Eva Aagaard, MD is the Carol B. and Jerome T. Loeb Professor of Medical Education, Senior Associate Dean and Associate Vice Chancellor for Medical Education and Professor of Medicine at Washington University. She serves in national leadership positions with the American Board of Internal Medicine, National Board of Medical Examiners and the Society of General Internal Medicine. She recently spearheaded the Gateway Curriculum renewal effort and has a history of excellence in medical education.
Alyssa Self: How did you choose your specialty?
Eva Aagaard: I went to medical school as a first-generation college student on my mom’s side, so my conception of a doctor was a family practice doctor. I went to Cornell for medical school and they did not have a department of family medicine. I was particularly drawn to Internal Medicine and Obstetrics and Gynecology (OBGYN). I loved delivering babies! Didn’t love the OR that much, and ended up having the OBGYN residents talk me out of doing it. That’s how I chose internal medicine. I really never thought of specializing because I love the generality of internal medicine, both in-patient and out-patient. I like the relationships of primary care and the ability to see somebody’s course of life, and disease and health over a long period of time gives me a huge amount of satisfaction. I have taken care of multiple generations of family members, especially females. I have always been interested in women’s health, that has been a focus for me.
Self: What were some pivotal moments that made a big difference in your journey?
Aagaard: The journey is about doing what you love. The first pivotal moment in my career was when I was a second-year resident and a chief resident told me that I did not get picked to be chief resident, and I was number seven (University of San Francisco [UCSF] had six chiefs at the time). This was a very shocking conversation because I never thought I would be in consideration. That was an interesting experience for me … the recommendation she made for me was to decide what I wanted to do to pursue my passion for teaching. She suggested I meet with people; this was horrifying as I am a natural introvert, it is hard for me to randomly meet with people, I had never had a mentor in my career! I ended up meeting with about 40 different people, and that process culminated in my pursuing a general medicine research fellowship focused on medical education. My career mentor was not there when I made that decision, but came shortly thereafter. Dr. David Irby taught me a ton about research, education, leadership. So that was a pivotal time for me.
Another pivotal time in my career was when I chose to leave academic medicine. I was an APD, young faculty, very happy at my job, but I was pregnant with my second child and we were taking care of my father-in-law who was battling lung cancer, I was commuting 3 hours at times, and I could not do it anymore. It was clear that my son was starting to manifest behaviors that many years later were found to be consistent with Asperger’s. Everybody told me that once you leave, you can never come back. And now we can say, that is a total fallacy! Eventually, 3 years later I came back to UCSF after my husband decided to become a stay-at-home dad. And that is a common theme in families who have a special-needs child. At that time, we decided that he would be the person who would be the home manager.
Then the next pivotal time was when I moved to University of Colorado (UC), difficult decision, again driven by personal circumstances. It was financially very hard to make ends meet. I was recruited as Vice Chair of Education and it was an interesting time for me as I had just finished treatment for my breast cancer. I was bald! It was hard because I had had a lot of support back at UCSF with my cancer diagnosis. It brought home to me the challenges of trying to manage family, home, money and work. I ended up applying and, for the benefits to my family, I made that decision to move. Great decision, because at that institution I had a lot of opportunities to do things, but since I was the most experienced person in education I did not have a lot of mentorship, and that really helped build my career as I got to do a lot of things on my own. Finally, for the first time ever, I made a move for my personal career growth where I wanted to unite that passion for underserved care with that for education and moved to Washington University.
Self: You alluded to this already. What brings you joy?
Aagaard: Patient care gives me a lot of joy. I really enjoy in-patient medicine for the team aspect of it, and primary care medicine for the personal relationships with patients. That is one thing that has changed since I have come here because I don’t have my own clinic, and it feels like a little bit of a loss. Teaching in the clinical setting brings me a lot of joy, that has always been my favorite form of teaching! I dislike lectures! I get asked to do that a lot now, but for me it is clinical medicine, clinical medicine, clinical medicine, then small group teaching or any kind of faculty development. That interaction piece gives me a lot of joy!
