Specialty Profiles

Preventive medicine at the state level: Shadowing Dr. Braund

As a medical student, do you ever wonder what it’s like to specialize in preventive medicine? Meet Wendy E. Braund, MD, MPH, the state health officer for Wyoming and a featured physician in the AMA Wire® “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out her insights to help determine whether a career in preventive medicine might be a good fit for you, and compare her responses with those of two other physicians in this specialty, Daniel Blumenthal, MD, and Robert Carr, MD, MPH.

“Shadowing” Dr. Braund

Specialty: General preventive medicine and public health

Practice setting: State health department

Employment type: Government

Years in practice: 10

A typical day and week in my practice: My days are highly variable and often depend on both the time of year—for example, during legislative session—and emerging public health issues. Typically, I’m in the office Monday through Friday for 10-plus hours per day, but because of the nature of my job, I’m always on call to respond to a public health emergency.

As the state health officer for Wyoming, I have broad jurisdiction over public health events that occur in Wyoming. We get a surprising number of inquiries from residents looking for answers on things covered within the public health statute, from


rodent infestations in empty lots to ownership rights on common graves. My staff and I also respond to any public health emergencies that arise, such as communicable disease outbreaks, floods and fires.

The most challenging and rewarding aspects of caring for preventive medicine patients: Everyone in Wyoming is my patient, which poses some unique challenges and opportunities. Lack of funding and inability to hire staff with formal public health training and expertise are chronic issues. Many of the public health problems we are addressing have long-term outcomes, so determining appropriate proxy measures to determine the impact of our programs and initiatives in the short term is challenging but necessary.

It is a tremendous privilege to be the state health officer and to have the opportunity to set the public health agenda for the state. Everyone within this enterprise knows they are working for the public good, which is very rewarding, especially when we see people getting healthier and living longer, better lives because of it.

Three adjectives to describe the typical preventive medicine specialist: Dedicated, resourceful and data-driven.

How my lifestyle matches, or differs from, what I had envisioned in medical school: Like most medical students, I envisioned a life of seeing individual patients, but now populations are my patients. I do much more administrative work than I envisioned, but like many other specialists, I’m on call.

Skills every physician in training should have for preventive medicine but won’t be tested for on the board exam: Leadership, systems thinking and financial management. Also, if you’re going to practice governmental public health, you absolutely have to be politically savvy, because getting things accomplished, particularly from the legislative perspective, requires navigating the system. You have to be able to put public health issues in terms that are understandable to decision-makers and also know which battles to choose and how to frame them.

One question physicians in training should ask themselves before pursuing this specialty: Are you OK with not seeing patients on a regular basis?

Books every medical student in preventive medicine should be reading: Anything by Abraham Verghese, MD, and Oliver Sacks, MD, as well as A Chancellor's Tale: Transforming Academic Medicine, by Ralph Snyderman, MD.

The online resource students interested in my specialty should follow: The Community Guide.

Quick insights I would give students who are considering preventive medicine: Do a rotation in preventive medicine. Also, talk with preventive medicine doctors in multiple settings. Preventive medicine physicians have very broad skill sets—including clinical preventive medicine, occupational medicine, health policy, health systems and health administration—and there is huge variability in their practices, from public health to academic medicine to clinical preventive and lifestyle medicine.

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