How to Succeed in Academic Medicine
Fellowship Equips Doctors with "Survival Skills"

When Heather Callaway is having a bad day, she shifts her attention to a framed photograph on her desk. Instantly, she feels better, reinvigorated. The photo is of a 3 year old, Abraham, whom she met during the first year of her pediatrics residency at Children’s Hospital in Denver. Born three months prematurely, Abraham faced a myriad of obstacles.

“He was on every major life support intervention imaginable, but today, he’s healthy and happy, with no medical complications at all,” says Heather, who took care of Abraham in the neonatal intensive care unit and later became his primary care doctor. “Abraham reminds me of why I do what I do.”

An often-opened scrapbook overflowing with pictures of children she has treated attests to the affection the young doctor feels for her patients, whom she calls “all my babies.”

A handful of people are born knowing precisely what they want to accomplish in life, and Heather is one of them. Since childhood, her sights have been set on becoming a pediatrician.

“I can’t imagine doing anything else ... this is my purpose and my passion,” she says.

Unlike many who experience major changes or just change majors before setting out on a solid career path, Heather carefully plotted her future, and moved steadily in the direction of her dream.

Now, with medical school and residency completed, the 29-year-old doctor treats her pediatric patients with the same level of intense commitment and dedication that carried her to where she is today.

Proudly, she displays a needlepoint wall hanging sent to her by Abraham’s mother.

“Thanks to you, I’m a winner,” it reads, and bears Abraham’s name and birthdate at the bottom.

It’s experiences such as this that led Heather to think big ... to ponder how she might positively impact the lives of patients not just one at a time, but time after time, in large numbers.

Abraham’s parents, like most families Heather encountered during her medical training, were immigrants and virtually penniless. These families almost always were recent arrivals from Mexico, hoping to lock in U.S. citizenship and a brighter future for their children by birthing them in this country.

“Parents arrive with nothing, other than dignity and love for their children. They’re willing to work hard to earn American citizenship, doing jobs no one else will do, so their children will have a chance to succeed,” Heather says.

In gratitude for the medical care and concern Heather showed their children, mothers often gifted her with comforting, homemade casseroles like arroz con pollo (chicken and rice), or conchas (oversized, Mexican cookies that resemble pastel hubcaps).

Through her affiliation with these families, Heather became increasingly aware of the need to improve access to health care for immigrants’ children.

“Many of these kids never receive basic, preventive care, like immunizations or dental checkups. Parents who are here illegally shy away from accessing public services out of fear of deportation or separation from their children,” she explains.

“It’s heartwrenching,” continues Heather. “After all, every American is the descendant of an immigrant.”

With her usual resolve, Heather moved to Houston, home to one of the largest immigrant populations in the United States, and enrolled in a unique program at The University of Texas Medical School that grooms practicing physicians to become successful academic doctors – doctors who not only provide health care to patients, but also hold faculty appointments in accredited college or university medical schools. As such, they take on responsibilities that transcend those of private-practice physicians. In addition to patient care, academic doctors conduct medical research, teach medical students and residents, and sometimes administer departments and programs – exactly the skills Heather believes she needs to effect a climate of change.

“I’ll continue providing one-on-one care to my patients, but I have to think beyond the exam room to achieve a greater good,” she explains.

Heather has earned one of six coveted spots as a physician enrolled in the Joint Primary Care Fellowship program, which provides primary care doctors – family practitioners, internal medicine doctors and pediatricians – with “survival skills” to make it in the world of academia.

At a minimum, these fellows have already completed four years of medical school, then an additional three to four years of residency training designed to qualify them as specialists in their chosen medical fields. Some have training above and beyond. All are medical doctors, M.D.s, in the fullest sense.

“Now they’re back for an additional two-year fellowship, because they believe they have something to contribute toward reshaping the future of health care ... they want not only to treat patients, but also to research issues that affect patients, and to help formulate solutions to those issues,” says Linda Nieman, Ph.D., fellowship director.

The Joint Primary Care Fellowship is for people who know where they are going and who don’t think small, says Nieman, who also is professor and vice chair for educational affairs in the department of family practice and community medicine at the UT-Houston Medical School.

