Insiders Scoop: Scaling Impact via Public Health – Dr. Madhury Ray

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Name: Madhury Ray, MD, MPH

Interests: Public Health | Disaster Preparedness & Response

Education: Penn State (BS/BS/BA) | Drexel University (MD) | Harvard University (MPH)

Current Position:  Director of Data Analytics for Child Care | Disaster Management Innovator at the Intersection of Health Equity, Public Health, Medicine, & Data

About Dr. Madhury Ray:

Madhury (Didi) Ray, MD, MPH is an innovator in public health emergency management and works at the intersection of medicine, data, health equity, and public health in the NYC Department of Health and Mental Hygiene’s fight against COVID-19. Outside of COVID-19 response work, she is the Director of Data and Analytics for Childcare. Previous to working in NYC’s Health Department, Dr. Ray completed her M.D. at the Drexel University College of Medicine and trained in general surgery at the Massachusetts General Hospital and the University of California in Los Angeles. She additionally completed a Masters in Public Health from the Harvard T.H. Chan School with a specialization in Global Health and a concentration in Humanitarian Studies, Ethics, and Human Rights, and was a Fulbright Scholar in Ukraine during the Orange Revolution. She is one of 2021’s 40 Under 40 Rising Leaders in Public Health.

 

1 | As a physician engaged in Public Health in NYC, what does your role entail?

I work for the New York City Department of Health & Mental Hygiene and I spent the last few years primarily focused on Disaster Preparedness and Response from a Public Health perspective. Before 2020, I worked on the systems that help us respond to disasters like measles, earthquakes, hurricanes and more. Of course, in the spring of 2020, everyone shifted focus to COVID-19. The roles required me to think from a systems perspective, and I leverage data to assemble and develop the structures that guide large-scale responses to crises.

When it comes to engaging with data, a lot of people have the misperception that data analysis only involves churning out numbers and automating metrics, but in reality, it’s about building systems and structures and piecing together a common operating picture.

I’ve always been an analytical person having studied as a math major in college, but when it came to fulfilling the data-heavy duties of this role, I taught myself everything. There were questions I encountered – especially in public health – and finding the answers required me to make sense of this language and hone this skillset, which complements rather than replaces my clinical experience and background.

Today, I serve within the Bureau of Childcare (Environmental Health). The pandemic has renewed the nation’s focus on the fundamental importance of child care, so this an area of tremendous opportunity. Moreover, environmental health is a niche I’m particularly interested in – the challenge of climate change, heat emergencies, and others have always been of interest to me, and I’m able to fuse my clinical background in these domains uniquely.

 

2 | What experiences solidified your interest in Public Health?

It’s interesting to reflect upon the roots that led me to where I am today because early in college, I took a Public Health 101 class which was, admittedly, very boring. The material was not engaging. It was all about health insurance, and it was descriptive and slow and focused on documenting problems instead of solving them this was greatly different from the Public Health work that really fascinated me towards the end of college.

I was majoring in Math and Russian as a premedical student, and my Russian Professor actually became my college mentor. I had a deep interest in the geopolitical history of the former Soviet Union, which I was able to study closely and get more involved in with time, but I also had an interest in emergency and surgical work that I gleaned insight into from the limited clinical experiences I had as EMT. That kind of public health was vastly different from what I was seeing in public health class.

Towards the end of college, I had the opportunity to learn a lot about Ukraine and get involved with the Orange Revolution, which was very exciting. The opportunity to immerse myself in a place undergoing revolution is arguably the most exciting thing any college student can dream about, but the experience was particularly influential because I delved firsthand into a global health atmosphere where clinical and policy leaders were coming together and laying recommendations for the healthcare system. They were envisioning a redesigned healthcare system operating under a new administration and new government.

That was when I saw Public Health as a change-driving force that brought together leaders from different fields and was undergirded by a collective clinical familiarity and diversity in thought.

This experience largely crystallized my interest in Public health – a version that was far more focused and dynamic than the Public Heath I had been introduced to.

 

3 | How did you support NYC’s response to the pandemic?

At the beginning of the pandemic, the virus was ravaging NYC and there was conflicting information being disseminated every day – the truth involved facts and ideas that would be disproven or changed on a daily basis. Recognizing this, the first role I undertook required me to find a means of disseminating information in a manner that allowed us to share a  growing understanding of this virus – and relying on slide decks and presentations that would become outdated and inaccurate on a weekly was impossible.

