The Shape of a Career: From Country Doctor Aspirations to Public Health Leader, with Dr. Paul Erwin
by Sheryl Monks, MFA
“I thought I wanted to be a country doctor and carry my own black bag, but I was open to other possibilities.”
Last spring, Dr. Paul Erwin was appointed Dean of the School of Public Health at the University of Alabama at Birmingham, but his journey to that position, like many others in public health, wasn’t a straight, taut line. Rather, it wound its way like a river, slowing and turning at points too narrow to pass to forge new channels, picking up swiftly in open spaces, and meandering back around, quite poetically, to its place of origin. He could have taken a shorter route, a direct path to a successful career in medicine, and he almost did. His father was a country doctor, who carried a black bag and made house calls in rural Alabama, a worthy vocation in the eyes of young Erwin, who was inspired to follow in his footsteps. But once he started medical school himself, he soon realized the business aspects of private practice were uninspiring, and as he says, “not a viable option.” Talking with him, listening to his soft-spoken, carefully chosen words, it’s clear that he genuinely wanted to help people, and he didn’t mind going out of his way to do it.
The opportunity to do something that truly inspired him presented itself during his last semester in med school when he came upon information that the Johns Hopkins School of Hygiene and Public Health was sponsoring a medical expedition to Nepal. He signed on to participate in a health survey of the Arrun River Valley. And that, he says, is where his life’s path changed:
“That’s where I became exposed to the whole notion of public health, the health of populations, and the factors that really influence whether or not a community has the capacity to be healthy.”
It was there in Nepal where he made the connection that social determinants of health (education, income, employment, housing) are factors that have a strong influence on community wellness. He also developed a relationship with Dr. Jack Bryant, international health expert, a figure who would become one of many lifelong mentors to help guide him. Despite Erwin’s previous misgivings, Bryant encouraged him to complete his clinical training as a foundation for a career in public health.
Following med school at the University of Alabama at Birmingham, Erwin completed an internship and residency in internal medicine at the University of Virginia Affiliated Hospitals, and then he went on to complete his MPH with a concentration in international health at Johns Hopkins. During that time, he reconnected with Bryant, who was then at the Aga Khan University in Pakistan. Erwin joined his mentor to work on a two-year fellowship to help develop primary care for the squatter settlements in Karachi. That experience piqued his interest in governmental health services, so upon his return to the US, Erwin took a position at the Tennessee Department of Health where he would come to oversee 15 county health departments in rural Appalachia for the next 16 years.
“That’s where I really learned public health,” he says. “I found the same cycles of illness and absence of capacity for good health, and lack of education, poverty, and low employment that I saw in Nepal.”
After years of working in public health practice, Erwin’s career interests began to shift again, this time toward academia, in part due to an adjunct position he’d taken at the accredited program of public health at the University of Tennessee. He felt he needed firsthand experience of the dissertation process, so he immersed himself in the DrPH program at UNC-Chapel Hill, and upon participating in an executive program, came into his next position, at the University of Tennessee-Knoxville where he would establish the Center for Public Health, and then later the Department of Public Health.
Returning last spring to the University of Alabama at Birmingham brings his career — spanning practice, research, and academia — full circle, a journey that has given him the unique perspective of seeing (and cultivating) their mutually beneficial points of intersection. During his tenure at UAB, he hopes to strengthen the connections between practice and academia that have already been established between the university and local and state health departments so that the exchange is valuable for all involved: each practice, the workforce, UAB faculty and students, and ultimately for the communities they all serve. Service to communities is important to Erwin.
“I bring a strong sense of the institution’s obligations to the communities in which we’re located, the obligation that we have to serve our community, to bring our expertise to bear on the challenges and issues and problems that our communities face. I want this school to be fully engaged in that.”
He also brings a keen understanding of the challenges presented by the gap in the public health workforce, the disconnect between academia and practice, and the importance of preparing students to step into the roles of future practitioners and academicians. “It’s an interesting place where we are and at the same time a curiosity,” he says.
“We couldn’t imagine a medical school or nursing school without a teaching hospital. In fact, when a medical or nursing student is in those clinical years, there’s rarely the recognition that these are actually separate entities. There’s the medical school; there’s the hospital. We see them as integrated, as one. If that is the case and the model for health professions’ education, why have we not considered that important for public health?
The academic health department, Erwin says, is a critical component of addressing the workforce problem. At the same time, “the formalized relationship between the academy and the practice site provides students an opportunity to apply classroom theory to real-world problems; it provides faculty with opportunities to have practice-informed teaching (does our curriculum provide the kind of education that results in having students who are competent to work in the practice setting?; do we a really teach to what the workforce actually needs?; is the research we’re doing relevant to the needs of practice?; does it answer their research questions?) and at the same time, health departments are known (and required) to collect data… how can faculty work with practitioners to both understand and analyze those data so those data become the evidence base for what public health practice then becomes?”
