20 Questions: Marc F. Stern, MD, MPH, FACP, Correctional Health Care

Marc F. Stern, MD, MPH, FACP, is a correctional health care consultant in private practice. He received a bachelor’s degree in biology from University at Albany (1975), and started his medical studies at Universitélibre de Bruxelles, facultéde Médecine in Brussels, Belgium, and transferred to University at Buffalo School of Medicine where he received his MD (1982). He completed a one-year residency in internal medicine at University at Buffalo Affiliated Hospitals (1985), and a VA/NIH fellowship in primary care medicine and health services research at Regenstrief Institute in Indiana and Richard L. Roudebush Veterans Administration Medical Center (1992). Dr. Stern received his MPH from Indiana University School of Public Health in Bloomington (1992).
Dr. Stern is an affiliate assistant professor for the University of Washington Department of Health Services School of Public Health, and volunteer faculty for preventative medicine at University of Albany School of Public Health. He is a member of the education committee for the National Commission on Correctional Health Care and the Society of Correctional Physicians, as well as a grant reviewer for the Langeloth Foundation. Dr. Stern is a reviewer of the American Journal of Public Health, a reviewer and member of the international advisory board of the International Journal of Prison Health, and an editorial board member/reviewer of the Journal of Correctional Health Care. He has been published in Annals of Internal MedicineAmerican Journal of Public HealthDrug and Alcohol DependenceNew England Journal of MedicineAmerican Journal of NephrologyJournal of Clinical Outcomes Management, and New York State Journal of Medicine.
When did you first decide to become a physician? Why?
I decided as a kid, but it was a gradual thing. Early on in middle school/junior high, I was drawn to chemistry and science. In high school it was biology. In high school, I bought a book called Understanding Surgery. I was fascinated with science.
How/why did you choose the medical school you attended?
In college I was interested in health care and wanted to be a doctor. My friend started a volunteer ambulance service, and I helped him do that freshman year. It was a big job developing and running an ambulance service. When it was time to fill out my medical school application, my transcript had lots of “lower letters,”and I was not well positioned to earn a seat in a U.S. medical school. But I was determined, so I looked outside the U.S. for medical schools. There were a few different countries to pick from, and I looked at the U.K., Italy and France. I knew high school French, and ended up at a medical school in the French part of Brussels. I spent four of my seven years of medical school in Brussels and did well there. My wife was having trouble finding work, so I applied and was accepted to the University of Buffalo. I took it and transferred in the middle of medical school.
What surprised you the most about your medical studies?
Nothing surprised me, but I did notice the difference between American and European medical schools. First, as a culture, Europe has a more paternalistic view of doctors, where the doctor decides what is best for the patient. In the U.S., the doctor-patient decision making is collaborative. Regarding the curriculum, European medical school offers longer and more in-depth anatomy, a full two semesters where every extremity is dissected. However, later in the process, the U.S. offers more hands-on training, where the European way is more “watch what I do”. I am sure a lot has changed since the 80s, though.
What is your specialty/focus and why did you decide to specialize in your field? 
I fell into correctional health care by accident. I was a VA physician in Albany and left to pursue other things. I got a call at home from the Commissioner of Health in the county where I lived, and he had just fired his jail physician and needed someone to cover the weekend. That weekend turned into the following week, and I stayed on because I was bitten by the correctional health care bug—I was hooked. It has all the positives of the VA system, with clearly a different type of underserved population with a higher prevalence of chronic medical problems (they don’t expect to be treated with respect, and they actively participate in their well being).
If you had it to do all over again, would you still become a physician and/or specialize?
In would hate to have missed my VA experience, but I wish I had discovered correctional health care sooner than I did. From a career standpoint, I wish I had had a longer run in one or the other. I was a relative latecomer to correctional health care.
Has being a specialist met your expectations?
I don’t think any of us have a correct idea of what the process will be like—not a complete image, anyway. Regarding the content itself, yes, taking care of people and the science of medicine has met my expectations. What I didn’t expect, or even appreciate until a few years later, was the honor it is to be allowed into someone’s life the way a physician is. It really didn’t hit me until a few years ago. It’s a tremendous responsibility anyway, but not many people in society get that privilege.
