Disclaimer: this is what my life is like in the nation's public health agency. It doesn't reflect anyone's view but my own, which is guaranteed to be warped.
A lot of folks ask what it's like to work at CDC, and whether it's like the movies, which is a good time to stop and ask yourself, "Is my own job depicted accurately in the movies?" There are zillions of exciting things happening every day at CDC, but every exciting event is a direct result of all the tedious, exacting, slow-moving things that would put any self-respecting movie audience into a death-spiral coma. We spend a lot of time counting up the health-related things that happen to people, and you only see us on the news when one of those counts shifts enough to make it past some news editor's desk. But in this mega-important organization, you run into a set of archetypes, a cast of characters that form the basis of a thousand great stories. This is one offbeat characterization of the types you find in our hallways.
First, the overlords, generally MDs, usually with an ancillary degree like an MPH. It's medical organization, after all, responsible for the health of the United States, and no Congressional or Cabinet staff will be impressed by anything less than a "real" doctor in the top ranks. Naturally, there are those who say the medical doctors are arrogant, clannish, spoiled and demanding, forever issuing edicts as though the rest of us are their serfs. All stereotypes start somewhere, but overall, I've had a great experience with our docs.
The problem comes in when people don't understand the differences in how people are trained to think and act. Doctors are much like military veterans in some ways. They go through a training process designed to break them. The obstacle courses might not be purely physical, but the demands of medical training are just as intense. They are trained to work through immensely complicated decisions about which body system to adjust for what reason, and they have to present their decisions with an air of assertiveness and certainty that forms the basis of their reputation for arrogance. Ask yourself if you would trust a doc who admitted she didn't know what the hell was wrong with you, but said a z-pack will probably keep you alive. Nope. That uncertainty has to be removed from doctors, the same way uncertainty about blowing something up is removed from infantry soldiers.
The analogy goes even further, because like soldiers who are uncomfortable with civilian colleagues, medical doctors -- or any kind of people -- prefer to deal with people who were trained in the same way they were. They are fellow survivors, veterans of the same ugly-ass boot camp, and it's hard for them to realize the value of other people's thought-training. Some of them are more self-aware than others, and try to extend their minds to other points of view, but some of them aren't there yet. But judging them all as narcissists with god complexes is hugely unfair.
Then there are the PhDs, my level, and our training is so different than medical training that we tend to clump together in our own circles, too. We are just as guilty of cluelessness as to the mental workings of others, and it makes us just as clannish. We are the people who run studies and experiments, carry out large- and small-scale analyses, and develop research plans. We are the biochemists who direct the lab work, or the social scientists who try to understand developmental disabilities. We tend to know a topic area like zoology really well, but we might not know a damn thing about other scientific areas. We are experts, but not at everything. Our knowledge is usually deeper than it is broad. To be successful and useful at CDC, we have to figure out where our deep expertise can be used broadly, not just during an outbreak of a horrible new virus, but also during the times when we are just trying to keep the nation healthy.
The MPH and other master's level people come to us through a few pathways. Sometimes they are nurses or other medical folks who went back to get a degree in public health. Sometimes they are fresh from undergrad to grad school to public health. And there are many who went from undergrad to the Peace Corps to grad school; those people tell competitive latrine stories and compare malarial experiences. Going to lunch with them is an experience.
Most MPH students, and probably a lot of other master's students, have spent some amount of time working for professors in their public health school, interviewing patients, gathering data, writing reports, and doing the grunt work of grant-funded research. In graduate school, they are usually someone's work horse, and sometimes they fall into the same roles in their professional lives. That can be great for them, or a bit on the demeaning side, because many of them are at least as expert as the doctoral level people; they just didn't have the money, time or inclination to go for the "higher" degree.
And then there's our real work force, the public health advisors. You've never met a group of people who are as dedicated, or who have the kind of experience they have. They've all been to college and some to grad school, some on the GI Bill, but others in the more direct way. They usually start their career in a county health department, helping run clinics or programs for anything from bedbug infestations to restaurant inspection to testing for water safety to vaccine programs to STD case management, to TB directly observed therapy...usually all at the same time. County health departments don't have the money for specialists, so these folks do EVERYTHING. A good many start off in the infectious disease programs, knocking on doors and telling people, "Hi, I'm from the health department and you've been exposed to an infectious disease, so we need you to come down to the clinic and get tested." They with junkies, tweakers, sex workers, crack whores, school kids, frat boys, rent boys, hustlers, runaways, homeless, and pretty much anyone else that you wouldn't want sitting next to you in a fancy limousine. Know where the best place is to find a lot of disease? Jails. So guess who gets sent to the detention centers to find cases? The public health advisors have seen everything. They can spot a bullshit artist or someone hiding a needle or a person who needs help, and they are trained to treat them all as people worthy of respect.
Those people work their way up the public health ladder, and many find themselves at CDC, working with the rest of us. All those people form teams to solve a problem, and there is not one person on the team more or less valuable than any other. If you don't have someone with medical knowledge, how are you going to figure out what's making people sick? If you can't figure out how to help the states contact the sick people and get them into treatment, what good is the health program? If you can't gather data, analyze it, report on it, put it into the context of larger issues, how are you going to figure out what's going on? And how will you know you did the right thing, in the long run, without the people who can test hypotheses and build the evidence base?
Nothing can be done without the whole team, which makes it sad that I can even order this list by people's degrees and backgrounds. But it's as good an organizational system as any of the others, as long as people understand that the degree and the salary are not the same as the value that people bring to the team.
And I haven't yet mentioned the enormous administrative staff that we need to keep all this running. The biggest mistake anyone could make at CDC is insulting or demeaning the admin staff. Apart from being generally an obnoxious and dickish thing to do, belittling the admins will run you an excellent chance of having a front-row seat at your own funeral, assuming they mercifully let you die someday. On the other hand, building a good and respectful relationship will mean your life at CDC is infinitely easier. Considering the skill and experience level, and the fact that there are truly great people on the staff, why would anyone treat admins as lesser career people?
Why would anyone on this team treat anyone as lesser or better? Well, some of the folks are bosses, and most aren't. Some are in charge of teams of people doing projects, and when work loads get bigger, tempers get shorter. People stop thinking, hey, this person has a different skill set and training, and they start thinking, "Why doesn't this person just get this stuff done?" It's easy to lose sight of the fact that other people don't know how to test behavioral theories or why the hell that's important. People forget that they were new to this career at one point, and they need to stop and mentor the people who are newer. People forget to ask how the wedding went, or how someone's mother is feeling, before they rush in and demand some new product. We get caught up.
Which is why, after being gone for five weeks and only after being gone for five weeks, I can take a breath and think about how this whole team works, or how it should work. I can remember why I do this.
I can remember why it is a good thing I landed in this career, as opposed to that whole violin-playing strip-tease gig I thought about so seriously.
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