Maria: Why should consider specializing in infectious disease? That's next on the Med Student Mentor.
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Maria: Today we're going to explore specializing in infectious disease with Dr. Andrew Pavia, Chief of Division of Pediatric Infectious Disease here at the University of Utah. Thank you, doctor, for joining with us today. We're really excited to have you.
Dr. Pavia: Thanks for having me.
Maria: So first things first. What is it like to be an infectious disease doctor?
Dr. Pavia: Well, there is very little in medicine that's quite as exciting. You never know what you're going to see any day or any year, and if you think about the headlines just from this year, we're dealing with outbreaks in diseases that we never thought about. We're dealing with Ebola, we're dealing with measles outbreaks, enterovirus D-68, and that's just on top of taking care of some of the sickest people. If we do our job right, we're really helping them get better because the cool thing about infectious diseases is that they can kill you quickly, but many of them are curable.
Maria: Tell me more about what opportunities you've had professionally as an infectious disease doctor?
Dr. Pavia: Let me go back to the beginning of my career. When I graduated medical school, it was 1981 and nobody had ever heard of a disease that was affecting young gay men. My first night as an intern about a week after the CDC had first described the outbreak of pneumocystis and CMV, I took care of a guy with what turned out to be pneumocystis and CMV.
That shaped an early part of my career, and I think that gave me this drive to be involved in working with these new and emerging infections. AIDS really shaped my career and my life because it was something that many other people didn't want to touch, and yet every day we were learning something new. What we were learning was both scientifically incredibly complicated and fascinating, but we could take it to the bedside and help our patients who at the time had very little hope.
Maria: That sounds very exciting. It sounds like you were able to just take the lead and say, "I want to make a difference," and you went for it. Was there someone that helped you along the way, and was there someone that you looked up to at the time that helped you make that decision to just jump into something maybe others hadn't done in the past?
Dr. Pavia: Well, there were probably a lot of people who inspired me. I had two terrific Infectious Diseases Professors in medical school, although ironically back then they said, "Well, there's not much new in infectious disease, and there's not much money in the field." Well, they were wrong on the first point.
The other big career changer for me was a friend of mine found out about a program at the Center for Disease Control. He went down and served as an academic intelligence service officer, which is a job in which usually young ID-trained physicians who are people who are interested in infectious diseases, go down and they're involved as the disease detectives for the CDC. So after I finished residency I went and did that.
But there's another little story that connects the two there. When I was a third-year resident I took care of a young man who was about 16 who came in with bloody diarrhea and went on to get severe renal failure and he had low platelets. He turned out to have hemolytic-uremic syndrome, a disease that back then people knew very little about. Nobody drew any connection between that blood diarrhea and the hemolytic-uremic syndrome. In fact, they thought he probably had Crohn's disease incidentally.
When I got to CDC I had a chance to work on E coli 0157, and so there was another aspect in which something that just two years ago we knew almost nothing about we were able to work on, and now understand what's way more important, foodborne diseases. I think my friends and colleagues in infectious disease could all tell stories like this about ways that new discoveries really change the face of what we do in medicine. It's hard to find many other areas in medicine where you get to do that on such a regular basis.
Maria: And that was something that I was actually going to ask you about. I think that a lot of us go into medicine with this feeling that we want to go in and make a difference and change things, and we want that empowerment to really help. I was going to ask you how you feel that infectious disease helps you with that mission and helps you continue that mission throughout your career?
Dr. Pavia: In medicine, we try and make a difference in all sorts of ways. We try and make a difference for the patient in front of us, one-on-one. We try and make a difference by adding new knowledge that's really going to change things for a group of patients. We try and do things that might largely affect the world at large and people who have so much less than we do here in the United States.
In infectious disease you got to do all three because so many of the infections that we think about and that we worry about are global killers as well as big problems at home. So people who choose infectious disease can work in the clinical arena in the United States, they can do research on new and exciting scientific problems, they can work in global health. You can combine all of them, and all these things are a chance to really make a difference.
Maria: So it seems that there are different paths and different opportunities for you to take once you graduate and you're done with your fellowship and you're done with all this education. Is there a traditional route that people usually go through once they're done with fellowship?
Dr. Pavia: Well, I think that infectious disease practice these days breaks up into a number of different things that a typical infectious disease doc, if there is a typical infectious disease doc, may be hospital-based and may work with very sick patients such as transplant patients or hematology/oncology patients. They may also work on containing the spread of hospital infections. That's another major branch of our field, and that's something of a specialty in and of itself. There's a whole new area of quality improvement in antimicrobial stewardship which is continually improving the way all of us as a team practice medicine.
Other people go into practice and predominantly take care of outpatient problems. Others go into public health and work for state health departments or CDC or international agencies, and still others work in the field of global health and may work on problems like malaria, dengue, Chikungunya or Ebola.
Maria: That sounds exciting. It sounds like you have a vast number of opportunities and things to do. Is there anything that you would tell medical students to pursue or maybe what questions to ask if this is something that they're interested in?
Dr. Pavia: Well, I think you should do something in medicine that you love and excites you every day. I guarantee you that if you choose infectious disease, that will be your future. There are some downsides. If you want to be a cardiologist your income will be higher but you will be bored most days.
If you look at surveys, infectious disease docs are not the highest paid doctors by a long shot, but they always score highest on the question, "Would you do this again, and do you like your job?" And that, to me, is the most important determinant in choosing your career.
Maria: I agree. Thank you very much for all that amazing information. I think that it sounds like a very exciting field, and I think even for me, personally, as a medical student, I feel like I didn't know enough about it. I didn't know how exciting it was. It's really great to see someone that's been in this field for as many years as you have still just light up whenever you talk about it. I think that's really exciting and I think that's what we all aspire to do. So thank you.
Dr. Pavia: Thank you.
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