President's Podcast: ID/EIS Joint Fellowship

Carlos del Rio: [00:00:00] Hello and welcome to the Let's Talk ID podcast. I am Dr. Carlos Del Rio, the President of IDSA. And joining me today to discuss the ID/EIS joint fellowship are two guests, Dr. Molly Paras, program director of the Massachusetts General Hospital, Brigham and Women's Hospital Infectious Disease Fellowship, and Dr. Eric Pevzner, the Chief of the Epidemiology and Laboratory Workforce Branch in the Division of Workforce Development at CDC. Welcome, Molly. Welcome, Eric. Delighted to have you here. You know, at the recent CROI meeting, CDC Director Rochelle Walensky mentioned this program during her remarks at the Young Investigators Workshop. And many people asked me after that what this program was all about. So I'm really excited that we're going to be talking about it during this podcast because I think we need a little more people to hear what this fellowship is about. So, Molly. Why don't we start with you? This is going to be the first year of the joint ID fellowship program. What was the genesis of this program?

Molly Paras: [00:00:52] I will just start by saying how absolutely excited we are about the possibility of having this program launched this year. I'm sure Dr. Pevzner will have further comments as well about the genesis, but I think there's long been a need to increase the pipeline of people who are interested in infectious disease as a career with those interested in public health. And because of that need and that desire to make this a streamlined path, I think that has significantly led to the development of this program, which we are really excited to launch this year.

Carlos del Rio: [00:01:22] So, Eric, you know, why don't we step back a little bit and you tell us first what is EIS? You know, many of us, I know what EIS does, but a lot of people don't know what EIS is. So tell us about what EIS and why does making a joint fellowship actually make sense?

Eric Pevzner: [00:01:37] Sure. So yeah, it's the Epidemic Intelligence Service, it was a program established in 1951. It was an alternative for service in the military, and it was attracting at that time exclusively physicians to come in and learn to be disease detectives out of concerns of biological warfare, threats against the United States and the program evolved over time. Now we have physicians and all sorts of doctoral level scientists, nurses and veterinarians who come into the program. And it's really been an essential pathway at CDC to attract physicians to come to CDC and gain two years of training in applied epidemiology. So we bring in really exceptional clinicians and they get that two years where they get some didactic training in applied epidemiology. But one of the strengths of the program is they're working with alumni either at positions at CDC or state or local public health departments side by side over two years, and going out and doing field investigations, dealing with really complex and messy and challenging data sets where they're having to analyze and interpret data and then try and make something positive happen as a result of collecting that information. We call that the practice of consequential epidemiology. And so many of the physicians and other graduates that come from EIS have gone on to really important leadership positions at CDC, including CDC Director or going on to positions like state epidemiologist with state or local public health departments. So it's really been an important pathway for attracting clinicians and other exceptional people into public health.

Carlos del Rio: [00:03:18] You know, it's interesting the history of EIS. As you mentioned, it was started in 1951 by Dr. Langmuir. Dr. Alexander Langmuir started this as an early warning system against biological warfare, right? I mean, it really was a this idea that we needed to have this disease detection capabilities and we need to have the ability to to do this. And, you know, I mean, you're absolutely right. Some amazing work has come out of EIS. We all have great anecdotes. I will share one of of mine. At the beginning of the HIV epidemic, we didn't know it was the HIV epidemic, but a good friend that had just started EIS, Martha Rogers, sent me a postcard and she was very excited that she had just been assigned to go investigate this outbreak of pneumonia among gay men. And she said in her postcard, I wish I had saved it. She said, I don't think this is going to amount to much, but it's still very exciting to be out there investigating it. It's just amazing what EIS has has done. And you know, to me, for example, the most recent investigation of the Burkholderia outbreak, you know, related to the, the aromatherapy, you know, oil from I mean, it's just fascinating what EIS is able to do.

Eric Pevzner: [00:04:24] Yeah. I mean I think that's one of the exceptional things about the program is that we're really lucky because of the legacy of the program, we're able to attract exceptional people and then those exceptional people get placed in exceptional challenges and situations like some of what you just described, and then they take on that experience and that service that they provided and then go on to pass that on as supervisors for the next generation of EIS officers. And so that legacy just builds on itself.

Carlos del Rio: [00:04:51] So, Molly, you know, as you know and as you all know, many of us in IDSA are focused on on future workforce needs. How will this joint fellowship address existing health care workforce needs and how do we see this helping the ID workforce?

