The Dissertation

To begin with, the word dissertation comes from the Latin word "dissertatio", meaning "path".

I like this definition because it has to do with climbing a mountain. Getting on the correct path is the key, both at the beginning of the journey and staying on the path all the way to the end.

So how is a dissertation a path?

To begin with, most paths are not perfectly straight! A path winds around obstacles and up and down hills as it makes it's way to a destination.

When I began my PhD program I knew exactly what I wanted to study and write for my dissertation. I wanted to study Type 1 Diabetes and the environmental factors that are known to contribute to the development of the disease. In my first semester I found over 60 research articles on the subject and I began to read them and learn all that I could on the subject. My reasons for choosing Type 1 Diabetes were two fold. First, I have two nieces with Type 1 Diabetes and I have seen how difficult a disease it is to manage and how hard it can be on a young person and their family. I knew I wasn't in a position to find a cure but perhaps I could learn something about the onset of the disease and how to prevent it in the future. My project quickly expanded and I ran into the road block that all PhD students will face...GOOD DATA!

If you don't have good data to base your research off of then you are stuck in the mud. The problem with Type 1 Diabetes is that most of the data available combines both Type 1 and Type 2 Diabetes together. I was told many times that a good estimate for the number of Type 1 cases is 10% of the total. The two diseases are completely different and I couldn't believe that the data was still being combined. That left me with the option of collecting my own data and working with the local children's hospital to conduct a survey for all the newly diagnosed children with the disease. I would also need to find a control group and it would likely take about a year of data collection to really start to get some good data. The other obstacle I ran into was the fact that the strongest environmental factor, according to the literature, that was contributing to the onset of T1D were viral infections. In medical geography we attempt to map the explanatory variable and then spatially analyze the impact it might have on the at risk population near it. I cannot for the life of me figure out how to map viral infections, or viruses in general, and even particular viruses at that.

So...I was in Rockville, MD for a work conference and I was reading a Primary Care Needs Assessment from the State of Montana and a light bulb went off in my mind about a new dissertation topic that appeared to have much less data issues.

I was don't some work on Health Professional Shortage Aras (HPSAs) and Medically Underserved Areas and Populations (MUA/Ps) and I found a common theme that HPSA scores, which are a complicated system that I won't go into here, are not consistent with poor health outcomes in almost every area around the country. I immediately stated to map out the HPSA areas and get data from the County Health Rankings website so that I could do some preliminary analysis to see if this was in fact true. Come to find out that HPSA scores do not have a statistically significant correlation to poor health outcomes! This would be a great dissertation! The data is all public, it is relevant to my field of study, it has policy implications and I am already familiar with the subject.

So I went full steam down this path...until...again I talked to enough people and read enough federal regulations and manuals that I came to the conclusion that there is no point in correlating HPSA scores to health outcomes because HPSA scores were never meant to find the areas with poor health, they were meant to find areas with a shortage of providers and where NHSC providers might be placed. There goes that idea.....

Through all of this I have been reading many papers and learning more about my field of study and the topics of interest at this time. I am confident that I will figure out the next direction this "path" will lead me because I am not a quitter and I set my sights high and I know what it will take to get where I want to be.

One day I was walking across campus and I noticed a small tree near the path I was walking on and there was a plaque in front of the tree with the picture of a professor and a quote. It had a profound impact on me and has become almost the motto of my PhD journey.

"All things excellent, are as difficult as they are rare." - Spinoza