By Juliet Farmer
Christopher D. Anderson is a neurologist at Massachusetts General Hospital, neurology instructor at Harvard Medical School, and associated researcher for the program in medical and population genetics for Broad Institute in Cambridge. Anderson earned his bachelor’s degree in molecular and cell biology from Northwestern University, Weinberg College of Arts and Sciences, where he graduated magna cum laude (2001). He earned his M.D. from Northwestern University, Feinberg School of Medicine (2005) and completed an internal medicine internship at Beth Israel Deaconess Medical Center (05-06). Dr. Anderson then completed neurology residencies at Brigham and Women’s Hospital, Massachusetts General Hospital, and Harvard Medical Hospital (06-09), followed by a neurology research fellowship at Massachusetts General Hospital (09-10). Most recently, he completed neurocritical care clinical fellowships at Massachusetts General Hospital, Brigham and Women’s Hospital, and Harvard Medical School (10-12).
Dr. Anderson is a member of the American Academy of Neurology, American Heart Association/American Stroke Association, Society of Critical Care Medicine, Neurocritical Care Society, and American Society of Human Genetics. He has been published in Neurocritical Care, Epilepsia, Stroke, Archives of Neurology, American Journal of Human Genetics, Annals of Neurology, Circulation: Cardiovascular Genetics, Neurology, Lancet Neurology, Neurobiology of Aging, and Translational Stroke Research.
When and why did you first decide to become a doctor?
I actually told the audience of my fifth grade graduation that I wanted to be a neurosurgeon. I ultimately decided that I didn’t like the operating room as much as I thought I would, so my interests evolved into neurology. I knew from an early age that I wanted to choose a profession that would have a tangible benefit to society, and that desire coupled with my interest in human physiology made for what was ultimately a fairly easy decision. By the time I actually understood what physicians do on a day-to-day basis, it was the science that really drove me to the profession – I’d never met a neurosurgeon when I was in fifth grade, so I can’t even tell you what made me think it would be a good fit for me at that point.
How/why did you choose the medical school you attended?
I did my undergraduate work at Northwestern University, and I am from the Chicago area originally, so it seemed like a natural choice. I looked around at several schools in the Northeast, but the location of the Northwestern Feinberg School of Medicine is really in an amazing part of Chicago, and Northwestern Memorial Hospital has a good mix of primary care exposures, as well as highly subspecialized clinics and research. I was very happy with my choice – I got to see every specialty functioning at a pretty high level, and I even met my wife there.
What surprised you the most about your medical studies?
I think a lot of people probably say the pace of study, but it is really quite manageable if you stay on top of it. I think what amazed me the most is that we’re really great at describing what we see in medicine, but in a lot of circumstances the underlying mechanisms are still quite unclear. That was very exciting to me – the idea that we can be rigorous and scientific and thoughtful in this very old profession, but still have so much left to do to understand it all.
How and why did you decide on your specialty?
As I mentioned, neuroscience interested me from an early age. In medical school I did research in a basic neuroscience lab doing some rodent work in neuroprotection, and it all sort of clicked for me. Later on, during my clerkships, I had a really great time on the neurology service, particularly doing consults. Neurology is a black box to a lot of clinicians, so you really have an opportunity to help patients and educate colleagues. This can be a source of frustration for some, but I always found it fun. Also, neurology is complicated and filled with unanswered questions, and I think that was a prime motivator to my scientific side. Finally, our consciousness and only means of interaction with the world around us is mediated by the nervous system, so in the battle of the organ systems neuro always sort of won out for me.
If you had it to do all over again, would you still become a neurologist? (Why or why not? What would you have done instead?)
For me, I think I’ve made the best choice I could have. Training in neurology is very diverse, and you can find programs that suit a variety of interests. I chose a rigorous program with a strong stroke and critical care background, and was very satisfied and pleased with my training. But neurology is such a varied field that many educational paths exist that can lead to good training and successful practice in a range of subspecialties and clinical exposures. Neurology has given me the opportunity to become a clinician-scientist, balancing laboratory work and clinical practice in my area of interest (stroke and neurocritical care).
Has being a neurologist met your expectations? Why?
So far it certainly has. As a neurointensivist, I get to take care of some of the sickest patients in the hospital, and am constantly exposed to new research questions and areas we can improve. Our patients are very, very sick, but not all stories need to have happy endings to be meaningful and gratifying, and I can’t imagine a better motivator to drive my research interests. Working at a large tertiary care institution, I am perhaps a bit more insulated against the financial pressures that are omnipresent in the private practice environment, but academic practice has its own forms of pressure. In reality, this is essentially true of any career, medical or not.
What do you like most about being a neurologist?
For me, the research drives everything. I am a stroke geneticist, and technology has reached a point where annotation of the human genome in a vast array of disease states and conditions is a reachable goal. It is a very exciting time, and I believe we are poised for some dramatic leaps in prevention and treatment of stroke and intracerebral hemorrhage. With an aging population in the U.S., this is a great time to be a clinician-scientist in neurology, because our discoveries could have a large impact in a short amount of time.
What do you like least about being a neurologist?
There is nothing specific to neurology that I don’t like about my job. Issues like constant time pressures, medical insurance issues, and a constant struggle for competitive funding are all sources of frustration, but all physicians must deal with issues like these, not only neurologists.
What was it like finding a job in your field –what were your options and why did you decide what you did?
