a dialogue with...
BRENDAN CARR, M.D.
UNIVERSITY OF PENNSYLVANIA,
M.S. HEALTH POLICY RESEARCH 2008
TEMPLE UNIVERSITY SCHOOL OF MEDICINE,
POSTBAC CLASS OF 1997
LOYOLA COLLEGE IN MARYLAND, B.A. PSYCHOLOGY 1994,
M.A. CLINICAL PSYCHOLOGY
Brendan is an Assistant Professor in the School of Medicine at the University of Pennsylvania. He holds appointments in Emergency Medicine, Surgery & Epidemiology and is Associate Director of the Division of Emergency Care Policy & Research. He practices emergency medicine in the Hospital of the University of Pennsylvania. His health-policy research focuses on injury epidemiology, trauma care, and the emergency care delivery system.
He began this research as a fellow in the Robert Wood Johnson Foundation’s Clinical Scholars Program at the University of Pennsylvania. Brendan completed a residency in emergency medicine and a clinical fellowship in trauma and surgical critical care at the Hospital of the University of Pennsylvania before entering the Clinical Scholars Program. He was admitted to Temple University School of Medicine through Bryn Mawr's consort program. He is a board member of Physicians for Social Responsibility. Brendan and his wife, pediatrician Sarah Winters, who is also a Bryn Mawr postbac alum, and their children live in Philadelphia.
Bryn Mawr: Tell us about your fellowship in the Robert Wood Johnson Foundation Clinical Scholars Program at the University of Pennsylvania.
Brendan: The clinical scholars program trains physicians in health-services research, encouraging us to step out of the clinical care realm for two years to study big-picture issues in the American health-care system. We came together at Penn from various backgrounds, including Ob-Gyn, internal medicine, pediatrics, neurology, and emergency medicine. We studied economics and health policy, but we also learned to apply concrete research skills to study macro-level health-policy questions, focusing on the political leverage available to us to initiate change in the health-care delivery system.
Bryn Mawr: What sorts of health-care issues are you studying?
Brendan: One major area of my research looks at how to develop a coordinated, comprehensive emergency-care delivery system in the United States to solve the problems we are experiencing in emergency care, including emergency-department (ED) crowding, patient diversions, and the lack of coordination among hospitals for treatment of time critical illnesses including acute myocardial infarction, stroke, sepsis, etc. One great example of how to organize EDs is along the model of the trauma-care system, which has identified clear referral criteria for life-and-limb-threatening traumatic injuries and streamlined the process of transporting a patient to the appropriate level of care.
The other major area of my research is injury. The injury research group centered out of the Firearm & Injury Center at Penn (FICAP) examines intentional and unintentional injuries. Much of FICAP’s work has been around firearm injury. Although we continue to work in the area of firearms, we are increasingly thinking about how to broaden our injury portfolio. A good example is the growing interest in looking at public health interventions for falls among the elderly. In our urban Level 1 referral trauma center, one might expect to see shootings, stabbings, or motor vehicle crashes top the list of reasons for presenting with an injury. But falls, especially among the elderly, now account for a large proportion of visits to the trauma center at Penn. We suspect that there are probably public-health interventions that could keep older adults safer. The injury research community has dramatically reduced the consequences of motor vehicle crashes using public health interventions, and we hope that the same is coming for guns and falls.
Bryn Mawr: What are the challenges of balancing your clinical practice in emergency medicine with your academic appointment?
Brendan: It is certainly a challenge to keep my finger on the pulse of two different skill sets. First and foremost, there is clinical care. It is much easier to maintain your clinical care skills when you are taking care of patients every day. Stepping out of that environment to develop a new subset of research and health-policy skills puts you at risk of losing some of your clinical skills. The flip side is also true: the less frequently you take part in conversations about the federal health-care quality initiative, for example, the less you know about it. The solution is intelligent collaboration with your colleagues, knowing the limits of what you know, and staying curious.
Bryn Mawr: What are the opportunities and rewards?
Brendan: Oh, the opportunities are extraordinary. In my academic job, I have a fair amount of time reserved to explore some really exciting health-policy questions. As a result of that research, I hope we will be able move injury science and the emergency-care delivery system forward. It’s an amazing privilege to explore these big-picture questions.
When I close my office door and walk over to the ED, I am able to teach residents and take care of patients for eight or ten hours at a stretch. It makes for a very busy, and a very exciting life.
The opportunity to ask exciting research questions that are grounded in day-to-day patient care is very, very cool. The work is the reward: I wake up every day excited about what I do.
Bryn Mawr: You and your wife, pediatrician Sarah Winters, have two small children; how do you balance two medical careers and family life?
Brendan: “Balance?” I’m just glad when we get six straight hours of sleep! Seriously, kids have changed things quite a bit—in a very positive way. Sarah and I rely on each other quite a bit and make a pretty great team. I work shift work and do research, so my job can be pretty flexible. As long as I’m willing to get up a little earlier or stay up a little later, there is time to be productive. It would all be woefully impossible if I didn’t love Sarah, the boys, and what I do so much—something would suffer. I suggest marrying well and renegotiating your contract frequently.
Bryn Mawr: What advice do you give to others who are contemplating the long road to becoming a physician?
Brendan: First, understand that there is no finish line. That being said, medical training is extraordinary. Learning the basic science about physiology and biochemistry is interesting and eye opening for people coming from different walks of life. Then before you know it, that’s over and the next thing you know, you are standing at a patient’s bedside and trying to use what you learned in your pharmacology course to figure out why the patient’s heart rate is too slow and what you can do to make it better. Relish the day-to-day experience of medical education—it is an amazing privilege.
The great part is, you don’t have to know where you are going. A medical degree is extraordinarily versatile. In 1997, I couldn’t have told you that I would become interested in health-care policy questions and how we can get at those answers from scientific investigation. I just didn’t think that was coming my way. But the more time I spent looking at the way we deliver care, the more I thought that while impacting an individual life is important, an examination of the health-care system as a whole may enable us to impact scores of lives. And that’s what gets me out of bed in the morning.
Bryn Mawr: What about the person who wonders, “But I was an art major, or a business major. Where do I start?”
Brendan: I’d say, “You have already started.” A lot of people underestimate the importance of coming from a different place than biology or premed. As I look around at my colleagues who finished the Bryn Mawr postbac program with me—starting with my wife, Sarah Winters, an undergraduate history major who is now a pediatrician—it is exciting to see that those of us who have come along a different path have a different perspective on the practice of medicine. We think of physicians more as generalists, as advocates, and as researchers we see them in the context in which they exist in their communities rather than as simply the medical expert. Postbacs bring a different framework and a lot of different skills to the practice of medicine. I think that medical schools, residency programs, and the academic universe are hungry for people who haven’t followed the traditional straight-and-narrow path.
And when a colleague says to you, “Your background is interesting; it changes the way that you practice medicine and the ways that you think about policy questions,” you realize your background is an asset.
Bryn Mawr: What impact did the Bryn Mawr postbac program have on you?
Brendan: There are very few decisions in life that lead us down a path that is dramatically different from where we were going. My decision to go to the Bryn Mawr postbac program was one of those moments. What is special about the program is it gives you the opportunity to remain who you are while allowing you to emerge as who you are going to be in the medical realm. You are embraced for being different and special.
The clinical scholars program was the second big branch-point in my life. Adding research and public policy skills to my clinical repertoire was like an athlete doing cross-training. I am excited about a future where we inform our health policy decisions with scientific research performed by physicians who can wear a clinical and a policy hat—providing the essential basis in the clinical day-to-day reality for the big-picture decisions.
It’s a cool life!