How Graduating from an MCW’s Regional Campus Prepared me for Residency

 From the 2/19/2021 newsletter

Perspective/Opinion

How Graduating from an MCW’s Regional Campus Prepared me for Residency

Bradley Zastrow, MD

Dr. Zastrow, a current resident in MCW’s psychiatry residency program explains how attending medical school at the MCW-Green Bay campus provided him with several unique experiences that better prepared him for his journey …

Prior to attending medical school at MCW – Green Bay, I lived in Milwaukee for six years. While applying to medical schools, I knew I wanted to work with underserved populations outside of the relatively resource-rich city during medical school. Access to mental health treatment in rural Wisconsin is currently one of the most pressing issues facing our state. My experience training in a rural location was the first necessary step in preparing to help try to remedy this issue.

At its core, medical school calls on us to adapt to learn and work in a variety of settings. The most obvious example is rotating through different specialties. When primarily training at an academic center, students are typically restricted to rotation sites within a short drive of the main hospital. By completing medical school at a rural campus, however, I was able to rotate within a variety of hospital systems throughout northeastern Wisconsin. Family medicine in Oconto Falls, inpatient neurology in Appleton, and acute care surgery in Door County were just a few. What solidified my pursuit of psychiatry was the opportunity to rotate at the Wisconsin Resource Center (WRC) in Oshkosh, a joint effort between the Department of Health Services and the Department of Corrections, that serves the state prison population.  Patients in this setting require specialized mental health services. Without the unique access provided by a rural campus, the opportunity for medical students to learn in this innovative setting would not be possible.

 The expanded set of rotation sites at MCW – Green Bay afforded me the chance to work with several underserved populations. From members of the Oneida tribe to veterans in northern Michigan making their way to Green Bay’s VA outpatient clinic, I saw firsthand the healthcare disparities facing those who live outside of an urban or suburban setting. For example, where I completed my outpatient pediatrics rotation in Sturgeon Bay, the county lacked any formal child psychiatry services. As a result, this pediatric clinic was responsible for managing all patients with psychiatric conditions in addition to their general medical concerns. To contrast, in Milwaukee, these patients are routinely followed by, or at least have access to, a fellowship-trained child psychiatrist. My preceptor in the Door County clinic dedicated years of medical education credits to learn how to better serve this population. She was one of many physicians I met dedicated to expanding their scope and caring for those who needed it most.

 On Match Day, I was thrilled to learn I would be returning to Milwaukee for residency training. Thus far, I have found that my years of experience at the rural medical school campus complement my residency training in a more urban setting quite nicely.  During medical school I observed the challenges that patients and providers face with a lack of resources; in residency I am seeing programs and interventions that may help address those challenges.  As a psychiatry resident, I see patients at the Milwaukee County Behavioral Health Division with acute mental illness that I rarely encountered in the northern counties. Fortunately, Milwaukee County has developed resources to provide care for these patients who may not otherwise receive it. Within the county hospital, Psychiatric Crisis Services (PCS) provides an emergency department for this population, who may otherwise overwhelm the capabilities of other community emergency departments. The majority of the patients treated through PCS are those who would otherwise be unable to access mental health resources, whether that be due to lack of insurance, inability to navigate the system, or acuity of illness. This is one example of a program uniquely developed to triage and treat a highly underserved population.

 

In returning to Milwaukee, my goal has been to learn as much as I can from public health interventions already in place. I hope to take these and similar initiatives with me and adapt them to more rural populations, where I have seen how great the need is firsthand. Whether expanding access to patients waiting to establish or improving the access for those who already rely on our care, there is much we can take from models and programs in more urban areas like Milwaukee to improve psychiatric care throughout all of Wisconsin.

Bradley Zastrow, MD is a PGY2 resident in the Department of Psychiatry and Behavioral Medicine at MCW. He graduated in 2019 from the MCW-Green Bay campus.  