Neurocritical care is a relatively small and young field, and the fact that I was also looking to start a lab at the same time restricted my search to major academic centers in large cities. Because I do patient-oriented research, having a strong subject recruitment infrastructure was a major concern, as well as a need for senior faculty mentorship in my field of expertise. Also, because research occupies so much of my time, I was restricted to programs that could hire someone with a relatively low proportion of clinical time. Finally, my wife is an OB/GYN and was searching for a job at the same time, which even further limited potential practical locations. All in all, I chose to work at Mass General Hospital because it has an outstanding Department of Neurology with a large and productive Division of Neurocritical Care and Emergency Neurology and Stroke Service, with numerous highly successful and renowned clinician-scientists in stroke genetics and epidemiology. I was very fortunate that they also agreed that I would be a good fit for them.
Describe a typical day at work.
My days vary significantly depending on whether or not I am on service. Having an 11-month-old baby at home means that I’m up by 6 a.m. at the latest seven days a week. When I am the attending neurointensivist on service, I’m at the hospital by 7 a.m. and stay until everyone is tucked in for the night, which can go very late. Even after I go home, I’m on pager call 24 hours a day. However, when I am not on service, and I’m in the lab, my days are much quieter. While meetings have a way of growing to fill any time space, I have plenty of time to write articles, read and review manuscripts, and travel to national and international meetings. I also take call with the Acute Stroke Service, which includes TeleStroke, meaning that I am the attending on call for acute strokes that occur at any of 32 hospitals in our stroke network, across three states in New England. This program allows community and regional hospitals access to acute stroke treatments that they might not otherwise be comfortable providing, and gives an opportunity for triage of all forms of acute neurologic emergencies by our providers, with possible transfer to MGH for further care. Thankfully, we have outstanding neurocritical care and vascular neurology fellows who perform a lot of the initial assessments of these cases.
On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?
When I’m not on service in the ICU, I work about 40 to 50 hours a week. This can rise to 60 to 70 hours a week when I’m on service, not including pages and recommendations given from home. For sleep, I try to get six to seven hours a night if my son will let me. I take two weeks of vacation a year, but have not asked for more.
Are you satisfied with your income? Explain.
As a clinician-scientist who is dependent on grant money to fund the non-clinical portion of my salary, I have never operated under the assumption that I would be making a ton of money with my chosen career. That said, I am part of a two-physician household and am overall satisfied with my income. Living in Boston is extremely expensive, so looking at buying a house in this area can make almost any income seem like not enough. I think my salary is appropriate for my level of training and the work that I do.
If you took out educational loans, is/was paying them back a financial strain? Explain.
I have over $300,000 in education debt. It is a very real concern. I don’t have undue trouble making my payments, but it is sobering to have to drag that kind of debt around. All that said, education isn’t free, and I chose to go to a private university for both college and medical school, and I got a great education. But I would advise young people thinking about medical careers that they should be aware that all those Stafford and institutional loans they are signing are very real, and they will have to pay them all back someday – with interest.
In your position now, knowing what you do – what would you say to yourself when you started your neurology career?
I would tell myself to not be scared to choose a nonstandard path to my career. I chose to take a research fellowship after residency and before starting my clinical fellowship. There was much trepidation about that decision, but I can now say it was one of the best things I’ve ever done. It really helped to crystallize what I liked best about neurology and what I wanted from my career. You have to think about what is best for you, and remember that becoming an attending in your chosen field of practice is not the end of the journey, but just another milestone.
What information/advice do you wish you had known when you were beginning medical school?
I wish I had understood the medical culture a bit better when I started. I don’t think I had the best pre-clinical exposure to academic medicine, and it is easy to sweat the small stuff when you don’t have a broad view of things.
From your perspective, what is the biggest problem in health care today?
As I’m certain many would agree, disparities in access to health care have far-reaching ramifications to those from all walks of life, from insured to uninsured. The politicization of this issue has its own potentially disastrous consequences, but the problem cannot be ignored. Physicians need to be active participants in the discussion and agents of change, because if the decision is made for us by outside entities, I’m very certain we will be far less satisfied with the outcome.
Where do you see the neurology specialty in five to 10 years?
I’m really glad to say I don’t know. How depressing would it be if I could accurately predict the discoveries and care redesigns that will emerge in the next decade? My sincere hope is that the public will find neuroscience research to be a valuable investment and continue to advocate funding allocations through the NIH-NINDS to support neurologists and neuroscientists who are doing very exciting work that will shape the care of patients into the next decade and beyond.
What types of outreach/volunteer work do you do, if any?
With my current work and family requirements, I don’t really have time to do much in the way of outreach work.
Do you have family? If so, do you have enough time to spend with them? How do you balance work and life outside of work?
I would love to spend more time with my wife and son. I don’t think I’ll ever be satisfied that I give them enough of my time and attention. Striving to achieve that work/life balance is something we all grapple with, to varying degrees of success. I’m there when my son wakes up, and I have dinner with my wife almost every night. I try to go home at a reasonable time each day, even if that means I have more work to do after bedtime, but when I’m on service, the needs of my patients absolutely must come first. That is the nature of the job.
Do you have any final piece of advice for students interested in pursuing neurology as a career?
There are many naysayers who like to talk about neurology as being diagnosis-rich and treatment-poor. This is one of those old memes that seems to be permanently entrenched in medical school education. I’m not going to say I know where it comes from, but I will say it is no truer in neurology than in any other specialty. Many forms of neurologic disease can be managed to good effect, just as is the case with heart failure or chronic kidney disease. Acute brain injuries like stroke and intracerebral hemorrhage can be devastating and we often can’t do much about them (right now), but just because something is hard doesn’t mean we should ignore it. There is enormous breadth and depth of practice environments, clinical problems, and patients in neurology, and my experience is just one. If you’re exploring career options in medicine, give it a good hard look.