Member of the Month:
Travis Bias, DO, MPH, DTMH

Globe-trotting Texas doc brings family medicine to areas of need

Editor’s note: Our October Member of the Month is an extraordinary fellow to be certain, but alas, he’s also California’s most recent recruit. Yes, Dr. Bias has quite recently bid a fair adios to Central Texas and now hangs his hat in the Bay Area. As a tribute and a fond farewell, we’ll still name Travis Bias our Member of the Month.

By Perdita Henry

posted 10.04.17

If you could do anything, what would you do? Many of us would say, “I’d love to travel abroad,” but too often we put off the desire to place our feet on foreign soil. After all, there are responsibilities to be considered, and so those dreams are shrugged off with a rueful smile and a small sigh. Just a fantasy to revisit until you finally have more time, more money, and more energy.

On occasion we run into someone who decided not to wait. They refused to dampen the dream to do something unusual and went about doing it. They recognized there would always be responsibilities to tend to. Why not take the time, see the world, and try something different?

Travis Bias, DO, MPH, DTMH, has traveled to 30 countries. He’s the guy at the dinner party you can’t stop talking to because he’s had so many adventures. He has had the opportunity to see how other health care and educational systems operate up close. He’s hiked in South Africa, enjoyed the small accomplishments that come with learning a new city, shared dinner with strangers, tried cheese and chocolate pizza, and experienced all the things you never have time to think about while you keep up with the pace of American life. Bias and I got a chance to talk about his experiences overseas and how those experiences expanded his outlook on the way physicians are trained, how medical debt influences practice habits, and what advice he would give to someone with a desire to practice medicine in a foreign country.

What led you to family medicine?
The first time I ever traveled out of the country I went to Fiji with my family. It was the first time I had ever been exposed to extreme poverty. I thought it would be cool to marry my scientific and academic interests with my desire to serve low-income areas.

During medical school at TCOM, I rotated with Dr. Todd Richwine. He showed me what full-scope primary care could look like in a modern practice. I got to see him taking care of patients with chronic diseases and mental health issues, while also seeing patients for sick visits, prevention, and annual physicals. I recognized family medicine as a well-rounded specialty that would provide me with the necessary training to take care of patients of all ages and train me in obstetrics.

I love educating patients. Finding out what motivates the patient and then trying to educate them from that angle so they understand. Education can be used for prevention but it can also be used to motivate them to take care of themselves.

You’ve spent a lot of time overseas. Where have you been and why did you go?
Most of my time related to medicine has been spent in East Africa — Kenya, Uganda, Tanzania — as far as education and teaching. As a medical student, I saw that sub-Saharan Africa in general had some of the greatest needs and the fewest resources to meet those needs. In the early 2000s, the HIV epidemic was full-blown and completely out of hand in the area. I grew up around the beginning of the HIV epidemic. I’ve spent a significant amount of time looking at the history of the epidemic because it started when I was a child. I was interested in why there was such a high prevalence of the virus in early 2000s sub-Saharan Africa and why there was such difficulty in identifying and managing those cases. I thought using my training, education, and experience in the area would have an impact but I found that to be unsustainable. I thought through education I could have that would have a bit more of an impact.

I think family medicine is a no brainer. I have a well-rounded view of caring for the whole patient and the whole family. It’s the perfect specialty for people who work in any kind of low-resource setting because you don’t always have access to specialists. It serves me well in low-resource settings like Kenya or Uganda, because their general medical officers run many of the health centers, district hospitals, and even regional hospitals. It’s the generalist with a wide scope of practice providing most of the care and education.

What is a Diploma in Tropical Medicine and Hygiene and what did you do to get it?
During medical school and residency, I did a couple of rotations in rural western Kenya. During those experiences, I realized my training here in Houston hadn’t completely equipped me to fully care for a rural Western Kenyan population. That realization inspired me to obtain the Diploma in Tropical Medicine and Hygiene. It’s a course taught through the London School of Tropical Medicine and Hygiene. I spent three months in East Africa; six weeks in Moshi, Tanzania and six weeks in Kampala, Uganda.

