VA Researchers Who Served: Dr. Mary Jo Pugh

South Texas Veterans Health Care System

July 31, 2017

Dr. Mary Jo Pugh is an accomplished researcher in the areas of diabetes, epilepsy, and geriatric care. She's a professor in the Department of Epidemiology and Biostatistics at the University of Texas and a research health scientist at the South Texas Veterans Health Care System in San Antonio. She has led studies funded by VA and the U.S. Centers for Disease Control to examine the quality of medications that are considered problematic for older patients, the treatment of older patients with epilepsy, and the development of measures that can be used to examine quality of care for adults with epilepsy. She has also examined the simultaneous presence of chronic diseases among Veterans from Afghanistan and Iraq. Pugh is proud of the work that she's doing on behalf of Veterans and hopes it will improve their health conditions.

VA Research Communications: What drove you to military service?

Pugh: I grew up in northern Minnesota in a family that valued military service. My father was a Korean War Veteran who encouraged my brothers to enter military service. While he did not necessarily encourage me to join the military, he was very supportive and proud of my decision to do so.

I received an Air Force ROTC scholarship to study chemical engineering. After realizing that was not really aligned with my interests, which were more related to fitness and health, I switched my major to nursing and received an ROTC scholarship for nursing.

When and where did you serve in the military, and what did you do?

I entered the Air Force as a nurse and completed a nurse internship at Eglin Air Force Base in Florida. I transferred to Patrick Air Force Base, also in Florida, in 1985. The hospital at Patrick Air Force Base was a small facility, which allowed for an interesting mix of early leadership opportunities, exposure to a wide variety of clinical experiences, and a chance to support the U.S. space shuttle program. I was part of the team that provided ambulance support for shuttle launches on several occasions, including the Shuttle Challenger disaster in 1986.

During my service, I was a fitness advocate. I was training a team for a triathlon when I was hit by a car while riding my bicycle on a bike path. During that accident, I experienced a traumatic brain injury [TBI] and seriously injured my knees. This resulted in me medically retiring from the service.

Because I was married to another Air Force officer, I remained a part of the military community for another 17 years. As such, my opportunities for education were dictated by where I was located. Frequent moves complicated that ambition. I completed my doctorate in developmental psychology at the Catholic University of America in 1999 and shortly after that moved to Hanscom Air Force Base near Bedford, Massachusetts.

How did your research career begin?

Shortly after moving to the Bedford area, I applied for a job as an SAS programmer at the Center for Health Quality, Outcomes, and Economic Research at the Bedford VA. During my interview, Dr. Dan Berlowitz told me I should consider a post-doctoral fellowship in health services research, and that he would facilitate that if he thought I would excel at the work. A year later, I began the fellowship. That work, the people I learned from, and the Veterans included in my research have inspired me in my career.

Did you have mentors in your youth or at any other time who inspired you in life, the military, or your research career?

While I had a number of mentors who inspired me, I have to say that the mentor that most influenced me came during my research career. Dan Berlowitz hired me as an SAS programmer, trained me in using VA data for research during that job, and actually put his research program at a disadvantage in the process. His willingness to make the sacrifice to help me develop research skills and expertise has always inspired me and has been a model for me in training junior researchers on my own team.

Did your military experience inspire you to pursue a career as a VA researcher?

I honestly did not know that there was such a thing as VA research until I interviewed for the job at the Bedford VA. Once I was in the system, I became very interested in examining long-term impacts of military experiences. My personal experiences have deeply affected my interests and my current line of research.

My early VA research reflected how my experience as an Air Force nurse melded with the research interests of my mentors. As I developed more skills, I was better able to turn to issues that interested me personally. My own TBI led me to be interested in symptoms of TBI, such as epilepsy, which I started researching relatively early in my career. While my service was not one that occurred during wartime, my husband and many friends served and were deployed to the Gulf War and to Iraq and Afghanistan. Their experiences led me to be very interested in long-term outcomes associated with deployment exposures. My husband's Gulf War illness has sparked my interest in developing a line of research focused on Gulf War illness.

How do you feel about the possibility of making life better for Veterans through your research?

My current work uses longitudinal methods I learned in my doctoral work, with merged DoD-VA databases and primary data collection via surveys and interviews, to examine long-term outcomes of deployment. My first work started with TBI, and as I've formed relationships with DoD colleagues, I have extended that work to extremity injuries and male reproductive system injuries to advance VA-DoD collaborations and improve our understanding of the long-term outcomes of these injuries. Through this work, we are describing how commonly these injuries co-occur, the impact of each injury, and the combined impact of all injuries. This work is also identifying how early treatment at DoD is associated with later outcomes, and how the types of care at DoD and VA are associated with good and suboptimal outcomes. I am now beginning a similar line of work with Gulf War illness, which is particularly exciting for me. These studies have the potential to change clinical practice at DoD and VA. Even more exciting is the opportunity to help Veterans better understand factors that affect their physical, social, and emotional health, and the chance to ultimately learn of ways they can use that information to improve their lives. That makes the long days worthwhile!

Do you believe being a Veteran gives you a greater emotional tie to the work you are doing, or more insight into Veterans' needs?

Being a Veteran definitely fuels my passion to find answers. It gives me ideas that others wouldn't necessarily think of and unique insights into approaches that may be more or less successful in conducting research. In many ways, I am a researcher and stakeholder from the Veteran and caregiver perspectives in one. Not only does my experience give me different insights, but it also stimulates a sense of urgency to understand complex issues related to multiple chronic diseases.

Based on your life experiences to date, what do you believe are the keys to success?

The keys to my success have been adaptability, resilience, hard work, and relationships. When I completed my doctorate and moved to a place where I had no connection and no idea of what I should do professionally, I was open to a position that was not ideal but that opened doors to new possibilities. As funding priorities changed, I adapted my work to fit those priorities while addressing issues that are in my areas of expertise and interest. That required significant shifts in approach, a need to learn about new sources of data, and development of relationships within VA and DoD. Meeting these challenges has led to the most rewarding work I have ever done.

What motivational tips would you share?

First, be open to opportunity. Then, when the work gets hard, think of who we are working for and how this work will help. Finally, find others who share your passion and work with them. Those relationships will help you get through difficult times.

What's the next step for you in your VA career?

Thus far, my work with Afghanistan and Iraq Veterans has focused on describing their health status and injuries, and outcomes associated with those injuries. The next steps of this research will use complex statistical models and DoD health care data to determine if it is possible to identify Veterans who are at high risk. The work will also identify specific patterns of treatment that are associated with better outcomes. That information can inform research that evaluates the type of medication and non-medication approaches that are most effective for specific people so VA can provide care that will optimize their health and well-being. My hope is that this work will ultimately improve the social, emotional, and physical function of Veterans.