I and a few colleagues created a model of physician-led community engagement.

Of course, it started with me writing my own 15-minute COVID-19 public talk from scratch – which I had to deliver to the government and a skeptical audience of the healthcare system the next day (I was terrified.) After calming my nerves and as much preparation as I  could in the time I had, I just gave my first talk and then kept going to different places that needed information. We scaled the model by training more physician speakers and community-engagement leaders and were able to ensure that the public was engaged with the most accurate information. In this model, physician-speakers would be paired with trained community-engagement leaders and would facilitate the diffusion of accurate information across communities. This was at a time during which there was high anti-Asian stigma and distrust in policymakers, and leveraging physicians alongside community-engagement leaders helped us to meet a scared public where they were.

I also worked as the lead for ICU Surge Planning and Crisis Standards in the first wave of the pandemic in NYC there was a line that we skirted but didn’t cross where we would have to ration ventilators – I felt like I was holding my breath the whole time. The virus was ravaging the city in March, and there were a limited number of physicians at the Health Department with training in critical care. My clinical experience, – working as a resident in ICUs and the critical care specialist contacts that I had – put me in a position to understand the demands of critical care and address them accordingly. My job was mainly to convene ICU leadership, curate up-to-date critical care info and strategies, and share insights from other cities. For example, a close friend of mine from residency had experience running a hospital in Shanghai and shared important early insights with us. There were also points in time when my training in Disaster Response enabled me to anticipate resource problems and focus on response activities. At another point, scientists at the NYC Health Department encountered multi-system inflammatory syndrome in children – first identified in London – I worked with our team closely on this and we were one of the first to assemble a multi-disciplinary panel.

 

4 | What has been the most exciting part of your work throughout this pandemic?

One of the most fulfilling experiences I had was developing the hyper-local response in NYC. For context, race and disinvestment along with other social determinants of health have a tremendous impact on health in NYC, and the additional impact of a disaster is cumulative. During the pandemic, the NYC Health Department quickly discovered that this toll on health was not uniform across NYC.

For years, emergency management had been talking about a hyper-local response, where you tailor your emergency response and provide different resources to meet the needs of a neighborhood. We were able to implement this in a manner that has not been implemented previously in the United States, and we built this system around rapid qualitative data collection, analysis, and translation into operations – putting this together, I saw an idea evolve into a tangible, implemented product that was then out of our hands and left to grow and emerge.

Another exciting area of work was centered around the city’s educational systems. There are a lot of private schools in NYC – I believe the number is around 1,000 – and we needed to build an entirely new data infrastructure to support these schools in conforming to new COVID-19 standards. Given that our Task Force was convened very close to the week that school started, we were putting this system together at a rapid pace – almost as if we were building a boat while sailing it.

I also served as the Clinical Epidemiology Contact Lead for our contact tracing program – the largest contact tracing program in the United States. As the clinical lead, I would talk about the clinical implications and the developments on that front. Currently, I am a vaccine-adverse events specialist where I follow up on particular cases to support CDC investigations into adverse events. I also worked with our provider-communications group and presented our weekly provider webinar.

 

5 | What has been the most fulfilling experience you’ve had in Public Health?

One of the coolest things I’ve been privileged to be a part of is the declaration of racism as a Public Health Emergency in New York City.

This declaration has made clear that systemic disinvestment has created living environments where people can’t achieve the same level of health as others.

If you’re a policymaker, you need to remain accountable for this problem. The health inequities we see can be diminished if policymakers acknowledge and focus on reinvestment and building health equity – hopefully, this declaration is the first step to renewing widespread focus on this issue.

 

6 | What’s the fundamental difference between working in Public Health and serving as a doctor?

What medicine really means is that you understand and develop an instinct for how the body functions as a system – that’s why it’s more of an art, and it’s why you can’t have a checklist that encompasses all scenarios. There’s urgency to some things, and there’s other factors that you don’t have control over.

Public Health is similar to this, but it functions on a systems-level where you don’t always get to look at impacts and consequences, which are widespread and harder to see.

