Why economics is the best pre-med major [PODCAST]

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“Economics taught me that I didn’t have to culture cells in a dish to do interesting and life-changing work. I built a habit of being inquisitive and intellectually curious about the world around me because I learned in undergrad that our human, flawed world contains elegant experiments, puzzling oddities, and fertile ground for inquiry. That profound change in mindset is the most important lesson I could have learned from my undergraduate major, and I’ll always be a grateful ex-economist.”

Dan Donoho is a pediatric neurosurgeon and can be reached on Twitter @ddonoho.

He shares his story and discusses the KevinMD article, “An ode to econ: the best major for a would-be MD.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Daniel Donoho. He is a pediatric neurosurgeon, and he wrote the KevinMD article “An ode to econ: the best major for a would-be MD.” Daniel, welcome to the show.

Dan Donoho: Thanks so much, Kevin. I’m excited to be here and grateful to talk to you today from Washington, D.C.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Dan Donoho: Sure, as I think it’s a little bit relevant to my perspective. So I started off as an economics major in college, more because I was interested in model building and testing hypotheses and less because I was sure that it was going to be useful for me as a future physician. But I fell in love with the coursework and found that, actually, as my route back into medicine, I started working on answering public health questions while pursuing my other daytime career as a competitive athlete in rowing.

When that didn’t go as far as I had hoped, I then turned back into medicine, leaned into that with the skills that I developed, and went to medical school. I pursued a neurosurgical training program at the University of Southern California and a pediatric fellowship at Texas Children’s, and now I’m on the faculty at George Washington University in the Children’s National Hospital, Washington, D.C.

Kevin Pho: So we’ll get into your economics background in a little bit when you talk about your article, but I’m interested in just hearing more of the day-to-day life of a pediatric neurosurgeon. So tell me some of the challenges you face as a pediatric neurosurgeon.

Dan Donoho: I think the core challenges are twofold. There’s a technical challenge and a human challenge. The technical challenge is that we see a very wide variety of pathology. Anything that could possibly go wrong, and many things that have never been discovered or dreamt of, can occur in a child, and all of the pathology we’re dealing with is a life-threatening, life-altering disease. There’s no minor surgery. There’s no minor condition that we deal with, and we’re responsible for anywhere there’s a nerve, so that’s from your head to your toes and everywhere in between.

The personal challenge, though: It’s a field where oftentimes the people you’re interacting with are having the worst day of their life. I sometimes think, as I see the therapy dogs walking through the hallway, that we’re the exact opposite. Whenever a therapy dog walks in the room, that’s a phenomenal and positive experience, and the tendency, the possibility, is that if I walk in the room, that’s the worst news that anyone can receive, from the most minor, “You had a traumatic brain injury, but there’s no bleeding, ma’am, so it’s OK to take your daughter home,” to the most severe, life-threatening diseases. And how do you combat that? How do you join with your patients in their experiences? Those are things that I think about a lot, and I think those are our two main sets of challenges.

Kevin Pho: Now, for those medical students who may be listening to this podcast, what would you say is the number one attribute they should have to draw them to pediatric neurosurgery?

Dan Donoho: So it’s the culmination of a neurosurgical training program, so the first gateway is: Do you want to be a neurosurgeon? Are you someone who’s incredibly curious and inquisitive about diseases of the central nervous system, and do you like having your day’s work measured by doing something for a person? If you like those two things, there’s no more fulfilling field.

Then, once you’ve decided to enter that gateway, the next step to pediatric neurosurgery is complicated, and everyone approaches it for their own reasons. But things you might think about are: How much do I enjoy spending time with a particular group of people? How much am I OK tackling this challenge of managing really dizzying and different pathology, versus how much do I want to hone in on one particular disease and become a master of that particular condition or that particular treatment? And those are typically the folks who find a lot of meaning. Typically they’ll refer to pediatric neurosurgery as a calling, and those folks will often find a lot of enjoyment in our field.

Kevin Pho: All right, let’s transition now into the KevinMD article that you wrote, and like you mentioned, it’s “An ode to econ: the best major for a would-be MD.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to write it?

Dan Donoho: Yeah, so this article was born out of a lot of interactions that I’ve had with medical professionals, probably similar to the audience for your site: folks who are interacting or maybe thinking about larger aspects in their clinical practice, or maybe they’ve come into contact with a part of the medical system that seems frustrating or confusing or difficult for them to understand, why a person is behaving in a certain way. And I think that the systematic study of incentives, and fundamentally human behavior, which is how I view it, is a phenomenal lens through which to view some of these challenging and often upsetting facets that we come into contact with.

I view this both from a coursework standpoint but really from a practical skill standpoint, of what you might learn by studying economics, and this is something you could do throughout your entire life as a physician. I think it’s a little bit distinct from perspectives such as how do I invest, and maybe a little bit distinct from the more general study of perception or of cognition, and maybe it’s a little bit more focused on trying to understand why people do the things they do. And I found that very satisfying.

Kevin Pho: So can you share a story or give an example of how your economics background has influenced your day-to-day life as a physician?

Dan Donoho: Yeah, I think the systematic thinking about incentives kind of changes your entire approach to everything in medicine. For example, one of the things we’re thinking about is implementing a new technology for diagnosis that requires an interaction with the radiology department. Or, to use another example, my wife, who’s a phenomenal neonatologist, is trying to get providers from other fields to help her further her goals of performing a particular kind of diagnostic.

When you go into these meetings, or when you try to make changes, or when you try to understand why things are, you have to take the perspective of: What are the constraints and systems that other folks are operating in? What will they gain? What will they lose? What are their costs from action and inaction? What are the cognitive biases they may have? What are the larger systems and market forces that may either be on your side or may be allied against you?

