The following was originally published in our Vitals Fall 2016 issue.

Melissa Wu is the medical director and division chair for Immediate Care of Southern New Hampshire. She is the class representative for the Class of 1992 and lives in Nashua, New Hampshire with her husband, Tyler Brannen.  Together, she and Tyler enjoy the beauty of New England (hiking, canoeing, snowshoeing, cross country skiing) and are active members of their local running club, representing the club in running races all over the region, organizing the medical support for the club sponsored marathon, and taking running vacations all over the world.  Melissa’s classmates will likely recall that she was never far from her camera (taking all those group shots for the yearbook), and her friends, family, running companions, co-workers can attest that the interest in photography continues.

Why did you choose the UVA School of Medicine?

The short answer is that it was an in-state school for me. I was really fortunate to have an in-state medical school that was such a world class facility. At the time I was interviewing, UVA was in the process of building a new hospital. It was exciting to be coming to a state-of-the-art facility and know that we had world renowned research and discoveries being made right here. When I interviewed, I felt at home. It had the right fit.

What was your experience like at UVA?

I came from Johns Hopkins undergrad and felt that I was well-prepared when I get to UVA, but I quickly realized that my classmates were all from great schools, too, were incredibly bright, and many of them seemed to adapt to the all day lecture format of the basic science years better than I did. The work was a lot harder because there was a huge volume of information to be learned now in one or two lectures, that used to be covered in one semester in college. I found that I did not learn as well with this lecture format as I did once we started doing clinical rotations, taking care of patients. I also discovered that I thought I came in knowing what area of medicine I wanted to go into, but as I had more clinical exposure, I kept changing my mind about what I wanted to do. It wasn’t until I completed all my clinical rotations that I figured out which area fit the best.

What led to your area of concentration?

When I went through all my rotations, I enjoyed them all, but because I really enjoyed head and neck anatomy, I wanted to do ENT. However, after medical school, while doing a general surgery internship at Johns Hopkins, I had the opportunity to do a rotation in the emergency department (ED) and found that emergency medicine (EM) really pulled together everything I had enjoyed the most in medical school more so than going down the surgical route. Plus, the people I worked with and the lifestyle and personalities seemed to be a better fit for me.

I moved on to an emergency medicine residency at Johns Hopkins. Because EM was one of the newest specialties, the track for advancing in academics was somewhat different from more established fields like internal medicine or surgery. I liked teaching residents and medical students but did not really have a strong research interest; therefore, I wasn’t quite sure what I wanted to do after residency. Then the opportunity arose for me to do an administrative fellowship with a healthcare focused MBA at Johns Hopkins. I had double majored in Science and Economics as an undergrad and had never thought I would use the economics again, but now here was a chance to combine my interests in medicine and economics. This healthcare focused MBA was a new concept at Johns Hopkins, and came along at the perfect time for the start of an urgent care program in the Johns Hopkins ED. I was able to be the director of the new urgent care while working on my MBA, using new skills and knowledge from my class studies to build the urgent care center. This combination of administrative and clinical roles and urgent care medicine turned out to be a perfect niche for me, bringing together interests and experiences from throughout my life.

What are you doing now?

I am now the Medical Director and Division Chair for Immediate Care of Southern New Hampshire and have been in this role since 2009. Prior to this, I was the urgent care director at the Johns Hopkins ED, moved to New Hampshire in 2006 with my husband, a native New Englander, and spent 2 years as the Medical Director of a busy, 45,000 annual visit ED at a community hospital, Southern New Hampshire Medical Center (SNHMC).  It was a difficult adjustment at first from a teaching institution to one that was community-based. I had to learn new workflows, referral patterns, key players in the health system.

During my 2nd year as ED Director, the SNHMC leadership wanted to start an urgent care center that would be part of the hospital but off-site. Since starting an urgent care center was something I had done before, it was the ideal next role for me. So I worked with a clinical and administrative team to open our 1st urgent care center (called Immediate Care of Southern New Hampshire) in 2009. With almost no local competition, it was immediately busy and successful, which led to adding more Immediate Cares over the next few years, all at off-campus sites. As of Summer 2016, we have opened six Immediate Care facilities, and are adding a center in Massachusetts in Fall 2016. We pair the Immediate Cares with primary care practices to help with patient overflow and also to help grow the health system primary care base when patients come in without a primary care physician. Our care is also well coordinated with providers in our health system (primary care and specialty) because the Immediate Cares are part of the same health system, with shared electronic medical records, radiology, lab. Thus, we’re able to save patients’ time and are providing value added care. It is exciting to be part of an urgent care model that can be really helpful to patients.

Having been involved in building Immediate Care from the ground up allowed the whole team (receptionists, nurses, providers) to be part of the process, which has led to better buy in, loyalty, and a sense of responsibility for the success of the program. This results in more satisfied patients, providers, and staff.  This is unlike my experience working in the ED where you often couldn’t see patients quickly enough, leading to unhappy patients, and high stress level for the providers and staff. While there’s no perfect job, Immediate Care has ended up being something that our whole care team feels proud to be part of.

What advice would you give to today’s students?

Definitely take advantage of every learning opportunity. You never know how you’ll be able to use something you learned at some point during your life. No learning opportunity is wasted. In my case, although I didn’t end up going into surgery, I have been able to use skills that I learned during my surgical training to care for patients in the ED and Immediate Care. Also, my economics background came in handy when studying for my MBA.

Realize that you can learn from many sources, need to take the time to listen, and should practice respectful communication. Don’t assume that you’re just learning from your classroom, professors, attendings. You can learn from all members of the care team, especially the nurses. During residency, I realized very quickly the importance of teamwork and treating nurses with respect since they often knew more about the patients than I did, would look out for me and help me. Some of the residents I worked with who came in not listening to or respecting the nurses would have an antagonistic relationship which would lead to being paged often and kept up all night. You can also learn from your patients, so try to resist the urge to make assumptions or jump  to conclusions about who you think a patient is, otherwise, you may miss some important detail by not listening.

Don’t go into medical school assuming that you know what area of medicine you want to go into or what kind of doctor you want to be. You can miss an area of medicine that might really be the best fit for you if you don’t try to learn about as many medical fields/specialties as possible. For me, my varied experiences helped prepare me for a position that did not previously exist and that I was able to be involved in developing.

Since I did not take a straight line to find my perfect niche in medicine, I want today’s medical students to realize that if they try one job or start down one path in medicine but are not happy with that choice, it is never too late to change. If they “fail” to get into the residency or job that they really wanted, it is not the end of the world, and in fact may open new doors and areas to consider that they might not have thought about before. Ultimately, this may lead them to find their perfect job.

Anything to add?

I gained lifelong friendships during medical school. I have more friends that I still keep in touch with and have things in common with from my days in medical school than any other stage in my life. A few years ago, I got more involved by becoming class representative, and have really enjoyed planning reunions and getting back in touch with classmates.

I have held director/leadership roles ever since residency and being a naturally shy person, never felt that I was actively seeking out these roles, but had them almost fall naturally into my lap. I feel that I can credit my training and experiences at UVA Med with helping to shape me and many of my classmates into leaders and innovators. So many great things came from my experience at UVA.