Dr. Sonal Parasrampuria, PhD in Health Policy & Management | FDA Team Lead at Department of Health and Human Services

In this episode, we discuss the role of mentorship in helping Sonal understand how to combine her interests into a single academic trajectory in health economics and in connecting her with hands-on experience in the policy world, the different ways she tailored her PhD experience to prepare her to land a job working in the federal government, and the diversity of the work she does in her current role as the FDA Team Lead at the Department of Health and Human Services.

Hosted by Lois Dankwa

To connect with Sonal and to learn more about her story, visit her page on the PHutures #100AlumniVoices Project website.

Transcript

Lois Dankwa

Hi, I'm co-host Lois, Dankwa. And this is the 100 alumni voices podcast, stories that inspire, where we explore the personal and professional journeys of a diverse group of 100 doctoral alumni from Johns Hopkins University. Today, we're joined by Sonal Parasrampuria, PhD in health policy and management and current FDA team lead at the Department of Health and Human Services. Hi Sonal.

Sonal Parasrampuria

Hey, Lois. Thanks for taking the time to speak with me today.

Lois Dankwa

Yeah, how are you today?

Sonal Parasrampuria

I'm good. Thanks. 

Lois Dankwa

Well, I'm excited that you're here. I'm excited to dive in, and I wanna start by hearing a little bit about why you wanted to pursue a PhD in health policy and management, and also just hear about your graduate work a little.

Sonal Parasrampuria

Yeah, of course. So, I think I was always interested in politics as a child, and I was interested in health care as a lot of public health students tend to be. I also was interested in being a doctor when I was a really little kid, and so I think what I discovered when I went to college was first, that, like, I liked econ. So, for context, I have a PhD in health economics. And so, I discovered that I liked science. But I also liked a lot of the policy work and the way that I was able to meld both of those was to pursue health economics as a general profession. So, I studied economics and politics kind of simultaneously with policy focus in undergrad. And then, after that, I did a master’s in public health, discovered that I really liked the world of public health and worked with, worked in a couple of government internships and worked with a private company after college, and the MPH Program that helped me kind of narrowly tailor what I was interested in, and so kind of through that process I discovered, like, I really like the quantitative research aspects. I really like policy. And and I like doing research on like new ways to inform policy. And so that led me to do to look for basically a PhD program in health policy and management and Hopkins in particular has a pretty significant policy bent, which was the most appealing to me. So, I was very happy that I ended up there.

Lois Dankwa

That's great. And it's funny, because it's being someone that's studying health policy and management, I can certainly understand how a lot of us are people who who's background stem from some interest in medicine. And then realizing, oh, but I'm also interested in policy, and just realizing that all of the different ways that got us here have us interested in this topic that means a lot more than just the words on what the degree is called, so I love that.

Sonal Parasrampuria

Yeah. And it's a great way, like, it's the sort of job that I feel like little kids never know about, but it's a really good way to melf all of my at least my various interests from earlier in life.

Lois Dankwa

Yeah, I certainly understand that. So, I'm curious then what type of career did you see for yourself when you were in the PhD program? And like, how did your past influence that? But then also, how did that influence what types of jobs you started thinking about when you were looking for them? 

