Dr. De Sanctis is ABIM Board Certified in Internal Medicine and Infectious Disease. Currently, she is the Program Director of the Infectious Disease Fellowship at Spectrum Health/MSU in Grand Rapids, Michigan. Previously, Dr. De Sanctis served as Associate Hospital Epidemiologist and staff member of the Infectious Disease Division at William Beaumont Hospital in Royal Oak, Michigan. She also served as Associate Staff at the Infectious Disease Department of Cleveland Clinic.

Her research and clinical interests are transplant infectious disease, neuro infectious disease, cardiovascular and device infectious disease, and bone and joint infections. Dr. De Sanctis earned her medical degree from Universidad Nacional de Rosario, Argentina, and an HIV/AIDS master's degree from Universidad de Barcelona in Spain. She completed her internal medicine residency at Hospital Provincial de Rosario in Argentina and the Grand Rapids Medical Education and Research Center/MSU.

What it was like having to adapt to life and work in the different countries, and how did this experience shape you as a physician?

I was born in California but my family was originally from Argentina. When I was almost eight years old they decided to move back to Argentina for multiple reasons. My family was not wealthy and they were concerned that they would not have the money needed for me and my sister to go to college in the US. In Argentina, university and what they call here graduate education is free. So, my parents knew I was going to have a better chance of going through a graduate career in Argentina than maybe staying in the US.

The medical school program is different in Argentina. Straight out of high school you chose your path and start medical school right away. I finished medical school in six years and I did my residency in internal medicine - that is similar to here and takes three years. And then I did an extra fourth year as a chief resident. Around that time between third year and fourth year was when I started shifting my career toward infectious diseases.

I always say that I did not choose infectious disease, infectious disease chose me. Life does that sometimes and life made things happen for me to go into infectious disease. First, I started working as an HIV/AIDS provider and I felt that I needed to be more informed and prepared for my patients. I didn't feel I could be an HIV provider just coming from internal medicine, so I decided to go to Spain to do a master's in HIV/AIDS.

That's why I went to Spain. It was a two-year program that was especially designed for foreign doctors, so it was like an executive master's degree program. It was eight weeks one year and another eight weeks the next year. And in between you had to prepare your thesis to present.

Around that time Argentina had one of the most critical economic crises in its history. And I thought, well, I'm a US citizen, I'm still young and I will just go to the US and go into a residency program again there. I thought, it would be a new challenge - I had to repeat my internal medicine residency, but this time it would be in English. To me it was like a fun challenge. I feel blessed for all of my teachers and professors who took me under their wings and then I was able to fulfill my desire to be an infectious disease doctor.

How was your second training different than your first? What was the most difficult part for you?

I would say it consolidated a lot of my knowledge and it expanded it as well. Obviously, when you come out of medical school, you don't know everything. I still don't know everything; I'm still learning after more than 20 years of graduating from medical school. I would say the challenge was learning how this system works compared to the others. Argentina was considered like a third world country in regards to the availability of technology. I trained at a public hospital, not a private one, so we had what we had and you had to make it work for your patients. Here there is an abundance of technology.

Technology does help get diagnosis faster. There is a difference, though, in how you approach things if you have technology and if you don't. I think that was the biggest difference - how we had to take care of patients with limited resources in Argentina and with more resources in the US. And also, the language was challenging for me. I had to transform my whole vocabulary from Spanish to English. Medicine is all Latin-based so a lot of the terms are the same. But I needed to incorporate English now in a professional way in the medical language.

Do you think that going from a system where there is less technology to one where there's more made you see things in a different way? Do you think you approach things differently than if you had just studied in one country?

Yes, I think it makes you think about things in a different way. You can provide better patient care if you have all the tools, right. It doesn't mean that you can't provide good care without the tools. But you can kick it up a notch when you have all the technology at your disposal. So, yes, technology does help and does make you innovate, absolutely.

But not having technology, I would say, does make your skills sharper in some ways. You need to rely on your medical knowledge, your stethoscope, your hands, and not on a CAT scan or a test result that you can't get. You need to already anticipate and think 'what am I looking for, let's go and see if I can find it.' So physical exam is heightened when you don't have all the technology to tell you what's wrong. You have to really rely on your clinical skills.

I chose to train at a public hospital and not a private hospital in Argentina with all the limitations that come with it because of just that. I felt it was a better way to learn diagnostics and how to read between the lines than just relying on technology. Obviously, we're talking about 20 years ago, now the hospital where I trained has its own CT. But at that time, we didn't have all the technology. So, as an intern, it was my job to ride with the patient in the ambulance to go to the other hospitals to get the scan. Or if we wanted to order an echocardiogram, we had to go with the cardiologist to see the echocardiogram and learn from the cardiologist. We would wheel the patients to radiology and read the x-ray with the radiologist there. So, as interns we had to participate 100% in the care of our patient. It was different; it does teach you a lot of clinical skills that we should continue teaching our medical students and I do it on rounds, bedside sometimes.

For example, sometimes I will ask my students if anyone has ever taught them how to auscultate a spleen? They all just look at me like, what? And I tell them well, if you go to the old, old, very old school books of clinical examinations, you're going to find it. But you have to go to those old books in the old libraries. You don't need a scanner to know how big the spleen is if you know how to examine it. And then I show them. So, yeah, I can use some of those old teachings to my advantage.