Molly Paras: [00:05:04] Because it establishes a clear pathway to be able to take the ID training and then expand that to the public health space for anyone who might be considering public health as a career. It sort of opens up this new opportunity to think about combining the two. And because it is so well defined, I think that may actually excite people who had perhaps considered public health, maybe not considered completing fellowship as well, but as was just highlighted by a few of these examples. ID and public health work really do go hand in hand. And so making that a much more crystal clear path I think will help, Also will encourage those, who maybe are not yet to the level of fellowship, who are still in undergraduate work or in medical school to consider infectious disease as a career path. You know, they may have interest in public health work related to academic projects. They do either in their university studies or medical school. But then having that partnership with ID again shows them those career paths that might be available to them. I think it was important what was highlighted this past year when the Consolidated Appropriations Act was approved, you know, for 2023, it really highlighted some public health priorities, antimicrobial resistance, pandemic preparedness and things like that, showcasing that ID and public health go hand in hand along with these needs that are facing our current country is really important and I do think will excite people about the possibility of this pathway.

Carlos del Rio: [00:06:28] Yes, you know, it's interesting for myself being here at Emory, you know, right next to the CDC, we also have for convenience, I think, a lot long tradition of many people who start eyes and then decide to take two years to do an ID fellowship after they've done this. And an example of that is part of my fellowship class when I was an ID fellow, was a person that had just finished, which was Ken Castro, who then went on to be the director of the TB program at CDC. But the opposite, right? There's people here. Many people come here for ID fellowship at Emory and then go on to EIS after their fellowship. And an example of that in my own residency class was Bob Pinner, who then went on to be a very important figure also within CDC. So we have had here at Emory a very fluid connection, but it's still not a collaboration, right? It's still not that smooth transition, that program that that actually brings those two together. It's something that they have to do as two separate applications. So, Molly, tell us a little bit more about that.

Molly Paras: [00:07:26] Think you highlight a really nice point there. You know, you at Emory are positioned right next to the CDC and think that this program really offers up opportunities to fellowship programs around the country that maybe haven't always had such a tight, close connection with their local public health departments, their state or the CDC itself. And so that's the other thing that this program brings, is expanding those opportunities outside the new institutions as well.

Carlos del Rio: [00:07:53] Absolutely. So, Eric, give me an overview of the program. Tell us who's eligible. And in broad terms, how is it structured?

Eric Pevzner: [00:07:59] There's two different sets of eligibility criteria. So there's the criteria that you need to be able to apply to ID fellowships. And then there's also the criteria that you need to be eligible for the program and for the program. As a clinician, you have to be have an active license to practice medicine in the United States, and that can make you eligible as a physician to apply to EIS. And our applications are opening March 1st, so we're right around the corner to start this process. And so the way it's going to work is that people will go ahead that are interested in this joint IDSA AIS Fellowship. We have it advertised on both of our websites. We've been doing a lot of social media to try and increase awareness about this great opportunity. And starting March 1st for this first cohort, people can go ahead and apply to EIS and we're going to go ahead through our normal application review process. And after we've selected our candidates, people that are applying as they're going through the process will indicate if they are interested in the joint program and we'll look and see how many of those people that indicated their interest in the joint program get accepted to EIS and we will pass that list on to IDSA and then they'll go ahead and look at of those that said they're interested in this joint program, how many people get selected and placed with one of the 11 ID fellowship programs that are participating in this pilot. One of the things I think that's really important that Molly was just mentioning is we were really careful in selecting these 11 first pilot ID fellowships to participate. And we selected, you know, larger and smaller programs. We wanted to have good geographic representation. And we also wanted to see programs that already or had plans for these relationships with state and local public health departments, because, again, we all see the value of strengthening the public health and infectious disease workforce. So this is something we're really working on together.

Carlos del Rio: [00:09:51] I think many people don't know this, Eric, but if you can talk more about the numbers and other things, I mean, I know because I'm here again, some EIS officers. Our place here on CDC, but some of them are placed in states, right. And they work at local health departments. So approximately how many go out to. So you can be an officer and be assigned to Alaska or be assigned to California, right? Absolutely.

Eric Pevzner: [00:10:10] So each year we have anywhere between 60 and 90 officers per class based on the funds that we receive from Congress. And within each class, at least a third, about about a third are placed outside of CDC, at state or local public health departments or at some of our CDC's regional locations. Like we have offices in San Juan, Puerto Rico, Fort Collins, Colorado, Anchorage, Alaska. So again, you'll have the majority of positions that will be at our CDC headquarters in Atlanta, but about a third are out in the field that are at our state and local public health departments or CDC regional facilities.