I like changing systems, thinking about how you can use curriculum and systems to make important changes in how we train future physicians. The power of education is in creating an army of people who can go on and do good. Through education, you have the power to transform the future. And while you can do that individually as a teacher, through changing a system of education, through the multiplier effect, you can affect thousands of people! And right now, the thing that gives me the most joy is mentoring other people, supporting other people, being a sponsor to other people.
Self: Have you ever said ‘no’ to opportunities and why?
Aagaard: Yes. A lot of things, now. It is a new skill I have learned! Throughout my career, I have had to say no to a lot of jobs, opportunities within a job … I have said ‘no, that is not a good way for me to focus my time.’ All through your career, you will have to choose between things that bring you joy and those that do not bring you joy. But early in your career, it is hard to know what those things are. I’ll give you an example of something I said ‘yes’ to. I became chief of medicine at UC for a little while. There were a lot of problems! Duty-hours, well-being, toxic environment issues. That was really painful, but I learned so much about health systems. I only took the job because the chair told me to take it. But it ended up creating such an opportunity for me, I did not enjoy the work, but I learned so much that it is an opportunity I am thankful for.
I have said ‘no’ to a variety of job transitions that I did not feel would fulfill my personal goals. Now I say no to a lot of things on the national level that I don’t think are in the direction of my personal missions.
Self: That is a hard skill to develop, as a young female, to learn to say ‘no.’
Aagaard: At the start, there is value in saying ‘yes’ to many things. But if saying ‘yes’ prohibits you from completing what you are agreeing to, now you’ve got a problem. If you are failing to meet your deadlines or your promises, you are getting burned out, now you have really sabotaged your career. So now you have to pay attention to how much you are doing. That usually requires a mentor. You need to know what you can’t say ‘no’ to. Sometimes you don’t know where an opportunity is going to lead. A mentor can see the consequences of these decisions. A mentor will sometimes be the one to say “that will be a time suck! That will sink you”. That is where mentors are super helpful.
Self: Have you ever felt burned out?
Aagaard: Yes, of course! To be truly honest, I am not always the best person to recognize it in myself. The person who recognizes it best is my husband. He is a really good mirror for me, and he has done a really good job at pointing out behaviors I start to manifest when I am getting burned out. I become closed off, literally just sitting in front of the TV, binge-watching without being disturbed for 4 or 5 hours. That is both a recovery mechanism but also a warning sign that I need to shift what I am doing a little bit. When I do that, I start delegating responsibility.
The time I felt most stuck was when I was working at Kaiser. I loved my clinical work but my husband said “I know you think you have lots of time off, but it takes you 2 days to recover. You are not present, so you actually do not have that much time off.” I pride myself on being present and when I could not do that, that made me realize how burned out I had been, and I took action to change and make a move to academic medicine.
Self: That is great that you could recognize it and make changes to correct that.
Aagaard: When you are early in your career, as a resident it is hard, you have very little control over your life! That is one of the hardest parts of residency. But as a faculty member, what people tend to forget is that they actually have a lot of control. There are trade-offs in your control. Time, money, the work you can do, you usually have power over these choices. That is where my husband has been a mentor to me! There are opportunities to do the things you love. We often get locked into a pattern of thinking there is only one way. That is hardly ever the case, especially as physicians, we have a remarkable amount of ability to change what we do.
Self: If you could give one piece of advice to young female physicians, what would it be?
Aagaard: Make sure you take the time to engage in reflection about what gives you joy. And make sure that as you have the ability to make more and more choices in your career, you choose progressively those things that give you joy.
Don’t forget that you are powerful, you can make a lot of choices. And a choice you make once is not the choice you need to make the rest of your life. It is a long life and a long career.
Self: Finally, what makes you most proud of yourself?
Aagaard: I think it’s my kids. They are not perfect, by any means, but I feel I have really good relationships with my children. Despite the fact that for the majority of their lives, I have been the primary worker. We have open, honest and trusting relationships. I attribute this to advice a pediatrician gave me once. She told me “what your kids remember is whether, when you were present, you gave them undivided attention, not how much time you were there, but the quality of the time when you were there.” I have found that to be true. Both of my kids have said that to me independently.
Dr. Alyssa Self is a chief resident in the Internal Medicine Residency. She will be moving to University of California – San Diego this summer to pursue a pulmonary and critical care fellowship.