Global Health Career-- What does it REALLY look like?

[PremedSurvivor]

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I thought I wanted a career in global health. I've done some global health work (6+ month research in a resource-scarce setting abroad), but I feel like at med school, "global health" seems to be a buzzword that gunners attach themselves to in order to sound culturally competent and current.

So I want to know: what does a career in global health look like on a day-to-day basis? Is it always on site? What if you are interested in policy/media work?

Also, for the purposes of residency, does policy research look insubstantial compared to hard science research?

 

[alpinism]

Agreed, which is part of the problem.

Global health is a very broad catch all term.

Everything from international health policy to public health to medical education to preventive medicine to disaster response.

As a result, it varies a lot from university to university. Some doctors work almost entirely abroad, while others spend only a few weeks a year outside the country. Some work at a single site for years while others have multiple short term sites.

For the most part, research is research. As long as it's health policy related to medicine you should be fine. If that's what you're interested in, go for it.

 

[SMag06]

Agreed, which is part of the problem.

Global health is a very broad catch all term.

Everything from international health policy to public health to medical education to preventive medicine to disaster response.

As a result, it varies a lot from university to university. Some doctors work almost entirely abroad, while others spend only a few weeks a year outside the country. Some work at a single site for years while others have multiple short term sites.

For the most part, research is research. As long as it's health policy related to medicine you should be fine. If that's what you're interested in, go for it.

So, what does it look like for the doctors who are only doing something a couple of weeks out of the year? Do you any specifically - can you tell us a little about them like their specialty, their role in the international work, how they can take the time off etc.

 

[Affiche]

So, what does it look like for the doctors who are only doing something a couple of weeks out of the year? Do you any specifically - can you tell us a little about them like their specialty, their role in the international work, how they can take the time off etc.

I'm curious about this, too. FWIW, I've been told by multiple attendings who practice abroad that practically any specialty can get into global health, if the desire is there. They've all emphasized not to pick a specialty based on how easy it is to travel with it.

 

[Stagg737]

So, what does it look like for the doctors who are only doing something a couple of weeks out of the year? Do you any specifically - can you tell us a little about them like their specialty, their role in the international work, how they can take the time off etc.

My school has 2 or 3 profs that go abroad a few times each year for 2-3 weeks. They're all FM or IM physicians at my school, and they typically go back to the same clinic each year. One of them goes down to one of the Latin American countries where the city's MLB team does summer recruiting with the team. They do pretty much normal professor/clinical duties here when they're not abroad other than one of them who has some additional responsibilities as the president of a pretty large international med organization. They all just make sure they don't schedule patients in the U.S. while they're abroad. However, as Alpinism said there are a lot of different ways to practice international medicine regardless of what specialty one enters.

 

[Affiche]

My school has 2 or 3 profs that go abroad a few times each year for 2-3 weeks. They're all FM or IM physicians at my school, and they typically go back to the same clinic each year. One of them goes down to one of the Latin American countries where the city's MLB team does summer recruiting with the team. They do pretty much normal professor/clinical duties here when they're not abroad other than one of them who has some additional responsibilities as the president of a pretty large international med organization. They all just make sure they don't schedule patients in the U.S. while they're abroad. However, as Alpinism said there are a lot of different ways to practice international medicine regardless of what specialty one enters.

Thanks for sharing this. I'm curious about opportunities to travel abroad and work with resource-depleted communities. I'm not sure when in my life I'd be able to commit to something like DWB, but a smaller, perhaps annual, service trip that I could integrate into my career would be a dream.

 

[Stagg737]

Thanks for sharing this. I'm curious about opportunities to travel abroad and work with resource-depleted communities. I'm not sure when in my life I'd be able to commit to something like DWB, but a smaller, perhaps annual, service trip that I could integrate into my career would be a dream.

There are a ton of organizations that do international trips, and many that will pay for you to go. Especially if you're a licensed physician. I'll add a link to them at the end. I know a lot of people at my school consider doing an elective rotation abroad during fourth year and love it. I've done a couple and they really did remind me of why I wanted to go into medicine and refreshed my hope for humanity in general. Anyway, here's the link to a couple hundred orgs:

http://www.imva.org/pages/orgdb/wblstfrm.htm

You can see how long the trips are, where they go, and what the general cost/who pays is.

 

[Affiche]

There are a ton of organizations that do international trips, and many that will pay for you to go. Especially if you're a licensed physician. I'll add a link to them at the end. I know a lot of people at my school consider doing an elective rotation abroad during fourth year and love it. I've done a couple and they really did remind me of why I wanted to go into medicine and refreshed my hope for humanity in general. Anyway, here's the link to a couple hundred orgs:

http://www.imva.org/pages/orgdb/wblstfrm.htm

You can see how long the trips are, where they go, and what the general cost/who pays is.