Some Questions for … Matthew Hunsaker, MD - Dean, MCW- Green Bay Campus

From the 2/19/2021 newsletter

Some Questions for …

Matthew Hunsaker, MD - Dean, MCW- Green Bay Campus

Dr. Hunsaker, the inaugural Dean at MCW-Green Bay, talks about the regional campus and how its mission will improve the health of Wisconsin’s smaller towns and cities …

Transformational Times: How does a regional campus help address some of these challenges of rural health care? 

Dr. Hunsaker: It is atypical for a non-state university medical school to launch regional campuses. Although some might think of our community as small, Green Bay is the third-largest city in Wisconsin (population of 100,000) and has a total metropolitan population of 300,000. We have three health care systems, several institutions of higher learning, and sophisticated hospitals. And, of course, there is the Green Bay Packers football team and foundation that have been philanthropic supports of the school. That said, it does not take long to get from downtown to sparsely populated areas like Door County or Shawano.

As a regional campus, we have several unique opportunities to impact health care. 

First, we can recruit wonderful, talented students who have unique backgrounds. Many of our students are drawn from pools that “traditional” medical school admissions processes overlook. For example, some are non-traditional in the sense that they are the first of their families to enter medicine or even graduate from college. Many come from smaller towns and cities across Wisconsin. Many have graduated from smaller colleges and come from very modest backgrounds. 

Our focus and our approach to interviewing seek to identify those who have an affinity for primary care and psychiatry in non-urban settings. If a student at interview does not align well with those campus goals, we encourage them to consider our Milwaukee campus for other career paths that better align with their personal goals.

Once the admissions office has determined that an applicant has the aptitude to likely succeed in medical school, we rely on our Regional Applicant Advisory Committee (RAAC) to secondary screen and interview candidates and provide recommendations to the Admissions Committee. The RAAC members are trained by the admissions office in screening and interviewing. All are selected from the Green Bay community and represent a broad representation of Northeast Wisconsin. MCW-Green Bay is searching hard for their other qualities in addition to cognitive performance. We have people both the Admissions Committee and the Regional Applicant Advisory Committee screen each portfolio. The results of the local interview process are provided to the admissions committee who makes all the decisions about a candidate's status and extends offers to matriculate. Of the more than 2300 applications we received for Green Bay this year (including 275 Wisconsin) we are nearly finished interviewing eighty candidates from which to build the class. To flatten the inherent biases of one-on-one interviews, we have each applicant interview with a group of seven to ten people from the RAAC. This community-based interviewing approach provides us great feedback and a wonderful cohort of students. 

Next, we leverage our location and faculty to train outstanding physicians who will thrive in their careers, with a special emphasis on primary care and psychiatry in smaller communities across the state. We graduate students with the requisite skills for these practices who are equipped to focus on the central tenet of medicine, which is that a physician is merely a person who happens to have an advanced science degree helping another person improve or regain their health. Central to our program is the idea, nothing we teach should ever work to diminish the student’s ability to talk to another human being with empathy, compassion respect, and clarity. 

We want students to become part of the community. Each student participates in the Physician in the Community Scholarly Pathway. Students complete an IRB-approved Community Orientated Primary Care (COPC) research project while working with community-based organizations, to address local health problems. The student conceives the project, develops it with a local community organization, executes the project, and presents it to the community, their peers, and the local healthcare research forum. COPC requires them to participate in CITI research training, build research skills, community-based health care experience, interprofessional education exposure, and insights into health care challenges unique (and not so unique) to communities located away from academic medical center teaching environments. 

Many smaller communities and hospitals have huge problems with physician recruitment and retention, and a campus like ours can offer a pool of individuals already familiar with the region. Students who have rotated through, for example, Bellin or Prevea, might be drawn to work for these systems after they graduate. They can build connections even as they are in school or residency that lead to future career employment.

By observing their mentors, students recognize that working in smaller communities will allow them to practice closer to their full potential, functioning at the “top of their licensure and appropriate training,” that is, a family physician in a small town is more likely to deliver babies, perform GI endoscopies, and do minor procedures than one who works in the shadow of an urban institution with multiple subspecialists. They experience the satisfaction of providing services that would not otherwise be available in their zip code. 

