Another take on preventive medicine: Shadowing Dr. Carr

AMA Wire
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As a medical student, do you ever wonder what it’s like to specialize in preventive medicine? Meet Robert Carr, MD, MPH, a preventive medicine specialist and a featured physician in the AMA Wire®“Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out his insights to help determine whether a career in preventive medicine might be a good fit for you, and then compare Dr. Carr’s responses with those of another physician in this specialty.

"Shadowing" Dr. Carr

Specialty: Preventive medicine

Practice settings: Consulting, corporate, academic

Employment type: Self-employment, corporations, university

Years in practice: 36

A typical day and week in my practice: Each day can involve a mix of consulting, coaching, teaching and board work. In the consulting area, I focus on the competencies that one gets in the preventive medicine domain: population health, mostly around health policy, and strategic management, or the business side of health care. I consult with health care companies, academic medical centers, health systems and schools of public health and medicine, as well as community health organizations. I also coach executives in various industries.

In addition, I’m a professor at the Georgetown University School of Nursing & Health Studies. In that role, I teach executive master’s students in organizational leadership, as well as how disruptive ideas or events can transform health care delivery, planning and development. In addition, I’m on the boards and advisory boards of several health startups, providing both governance and advisory counsel.

At this point in my life, “work” is really an avocation, so it’s challenging, expansive and meaningful. Because I work for myself, I can pick and choose projects, and it’s really very enjoyable. I sometimes work about 60 hours per week, but my hours are highly variable.

The most challenging and rewarding aspects of caring for preventive medicine patients: The most challenging aspect is balancing population and individual patient needs and keeping connected to patients. I didn’t even know about this specialty when I was in medical school, because everything was focused on clinical care. You think the role of the physician is one on one with a patient until you realize that you have a lot of skills and insights that can be applied in many different areas that are not direct patient care.

People may sometimes ask, “Are you still a physician?” And you think, “Of course I’m a physician. I’m just not practicing direct patient care. I’m using the skills in broader areas that impact patient care, maybe through a policy or a design or a benefit plan from the government.” But it could be the same if you were a cardiologist. You might become chief of staff and then head of a hospital, in which case you wouldn’t see patients much.

The most rewarding aspect is that you can have a huge impact, helping millions of people through policy and strategic decisions.

Three adjectives to describe the typical preventive medicine specialist: Strategic. Epidemiological. Population-focused.

How my lifestyle matches or differs from what I had envisioned in medical school: It’s quite different from what I envisioned. There really wasn’t a model for my type of role when I was in medical school. As time evolved, I created my own career as opportunities presented themselves, and I haven’t exhausted all them. I have friends at Morgan Stanley advising on investment opportunities in health and friends at consulting businesses that do systems optimization and patient flow consulting for hospitals. That variety is both daunting and exciting.

Skills every physician in training should have for preventive medicine but won’t be tested for on the board exam: Courage, and the ability to navigate political and organizational cultures.

One question every physician in training should ask themselves before pursuing this specialty: Do you like variability, ambiguity and navigating cultures? Would you mind missing patient contact? 

Books every medical student in preventive medicine should be reading:

Man’s Search for Meaning, by Dr. Viktor E. Frankl

Nudge: Improving Decisions about Health, Wealth and Happiness, by Richard H. Thaler and Cass R. Sunstein

The Tipping Point: How Little Things Can Make a Big Difference, by Malcolm Gladwell

The online resources students interested in my specialty should follow: Harvard Business Review and Health Affairs.

One quick insight I'd give students who are considering preventive medicine: The policies that drive medicine today come from a variety of governmental and nongovernmental institutions, most importantly the Centers for Medicare & Medicaid Services, the Department of Health and Human Services, the Food and Drug Administration and the Centers for Disease Control and Prevention. Those are all populated by physicians in preventive medicine, who significantly drive the position papers that inform policies.

If you want to know more about how medicine evolves from a broader population context—the policies that drive reimbursement and the policies that drive benefit access and design—then preventive medicine is an area you might want to explore. Join the student section of the American College of Preventive Medicine, participate in preventive medicine annual conferences and network with the various experts who make up the preventive medicine profession.

If I had a mantra or song to describe my life in this specialty, it would be: We Are the World,” by U.S.A. for Africa.

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Apr 24, 2017
A social psychologist says that only by addressing breakdowns in physician engagement on a systemwide level will the incidence of burnout diminish.