Carlos del Rio: [00:10:49] So, Eric, since you're talking about this, you talk about people that are going to be applying and being accepted without revealing all the details. What is who is the ideal applicant and what exactly is CDC looking for as you think about accepting people into EIS?

Eric Pevzner: [00:11:03] So all these people that are applying are already highly accomplished. Almost all of them have you have to have a doctoral degree to be eligible unless you're a nurse. The nurses often have many other degrees or have a doctoral degree in nursing. So you have highly accomplished people to begin with. What we're looking for to help distinguish our people that, number one, have a service orientation. That's really important to us. The second thing is we're looking for people that can articulate to us why is is important in their career pathway and that they have an understanding of the program that they've taken the time to either attend the conference, which is free to attend, and this year will be April 24th to 27th in Atlanta. And there's a virtual viewing options as well. When you attend the conference, that's where the officers are presenting their work. And it's a great place to really see in detail the work that officers get to do. So you can say, Yeah, that's really the type of work that I want to be doing. Those are two really key things is that service orientation and being able to articulate how the training fits into your career plans and objectives.

Carlos del Rio: [00:12:08] You know, one of the other things that I find interesting and I frequently have to answer this question and Molly, maybe both of you could talk about I frequently when I have people that are applying for EIS, especially after they've done residency or fellowship, they always say, Well, you know, I worry that I'm going to lose my clinical skills. And and yet I said, No, you know, you're not going to lose them. And, and yeah, maybe you take a hiatus from clinical work during this time, but you'll come back if you can. And many people that work at CDC, in fact, also do have a clinical appointments and see patients. So how do you respond when people come with that concern?

Molly Paras: [00:12:39] From my perspective, people are coming through fellowship and are extremely well trained in their clinical world, and a hiatus may be what happens during their training, but that doesn't mean it's a permanent abandonment of those clinical skills and clinical training. We have a good number of physicians in our own faculty here who perhaps didn't go through the path but are strongly engaged with our State Department, our city local health department, who also maintain clinics as well and attend inpatient consult services. So just because you've made the decision to proceed with, you know, a more public health route doesn't mean that it closes that clinical door.

Carlos del Rio: [00:13:17] How about you, Eric? What do you think?

Eric Pevzner: [00:13:19] Before I was in the position I'm in now, I used to be an EIS supervisor working on global tuberculosis. And when I'd have physicians that I was responsible for supervising, I always encouraged them to maintain some clinical work during because we do allow a limited amount of clinical work because I, I thought it was important that they maintain those skills and it added to the value of the EPI training that they were getting. So oftentimes in TB, our officers would work at the local county TB clinic so they could maintain that experience. And and Ken Castro, who you mentioned, was my boss at that time, it was very supportive of that. So during EIS, there is some opportunity for limited clinical work for the clinicians to to keep those skills up.

Carlos del Rio: [00:14:02] Yeah, absolutely. And but I think people frequently don't think about. So I'm glad. I'm glad you brought it up. I think this is incredibly exciting and it's it's a fascinating time. I also worry that CDC and public health has taken quite a beating right now. Right. So we we need to work together to reinvigorate and really talk about the excitement and the enormous service that one does in this program. And I think it's a service to to the community, but it's also an incredible service to the nation that the EIS officers do When you're encouraging, when you're talking to people about doing this, what kind of things do you tell them?

Molly Paras: [00:14:35] Molly If I'm talking with someone who is considering a career in public health, I certainly do highlight that this is an opportunity for them to really get some hands on, you know, fantastic training with a Department of the US government that really touches so many different aspects across the nation and can provide so many different opportunities to apply their epidemiology training in the real world setting and learn how that. This sector of the government works network with people who are doing work in this space and really, you know, consider it a potential career path. Some people consider it for more short term, but the majority of people who are considering, you know, training and public health work really are committed to it for a lifetime. I really encourage them to explore on the website the CDC has for like, what does this job actually look like and training provides you and how is it going to get you to the next level of your career that you're interested in? And so bottom line is, how is this going to advance you in your career? And if it seems like that it will do that, then I encourage them to strongly consider it.

Carlos del Rio: [00:15:36] Yeah. Eric, tell us a little bit about what the experience has been about how competitive the program is and whether it's worth people applying or what are the chances of getting in and what the process is like.

