The Bloomberg School’s General Preventive Medicine Residency Program

Proactive Public Health

“Preventive medicine physicians are public health physicians who are interested in how we address health on a population level.”
—Ryan Lang, MD, MPH ’17, Chief Resident, General Preventive Medicine Residency Program

The General Preventive Medicine Residency program at Johns Hopkins Bloomberg School of Public Health is one of the nation’s oldest and largest preventive medicine residency programs.

The two-year program, which currently has 15 residents, focuses on preparing physicians for leadership roles in public health. In the first year, most residents complete a combination of MPH program coursework (which is fully funded by the program) with residency modules and clinical work with local health departments and other health centers. Students who already have an MPH spend their first year in practicum rotations. In the second year, residents complete 12 months of preventive medicine practicum rotations that last for two to four months each while continuing clinical work.

GPMR alum Ryan Lang, MD, MPH ’17, is serving as GPMR Chief Resident and an Instructor in the JHSPH Department of Health Policy and Management for the 2018–2019 academic year. Here, he talks about his path to preventive medicine and how the GPMR program prepares residents to take on preventive medicine leadership roles in public health.

Name: Ryan Lang, MD, MPH ’17

Hometown: Huntsville, Ala.

Undergrad: Oakwood University

Medical school: Vanderbilt University School of Medicine

What led you to preventive medicine?

[When I was growing up], my parents had quite a few friends in the health care field. Talking to them was my first introduction to the field of medicine and I did volunteer shifts at my local hospital in high school to confirm my interest.

When I went to medical school, I was interested in a lot of different specialties. I went to the American College of Preventive Medicine National Conference during my second year. That was a great opportunity to get exposure to the field and meet preventive medicine physicians.

When you first came to Baltimore, you were an internal medicine resident at Johns Hopkins Hospital. What was that experience like?

I applied for the urban health primary track of the internal medicine residency. That experience was amazing. It gave me a much better perspective of the social determinants of health, especially in an urban environment like Baltimore. I was doing rotations in substance abuse and learned about the impact of addiction and how that can play into primary care.

In addition to that, I had my own panel of patients in an urban primary care clinic where I was able to see how different social factors affect how people access health care. Many of the patients—in addition to having health conditions that needed attention—had a lot of social issues. I was able to focus not only on medical problems but on social factors and how those could be addressed.

That program was a great fit for me because I tend to be a big-picture person. I’m interested in all the factors that may influence health.

How did you end up in the General Preventive Medicine Residency program?

At the end of my internal medicine residency, I completed a rotation with a program that focused on patients who were frequently admitted to the hospital or who frequented the emergency department. I worked with the program’s medical director, whose role was to engage with those patients and address the social factors contributing to their frequent presentations to see what could be done.

The medical director was an internist who was also preventive medicine-trained. Working with her was a call for me to do the preventive medicine training because I had very similar interests.

I matriculated in the GPMR program in 2016. In addition to completing my MPH, I did rotations at various sites in Baltimore and D.C. in different aspects of public health, health systems management and advocacy. I got a great perspective of all the ways that physicians can have an impact in the public health sphere.

Moving forward, I want to be engaged on the community level with chronic disease prevention in urban populations. My hope is that I can either help to direct or implement programs that improve health in those areas.

It sounds like preventive medicine is the best of both worlds: You continue to practice as a physician but also as a public health practitioner. This mesh is pretty cool.

You’ll see a wide variety of career paths for preventive medicine physicians. Some will integrate clinical practice and public health involvement. Some will apply their preventive medicine training almost entirely within a clinical setting. Others are dedicated primarily to public health. They may or may not continue to see patients, but they’re working in programs that affect patients at a broader level.

Tell us about the GPMR program. What does it involve and what makes it different from a traditional residency for a medical student?

There’s a diversity of backgrounds coming into the program. Some have already completed an entire residency in another specialty, like I did. Some come in directly after an internship year, which is the minimum requirement for the program. We have current residents and alumni who previously trained in psychiatry, surgery, neurology, obstetrics and gynecology, family medicine, pediatrics, and internal medicine.

In addition to the MPH coursework, there’s a strong focus on professional development and leadership training, especially within the first year of the program. Those who come into the program with an MPH start immediately in the community doing practicum rotations in various areas. Those who do not have an MPH complete that coursework their first year and then begin rotations their second year.

This program produces leaders in public health and preventive medicine. There are many examples of alumni who are medical directors, like one of my mentors, Laura Dawn Sander, MD, MPH ’13, who I worked with during my internal medicine and preventive medicine residencies and who is now the medical director of Population Health at Sibley Memorial Hospital.