Sonal Parasrampuria

Yes. So, I think I'm a little bit unique here in terms of PhD students. I knew I wanted to work for the Federal Government when I was applying to PhD programs, and that never actually changed while I was in the PhD program. So, the different, like my focus in terms of research and what I was working on those sorts of things did change. But I think coming into the PhD, I wanted to work for the Federal Government cause policy was what was the most exciting to me, and all through the PhD that was something that was really exciting to me. And so, when I was applying to jobs, that's also kind of what I continue to do. And then I think, in terms of the research itself like that was obviously transitioning what I was interested in. I was working on a lot of Medicare-based programs and CMS programs prior to graduate school. I did end up also taking a job in Medicare after I graduated. So, a lot of continuity there. But I was working on like hospital and inpatient things prior to graduate school in the I started working with a professor on prescription drug policy my at the end of my very first year at Hopkins, and I loved that work, and that was something I continued my whole time in the PhD Program. I got to do a lot of policy work. I actually had an advisor who works with Congress a lot and works with Federal agencies. So towards my towards the end of my third year, in my fourth year, when I was kind of doing a lot more of my own independent research, I got a couple of opportunities to go to the hill with him and present to some Congressional staffers on various policy ideas and then I kind of continue doing that my through my last year at Hopkins and when I was applying to jobs obviously I applied to what a wide variety because you never really know what's gonna happen. But like when I got the Federal jobs I just I knew that that's what I was gonna do. And I've been there ever since, and love it.

Lois Dankwa

That's so cool. It's cool how you knew kind of what direction you wanted to go in, and then you had the chance to continue to build on that interest in a way that helps kind of prepare you for this moment. It sounds like. 

Sonal Parasrampuria

Yeah, no, exactly. I think sometimes it takes a really long time to figure out what you're interested in, and sometimes you just have to kind of pivot as you get new information and find new people to work with. So, I think for me I knew what I wanted job-wise going in, but I didn't know kind of how to make that happen and what the PhD helped me do was like narrow tailor it to finding a topic area that was of interest to me and also of national policy importance, and then, finding also ways to like when I was identifying my dissertation topics, I picked a dissertation topic that was in the policy realm of what the Government can do. I think that's something that a lot of people. It's not always clear whether or not you should do. But I tailor kind of my job market paper and my dissertation to the sorts of policy questions that the Federal Government would be interested in, because that was the job that I was interested in. And so, it worked out for me in a really great manner. And gave me a lot of insight and experience with the sorts of questions that I would be working on post-PhD, and that has been also very helpful to me.

Lois Dankwa

Yeah, I love hearing that. It's funny, because now my brain is going in 2 different directions for kind of what to where we go next. So, you kind of highlighted how you were a strategic thinker about kind of how you used your PhD to uplift you to kind of this next moment that you're in. But I'm curious. So, I think sometimes in doctoral programs the advice we receive is to stay open to the different opportunities that exist and are around us. And it it certainly sounds like you were open, but you also did very much have a narrow focus. And I'm curious how you kind of balanced like sticking to the vision that you had. But then also kind of being open to different opportunities and things that kind of were not part of your plan.

Sonal Parasrampuria

Yeah, of course. So, I think for me the difference was, I'm I was very narrow in my focus in terms of what sort of job I wanted, but I was not very narrow in my focus on the types of research that I wanted to do. And that is something that is also continued Post PhD, where my research is actually fairly diverse, like my main focus out of my, well, okay, so let's just, I guess, for baseline setting my PhD decision is on health insurance more broadly. But I have, like my job market paper was on the private insurance market. I did a lot of work in the Medicare part D market as well. In my current role I am the FDA team lead, and so I don't directly work on a lot of Medicare, although I do, I also act as one of the drug Pricing Co-Leads kind of merging and melding the in the Department of Health and Human Services, merging kind of the FDA realm of drug approvals and drug development, and in understanding how that interacts with kind of the payment by Medicare on the back end and utilization by Medicare beneficiaries and Medicaid beneficiaries. And so, I think, in terms of that, there's it's pretty broad and pretty open in terms of what I was able to gain experience in during my PhD Program through kind of some intramural projects that I was working on with professors versus what the research I was doing by myself. And that's something that I have continued. I've also done a lot of work in dementia care and understanding, like Hospice needs for elderly adults. I did some work in value-based care when I was in my PhD Program. And so all of those really helped me understand. From a broad perspective kind of how the various aspects of health care and health insurance impact access to care, equity and care, costs of care. And so that is pretty expansive in terms of the portfolio, but it's all within the realm, again, of Federal policy making, so I think, like balancing the very specific versus being very open for me was more about I know what I want to do job wise, but I'm very open, and I think that's also something that I've really enjoyed about kind of my positions. I've been in positions that required a fairly diverse set of expertise and policy perspectives and kind of understanding how to merge all of those different priorities.