TT: What challenges do you see in the rural health care workforce and rural health care in the coming decade? 

Dr. Hunsaker: Smaller hospitals and their health care systems face many of the same problems faced by their urban counterparts but have fewer resources, less flexibility, and greater risks as they attempt to meet the mandates and challenges. For example, the implementation of computerized medical records, enormous data and reporting systems, and the costs of health care delivery have had disproportionate effects on smaller hospitals. They simply cannot scale up as easily and the larger systems in many cases. As mergers and acquisitions are predicted to continue, smaller systems will likely continue to consolidate; towns like Green Bay which currently has three, might soon have fewer systems at some point in the future and if predictions are correct, alignment with other system-level resources. As physicians, we have seen the intrusion of “business activities” and documentation requirements at the bedside and we need to protect and champion the importance of meaningful interactions that preserve patient respect, dignity, and quality of care. Not long ago, I heard from a community member that they were disturbed that scheduling the visit on the phone took longer than the time spent with their physician. Who we train and how we train them will prevent “transaction” from overtaking the sanctity of meaningful doctor-patient interactions.

That said, all hospitals are facing increased mandated requirements and decreased margins. Rural hospitals will likely continue to adapt, and larger systems should identify the mutual engagements that encourage a healthy state. MCW-Green Bay’s efforts to recruit, train and support a workforce with appropriate primary care specialty distribution and geographic distribution are key to a sustainable future. 

Here is an analogy: 

We, as a society, have made the decision that every community, regardless of size or income, deserves clean water. If the water is bad or tainted, we will not tolerate it. Think of Flint, Michigan. 

We have similar beliefs surrounding public health. Generations ago, we decided that sanitation and clean water were basic rights. Over the past fifty years, we have added vaccination as being critical for human health. Over the past twenty years, we added health care screenings, as well. We began pivoting from disease treatment alone to screening and early detection. We are accustomed to believing that basic interventions like these decrease every person’s morbidity and improve everyone’s wellbeing. 

So, how do we extend this analogy of basic health care services to our rural areas? What types of interventions and sacrifices should we, as a medical school, contribute to ensure care reaches all of Wisconsin’s citizens? How do we assure equity to access and treatment despite where a person lives? How do we deliver services that are not easily scalable? Rural and Urban disparities are often similar in terms of workforce and accessible services.

These are huge challenges for our smaller towns and cities. It is a consideration for each of us to contemplate and participate in developing solutions.

TT: As a Dean, what have you discovered?

Dr. Hunsaker: Since our class sizes are smaller, I can schedule meetings with each of the medical students individually for half an hour each year and twice in their final year, all in addition to their career counseling, mentorship, and future planning provided elsewhere. As I meet with them, I realize we can measure their knowledge, but that we have a much more difficult time measuring and influencing character growth and the non-cognitive aspects of who they are becoming, yet these are critical to their success and happiness as physicians. The development of character and robust mentoring are key factors to success in and beyond medical school. 

TT: Any other advice?

Dr. Hunsaker: I have enjoyed my journey from working as a family physician in a small town in downstate Illinois to my decade at the University of Illinois College of Medicine at Rockford to now my work as Dean at MCW-Green Bay.

 I believe that our task as a physician is straightforward. It is to help people live longer, or feel better. If our advice and care fall outside of those goals, we need to contemplate what forces in medicine or society are driving our decision-making.

I believe that good doctors are the most aware of their biases, judgment, and care outcomes. Less successful doctors, on the other hand, wait for others to criticize or react to concerns from others. Pay attention to where the criticism comes from. As medical educators, we must incorporate this in our educational models so that the future peer is knowledgeable, successful, and one with whom their patients, and we as colleagues enjoy working.

Matthew L. Hunsaker MD, is the founding dean for MCW-Green Bay. Dr. Hunsaker provides overall leadership and management of MCW’s regional campus.

