It's Love, Actually: Sparking Passion for ID

Paul Sax: [00:00:12] Hi everyone. This is Paul Sax. I'm editor-in-chief of Clinical Infectious Diseases. And welcome to the Let's Talk ID podcast. Today we're joined by Dr. Darcy Wooten. She is professor of medicine at UCSD, where she is also the program director of their ID fellowship program. Darcy, welcome.

Darcy Wooten: [00:00:29] Thanks so much for having me. It's wonderful to be here.

Paul Sax: [00:00:32] So I've invited you on to discuss the wonderful piece you wrote in CID called, "The Arrivals Gate at Heathrow Airport." It's one of our Voices of ID series, and we'll get to that in a moment. But first, as usual, I'd like you to start us off by having you tell us your story, which is quite relevant to your piece. How did you end up becoming a doctor generally, and an ID doctor in particular?

Darcy Wooten: [00:00:54] So I had never had any intention of going into medicine. In college, I was an English major, and I wanted to be a high school English teacher, and I had to take a science class in order to fill my college's requirement to graduate. And I ended up in a course called Humans and Viruses and this course really changed the trajectory of my life. I was struck by the intersection between infectious diseases and social determinants of health things like poverty, discrimination, racism. And I saw infectious diseases and medicine more broadly as sort of a way to take on some of these issues by caring for patients really impacted by these things that plague our society.

Paul Sax: [00:01:36] Any role models?

Darcy Wooten: [00:01:37] So a number of role models. A professor who taught the Humans and Viruses course, Bob Segal at Stanford, incredibly enthusiastic about teaching and virology. Paul Farmer and the work that he's done in Haiti and all over the world was definitely something that inspired me and really spoke to me in terms of the intersection, as I mentioned, between infectious diseases and poverty and really trying to get at the root cause of these issues.

Paul Sax: [00:02:05] You know, you and I both have that in common. Where we were not science majors. I, too, was an English major. What would you say to a person in college now about pursuing non-science majors and going into medicine?

Darcy Wooten: [00:02:17] If you're interested in helping people and you care deeply about a lot of these challenges that our society faces, that medicine is really a great field for you because there's so much opportunity. I had never considered medicine because I had a lot of self-doubt for people that maybe feel that same way, or that medicine is difficult, or they're not kind of a science type person, that you still can do it, and it's incredibly fulfilling.

Paul Sax: [00:02:47] Well, it also gives us a chance to hear people's stories, which is kind of what drew me to being an English major to begin with.

Darcy Wooten: [00:02:53] Absolutely.

Paul Sax: [00:02:54] So anyway, let's go to your piece. It starts out by quoting a romantic comedy, The One Love Actually, and then mentioning the airport in your title, Heathrow Airport. So why is that?

Darcy Wooten: [00:03:07] Whenever I watch the movie Love Actually, I always feel incredibly happy and probably more importantly, sort of filled with hope at the end. Um, and for people who haven't seen the movie, as you can imagine, it's a movie about love stories and happiness. But there's also a lot of heartbreak and a lot of sorrow and challenges. And despite those things, I still really enjoy the movie and always feel hopeful. And so I started with the quote from Love Actually, because I wanted my essay to kind of do that, to sort of be this feel good rom com piece for our fields, that even though we have a lot of challenges, which I see as opportunities that we're facing in ID, especially with respect to the workforce, that there still are a lot of really wonderful, amazing things that are going on and wanted to kind of focus on that.

Paul Sax: [00:03:58] But what about the arrival gate at the airport?

Darcy Wooten: [00:04:02] That just really reflects perspective and how you can look at things in different ways. You can see the positive and or you can choose to see the negative, and that's a really core piece in terms of what I was trying to do with the piece, of seeing people engaging with one another and having these connections. And that's an analogy for connections that we have with patients that we have with each other and our colleagues in the field and society as a whole.

Paul Sax: [00:04:31] Yeah, it is amazing when you know, airports are in some ways such miserable places. But there is always that moment when you get off the flight and you're walking out and then you see the families, the loved ones waiting for their family members to arrive. It can be quite moving. Then you mentioned in your piece you mentioned, some anxiety you had felt at that, you know, and when you were kind of awaiting the results of this year's ID match. So what was going on in your head at the time and why?

