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20 Questions: Beth Seltzer, MD, MPH

Created 05.01.11 by Juliet Farmer
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Dr. Beth Seltzer

Beth Seltzer’s path to MD and MPH was not a straight line. She started out as a documentary filmmaker in San Francisco, where she created award-winning documentaries with a national reach, shared in creative decisions from idea to final edit, hired and supervised staff, conducted community outreach campaigns, wrote grant proposals, and managed finances. While there, she co-produced programs that garnered long list of honors such as Northern California Area Emmy Award; Gold Apple, National Educational Media Festival; Gold Hugo, Chicago International Film Festival; Best Documentary Short, Nashville Independent Film Festival; and Finalist, IDA Documentary Awards.

Beth received her MD from Case Western Reserve University School of Medicine, Cleveland, in 2003, and her MPH from Columbia University Mailman School of Public Health (NY) in 2008. Her residencies included general preventive medicine and public health at Stony Brook University School of Medicine, and a transitional year at Lehigh Valley Hospital in Allentown. Beth is board certified in Public Health and General Preventive Medicine, and is a medical consultant and writer, creating original, nonfiction works for wide audiences, including 101 Careers in Public Health, a comprehensive career guide from Springer Publishing Company, which has been endorsed as “first-rate advice” by the American Public Health Association.

Why did you choose to become a physician?
I actually started out as a documentary filmmaker. That was my first “real” job after college. It was a lot of fun, and we did some great work. But after a while, I decided it was time for me to get out from behind the camera. I wanted to try another way of making a difference. I looked around and thought about what types of work I admired, and I decided to go to medical school.

If you had it to do all over again, would you still become a physician? (Why or why not? What would you have done instead?)
Medical school was certainly a privilege. You get to see things you’d never have access to otherwise. You witness incredible surgeries. You share deeply emotional moments with patients and their families. You have the opportunity to make a real difference in people’s lives. But I also have been very frustrated with the state of health care in our country today and with the way our medical system works.  Sometimes I wish I didn’t know the things I do.

What would I have done instead… it’s hard to say. Now that my first book has been published, I often think I could have been happy just being a writer, without the medical training. But I’d probably still be focused on health and social issues, the same sorts of things I want to accomplish with my medical career.

Why did you choose your specialty?
Public health and preventive medicine was a natural fit for me. During my clinical training, I often felt like we were chasing after diseases that could have been prevented. For example, type 2 diabetes was rampant, but the main thing we had to offer seemed to be medication. I wanted to spend more time talking to my patients about things like diet, exercise, and other health-related behaviors, but the way the system is set up it’s hard to do that and stay on schedule. Now, I’m surrounded by people who make that sort of thing the focus of their work. How can we address health behaviors on the population level, so fewer people will get type 2 diabetes (or HIV, or heart disease, or smoking-related cancers) in the first place? I also think a lot about the quality of health care and how we can improve our system, which is another big focus for my specialty.

Did you plan to enter your current specialty prior to med school?
I didn’t even know this specialty existed!

Has working in your specialty met your expectations?
So far, so good. I absolutely love my colleagues, the people I trained with and the people I meet at events like the annual meeting of the American College of Preventive Medicine. They are all doing such exciting things. I have friends who do important work at the health department, who help keep an eye on the quality of care for people in the Medicare program, who make sure that pharmaceutical companies do good, honest research. I’ve met doctors who do things like protect the health of workers at large corporations, set good standards for insurance companies, and give advice on important matters of health policy.

What do you like most and least about your specialty?
I love the idea of making a difference on a large scale. I also really appreciate the sheer variety of different opportunities. We’re trained in the techniques of public health and prevention, and those can be applied to just about any health topic and in any kind of organization. That’s not to say you’ll get the exact job you want right away, but it’s often possible to build up experience and get there eventually.

The thing I like least is trying to explain my specialty at cocktail parties. People know what a family doctor or an ophthalmologist is. When you say your specialty is “public health” or “preventive medicine,” they just look at you blankly. Or else they think you do acupuncture. Not that I have anything against acupuncture, but that’s not what “preventive medicine” means!

How do you define public health?
That’s a great question. When I was researching 101 Careers in Public Health, I found that the field has grown and expanded so much, it’s gotten hard to define. Basically, doing public health work means that you’re focusing on promoting health on a population level, instead of one-on-one. That can include a lot of things. For example, there are public health experts monitoring health measures, investigating outbreaks, setting policy and enforcing laws, doing research, making sure that necessary services are available and that people can access them, and working to enhance the quality of care.

What led you to write 101 Careers in Public Health?
Springer Publishing Company was looking for someone to do the public health volume in their series of career books, and I jumped at the chance. I remembered how excited I’d been to discover the field of public health. And since I started my training, I’ve met so many people who share my passions and my interests but don’t know about all the opportunities available. It’s so common for doctors to hear about my specialty and say, “Wow, that’s really an option?  I wish I’d known!”

