As a child, when someone asked “What do you want to be when you grow up?” my answers included gardener, chef, and baker, but never doctor. Later, I wanted to see the world and work as a diplomat. This led me to move from my native Norway to France for high school, where I first became excited about science. My high school biology teacher inspired me to leave diplomacy behind; through the lens of the original research studies, he introduced me to cell biology and molecular biology, creating a passion for the scientific method and human biology. Although a career as a PhD researcher tempted me, I was not ready to let go of the human interaction that I had envisioned in a diplomatic career. I therefore decided to pursue medical school, which led me to the Royal College of Surgeons in Ireland.
I love biochemistry and human physiology because an understanding of their underlying principles allows one to make sense of complex clinical scenarios. This also translated into an immediate affinity for the feedback loops, receptors and metabolic processes of endocrinology. But I also found medical genetics to have a similar logical underpinning, which led me to my first clinical experience in the United States: completing an elective in medical genetics at Johns Hopkins Hospital under the supervision of Dr. Ada Hamosh. Although medical genetics was not the path I pursued, I was awestruck by the advanced level of patient care, by the focus on education in the graduate training programs, and the research opportunities in the United States. I decided to pursue training after medical school in the United States.
While I never grew up to be a diplomat, a career as an endocrinologist has allowed me to go to many new and exciting places – if not geographically, then at least intellectually.
However, before moving to the United States, I completed an internship in Ireland. During this time, I had the luck of working with Dr. Christopher Thompson and Dr. Rachel Crowley in the Endocrinology Department at Beaumont Hospital in Dublin. Dr. Thompson introduced me to the intriguing and variable clinical presentations in endocrinology, and he modeled a rigorous and physiology-based approach to diagnosing and treating endocrine disease. The patients taught me the importance of understanding their subjective disease experience, even if the diagnoses and treatments often rely on objective test results. Dr. Thompson also insisted that all his trainees experience the academic aspects of endocrinology. I was therefore mentored by Dr. Crowley in my first clinical research project, examining the morbidity of craniopharyngiomas, and I served as a tutor for a group of medical students.
Eventually, I made it to the United States, where I started my internal residency training at Brigham and Women’s Hospital (BWH). My mind was set on endocrinology as a subspecialty; while I had not had a lot of research experience, I nevertheless had enjoyed learning about research and therefore was planning a career as a clinician-investigator. However, early on I benefitted from the mentorship of Dr. Graham McMahon, who at the time was a faculty member at BWH and had graduated from the same Irish medical school as I had. He has had a successful career as a clinician-educator, and I suspect that he could see my passion for teaching and clinical care rather than research. Although I pursued research training during endocrinology fellowship, the teaching opportunities afforded to me by Dr. McMahon and my residency program director, Dr. Joel Katz, excited me the most. The opportunity to convey the enthusiasm about endocrinology and patient care that my biology teacher and mentors showed me gave me a new energy and direction. As I wrapped up my fellowship, I realized that the clinician-educator path would be my future.
The field of endocrinology has afforded me multiple valuable opportunities. First, due to the non-procedural and outpatient nature of the specialty, it combines well with non-clinical endeavors such as medical education; it is my impression that endocrinologists are heavily overrepresented in medical education positions – including the dean of Harvard Medical School when I started my first faculty position. With this flexibility, it was possible for me to combine clinical practice with several positions within education administration – as the associate program director of the BWH endocrinology fellowship with my mentor, Dr. McMahon, as the program director; as an assistant program director in internal medicine in which I mentored and evaluated internal medicine residents; and in a range of other mentorship and course director roles. Thanks to the flexible nature of endocrine practice, I have also taken on a role as an education editor for the New England Journal of Medicine.
I have realized that endocrinologists are on the front lines of one of the civil rights issues of our era, namely the rights of transgender people. We are often the primary providers for transgender people in our role as prescribers of gender-affirming hormone therapy.
Second, I have realized that endocrinologists are on the front lines of one of the civil rights issues of our era, namely the rights of transgender people. We are often the primary providers for transgender people in our role as prescribers of gender-affirming hormone therapy. Of all the patients that I care for, this is where I think I can make the most difference – both in the actual provision of gender-affirming hormonal therapy, but also in providing a compassionate and caring clinical setting where patients can feel safe, valued, and heard.
Third, my fellowship and early faculty years have overlapped with the rise of cancer immunotherapy, with attendant endocrine side effects. In addition, the cancer survivorship population is increasing in size. I realized that understanding both cancer treatments and endocrine disease would be an asset, and thus delved into the cancer literature to understand the endocrine effects – both acute and chronic – of cancer therapies. This allowed me to develop the oncoendocrinology clinic at Dana-Farber Cancer Institute. Through this clinic, I strive to be at the cutting edge of endocrine disease, treating endocrine complications of cancer agents that are still in the clinical trials phase.
While I never grew up to be a diplomat, a career as an endocrinologist has allowed me to go to many new and exciting places – if not geographically, then at least intellectually. And I still garden, cook, and bake in my free time!
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