Interview by Bruce H. Campbell, MD

The Fauci Effect: An unprecedented rise in applications to medical school provides an opportunity, but might we miss it?

From the 2/19/2021 newsletter

Director’s Corner

The Fauci Effect: An unprecedented rise in applications to medical school provides an opportunity, but might we miss it?

Adina Kalet, MD MPH

Applications to medical school are at an all-time high. In this week’s issue focusing on Rural Health and Medical Education, Dr. Kalet considers the opportunities this may afford us to address the significant geographic and specialty maldistribution among the physician workforce and, thus, address health disparities.  Or not …

When I entered medical training in 1978 at the Sophie Davis School for Biomedical Education at the City College of New York (now the City University School of Medicine), I signed a contract committing me to practice in a medically underserved urban community. I thought I wanted to be a physician (What did I know? I was 17 years old!) and, compared to what I had heard about the competitive grind of the typical pre-medical pathway, the social mission of the six-year accelerated BS/MD program I was entering appealed to me. My classmates were typical inner city public college folks, over 30% of us were Black and Latino, most were from lower middle class and working poor families, and many were immigrants or first-generation Americans. As I discovered later in my training, ours was not the typical make up of a medical school class. 

Medical education is never simply a straight path an individual takes toward their clearly articulated career goal. Most medical school applicants share a desire to serve others, but few have a clear idea of what that really means, much less have any specific ideas of what they want to do. Instead, medical school and residencies expose trainees to a variety of opportunities while the curricula (both the explicit and hidden) mold, shape, and guide them. There are twists and turns along the way. Career choices evolve. Role models inspire and disappoint. Exposure to challenging societal and public health issues can leave deep impressions. Outside events intervene. Powerful forces influence choices and address societal challenges. 

Why are more students than ever interested in becoming physicians? 

This year, even as applications to colleges and universities have been falling, we are seeing an unprecedented 18% overall increase in the number applications to medical school. Some are calling this the “Fauci Effect,” attributing the increase to the inspiration provided to young people by Anthony Fauci, the physician, scientist, director of the National Institute of Allergy and Infectious Diseases (NIAID), and voice of science and reason during the  COVID-19 pandemic. When the history of this remarkable time is written, Dr. Fauci may well have a special place as the single most trustworthy public advisor of our era. With his comforting, thick Brooklyn accent, he expertly translates “science” into accessible language, giving advice to a broad national audience and demonstrating the courage to be truthful, objective, and - when appropriate - uncertain about the future. He has become the nation’s physician. 

Of course, there could be other explanations for the dramatic rise in applications. Perhaps a large number of recent college graduates simply have more time on their hands to complete the complex application process and study for MCATs. They are inspired by the heroism demonstrated by health professionals who - at risk to their own health and well-being - have cared unselfishly for others through their own physical and emotional exhaustion. This altruism should be harnessed and focused on what ails us. 

Why it is important to improve the primary care physician work force

Today at the Transformational Times, we turn our attention to rural health and our regional campuses. Small cities and towns face projected life-threatening shortages of physicians over the coming decades.  Despite an overall increase of 35% in the number of students graduated annually from US medical schools, the American Association of Medical Colleges (AAMC) is projecting a shortage of up to 139,000 physicians by 2033. More than two out of every five doctors now practicing will reach retirement age over the next ten years and this loss will disproportionately reduce access to primary care in rural communities. 

More worrisome, and despite evidence that greater primary care physician supply is associated with lower mortality, the density of primary care physicians has decreased by 11% over the past decade, leading to an increase in the number of deaths from preventable causes. For every ten additional primary care physicians per 100,000 population, the associated deaths from cardiovascular, cancer, and respiratory mortality dropped by 0.9% to 1.4%. Life expectancy improvement was more than 2.5 times that associated with a similar increase in non–primary care physicians.  Programs explicitly focused on training, attracting and sustaining the primary care physician supply should be a national policy priority. Medical schools are an important part of this equation.

