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Medical Scientist Training Program

The Surgeon Scientist: A Conversation with Alumni

Posted by on Monday, August 28, 2017 in Alumni .

by J-N Gallant (M3)

A conversation with alumni, including:

  • Charles Davis, M.D., Ph.D., Class of 1991, Professor of Orthopaedics and Rehabilitation, Penn State University
  • David Poon, M.D., Ph.D., Class of 1996, general surgeon, Kaiser Permanente, San Diego
  • Elizabeth Tyler-Kabara, M.D., Ph.D., Class of 1997, Associate Professor of Neurosurgery, University of Pittsburgh
  • Zoe Stewart, M.D., Ph.D., Class of 2002, Associate Professor of Hepatobiliary and Transplant Surgery, University of Iowa
  • William Tu, M.D., Ph.D., Class of 2005, Urologist, Kaiser Permanente, San Francisco
  • Walter Jermakowicz, M.D., Ph.D., Class of 2012, Resident, Neurological Surgery, University of Miami
  • Britney Grayson, M.D., Ph.D., Class of 2012, Resident, General Surgery, Vanderbilt University
  • Kevin Kumar, M.D., Ph.D., Class of 2016, Resident, Neurological Surgery, Stanford University
  • Pratik Talati, M.D., Ph.D., Class of 2017, Resident, Neurological Surgery, Harvard University

and others who wished to remain anonymous as not to bias the reader.

As I slogged through my cancer biology PhD I felt a constant and vague unease about the future: what was I going to “do,” clinically? My PhD was coming along, as well as it could, and return to clinic seemed ever closer. The most obvious answer was to leverage my cancer biology expertise into a career as a medical oncologist and cancer researcher. After all, this is the track that my mentor, Dr. Lovly, and others before her, had successfully pursued—and I aspired to their excellence. However, something didn’t quite feel right. I couldn’t imagine myself as the classic 80:20 physician-scientist, running a lab and being on service 2–4 weeks per year. I knew I wanted to be involved in the care of cancer patients; but, I wanted to approach the problem from a different angle and to use my time in another way. To these ends, I explored oncology-related surgical subspecialties during my PhD. After spending time in clinic and the OR with Drs. Thompson (neurosurgical oncology), Rohde (head and neck oncology), Grogan (thoracic oncology), Idrees (surgical oncology), Brown (gynecologic oncology), and Halpern (musculoskeletal oncology), I was sold. These were my people, and the OR was everything I liked about lab (intense, procedural, precise, and hands-on). Spending more time with each of these services led to my current passion for otolaryngology, which is what I intend to match into next year.

However, now that I’m sold on a surgical career, I’m faced with the daunting prospects of life as a surgeon-scientist. The outlook for surgeon-scientists1 appears even bleaker than for physician-scientists at large2. Still, I am determined. There’s a clear need for basic science research in otolaryngology, especially when it comes to tumor biology. I am well positioned to make immediate impacts on people’s lives, surgically, and to make lasting contributions to the field by leading a molecular biology lab. In order learn more about what’s ahead of me, I reached out to alumni from our program who are completing or have completed surgical residencies. I called, emailed, and picked their brains about their career path, current role, and any/all advice they had for MSTP trainees aiming at or interested in a surgical career.

What follows is a 2-part Q&A series on their thoughts about their time during the MSTP, residency, and as surgical attendings.

How did your time as an MSTP student influence your decision to pursue your current career?

  • “I worked in a lab where the PhD mentor worked closely with surgeons. I was able to learn the difficulties surgeons faced and, by interacting with them, designed solutions that met real-life constraints. The PhD experience convinced me that there was definitely a role where I could combine my academic and surgical interests.”

  • “The MSTP path gave me the time and opportunity to choose a career in urology. Before medical school, I had performed research in microbiology so I naturally thought that I would become an infectious disease specialist. However, my research took a turn towards prostate cancer, and interactions with urologists in the department lead me to a career in urology.”

  • “I was fortunate to be mentored in my first year of medical school by a functional neurosurgeon, Dr. Joseph Neimat, who gave me a first introduction to the operating room and to the specialty of neurosurgery. Over time, I began to spend more time with the department at Vanderbilt, a relationship that I maintained during graduate school.”

