MASA forum: activities
Minutes from "Career Options for
Medical (and Cultural) Anthropologists: Exploring
the Range of Possibilities"
SMA Graduate Student Committee
Special Event
2002 AAA Meetings, New Orleans, LA
Chaired by Dorothy Weaver
The Special Event took place on Thursday November 21, 2002 at 6:15pm and included brief reports from six medical anthropologists working in a variety of fields. Panelists included Nancy Vuckovic, an Investigator at Kaiser Permanente Center for Health Research, Sue Estroff, a Professor of Social Medicine at University of North Carolina (UNC)-Chapel Hill Medical School, Stan Yoder, a Qualitative Research Specialist with Macro International Inc., Suzanne Heurtin-Roberts, the Health Disparities Coordinator for the Behavioral Research Program of the National Cancer Institute, Kate MacQueen, a Senior Scientist at Family Health International and Margie Aken, a Cultural and Linguistic Services Specialist with Molina Healthcare. Panelists presented brief comments about the paths that led them to their current positions, what kinds of training was most relevant, and other suggestions on how to get jobs in their fields.
Nancy Vuckovic -- Sue Estroff -- Stan Yoder -- Suzanne Heurtin-Roberts -- Kate MacQueen -- Margie Aken
Nancy Vuckovic works as an investigator at Kaiser Permanante Center for Health Research in Portland, OR. She graduated from the University of Arizona with a PhD in cultural anthropology, specializing in medical anthropology. She had a previous career in advertising and marketing and retains an interest in words and images and how information affects behavior. During graduate school she worked on a long-term NIH-funded project dealing with dieting and smoking behavior among teenage girls. The experience taught her how grants are managed and how to go about the research process, including the integration of quantitative and qualitative methods. She also learned how to produce something that a government funding agency is willing to fund. After graduation, she held a two-year post-doctoral fellowship at the Oregon Health Services University in Portland working with health researchers, scientists and doctors on questions of how people use medical resources. After the post-doc ended, she stayed on at the institute as a permanent employee, having convinced them of their need for an anthropologist. She has been employed there for six years. One of the advantages of her job is her interaction with people from many different disciplines, whom she would be unlikely to encounter in an academic setting. This interaction gives her the opportunity to exchange perspectives with researchers who have different theoretical and methodological approaches. They learn from each other by approaching the same problem from different perspectives. Another advantage in her job is working within an organization that has good resources for recruitment and administration. Because the organization is affiliated with Kaiser Permanente, they often recruit physicians for projects which gives her the opportunity to work in clinical settings. The organization also employs grant writers and editors to help with administrative work so she can focus more on the science. A disadvantage is that she often finds herself having to explain the value of anthropology to her co-workers, most of whom rely heavily on survey data. Once they become interested in qualitative research methods, she has to educate them about the rigor and systematicity of qualitative methods. Although she does not teach in a classroom setting, Nancy finds herself doing a lot of day-to-day teaching in her job. This involves some “loss leader” activity, meaning doing some extra work that does not result in an immediate profit but that is an investment for the future. Spending time with colleagues and assisting them with qualitative methods helps strengthen her long-term relationships. In her job, she has learned how to talk to people from different disciplines which has strengthened her grasp on what anthropologists do and increased her confidence as an anthropologist.
Sue Estroff is a Professor of Social Medicine in the School of Medicine at UNC-Chapel Hill. She mentioned the value of serendipity in the job search process, which is how she ended up in a department of social medicine comprised of social scientists, humanities and ethicists, lawyers and clinicians. She warned anthropologists against assuming that things will get better in a department within a school of medicine, nursing or public health, where it may be difficult to be the first or only anthropologist. Rather, Sue encouraged anthropologists to find a place where they fit and where they belong. She mentioned that post-docs are a good way to learn about subject matter from all the angles, and are a good transitional step towards a career. Sue had five pieces of advice for anthropologists who wish to work in schools of medicine, nursing or public health. First, she recommended staying away from the role of selling others on anthropology, but rather focusing on doing work that stimulates you and having a productive scholarly career. She mentioned that it is easy to get caught up in worrying about what others think and about selling out to one side or the other, but it is better to concentrate on being a multi-vocal scholar. Second, Sue warned the anthropologist not to get seduced by the clinician’s role, unless you are one and you are practicing. Third, Sue encouraged taking new risks and exploring collaborations in substantive areas that you never thought you would investigate. Again, she mentioned the role of serendipity in leading her to a new topic of research in fetal surgery, after spending twenty years researching people with severe mental illness. She commented that sometimes “loss leader” activities do not pay off as she spent two years talking to an osteoporosis team which came to naught. Fourth, Sue emphasized her role as a colleague in a medical school and the importance of being on committees and advising students. She warned about existing stereotypes and biases and emphasized the importance of not apologizing for yourself as an anthropologist in a non-traditional setting. One of her advisees who was having academic trouble was labelled as a “typical female anthropologist” by a committee member. This finding allowed her to successfully appeal her case at the trustee level. She has also experienced difficulties with IRB approval. Although incomprehensible oncology protocols may pass through easily, her own protocols are scrutinized because the IRB doesn’t understand them. Finally she cautioned that confrontation begets confrontation. It is best to stay away from it without being a “wuss” and without being too rigid. Sue advises against evangelizing for anthropology, but rather recommends evangelizing on behalf of one’s own intellectual interests and rigor.
