WOWOWOW! I can’t believe I am writing this post. It still feels surreal to have made such a life and career-altering decision, but I am thrilled to share that I will not be starting med school in 2020, and will instead be starting a postdoc!
Last April, I decided that I would take a year off between finishing my PhD and starting my MD. It was the single best decision I’ve ever made. The last few months have been great to clear my head and take time to reflect on what I really want out of the next few years.
I’m writing this largely to wrap my head around this big decision, but also in case there are any other pre-med, pre-MD/PhD, or current MD students who are reconsidering medicine as a career and might benefit from my perspective.
Why I enrolled in an MD/PhD program in the first place
As most of you know, my healing journey started with stubborn chronic eczema. After being continuously frustrated by conventional treatments for nineteen years, I finally discovered integrative/root-cause medicine, learned about the importance of gut health and nutrition, and achieved completely clear skin for the first time in my life. It quickly became clear that I wanted to spend my career bringing this approach into the standard of care.
At the time, the only way I could see doing this (and ensure that I could make a living doing it) was to become a functional or integrative MD. I’d never been a people-person but thought I might grow to like helping people one-on-one to overcome their chronic health issues in a clinical setting. But I also liked research, and the idea of a dual degree MD/PhD program certainly seemed appealing to establish further credibility and come out of med school debt-free.
Disillusioned from the start?
For all of these reasons, an MD/PhD program made a lot of sense. Knowing that you are entering a broken system isn’t easy though, and some part of me was disillusioned with med school from the start. While I wholeheartedly supported modern medicine for emergency care and acute treatments, I knew it was going to be difficult for me to watch patients receiving less than optimal “band-aid” treatments for chronic diseases.
I justified this in a number of ways throughout my PhD years, telling myself I “needed the background knowledge of the conventional medical system” and that the credibility of an MD would “allow me to change the system from within”. While the MD probably would have given me both of these things to some extent, these justifications ultimately served to cover up my true feelings about attending med school. They worked so effectively that I almost resigned myself to 5-7+ years of medical training.
Starting with the PhD
By pure coincidence, the year I was due to enroll was the year that marked a transition for the dual degree program in Urbana-Champaign, which was anticipating the closing of the old University of Illinois College of Medicine and the opening of the brand new engineering-based Carle Illinois College of Medicine.
Instead of beginning M1, as most incoming MD/PhD students do, I was to complete my entire PhD at UIUC, and then all four years of MD at another UI campus. At the time, this didn’t really have much weight on my decision to enroll at UIUC. I soon started my PhD in Nutritional Sciences, studying the effects of diet and exercise on the gut microbiome in Dr. Jeff Woods’ lab.
While I had occasional contact with the dual degree program for advisory meetings, annual retreats, and research symposiums, in most ways I was just like a regular PhD student. And I came to be very grateful that I wasn’t juggling medical school alongside 40+ hours a week of classes and research, because it afforded me the opportunity to continue competitive soccer, work as a part-time research assistant for Chris Kresser, and eventually start this blog.
Starting NextGen Medicine (this blog)
I never really thought of myself as a writer, but it just sort of happened. I actually had the idea to start a blog in my final years of undergrad — I was eczema-free for the first time in years, was loving my new diet and lifestyle, and was excited to share my healing journey. But I didn’t feel I had the credentials to support it and wasn’t sure I’d enjoy writing enough to keep it up. So I dropped the blog idea.
Fast forward a few years later, and I was nearly a year into my graduate work when I received an email from Chris Kresser, a globally recognized leader in functional and integrative medicine, about an opening on their team for a research assistant. I had been following Chris’s blog for four years, and his work was instrumental in helping me find the information to heal my skin. Despite my already busy schedule, I applied without thinking twice, got the job, and soon discovered that I loved research writing.
With regular and deliberate practice, I became adept at reading and synthesizing the scientific literature, in a way that I never would have gotten from my PhD alone. I soon became interested in some more technical aspects of gut health that were relevant to my research but wouldn’t necessarily serve the audience at chriskresser.com. With some encouragement from my now-husband, I decided to unearth the blog idea and publish my series on short-chain fatty acids.
Key insights from two years of blogging
Over the next two years, I continued writing and posting things that interested me. I told myself that I wanted to stick with blogging for at least a year and a half, even if it didn’t gain any traction or subscribers. It’s funny reflecting on that now, having so many wonderful readers that have found my work and so many incredible opportunities that have come out of maintaining this blog. To this day, though, I haven’t looked at the analytics for my blog, other than knowing how many people subscribe to my email list.
I had several key insights from two years of blogging:
- I didn’t need an MD to demonstrate credibility and help people 1-on-1 with their gut health. I could build a wealth of background in gut health through independent research, demonstrate my knowledge through producing free and helpful blog content, and be able to help people 1-on-1 with their gut health. Yes, I was restricted to “health coaching” and not able to order labs, but I was still able to speak to people about the evidence for certain interventions and get a taste of what a life of private practice would look like.
- While I enjoy helping people 1-on-1 with their health, it became clear that this model would never be a scalable solution to re-shaping healthcare. No matter how many clients I helped, I always had more pouring onto my waitlist that needed help and not enough time to consult with them. I also realized that researching and producing content were much more rewarding to me and could reach a much greater number of people.
- That I was most excited about my “work” when I was able to follow my natural curiosity about a topic of interest. I seriously love nothing more than to sit for hours in a vortex of Pubmed research on something related to the microbiome, nutrition, or gut health and try to work it into something worth reading.
All of these things were becoming increasingly clear by spring of 2019, and I knew that starting medical school would also mean scaling back significantly on my blog.