Eric Pevzner: [00:15:47] It is a highly competitive program. The first step of the process is, like I said on March 1st, our application cycle for this upcoming year is opening and you submit an online application that also requires that you submit some standardized letters of reference. And once that application comes to us, we have a team of scientists here at CDC that have all gone through extensive training to promote diversity, equity, inclusion and accessibility. So they've all gone through a special unconscious bias training so that we can be as fair and standardized in our review of our applications. And we do a first cut there where we go ahead and select a group of people that will then be invited to the next stage to come in for interviews. Then people come in for our interviews and for our interviews. Again, we have standardized questions, and everybody that's participating in those interviews from our side have also gone through another workshop that addresses unconscious bias and making sure that we're aware of anything that could be contribute to the introduction of bias or any discrimination in our processes, where, again, we're trying to really promote DIA and everything that we're doing. So they've gone through that workshop and people come in and they're going through standardized interview, and then there's also a writing assessment. And then we take the scores from the interviews and from the online application, and that's what we use to rank people and accept them into the program. And we have anywhere from 500 to over 300 applications every year. And again, our class size is from 60 to 90. So based on a number of applications on any given year and the funds we had to bring in officers, it remains a highly competitive process.

Carlos del Rio: [00:17:31] Yeah. And after that, you also have sort of a mini match, right, where people rank what programs they want to be part of, and then the programs rank who they want to choose. So there's internally also a sort of a mini match to try to allocate because let's, let's suppose I might train, I may want to be in the diarrheal disease division, but maybe the people in chronic diseases are really interested in me. So there's also an internal sort of match between the programs and the accepted candidates, right?

Eric Pevzner: [00:17:56] That's absolutely right. So after you're accepted in the program, you have a spot in the program. Now, your actual assignment where you spend your two years, there's two parts to it. There's first, which is what we call our pre match, which is shortly after getting accepted into the program, we offer this to everyone that's been accepted and the top tier of the waitlist and we offer positions that sometimes are hard to fill because they might be geographically less desirable or they are a position at CDC that does not always appear as exciting because it might not be an infectious disease position. It might be something in an area that's non-infectious that sometimes is harder to fill because there's not as many outbreak investigation opportunities. So we'll offer those hard to fill positions for the pre match and you can go ahead and interview for those and be selected for that. And that's a first group that then they know their positions for the next two years. The majority of the class comes to the conference in April or May each year. And at that conference you have a regular scientific conference going on where all the officers are presenting. But then there's that other part, Carlos, that you're referring to. It's the real chaos of the conference where you have anywhere from 60 to 100 positions that are recruiting. They're either from CDC and or state or local public health departments, and they're courting the incoming officers all week. And then coming officers are spending their time. Go ahead and meeting with all these people, trying to determine which position might be the best fit for them. And then at the end of the week, everyone has to sign up for between 6 to 10 interviews and the incoming officers go through those interviews and then they'll go ahead and rank the positions they interviewed for and the positions will go ahead and score the officers. And then we have an algorithm that matches everyone to try and give everyone their highest rank as possible. And that's how people end up with their assignments. Yeah, So.

Carlos del Rio: [00:19:45] So no different than a fellowship match, I guess, except a little more chaotic. You do all your interviews in 1 in 1 very short period, right? Somali Any final thoughts? I mean, what kind of jobs would somebody who does this program would you expect them to be able to? Apply to or have after. What is this additional skill giving people?

Molly Paras: [00:20:02] I would think you could take the skill set learned during your combination of fellowship and training to a wide variety of careers, including work with public health departments either at the national or local level and everywhere in between. I would also see that this could kick start an academic career for people who want to pursue physician scientist work and research in the public health sector. I think it would really give people those strong tools to be able to do that. And quite frankly, everything in between from more clinical work all the way to the physician scientist path. And I think the networking opportunities, training opportunities that come from both fellowship and the training will really set people for success in whatever their career path ends up looking like. Yeah.

Carlos del Rio: [00:20:45] What do you think, Eric?

