I added this section to my website because I get lots of e-mails from students, prospective students and “maybe-I-should-become-a-student”s asking me:
- How did you get where you got?
- How do I get a job like yours someday?
- What is the best way to combine behavioral economics and medicine?
- Or ethics and medicine?
- Or all of the above?
I thought it would help if I put some of that information here.
Fact #1: I never planned for this kind of career.
I majored in philosophy as an undergraduate, to my father’s chagrin, because I loved wrestling with the big questions. I certainly did not major in philosophy in order to advance my career. That said, I think philosophy is wonderful training for science and for any career where critical thinking and logical reasoning are valued.
Fact #2: After college I went to medical school.
Who knows why any of us go to medical school? I am not criticizing the medical profession. I’m just saying: How many undergraduates have a good feel for what it’s like to be a physician, before committing a minimum of seven years of their lives training to become one? In my case, I liked science and humanities, and thought that being a physician meant working with people, which seemed a lot more interesting to me than working with inanimate objects.
And I was right! The practice of medicine, especially of primary care medicine, is a wonderful mixture of humanities and science. This career requires one to process an inhuman amount of information. Suffice it to say that a medical career is not a good choice for someone who wants to stop learning.
Fact #3: Once I entered medical school, I found myself asking questions about medical practice that no one seemed to have good answers for.
I got in trouble for publicly questioning an oncologist who offered salvage chemotherapy even though he said the patient had little or no chance of benefiting from it. I took care of a patient who had just received his fourth liver transplant, and took it upon myself to write an article questioning such a practice. That almost got me kicked out of my research Fellowship.
Fact #4: So I trained in bioethics.
After my internal medicine residency, I pursued fellowship training in bioethics at the University of Chicago and at the University of Pittsburgh. I had learned that it was possible to pursue an academic medical career, mixing the practice of medicine with inquiry into the assumptions underlying medical care. For those of you looking for such opportunities, find universities where there is a critical mass of people working on the topics you want to pursue. These topics could include ethics, health policy, behavioral medicine, medical history, medical sociology, etc. Then contact some of the people working at those universities and see if there are fellowship training opportunities there for you.
Fact #5: I stumbled upon behavioral economics.
While at the University of Pittsburgh in 1992, I was introduced to several people at Carnegie Mellon University who were doing research in behavioral economics. George Loewenstein was kind enough to let me audit his class that winter, and I was hooked! I realized that many elements of medical practice in health policy were operating under unrealistic assumptions about how people think and decide. I knew I could make a career of exploring the overlap between ethics, behavioral economics and medicine. Twenty years later, I haven’t, um, Petered out yet.
Fact #6: I never got a PhD or Masters degree.
When I was in my research Fellowship, my peers were getting Masters degrees in either bioethics or public health. I felt like the time I would need to spend on course requirements was better spent writing and researching. So I audited relevant classes, but instead of doing homework, I did research. I then got lucky, and found a job at the University of Pennsylvania despite my lack of credentials beyond my mere medical degree. Probably not the best plan for everyone out there. But other than my father, no one seems to worry these days about my lack of additional degrees.
That said, people who know they want to go in this direction might want to consider MD PhD programs, or fellowship programs which offer master’s degrees at the same time as they help you develop your research skills.
Fact #7: I have gotten by by collaborating with smart people.
I think the people you work with is really important to achieving academic success. I have been lucky to work with some leading experts in bioethics, decision psychology and behavioral economics. You can see some of my mentors and collaborators on my “my peeps” page.
Fact #8: I try to write every day. And exercise, too.
…And play piano!