The key to doing both is to recognize that just as a Urologist is responsible for understanding his primary organ system and the means by which the urinary system is interconnected with the other systems, when it comes to Public Health, your work forces you to understand far more than just health care. You’re required to understand more systems and institutions than solely the delivery of care, and the impact you’re able to impart is hugely tangible.

Like clinical medicine, the Public Health of the future is fast. It is operational. You’ll encounter a problem, learn that problem very deeply, do something about that problem, evaluate the impact, and then you do it again. That doesn’t happen over the course of fifty years or a generation, it happens rapidly.

 

7 | What led you to transition out of surgery and immerse yourself in Public Health?

Even before I had any clinical experience, I was intrigued by emergency and surgery, which led me to medical school. I was also interested in the kind of public health and global health I had seen in Ukraine, but it was very difficult for me to do both. I kept putting off until the next milestone – med school was over, residency was over, etc. In residency, there was a point where I started regularly seeing very complex surgeries. This was great – as a resident, there’s nothing cooler than being able to be a part of these complex interventions and see the impact of them firsthand. I was able to synthesize a stronger and deeper understanding of the various systems and how they were interconnected, which I loved.

That said, the work was fulfilling and exciting, but it was hard physically. I also have an autoimmune disease which made it challenging to meet the physical demands of the role. This was something I wasn’t treated for at that point, and given the culture, I didn’t want it to be known that I had this chronic condition.

Ultimately, however, I came to realize that while we’d complete our surgical work perfectly, we’d discharge the patient, who was then forced to go right back into the same environment that was responsible for that patient’s circumstances in the first place. This part of the work became frustrating.

There are many brave and courageous folks out there who are able to delve into clinical medicine and still make time for Public Health work. For me personally, however, I didn’t have the energy or focus to do both well, and with the track that I was on, I realized I wasn’t ever going to be able to do the things I wanted to in Public Health along with clinical medicine.

 

8 | What were some of the hindrances you faced when transitioning?

Over the years, your identity and life are built around clinical medicine. Internally, I had resisted this a lot by engaging with people and hobbies that weren’t medicine-oriented but the work crept up on me.

That said, to undergo this transition, I had to dismantle my sense of self – and I think a great deal of us do that in medicine especially when we are unhappy. There’s a feeling we have – in the face of the realization that the work we’re doing isn’t what we want to do, we assume that something must be wrong with us and we should remake ourselves to eliminate that sense of dissatisfaction.

The transition out of surgical residency was tremendously difficult – there was financial, physical, and emotional stress. There’s a great deal of investment that I put into clinical medicine – not just finances but an investment of identity.

There’s a surgical culture where the work itself is seen as the most meaningful part of one’s life. In surgery, one can have other things – hobbies and interests – that provide some level of meaning, but for many surgeons, those things aren’t as gratifying or fulfilling as the surgical work itself.

People who go to medical school are talented., Many come to realize at one point or another that the work they’re doing in hospitals and clinics isn’t where their talents shine. I’m sure that with insurmountable effort and dedication, anyone can become an expert at anything, but if you don’t work where talents shine, you’re making a sacrifice.

After stepping back, I went to Harvard to pursue my Masters in Public Health. There, I was almost overwhelmed by all the opportunities around me and I just kept going and going after them. I realized how many opportunities really lie in Public Health. The hospital isn’t the be-all or the end-all – there’s a whole world that the hospital interacts with, and the questions that arose and things I had been thinking about confirmed my desire to go into Public Health.

 

9 | What would you like to share with people thinking about pursuing other routes in medicine?

Personally, I did very well in medical school and loved what I was doing. My best friends and I were competitive and we competed, but then we congratulated each other’s success. As I said, in the face of these past accomplishments and the sheer investment of time, energy, self, and identity, the prospect of leaving clinical practice brought along a huge feeling of a lack of self-worth.

This sentiment is relatable, but there are steps that can be taken to manage it and effectively navigate this transition. I went back to school – which I was really good at – and I will say that if you’ve been in something for years if you have the opportunity, don’t hesitate to study something new and absorb all that you can. I didn’t sleep when I was at Harvard – there were opportunities everywhere. You’d just look to the left and some famous individual who pioneered a field entirely would be there. So I worked hard and ran myself ragged and then needed to go back to the real world and get a job.