Darcy Wooten: [00:04:59] Yeah, probably all program directors get very anxious the night before match day, and maybe even more so than applicants. Our program, unfortunately, had not filled the year before and so. This year in particular, I was probably more anxious than usual because I was worried that our program was not going to fill. And I absolutely love recruitment season. I love talking to applicants and kind of hearing about their passions, as they're sort of embarking at the very beginning of their careers and ID and honestly, I would love for everybody to be able to come and train with us at UCSD. I'm always so inspired after recruitment season, but sometimes when you know you want something so badly and then things don't turn out the way that you want or the way that you expected, it can be a bit of a blow. I had taken our year when we hadn't matched a bit personally and felt a little bit responsible, and so I was even more anxious than usual for this current match.

Paul Sax: [00:05:56] A recruitment is very much almost like dating season. [laughs]

Darcy Wooten: [00:06:02] [laughs] Absolutely.

Paul Sax: [00:06:03] Of course we're going to feel rejected by people who choose to go elsewhere, even if there's totally good reasons for doing so. Anyway. It's inevitable, but it is. It is very interesting to look at the match results. And I now known you for a few years, and I know you are a glass half full person. I'm also a glass half full person, but how do you look at the data and not come away feeling a little bit discouraged? So what's your interpretation of the data?

Darcy Wooten: [00:06:34] I'm probably more of a middle of the road type of person on this, and I am usually a glass half full, but some days I am a glass half empty. So I want to be full disclosure there, but there are a lot of positive things that we're seeing in some of these numbers. The number of people applying to ID, for example, is more than it was ten years ago. Five years ago even. We have more training programs, more spots available than we ever have had in the history of our specialty. At the same time, you know, the numbers did go down. The numbers are the numbers. We had about 350 people apply last year. 300 people applied. This year is that a trend? Is that a blip? Hard to say, but what I would argue is sort of the most pressing issue to me is that we have a mismatch in our supply and demand. From what I see in clinical practice and the investigative spaces and physician scientist pathway, we need more people. We need more people to be ID physicians. We need more ID physician scientists. This is what leads to, you know, a lot of angst around this issue is that there is a need, and we need to recruit people to fill that need for the public health.

Paul Sax: [00:07:47] This brings us back to the main theme of your piece, which is how to communicate your passion for ID to our potential trainees. So how would you summarize that core message?

Darcy Wooten: [00:07:58] The core message, it's interesting because it's so simple. It's difficult to articulate. It's hard to put into words. And the reality regarding the ID workforce issue is we do need this multifaceted approach to address all of these things. One component of that is connection. Connecting with trainees on a personal level, on even an emotional level about why we chose to go into ID, why we stay here, why we love this field, and why they should consider this for a career choice. For me, it was really the opportunity to have a meaningful way to address health disparities and really work against injustice. And I think this is something that resonates with people that are going into medicine, millennials, Gen Z, the up-and-coming generation. We need to communicate that passion. And what I like about this is that anybody can do this. I don't have the knowledge base, or the skill set to understand how and why we should adjust, you know, physician compensation and loan reimbursement and things like that for ID physicians. But everybody can talk about why they love ID, why they went into it, and hopefully have that influence on the people with whom they're working, the trainees. It's sort of a grassroots approach.

Paul Sax: [00:09:16] When someone says to you, you know, I graduated from medical school with, you know, gazillion dollars of debt. You know, I could just go right from my residency program to a hospitalist position that pays as much, if not more than an ID position. And I don't have to go through another 2 to 4 years of fellowship before doing that. What do you say to them?

Darcy Wooten: [00:09:37] I say those are absolutely legitimate concerns and points. Those are things that we definitely need to keep addressing. IDSA is doing a ton of work in this area, and change does take time, but there's a lot of really good work that's being done. IDSA was just in DC talking to lawmakers about the Bio Preparedness Pilot, the Pasteur Act, all of these things. We are going to see change. But at the end of the day, you can sort of we have we have a choice. So you can choose to kind of believe that the sky is falling and that there's not a great or bright future for our field. Or you can choose to see it differently and kind of come together and keep going and keep fighting for something that you believe in and that you think is important, not just to those of us in the field, but, you know, for society as a whole, as we have the very real experience with Covid. But there's nothing that I can say, people that argue with all of that debt and going into a field that doesn't compensate what I think is fairly at this stage yet, it's a very real concern.