Stan Yoder is a qualitative research specialist with Macro International, a private company that conducts survey research in Asia, Africa and Latin America. Stan works with a group of researchers including demographers and statisticians to design and carry out research projects. He began the position five years ago when USAID asked Macro to hire an expert in qualitative research methods. Since then another anthropologist has been hired. So far, Stan designs and directs health-related research projects in Africa, though in the future he may work in other regions. His job is to produce five to ten small-scale research projects within 4-5 years. An advantage of his job is that most of the projects he works on are his own design. The first study Stan worked on dealt with women’s experiences of female genital mutilation. Although he resisted the project at first because he didn’t understand it, he felt his study ended up improving the overall data set collected. Another study he designed dealt with public interest in HIV testing in Malawi in order to produce a larger survey. Afterwards, they asked people to contribute blood for HIV testing to measure prevalence rates, which was a first for Macro. A follow-up study investigated the effectiveness of the informed consent statement used for the blood testing and found that many people had not understood the statement. Another study Stan designed dealt with how mothers in Central Guinea recognize signs of illness. As part of his job, Stan is supposed to advise USAID on policies, although he admits he is much more interested in the research aspect. One of Stan's goals at Macro is to make qualitative research more transparent because he cannot understand much of the qualitative research he reads, he doesn’t know where it comes from and therefore he has no way to evaluate it. Another goal is to get demographers to think of their survey research as a process, and their data as a result of a process, though he says he hasn’t had much success so far. Finally, Stan hopes to improve the quality of the text in research reports written at Macro. There are many tables but they are accompanied by poor and uninformative text. Before he started at Macro International, Stan worked for one year in a psychiatric institute doing research and then spent seven years evaluating health research projects, along with specialists in quantitative analysis and psychology at the University of Pennsylvania. He also did a lot of consulting. To work in these settings, it is important to be very clear about one’s research design and concept, and to be able to explain the results and what they are worth. Stan’s dissertation research in Zaire was on ethnomedicine and healers' practice which gave him a common sense understanding of how people there live. He is fluent in French and has workable Portuguese and Swahili. The most important skills needed for his job are the ability to think carefully about your research design, research questions and assumptions, and then how you interpret it. It is possible to use a wide variety of research methods as long as these connections are made clear.
Suzanne Heurtin-Roberts is the Health Disparities Coordinator for the Behavioral Research Program of the National Cancer Institute, National Institutes of Health. Suzanne’s work is different from the previous speakers as she works within the government bureaucracy. She does not actually do research, though she could if she had the time. Her program funds and sets up health research programs, but she describes her position as being an "idea warrior." She fights for certain ideas to be funded and researched, and argues for different approaches to research topics. She helps shape the research, and redefines and redirects the discourses and paradigms of research projects. She challenges anthropologists to consider the importance of public service. While administrations change, the bureaucracy remains, provides continuity and gets concrete things accomplished. As a government bureaucrat, she feels she can have an impact on the public's health and well-being in a way that she could not in academia. She has recently helped push through a $56 million, five-year Population Health and Health Disparities research agenda to establish research centers across the country. They will establish a new paradigm for looking at health and social justice issues in populations that acknowledges complexity, is inter-disciplinary, crosses levels of analysis and is participatory-based. Her participation in these efforts makes Suzanne feel very good about the work she does. Serendipity played an important role in getting her this job, but she was able to take advantage of it because of her previous work experience. Her background included two post-docs, a Master’s in Social Work, clinical experience in locked psychiatric units, experience in gerontology, and more. She encourages anthropologists to apply to her institute via the NIH website. Sometimes positions cannot be filled because of a lack of applicants and anthropologists are qualified and have a lot to offer. She recommends getting as much experience in as many realms as you can in order to see the big picture and how things work together. She did not hang on to a rigid research and career path, but took advantage of opportunities as they came along. In her work setting, anthropologists need to check their "anthropological arrogance" at the door and to think in terms of being a colleague and to respect other disciplinary approaches to problems. Anthropologists also need to speak up and have a sense of humor. Suzanne was responsible for organizing a cross-institute effort to write "Guidelines for Qualitative Methods," for both proposals and reviewers, which has had an important impact on government sponsored research.