Facilitating collaboration has long been one of Erwin’s strengths. Throughout his career he’s built partnerships that bolster community health, whether it has been as a med student teaching governmental health service professionals how to implement primary care in Pakistan, or as the Regional Health Director of East Tennessee working with the Knox County Health Department to implement MAPP (Mobilizing for Action through Planning and Partnerships), a NACCHO-sponsored work group he helped to develop and later chaired, during a period of great change when the KCHD was developing a strategic plan to shift from a focus on being a public health agency to undergirding a public health system.
“All of us involved in the development of MAPP saw the huge potential for MAPP to be a place of connectivity between practice and academia. In my experience, it’s certainly played out that way. It played out that way when I was in practice, where I was part of doing one of the four MAPP assessments (the local public health systems assessment). We actually partnered with the University of Tennessee’s MPH program, which had a course in community health assessment. So doing the local health system assessment in the field became the work of the course.”
These days, he’s working at UAB with the Jefferson County Health Department to assist JCHD’s work in the four MAPP assessments. “I think MAPP provides a great platform for practice-academic linkages that really do maximize the expertise of each of those players, and again, ultimately for the benefit of the community because I think it does result in a very comprehensive, evidence-based strategic plan that provides the springboard for action.”
Erwin’s relationship with Dr. Jack Bryant spanned decades, from the time they met in 1983 to working together in Karachi in 1988, to more recently in 2012-13 when they reunited again on projects in Kenya, and on up until Bryant’s death in 2017. He counts the experience, like most things he’s involved with, as being “mutually fruitful.”
“I tell students to poke around faculty pages on university websites. Read what faculty are doing and if you find something that gets your passion stirred, reach out to that faculty person, be intentional about setting up time to meet with that person and talk with them… Faculty welcome that contact. Faculty actually thrive on that kind of initiative on the part of students. And it’s often an entryway for students to become engaged in that faculty person’s scholarly work… And as you identify that mentor, nurture that relationship. Stay connected. My staying connected with Dr. Bryant spanned a lot of years, and he remained a mentor until he passed at 92.”
But there have been other important mentors in his life as well. In addition to Drs. Bill Keck and Doug Scutchfield, who offered him opportunities to work in Cuba several times and to engage in public health systems and services research, he also counts Dr. Lloyd Novick, Editor-in-Chief of the Journal of Public Health Management and Practice, among them. “For whatever reason, in his wisdom and insight, he saw something in my early attempts at producing a scholarly paper or two for the journal, that although I was certainly rough around the edges in many ways and needed guidance, that propelled him to invest time and that produced confidence in me and in him.”
Erwin joined the editorial board of the Journal of Public Health Management and Practice in 2009, and has written and published there over the years on linkages between practice and academia, the evolution of the academic health department, MAPP as a framework for those linkages, health department accreditation, and the importance of building coalitions, among other subjects.
“I think the journal has been the place that has allowed public health professionals who don’t come into the scholarly work from a purely academic position to tell their story,” he says. “Not everything that’s important has a P value attached to it. And although there certainly is quite a good bit of quantitatively focused scholarly work that gets published in the journal, what I have been particularly impressed by over the years, is the opportunity for practitioners or people who are in the early stages of an academic career to have a platform for telling a story well in a way that creates a substantive article, that isn’t just a personal memento, but is scholarly work that’s more qualitatively oriented. I think that’s been one of the greatest contributions of the journal. It’s also, in that sense, been a community of practice-focused scholars and scholarly-focused practitioners. And I know of no other journal that does that kind of embracing.”
After his first year of residency in medicine, Erwin took a year off to return to his college alma mater Sewanee, well-known and highly regarded for its creative writing programs. He wanted to hone his skills as a poet, a long-held interest. What he learned from the experience was an appreciation for language, expression, and the craft of writing. “I try to channel that same creative energy into what I hope is good editing in some of my journal responsibilities, and what I want to be as thoughtful writing that invites people to read.”
Paul Campbell Erwin, MD, DrPH, is Dean of the School of Public Health at the University of Alabama at Birmingham. Erwin earned his bachelor’s degree from the University of the South (Sewanee), his medical degree from the UAB School of Medicine, a master’s degree in public health from Johns Hopkins University, and a doctorate in public health from the University of North Carolina. He is board certified in internal medicine, and public health and preventive medicine, and is a Fellow of the American College of Preventive Medicine. [Full bio]