January 26, 2018

Josh Underhill: Surging ahead

Good mentors and room to explore are keys to finding the best specialty fit

Decompressing at the semi-annual Biorhythms performance

M4 Josh is the first person in his family to attend medical school, which presented a unique set of challenges and benefits. Now as he nears the finish line with a dual MD/MPH degree, he answers 11 questions about his road to Michigan Med and the people who have inspired and helped him along the way.

What called you to explore a career in medicine?

To be honest, my decision to pursue medical school was at first a haphazard one. In high school, I knew that I was more of a math and science type brain, so I decided to push myself for a challenging career that would use those skills. Being a premed just seemed to be the obvious answer. I was lucky to see my decision confirmed as I went through college and medical school.

As a premed, I began volunteering at hospitals: in the emergency department, in the ICU, and in the surgery waiting areas. I was immediately in love with the healing atmosphere in the hospital, finding that even helping in small ways as a volunteer could have a huge positive impact when patients and families are enduring very stressful times. Also, during my first of undergrad, my mother was diagnosed with breast cancer. She built incredible relationships with all of the doctors on her treatment team, and I saw her pull incredible strength from them, which helped her immensely in fighting her cancer. After seeing how much these doctors had helped our family, I knew that I wanted to be that same source of strength and healing for others later in my life.

What have been your biggest challenges/greatest rewards as first generation medical student?

Medical school was certainly an adjustment for me as someone without any doctors in the family. I was entering a world that I knew very little about, hoping that I could figure it out as I go. Many other students had parents in some specialties so they knew that type of medicine and lifestyle fairly well. They were able to make more informed decisions early on.

For me, I didn’t know much about any specialty. I just had a hunch that surgery would be a fun way to use what I thought were my best talents. In one sense, that made career discernment a longer and more difficult process for me. I wanted to see everything that medicine has to offer, and I needed to give every specialty a fair shot before I could confidently choose the one for me. I wasn’t sure that I would pursue general surgery until three months into my fourth year. Michigan Med has incredible counseling and mentorship for students, so I never felt entirely lost, but this obviously created a lot of stress for me as residency applications loomed closer and closer.

Despite that stress, I am very thankful that I had this perspective coming into medical school. My family was as clueless as me, so we saw everything with very fresh eyes. I never felt pressured to go in any certain direction. I was only pushed to find what would make me happy and where I could create the greatest impact as a doctor in my community. This has made me very sure that I am picking my future career for the right reasons.

What other factors did you consider in choosing your specialty?

Lifestyle considerations were definitely a factor in my ultimate decision for residency. I had been warned by multiple faculty and residents (both surgeons and otherwise) that surgery is a very difficult lifestyle and training process. Some even went as far as to say that you should only pick surgery if you couldn’t see yourself doing anything else. I found that somewhat insulting because I don’t like thinking of my career choice as a last resort, but I understood the sentiment. It’s incredibly rewarding, but it consumes almost all of your free time. Choosing to pursue surgery really is choosing to live as a surgeon.

However, as I continued further into my training, that consideration became lighter and lighter. Once I finished all my core clerkships, I knew that surgery was by far the most personally rewarding to me. I was no longer worried that I would regret losing my free time in this difficult career path. Instead I was worried that I would regret not becoming a surgeon, years into a career in some other specialty. Once I saw that shift in my thinking, my decision was made.

What resources have you found most helpful in your medical education?

The strongest resource at Michigan is absolutely the faculty in terms of teaching and career counseling. Michigan does not have the typical intimidating culture that so many surgery programs are famous for. The faculty here are excited to see you succeed and are willing to go to bat for you to make sure it happens.

Early on, the best thing you can do is build mentoring relationships with doctors here. I was lucky to be placed with Dr. Dawn Coleman, a vascular surgeon here at Michigan Medicine, during the Young Academic Surgeons fellowship the summer between my M1 and M2 years. The fellowship program placed me on a team of four medical students working with her on a research project. That project was certainly a useful exercise and great training in clinical research, but more importantly, Dr. Coleman immediately became my greatest mentor in surgery. She took an interest in me as a learner and wanted to support me in my career discernment process. As the residency program director for vascular surgery, she gave me great advice on how to build a strong application for surgical residencies.

As our summer project finished, she immediately offered our group a second project so we could all continue building research resumes and improving our research skills. She encouraged me to present our research at multiple conferences and talked highly of me to many surgeons in attendance. I became a sub-intern on her service as an M4, and as she introduced me to the team, she spoke very highly of my clinical skills so I was able to hit the ground running with a team of residents that trusted me off the bat. Every step of the way, Dr. Coleman has used her knowledge and standing to improve my experience as a learner and set me up for the next step. She has been an invaluable resource to me. Yet I can confidently say that I’m not an outlier in having such an outstanding mentor. Many of my fellow students talk about having similar relationships with other faculty here. It’s part of the culture at Michigan. Education is enormously important. The faculty don’t only want to succeed themselves; they want to train excellent doctors who will succeed here and elsewhere.

