Dr. Catherine DeAngelis, Editor-in-Chief Emerita of JAMA
Jun 16, 2014
Dr. Catherine DeAngelis is the first female and first pediatrician Editor-in-Chief of JAMA, The Journal of the American Medical Association. She earned her medical degree from the University of Pittsburgh's School of Medicine and her master's degree in public health from the Harvard Graduate School of Public Health. She then completed a speciality in pediatrics at The Johns Hopkins Hospital. Dr. DeAngelis has been awarded seven honorary doctorate degrees and many awards in honor of her humanitarian efforts. We were very excited to have the opportunity to ask her about her experiences as both a pediatrician and the editor of a prestigious publication.
How did you decide on a career in medicine?
I knew I wanted to be a physician when I was four years old. I distinctly remember asking my parents for a doctor’s kit at that age, though I’m not quite sure why I felt so strongly. I grew up in a family where to say we were not rich was an understatement. Both of my parents had eighth-grade educations; my dad worked in a silk mill and my mom worked as a waitress a few nights each week so we’d have more than the basic necessities of food and shelter.
During those formative years I realized that among all of the people I had met two in particular were treated with the greatest respect: the doctor who cared for my grandmother and the priest. I knew I couldn’t be a priest, so that made my choice easy. Fortunately, I developed an innate interest and ability in science when I got to high school so that was in line with my choice to be a physician. I had one of the greatest teachers you could ever imagine, who first taught me general science in ninth grade followed by chemistry as a senior. He was such an excellent teacher that I wound up using his notes during my first year of medical school. The love for science that he instilled in me had a long-lasting impact on my career as a physician researcher and eventually editor of a rigorous publication.
What made you pick pediatrics as your specialty?
My first love was for surgery, actually, because I was quite good at it. The summer before I began medical school I worked in a research lab focused on interferon research at the University of Pittsburgh School of Public Health. It was my job to remove the adrenal glands of guinea pigs and keep them alive for the next 10 days while we ran experiments. Then when I got to medical school I lived in Liberia for three months to work at a Bush hospital where I was able to first assist on a number of surgeries.
Throughout medical school I worked on my surgical proficiency so keenly that by my last year the chief resident of pediatric surgery asked if I would take call every fourth night to give him some relief. No one seemed to mind because they knew I was able to handle it. Of course I didn’t do any of the surgery, but was able to manage most of the general surgical problems that arose.
So where did pediatrics come from? I had loved working with children for a long time, and to be honest one reason I hadn’t considered the career as strongly as surgery was because it was one of the fields “expected” of me as a women. However, I realized that wasn’t a good reason to write a career off; after all, even within surgery I found that I loved pediatric surgery. In my fourth year the chair of surgery at one of the hospitals at the University of Pittsburgh was impressed with my research background and offered me the opportunity to do pediatric transplant surgery on the condition that I do my basic pediatric training first.
That led me to Johns Hopkins, which was my first lengthy experience working with a primary care pediatric population. I realized that for every child I could help as a transplant surgeon, I could help a thousand more as a general pediatrician. The potential scale of impact is why I decided to stay in pediatrics.
Can you describe your journey to becoming Editor-in-Chief of JAMA?
It was my research experiences that helped me develop into a decent writer. I was training Fellows at Hopkins and became very interested in teaching people how to do research, write it up, and get it published. I was offered the editorship of what was then the Archives in Pediatrics and Adolescent Medicine, which was flexible and could be done with 20 percent time Based on an 80 hour week, that is). As a result I was invited to serve on the JAMA Editorial Board. After the former Editor-in-Chief, George Lundberg, left JAMA a search committee was created. At the time I was considering a Deanship, but then I got a call from the committee inviting me to be the Editor-in-Chief. My first reaction was to decline because I was not interested in the politics involved in the position, but they urged me to take the weekend to think about it. I agreed and over the weekend went on a walk with my husband, a psychiatrist, who asked me how many medical deanships there were. I answered that there were around 125 (at the time). Then he asked how many Editors-in-Chief of JAMA there were, which was obviously one. The point he was making was that in terms of influence I would be able to have a larger platform if I took the JAMA position. So I accepted the position, but only under my terms of complete editorial independence.
Every few weeks there appears to be a new report discussing burnout rates of physicians and the fact that many would decide not to pursue medicine if given the chance. In this somewhat disheartening environment, do you have any advice for current medical students about avoiding burnout?
Many young physicians are choosing careers in medicine based on earning power, rather than by following their hearts. If you think becoming a physician is going to make you a millionaire, you’re going to be driven crazy. My husband is a psychiatrist and I’m a pediatrician; we represent the two lowest-paid specialties and even though we are helping to support three families we are happy as clams. We’ve avoided making decisions based on money, but rather based on our interests and what makes us happy.
Another problem that has led to disillusionment and burnout among physicians is that we as a group have given too much of our profession away to non-clinicians including lawyers and businesspeople. That’s why we continue to use tools such as electronic health record systems that are great for billing, but very inconvenient for physicians to use and as such actually impede patient care. You know what would happen if physicians collectively objected and said, “No, we refuse to use this system because it prevents us from taking care of our patients”? However, physicians seem to be afraid of taking stands on such important issues. I’ve written many editorials about this topic.
What are the top two things you would change about the way we train our physicians?
Number one is I think that we do not emphasize professionalism enough. We talk about it and use the word without really having a clue about what that means and not really teaching by example, that the patient is the center of why our profession exists. It’s very important for us to understand the science of medicine, but we’ve forgotten how to actually talk to the patient. In 1992 I received a 2.5 million dollar grant from the Robert Wood Johnson Foundation to change our curriculum for the first time in 70 years. One new course was called the Physicians and Society (PAS), which occurred over four-years during which we emphasized patient care and professionalism to a high degree.
The second thing I’d change is allowing people to truly elect rotations and not waste the last six months of medical school, which they are paying for by the way. For example, let’s allow more students the to experience working in an under-resourced area whether it is a developing country or a poorer section of the US. I would not trade for one minute the months I spent working at a bush hospital in Africa. It’s a whole different way of looking at things and actually augments the first aspect of care and professionalism.
You have been a pioneer in many ways, including becoming the first woman and first pediatrician to head up JAMA. Do you have any advice for medical students who are pushing the envelope as well?
Whenever you want to start something new and be a leader, you’ll face challenges and naysayers. How do you stay the course? I like to think that it takes having the “Four Ts”:
Tough-minded (but not tough!). If you know what you’re doing is the right thing to do, you should stick with it. Only if someone can provide specific information that you are wrong should you change course.
Tenacious. You may fail a couple of times, but the key is to keep going and not be discouraged.
Thick-skinned. This is probably the hardest of the four. As soon as you start doing anything new or different, you’re likely to displease some people.
Tender heart. It’s important to forgive those people who may have thrown stones at you. One of my favorites sayings is from David Brinkley who said, “A successful man is one who can lay a firm foundation with the bricks others have thrown at him.”