Lois Dankwa

That's such a good reminder to like while it's possible slash important to have a very specific thing that you're interested in, whether it's a topic or a method or a skill set that you're trying to develop, remaining open identifying ways that there's a larger applicability of that thing that you want to hone in on. I love that.

Sonal Parasrampuria

Yeah, exactly. And just being kind of open to change and adapting as policy change policy change occurs. Like, for example, one of my dissertation papers was looking to identify kind of how what would be an appropriate out-of-pocket cap for the for a prescription drug spending in Medicare part D, which hadn't been done before, and that actually was just passed as part of the inflation reduction act last August. And now I'm I get to work with CMS and FDA and other people in the agency on implementing this giant rule that I've been working on since the early days of my PhD, so it's really, really really full circle moment. And I actually got to go to the White House for the for a big celebration that they had for the Inflation Reduction Act cause it like that's work that I've been doing on an ongoing basis in like so many different ways. Like, I started as a graduate student, got to present a little bit to Congress at the time, started then at HHS, and have been really involved with kind of the drug pricing plan that the Department has been putting together as a whole and then now on the back end get to implement this giant role of something that I had, this tiny, tiny little part of when I was a graduate student. So, it's a very full circle world and kind of required adapting at all points in time, but within the same one research space.

Lois Dankwa

Yeah, I love that. I love how you've had an opportunity to be a part of the implementation part of the research that you do. But then also being able to just see in real time, like the impact of your work. And I'd love to hear more like what does it feel like to see and experience the results of your work, whether it's going to the hill or now going to the White House like, how do you balance the excitement of seeing kind of the products of your work happening beyond it being like a research publication and how does that influence the type of work you choose to do later?

Sonal Parasrampuria

Yeah, I, think it, I mean, it was an unbelievably rewarding experience and something that I'm still really excited about on a day-to-day basis. I think what the important perspective here is that, like the type of work that you're doing it like I do research in my job now. I did it at the beginning. So, like I've always done research. But the type of research that I was doing changed, and how I frame my research in the findings changes a lot. So, like when I was going to the hill, I would give a 5 to 10 min presentation on a paper that took me several months to research and write, and so kind of translating it, like I needed to for my own interest and for disseminating things in academic policy context it was very important to be very rigorous, and do everything, comprehensively, and have just like a lot of sensitivity checks and those sorts of things. Those things never show up when you are presenting to people on the hill, because they need like main takeaways for what they should be doing, and kind of the main evidence that backs it up and who they're helping. And so, the policy framing is always really different. So, I think that that is really important to understand. And I think that same thing is true now, where, like I get like I got to see that this one paper of mine influenced a very tiny bit of the policy that the Hill eventually got to make, and then now I work on implementation. And there's like a whole different set of questions and like research questions that happen at the back end when you're looking to inform how implementation choices are getting made. And I think, like the scope and the scale can often be different. So, at the be. So, when you're trying to craft legislation, it's big picture big picture questions of like what sorts of policies should be in the bill and what are the potential implications of that. When you're at the backend, and the bill has already been signed, and now you’re trying to implement a lot. It's oftentimes like here are these tiny little choices we have like an agency has a 1 million different options. You work with lawyers to understand what like, what's what are the within the legal parameters of a law. You work, and then, on the policy side, we're being asked to kind of help inform like, maybe they're going to be all these spillover effects in terms of how we implement drug price negotiation or inflation rebates or anything else that's part of this bill. What are the potential spillover effects? How can we mitigate those sorts of questions ahead of time to avoid negative implications? What are potential implication costs? What are their what are implications going to be on like the commercial market or other markets that are not necessarily covered by the law? So, I think that's kind of the types of questions change depending on where you are in this process. But research is still a very, very critical part of any sort of policy making at all points in time in terms of informing legislation or informing implementation, and then eventually down the line once there once this bill is finally implemented, there will also be lots of research that needs to be done to actually evaluate the impacts and kind of continue changing how things are being done and optimizing that.