Describe a typical day at work.
Right now, my work is not exactly “typical” for a doctor with my training. At the moment I’m doing a couple of different things. I work as an independent contractor with a show on the Discovery Channel called Discovery Channel CME. It’s a medical education show directed primarily at doctors, although all sorts of people enjoy watching it and learning from it. I spend a lot of time looking at what doctors need to know and how to teach them, which means I’m constantly using my statistics, epidemiology, and research training to interpret medical studies. Sometimes I help create programs about health for the general public.

In my spare time, I’m working on some new book ideas. I’d like to help people with practical information about lifestyle change. And I’m giving some thought to the next steps in my own career—whether to stay in the world of media, look for more traditional public health work, or possibly create a clinical practice that’s focused on lifestyle and prevention.

What mix of clinical/research/teaching work do you do? How much power do you have to change that mix?
I don’t do any clinical work right now, although as I said that may change in the future. I do a whole lot of secondary research, meaning reading the medical literature and interpreting it for doctors and sometimes the public. As for teaching, you could say that’s pretty much the focus of my work at the moment, but obviously not in a traditional classroom!

Other doctors with my training do all three of those things in all kinds of combinations. Some have done clinical residencies as well as preventive medicine, and they take their skills back to their clinical practices. Some are out in the field doing original research. How much you can change the mix really depends on the job, your own interests, and your personal level of determination.

On average: How many hours a week do you work? How many hours do you sleep each night? How many weeks of vacation do you take?
How many hours do I work? Too many! And no, I don’t get enough sleep either. But that’s just me, because I have so many things I’m trying to do right now. Doctors who work in traditional public health jobs usually have nine-to-five schedules and weekends off, unless there’s a crisis.

Why should students consider a career in public health?
Because it’s important work that also allows you to have a life. Because it gives you the chance to address the root causes of health problems in our country and our world. Because you might get the chance to improve a piece of our health care system, instead of battling against it. Because you’re almost guaranteed to meet great people who still believe we can make the world a better place.

In your position now, knowing what you do – what would you say to yourself 10 years ago?
I’d let myself know that “public health and general preventive medicine” is an actual medical specialty! Had I known, I think I would have made some different choices early in my training.

What information/advice do you wish you had known when you were an undergraduate? (What mistakes or experiences have you encountered that you wished you had known about ahead of time so you could have avoided?)
When I started out in medicine, I had no idea how the social hierarchy of medical training worked. I was coming from the world of independent filmmaking, where everything’s pretty egalitarian and everyone’s on a first-name basis. Not to mention the fact that, as a producer, I was used to being in charge of things. I would have fit in a lot better if I’d realized that some people would see my asking questions as “talking back”—or that my first attending would be horrified when I called her by her first name!

From your perspective, what is the biggest problem in health care today?
I worry that the relationship between doctors and patients has broken down. I think it’s a function of the 15-minute appointment, combined with a tendency to practice defensive medicine. I hear it from doctors, who are saddened that they can’t practice medicine the way they want to. And I hear it from patients, who are sad because they feel their doctors have let them down.

From your perspective, what is the biggest problem in your specialty?
The biggest challenge is that people outside the specialty don’t understand what we do. It can make it hard to get that first job, because you don’t fit into people’s boxes about what a doctor is supposed to be.

Where do you see your specialty in 5-10 years?
I hope we’ll be overcoming that problem I just described. There’s been a lot of talk lately about disease prevention as an element of health reform, and I hope that will mean a new appreciation for doctors who understand public health.

Do you have a family and do you have enough time to spend with them?
No husband or kids yet. But when I do have a family (which I hope to!), I have no doubt I’ll be able to arrange my schedule to give them plenty of quality time.

Are you satisfied with your income?
Well, I’m not going to be a millionaire anytime soon. But yes, I make a comfortable living, and so do most doctors I know in my specialty.

If you took out educational loans, is/was paying them back a financial strain?
I was extremely fortunate, in that a scholarship covered a big part of my medical school tuition. So I have some financial flexibility. Some graduates in my specialty find that they have to take jobs they’re not thrilled about, to make ends meet. But once you have your foot in the door, you can work toward something you enjoy.

What types of outreach/volunteer work do you do, if any? What do you like to do for relaxation or stress relief? Can you share any advice on finding a balance between work and life?
I spend my summer Saturdays out by the Hudson River, helping to run a free kayaking program. Anyone can walk up, borrow a boat, and go for a paddle. Our group is involved in promoting access to the New York City waterways. As for me, I love that people come to our program to have fun… but they’re getting some healthy exercise in the process.

My best advice, if you’re someone who tends to get caught up in work, is to find something that you enjoy and make a commitment to get involved on a regular basis, so you can’t get stuck at the office or in front of the computer. I know my kayaking friends and our “customers” are relying on me to be out there every Saturday morning, no matter what else is going on.

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