Maricruz Merino, MD, finished her residency at Brigham and Women’s Hospital (BWH) in 2010. Following graduation, she went to work for the Indian Health Service (IHS), a federal agency within the Department of Health and Human Services that provides comprehensive health care services to nearly 2 million American Indian/ Alaskan Natives. Merino is the director of medical education and practices internal medicine at the Gallup Indian Medical Center, a 99-bed facility in Gallup, New Mexico. The volume at Gallup is one of the highest in the IHS with 250,000 outpatient encounters annually.
Q: What drew you to the residency program at Brigham and Women’s Hospital?
A: When I was in medical school, I learned about and was inspired by the work Paul Farmer was doing with Partners In Health, and then learned he did his residency at Brigham and Women’s Hospital, and knew I wanted to apply. When I interviewed at the Brigham, I was very impressed because everybody I spoke with was extremely intelligent, global-minded, and incredibly kind. I was thrilled to be accepted into the program.
Q: Why did you decide to work for IHS when you finished your residency?
A: I had done a rotation at the Northern Navajo Medical Center in Shiprock, New Mexico, when I was a resident and really enjoyed my time there. I felt the Four Corners area of the U.S. offered a wonderful opportunity to practice rural medicine. I very much wanted to perform internal medicine in a more traditional way, where you are on your own more than you would be if you were in a major metropolitan area with access to many specialists. I wanted to be challenged by difficult cases.
However, probably the biggest reason I came out here is because I strongly believe in the mission of the IHS. When I was in Shiprock, I caught a glimpse of the inequities in healthcare within our own nation, and was inspired by the dedication of the physicians working to reverse that. I wanted to be a part of that team. I also knew there were already other Brigham graduates here doing good work, and that I would have access to their mentorship.
Q: Was there any one moment when you realized working for an organization like IHS was how you wanted to pursue your career?
A: During my rotation at the Northern Navajo Medical Center there was a young man, about 18 years old, who was admitted to the intensive care unit with severe pancreatitis. He was critically ill and we were not able to fly him out to a tertiary care center at the time. Later I found out he had passed away. That experience showed me that I would have to be prepared to bring the highest level of training possible to the job, and that this was a place where I could really use all of the skills taught to me at the Brigham, even those that are not traditionally viewed as part of primary care.
Q: What’s a typical day like for you in your current role?
A: It’s a very broad practice, a combination of in-patient and out-patient internal medicine. I could start the day visiting people in their homes, and then be in clinic during the afternoon. If I’m on the wards I might have to admit someone to the intensive care unit. I also get a little bit of administrative time to pursue things that interest me.
One of the nice things about working in a small hospital is I can take my pick of projects. There’s always a lot that needs to done. My main focus has been on medical education. As the director for medical education at my hospital, I have been able to work closely with other hospitals to keep up with the changing medical landscape. I find that incredibly rewarding and enjoyable.
Q: Healthcare is very specialized in today’s healthcare world. How does that affect you, your setting, and situation?
A: We have an outpatient neurologist and cardiologist at the hospital, and access to some specialty services like orthopedics and ob/gyn, but essentially I have to read on my own for everything else. I’ll often call people and ask former colleagues for advice.
Q: Do you utilize your BWH network when dealing with your patients?
A: Absolutely. I’m physically very far away from the Brigham, but I actually still feel quite close to everyone I worked with while I was there. A lot of mentors are still in touch, and medical students and residents will do rotations here in New Mexico.
The Brigham and Women’s Physician’s Outreach Program is also a valuable resource. Brigham specialists provide consultations and remote teaching opportunities via scheduled monthly videoconferences and conference calls. Through the program, Brigham staff also can volunteer in Gallup or Shiprock, which is a tremendous help. For example, we almost never have money to send patients for certain non-emergent services, like dermatology, and Brigham volunteers can see twenty to thirty patients a day.
Q: Any advice for current residents?
A: When I was a resident, one of my mentors was Jane Sillman, the director of the Primary Care Residency Program at the time, and she said to me, “No one will ever know if you’re truly happy except for you.” Those words spoke to me and stayed with me. I think it’s important to listen to your gut, and to do the things you think are going to sustain you, because medicine is a wonderful and dynamic career, but it can also be very difficult. Training at Brigham and Women’s opens many doors. Choosing the one that resonates with your values is a privilege, and will carry you far.
Q: Are there any areas you’d like to change in the healthcare landscape?
A: I would love to see more residents choose to practice medicine in locations like Gallup and Shiprock, because we need more good doctors and healthcare innovations in these types of areas.