Lois Dankwa

It's cool to hear how you're such a part of kind of all of the different parts that exist to develop a policy kind of from the inception to seeing it actually after it's been accepted. And I'm curious what are the kind of what are challenging parts of the work that you do now?

Sonal Parasrampuria

Yeah, so I think the biggest challenge is kind of the scope and the timing of it. So obviously like this is a massive piece of legislation, and I feel very, very lucky to have been able to see something come to fruition. Like, I think this is a once-in-day career opportunity where like something you're working on actually gets passed into law and obviously the ACA was a really big version of this in 2010, and I think for people who graduated in my timeframe like especially somebody who was working specifically in drug pricing, this is like very much, absolutely lucky. It was like it came up so many times over the course of the like 6 or 7 years. This Bill kept coming up, and then it would kept kept dying in Congress, and then it suddenly passed out of nowhere. And it's like, oh, this is my opportunity to like hopefully have some sort of policy impact. But I think like it's a massive law. There is tons and tons of choices. There's tons of research that needs to be done and timing is really the issue, because you can never be prepared for everything. And so, you're just trying to do things as quickly as you can, because, like, things need to be implemented really quickly and so you do as much research as you can. You cannot always do a perfect research project, because there is too many variables that you don't can't identify. I think you don't have time to do all of the analysis that you would do kind of absent timelines, but so we review documents. We do kind of like quick and dirty analyses with as much data as we possibly can gather in a short amount of time, and then, to the extent that we can help others make policy choices going forward.

Lois Dankwa

Yeah, that's great. So, I earlier, you were talking about how you had an awesome advisor that kind of helped take you and expose you to different things. I'm curious to hear more about what the role of kind of mentors and advisors have been just throughout your career journey and to get you to this moment that you're in now.

Sonal Parasrampuria

Yeah, sure. So, I think mentors have been extremely important to me. As I mentioned, kind of when I was in college, I was exploring a whole bunch of different topics in terms of economics and politics, and also, I was pre-med for a while. So, I took a lot of biology classes chemistry classes engineering classes like I had no idea what I wanted to do. And so, mentoring there was really important to kind of for somebody to help me understand that like these are the things that you're really interested in. And here are the ways that are it's possible to actually meld all of your interests in a way that I wouldn't have been able to identify necessarily myself prior to college. And then, I think, also gaining fundamental skills was really important. So, like learning how to read, learning how to write, and coherently and synthesize information and present it, are kind of the most important topic or most important skills that I think that I have. And those sorts of things are very much kind of ingrained in me in when I was in college. In terms of my PhD advisor, I would absolutely not be where I am right now without his support and input, because again, he opened the world up to me in a way that I didn't know. So, like I theoretically really liked this world of policy. But I didn't know how to get involved in it, and he was able to actually provide a lot of mentorship in terms of understanding like these are the sorts of questions that somebody with this perspective or this position is going to be interested in, like understanding how to tailor a message to those sorts of people and then actually giving me the opportunity to do it. It was a completely invaluable experience, because if I can do it as like a third or fourth year graduate student, even if it's a 5 minute speech to somebody that I find really intimidating, just a couple years down the line, it's not intimidating anymore and having him as a backup was like absolutely invaluable. So, he taught me how to think about policy questions, how to write a research project that was both rigorous in an academic setting, but also could then be translated more easily into a policy setting, and then actually like he opened a lot of doors for me and gave me opportunities and helped a lot when I was on the job market in terms of opening up just his connections and allowing me to speak with those people and eventually getting a job. And then, as my career progresses like, I still meet and talk to a lot of people that work with him, and I actually still work with a lot of the researchers that I worked with at Hopkins because I have access to one set of policymakers. He has access to a difference set of policymakers, and we all have shared research interests and do continue to do work that is very similar to one another. So, like having those people to be just be able to speak to and kind of help develop policy questions and research questions as I progress in my career has been invaluable. So very important as a mentor when I was in my PhD Program, but also continues to be a very critical mentor in my life.

