Family Practitioner, Author, Advocate: An Interview with Dr. Alexa Mieses

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Interview with Dr. Alexa Mieses, family medicine resident, mentor & writer [Show Summary]

Do you want to be a clinician? Are you concerned about your ability to gain acceptance to med school? Listen in to today’s interview with the author of The Heartbeat of Success: A Med Student’s Guide to Med School Admissions, Dr. Alexa Mieses.

The journey of a family practitioner, author, advocate [Show Notes]

Our guest today is Dr. Alexa Mieses, who has an MD and MPH and in her own words, “strives to have influence beyond the confines of the examination room.” She is a resident physician in the Department of Community and Family Medicine at Duke University Medical Center. In addition to providing clinical care to marginalized patient populations, Dr. Mieses’ interests include population health, increasing diversity in the physician workforce, mentoring premedical students, writing, and research.”

Dr. Mieses graduated from CUNY magna cum laude in 2011. She then studied for her MD/MPH at Icahn School of Medicine at Mount Sinai from 2012 to 2016 and graduated with distinction in Research and Excellence in Family Medicine. She has been a Family Medicine Resident at Duke University since 2016 and has earned the Harvey Estes, MD Memorial Award for Leadership and Advocacy.

Can you tell us about your background outside of medicine? Where you grew up? What do you like to do for fun? [2:45]

I am a native New Yorker. I grew up in NYC in Queens and had a very interesting childhood. I am bi-racial – my dad is from the Dominican Republic and my mom is American of Italian/Irish descent, so I grew up in a very ethnically diverse family and neighborhood, which shaped who I am and what I have done in my career. I have been a writer since childhood and have incorporated that into my career and leisure time. I really enjoy spending time with friends and family, and I am a mom of three pets – two cats and a dog.

How did you know you wanted to be a doctor? [3:57]

I really feel like medicine is my calling, and it’s something I’ve thought about since I was a kid. I was first interested in science when I was 3 or 4 and told my parents that I wanted to be a marine biologist. I was a big nerd and loved watching National Geographic specials, and I would read encyclopedias. I was always fascinated by life science. My mom actually got me interested in medicine – not because she is a doctor, and in fact neither one of my parents went to college. My mom had diabetes, but I remember helping her check her blood sugar and going with her to her doctor and seeing the positive relationship she had with her doctor and wanting to have that same positive impact on someone’s life.

What was the hardest part of the med school application process for you? [5:26]

I remember that it was a marathon and not a sprint. In hindsight I feel like I lived, breathed, and slept my dream of becoming a physician, which meant I was very intentional about what I did. For example, I was accepted to both a science high school and a performing arts high school. I probably would have been fine going to either, but at the time it felt do or die, and so I chose the science high school. As another example, in my first and second years of college I was working fulltime in addition to going to school fulltime so I had to make serious decisions about the type of job I took that would allow me enough time to study. So it was all about being really thoughtful and intentional about things. Every decision you make has the ability to make your path easier or more challenging. I would never want to go through the agony of being an applicant again, though the good news is it gets easier each step along the way. Being a premed student is by far the hardest.

You took a gap year between undergrad and med school. What did you do and are you happy you did it? [9:00]

I knew early on that clinical medicine alone would not allow me to have the kind of impact I wanted to have on my community. I was also considering having research be a large part of my career and being a physician scientist, but in undergrad I didn’t have sufficient time to really figure out if research was for me. I wanted to do fulltime research to figure that out so I pursued a postbac fellowship at the National Institute of Health. I spent a year in Baltimore looking at drug addiction from both a behavioral and genetic standpoint, and realized biomedical research was not for me, which was really valuable to know.

What did you like best about your medical school experience at Icahn School of Medicine at Mt. Sinai? [10:47]

One of my priorities was to stay in New York. It was important to train in the community I grew up in. What really appealed to me, though, was that much in the same way I crafted my own path in college, Mt. Sinai asked students to create their own path. There we talked about being an MD+. Our primary responsibility is to learn and graduate from medical school, of course, but we are encouraged and sometimes required to do things outside of the traditional curriculum. I was able to get my MPH and MD together in four years, which allowed me to get training outside of clinical medicine which has been really rewarding for me. I was involved in many activities including writing, research, and volunteering at a clinic. I was involved in a number of community initiatives – mentoring in the diversity office, teaching junior high students about anatomy of the heart, and mentoring other premed students which spawned my book. I had been writing for WebMD so I thought why not unite the two to reach a larger audience. The summer between my first and second year of medical school I wrote and published my first book, which is a medical school admissions guide for aspiring first generation physicians.

What could be improved? [13:49]

The year I started at Mt. Sinai they started a department in family medicine. When I met mentors in family medicine, it clicked. If I had gone there a year earlier I wouldn’t have known that. There are several prestigious schools that don’t have family medicine departments, which I think is a missed opportunity, because we need smart, driven physicians to go into family medicine.