How would you rate your clinical education at Michigan Med?

The clinical education here is by far the strongest aspect of the program. In every specialty, you are working directly with rockstars in their fields. Excellence isn’t just encouraged. It is expected. Our students are given a lot of responsibility early on, helping them to really own their patients and deeply understand all the aspects of caring for them.

I saw the value of this while working with students from other schools. I felt that we had more hands-on training while students from other schools learned by watching. On the interview trail, some students and interviewers were shocked to hear that I had carried the pager on overnight call, or that I had formulated my own treatment plans that the team respected. As a Michigan student, those things feel like the norm, but elsewhere it’s surprising to have medical students so involved.

Now that you have been out on the residency interview trail, how have you been received as a candidate from the University of Michigan Medical School?

The Michigan name is very well-respected on the interview trail, particularly in general surgery. I had plenty of interviewers start off a conversation by telling me how much they love Michigan’s program, and how Michigan trains incredible doctors. And plenty more who showed me all of their Wolverine gear as fans of the football team. Michigan is known to be an academic powerhouse that top-tier programs compare themselves to. Being a Michigan medical student has opened many doors for me.

How have you balanced spending time on your other interests with med school?

Balancing medical school with other interest is certainly a challenge. Early on, you learn about prioritizing and organizing your time. Despite these time constraints, I still think it is very important to keep some interests outside of med school. Simply for your sanity, you can’t spend every moment of every day studying and worrying about the next evaluation. You need time to decompress and enjoy life. I got involved with a bunch of organizations here, but my favorites were definitely Biorhythms and the Smoker.

Biorhythms is a dance show put on twice a year by the medical students, and the Smoker is a (surprisingly good) student-run musical where we roast the faculty. In both of these, you get to see your classmates trying something entirely unrelated to medical school, and there are great chances for people of all skill levels to really enjoy some time on stage. With no formal dance training except watching a lot of America’s Best Dance Crew in high school, I somehow became one of the main choreographers of these shows, and I’m now one of the dance demi-czars of the Smoker for this year. It’s been a blast all the way through, and it’s a great way to relieve some stress.

Why did you decide to pursue a dual degree?

I chose to pursue the MPH fairly late in the process. As an M3 going through my core clerkships, I was learning tons about clinical medicine, about diagnosis and treatment decisions, but I found that there are limits to what we can do for our patients as doctors. Many other factors affect the health of our patients: their medical knowledge, health coverage, access to health care facilities, and much, much more. I realized that I wanted to treat more than just the patient in front of me. I wanted to be involved in reaching out to the community I served, making sure that the health system I work in is doing everything it can to do right by our patients. This is why I chose to apply to the Health Management and Policy program at Michigan’s School of Public Health.

When I made this decision, I was in the middle of my surgery rotation, studying for my shelf exam, and trying to work on a research project. I already was struggling to finish my work and get enough sleep as it was, but the deadline to apply was only a month or two away. Despite the difficulties there, I knew that the MPH would be a very important part of my career, so I quickly lined up some letters of recommendation and got my application together. It was certainly a stressful time, but I couldn’t be happier now that I’ve done it.

How does an MPH fit into your future career plans?

The MPH gave me incredible training to become a surgeon-leader in my future. I describe the health management and policy program as a hybrid between an MPH and MBA. We learned a ton about the functioning of health systems: how they are financed, how they assess the needs of the population they serve, how they improve the quality of the care they provide, and much more. This training gives me the ability to participate much more readily in quality improvement projects and health services research. It will allow me to interface with hospital administration in order to improve the services our health system provides, and serve our community in the best way possible.

How do you like living in Ann Arbor?

I moved to Ann Arbor from South Bend, Indiana since I graduated from Notre Dame. While they are both college towns, Ann Arbor has far more fun things to do. Restaurants here are delicious with tons of variety to try out. In the fall, football season is a blast (even if your loyalties lie with a different team). There are plenty of breweries and cocktail bars that are perfect for sitting with friends and decompressing after a big test. It was easy to move here and enjoy the city.

What is one thing you wish you would have known before applying to medical school?

Keep everything in perspective. It's very easy to get bogged down on specific grades and test scores (which are important), but it's all about attaining the end goal. Don't paralyze yourself freaking about deficiencies in an application. Just work hard in the future to make up for them and show how you've been able to learn and improve from failures.