Kate MacQueen is a Senior Scientist at Family Health International. She traced her career path to show how a mix of serendipity and purposive decision-making led her to her current position. Kate was always interested in bio-cultural anthropology, which made it somewhat difficult to find her niche at first. During graduate school she was offered an internship at NIH, but was warned that this would lead her in the direction of biological lab work and away from her bio-cultural focus. After thinking about it, she turned down the opportunity and she is grateful to this day for the advice. After graduating she worked as a visiting professor at UGA where she taught all the graduate research methods classes. Although she loves methods, she realized that the subject is not highly valued in anthropology departments and it might be difficult for her to get a tenure-track position. Because she was teaching so much, she was unable to get a lot of publishing done and had trouble fitting into departments since she was too “biological” for the anthropologists and too “cultural” for the biologists. Then her dissertation advisor notified her about a post-doc at Emory's School of Public Health in conjunction with the CDC that seemed to be created just for her, as it was intended to bring social and behavioral scientists into HIV/AIDS research. During the post-doc, she earned a Master’s in Public Health at Emory and gained valuable experience and training. Afterwards, she stayed at the CDC and worked on preparation for HIV vaccine trials, a topic she found exciting, and socially, behaviorally and ethically complex. She says that the post-doc and subsequent job at the CDC were a result of being in the right place at the right time, having the right set of skills, and also following her heart by sticking with her primary interest in bio-cultural research. She spent ten years at the CDC, eight years as a researcher, and acquired a lot of expertise in the area of ethics. At that point, Kate was heavily recruited for a director of science position in which she would not be doing research herself, but would facilitate research for other people. Initially she refused the position, knowing that she did not want to give up doing research, but finally she was convinced that the position would be good for her career. She stayed in the position for two years and while it did boost her career, she missed doing research. Then an opportunity arose at Family Health International in North Carolina, which would bring her back to her roots as a methodologist in qualitative research methods, and also allow her to put to use her expertise in ethics. This was another place where two possible career paths diverged for her and she had to make a choice between continuing in a science management role or returning to research and ethics. After careful consideration, she decided to take the methodologist position and has been very happy at Family Health International for the last year. Kate advises anthropologists to look for opportunities and serendipity, but never to just say yes immediately to the first opportunity that comes along. Saying no can be depressing and may mean some hard times for awhile, but it can also open up the door to something that you really want. She recommends making the sacrifices you need to make to get to the goal that’s important to you, rather than getting stuck somewhere, because there are so many opportunities available now.
Margie Akin is a Cultural and Linguistic Services Specialist with Molina Healthcare, a small HMO in California with about 300,000 employees. Margie designed a six-hour training course in cultural competency that is required for all staff at Molina. She conducts training for physicians in topics such as ethnocentrism, how to provide translation services to non-English speakers, how to talk to patients from various cultures about sensitive topics such as STDs, and others. She also arranges for translation and interpretation services and designed “request cards” for non-English speakers to request interpretation services. She convenes the community advisory committee to provide an opportunity for community members to let healthcare providers know how better to serve them. Margie also drafts Needs Assessment Reports and does grant writing. Margie had been an itinerant professor of anthropology when she saw an ad in the paper for her current position. She emphasized that healthcare organizations do not know who anthropologists are, and anthropologists frequently do not know about these kinds of jobs. She feels it is useful to be evangelical about the skills anthropologists have and how they can be applied in healthcare settings. According to a new law in California, HMOs that receive state or federal funding are now required to have cultural and linguistic services specialists. She believes this trend will follow in many states, as the Office of Minority Health recently adopted national standards for cultural competency in healthcare. For a job in her field, Margie recommends getting a good four fields education. Her own dissertation research was in ethnoarchaeology and she uses all four fields of anthropology in her work. Her knowledge of research methods and the substantive content of her dissertation are useful to her in her present job. Most health organizations look for someone with a Master’s in Public Health (MPH) for positions like hers, and a MPH combined with an anthropology degree is a good background to have. It is also necessary to be skilled in statistical analysis. To work in healthcare settings, Margie emphasized the importance of presenting yourself in terms of your skills and not your degree, as most healthcare providers are not familiar with anthropology. Margie enjoys her work and feels she now has a concrete focus for her years as a community activist.
Overall, the panelists recommended that anthropologists should not deny the importance of serendipity, but that they should set themselves up and know what they want when searching for a job. Volunteering is a good way to learn about job settings, and it is useful to learn about clinical settings and how clinical practice works.