Jean Junior AB '09 MD '16

How did you find your path to medicine?

I chose to do medicine because I thought it would be the best way for me to make a positive impact on the world and try to do my part to make the world a better place. I majored in sociology and did City Step as an undergrad, so I wasn’t really the traditional pre med student, at least when I was going through undergrad. I really gave serious thought to not doing medicine, because there are just so many ways to address poverty, inequality, and injustice, and all of these issues that I care so much about. In the end, in reflecting a lot on the different options (even making a concrete list of different job options and really analyzing it), I thought that medicine would be the best choice for me. 

I could have an impact on the individual patients that I hopefully helped and make a broader public health policy impact as well. What really keeps me going in terms of doing medicine is that very same motivation I started off entering the field with: just trying to make people’s lives better. There are a whole lot of problems in the world I can’t solve, but I can often solve the problem of at least a few patients in front of me during my shift in the ED, where I’m currently a fellow in pediatric emergency medicine at Boston Children’s. 

I have a strong interest in global health, poverty alleviation work, and policy efforts to address political inequality. For example, I try to register patients to vote in healthcare settings. It’s nice being almost at the end of my training and seeing how you can use a medical degree to do all sorts of things, from on the ground work to helping individual patients and more structural policy work. 

How do you deal with the struggle that structural inequities are often big and difficult to resolve?

I get very specific and concrete. For me, the way to try to maximize impact is to work in a setting that has the greatest need for pediatricians. When I finished residency, I spent a year working on the Pine Ridge Reservation in Pine Ridge, South Dakota, with the Indian Health Service. There was just a need for a pediatrician there, so I felt that was a way to try to maximize my impact. This was a major reason I decided to do my fellowship in pediatric emergency medicine, even if it would add three additional years to my training, which is not trivial at this stage when you’ve already finished residency. I really wanted to hone my critical care skills, acute care skills, so I could care for the most seriously ill and injured kids then. 

With this fellowship experience, I could be in a better position to competently deliver care in the US and other resource care settings where there’s not a pediatric ICU doctor or pediatric anesthesiologist right there. In a place like Pine Ridge Reservation, the closest PICU is hours away so you have to figure out a way to deal with the kid in front of you. Having these critical care skills is a benefit because, in care settings lacking resources, which are often abroad, there’s just no one to back you up sometimes. It’s a very difficult thing when you feel like you weren’t able to do all that you could for a patient for any reason, so having that extra skill set was crucial for me to commit to this fellowship. 

The other aspect of my career is working on making structural changes. This is just as important, and I like to say that if I could wave a magic wand and completely resolve poverty, injustice, political disenfranchisement, and all these other huge structural determinants of health, but the tradeoff is that I would never be able to practice medicine another day in my life or touch another patient, I would choose that in a heartbeat and leave medicine behind forever. But I can’t do that, at least at this point. 

That being said, there are many, many ways to have a structural impact as a doctor. As you get out of training status, you have more control over your time. You can have political influence, and if you don’t directly, there is a way to at least contribute by registering people to vote and trying to get out the vote. The American Academy of Pediatrics has a campaign that they do every election to help pediatricians encourage patients to register. There’s a growing body of research that indicates voting is correlated with greater political representation and policies to promote public health, alleviate poverty, and result in better health outcomes for children of underserved populations. Even if this is just correlation so far, it is evidence.

Another way you can influence the structural determinants of health is trying to really make an influence in the marketplace of ideas. Be someone who is doing research on the association between a structural determinant of health and health outcomes, writing these articles and trying to become a public intellectual who nudges the discourse in a direction of policy solutions that we know work. There was a policy report back in 2016 when I was a medical school student, and it was just this blueprint where, if you copied and pasted this blueprint from the Children’s Defense Fund or from the National Academies of Sciences into a bill, you would have cut child poverty in half. It would not take any new programs or major innovations, but it was just about the choice to devote money into it. And it’s just sitting out there, waiting, to be implemented and help bring huge cost savings in the long term, too. It drives me absolutely nuts! The evidence is there, but it’s just the will we need to nudge the public discourse more in the direction of interventions that we know work. Too often, the discourse is dominated by commentaries that don’t mention these fixes at all or they are lost in the shuffle of things entirely. 