The benefit to completing a course set in East Africa was learning alongside young doctors working in the area. I taught in a new family medicine residency program in Kenya for over four-and-a-half months and then I taught for eight months in a public medical school in Eastern Uganda through a Peace Corps program called the Global Health Services Partnership.

What did you enjoy most about working as a physician overseas?
I’ve always enjoyed seeing something a little different, getting to a new place, and meeting new people. I think changing your setting every now and then is good for your own motivation. There’s something about those small accomplishments — figuring out where the best specials are at the market, finding the good local coffee, taking a subway ride — that gives you a sense of calm and confidence. It shows you can adapt to any setting and live comfortably wherever you are.

What’s your favorite country?
That’s a tough one. I’ve traveled for fun as well and I think I just hit country number 30. My favorite place is Cape Town, South Africa. Hands down. I’ve been there three different times and it is just gorgeous. It’s on beautiful blue water, surrounded by mountains; there’s a lot of hiking and fantastic views. I think it’s that combination of things, and of course the South Africans that I have come across are just warm, welcoming, and hilarious. I am fascinated by South African history. And then there are the wine farms about 45 minutes inland.

Practicing family medicine in Africa or some other far-flung spot on the globe is a dream of many, but few actually do it. What advice do you have for students, residents, and family docs (young and old) who want to fulfill this dream?
I would say first, truly analyze and evaluate your motives for wanting to do that kind of work. Once you’ve decided to do it and you’re planning a trip, make sure you understand how their practice — whether it’s through an NGO clinic or a governmental facility — fits in with the local country’s clinical guidelines, how their practice fits in with the local health system, and that you understand the context in which they are practicing. One of the things I’ve observed is sometimes health care personnel coming in from outside the country are practicing in a way that’s not consistent with the local evidence base or it’s something not well tied to what the local health system is doing. That kind of care is unsustainable and at worst harmful.

Is there a question you’d suggest someone ask themselves before they set off for a trip?
What are my expectations? Many health care professionals going to work in these settings take on the role of martyr. They run themselves ragged seeing patients 24-hours a day for weeks on end and they’re sometimes doing things that might be outside of their scope of practice. If it’s unacceptable to do in practice in the states, it’s likely unacceptable in the international setting you’re practicing in. In these situations, pay extra attention to self-care. When you practice in the states you think about taking care of yourself mentally and physically and I think that’s even more important when you’re exposed to extreme poverty and the health outcomes that come along with that.

You finished your training with a lot of debt and then entered the work force like so many doctors. How do you think that level of debt affects newly minted family physicians and what made you choose such a different path from so many of your colleagues?
I’ve seen research that says educational debt doesn’t affect practice patterns or specialty choice, but I would argue those people have never been $200,000 in debt. To think that type of debt doesn’t affect practice patterns or work habits is unrealistic. That might sound harsh but it’s the truth. Most doctors don’t want to worry about the financial side of things but that amount of debt requires you to think about your family, financial solvency, and so on. Many of us want to bury our heads in the sand because debt has been a part of our lives since medical school but at the same time, it weighs heavily on career decisions. The $30,000 in debt forgiveness is exactly why I worked with Global Health Services Partnership.

You’ve thought and written a lot about medical education. Why does this interest you and what would you like to see change about the way we recruit and train physicians in the United States?
Our system is quite rigid in the way we educate physicians. There’s not a lot of room for creative scheduling to make sure that people have time to pursue other academic interests. Here I was never given more than a few weeks off a year from residency and if you were to take maternity leave or any other extended leave, you would have to repeat an entire year of residency. In other countries, they piece together their training a little more. There’s more flexibility when you’re training in places like the U.K. or Australia. The Australian training systems allows you to take breaks. You might take six months off, but during those six months you’re doing research and building your CV.

One of the things I’m most thankful for when it comes to working abroad is how it has expanded my perspective and changed the way I view our system, and how we practice medicine within it. The reason I have an interest in medical education is because all these practice patterns and habits start in medical school while you’re observing physicians and continues into residency when you’re learning practice habits from attending physicians.

TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting TAFP by email at tafp@tafp.org or by phone at (512) 329-8666. View past Members of the Month here.