What do you like most about being a physician/specialist?
I like the thought process. You use a certain way of thinking that you enjoy—you’re hardwired for it, this mental process. Internal medicine is like trying to solve a puzzle, plus there’s a close relationship with another person. Internal medicine offers personality pieces that match me.
What do you like least about being a physician/specialist?
I dislike the overwhelming paperwork/insurance/payment aspect of it. I have largely escaped that in my career, but I dislike the non value-added activities of medicine.
What was it like finding a job in your field—what were your options and why did you decide what you did?
I knew I wanted to be a generalist, I like doing a little bit of everything. I received an offer while in residency to stay on in the emergency room at the VA hospital, and I thought that would be good.
Describe a typical day at work.
I am in a weird boat, because technically I am a consultant. I consult, teach and research, working seven days a week from home. I provide a lot of expert work for federal entities such as Homeland Security, the Department of Justice and the Courts regarding health care in prisons. About half of my time is consulting, with the rest a mix of teaching, research and clinical work. I also travel in spurts. I went to Africa in November, and I am on the road for nine weeks straights starting soon. I would say my travel averages out to a week per month.
How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take per year?
I work 50 to 60 hours a week. Sleep about seven hours a night (since I left residency, sleep isn’t an issue). Vacation is different as a consultant. Projects run into each other, and it’s harder to find the time to take vacation in large blocks.
Do you feel that you are adequately compensated?
My career changes early on resulted in my salary decreasing. From attending to fellowship, there was a decrease, and it kept going down for a while. I think on the whole we are overcompensated as physicians—it’s out of hand and inequitable, we are paid out of proportion to other professions in society. But I/you expect to be paid less by the government, and it’s fair. My consultant earnings are adequate based on the going rate and my lifestyle.
If you took out educational loans, is/was paying them back a financial strain?
I did, but I lucked out and married an accountant. She was a financial manager. But it took a conscious effort to live within our means in order to pay off our loans.
In your position now, knowing what you do—what would you say to yourself when you were beginning your medical career? What information/advice do you wish you had known when you were beginning your medical studies?
I wish it was more acceptable not to go directly to college from high school. I was expected to go straight to college, and I wasn’t ready. I needed to grow up a little bit. Students in medical school are so young, and they are expected to handle situations before they have life experience. I also wish individuality was encouraged, such as spending a year in the Peace Corps.
Regarding my career, I figured out I am a primary care person, and I like to teach and research. When I knew I wanted a fellowship in internal medicine, I had a shopping list of what I wanted to learn.
From your perspective, what is the biggest problem in health care today?
I am waiting to see how Obamacare works, but there are still gaps. Undocumented aliens still have no access.
I also think there are physicians that practice defensive, knee-jerk medicine and society expects perfection, and that equals ineffective, poor health care.
Where do you see your specialty in five years?
I think it is becoming and will become more recognized as a specialty of its own. About 30 years ago, it was not respected and it was actively disrespected. Even with a restricted license, a doctor could still work in a prison. No one went into it or studied it until more recently. It’s now a choice, a bona fide specialty.
What types of outreach/volunteer work do you do, if any?
I have volunteered at a neighborhood free clinic one-half day a week for the last five years. That clinic is closing now, and I need to look for another volunteer opportunity with the corrections-related population. I also volunteer teach medical ethics at the schools of public health in New York and Washington.
Do you have enough time to spend with your family? How do you balance work and life outside of work?
I think I was more imbalanced earlier in my career, and I could have done better at balancing, but I am getting better at it. Sometimes it doesn’t work out, because all of my clients expect 100 percent of me. But I have an understanding family, especially during crunch time. I am making a conscious effort, though, because I owe it to my family.
What is your final piece of advice for those interested in pursuing a career in your field?
Appreciate the honor of being an intimate member of someone’s life.
Don’t be afraid to do it your own way.
Do not assume that things have to be the way they are if parts are not enjoyable. Look for what you want to do. Think beyond the menu offered to you and then create it.