Read the inspiring interviews with Deans Lisa Dodson of MCW-Central Wisconsin and Mathew Hunsaker of MCW-Green Bay. Look at their “soup-to-nuts” explanations of how recruitment, admissions, curriculum, financial aid, and social support can intentionally address the needs of rural populations. These smaller, mission-oriented programs demonstrate there are many paths toward educating excellent physicians. We are listening to them and learning from them. As we recover from the pandemic, the seeds they have sown might offer us great opportunities to mark the beginning of a new era in medical education. 

This year’s unusually large and more diverse applicant pool provides us opportunities to accelerate workforce diversification. Compared to the same time last year, the number of students representing racial and ethnic minorities who are taking advantage of the AAMC’s needs-based application costs is higher than ever, enriching an applicant pool with individuals from lower socioeconomic status. If, in addition, we attract more individuals who grew up in rural communities, and who are the first in their families to pursue professional education, we could begin to reverse the geographic and specially maldistributions which contribute to health disparities. Admissions committees can assemble medical school classes more likely to meet the missions of both the school and society. 

Debt affects career choices …

Of course, admission criteria alone are not enough. Medical school graduates finish with, on average, a staggering $241,560 of student loan debt, discouraging many from pursuing medical careers. Among those who do, indebtedness pressures students away from choosing lower-paid specialties even when they would find a career in primary care highly satisfying. A comprehensive set of incentives, dramatic increase in scholarship money and loan repayment, and payment and practice reform, to name a few, would be needed to dramatically improve access to primary doctors for those in rural communities.

I graduated medical school with about $25, 000 in debt, less than a third of debt typical of the newly minted physicians graduating that year, and one-tenth of typical debt today. I never took MCATs (medical school admission was guaranteed to all of us who maintained passing grades), calculus, or organic chemistry (we started with Biochemistry). And despite a great deal of initial angst (“Was I being brainwashed?”), I enthusiastically served for ten years as a Primary Care Internist in a publicaly funded ambulatory care center on the Lower East Side of Manhattan in one of the poorest neighborhoods in New York City. No one ever reached out to confirm if I had honored my contract; they didn’t have to; my education and mentors had prepared me and had ensured I would. Many, but not all, of my classmates did, as well. 

Alongside the usual foundational and clinical sciences, I took a course entitled “Community Health and Social Medicine” as a college freshman; this would be called Population Health Science in today’s parlance. Among other things, I worked in a clinic for homeless pregnant teenagers teaching basic health courses and spent a summer doing a community mapping and survey project for the Navajo Nation Health Foundation in Ganado, Arizona, a place as far from New York and as rural as one could get. The education in public health and the practical experiences I had with the people in these underserved areas opened my eyes and changed my life. 

… but, so do role models

Dr. Fauci isn’t so certain that he is the reason that medical school admissions are soaring. “It's very flattering," he said recently. "Probably a more realistic assessment is that, rather than the Fauci Effect, it's the effect of a physician who is trying to and hopefully succeeding in having an important impact on an individual's health, as well as on global health. So if it works to get more young individuals into medical school, go ahead and use my name. Be my guest."

We are on the cusp of changes in medical education and this unexpected bolus of applicants provides us a unique opportunity. Our country needs more primary care doctors. Our regional campuses have experience with matriculating classes of individuals who are more likely to enter careers in primary care working in regions that truly need them. We can learn from them. 

An active process is needed. We need deliberate planning and additional resources to recruit, matriculate, and support the “non-typical” medical school applicants who are statistically more likely to choose to practice in underserved areas. I think Dr. Fauci would tell us to plan, gather our resources, work together, and make a change. If we fail to act, it will be business as usual. 

For further reading

https://www.aamc.org/news-insights/applications-medical-school-are-all-time-high-what-does-mean-applicants-and-schools

Basu S, Berkowitz SA, Phillips RL, Bitton A, Landon BE, Phillips RS. Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. JAMA Intern Med. 2019 Apr 1;179(4):506-514. doi: 10.1001/jamainternmed.2018.7624. PMID: 30776056; PMCID: PMC6450307.