Why did you want to pursue an MPH in addition to the MD? [15:21]

Clinical medicine for me is a beast. People say it is like drinking water from a fire hydrant, and that is an understatement for me. There aren’t enough hours in the day to learn everything about clinical medicine, so a lot of medical education is learning basic principles, but also refining critical thinking skills and knowing how and where to get information once practicing. A lot of what drew me to medicine is social justice and population health. Social determinants of health have a greater impact on how long someone lives or their quality of life than any drug I could prescribe. With my MPH I chose to do a concentration in health promotion and disease prevention, which meant I learned principles related to epidemiology, things about counseling and motivational interviewing, community engagement, and how to partner with community organizations, which is integrated in my role as a family physician.

Was there ever a time either in medical school or since when you really wondered if you had made a mistake and thought about leaving medicine? [19:13]

The short answer is no, but there were times in the first year when I wondered what I had gotten myself into. Absolutely. My expectations for medical school were very different than the initial reality – I had read anything and everything, talked to anyone and everyone related to the medical profession, and that first year we were there just studying all the time. I was so thirsty for patient contact, wanting to learn about the medicines and tools and strategies to use to help people. That first year was really tough, because I felt like I was getting a PhD in biomedical science as opposed to taking care of people. I dealt with that by being involved in the student-run clinic, which was a great way to learn and stay motivated.

What about having to deal with an unfortunate outcome? Did that ever make you think twice about your profession? [21:35]

One of the ways I’ve avoided feeling regret about almost anything that ensues after making a decision is that I know those decisions have been aligned with my core values. I often sit down and intentionally think about what my core values are, so if things ever turn out the way I don’t expect them to I will know the decision made me feel at peace at the time.

When you were a second-year med student, you wrote an excellent book on med school admission called The Heartbeat of Success, which you directed primarily to high school and college students considering a career as a physician. Why did you write the book? [27:26]

As the first doctor in my family, I was so hungry for information in terms of what I needed to do to get into med school and what it’s like once I am there. I was really fortunate to be involved in Mentoring in Medicine, where two physicians served as role models, cheerleaders, and coaches, and they helped me be successful. I felt the urgency to pay it forward, which got me into the idea of writing the book. The second edition came out because the MCAT had changed and other things have changed in the admissions process.

What do you like about the practice of medicine? [29:57]

Every day is something new, and I will be learning every day for the rest of my life, which I love. In family medicine you don’t know what you are walking into on a daily basis. You could have a newborn visit – the first time the child is seen by a doctor, and you are spending 30 minutes counseling parents on things like why not to sleep in bed with the child, and my next patient could be 85 years old and there with her adult daughter talking about end-of-life decisions. I could see young people, old people, deliver babies, I love it!

What frustrates you about the practice of clinical medicine? [31:58]

I’m very goal-oriented and results-driven, and sometimes you don’t get immediate gratification in terms of solving a problem for a patient. I have patients I have been seeing for the last three years that can’t get their hemoglobin to the right place, but at the same time I have been their doctor for three years and they trust me, which is really great. The administrative burden family physicians have to endure is excessive and frustrating, but to listeners, don’t let that serve as a deterrent. There are efforts being made to enact change, which is really helpful.

How do you see your career evolving after residency? [33:28]

I’ve accepted a faculty position at UNC-Chapel Hill and will be doing inpatient medicine, outpatient medicine and being involved with the med school around health equity. It is allowing me to continue to do all the things that help me sleep well at night, connect with other people. More broadly I will always be involved in patient care, and with public health on some level, through advocacy, organized medicine, academic work… I will use my experiences to help inform others and shape the future of medicine.

What would you have liked me to ask you? [35:14]

Right now there is a lot of conversation about burnout. When people hear my story they see I was involved in 10,000 different things as a premed and med student, and they think I was always successful. I’d like to share a story where I was not successful.

When I started college I had placed into pre-calculus, which I had done in high school. And in addition to going to school fulltime I was working fulltime, and I failed my pre-calculus class. I had just over-committed. At that moment in time I felt my life was over. However failing pre-calculus is NOT the end of the world. I took away several lessons from that experience:

I had to tap into my network of mentors to figure out what went wrong – why did I fail –and I needed some encouragement. I realized I was working too much so had to find a more student-friendly job. Once I did so, I retook pre-calculus and did great and then got an A+ in calculus.
I needed to have more realistic expectations in terms of balancing work and course load.
I had to be surrounded by encouraging people.
I had that F on my transcript, but the world was not over, and it was an opportunity to learn and not allow it to happen again. And moving forward it never did.

Nobody is perfect, and when you reach a bump in the road, you do your best to prevent it from happening again. One blemish does not have to end your med school dreams – you’re human! Much of being a physician is about your ability to be resilient.

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