For myself, I’ve worked on research projects that are in line with my own interests to solve these questions. For example, my pediatric emergency medicine fellowship project was on the association between state level tax policy and infant mortality rates. It’s not something your typical fellow does like doing research on pneumonia or something like that, but if you can make an argument for why you are researching this topic, you can generally make it work. 

The number of ways you can make a difference are certainly endless — you can become a state or city public health official — so when you’re trying to change the rules of the game, in addition to giving donations, there is always something you can do to make concrete change. 

How has concentrating in sociology had an impact on your career in medicine?

Sociology has had a huge influence on my career. I absolutely loved sociology, even though I didn’t know what it was before I came to college. I actually took my first sociology class based on the past course ratings that were amazing, and the rest is history. That course really opened my eyes to structural inequalities in the world, and between that and getting involved in the global health community at Harvard College and reading books like Pathologies of Power by Paul Farmer, I really saw medicine as a means to an end of addressing human suffering and inequality. I have found that’s what actually made me happier throughout my experience in training. 

Becoming a doctor is not for the faint of heart. It is hard, and there are lots of challenges and demoralizing days. If I were just doing medicine for status or reputation or financial reasons, I would find it a lot more difficult to sustain myself. But because I have this goal that’s bigger than myself and the practice of medicine, there’s this light that guides me forward as my true North. I know that if, tomorrow, for some reason I could not practice medicine anymore, I can still work on pursuing that larger goal; it’s just that medicine at this point is the most expeditious route that I can think of to get there. 

Doing global health work also makes you really thankful for all that we have in the US. I remember volunteering as a second year resident in Liberia, and there were just so many babies who died because of a lack of resources. I came back to finish out my second and third year of residency, and it made all these tough rotations seem not so bad because I knew how much worse it could be. There are people all over the world who are doing 24 hour calls every three or four days indefinitely for the rest of their lives. I feel so lucky to be in a place where we have an easier time, and with that luck comes great responsibility to give back and lighten the load where there just aren’t as many doctors available. 

Why did you choose to specialize in pediatrics?

When I finished my rotations during my initial clinical year in medical school, it became crystal clear to me that pediatrics was the right field. One big reason was that there is very strong evidence that intervening earlier in a patients’ lives to try to disrupt social or health makes a much bigger impact on their life than intervening at a later time point. Interventions targeted at young children also tend to be more cost effective because, if successful, their whole life is on a different trajectory than if they went the other way. At the end, if you let the problems balloon, you have a fifty-seven-year-old who is found down in the park with an alcohol use disorder and uncontrolled diabetes and a history of trauma. 

Also, pediatricians tend to be nicer! It was a huge incentive for me because liking the people you work with is great. I really felt like I could gel with my co-workers. I also really appreciate that the American Academy of Pediatrics is much more advocacy focused on behalf of their patients than other medical associations, often in part because their patients are children who don’t necessarily have their own political voice. I love the variety of what I see in pediatrics emergency medicine in particular — everything from primary care problems to kids having a heart attack or stroke. 

I see the wide range of pathophysiology that I could see with adult patients, but then they are cute, funny kids who brighten my day. You really see the outcome of your work not just for the child, but for the broader set of people (the family) who care about this person. Of course, that also makes bad outcomes more difficult, but in general the hope is you have more positives than negatives. 

What is your biggest piece of advice for our community of students and learners of all ages?

The biggest thing that has influenced my life and career is really just finding my why. Once you know your “why,” and it has to be very specific to the core thing that motivates you to be successful, you can build a life’s work around it. Decisions don’t necessarily become easy, but they can become easier. There often are many ways to achieve your goal, and if you don’t like the way you’re using at this point, you can choose another. Once you find that underlying why, then, the rest can a bit more easily fall into place. 

Jean Junior

AB Sociology | 2009 

MD | 2016 

Interviewed and compiled by Felicia Ho