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What happens to the mortality rates of cardiac arrest patients on days when there is a marathon happening in the city? What happens to surgical complication rates when it's the surgeon's birthday? Why do patients of younger doctors seem to have better health outcomes?
These and other quirky questions are what preoccupy health economist Anupam Jena, MD, PhD, a professor of healthcare policy at Harvard ľֱ School and a professor of medicine at Massachusetts General Hospital, host of the popular , podcast, and, together with Christopher Worsham, MD, co-author of the 2023 book .
Over the course of Jena's conversation with Henry Bair and Tyler Johnson, MD, they discuss the often-unintuitive role that random chance plays in our health outcomes, the hidden drivers of medical decision making, misconceptions about physician burnout, and more. Through tackling what can be amusing questions about why physicians and patients behave the way they do, Jena encourages us to reconsider our own ways of thinking and imagine how we can do better and be better.
In this episode, you will hear about:
- 2:18 The path that took Jena to the intersection of medicine and economics
- 8:54 How Jena discovers topics for research
- 12:12 Unexpected and important findings that Jena has learned over the course of his work
- 19:18 Jena's focus on "natural experiments"
- 22:02 Thinking about physician burnout from an economist's perspective
- 36:42 The mission Jena had when he set out to write Random Acts of Medicine
- 44:08 Jena's advice for medical trainees on how to understand the hidden forces of the medical system
The following is a partial transcript (note errors are possible):
Bair: Before we dive into your fascinating explorations of health and behavioral economics, can you tell us what brought you to medicine initially?
Jena: You know, when I was 2 years old, I knew I wanted to be a doctor. My mom was a doctor, and she ... she's still alive, but she's retired now. And my dad is a physicist, a university professor. And so I always had this interest in medicine and research, in part because of just who my parents were.
I had gone to study college at MIT and did econ and biology, and the only reason I did econ at that time, this is late 1990s, was I thought I should study a humanity to help me get into medical school. This was sort of my thinking back in the day. Turns out MIT econ is considered a humanity, even though it's far from it. But that's why. That's why I studied economics and I worked in the lab, though, doing basic science research in the summers and applied to MD/PhD programs.
This had been around 1999, thinking that I wanted to do an MD and a PhD in the basic sciences, and when I went to the University of Chicago for an interview, the director of the program at the time said, "Oh, I noticed you studied economics. We have a good economics department. Would you want to do your PhD in economics instead?" And I was like, wait, is this guy saying that I shouldn't do a PhD in immunology? What's he trying to suggest here? So I took him up on it. I tried it out, and I knew that if I couldn't do it or if I didn't like it, then I would have gone back to the path I had initially thought.
And so that's how I found myself in medicine and economics. It was a, you know, quite a bit by chance, just, you know, this person happened to suggest it to me. I happened to be of the mindset that I could try it out. It worked out well and the rest is history.
Bair: I personally haven't heard of an MD/PhD candidate doing their PhD in anything that is not like a laboratory science, personally.
Jena: They exist. They're not a lot, but they are out there.
Johnson: Yeah, so I have known a few. They are very rare. I've known a couple of people who've gotten a PhD in anthropology or related fields, or sometimes in other so-called softer sciences, but they are quite rare. So, can you walk us through then from that point forward, where did you go from there?
Jena: I finished in 2009 from the University of Chicago and then moved to Boston. I did internal medicine at Mass General Hospital. Why did I do internal medicine? Well, it's what everybody else had done. All the MD/PhDs who came before me, who were economists, I think almost all of them had studied internal medicine.
And even though I -- I like surgery -- I liked working with my hands. I thought to myself, you know, could I really be a surgeon working on totally random topics at the intersection of medicine and economics? And at that time I thought, no, that wasn't going to work. It might be a different story nowadays, but back then I said it wouldn't work. And so I went into internal medicine and I, you know, I had appreciation for it in medical school, but it's not necessarily what I would have picked otherwise.
Johnson: Also, with apologies to ophthalmology and all of those other lesser disciplines, it's also just the right answer. So, there's that.
Jena: True. That's true. Yeah. Exactly. That's exactly it.
Bair: Okay, okay, I get it. I've made the wrong career decision for life. I will regret it forever. But anyway, you finish internal medicine residency and then what happens next?
Jena: Well, it actually starts a little bit before that. So I was an intern and was thinking about what the job market would look like for me in a few years. And in economics, the job market is very different than what you see in medicine. The job market is that you finish your PhD, and in your last year of your PhD, you go in this very organized market, which is really strange. You send applications through this sort of common platform to all of these places, many universities, they decide whether to interview you.
And that first interview typically happens at the American Economic Association meetings. And it used to be the case that PhD students would go to hotel rooms, and a group of professors would be sitting in the hotel room doing an initial interview of somebody. So that's what the econ world looked like.
I didn't really know where I was going to go and what I was going to do, but it just so happened that in my intern year, the department where I am now, which I've been in since I finished residency, it's called healthcare policy, and it's at Harvard ľֱ School. They were looking to hire a junior faculty. They asked me to come out there and give a job talk. I gave a job talk, met with a lot of the faculty. They extended me an offer and decided to hold it until I finished my residency, which is about a year and a half, 2 years later.
So it was kind of an interesting feeling, being in residency, knowing where my first job would be right after I finished. So I didn't actually go on a formal job market. I didn't search around the country for different jobs. I didn't try to leverage one job offer against another. I just kind of stayed. And I've been at Harvard ever since.
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