Voices that Transform: Stefanie Brown, MD, Med-Peds
Dr. Stefanie Brown is a board certified internist and pediatrician (Med-Peds) and has spent her career as a clinician educator and lifelong learner. She practices Internal Medicine and Pediatrics in hospital and ambulatory settings for the University of Miami in Florida. She is Associate Professor of Medicine and Pediatrics at the University of Miami Miller School of Medicine and the Internal Medicine Residency Program Director at the University of Miami/Jackson Health System program and the Med-Peds Division Chief. She is also a member of ABIM’s Internal Medicine Board.
How did you become interested in Med-Peds?
When I went into medical school, I wanted to do family medicine. Those of you who are from my generation or a little bit older probably remember the TV show “Marcus Welby, M.D.” Well, he was one of my early role models for a physician. I wanted to see the whole family so I thought family medicine was the way to do it. But during my first internal medicine clerkship, I worked with an intern who was doing Med-Peds and I realized that I had more than one option for residency if I wanted to see both adults and children. Once I started talking to other Med-Peds residents and to the program director, I realized that they were my people. They had the same values, same ideas about what physicians should be and that was it—I had found my home. Med-Peds is about wanting to take care of whole families together—being interested in the medicine, as well as the psychosocial aspect of health care.
What are some of the challenges of being in that field?
I think some of the challenges come with us being a bit unique. So, things like which department do you belong to—Internal Medicine or Pediatrics—differs from program to program and from institution to institution. I think we always add value to both sides of the coin and we bring a different skill set from each side of our patient care. I think we also add real value when it comes to transitioning children with chronic illnesses from their pediatrician to the physician who will take care of them as an adult.
How does your work as a pediatrician make you practice differently as an internist?
The pediatric model of care is very highly focused not only on the child, but also on the home environment. We ask questions like: What’s going on at home? How many people live there? Do you eat dinner as a family and when? Just thinking about questions like those helps us to see the whole patient. I’m including those types of questions in my internal medicine side, and as an internist it helps me to focus not only on the patient, but on their whole environment. I think that strong pediatric focus on family-based care has made me practice differently.
The other thing is that I will often take care of entire families. I’m not just taking care of the internal medicine patient, but I may also be taking care of their children or their grandchildren. It’s allowed for family visits where the whole family comes together and everyone is seen at the same time. And there are discussions about health behaviors that happen for the entire family and that can be extremely beneficial.
As the Internal Medicine Program Director, how do you work to make your program more inclusive?
As a program director, there are several simple things that we do for inclusion. We have something called “holidays schedule” where everyone can get four days off around a holiday. Traditionally those holidays had been Christmas and New Year’s. We expanded that so people can request those days around any holiday—it could be the end of Ramadan or Lunar New Year…whatever our residents celebrate. Things like that show you are aware of different needs and are willing to accommodate them.
You’re in Florida, a state that is politically charged and not known for being very open to equity issues. Does this make it difficult to recruit and retain residents?
Florida is a challenge. I think when it comes to recruitment, some people are turned off by the politics of the state and they choose to go elsewhere. So, for recruitment, it can be a negative. But our program is very progressive and focused on providing unique opportunities for our residents. Miami is a vibrant city with a diverse population and that provides great opportunities to learn in an urban setting.
How do you overcome some of the strong politics of Florida and incorporate things like gender-affirming care into your program?
I think learning about gender-affirming care is really important. And including it in the the curriculum to make sure that our residents understand that there are special challenges in any marginalized population is important. We start with the patient. We make sure that we ask people their preferred pronouns and that’s included in the medical record demographics so that when the patient comes in you can refer to them in the way they want. I think it’s important that we do have some clinical practices that provide gender-affirming care to the community that needs it. As a physician, it’s first “do no harm” and that includes psychologic harm. Making sure that you are open and inclusive with patients and that there’s an understanding that you are going to treat them with compassion for whatever they come to you with is important. And we teach that to our residents.
You encourage residents to participate in curriculum development. Can you explain what that looks like?
There’s a very strong focus now within medical training on early career development. Part of that includes ensuring that people have access to the opportunities that they want or need with regards to curriculum. We have a two-week elective where a resident can work with faculty to create something new for the program. A health care administration pathway came out of an elective that was created by one of our residents and is now a pathway for people who are interested in pursuing health care administration. That resident is now Associate Chief Medical Officer for Ambulatory Care and currently running that pathway.
Two of our residents who are interested in humanities wanted a creative outlet to reflect on medical practice and created an elective with the Lowe Art Museum, which is part of the University of Miami. We’re working with professors in the humanities and arts departments to provide creative outlets for our physicians. It will run next year as a medical humanities elective for residents who are interested in medical writing or art that represents medicine. We have mentors in the program who are musicians, artists and performers and they help residents reflect on medicine through any humanities-based media. These types of electives help foster the development of the whole person and allow for creative outlets that minimize feelings of burnout. That, in turn, makes them a better doctor.
Can you talk about your urban health program and how it works?
The urban health track prepares physicians to work in urban health communities within the United States, which are primarily the underserved who are uninsured or underinsured. It includes rotating with psychology and psychiatry to learn about cognitive behavior therapy and counseling people with mental illness, and teaches physicians to initiate their own mental health care when feeling burned out. They work within our HIV primary care practice so they can learn about prescribing medications for initial diagnosis of HIV. To learn about harm-reduction, they work in our needle exchange van and our street medicine program, which provides primary care to people experiencing homelessness.
Why did you decide to join ABIM Governance and why is it important for you to maintain certification?
I started thinking about trust and then trust in medicine and the system during COVID. When the ABIM opening popped up, I thought about it as a way to contribute to helping to build trust in physicians once again. I really like administrative roles and I thought this would be the perfect opportunity for me to blend my interest in generating trust in physicians as well as administration. I thought it would be a great opportunity for me to bring a little bit of my pediatric side to the board as well.
I think it’s very easy for all of us as physicians to just put our heads down, do our work on a day to day basis and just take care of our patients. But medicine changes rapidly. Everyone needs motivation and maintenance of certification is one of those motivators. It helps to remind you that you need to always be learning. Part of being a physician is lifelong learning.
