The first flood was alarming. The second, less than a decade later, was clarifying. When Sheetal Khedkar Rao watched her basement fill with water a second time from what was classified as a "100-year flood," she recognized something her medical training had not prepared her for: climate change was not a future threat. It was already inside her patients' lives, and her own. That recognition sent her looking for a different kind of education.
Rao, an internal medicine physician, completed the University of Colorado Climate and Health Policy Fellowship in 2023, an institutional credential that remains relatively rare in academic medicine. The fellowship reflects a broader, if still nascent, shift in how some physicians are demanding to be trained. Planetary health curriculum is beginning to appear in medical schools, and a cohort of clinicians is making the case that understanding climate science is as relevant to patient care as understanding pharmacology. Rao came to that position not from ideology but from lived experience.
The clinical implications she describes are wide-ranging and specific. Future physicians, she argues, will need fluency in the full spectrum of heat-related illness, covering both acute presentations and the slower, harder-to-diagnose effects of chronic exposure. They will encounter more patients carrying the psychological weight of extreme weather events and climate displacement. As she put it:
"They will see more mental health effects of the planetary crisis which will include trauma from extreme weather and climate migration."And the infrastructure problems will reach into treatment itself. Water insecurity, Rao notes, could limit access to therapies like hemodialysis while simultaneously driving higher rates of waterborne illness. Vector-borne diseases will require sharper diagnostic attention as their geographic range expands.
Her interest in community-level intervention connects the clinic to the neighborhood. Expanding greenspace, particularly in historically underserved areas, is among the interventions Rao points to as evidence that environmental conditions are measurable health determinants. The data she cites is striking in its breadth: increased greenspace is associated with reduced all-cause mortality, fewer heat-related illnesses, improved mental health, less violence, and fewer preterm births. These are outcomes that primary care physicians track constantly, yet the conditions shaping them often sit outside the traditional scope of clinical practice.
That gap, between what physicians are trained to treat and what is actually making patients sick, is the tension running through the emerging field of planetary health medicine. Rao's trajectory suggests one way to close it: seek out the training the system has not yet built in, and bring it back to the bedside. The question is whether academic medicine will create the infrastructure to scale that approach, or leave it to individual physicians to find their way to one of many training programs, like those offered in Colorado.
