Aleks Kostic joined OrACORe as a research assistant after graduating from Princeton University with a…
Angel Reyes spent most of his childhood on the move. He was born in California to parents who immigrated to the U.S. from El Salvador and worked as migrant farmworkers, always in pursuit of seasonal crops. Most members of Reyes’s immediate and extended family spoke Spanish, as did he, and few had easy access to health care. If one of them ever did seek medical care, the language barrier could be overwhelming. Now at OrACORe as a T-32 training fellow, Reyes is conducting research inspired by his experiences with an imperfect health system.
The Road to OrACORe
After moving with his family to Washington state, Reyes attended Stanford University, where he studied chemical engineering. Acting on a long-held interest in the science of health and medicine, he began volunteering at a local free healthcare clinic as an interpreter for Spanish-speaking patients in his freshman year. “The more I learned about medicine and social determinants of health, the more I became interested in the interplay between people’s social situation and how that impacts their ability to have good health and access to health care,” Reyes said. “That was the major motivator to go into medicine.”
One year after graduating from Stanford, Reyes began his medical training at Harvard Medical School (HMS). The transition to medical education was difficult — adjusting to a new city and finding a social group were challenges — but exciting nonetheless. Reyes remained fascinated by the human body’s complexity and the various ways things could go wrong.
On his first day on the wards, Reyes scrubbed in on a CABG (coronary artery bypass graft) procedure and held a beating heart in his hands. “Experiences like that are just incredible. It is such a privilege to be present in those moments when someone is putting their life in a surgeon’s hands,” Reyes said. “We go to medical school to treat and help patients, so it’s very satisfying to be in the hospital and finally doing what you’ve worked towards this whole time, applying the knowledge you’ve learned through books and lectures and classes and then actually seeing patients and trying to help them get better.”
Reyes’s experiences in the operating room (“it’s a really special place”), love for anatomy (“the human body is miraculous”), and desire to see his own positive impact on a patient (“the outcomes can be really great”) were ultimately what brought him to orthopaedics. “Giving people function is super satisfying,” he said. His parents’ previous work as migrant farmworkers also helped him decide on a specialty. “Many of my relatives are still working in the fields,” he said. “For laborers who depend on their bodies for their livelihoods, musculoskeletal health is extremely important. Injury or disability could prevent people from financially supporting themselves and their families, and if I can contribute in any way to helping them get back on their feet, that would be incredibly meaningful.” Reyes’s sub-internship in orthopaedics at the Brigham sealed the deal. “I knew immediately,” he said. “I was working really hard and loving it. I couldn’t stop talking to people about how much I enjoyed this experience. It wasn’t until I lived orthopaedics for a month that I realized, ‘yeah, this feels right.’”
Many of my relatives are still working in the fields. For laborers who depend on their bodies for their livelihoods, musculoskeletal health is extremely important.Angel Reyes
Partly to learn more about orthopaedics as a specialty and partly to immerse himself in research, Reyes decided to take a research year following his third year at HMS. OrACORe seemed like the perfect choice. He first heard of the COMET T-32 program from Alex Cortes, a former T-32 fellow whose research focused on expectations in orthopaedic surgery and is now in San Francisco for his residency in orthopaedics. Cortes’s contact information had been included as a resource for orthopaedics-related advice in an email to HMS students interested in the specialty. Reyes, who had never met Cortes personally, reached out to ask about research before residency and was encouraged to look into OrACORe.
A Bridging of Interests
The COMET program, which fully funds its pre- and post-doctoral trainees as they research pressing orthopedic and musculoskeletal problems, is now in its 12th year. Reyes is the 29th and newest addition to the T-32 cohort. “Everyone has glowing reviews of [OrACORe Director Jeffrey N. Katz, MD, MSc], OrACORe, and how much they learned here,” Reyes said.
So far, Reyes has been working on two projects, both of which bring together his interests in social determinants of health and orthopaedics. His first project is using data from the National Inpatient Sample (NIS) to analyze usage of lumbar spinal fusion methods by patient sociodemographics, including race, gender, and socioeconomic status. Essentially, are certain populations having different lumbar spinal surgery than others? “Differences in the use of surgery between groups is not immediately ‘good’ or ‘bad,’” Reyes said. “But if differences do exist, then we wonder why that is the case.”
The second project is a chapter on disparities in the management of osteoarthritis, which has Reyes delving deep into existing literature. His attention is currently fixed on the lower rates of total joint replacements observed within racial minority groups. Despite evidence that racial minorities, especially African Americans, have just as prevalent and just as severe osteoarthritis as whites, they are much less likely to get a total hip or total knee replacement. “It’s not just an access-to-care issue or that surgeons are offering it less, although there is evidence to show that that’s also true,” said Reyes, whose speaking pace picks up as he goes into more detail. “It’s also patient preference. Some racial minorities, for a number of reasons, are less likely to want to get surgery.”
Total joint replacement really is a phenomenal surgery. It is life-altering for people. I think we would like to see more patients benefiting from the surgery.Angel Reyes
One of those reasons may be education, including a lack of understanding about what surgery and recovery entail and the extent to which total joint replacement can relieve pain. There is some evidence that these types of barriers can be overcome through educational initiatives. More problematic, though, is distrust of the health care system. “Racial minorities may be understandably suspicious,” said Reyes, referencing historical examples of the system’s abuse of vulnerable populations. “Total joint replacement really is a phenomenal surgery. It is life-altering for people. I think we would like to see more patients benefiting from the surgery.”
The learning curve associated with starting a research year has been steep. The autonomy has been a challenge for Reyes. “It’s really up to me as an individual to make sure that things are moving and that I’m asking the right questions,” he said. Navigating ICD codes and administrative databases has also been challenging. Nonetheless, Reyes is confident he made the right choice coming to OrACORe. “The people are great,” he said, highlighting Dr. Katz’s mentorship as one of the most valuable aspects of his time here. “It’s such a cool environment to be in. There’s so much interesting work going on.”
A Path Forward
Reyes’s experience at OrACORe has been an “affirming” one so far. “I think research is something I’ll want to be involved in throughout my career,” he said. “I’m always going to have questions: why is my patient presenting this way? How can we best serve patients and their communities? [My time here has] given me more confidence that I will be able to incorporate research into my future.”
Next fall, Reyes will return to HMS for his fifth and final year, applying to orthopaedics residencies along the way. In residency, his focus will be on gaining clinical expertise, becoming the “best surgeon and physician I can be.” Eventually, he would like to return to issues of care disparities as an advocate, perhaps through research, policy, or community engagement. The quality of his clinical care will always be a priority, but “it’s also important to keep in mind the big picture. The systems and institutions around us affect people’s health.”
For those considering medical school, a research year, or any future in health care, Reyes has one piece of advice: reach out to those further along the path than you. After all, he wouldn’t be at OrACORe if he’d assumed Cortes had nothing to share.
To learn more about the COMET T-32 program, click here.