On behalf of the Endocrine Society’s Early-Career Special Interest Group (SIG), Milay Luis Lam, MD, shares her early-career journey from Peru to the U.S., and what she learned every step of the way. Read why it’s important for the next generation of endocrinologists – both physicians and scientists – to be aware of the varied options available to them in the clinic, laboratory, and classroom.
I was born and raised in Peru and attended Universidad Peruana Cayetano Heredia, an excellent medical school. I can’t complain much about my medical training; it provided me with significant clinical exposure that allowed me to decide which area of medicine I wanted to focus on. It also nurtured the love I still have for the field today.
At the time of my education (2000 – 2006), smartphones were not yet available in Peru, and most of our learning materials came from books, copies of journals, and class notes from our professors. Technology has since revolutionized access to information, not just in healthcare, but for everyone. While much has changed in how we treat various conditions and in how medical education is delivered — especially with the current focus on technology — one thing that remains constant is the perception of a medical career and its branches in medicine.
We need to do a better job of educating the next generation of physicians about the diverse career options within medicine. Many may feel compelled to leave the profession because they’re unaware of the alternatives available to them.
Back when I was in school, professors and attendings often divided clinical medicine into two areas: academia, where individuals were driven by research, and private practice, where physicians focused solely on clinical care without involvement in research. After graduating, I spent about a year and a half at my university assisting with the international accreditation of pre-graduate courses. During this time, I learned that my first boss had never practiced clinical medicine; instead, she pursued a master’s degree and a doctorate. That was my first clue that there could be more to a medical career than just clinical practice or research.
A Clinician at the Bench
I then transitioned to working at Pfizer in Peru as a clinical research associate. At that time, having an MD was a requirement for the position. This experience helped me realize that physicians could also contribute to the background side of research. However, my ultimate goal was always to come to the U.S. to broaden my knowledge. Early in medical school, I decided I wanted to specialize in endocrinology because I grew up in a family where almost everyone had diabetes. This personal connection gave me a unique perspective on the disease from the patient’s point of view.
When I began applying for observerships and clerkships, I met Celso and Elise Gomez Sanchez, who offered me an opportunity that would change my career. I moved to the U.S. as a postdoctoral research fellow to work with them at the University of Mississippi and spent three years working with them in basic research. At this point, Celso did 90% of the research and 10% of clinical work at the VA. I still thought there was a clear distinction between clinical medicine and research, and after my research experience, I believed I would focus solely on research after completing my residency.
During residency, the divide between academia and private practice was still very much present. I began to understand that research comes in different forms: case reports, quality improvement projects, and clinical trials, whether industry-sponsored or investigator-sponsored.
When I entered fellowship, I assumed that all academic centers were similar. My training at SUNY Downstate exposed me to five different practice models: the VA, a community hospital, a large city hospital, a private practice with residents and fellows, and the main academic teaching hospital. Although these experiences helped me understand the various facets of clinical medicine, it wasn’t until I moved to University of Pittsburgh Medical Center (UPMC) in 2019 that I truly grasped the full spectrum of academic medicine.
Academia: More Than Research
After UPMC, I realized that academic medicine wasn’t solely about research. There was a path of clinician educators, where physicians focused on teaching and patient care without necessarily engaging in bench research.
Trying to balance my life in academia, particularly in a phase when I was the sole breadwinner (my husband was working on his PhD and we had a young child), I discovered the possibility of moonlighting in endocrinology, which helped supplement my income.
We are perpetuating the cycle that clinical medicine is private practice or academics, and I wanted to break that cycle especially since now as we see many people leave clinical medicine due to burnout.
Initially, I thought I would remain in academia, but as I was trying to figure out our finances and my love for my career, I felt like I was against the wall. I felt that leaving UPMC and the academic world might hinder my career, and I feared that without an academic title, I wouldn’t be seen as credible. I didn’t want to go into private practice, as I had been taught that it had no connection to research. But, I later realized I had been wrong.
Breaking the Cycle in Medical Education
I learned that clinical medicine encompasses much more than I had originally thought. There are hospital-based practices that involve teaching medical students and residents, but without the title of professor (a title many of us were led to believe would make us more credible or intelligent in the eyes of the world). There are also locum tenens opportunities in both academic centers and private practices. And there are private practices that do research that can industry-sponsored or even self-sponsored.
Speaking to my last medical student a few weeks ago, she made me realize that we still teach students the same thing I was taught, so we are perpetuating the cycle that clinical medicine is private practice or academics, and I wanted to break that cycle especially since now as we see many people leave clinical medicine due to burnout.
We need to do a better job of educating the next generation of physicians about the diverse career options within medicine. Many may feel compelled to leave the profession because they’re unaware of the alternatives available to them. By showcasing the variety of paths within our field, we can help them stay engaged in a career they’ve chosen, instead of feeling like their only choice is to exit the profession. This is still a great time to work in medicine!
Milay Luis Lam, MD, FTOS, is a division chief and medical director at Meritus Endocrinology, Meritus Medical Center, Hagerstown Md.
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