20 Questions: Otha Myles, MD [Infectious Disease]

Otha Myles, M.D. is the Deputy Chief of Epidemiology and Threat Assessment at Walter Reed Army Institute of Research’s United States Military HIV Research Program in Rockville, Maryland.

Dr. Myles graduated from the University of Maryland School of Medicine. He went on to complete his residency in internal medicine at Walter Reed Army Medical Center in Washington, D.C. followed by a fellowship in infectious disease. He was also a recipient of the U.S. Military’s Health Professions Scholarship Program (HPSP).

Dr. Myles has become one of the leading researchers in the field of HIV. His involvement includes projects in the United States, Europe, Asia, and Africa. Dr. Myles recently sat down with SDN to give us a glimpse into the lifestyle of an Infectious Disease specialist.

Describe a typical day at work.

Being a principal investigator as well as a physician, my days consist of performing both research and clinical infectious disease specialty consultation. As a principal investigator, my days are kept busy working with other investigators to develop a globally effective vaccine to protect soldiers around the world against all subtypes of HIV. I develop research protocols aimed at gathering information regarding the prevalence, incidence, and sub-type of HIV at locations around the world and then bring it back to our headquarters in Rockville, Maryland for further analysis and potential publication. I also develop and attend lectures on continuing medical education topics in Infectious Diseases in order to keep up to date on the progress being made in my field. As the deputy chief, I communicate with others in our department and the chief of the department, providing expert infectious disease consultation as needed. Working within a military research institute, my day usually begins at 7:30 and ends at 4:30 on most weekdays with little to no weekend or on-call duty.

If you had to do it all over again, would you still become a doctor?

I definitely would still become a doctor. For me, it was a true calling. From a young age, I would follow my mother as she would provide healthcare for the community. This gave me a great value for helping others.

Why did you choose your specialty?

One of the things that influenced me to go into infectious diseases was my experience working as a Research Physician’s Assistant in the NIH’s AIDS Minority Infrastructure Program (now called AIDS Clinical Trials Group or ACTG). Also, I saw the benefit of working in infectious disease as a military physician very early in my internal medicine training. The opportunity for travel medicine, tropical medicine, and biological weapon consultation is very different than those offered to others in non-military training programs and workplaces.

Now that you’re in your specialty, do you find that it met your expectations?

My expectations have definitely been met, even though now I do more clinical work than before. One of the greatest things about my field is that I am able to help populations of patients as opposed to just one individual at a time. Working in public health (clinical epidemiology) is basically protecting populations of individuals at once. Also, I feel like I am able to be more personal with my patients based on the nature of their illnesses and the type of personalized management each individual may require.

Are you satisfied with your income?

I have to say that I am fortunate to make the salary that I do now. However, military physicians’ direct incomes are somewhat lower compared to civilian physicians. The military tries to give bonuses in order to bring physicians’ income up compared with their qualifications and training.

What do you like most about your specialty?

You get to see exotic cases. More often than not these are very complex cases and it depends on you to figure out the diagnosis. It is absolutely a great challenge. On top of that, you get to know a little about places all over the world. You tend to become a more international/global individual. One of the positives is that contrary to what most people think about this field of medicine, patients get better. There is a very small mortality rate. It feels as if you are actually “curing” people.

If you took out educational loans, is paying them back a financial strain?

Since I went to medical school through the HPSP, I did not have to pay for medical school because the military paid for it in return for service after graduation. I was considered to be a non-traditional student due to the fact that I was married, had a young child, and had a mortgage to pay. So even though the military paid for school, I still had to take out loans to support my family. There is very little strain now because the military pays for most things, such as housing and medical care.

On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?

The Army gives you thirty days of leave per year and unlimited sick days. At least once a year, I take two weeks off which I usually coordinate with my children’s school schedule. For the summer, I take one week off. Being a military physician, my schedule goes by the military work hours which is normally from 7:30 to 4:30 pm or 5 pm, Mondays through Fridays. During the week I do not take calls unless I am on the ward. I do not usually work on the weekends.

What types of outreach or volunteer work do you do, if any?

In my job, everything is considered to be outreach work. However, one of my personal community outreach concerns is related to providing the opportunity for underrepresented students to be able to go to medical school and receive a stellar medical education. I have created a scholarship with one of my own mentors (Dean Emeritus Donald E. Wilson, M.D.) called the Donald E. Wilson Legacy Scholarship Fund. Just by grassroots efforts alone, we have been able to raise nearly $50,000. My goal is to raise at least $2 million over the next five years.

From your perspective, what is the biggest problem in healthcare today?

One of the biggest problems I see with our field is the limited number of admissions of underrepresented minorities into medical school and graduate school. The shortage of these students being admitted greatly impacts the medical care that can be provided to disadvantaged patients in the future. Unfortunately, it is often individuals from minority communities that are infected with diseases such as tuberculosis (TB) and HIV and without the insurance or resources to obtain the appropriate medical treatment. Consequently, due to the extremely high cost of attending medical school, many minority students are discouraged to even apply let alone attend. I believe that we should work on making medical school less of a financial burden for all students and that finances should not keep any qualified students from attending.

What is the best way to prepare for this specialty?

The best preparation is, to begin with, a residency in internal medicine, then a fellowship in either adult or pediatric infectious disease. Students who are interested should [aim] for primary care and global medicine-based programs. Also, doing a rotation outside of the country and working with disadvantaged patients is definitely beneficial and gives students greater exposure to the field of infectious disease.

Where do you see your specialty in 10 years?

In many places, the majority of ID is HIV and it is now expanding to doctors actually chronically managing it. Through medications and therapeutic research, it is becoming much more of a manageable disease. People are now living greater than 19+ years post-diagnosis. With adherent patients, it becomes the same as treating any other chronic disease such as hypertension and/or diabetes. Hopefully, with HAART (Highly Active Anti-Retroviral Therapy) we will be able to keep patients living for a very long time.