Taking a gap year
So, when the opportunity arose to take a gap year to work nearly full-time on NextGen Medicine before going to medical school, it seemed too good to pass up. Steven and I had always wanted the chance to travel, and I liked the idea of seeing what digital nomadism and a life of more blogging and consulting would look like.
After finishing my PhD and packing up most of our belongings into storage, we set off for three months in Australia, New Zealand, and Japan. I didn’t get nearly as much blogging done as I had originally planned, but I think I needed some time to float. Med school was feeling less and less like the right path, but giving up the system entirely for a life of blogging and consulting didn’t feel right either at this point in my life, so I continued to make plans to start my MD in August 2020.
The wrong reasons to go to medical school
Over those three months of travel and exploration, I slowly realized that there were a lot of reasons I was going to med school, none of which were the right reasons:
- Because my tuition is paid for: I know that there are going to be some people who read this article and think I’m literally insane for giving up free med school. I realize how incredibly fortunate I was to just be admitted to med school, let alone given a free ride. And it seemed like common-sense to keep med school as my default career path because I’d already passed the difficult enrollment process. But objectively, there is a LOT more to med school than the cost of tuition, in terms of what you price you pay in time, stress, health, and relationships. Ultimately, I realized I was dealing with loss aversion, and when I asked myself: “If I didn’t have this opportunity already, would I work hard to apply and get into med school?” the answer was pretty clearly NO.
- Because my parents want/expect me to: I’ve always been a bit too eager to please my parents. I love them dearly and owe a great deal of gratitude to them for helping me to navigate the MD/PhD application process in the first place, for driving me around to interviews, and for generally looking out for what they felt was best for my career. But even if I knew they would ultimately accept whatever career path I chose, I also knew that deciding not to go to med school would disappoint them, and it was a factor that carried a little too much weight in my decision.
- Because of the status benefit/ego boost of an MD: it wasn’t until I started reading about the ego and started to get more into meditation that I realized my desire to go to med school was at least in part my ego and highly conditioned “need-to-achieve-to-be-worthy” program coming in. We all have this ego infiltration to some extent (some more than others), but becoming more aware of it is key to ensuring you’re doing things for the right reasons. I’d already proven that I didn’t need the MD to have credibility, so what was this really going to get me, career-wise? Would I really feel any better about myself, or care about anyone thinking less of me for being a PhD instead of an MD/PhD? Nope.
- Because it’s the only way to change healthcare: In the final two years of my graduate research, I had the chance to meet several world-renowned PhDs who were shaping healthcare through novel research with the potential to change the standard of care. I also got really interested in complex topics like the oxygen-gut dysbiosis connection, and could see the potential future impact of research that used this mechanistic knowledge to explore therapeutic treatments. It became clear that I didn’t need to be an MD on the inside to improve care.
- Because it’s the best way to learn about medicine: this is perhaps the most controversial, but one of the most important reasons that ultimately led me to my decision to do a postdoc. Going through my old school boxes from elementary, middle school, and high school over the holidays, I was astounded by how little of the information I’d retained or found useful now. At the time, I also happened to be reading and listening to a few books related to anthropology, culture, and education, and had come across the term “unschooling” several times. This is essentially the idea of letting a person’s natural curiosity shape what they learn, leading to greater retention. A quick google search for “unschooling medicine” found this article, and several sources suggesting that knowledge retention of the basic sciences (M1 and M2) is often as low as 13-16 percent. Reflecting on my current knowledge base of medicine, gut health, and nutrition, I realized that virtually all of the knowledge I have retained over the last few years have been directly related to my research or the blog articles I have written, not material I learned in class and regurgitated on exams. My basic assumption, that med school would best “help me learn background knowledge of the human body” so that I could improve healthcare was quickly falling apart.
Postdoc, here I come!
As I thought more about what I would REALLY want to spend the next few years of my life learning, it was obvious that I wanted to dive deeper into microbiome medicine and gut health.
And then it was as if it was sitting in my lap all along: a postdoc!!
Funnily enough, I had seen countless friends finish their PhDs and go on off to postdocs, the de facto next step on the academic career path, but until a few weeks ago, had never even considered it as a potential option for me.
I had free med school, right? How could I possibly turn that down for something else?
But as soon as the idea crossed my mind, I knew it fit exactly what I wanted out of the next few years:
- to deepen my knowledge of the microbiome and gut health in a way that not only challenges me but also follows my natural curiosity;
- to develop my background and skills as a researcher and learn new techniques, while still being able to share new insights through my blog;
- to contribute to some fascinating research and test some of the research questions that I most want to see tested
This 2-3 year position will also prepare me to pursue a full-time academic faculty position where I can continue to facilitate novel research, a path I feel increasingly excited about!
I’ll certainly learn bits of physiology, immunology, and neuroanatomy along the way, but in a way that is directly relevant and important to my research or the blog articles I will continue to write outside of my hours in the lab.
I am beyond excited about this new direction and have already given my notice to the medical scholars program at UIUC that I will not be attending med school at Chicago in the fall.
Looking back, I am still so grateful to have been a part of the dual degree program. I met so many wonderful friends through the annual retreat, College of Medicine research day, and medical student councils. The faculty directors were also unbelievably supportive when I asked for a gap year, and when I recently told them that I wanted to pursue a postdoc. (If you are considering med school for the right reasons and like research, I would highly recommend the UIUC dual degree program!)
My ideal postdoc position
So now, the search begins! As many of you know, I became particularly fascinated by colonocyte metabolism and the oxygen-gut dysbiosis connection after meeting with Dr. Sebastian Winter last spring.
In my recent article, I suggested a number of possible therapeutic interventions (e.g. 5-ASAs, butyrate, ketones, exercise, phytonutrients, etc.) for breaking the vicious cycle and restoring gut homeostasis.
That’s all for now. If you’ve made a similar career switch, I’d love to hear your experience in the comments!