Thank you so much for posting this!

 

[MedicalDoctorV]

'Global health work' is 100000 different fields. You can be purely clinical (like me), or you can be US-research based, or you can do policy. There's no one track. Luckily, the more medical schools and hospitals that get interested - the more structured paths you have to choose from. One piece of advice - and if you have 10 mins to read the below - don't just do scattered volunteer trips if you actually want a global health career. Fine- if you just want to volunteer your time, but you won't ever turn it into a career. Also; having done this for about 5 years - you're not doing local health systems a favor if patient care is dependent on your clinically skills. Local clinics and hospitals need to figure out how to get local docs to stay and provide care to the population - rather than relying on a (sometimes) unreliable foreign population of interested docs. The best NGOs work this way - and empower local actors to build capacity, rather than just being a stop gap.

MY EXPERIENCE:

I'm internal medicine trained - and now a hospitalist. I finished residency in NYC 2012. Signed up for doctors without borders - sat around for 4 months and they sent me no where (seriously, this happens sometimes). So I ended up doing a series of rag-tag volunteer missions to Haiti - one successively more futile than the last. (That place really is a minefield of NGOs, each doing their little part to make things better... but only in their own minds). I supported myself by doing locum tenens gigs in rural Maine and upstate NY for 1-3 months at a time - and then going back to Haiti. My advice- don't do that. Besides making yourself feel better, you're doing very little to help structural problems.

After this, I decided that if I wanted to get serious about 'global health' I had to go somewhere that had formalized training. So i did a UCSF-global health hospital medicine fellowship. Mouthful... probably why they renamed it to HEAL Initiative https://healinitiative.org. Now it actually includes an MPH if you stay two years. Basically 6 months in the US as a hospitalist, 6 months at a partner site. They pay you a fellow salary i.e. PGY4 salary - and pay for your healthcare, flights to and from, and food/accomodation. They pay probably double what seedglobalhealth.org/ does.
Although i met amazing people (Paul Farmer from Partners in Health) - i felt like an underutilized asset. Mind you I was board certified in internal medicine already, and because of the 'fellow' designation people treated me like a MS3/4.
In the defense of UCSF - they've made the program a lot better now, as evidenced by their re-brand, and their value add of giving you an MPH for free.

After i finished my one year 'fellowship,' i got a 50% hospitalist job at Brigham and Women's - which has a huge number of faculty in different departments doing 'global health' of some sort or another. They let me stack together my shifts for 3 months block (45 shifts) x 6 months total - so i could serve as a senior clinical advisor to a NGO in rural Nepal. Actually the NGO. possiblehealth.org had hooked up the Hospitalist gig because the main job I wanted was the Nepal component. So i did 3 months boston-3 months nepal, then repeat. This was immediately double my PGY4 salary, but still less than half of what i'd get as an actual hospitalist working full time. My time in rural Nepal felt like a 180 change from Haiti. The team was excited to have me, they had specific roles assigned, and they really wanted me to push the local staff.

This is what i did day-to-day when at my overseas site.

Fellow at UCSF
Shadowed around Haitian docs
Gave a few 'talks' to Haitian family medicine residents
Honestly seemed like no one really knew why i was there, what they could use me for.

Hospitalist at Brigham / Senior Clinical Advisor in Nepal (possiblehealth.org)
Teaching conference - i would either present a topic, or force the Nepali staff / health assistants to present a morning report type case and then grill them as to WHY they did things. They loved it.
Morning rounds - these turned into dispo rounds - why is this person still here after 18 days for a uti?
Afternoons in clinic with 50+ patients per provider - i circulated around and helped the midlevels (health assistants).
Afternoons - help implement an EMR

Anyway, I'll stop my rant now. As one of my mentors told me - be picky in choosing your experiences. Actually interview the organizations you're going to work with and make sure they're invested in you. You're a valuable resource - and you shouldn't be mismanaged/ wasted. The same way you shouldn't waste the time of those you seek to help.

 

[lymphocyte]

I thought I wanted a career in global health. I've done some global health work (6+ month research in a resource-scarce setting abroad), but I feel like at med school, "global health" seems to be a buzzword that gunners attach themselves to in order to sound culturally competent and current.

So I want to know: what does a career in global health look like on a day-to-day basis? Is it always on site? What if you are interested in policy/media work?

Also, for the purposes of residency, does policy research look insubstantial compared to hard science research?

Let's keep the rant train going.

@MedicalDoctorV is so spot on. If you want to do field work, fine, more power to you, but focus on sustainability over anything else. Too often field work is just a kind voluntourism that exploits the poor for the warm and fuzzy feelings of the rich. It's also increasingly being used as a marketing tool for medical schools and residencies, with questionable benefit (or even harm) for host nations. If you really want to do good, either work on structural issues (which takes time and committed effort) or earn as much money as you can as an attending and give that money to people who know what they're doing. Generally speaking, so many more lives would be saved with 1 week of attending salary than with 1 week of attending time.