I remember there was one particular recruiter who helped me recognize that the world is not designed for people who transition out of medicine. Generally speaking, the world is designed to tailor to certain pre-established career pathways. Medicine is kind of the same, but it’s so structured: when applying to residency, you choose from a set of options and narrow your interest; when it comes to fellowships, you do the same. But in medicine you aren’t taught how to apply for a job and you don’t negotiate your salary until you’re a junior attending. And even then, the money you make as a junior attending is so much after having managed with the training salary.

People will tell you you have to start from scratch or treat you like your skills aren’t transferable. However, when you undertake this journey and step out of the world you’ve been working in, you can bring a fierce, unseen perspective to a new field. Insights come to light that can have profound effects – these insights are tough to explain but rooted in one’s ability to look at a problem from a different angle. And the people who’ve spent their lives in that field oftentimes aren’t able to come up with these insights.

The first time I was working in a disaster, I was able to assemble a team and organize a list and solve fifteen problems at once because that is what I had been training decades to do – that skill set doesn’t go away. Once you get that MD, you earned it and it’s yours forever. No one can take it away.

So if you transition into something new, embrace the prospect that you are bringing with you a honed skillset that is tremendously valuable. Your previous experiences will instill within you a diversity of thought that will equip you with a capacity to tackle problems in unforeseen ways.

 

10 | What would you like people undertaking a career transition to know?

First, remember t a lot of people do this. You may have heard some story about someone at a specific program who left clinical medicine and nobody knows what they’re doing. But the reality is that this transition is one that many undertake.

The healthcare system is difficult to work in – everyone has always said that if you can think of doing something else besides medicine, pursue it. That idea – that you should only pursue medicine if it’s the one and only thing you want to do and not otherwise – hits people once they’re so far into the process. It’s difficult to imagine what the work will be or who you will be when you make the decision as a teenager that you want to be a doctor.

You’ll feel like there is but there’s no shame in leaving clinical medicine. There’s so much you can do and so much impact you have elsewhere. If there is a huge driving pressure that leaves you feeling like you need to endure and push through, remember that there isn’t – and shouldn’t be – any shame in leaving.

You should also recognize that intelligence is not picking something out of the blue (as a kid) and instantaneously making the right decision – it is correcting for the path you’ve been on. That’s the sign of maturity.

Recognize that if you’re applying to medical school, or if you’re applying to residency, you are a talented person with intelligence and drive and an intrinsic capacity that makes you uniquely valuable to society. You can leverage that talent and ability within a clinical setting or outside of a clinical setting, and if you take the time to regularly examine yourself, identify your strengths and your weaknesses, and play to them accordingly, you’ll ultimately be of great value to society.

 

11 | What does your day-to-day look like?

My day-to-day has changed a lot and often changes based on the nature of the project at hand. I have an office in Manhattan and I am still hiring my team. Usually, we have random requests that come in – for example, perhaps somebody needs information about the number of child care programs that start with the letter “c” in the Bronx. We resolve these requests, but we’re also trying to build a more cohesive system and spend a great deal of time on broader, core problems.

Recently, they just mandated that all childcare providers in New York City who interact with children are required to be vaccinated. Before the enforcement of this mandate, there is an educational period where my team is looking at a multi-tier engagement plan that we’re just starting to enact. We do large-scale analyses of whether our enforcement is equitable and whether we’re doing the right things – we have to dig into the quality of child care and are fundamentally responsible for the enforcement of regulations.

In addition to these core roles, I also do public talks, vaccine-adverse event investigations, and I’m working on my own publications. Of course, if another disaster hits, who knows what my day will be!

 

12 | What advice do you have for premeds, medical students, physicians, and other Public Health leaders?

Personally, at this point, I spend a good portion of my time investing in myself – publishing my work, building my networks, and achieving recognition where I can. It’s so important to remember yourself, you as a person, and your career. In medicine, there is a great deal of self-sacrifice and dedication that is part of what you do. In a lot of ways, there is a tide pushing you forward and as you act on ideas and produce great quality work, you give the credit to the institution you’re working for. At the end of the day, however, you also have a responsibility to push your career on your own terms and there isn’t a handbook to help show you how to do that.

We’ve all seen this when you apply to medical school. You can be volunteering for years at an organization, and someone else will just show up and get just as much credit. You need to think about how you move through these spaces and what you take with you and figure out how to make the most of it – this often ends up being better not only for you but for the organization too.

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