Lois Dankwa

That's such a good point that it's so important to maintain connections and relationships where sometimes people that start as mentors in a way where you are learning and soaking up so much information from them in the beginning, you slowly start to turn to collaborator as well. They still hold a mentor role. You get to. They get to begin to learn from you in ways that you learned from them. And it's cool to kind of see and experience that shift for sure.

Sonal Parasrampuria

Yeah, no, of course, that I think that has been really rewarding, like, I'm not. I think because I now have access to a whole set of people, it's not necessarily that he's learning anything from me per se. But it is nice, like we do act a little bit more like peers, and we are in kind of spaces together, and we're able to handle like jointly present. Like he is this academic from an academic institution, and has like his own set of expertise. But I do have like a lot of institutional knowledge from the government's perspective now, and having a being having those sorts of discussions is just really rewarding, and it's exciting to see kind of how I have been growing and developing over time. But still obviously require his advice and input, because he has a much longer career and still knows much more than I will.

Lois Dankwa

That's true. Well, I have 2 more questions for you, Sonal, and I am curious what advice you would give to someone who might be interested in a career that looks like yours where they they know what they wanna do, but they're also open to learn government, all of the things?

Sonal Parasrampuria

Yeah, sure. So, I think in terms of advice, I think, being flexible is really important, like, you never know what's gonna happen. And things in the policy world change a lot like that's probably true for all of the worlds. But at least in my own experience, like things change a lot, and you need to be able to adapt, and then identifying actually like really good mentors and fundamental skills that are going to help you, no matter what job you have and what the world looks like is my other piece of advice. So, I think as I mentioned like understanding how to read critically, analyze what you're reading, synthesizing that information is kind of core to a PhD. Like, you have to be able to everybody knows how to do the analytical work, but actually understanding, what are the key takeaways from this research help, both in terms of writing a paper, and then also conveying that information to other people who are able to make decisions is really important. So, I think like focusing on those skills when you're in graduate school to really home them is important. And then finding it like a finding a group of people that you like working with, and who can help you learn and grow as as you continue in your career is also really important, like, as I mentioned, I have like a team of people from my PhD days that I can rely on and reach out to whenever I need to. They provide a lot of support in my current career, and and as I was, as I was graduating and getting a job and kind of I have, I have had a couple of jobs in the government, so as I was transitioning between those roles as well, and that has been really helpful to have kind of outside people who can provide their advice and their support, and other sorts of things.

Lois Dankwa

Yeah, community is such an important thing that just helps keep us going. So as my last question, I'm curious what inspires you right now?

Sonal Parasrampuria

I think that, like the fact that there is a lot of change happening in the world is very inspiring to me. Again, like, I think a lot of my circumstances are unique, and it's like absolutely luck that something passed that I got to be a part of, and I happen to be positioned specifically so that I could actually help with the work that I would want like if I was an outsider. I'm doing exactly what I could I would want to do from that perspective. And I think that really inspires me, because whether or not like I'm working as part of this giant team, all these people, or making such important decisions and to play even a little role in that is really inspiring because it shows that kind of all of my training and education can potentially help me help somebody else now, and like well into the future. I think just seeing there's lots of change happening.

Lois Dankwa

Yeah, I love that. That's that is certainly inspiring. And I’ve just loved this chat today, Sonal. So, thank you so much for taking time with us and just sharing a little bit about your experiences today.

Sonal Parasrampuria

Thank you so much for speaking with me, Lois. It’s been a pleasure.