Think of the program and the skills it teaches as a four-legged stool, advises Lynette Mazur, M.D., fellowship co-director and professor of pediatrics.

“A successful academic physician is involved in four endeavors – patient care, research, teaching, and administration,” explains Mazur. “Depending on your own uniqueness and motivation, the fellowship program ensures that you are well prepared to develop any one of these four areas and make it your strength.”

Physicians enrolled in the program spend 30 percent of their time – roughly one and one-half days per week – treating patients and 70 percent conducting research and completing a rigorous academic curriculum that will lead to either a master’s degree from the UT-Houston School of Public Health or a Master of Science degree in clinical research, offered jointly by UT-Houston’s Medical School and The University of Texas M.D. Anderson Cancer Center.

“Truthfully, if you look at the people who head primary care departments, the trend is that they have M.D. degrees and a M.P.H (master’s degree in public health) or M.S. (Master of Science degree) in clinical research. The Joint Primary Care Fellowship gets you those degrees, and so much more,” says Nieman.

Participants get a two-year head start toward building their portfolios by conducting research, writing and publishing, and acquiring teaching and administrative skills before they become weighed down with faculty appointments, Nieman says.

Their projects are presented at regional and national meetings, and documented in manuscripts suitable for publication in peer-reviewed journals. A full-time research assistant, statistical support, a research stipend, travel money and office space are provided. Research posters line the hallways of the family practice department, representing presentations made at professional conferences by former students.

Before Andrea Bortot enrolled in the program, her training as a physician was superb, but her training as a medical teacher was nonexistent.

“For years I was on the receiving end as a student. Now I’m going to be on the giving end as a teacher,” Andrea says. “When you finish your residency and join a university-based medical practice, they say ‘Go,’ and you’re expected to present lectures and give feedback to medical students, but nobody ever teaches you how. For the first time, I’m learning, before I go out there and teach.”

The program also imparts basic administrative and time-management skills like how to run a meeting, and how to divide time into blocks so that patient care, writing, and reviewing literature all get the attention they deserve.

A native of New York City, Andrea completed her pediatric residency training at the Downstate Medical Center of the State University of New York in Brooklyn. With an interest in adolescent sexual behavior, she is now opting for “double duty” by simultaneously working toward completion of the Joint Primary Care Fellowship and an Adolescent Medicine Fellowship offered through the pediatrics department. To fulfill the patient care component of her fellowships, Andrea sees patients at two school-based clinics and at the Harris County Juvenile Detention Center.

The variety of patients found only in academic medicine appeals to her.

“Anything can walk in the door ... it’s not the staid environment of private practice,” says Andrea, whose father is an Ob/Gyn private practitioner.

Research, in addition to teaching, is a major focus of the fellowship program. Research (or lack of) can often make or break a faculty member’s ability to achieve tenure, says Eric Thomas, M.D., fellowship co-director and assistant professor of internal medicine.

“To be recognized as a clinician-researcher in today’s climate, you absolutely must conduct and publish research, and write grants that bring in money to support your research. This is in addition to your teaching and patient care responsibilities,” explains Thomas.

It’s no secret that primary care physicians are not known for conducting research, Thomas says.

Challenging this long-held view, program leaders designed the fellowship to “immerse” participants in research from the onset. By the fourth week of enrollment, fellows already have identified the research project they will design and complete during the remaining two years of the fellowship.

John Culberson, for example, is pursuing his research interests in end-stage Alzheimer’s disease and advance directives. An honors graduate of New Jersey Medical School, John completed his residency training in family practice at Baylor College of Medicine where he served as chief resident. Subsequently, he became a full-time faculty member and associate director of the family practice residency program at St. Joseph’s Hospital downtown. It was at St. Joseph’s, where the majority of patients are retired military personnel, that he initially became interested in geriatrics.

“I’m amazed when people ask ‘Why do you want to spend your life caring for geriatric patients?’” he says. “Just look around ... where else can you get all this?” he asks, motioning to a bevy of serious bingo players competing for cash, cookies and candy at St. Dominic’s retirement center.

