Perhaps I was atypical: when I decided to apply for medical school, I was uncertain whether I wanted a career as a primary care clinician, a public health practitioner, or a bench-top laboratory researcher. By the time I applied for combined residencies in internal medicine and pediatrics (Med-Peds), I had eliminated laboratory work from consideration. I never decided to forego clinical medicine; instead, I simply chose to pursue public health for a while. By sharing the story of how my career took its present path, I invite you to think in new ways about the future of your career.

As a second-year Med-Peds resident, I paid attention to what I called my "banner days" - the days (or nights) when I came home from work thinking, "Wow, I love what I do!" More often than not, those were the days in which I was involved with a patient or a family in a prevention intervention. I looked around at my colleagues, and for many, their banner days were when they had seen a patient with a diagnosis they had never seen before or when they had performed a procedure they had never done before. That was telling for me. My interest was prevention.

Outpatient practice in my continuity clinic reinforced that realization. As I became more experienced at the clinic, every few months my schedule would be tightened, reducing the amount of time I was given for each patient's visit. The first week of the tightened schedule was always somewhat fun; it was a race against the clock - could I keep up? Yet over time, I realized that what I loved most about my continuity clinic was precisely what was getting eliminated, that is, the opportunity to learn about what was going on in my patients' lives and the time to go beyond the reason for the acute-care visit and engage the patient or family in health promotion.

When I learned about the Epidemic Intelligence Service (EIS) at the Centers for Disease Control and Prevention (CDC), I knew I had found a perfect opportunity to learn about prevention from the public health perspective. EIS is a 2-year postgraduate training program in applied epidemiology for health professionals. EIS officers are often referred to as "Disease Detectives;" they are the cadre of professionals sent by CDC throughout the country and around the world to investigate disease outbreaks, disease clusters, and trends of acute and chronic diseases.

I applied to EIS in 1997, early during the second year of residency, thinking, at the time, that I would spend 2 years as an EIS officer in the middle of my 4-year residency. I flew to Atlanta to interview - and what a day it was! I spent the whole day talking with CDC staff who had jobs I would love to have. I returned to residency incredibly energized, but somehow restrained. I now recognized that EIS could alter the path of my career, and I feared that if I went to CDC after my second year of residency, I would never return to finish it. After intense deliberation, I decided to withdraw my EIS application. I also decided to finish residency in pediatrics (rather than in Med-Peds). After all, keeping up in one field can be challenging enough when engaged in that field full-time, and I was now thinking that clinical work would be a much-less-than-full-time endeavor for me. I reapplied to the EIS program to begin the summer I finished my pediatrics residency.

I was ecstatic when I received the call that I had been accepted to the program. As with all incoming EIS officers, I had been accepted into the overall program, but not to a specific position within CDC. During the EIS conference every spring, incoming officers interview for and are then assigned through a match process to positions throughout CDC. On July 1, 1999, I began my federal employment as an EIS officer in the Division of HIV/AIDS Prevention.

During my 2 years of EIS, I was involved in a number of exciting, challenging, and fulfilling projects. I analyzed data demonstrating that routinely offering HIV testing to patients in an inner-city urgent-care center identified persons with previously undiagnosed HIV infection and linked them to medical care. I provided technical consultation to USAID-Guatemala to strengthen HIV/AIDS surveillance in the country. I did formative field work in Kenya to provide information for the design of a study of adverse consequences (e.g., violence or abandonment) experienced by women who disclosed that they were HIV-infected after testing through an antenatal program.

Overall, the transition to life and work at CDC was fairly easy; perhaps anything that followed residency might have been. Certainly, I had to make a few adjustments that took time. The first was having a desk job. I did not like that my day was so sedentary - I still do not - but I learned to increase activity in my after- or before-work hours. In fact, I ran my first marathon during my first year in EIS.

Second, as an EIS officer, I found setting expectations and assessing my performance was often difficult. Sometimes at the end of a day, I found myself not knowing whether the day had been productive. In clinical medicine, one has a schedule for the day, and the day ends when the charting for those patients has been done. The tasks of public health research are not so concrete, and they do not lend themselves to that type of scheduling. Periodically I wondered - and believed I had no way to assess - how well I was doing. I remember talking with my supervisors who were veteran public health practitioners. One through nods and the other with chuckles, both acknowledged that evaluating their own performance was often still a challenge for them.

Third, I missed the immediate gratification of clinical medicine. During my residency, patients responded to medication; they were discharged from the hospital; or they expressed gratitude for caring words, a gentle touch, or a silly and child-friendly approach. The rewards of public health research are not so tangible or immediate. An e-mail reminder for a team meeting expressed this with beautiful humor, "Today we're going to talk about how many cases of HIV we each prevented today." Certainly, the gratification of public health research cannot come from seeing the smiles on the faces of the people whom you helped protect from HIV, nor does it come from counting or recounting the people whose lives you have touched. But, at least for me, the gratification comes from working with bright, dedicated, and passionate professionals to accomplish practical research whose results have clear implications for public health programs and policies.

Toward the end of my 2 years in EIS, I thought about beginning a fellowship in adolescent medicine, contemplating a career that might combine clinical medicine and public health. Although I was accepted to the two programs to which I applied, I ended up deciding that I was not yet ready to leave CDC. And now, more than 7 years after coming to CDC, I am still not ready to leave.

Without a doubt, all days in public health work are not banner days. The bureaucratic process can have its share of frustrations. Thankfully, the results of public health research are far more gratifying than the sum of the paperwork, the budgets, the approvals, and the other logistics that were necessary to bring the study to fruition. I never decided against a career in clinical medicine. (In fact, as a physicians at CDC, I have the opportunity to do a limited amount of clinical work.) I have just decided to do public health work - at least for a while longer.