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Making global health a sustainable career

April 2014

Published in the April 2014 issue of Today’s Hospitalist

WHEN YOU HEAR ABOUT GLOBAL MEDICINE, chances are you think of doctors leaving their job for two or three weeks to treat patients in a poor country. But Phuoc Le, MD, MPH, who co-directs the global health-hospital medicine fellowship program at the University of California, San Francisco (UCSF), the nation’s first such fellowship, is out to change that perception.

Dr. Le, a UCSF hospitalist who treats both adult and pediatric patients, also directs the global health pathway for UCSF’s pediatric residency program, the international rotations for UCSF’s internal medicine residents and the interdisciplinary masters of public health program at UC Berkeley.

His own extensive experience has been in Rwanda, Lesotho, Malawi and Haiti. While he’s curtailed his travels recently to stay close to his toddler daughter, he’s used to spending several months a year in the field.

Dr. Le notes that global health is now undergoing a major paradigm shift away from what he calls the “missions model.”

“You take two weeks of vacation, gather supplies, see 1,000 patients, then leave and plan next year’s trip,” he explains. While such physicians have stellar intentions, the “medical brigade” approach can in some cases undermine the development of local health care infrastructure.

Instead, the model he champions is to build local capacity so host countries won’t have to depend on foreign physicians. “We transfer clinical and knowledge skills to our local counterparts,” he says, “to strengthen the existing systems we find in other countries. We are true partners in that we don’t dictate what we do. It’s a collaborative process.”

The number of hospitalists interested in public health “both here and abroad “is growing, Dr. Le adds. And “we don’t want global health to be a hobby or a side thing from our regular job. We want it to be a synergistic part of our job that makes our hospitals and our hospitalist work in the U.S. stronger.”

That means that interested physicians have to become creative in finding ways to fund their dual career. Like him, doctors in academic practices can take global-health leadership and mentoring positions in residency programs.

“We’re striving for a sustainable career in global health-hospital medicine, even though there is no set track or path,” he says.

Hospitalists are ideal candidates for global health, he adds, and not just because of their flexible schedules. “Hospitalists are very good at systems problems and quality improvement, so hospitalists and global health are a really good fit.”

Just don’t refer to his fieldwork as “taking time off.” “You have fewer resources, the living conditions are tough and the work is very hard,” Dr. Le says. “So coming back from the field and working in a state-of-the art hospital: that’s the vacation. That’s my actual break.”