But you asked about policy. I've done policy work at WHO. It's not as exciting as some may think. 9-5, European hours, bureaucracy like you would not believe, resource and morale depleted. The stories I could tell: one nation point-blank refused to wire transfer their funding obligation for the quarter, the Director-General then cried during a sub-committee meeting of the World Health Assembly, and the delegate from Argentina half-teasingly started singing "Don't Cry For Me Argentina"--yes, this actually happened. Donor-dependency, bitter tears, and cynicism. Welcome to global health policy.

Mostly it's an administrative and quasi-regulatory organisation that provides technical expertise when asked. That means the work is generally quite boring. Lots of writing, lots of coordinating, lots of research, lots of meetings, lots of memos, lots of talk--not much "action" (which is fair, because this kind of work is really damn hard with many moving parts.). Like a corporate job really. I know I'm coming across as jaded, and I am. (Again, the stories I could tell.) But I've developed a huge amount of respect for the true-believers. Plus Geneve is a great city (though it's much cheaper and nicer to live across the border in Ferney-Voltaire). They take interns, but you'll need to secure your own funding.

This is just one tiny sliver of global health. (And I never worked on the crisis/resource coordination side of things at WHO, which is very different.) Global health also includes NGOs like MSF, Gates Foundation, ICRC (each with their own agendas that may or may not comport with reality), GOs like USAID or UNAID/PEPFAR, and a million other things. All very, very, very different.

But here's the thing: you are valuable. A MD gets you very far and opens lots of doors, mostly because there's little compensation and not many are interested in committing for the long haul. @MedicalDoctorV's advice is perfect: you gotta be picky, with your time, with your mentors, and with your commitments. Doing so will set you on the right path.

 

[parachichi]

It's not as exciting as some may think. 9-5, European hours, bureaucracy like you would not believe, resource and morale depleted...

Mostly it's an administrative and quasi-regulatory organisation that provides technical expertise when asked. That means the work is generally quite boring. Lots of writing, lots of coordinating, lots of research, lots of meetings, lots of memos, lots of talk--not much "action" (which is fair, because this kind of work is really damn hard with many moving parts.). Like a corporate job really. I know I'm coming across as jaded, and I am.

Love this. You just described my experience in working with a state health department, too. The job helped me understand why change happens so slowwwly. Thanks for sharing.

 

[PremedSurvivor]

Let's keep the rant train going.

@MedicalDoctorV is so spot on. If you want to do field work, fine, more power to you, but focus on sustainability over anything else. Too often field work is just a kind voluntourism that exploits the poor for the warm and fuzzy feelings of the rich. It's also increasingly being used as a marketing tool for medical schools and residencies, with questionable benefit (or even harm) for host nations. If you really want to do good, either work on structural issues (which takes time and committed effort) or earn as much money as you can as an attending and give that money to people who know what they're doing. Generally speaking, so many more lives would be saved with 1 week of attending salary than with 1 week of attending time.

But you asked about policy. I've done policy work at WHO. It's not as exciting as some may think. 9-5, European hours, bureaucracy like you would not believe, resource and morale depleted. The stories I could tell: one nation point-blank refused to wire transfer their funding obligation for the quarter, the Director-General then cried during a sub-committee meeting of the World Health Assembly, and the delegate from Argentina half-teasingly started singing "Don't Cry For Me Argentina"--yes, this actually happened. Donor-dependency, bitter tears, and cynicism. Welcome to global health policy.

Mostly it's an administrative and quasi-regulatory organisation that provides technical expertise when asked. That means the work is generally quite boring. Lots of writing, lots of coordinating, lots of research, lots of meetings, lots of memos, lots of talk--not much "action" (which is fair, because this kind of work is really damn hard with many moving parts.). Like a corporate job really. I know I'm coming across as jaded, and I am. (Again, the stories I could tell.) But I've developed a huge amount of respect for the true-believers. Plus Geneve is a great city (though it's much cheaper and nicer to live across the border in Ferney-Voltaire). They take interns, but you'll need to secure your own funding.

This is just one tiny sliver of global health. (And I never worked on the crisis/resource coordination side of things at WHO, which is very different.) Global health also includes NGOs like MSF, Gates Foundation, ICRC (each with their own agendas that may or may not comport with reality), GOs like USAID or UNAID/PEPFAR, and a million other things. All very, very, very different.

But here's the thing: you are valuable. A MD gets you very far and opens lots of doors, mostly because there's little compensation and not many are interested in committing for the long haul. @MedicalDoctorV's advice is perfect: you gotta be picky, with your time, with your mentors, and with your commitments. Doing so will set you on the right path.