Eric Pevzner: [00:20:46] Like Molly said, I mean, we, you know, we bring in these exceptional people now and now we have people coming from another exceptional training with the training. Then they come and add on top of it. So these are really special people and they get the great experience over those two years and they are in such high demand for positions at CDC, state and local public health departments. Many of them go on to positions at the World Health Organization with PAHO. Some of them will go over to USAID. Some of them get taken up by pharma academic medicine, and then some will just return back to they realize, hey, this was a great experience, but I really miss the clinical work and they'll go back to clinical work full time, but they've got that added level of perspective and experience now that even many who return to clinical medicine then come back to public health later and they kind of yo yo back and forth. So we're lucky that we're able to attract these great people into this this dual program that we're putting together. And it's amazing to see what they accomplish and the positions that they go on to after training and is.

Carlos del Rio: [00:21:47] Yeah, no, I think it's an exciting marriage of two fantastic trainings. You know, the training in clinical medicine and research that we do in clinical ID and the training in public health and epidemiology, and that is provides and hands on opportunities. And this is just an incredible opportunity to really a synergy that I think is going to be fantastic. So any parting words, any last thoughts, Molly?

Molly Paras: [00:22:10] I'll just remind people that if there are more questions, you know, definitely check out the website has a whole page dedicated to the joint program, which contains a lot of really good information. And so if people have questions about eligibility, the application timeline, this is the first recruitment season. The team is gearing up for applications to open March 1st for fellowships who are in the pilot program this upcoming summer recruitment season will kick start our piece to this as well. And so I think we're really excited to get the pilot program up and running and go from there.

Carlos del Rio: [00:22:43] How about you, Eric? Final thoughts?

Eric Pevzner: [00:22:45] Yeah, one other synergy that I failed to mention I think that's really important is with the way we have the program structured, that you'll start your fellowship first and then during your first year of your fellowship, you come to the conference and that's where you'll find what program you'll match to. Now you still have to go back and finish your second year of fellowship before you come to us, but it creates a great opportunity. So, for example, if you find out that you're matching with the domestic HIV program at CDC, you've got that second year of your fellowship that you can start with research where you can begin potentially collaborating with your group at CDC on HIV related research to really get into some really in depth and great work that can be of benefit to your academic institution and to CDC to further strengthen that collaboration and that partnership between CDC, state and local public health departments and the academic institutions. So that's another part that we're really excited that we think is really helping with strengthening the public health workforce and that connection between infectious disease training and public health.

Carlos del Rio: [00:23:49] No, that's great. You know, you just reminded me of an example of my own I had many years ago a CDC grant called Artists and Artists then led to an intervention that we use to link people to careers as CDC. You know, evaluated and validated intervention. But we were doing the artist study. I had an ID fellow that was working with me, an artist. His name was Wayne Duffus, and I talked to the people in the HIV prevention at the CDC. And I said, You know, Wayne is doing some analysis of some data from artists. Could he be inside CDC? Could you guys give him a little space within the division of HIV Prevention so he can actually do the analysis there and be part of CDC as the data is coming? Because he's not only using the data from my side, but is using the data from all the different sites. And they said, sure. And Wayne published some very nice papers. But then he went on to do this and stayed at CDC. But I mean, that initial connection that started his fellowship really sparked his interest. And, you know, Wayne Straining was an MD PhD. He had no idea that he wanted to go into public health, But it was that ability during his fellowship year to interact with with with the people at CDC that really changed his career trajectory and had them then, you know, go into is. So yeah, the opportunity of doing that during the second year I think is really fantastic. So I want to thank both of you. I think this is a great opportunity for for our trainees. And this is something that we need to let people know. And it's very excited. And I look forward and a couple of years looking at the evaluation and seeing what what the outcomes are of this program and hopefully the pilot of 11 academic institutions, academic programs and ID will, you know, if that's successful and we have the funds, maybe expand it to have more sites included. 

Eric Pevzner: [00:25:22] That's our hope. And also I should say that as a result of this collaboration, so many other residency training programs have reached out to us and they want the same thing. So Pedes want something, emergency medicine wants something. And so we're telling everybody, you know, let's wait and see the data from this. But we're very excited. And it's just generated some jealousy and interest from a lot of other programs. So we're super excited about this based on all the success that we've had with so many years with having physicians come through is we think that having this known for your pathway with this linkage early, for this opportunity, for greater collaboration is just something that's going to be so helpful. And like you said, you know, Carlos, you've dealt with and Molly mentioned so many people that come in and they struggle, which should I do first? And this just helps establish that pathway for people that's going to make we know people are so excited about this, so we can't wait to to share the data with you.

Carlos del Rio: [00:26:15] Incredible. And I really thank you both and thank CDC and thank IDSA for putting this together, because this is this is wonderful. Thank you so much.