Zabar S, Wallach A, Kalet A. The Future of Primary Care in the United States Depends on Payment Reform. JAMA Intern Med. 2019 Apr 1;179(4):515-516. doi: 10.1001/jamainternmed.2018.7623. PMID: 30776050. 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

Valentine’s Day: I am Not (but, Thank Goodness, My Husband is) a Romantic

From the 2/12/2021 newsletter

Director’s Corner

Valentine’s Day: I am Not (but, Thank Goodness, My Husband is) a Romantic

By Adina Kalet, MD MPH

In this week’s Director’s Corner, Dr. Kalet talks about the links between love at home and high quality, world-changing science at work. She highlights the importance of strong, egalitarian partnerships in creating a life of meaning, purpose, and flourishing …

COVID-19 has highlighted the importance of having clinician investigators “on the ground” to care for both patients and populations. This group is the most likely to detect emerging disease variants, run innovative therapeutic trials, and move new discoveries to the bedside and into the community. Translational scientists save lives. We need to nurture these clinician investigators as they fulfill their vital scientific and societal roles and provide them with the resources they need to stay healthy and train the next generation of physician scientists. 

Despite their importance, though, over 40% of well-trained physician scientists leave academic medicine, causing a serious shortage of physician researchers and a resulting in a huge loss to the health science workforce. Given how exciting and important their work is, why do so many step off the track? 

I believe they leave because of the constant and recurring challenges these individuals face trying to balance their own lives while attempting to pursue meaningful clinical and research careers. Without solid, deep, and meaningful support both at home and at work, the challenging lives of clinician scientists can become overwhelming. 

What does this have to do with Valentine’s Day? 

In our recent paper entitled “Challenges, Joys, and Career Satisfaction of Women Graduates of the Robert Wood Johnson Clinical Scholars Program 1973–2011,” our group, including Dr. Kathlyn Fletcher, reported on a long-term study of the women graduates of this highly successful fellowship aimed at training change agents in the transformation of American healthcare quality. Among many findings, we identified that - of all these remarkably successful and influential women - the most satisfied were likely to describe their work as “…deeply meaningful and have egalitarian spousal relationships.” The views of these well-trained women clinician scientists offer important lessons to those interested in repairing the leaky pipeline of clinical researchers.

Most of the program graduates in our study were in committed, dual career, personal partnerships. What did “egalitarian spousal relationships” mean to them? It was very complex. We asked the women, some younger and some close to retirement, to reflect on the course of their working lives. On one hand, successful respondents noted that culturally determined and structurally maintained “traditional” gender social roles became flexible and negotiated over time as the needs of the couple changed. A small number of the women in our study reported that, during the child rearing stage of their lives, their partners were the primary parents while they were the sole employed spouse. Most women, though, were constantly juggling home and work. While some respondents reported satisfying lives of “serial monogamy,” divorce was uniformly reported as disruptive to careers and life satisfaction. 

Even as they support early career clinical investigators and scientists, funders such as the National Institutes of Health, the Robert Wood Johnson Foundation, and the Doris Duke Charitable Foundation, have not explicitly and formally addresses how to create, maintain, and sustain “egalitarian spousal relationships” that might be associated with a thriving, impactful, and flourishing life in medicine and science. This might be an area for future study.

What would a relationship curriculum for clinician scientists (and others) cover? 

Love relationships, although universally seen as positive and important are, typically, firmly in the personal and private domain. Most of us learn how to make a life from our own families, our particular cultural groups, or our close peers. Career-focused women in my generation, facing lives very different from that of our parents, had to be creative. We talked “offline” with our peers, scanned our mentors’ offices for evidence of outside lives (e.g., family photos, children’s artwork, dry cleaning, grocery lists), and asked directly when it seemed safe: “How do you do it all?” “Who does the laundry?” “When the kids are sick, who stays home?” “When do the grants get written?” “How do you decide if it is right to relocate?” 