To fulfill a portion of the fellowship’s clinical requirements, John tends to patients at the center two afternoons a week.

“Older individuals are complex and fascinating,” he says. “Take the time to listen ... I guarantee you’ll be challenged and intrigued.”

Immediately preceding his enrollment in the Joint Primary Care Fellowship program, John completed a one-year, accredited fellowship in clinical geriatrics at the UT-Houston Medical School – an accomplishment that qualified him for a Certificate of Added Qualification in Geriatrics, and strategically positioned him for success in a career as an academic geriatrician.

That’s a big career jump for the former high school biology teacher. But in retrospect, childhood influences began swaying him in the direction of becoming a doctor long ago. As a boy, John’s father, a neurosurgeon, often took his son to the hospital while making rounds. Nurses would ruffle John’s hair, and ask, “Are you going to be a doctor like your dad?” Occasionally, a grateful patient would rush up to the little boy, proclaiming, “Your father saved my life!”

“Subliminally, my future was being shaped,” says John, a competitive triathlete who is serious about sports and coaches his 9-year-old son Stephen’s baseball and basketball teams.

Additional fellows include Joe Livingston, Isitri Modak and Aime Serna, who ironically, are all married to physicians who are completing their medical training in other programs.

A dual-residency household can be a bustling place, says Joe, whose wife Allison finishes a pediatric residency at Baylor College of Medicine next summer.

The couple have two children, Annalise, 5, and Benjamin, 7 months, and no child care, other than an occasional babysitter.

“I arrive home, my wife passes the baby to me as she leaves for the hospital ... I put on a Disney movie and microwave some mac ’n’ cheese for my daughter, while my son crawls on me as I collapse on the floor. Then we do it all in reverse when my wife gets home,” says Joe, whose interest lies in child abuse and maltreatment.

A graduate of the Oregon Health Sciences University in Portland, he serves on the Harris County child fatality review team and the Memorial Hermann Children’s Hospital child abuse team, and provides clinical care at Children’s Protective Services’ clinic, the Children’s Assessment Center, and Harris County’s Lyndon B. Johnson Hospital. Currently, he is developing resources for documenting child abuse online.

To maintain balance in their lives, Joe and Allison will run a 26-mile marathon next month in New York.

“We won’t be fast, but we’ll finish,” he says.

Isitri Modak, called “Ish” by her classmates, completed her medical school and internal medicine residency training at UT-Houston. Recalling the days when she accompanied her physician grandfather on house calls in rural India, she is struck by the similarities between underserved urban areas in the United States and the destitute, rural regions of India.

“Poor is poor in any language,” she says.

Interested in helping underserved populations avoid complications of diabetes, her goal is to improve patient education and determine why educational approaches that work for one group don’t always work for everyone.

Everything about medical school appealed to Aime Serna, making it difficult to settle on a specialty. Finally, she chose internal medicine because “it’s like figuring out a puzzle – putting all the pieces together to come up with a diagnosis.”

Today, her primary interest is obesity, and she is designing a program to educate the public and intervene in the prevention and management of this national epidemic. She also provides health care services to UT-Houston’s student clinic in fulfillment of the Joint Primary Care Fellowship’s clinical requirements.

A graduate of the University of South Florida Medical School in Tampa, Aime completed her internal medicine residency at UT-Houston, where she was chief resident for one year.

During that time, she met her future husband, Humberto, a UT-Houston nephrology fellow, as they shared a lunch table in Memorial Hermann Hospital’s crowded cafeteria. The attraction was instant and mutual, and the couple, who share Latin roots and love to salsa dance, married after a romantic proposal on the same beach where they experienced their first date.

Offered since 1995, the Joint Primary Care Fellowship program is funded by the UT-Houston president’s office and by a grant from the federal Health Resources and Services Administration.

The program starts July 1 and accepts three students every year – one each from family practice, internal medicine, and pediatrics. Applications are received and reviewed by fellowship leaders each fall.

For more information, contact Diana Brownfield at (713) 500-7609 or dbrownfield@uth.tmc.edu.

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©2006 Texas Medical Center

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