My Kind of Medicine: Real Lives of Practicing Internists: Erin Roe, MD, MBA, FACP
Growing up, Dr. Erin Roe was always interested in health, wellness and science. She enjoyed talking with people about their medical concerns and offering advice. She was a high school student during the first attempts at national healthcare reform under President Clinton ("Hillary Care"), and observing the failed attempt left her convinced that physicians would need more advanced training to navigate the changing financial and political pressures facing modern healthcare. Dr. Roe, whose maiden name is Dunnigan, chose the University of Notre Dame for its strong pre-medical education program and its emphasis on developing the whole person. In addition to her science coursework, she enjoyed studying music and vocal performance and used her elective time to take business courses in accounting and finance. A unique opportunity allowed her to stay for a fifth year and complete a Masters in Business Administration, certainly an atypical career path to medical school in the 1990s in the midst of the "dot.com" bubble when many classmates were headed for Wall Street.
"It was certainly a risk, stepping outside the normal medical school 'track.' Many physicians were and continue to be weary of the encroachment of the 'business mindset' in the delivery of healthcare. But I didn't see any possibility that the trend would reverse itself particularly with the trajectory of US healthcare spending. Physicians need to be firmly committed to improving the larger healthcare system. Getting an MBA was a natural fit with my interests and talents--the quantitative aspects appealed to me and the ability to shape -decision making on an institution or national level was exciting," says Dr. Roe.
From Notre Dame, she moved onto medical school at Ohio State University College of Medicine where she participated in the Problem-Based Learning Program, a case-based program integrating all pre-clinical disciplines into a unified curriculum. The faculty partnered a basic science researcher with a clinician to lead a small group of 6-8 students through case studies that illustrate pre-clinical science topics. This approach served as a springboard for further self-study in the basic, clinical and behavioral sciences. "Many of the faculty in this program were internists and I was constantly impressed with their breadth of knowledge and 'detective' like approach to clinical problem-solving. I also liked the variety of practice opportunities - from outpatient ambulatory care to hospital medicine - training in internal medicine develops a broad base of medical knowledge that allows a physician to deliver care in many different settings."
As a medical student, Dr. Roe was also involved in her school's Internal Medicine Interest Group, which focused on a different subspecialty each month to complement the curriculum. "We would invite a pulmonologist to review spirometry, for instance, in a dinner session with free pizza, and also ask him about his career path and what it was like to work in an ICU. It was an excellent way to ask questions of the faculty and fellows, outside the typical rotation or classroom setting."
Dr. Roe's advisor, Dr. Andrew Thomas, now the Medical Director at Ohio State University Hospitals, took note of her enthusiasm for internal medicine, education and advocacy and suggested she become involved with American College of Physicians. She applied for a position on the Council of Student Members (CSM) which represents the needs and interests of the 28,000 ACP Medical Student Members across the country. Dr. Roe's favorite part of serving on the CSM was helping to design programs for the annual ACP Internal Medicine meeting, including the perennial audience favorite, Stump the Professor. "It was always a special challenge trying to locate a case to challenge ACP's most senior faculty and teachers."
ACP is also unique in that it involves a medical student, resident and young physician on its delegation to the American Medical Association. "Being part of the process to set policy at the national level was such an exciting opportunity."
"My involvement with ACP provided a window into all topics impacting the field of internal medicine including developments in medical education such as the introduction of the NBME Step 2CS exam and the inception of MKSAP for Students (now in its fifth edition) to help structure the medicine clerkship curriculum. Even the fact that medical students weighed financial considerations when selecting a medical specialty was a novel and important observation from the CSM. "Our perspective as medical students helped to shape the conversation at ACP on the urgent need to reform the dysfunctional physician payment system. It affects not only current physicians in practice but also the perception among those contemplating a career in internal medicine."
After completing her term on the CSM, Dr. Roe applied to serve on ACP's Council of Associates (COA) to represent the interests of residents and fellows-in-training. Unlike the CSM, all representatives on the COA have made a formal commitment to internal medicine by virtue of their residency selection and by continuing to volunteer their time with ACP. The COA dealt closely with issues of medical education that included hot topics such as: changes in duty hour requirements, the timing of the subspecialty match and new competency milestones for residency completion. Lobbying on Capitol Hill during Leadership Day also took on greater importance, "Legislators and their staff members weighed our opinions heavily during office visits. Our message was less about the financial motives and we had firsthand knowledge of the safety-net teaching hospitals across the country. We could relate story after story of patients falling through cracks in the system because of poorly-coordinated, inefficient or inaccessible healthcare."
After medical school, Dr. Roe moved on to Duke University Medical Center where she completed a categorical medicine residency in their academic generalist track and continued her interest in endocrinology, diabetes and metabolism. A rotation in clinical epidemiology exposed her to the basics of clinical research methods and biostatistics. She completed her fellowship in endocrinology at the University of Texas Southwestern Medical Center, Dallas, Texas during which she was able to use this training to perform her own clinical trial in type 2 diabetes.
"I entered a three-year research fellowship, and the first year was primarily devoted to clinical activity at Parkland Memorial Hospital in Dallas, a safety net hospital with a high density of indigent and immigrant patients. Metabolic syndrome and all the complications of diabetes were rampant among this patient population. We also had specialized clinics in lipid disorders, mineral metabolism (osteoporosis, bone disorders and kidney stones), and pediatric and reproductive endocrinology. The latter two years of fellowship were spent largely in clinical research. Using the clinical epidemiology training from Duke and additional coursework in the Department of Clinical Sciences at UT Southwestern, I had the opportunity to develop my own projects. I really enjoyed the freedom to pursue my research questions. I was able to come up with projects on my own and carry them out independently. The project management training from business school has proven invaluable."
Dr. Roe's research project looked at the impact of a new oral diabetes medicine (Cycloset™, a dopamine agonist) in patients who were inadequately controlled on insulin and metformin. "We have many different drug classes to treat diabetes, but relatively little is known as to the best combination, sequence, and timing for adding these agents. Comparative effectiveness research to guide clinical-decision making has become increasingly important." A training grant to fund the 24-week trial was provided by the Endocrine Fellows Foundation and the final results were presented at its June meeting held in conjunction with the annual meeting for the American Diabetes Association. Dr. Roe is currently in the process of preparing the manuscript for publication.
Dr. Roe will be able to continue clinical research in her new position as an endocrinologist at the Baylor Endocrine Center (located on the campus of Baylor University Medical Center in Dallas), a teaching hospital affiliated with Texas A&M University. She considered several different practice types after her fellowship, but decided on Baylor because it would allow her to pursue additional opportunities in clinical research and quality improvement in diabetes care in addition to building her own practice in diabetes and general endocrinology. Dr. Roe looks forward to her new position at Baylor and the opportunity to work with patients. "One of the greatest aspects about practicing medicine is that patients share with us some of their most intimate problems and deepest concerns. I enjoy hearing patients' stories and identifying ways that we can make positive changes, whether in lifestyle, diet or with new medications to achieve a better quality of life."
She encourages medical students to think broadly about their education, and if the opportunity presents itself, consider getting training in a related discipline and applying these skills to develop better health solutions. "Now there are so many dual degree programs in public health, public policy, education, hospital or business administration, it's really up to medical students to find their passion in medicine and explore how they can best apply their natural talents to improve the system."