When I was raising my own children, I loved gently interrogating medical students and residents who had “working mothers.” I asked about their experiences and views, hoping to learn anything that would improve my chance of being a good mother. Since then, there has been an accumulation of material to read and discuss. Role models are more common. We can now think about what a structured curriculum might include. 

There is much to learn about finding love, building healthy relationships, and negotiating lives of meaning while not driving each other crazy! When I was starting out, it would have been great to have access to “paired” autobiographies, such as Michele Obama’s Becoming and Barak Obama’s A Promised Land, to gain insight from each partner’s point of view into how hard, but inspiring, it is to maintain a loving relationship under the pressures of “dueling” careers. We can learn from others as they cope with the types of accumulated, complex life experiences that author Nikos Kazantzakis had his protagonist, Zorba the Greek, lament when he said, “I'm a man, so I'm married. Wife, children, house--everything. The full catastrophe."

Ah, yes. The “full catastrophe.” 

A curriculum on creating egalitarian relationships might include exercises on how to determine if each partner shares values and a common view of the future. Children: yes or no? Bedroom window: open or closed? How important it is to “fight” fairly and forgive often? But in the end, it is not those issues alone that make a relationship work for the long haul. 

What might men in egalitarian relationships report? I suspect it would be very provocative but reassuring. To understand how best to create lives full of meaning, we must think deeply about how both people contribute to nurturing, sustained, and flexible loving partnerships. 

Let me tell you about my Valentine … 

My husband has received many “kudos” for playing nontraditional roles, yet when we both switched to four-day work weeks after the birth of our first child, colleagues were supportive of my choice but warned that it would “ruin his career.” (Today we are both tenured full professors.) When we share that he does most of the cooking, he gets showered with praise yet my years of boiling the water for pasta or broiling the fish still go unacknowledged. Thus, as my experience exemplifies, egalitarian relationships are better for both partners but still require different sorts of internal and external negotiations for men. Attention to this, with a reliable evidence base could lead to greater flourishing for all of us. 

Here comes my Valentine’s Day theme. I have had the benefit of such an “egalitarian” loving partnership, and it has made all the difference. I met Mark in July 1984 when we were the interns on the 16 East medical team at Bellevue Hospital. Needless to say, we became very interdependent that summer, meeting regularly in the ICU to replace central lines or draw blood cultures, writing progress notes side-by-side well into the wee hours. I suspect there are few ways to get to better know a person’s character than sharing a 2:00 a.m. cup of cold “food truck” coffee. That summer, well before we became a couple, we were partners.  

Mark recalls that time with much more “romance” than do I.  He has always been the cornier one. I am the “realist,” skeptical that romantic love even exists. I have been free with my feminist critique of all that life has thrown at us. He is the one who still believes in magic. 

Over thirty-three years of marriage, there has been lots of tension and compromise.  There were certainly many ways it could have - and almost did - go wrong. We have challenged assumptions, gained self-awareness, believed in and pushed each other, experimented, and occasionally jumped off the deep end.  We never seem to get it exactly right, but we have gotten better at getting it close enough. We have made a home, raised children, and had our share of adventures. Our egalitarian relationship is a perpetual work in progress, more of a constant juggle than a harmonious balance. We are both better people because of it and, I might add, we have both found rewarding roles as clinician scientists and administrators.

So, is this just good luck? Maybe. I certainly feel lucky. I know many of our junior colleagues think of us as a “dynamic duo.” My response when I hear this is “Forget the Marvel Comics version and come to dinner, see our messy but warm home, meet our kids and the cats, and watch us work it out.”    

For further reading:

Kalet, A, Lusk, P, Rockfeld, J, Schwartz, K, Fletcher, KE, Deng, R, & Bickell, NA (2020). The Challenges, Joys, and Career Satisfaction of Women Graduates of the Robert Wood Johnson Clinical Scholars Program 1973–2011. Journal of General internal Medicine, 35, 2258–2265.

Kalet, AL, Fletcher, KE, Ferdman, DJ, & Bickell, NA (2006). Defining, navigating, and negotiating success. Journal of General Internal Medicine, 21(9), 920-925.

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.