exciting. It sounds like you have a vast number of opportunities and things to do. Is there anything that you would tell medical students to pursue or maybe what questions to ask if this is something that they're interested in?

Dr. Pavia: Well, I think you should do something in medicine that you love and excites you every day. I guarantee you that if you choose infectious disease, that will be your future. There are some downsides. If you want to be a cardiologist your income will be higher but you will be bored most days.

If you look at surveys, infectious disease docs are not the highest paid doctors by a long shot, but they always score highest on the question, "Would you do this again, and do you like your job?" And that, to me, is the most important determinant in choosing your career.

Maria: I agree. Thank you very much for all that amazing information. I think that it sounds like a very exciting field, and I think even for me, personally, as a medical student, I feel like I didn't know enough about it. I didn't know how exciting it was. It's really great to see someone that's been in this field for as many years as you have still just light up whenever you talk about it. I think that's really exciting and I think that's what we all aspire to do. So thank you.

Dr. Pavia: Thank you.

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