Catching up with...Dr. Christopher Russell
- 1. You have been the recipient of numerous mentorship awards from fellows in the CHLA PHM Fellowship program. What is the secret to your success?
As mentors, it’s sometimes hard to balance being supportive with keeping the mentee accountable. I try to maintain accountability by setting realistic goals, helping the mentees overcome anticipated barriers, and readjusting as needed. The mentors also should be accountable—I try to always do what I say I am going to do and try to respond promptly to any questions or feedback requests. One of my friend’s mentors has a goal to respond to every mentee inquiry within 24 hours; while I’m not that efficient, I don’t want to be the roadblock in their progress.
2. In January 2013, you were one of 13 pediatricians nationwide chosen by the Academic Pediatric Association to participate in the prestigious Research Scholars Program, a faculty development program created to assist participants interested in preparing for a career in academic medical research. What advice do you have for fellows and junior attending who wish to become involved in research or build a research career?
My first piece of advice for becoming involved in or building a research career is: Start with your passion or with what frustrates you in your hospital and everyday work. For the first three years on staff (2010-2013), I had a primary clinical career. Much of my time was spent caring for children with tracheostomy tubes hospitalized for suspected bacterial respiratory tract infections. Given my desire to practice evidence-based medicine and my limited experience with this population, I did a literature search and found fewer than 10 articles. I became discouraged at the lack of clinical research surrounding the management of respiratory infections in pediatric patients with tracheostomy and saw that this led to variations in care, increased resource utilization and inconsistent care plans with each admission that frustrated families. This motivated me to start a series of projects to examine bacterial tracheostomy-associated infections in children.
After identifying possible areas of focus, identify local allies in your division and department who are invested in your career. Because PHM as a subspecialty is relatively young and because our scope of practice covers many organ systems, PHM research mentorship often comes from outside PHM divisions. If possible, align your research interests with larger hospital initiatives—it’s easier to get resources and buy-in if your efforts also positively affect hospital-wide efforts. Finally, take advantage of opportunities through national organizations, such as the AAP and APA, to get national mentorship. When I attended my first Pediatric Academic Societies in 2012, I participated in a Speed Mentoring event. In sixty minutes, I met with six preeminent pediatric researchers and learned of several programs, including the Research Scholars Program, for early career faculty interested in clinical research.
3. You are active in diversity and inclusion efforts locally and nationwide. Why is this topic important to you and how does being a pediatric hospitalist affect your goals and strategies for change?
As a mixed-race male raised by a single mother in Los Angeles, California, issues of race, ethnicity and class were pervasive throughout my childhood. Participation in diversity and inclusion efforts in college, medical school and residency supported my success, so I want to give back. The current landscape for underrepresented minorities in medicine concerns me. Despite the growth in the slots available in medical school classes, the absolute number of black men entering medical school is lower than the number entering medical school in the 1970s. In pediatrics, the current faculty numbers aren’t much better—with the most liberal assumptions, under-represented minority faculty make up 15% of all pediatric faculty. This amounts to 222 black and 239 Hispanic/Latino male faculty out of over 22,000 pediatric faculty at U.S. medical schools in 2017. We must do better, not only for ourselves but for the diverse patient population that we serve. As both African Americans and those from disadvantaged backgrounds are underrepresented in biomedical research and health-related science careers, as an underrepresented minority in medicine, I hope to become a role model to help these underrepresented groups interested in clinical research careers achieve success.
4. Congratulations on earning a Master’s of Science degree in Clinical, Biomedical and Translational Investigations at the University of Southern California. How do you plan to use this degree in your everyday practice?
Besides using the research methodology and statistical analysis tools that I learned in my own research, the master’s degree provided me with the tools to assess research rigorously and helped me to understand the implications of research findings. The training helps me to make informed decisions about potential interventions or therapies and to explain these decisions in a way that families can understand. Ultimately, it enhances my ability to help families participate in shared decision making.
5. In March 2014, you received a 3-year USC-SC CTSI KL2 Mentored Research Career Development Award, which offers research mentoring, career and professional development and funding to junior faculty. I think many of us dream about such an award and struggle with juggling clinical, personal and research obligations. What advice do you have for those looking into grants/funding and how do you balance your work and personal life?
I have to laugh—I’m not sure that some of my close friends and colleagues would agree that I have a good work-personal life balance. However, I have implemented a few key strategies to attempt to have some semblance of work-life integration. A research career is a marathon, not a sprint and you have to work a little every day. Unlike clinical work, when you are off when your service week ends, there is always another paper or grant that could use some work. While I accept that there will be times that I might work at night or on weekends, I am firm about protecting my personal time outside of business hours.
One concrete thing that I did to protect my personal time was to set limits on work email. Outside of business hours, I try to not check or respond to work emails. I check my work email once each weekend day and only respond to very urgent emails. This sets an expectation that I am not available at all hours. When my profile changed to 75% research, I took my work email off my iPhone, which forces me to take extra steps to check my email.
6. You published “Care of Children with Medical Complexity in the Hospital Setting” in 2014 in Pediatric Annals (2014 Jul 1; 43(7):e157-e162). In it, you mention that complexity is increasing and discuss the importance of shared care plans and intense medication reconciliation. In terms of pediatric complex care, where do you think the research/performance is currently lacking and what opportunities for research do you see in the future?
I think an opportunity to impact children with medical complexity (CMC) is to continue exploring the family and caregiver experience for CMC. Taking care of CMC at home often exerts a physical, emotional and financial toll on families and other caregivers. For example, in the greater Los Angeles area, we are suffering from a tremendous shortage of home nurses, particularly for those on public insurance and those who are non-English speaking. Therefore, families and other caregivers become de-facto nurses, managing >10 medications and multiple technologies. Clearly this role impacts both the primary caregiver’s life and that of the entire family. I am reminded of a recent history and physical that I completed for a child supported by tracheostomy, home mechanical ventilation, gastrostomy tube and numerous medications. I asked his mom and primary caretaker, “When’s the last time you slept for more than 2 or 3 hours in a row?” She replied, “Over two years.” Like other medical providers, primary caregivers are at risk for burnout and medical errors. How can we better support families who already sacrifice so much?
As hospitalists, we often focus on traditional outcomes, such as discharge, length of stay, and readmission rates. Hospitalists need to balance decreasing inpatient and emergency room utilization without increasing the caregiver burden at home. Maybe keeping the patient one more day might alleviate a lot of family stress. However, the current financial pressures for both Medicaid and private insurance may make such decisions impossible. How do we design innovative payor models and advocate for higher—and more appropriate—reimbursement for both inpatient and outpatient providers of children with medical complexity, so that they can spend the time necessary to provide the care necessary to help this population maximize their health.
7. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
In research, there is a lot of rejection. Manuscripts will get rejected multiple times. Grants will not be funded. Despite your carefully crafted writing, reviewers will miss information. Rather than dismissing or diminishing feedback, embrace all manuscript and grant feedback as an opportunity to improve your work. Learn to depersonalize the process and celebrate the successes that come, even if they are far between.