So for me, in developing this particular kind of diagnostic test and hoping to roll it out throughout the hospital, this is something that we’re facing every single time we go to a meeting or meet with a different subspecialist: How can we make this something that they want? How can we understand their incentives for their behavior, understand their views, their emotional and philosophical thoughts as well as their financial perspectives, and get them to become our allies?

Kevin Pho: Now, as you were progressing through your medical training, medical school, residency, and fellowship, I’m going to safely assume that a relative minority has your economics background. Tell me how you’re able to contribute to the discussion from an economics perspective as you’re progressing through medical training.

Dan Donoho: Yeah, I think that many physicians, especially as we progress in our careers to more senior levels of training and certainly into independent practice, will find that many events will happen to us that we don’t entirely understand. It could be a business decision by a hospital administrator to expand or contract a particular service. It could be a patient decision for why they come or why they don’t come to see you in clinic. And those are all fundamentally, often, economic decisions, meaning not just financial but motivated by human incentives.

So from an economic standpoint, I think as a trainee you’re one step ahead. You’re already thinking about these as incentive problems. You’re formulating them and framing them in a way that you can generate hypotheses, test them, and maybe even come up with solutions.

Kevin Pho: Now, as you were going through your economics training in undergraduate studies, did a lot of your colleagues then also do premedical work?

Dan Donoho: I don’t know. I’m sure there was another person in our cohort, but I don’t think that there was. I was really lucky because the professor for one of my senior classes is a health economist, and so I was sort of set up. Although none of the work I did as an undergraduate had anything to do with health care, I was sort of primed in some basic way to think that there could be such a thing as somebody who uses economic knowledge to understand health on a population or individual level.

So it’s pretty rare, and I would like to think that maybe it could be more common, because it complements the medical school skill set, and it’s a skill, or a method of analysis, that’s really rarely taught in medical schools.

Kevin Pho: Well, I completely agree with everything that you say. I think that more physicians need that background in economics. So what would you say are some of the obstacles that prevent medical students from pursuing an economics major?

Dan Donoho: Yeah, so from maybe economics thinking, you might ask, “Well, maybe the incentives aren’t aligned very well.” Maybe the fact that they are required to take a series of classes, and they’re more likely to become friends with other folks in those classes or have advisors from those specialties, will funnel them into more classic STEM fields, and that’s all. But they might not even think to take an economics class because it’s not put in front of them, and they’re not rewarded on its face for taking those courses.

The other thing is, I think sometimes people develop a certain belief about the subject matter: “Oh, I would never be interested in fiscal policy,” or “Oh, I’d never be interested in trade or industrial organization.” And I guess the thing that I would want to drive home to the listeners is that those are really examples, but not the method itself. And maybe it’s useful to have skills that are a little bit orthogonal to where you are. To have something that’s a little bit different often is a positive, especially in our increasingly competitive world.

Kevin Pho: Did you ever get asked, as you were applying to medical school, why you chose economics as a major?

Dan Donoho: Yeah, it was really puzzling to people. Actually, sometimes folks would think of it as a negative: “Why aren’t you a biology major? Why didn’t you take more of this or that or the other thing?” But I think that there’s rigor there, especially in the approaches that I enjoy in terms of analytic methods. It’s where I learned the most basic computer programming. It’s where I learned statistical analysis, and really find it.

And I think that if you can frame it in that way, it’s a phenomenal tool for answering the problems that we have, and you can explain it to interviewers very clearly: “I’m interested in health, but I’m interested in people, not cells.”

Kevin Pho: We’re talking to Daniel Donoho. He’s a pediatric neurosurgeon, and he wrote the KevinMD article “An ode to econ: the best major for a would-be MD.” Now, for those premedical students who may be interested in pursuing economics as a major, what kind of advice do you have for them?

Dan Donoho: Go for it. Find applications that are relevant to your areas of interest or your passions. Find natural experiments in the world that are compelling to you, and don’t see the field as limited to those who want to make a lot, because that actually has nothing to do with the field whatsoever. It’s not a training ground for investment bankers. It’s a training ground for people who want to think rigorously about human problems using quantitative methods. So find ways that you can take things from this field into medicine, and I think you’ll be well ahead of the curve.

Kevin Pho: And from a course standpoint, how challenging was it for you to pursue an economics major as a premedical student?

Dan Donoho: I think at most undergraduate institutions it’s quite possible to take the premedical courses separately and still complete a standard degree in the standard time. But I’ll be honest with you, I didn’t complete my premedical courses entirely in undergraduate. I took one or two afterwards, because I loved this and I loved what I was doing, and I wanted to follow the courses that I thought were important to me.

And I think that’s the message I would really give to the undergrads, which is: Don’t worry about completing the premed prerequisites or not completing the premed prerequisites. These are your four years, and own it. Do things that you might not ever think about or study again. Encounter diverse perspectives, not just on-paper diversity, which is good, but also very profound intellectual diversity and life-experience diversity, and seek those out really aggressively. Because the time is finite, and you can always go back to take classes afterwards at really little or no penalty, but you’ll never have access to the institution and to your peers and to this variety of experiences.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Dan Donoho: Yeah, my take-home message is that economics is a way to think about people, and problems that people have or challenges that people encounter, in a rigorous and quantitative way. It’s a phenomenal tool that more physicians can use to answer and understand situations where they may feel stymied or frustrated by the behavior of another. It’s something that’s available to all of us, whether we’re students in an undergraduate institution or lifelong learners, and I encourage all of you to walk this path with me. And I’m happy to always correspond with anyone who has further questions.

Kevin Pho: Yeah, thank you so much for sharing your time and insight, and thanks again for being on the show.

Dan Donoho: Awesome, thanks, Kevin.

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