Wow, thank you for the candid insights. I really appreciate it. This is really helpful, because I'm deciding between an MPH and MPP (in addition to the MD). I have since done research that focuses on structural issues, like you were mentioning, because I can't stand people that waltz off to a poverty-stricken country and come back with little to show for it besides a tan and a new profile picture accessorized with impoverished kids. (You're not the only jaded one 😉 )

You mentioned crisis/resource coordination side of policy; could you please elaborate more on this? Thank you in advance!

 

[PremedSurvivor]

'Global health work' is 100000 different fields. You can be purely clinical (like me), or you can be US-research based, or you can do policy. There's no one track. Luckily, the more medical schools and hospitals that get interested - the more structured paths you have to choose from. One piece of advice - and if you have 10 mins to read the below - don't just do scattered volunteer trips if you actually want a global health career. Fine- if you just want to volunteer your time, but you won't ever turn it into a career. Also; having done this for about 5 years - you're not doing local health systems a favor if patient care is dependent on your clinically skills. Local clinics and hospitals need to figure out how to get local docs to stay and provide care to the population - rather than relying on a (sometimes) unreliable foreign population of interested docs. The best NGOs work this way - and empower local actors to build capacity, rather than just being a stop gap.

MY EXPERIENCE:

I'm internal medicine trained - and now a hospitalist. I finished residency in NYC 2012. Signed up for doctors without borders - sat around for 4 months and they sent me no where (seriously, this happens sometimes). So I ended up doing a series of rag-tag volunteer missions to Haiti - one successively more futile than the last. (That place really is a minefield of NGOs, each doing their little part to make things better... but only in their own minds). I supported myself by doing locum tenens gigs in rural Maine and upstate NY for 1-3 months at a time - and then going back to Haiti. My advice- don't do that. Besides making yourself feel better, you're doing very little to help structural problems.

After this, I decided that if I wanted to get serious about 'global health' I had to go somewhere that had formalized training. So i did a UCSF-global health hospital medicine fellowship. Mouthful... probably why they renamed it to HEAL Initiative https://healinitiative.org. Now it actually includes an MPH if you stay two years. Basically 6 months in the US as a hospitalist, 6 months at a partner site. They pay you a fellow salary i.e. PGY4 salary - and pay for your healthcare, flights to and from, and food/accomodation. They pay probably double what seedglobalhealth.org/ does.
Although i met amazing people (Paul Farmer from Partners in Health) - i felt like an underutilized asset. Mind you I was board certified in internal medicine already, and because of the 'fellow' designation people treated me like a MS3/4.
In the defense of UCSF - they've made the program a lot better now, as evidenced by their re-brand, and their value add of giving you an MPH for free.

After i finished my one year 'fellowship,' i got a 50% hospitalist job at Brigham and Women's - which has a huge number of faculty in different departments doing 'global health' of some sort or another. They let me stack together my shifts for 3 months block (45 shifts) x 6 months total - so i could serve as a senior clinical advisor to a NGO in rural Nepal. Actually the NGO. possiblehealth.org had hooked up the Hospitalist gig because the main job I wanted was the Nepal component. So i did 3 months boston-3 months nepal, then repeat. This was immediately double my PGY4 salary, but still less than half of what i'd get as an actual hospitalist working full time. My time in rural Nepal felt like a 180 change from Haiti. The team was excited to have me, they had specific roles assigned, and they really wanted me to push the local staff.

This is what i did day-to-day when at my overseas site.

Fellow at UCSF
Shadowed around Haitian docs
Gave a few 'talks' to Haitian family medicine residents
Honestly seemed like no one really knew why i was there, what they could use me for.

Hospitalist at Brigham / Senior Clinical Advisor in Nepal (possiblehealth.org)
Teaching conference - i would either present a topic, or force the Nepali staff / health assistants to present a morning report type case and then grill them as to WHY they did things. They loved it.
Morning rounds - these turned into dispo rounds - why is this person still here after 18 days for a uti?
Afternoons in clinic with 50+ patients per provider - i circulated around and helped the midlevels (health assistants).
Afternoons - help implement an EMR

Anyway, I'll stop my rant now. As one of my mentors told me - be picky in choosing your experiences. Actually interview the organizations you're going to work with and make sure they're invested in you. You're a valuable resource - and you shouldn't be mismanaged/ wasted. The same way you shouldn't waste the time of those you seek to help.

You're at BWH? What a coincidence! I'm an MS3 there right now, trying to determine what I want to focus on in my year off (MPH, MPP with a focus on global health or 1 year of dedicated research into global health). Any thoughts?

Also, may I ask what your take on policy is? I've done global health policy research in addition to the on-site research mentioned above, and it seems like it has a tangible impact. Do you feel that is the case?

And thank you so much for lending me your time and advice. This honest perspective from someone who directly experienced these things firsthand is invaluable.