You mentioned residencies in Franklin Square and Johns Hopkins Hospital. Is there anywhere else?

The residents have clinical rotations at various clinical sites where they see patients in addition to their preventive medicine responsibilities.

We have agreements with sites such as the Baltimore City Health Department and Charm City Care Connection, a non-profit that provides care to low-income, uninsured populations. Some of our current residents have surgical backgrounds, so we have new rotations that provide wound care to people within the city, especially in the setting of addictions—there was a needle exchange with the city health department and they’re trying to build in a wound care component.

Do trainees having a minimum requirement for patient care?

Our accrediting body, the Accreditation Council for Graduate Medical Education (ACGME), requires all of our residents to see patients in a clinical setting at least two half days a week.

This program allows more time to really develop and work toward that public health focus that people come here for.

Even though there is a requirement to see patients, that can take on many different forms. That flexibility is one of the great things about this program. It allows you to do so many other things in public health.

What’s unique about this program?

There are a plethora of opportunities in terms of training and practicum rotations. Given our proximity to Washington, D.C., the program also allows for the opportunity to do a lot of clinical experiences or practicum experiences with the federal government.

This program also provides full funding toward the MPH, which is a great benefit. Some residency programs are housed not within a school of public health or medicine, but maybe in a health department. In those settings, an MPH—or another master’s degree in the public health discipline–is a requirement of completing the program, but they may or may not cover the expenses for it.

The MPH gave me a really large-scale view of the many ways that I can be involved as a public health physician. I learned an immense amount about public health and community health. It was a bit of an adjustment to be back in the classroom after working in the hospital and clinic for three years as an internal medicine resident physician, but the faculty are amazing, and I learned so much from the coursework I took.

You’ve been chief resident since July. What’s your experience been like so far and how will this set you up for what you hope to do down the road?

I finished my residency training, so I’m here for an additional year serving in this role.

My main responsibilities are planning academic programming and coordinating the training for the residents, primarily during their first year. I’m also planning a few elective experiences for medical students or residents in other programs who are interested in learning more about the field of preventive medicine. We have an elective program that I run that will happen twice this year. For a month, we’ll invite people to come to the campus and work on projects, meet with faculty and tag along with our current residents to see what preventive medicine is all about.

I work closely with our director, Clarence Lam, MD, MPH ’10, to make sure that residents are getting the training they need to be fully competent preventive medicine physicians. Specific examples include planning training modules with various faculty in areas such as emergency preparedness, project management and leadership. I also assist with course planning for a Problem Solving course that is taken by preventive medicine residents and provides a framework for addressing a wide range of public health issues. We also make sure that residents are adhering to ACGME requirements.

It’s been a great experience to work closely with the first-year residents and mentor them, career-wise. I was in their shoes just a couple of years ago, and I remember the people who helped mentor me when I was starting off.

This role provides a great opportunity to learn about the inner workings of a residency program and to engage in management. This will really set me up to be a leader within community programs in general public health.

What does the future look like for you?

I’m still figuring it out. There are possible opportunities in local health departments, primarily in chronic disease prevention. I’m also very interested in health communications, and this year I’m planning to collaborate with the Center for Communication Programs. I’ve met with a team there that’s engaged in local initiatives like B’More for Healthy Babies.

I hope to be engaged in projects geared toward health communication and health promotion in urban populations. How do we deliver messaging in a way that is inclusive and that can help them to access health care more readily?

Lang and a colleague in 2017 at a “Community Conversation”—part an initiative of the Baltimore City Health Department.

Will you continue practicing as a clinician?

I want more of my involvement to be within the public health space, but I think I’ll continue to have some involvement in clinical practice.

What do you do around the city in your free time? What was your experience of moving here?

It took me a few years after moving here to really see all Baltimore has to offer, mainly because I was so busy as an internal medicine resident. I’ve had to make a concerted effort to look into what this city has to offer, and it really does have a lot! I’ve been to the Baltimore Museum of Art and the Reginald F. Lewis Museum. The people here are also really special. It’s a very eccentric city. There’s a spirit of diversity and innovation and “we’re gonna do things our own way and we don’t care what other people think.” I just love that.

I really like that Baltimore has that openness to many different perspectives. Being here has helped me to be more open.

What advice do you have for future residents or program participants?

Keep an open mind, and know that your training here in preventive medicine will open many doors in public health for you.

RELATED:

• Greater Baltimore Medical Center looks to Hopkins MHA for future leaders
• Internships—The Alternative Gap Year