Kathleen McDemott (’23) was recently accepted to the National Health Service Corp; she is committed to serving in Health Professions Shortage Area after she completes residency. Student Doctor McDermott shares her background in public health and research that helped foster her passion for serving underserved patient populations.
My name is Kathleen McDermott, and I’m a rising third year medical student. I was born in Massachusetts, but I’ve lived in Cary, NC most of my life. I earned a Bachelor of Science and Masters of Science in Public Health at UNC Chape Hill.
Tell us about the NCDHHS Mental Health and Substance Abuse Fellowship?
I participated as a fellow last summer after my MS-I year. The project was supposed to be focused on opioid dependency, but then COVID-19 struck and the focus shifted. If I had been a fellow in any other year, it still would’ve been a good experience, but it wouldn’t have been the same.
I got matched with the historically marginalized populations work group, and their entire focus was the big disparities in infection and mortality across patient populations. The goal was to get information and testing out to patients to make sure all communities had access to testing. I got to see what happens when the state launches a response to a big public health issue. I got to see all the different people they pulled in: doctors and public health people, communications team, and community organizations to pull in stakeholders to make sure we were really including everybody.
I also got to design my own project regarding the disparities. I looked at different social determinants of health to see if we could find explanations – were disparities associated with some of those social determinants of health? I discovered some of them were, and some of them, we couldn’t really explain. It took my research and my medical and my public health experiences and put it all together.
What would you say is your most interesting or unexpected finding even though it was kind of early in the pandemic?
The biggest thing I found – more than any other factor such as education level or poverty by County – the strongest association for higher COVID infection rates tracked with higher percentages of people who were not fluent in English. So, my takeaway from it was, if you have some people without access to the information due to a language barrier, it can really affect the spread within a community; it only takes a few cases to balloon into more.
Another interesting aspect to this is comparing the difference between what percentage of people are not fluent in English county to county; it did not vary much – maybe from 1% to 3%. Yet, those small changes make a really big difference. I think that’s part of why the state really made an effort of making sure they could get communications out to people in their native language as much as possible. To make sure everybody could know what was going on, the three W’s, risks and quarantining.
What was your prior experience with HRSA and what did you learn?
After earning my masters, I worked on a HRSA funded project at NCDHHS in Wake County; Wake County has a ton of resources. It was great because even my high need patients, I could get them a lot of things because the resources are there. However, as a first year medical student I began volunteering with the Campbell University Community Care Clinic; I was a Health and Wellness coordinator. We are one County over, and it is very different.
I was the direct point of contact for all of my patients I was helping in the clinic. I was the person to troubleshoot access issues, etc. My patients were really lucky I was there in this role, but that’s not always the case. We need to fund our public health and our free clinics better so there is a better safety net for patients.
Because of these contrasting experiences, I know to make a point of learning what resources are available to patients. That was the best thing I learned from the clinic – I know more about what options we have for patients and where to look for help. For example, if I need patients to start a medication and they can’t afford it, I know what resources Harnett County and pharmaceutical companies have to assist.
How will this help you as a future physician?
I feel like it was really important for me to get that kind of experience before I enter practice. I believe it is important to integrate public health knowledge early on in medical education, and I feel like Campbell does a pretty good job of that.
Even if you don’t plan on working with rural and/or underserved populations, it’s really important for everyone to gain this perspective. You need to know what your patient’s going through and what is going on in their community. We are never going to know unless we make an effort to know it. As doctors, we really should do our best to understand our patient’s individual situations.
It’s great if you have a social worker and other staff to help you, but in many locations you will not have this support, so you need to recognize this and know what to do to help your patient. You can be a great doctor, but if your patients can’t afford the medication you prescribe, and you don’t know how to help them get it, that’s a huge problem.
I hope public health is integrated more into medical education, and we continue to emphasize it at Campbell. If a student hasn’t had an opportunity to have one of those experiences before they came to medical school, I would encourage them to get involved with our free clinic – it is a great introduction. You really learn about providing free care and the limitations. Every student should volunteer at least at least one night because it is a different world being a public health kind of provider versus a private practice provider. They are both good and necessary, but I think we need at least a little bit of the public health.
We need the space to be allowed to get to know our patients and their resources – that is something I would like to see change. In a 15 minute patient encounter, you really don’t have a lot of that, so sometimes it’s not a lack of willingness to do something it’s the inability in the system. But, I think we should all try a little harder to make that effort for our patients. You can’t give someone without stable housing a refrigerated medicine, so we need the time to ask and the wisdom to know to ask.
What are you hoping to specifically accomplish through the National Health Service Corp?
The loan forgiveness is a huge piece of the puzzle. But outside of that, my big, big passion is community mental health. Even if I don’t pursue psychiatry, I really want to have some role some role in normalizing mental health services and integrating them into primary care as much as possible.
You have the opportunity to go where you want for residency, pursue the specialty you want as long as it’s a primary care discipline, and you have a lot of flexibility in where in the country you go afterwards as long as it meets the HRSA score requirement for it to count as your service.
I’ve seen what going to managed care has done for mental health in North Carolina, and think we need to be putting more of our money there. I don’t know if there’s a specific experience I’m seeking, but I think we need more people to stay in that space so we can make sure when we do public health interventions, they are realistic and actually doable. I hope I can help influence these types of changes and serve my patients well.