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Why Preventive Medicine?

Trying to figure out what kind of doctor you should become? Wondering what specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Dr. Mora Pinzon is discussing her path into Preventive Medicine and what it's like to be practice preventive medicine.

Let’s start with the basics: Preventive Medicine & Public Health is a board certified specialty. We are not a part of family medicine or internal medicine. You may not have heard about it because - rather than traditional "bedside" medicine - we take care of populations and often work from public health departments, universities, non-profits, and government entities. We study epidemiology and population statistics; we are at the forefront of quality improvement and research; we are advocates for improvement in patient care and health policy. And yes, we are full fledged doctors. We attend med school, go through residency, and obtain medical licenses. Furthermore, many of us DO take care of patients in more conventional settings (e.g. clinics and hospitals) in addition to public health. At the end of the day, the responsibilities and scope of practice of a preventive medicine physician are highly individualized; no two paths are the same.

During med school, I always had a hard time defining what exactly I wanted to do. I enjoyed thinking about how sociodemographics and environmental conditions affect a person's ability to stay healthy and access healthcare. Most of the physicians that I met who were involved in this type of work were retired, teaching, and/or had limited patient interaction. At that time, I thought that medicine occurred at the bedside and in the hospital. I didn't know how to reconcile my desire to treat patients and my interest in public health. So, when the time came to pick a specialty, I went into general surgery. There was gratification in helping patients and seeing direct and immediate outcomes.

However, during my intern year, I knew something was missing. I became jaded, cynical, and felt impotent. In retrospect, I realize that I had been suffering from early signs of burnout. Every day, I saw victims of trauma (gunshots, stab wounds, accidents). Even though many of these events are preventable (even gunshots!), I had no idea what was being done at the institution/city level to prevent them. Every time that I discharged a patient, I felt that I was doing him/her a disservice. Despite giving my patients as much time as I could, discharge information about their condition, available coping tools, and means for prevention seemed inadequate. I saw many readmissions for things that are preventable (e.g. patients unable do wound care as instructed because they had to work). I thought there must be another way, so in my free time I did research. I looked at various data to help identify things that made patients more susceptible to bad outcomes. Then, I helped to determine what we can do at the systems level to predict and prevent those events.

In my second year of general surgery I asked myself: is this what you want to do for the rest of your life? The answer was clear; it was not. I thrived doing research, but I also loved spending time with my patients in clinic and in the hospital. I enjoyed aspects of bedside medicine, but also found myself preoccupied about many elements of public health and policy. I frequently found myself asking: what can we do at the systems level to make everyone healthier? I felt that general surgery training would never give me the tools and skills that I need to answer that question.

Consequently, I reached a crossroad in my career. If not general surgery, what then? Not only was I contemplating a change in specialty, I felt my skills and interests lay in something outside of traditional medicine. I looked for PGY2 residency positions (via ERAS website) and saw something called: Preventive Medicine and Public Health. I read everything I could find, and discovered that people with similar interests in public health/research existed. And more importantly, that there were training programs for people (like me) with these interests.

I applied and interviewed across the country, from coast to coast. Each program was uniquely different. Some programs had partial emphasis on clinical medicine (e.g. travel clinic, occupational health, women’s health, primary care). Other programs were entirely dedicated to research and quality improvement. At the time, I was certain of one thing: I wanted to make my work matter. Bedside medicine is important, but often fails to address other determinants of health. Research is important, but only if it translates to better understanding and meaningful quality improvement. I already knew how to conduct research, but I needed to learn to convert data to practice. Ultimately, I chose a program that allowed me to explore all of the above and more. If you have ever met me, you know that I refer to this as the best decision of my life.

Preventive Medicine Residency is a two year program. You need to have an MPH or equivalent Masters degree in order to graduate.

Preventive medicine graduates work in academia, doing research and teaching the next generation of physicians and healthcare leaders. We are in hospitals, taking care of patients by using data to improve the quality of care and preventing adverse outcomes. We are in the military, keeping our troops safe. We are in clinics, taking the time to teach our patients about nutrition and exercise. We are in government, creating policy and regulations in healthcare.

I tell students interested in Preventive Medicine, you can do it! And your path to Preventive Medicine can be customized to suit your needs and interests. For those that still want to practice hands-on, bedside medicine - you can complete a residency in any specialty and do a Preventive Medicine fellowship afterwards. At the end of the day, each preventive medicine physician is different.

So if you are wondering what is my elevator speech, here is it:

I am a Preventive Medicine physician, yes it is a real specialty! Yes, we are board-certified! And yes, I have an active, unrestricted medical license! I use epidemiological research, quality improvement and policy to improve the health and healthcare of populations. My area of expertise is health equity, which means that I work to make sure that everyone has a fair shot at health, regardless of their gender, race or ethnicity. I'm heavily vested in community outreach and outpatient settings, because health is 80% about where you live and what you do, and only 20% about the healthcare that you receive.

I no longer believe that medicine is limited to what happens at the bedside or in the hospital. I am the doctor taking care of the 80% of the things that affect health and occur beyond the four walls of the clinic, and I am proud of that.

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