aaem.org
Spotlight On...
Kevin Merrell, MD/PhD, an Emergency Medicine Physician who also continues to do basic science research
Tell us a little bit about your medical education background:
I started out years ago in the Medical Education Program, a seven year
integrated undergraduate/M.D. program, at Brown University. At the
time, I was very interested in public health and third world medicine
after having spent some time doing relief work in Latin America. While
in college I spent my summers working at a biotech company and realized
I loved research. So, I left Brown after my undergraduate to do an
MD/Ph.D. at Columbia. I did my PhD in the lab of Dr. Kathryn Calame in
the microbiology department studying regulation of immunoglobulin gene
transcription. I did my internship at Mt. Sinai in New York and then
went to Denver Health for my EM residency.
How did you end up in Emergency Medicine:
As I was finishing up medical school I was very torn about what to do.
Traditionally Columbia MD/PhD's did internal medicine, neurology or
pathology. A few did peds and a very rare few did ophtho, derm or
neurosurg. Nobody did EM. My research interests were most aligned with allergy-immunology or rheumatology but I didn't really enjoy the clinical aspects of those fields. I liked the more critical care
oriented fields like cards or pulmonary but I wasn't sure I loved them
enough to do all those years of residency and fellowship and I wasn't
sure I liked the research side of those fields as much. My wife was
already an EM attending and she showed me some basic science papers by
Steven Thom and basically said, "look you can do basic research and
still do EM." Then I met Dr. Thom and realized it really was possible.
I did an elective month at Denver Health and really enjoyed it. I liked the pace, the variety, and the procedures. I also really enjoy the intellectual challenge of starting with an essentially unworked up
patient and trying to figure out what is wrong with them and how to fix
it with a limited amount of data and time to work with. Gradually, I
realized that I could do a three or four year EM residency and then go
back into the lab. I wouldn't be out of the lab any longer than if I
did IM plus the clinical part of the fellowship and with the broad
range of EM and the freedom to do what I wanted I wouldn't have to fit
my research into the boundaries of a specific subspecialty. In the end
after interviewing in IM and EM I ranked all the EM programs ahead of
the IM programs. Some people at Columbia were kind of shocked and I
think a few were sort of "peeved" when they saw my match but most of
the reaction was blunted by the fact that an MD/PhD classmate had
chosen to match in orthopedics that year.
Why did you choose to become a MD/PhD?
Everyone always says because they want to be the true triple threat
doing clinical work, teaching, and research but I think many like
myself just had trouble making up their minds whether they wanted to do
clinical work or research and so they chose to delay the decision by
doing both.
What is the best part of being a MD/PhD?
The MD is really the best broad education in general human biology you
can get and that perspective is important. PhD education is by
necessity very narrow and focused. It is easy to lose the broader
perspective when you are so focused on a specific problem for years.
Having both degrees gives you both opportunities and points of view
that you wouldn't have with either degree alone.
What is your least favorite part of being a MD/PhD?
It is very hard to really balance research and clinical work. I think
we fight it as much as we can but most of us end up gravitating toward
one or the other and not using the other degree very much. I still
don't know where I'll end up but I constantly feel pulled in both
directions and wonder how long I can continue to do both.
What are you doing now?
As I said before, being in EM allowed me to really look everywhere
when it came to looking for research interests. I decided that what I
really enjoyed was fundamental basic research and what I wanted was to
have a good enough record in the basic sciences to compete with
straight PhD's for a professorship in the basic sciences. I think that
is the best way to get the grants, graduate students, and postdocs that
you really need to be successful in the basic sciences. I figured the
best way to get there was to do a postdoc like any other basic science
PhD. Presumably, if I got the basic science position any affiliated EM
department would be glad to have me as an adjunct appointment and then
I could do a bit of clinical work for fun and to supplement my salary.
I am now a Research Associate at National Jewish Medical Research
Center studying the molecular, biochemical and developmental mechanisms
underlying the development and maintenance of B cell immune tolerance.
Recently I have begun talking to people about a position that meets my
goal of a basic science appointment with an adjunct clinical
appointment.
What is one thing your Emergency Physician colleagues would be
shocked to know about you?
I work for a small democratic group that staffs one local ED. Most of
my colleagues know that I do some sort of research most of the time but
very few know what I study. A few have asked but their eyes tend to
glaze over when I start talking about inhibitory signal transduction
molecules and the role they play in preventing activation of
autoreactive B cells.
If you could give one piece of advice to possible MD/PhD students, what would it be?
Don't feel that you have to follow the herd. There are literally
thousands of MD/PhD's in internal medicine. The surest way to quickly
get to some sort of professorship is probably to follow the standard
model of IM residency, then fellowship with research, and then an
assistant professorship with 1 day a week in clinic and 1 or 2 months a
year on the teaching service. That model has worked for thousands of
MD/PhD's and it will probably work for you but it may not be right for
everyone. Have the courage to try something else if you think it will
work for you. When I was applying to residency there was literally only a handful of MD/PhD's with EM training doing what I would consider real basic science. A few years ago at ACEP I met several hands full just at the basic science poster session and I'm sure it will continue to grow. You can follow the herd or you can find your own path but the depth and breadth of your training should allow you to do whatever you want.
If you could give one piece of advice to Emergency Medicine Residency
applicants, what would it be?
Do research, either basic or clinical, only if you like it. An awful
lot of bad research gets done and an unfortunate amount of it published
just for the sake of doing research. I think many residency programs
have moved away from requiring everyone to do research and have instead
added other "academic" projects and I think this is a good thing. If
you don't like research and you are going in to private practice I
don't see why you should be forced to do some essentially meaningless
project. On the other hand if you like it than pursue it for all its
worth. There are whole huge areas of EM related research just waiting
for people to branch out and explore them. Unlike IM where whatever you do you can pretty much assume dozens of other people around the world are studying the same thing, in EM you can carve your own niche.