Paul Sax: [00:10:42] Yeah, I mean, those are real concerns. I one approach I take is I tell them that, you know, I've never been bored for a single day in, in ID, clinical practice, clinical research, clinical teaching. It's really interesting I know that sounds like too much glass half full, because obviously there are boring things about being a doctor in any field. But the actual material is so fascinating. Endlessly so. Anyway, I try to convey that so as someone who doesn't like being bored, I say choose a field that's not boring, because it really isn't. It is, you know, even the really the trauma of Covid 19 was interesting, you know, the most fascinating way, scientifically discovering a whole new virus and the immune response to it and therapeutics and watching now how it's changed. It's still interesting. Anyway, I don't have to convince you. [laughs]

Darcy Wooten: [00:11:35] I agree with you. And I think the fact that it's never boring, you never have a day that's the same. And also just the meaning, I think the meaning that we get from our work, it's so rewarding. And I tried to convey that in my piece in terms of, you know, even if it's something so little, but it means so much to a patient that you really feel like you're doing something that matters. And I think, yes, money is important, and having a career that's meaningful is also important.

Paul Sax: [00:12:03] That's right, that's right. You know, one thing that I've actually said to my brother, who's a wonderful guy but works in finance, is I've never had to sort of wonder for, you know, why I'm doing what I'm doing, you know, because of the meaning that you just mentioned Darcy. All right. So now, um, I'm going to ask you, when did you decide to write this piece and have you written before? Do you have other aspirations as a writer?

Darcy Wooten: [00:12:27] Well, despite being an English major, I haven't really written much. And so I feel very much in uncharted territory. There was a great session at IDWeek on narrative writing and medicine that was really wonderful, and I always am really moved by a lot of the story type pieces that are published in various journals. And so I was so happy to see that CID included this Voices of ID section, which is I love reading those pieces. And so this was again, sort of something that I felt that I could contribute. I could put my thoughts and, and my story out there in a way that hopefully was productive and could potentially speak to people thinking about going into ID and those leaders and mentors who are working with people who might go into ID as maybe one more tool in the toolkit that could be helpful addressing this workforce issue.

Paul Sax: [00:13:21] Well you did a great job and the feedback has been outstanding. So thank you. So ready for some quick questions?

Darcy Wooten: [00:13:27] I'm ready for them.

Paul Sax: [00:13:29] Okay. So what would you have done if you hadn't chosen ID as a career?

Darcy Wooten: [00:13:32] So I would have been an English teacher with a part-time gig as a dog walker and dog caretaker. [laughs]

Paul Sax: [00:13:40] [laughs] Ok, that's good. And what is your dog's name?

Darcy Wooten: [00:13:44] My dog's name is Bourbon. He's a Aussie doodle. An Australian shepherd Poodle mix. Should be very, very intelligent. But he is not. But so lovable. So it all works out.

Paul Sax: [00:13:55] And what do you do in your free time? As if you have so much free time?

Darcy Wooten: [00:14:00] I love spending time with my five-year-old daughter, Maya. The imagination of five-year-olds could solve the energy crisis. So we do things that she imagines and thinks of and a lot of make believe in unicorns. And it's wonderful.

Paul Sax: [00:14:14] So now tell us something surprising about you that's not on your CV?

Darcy Wooten: [00:14:20] So growing up, I competed in artistic figure skating. Not on ice though, which probably most people are familiar with. But on roller skates this was remember like 80s 90s when roller skating was really big. And so we do all of the same moves and tricks that they do on ice. We just do it on four wheels, which I think is harder. There's more friction.

Paul Sax: [00:14:39] And are you still a roller skater? [laughs]

Darcy Wooten: [00:14:41] Uh, no. [laughs] I gave I gave that up when I went to college. It was either a career in roller skating or get a college degree. So I went with the latter.

Paul Sax: [00:14:50] And the last question is, what was a typical day for you, like when you were ten years old?

Darcy Wooten: [00:14:54] I think I probably peaked when I was ten, so this is a great question. But I would go to school, I had skating practice, I would roam around the neighborhood on my scooter, soccer practice, and I loved putting on plays and productions with my neighborhood friends.

Paul Sax: [00:15:11] Alright, Darcy. Any final thoughts for our listeners?

Darcy Wooten: [00:15:13] Just think about your "why." For those of us in ID and kind of why you chose this field and why you're in this field, and then don't forget to communicate that to the people that you're working with. It can be hard when you're in a busy consult service or a busy clinic, and there are lots of things that might be negative or challenging, but remember to kind of highlight and emphasize those positive things and to communicate your "why." Because it's in there. And I think it can be very powerful in terms of influencing the next generation.

Paul Sax: [00:15:44] Well that's terrific. Thanks so much. Once again, I've been talking to Dr. Darcy Wooten. She's professor of medicine at UCSD and she is their ID fellowship program director. Thanks a lot, Darcy.

Darcy Wooten: [00:15:54] Thanks for having me.