I would say coming from Argentina I was a very well-trained clinician. And with my residency here I learned how to utilize a lot of the technology to my favor.

You said you started out treating a lot of HIV/AIDS patients; is that something that you were drawn to?

Yes, I was drawn to working with this population. But like I said, sometimes life chooses for you. At the hospital I was working at we had an internal medicine doctor who was among the first taking care of HIV patients. At that time, back in 1997 or 1998, we only had two or three drugs for HIV/AIDS. She was going on vacation and she asked me to cover the clinic for her and she told me the protocols and treatments. I had just had my first patient who was an HIV patient with crypto meningitis. So, I covered for a her. And then she came back and said she was going to do a two-month master's program in Spain and asked if I could cover for her again. So, I thought, well, I think I need to prepare more to cover the clinic and I started doing more studying and participated in the International AIDS Conferences and did whatever I could just to learn about HIV/AIDS and treatments. And then she comes back and says, 'I'm getting married in France and I am moving there, the clinic is yours.' I just thought 'oh my God, now I really need to do something.' And that is when I decided to do the HIV/AIDS master's in Spain.

And then in the middle of all that is when Argentina's crisis happened and I decided to restart my career in the US. So, there you are. Life takes you to different places and sometimes you just go with it.

There's been a lot of discussion of 'the Fauci effect,' where more people are moving into infectious disease. What are your thoughts on this?

Absolutely, I can speak from experience. When COVID hit, I think many people were able to see everything infectious disease entails and were drawn to it. We were on block 10 of fellowship when COVID hit and I asked my internal medicine resident what he wanted to do when he was done with his training, and he said he wanted to be a hospitalist. I asked why not infectious disease. But after a few weeks, he was on the team that had the first transplant patient that had COVID in our hospital. And he presented that case and then COVID research, and immunosuppressed and everything that happened on that block, and he got completely involved in infectious disease. He saw what an infectious disease doctor could do, what is our role, how important infectious disease was and he is my fellow now.

This year, we had more applications than last year. It could be because it's all virtual. And so maybe it's the Fauci effect or the virtual effect where it's easy to apply, and less expensive because you don't have to spend money traveling. But I don't think COVID has had a negative effect for infectious disease. I think on the contrary, it had a positive effect in that a lot of the younger residents saw how important the role of the infectious disease doctor in the hospital is - from infection prevention in out-patients from ambulatory clinics, to vaccination and all the different areas where the infectious disease doctor is needed. So, yes, I do think the Fauci effect of everybody wanting to be part of something bigger is there.

How have you changed the way you do things because of COVID?

I love virtual. Team meetings and our conferences, will stay virtual. I think that the participation of faculty is at 100% - everybody attends. They attend from wherever they are. We already had virtual medicine before COVID, so it's not that it changed much for us. We started doing a little bit more and offering it to patients who live far away. If they felt unsafe coming to the hospital, if they wanted to do a virtual visit, they could. For infectious disease in particular, we don't necessarily need to touch patients to follow-up a treatment or to check how they are. So, I sometimes tell them in the winter if they want to stay home, we can do virtual. And then when the roads are better or when you feel like you want to come and visit me, come in. You give a little bit more independence to the patients and flexibility on how they would like to be seen by their doctor.

Why did you decide to join ABIM Governance?

Well, I got an email saying that they wanted to have the perspective of an IMG graduate on the Infectious Disease Board. And I thought that was a very interesting ask because international medical graduates have a journey that is a little different from a US graduate. I don't know if it's a perception, or if it's really a little bit more difficult. The process is confusing, at least it was for me! Maybe other residents or medical students have more coaching but I was kind of like solo and really didn't know what to do. I just Googled everything and I didn't get coaching I could have used. Like, a simple example of that for me was when I was applying for residency. It said the opening time to submit applications was July 1st to November 15th. So, on November 14th, I submitted everything. That was very late - I should've done it on July 1st, but I didn't know. I had no idea.

And there might be others like me who experience this kind of confusion and that's why I felt that having a place in the ABIM to voice things like - 'how do we screen these candidates? Do we only look at their scores? Do we look at all their experience and their previous medical school or we only going to measure them by their step scores?' - would be very helpful. Because it's different, but you can miss some great candidates if you only look at some specific things and don't consider others.

You can't compare a US graduate that has been working towards those step scores their whole career to international students who have never taken a standardized test, right? Students in the US have been doing standardized testing their entire student life. All of my testing prior to coming to the US was oral. I rarely took a written exam. Our exams were maybe even with patients, real patients, that we had to examine and diagnose. How you're taught and trained in medical school is different in different countries. I think that's important to have all the voices at the table when we discuss these things.

What do you do in your free time?

I have three girls (ages 8, 13 and almost 15), so when I'm not working, I spend time with them. I love to bake with them. Yesterday we made jelly. We made flavored salt, that's a new thing, I guess. We made bread. I like to garden. We have our own garden where we grow some vegetables. We make pesto from our basil and things like that. So, yeah, I like the kitchen a lot. I always said if I could I would take some courses for chefs. My mother was a great baker and I know how to bake, decorate cakes, and I think I get my love of the kitchen from her.

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