Name: Annie Cowell, MD, MPH
Specialty/Interests: Infectious Diseases/Malaria, Tuberculosis, Whole genome sequencing to investigate drug resistance
Education: Tulane University (MD/MPH), Yale University (Residency in Internal Medicine/Pediatrics), UC San Diego (Fellowship in Infectious Diseases)
Current Position: Assistant Clinical Professor, Division of Infectious Diseases, Department of Medicine, UC San Diego
1 | What drew you to subspecialize in infectious diseases?
I originally became interested in infectious diseases (ID) through my interests in global health and HIV medicine. I did rotations in HIV and tuberculosis clinics in South Africa and Malawi during residency and found that I enjoyed the complex medical decisions involved in treating ID. Managing these infections required a comprehensive understanding of a patient’s social situation and resources. This is true when it comes to managing these infections in the United States as well. I also liked the detective work that goes into figuring out the underlying cause of an infection or a fever. We always ask the most thorough social history questions! Also, what is satisfying about ID is that many infections are now either curable or manageable chronic diseases. There are also so many different directions that you can take with a career in ID, including public health, hospital-based consultations, outpatient practice, HIV medicine, tropical infections, global health, etc. There are also ample research opportunities ranging from basic, clinical, and public health research.
2 | What do you think is the most exciting frontier in infectious diseases?
One particularly exciting area is the use of molecular testing to provide rapid information to answer clinical or epidemiologic questions. These tests use different methods of DNA sequencing to identify organisms in clinical samples quickly, rather than having to wait for them to grow in culture. You can have an answer on what bacteria is causing a person’s bloodstream infection and which antibiotics are most effective within a few hours. The use of either deep sequencing or broad range PCR can be helpful in identifying an unknown cause of an infection, particularly in identifying organisms which don’t grow well or quickly in culture. In the future, these molecular diagnostics techniques will likely become more rapid, accurate, and widely available.
3 | Why do infectious diseases fellowship programs consistently have unfilled positions?
Yes, many programs do go unfilled each year. I think part of the problem is lack of exposure to the field during medical school and residency. If someone doesn’t already have an interest in the field, they may not pursue a rotation in ID and may never learn that they like it. Another issue has to do with salary, since the extra years of fellowship training do not necessarily result in a significant salary increase. Many internal medicine residents may opt to get a job in primary care or hospital medicine, where they can start earning an attending salary immediately, rather than spend more years in training. Other residents may choose a procedural-based specialty where earnings are higher. For me, it was worth it to spend time pursuing additional training in order to do something that I loved, even though it didn’t significantly increase my compensation.
4 | What advice would you give medical students interested in infectious diseases?
This depends on the type of career that the student is interested in. For those who would like to learn more about the field in general, I encourage them to identify ID faculty at their institution to learn about what kinds of careers are available. At large academic institutions, faculty are typically engaged in research and/or clinical care. If they find a faculty’s career/research interesting, they should contact that person and see if they can meet with them. Most faculty are happy to talk with students, don’t be afraid to reach out! Students can also identify clinical practice settings at their institution or in the public health department that they would be interested in. This includes HIV clinics, ID consultation rounds, or public health clinics (such as the tuberculosis or sexually transmitted diseases clinics). Students can either shadow the doctors for a short period of time to gain a sense of what it’s like, or try and set up a formal elective.
5 | What is a typical day like for you?
This depends on the day. I spend about half my time working on the inpatient hospital ID consultation service. When I’m working in the hospital, I generally work with an ID fellow. I will work on research projects or clinic issues in the morning, then will meet the fellow later in the day to discuss the hospital patients and see them. When I am not working in the hospital, I have two half days of clinic per week. One clinic is focused on mycobacterial infections, which includes tuberculosis infections. The other clinic is a general ID clinic, where I see a variety of different infections and manage outpatient intravenous antibiotics. The rest of the time, I work on research projects or do teaching activities at the medical school, such as leading small group learning. I like that no day is quite the same.
7 | How do you maintain your work-life balance?
Work-life balance is always a challenge for everyone! I have two young children and my husband works full time as well. It takes teamwork with your partner to make this work, along with whatever help you can get. We are fortunate to have family help us out frequently. Sometimes things are not very balanced and you just need to minimize personal time to survive a busy period. Being as efficient as possible at work is necessary to maintain a healthy work-life balance. This means tackling the things that are most urgent first and avoiding distractions. But, it is also important to carve out time for yourself to relax and do things you enjoy, even if it’s for only fifteen minutes. For me, this includes practicing yoga, playing with my kids, cooking new recipes, and running.
8 | In hindsight, do you think that getting a MPH was worth it?
I do think that getting an MPH was worth it. At Tulane University School of Medicine, we were able to complete the MPH along with our MD degree in 4 years. This did mean spending the summer prior to medical school in classes and taking a few additional classes during medical school. However, the concentration in International Health that I took as part of the degree allowed me to take a summer class comparing the HIV epidemic in Vietnam and Thailand, where we got to travel to those countries and visit various organizations involved. I was also able to complete my thesis on a project in India. These experiences sparked my interests in infectious diseases and public health.
9 | How have you applied the knowledge/skills gained from your MPH in your career?
Having an MPH gave me a more in-depth knowledge of biostatistics that I have been able to use in my research. Although it’s hard to remember the details of all the calculations after not using them for a while, having that foundation helped me to understand the concepts faster later on. The MPH also gave me a broader viewpoint of health, in particular the social determinants of health and diseases.
10 | Any advice for medical students interested in doing international work with the underserved?
This can be a wonderful learning opportunity, not only in terms of medical experiences but also in regards to learning more about the world and yourself. You get to understand a little more about how medicine is practiced around the world and what it’s like to operate with fewer resources. You will likely see advanced presentations of diseases that you don’t normally see in the US and that could have been preventable with additional resources, an experience that can be hard to process. Be humble and remember that you have a lot to learn from those you will work with. Keep a journal and/or debrief with a mentor or fellow students to help process your experiences. Before you go, try to learn as much as you can about the place and culture. Try to learn at least a few words of the local language if they don’t speak English. Also, remember that there are also many “global health” opportunities available in the US if you don’t have the resources to go abroad. This includes work with refugee or immigrant communities, in addition to work with underserved populations such as the homeless.