  • “I enjoyed my time as an MSTP student and feel that it benefited my career; but, I am not sure that the MSTP influenced my decision to be an academic clinical physician.” [NB: is currently an academic surgeon]

  • “I got so burnt out during my PhD that I wanted a specialty that would generate a lot of income but had an option for research (in case of the long-shot chance that I would start liking research again). Little did I know that, during residency, I would start liking research far more than I ever did—mainly because I had ownership of the project and because it was much more translational than my PhD research.”

  • “I started the MSTP thinking I would pursue a career in pediatric oncology, but I had an unexpected passion for surgery. I received good advice: to follow your clinical passion vs. trying to pigeon-hole yourself into something else you think will “work better” with research.”

  • “I never ran a Western blot during my PhD; instead, I only did electrophysiology (and am proud of it!). Relatedly, during the MSTP I learned that I was an instant gratification kind of person and that I liked taking care of kids. These two came to a head and led me to pediatric neurosurgery.”

Was time in lab or medical school (for either good or bad) more influential in your career choice?

  • “The time in medical school and graduate school both were critical in the decision.”

  • “Hard to say. I have a hard time pinning down how each one influenced my specialty area or decision to stay in academics.”

  • “Lab was more influential for me because I hated it much more, and I didn’t want to choose a specialty that was ‘friendly’ to research.”

  • “My clinical years in medical school were the most influential for my career choice. Being on the wards allowed me to see how different clinical services operate and provided me with an opportunity to ask questions to really understand what I wanted out of a career. After spending time on the wards, I knew that I wanted to practice clinical medicine and use research as a means of answering important clinical questions that I came across.”

  • “I think the lab time was influential in the sense that having independence and flexibility during graduate years made coming back to the highly structured clinical regimen a wake-up call for me—I needed a specialty where I could have more of that structured paradigm.”

  • “When I was in lab, I thought I would have a nice boutique clinical practice that would feed my research niche. In the end, being on the wards is what cemented my interest for surgery. My husband also had great insights into what was making me tick and could tell surgery was something I should pursue. In the end, I followed my interests over what may have been more popular.”

  • “After lab, I explored fields during M3/4 that I felt I could contribute meaningfully from a research perspective. It wasn’t always obvious which skills acquired during the lab equated to which medical specialty. In fact, I felt that my research skills were broadly applicable and, in the end, chose a surgical field because I enjoyed working on those problems and patients.”

Is there anything MSTPs could do to help those interested in surgery?

  • “The MSTP should have a thorough discussion/information regarding the requirements/challenges to being a surgeon/scientist and how to choose such a job.”

  • “The MSTP needs to just be honest about it. I always heard that a surgical career is less conducive to research, but I don’t think the reality could be more different. I got two years of dedicated research time during my residency that allowed me to establish a research career of my own. Many of my friends not in surgery failed to get grants because there were removed from their research during residency. Also, the fact that surgical research is translational makes it easier to get funding.”

  • “The MSTP could emphasize that there are several different career trajectories that make a physician scientist successful. Some could join industry or an academic research career without completing a medical residency while others can choose to incorporate research into their clinical career—be it part time or full time. While there are well-established PSTPs that fast-track a person through residency and fellowship to establish an academic career, there may be similar types of programs in surgical residencies. People interested in a surgical specialty should talk with mentors within those departments at Vanderbilt to get a better idea of the diversity of training options available for residency.”

  • “The MSTP should have more surgical physician-scientist exposure (I had a surgical oncologist sharing a bench during my thesis time and that was my first clue that surgeons could be empathetic, amazing physicians (I had total stereotype of surgeons, as I had not had any exposure). There was also an unfortunate felt proclivity to steer MSTP students away from surgery.”

  • “While everyone around me in MSTP seemed to be pursuing medicine-related specialties, I didn’t feel a push one way or another. If anything, I have had many more knocks on myself for being a woman in surgery as opposed to a researcher in surgery.”

  • “During my time in training, there was a lack of guidance and role models. The yearly retreats for instance heavily favored non-surgeons and there was never a surgical faculty to showcase their research. The journal clubs similarly were biased against surgical research, perhaps because most such research tended to be outcomes in nature.”

  • “The MSTP could potentially include surgeons in the advising college system.” [NB: in helping students on their various career paths, the MSTP leadership has added Jim Goldenring, M.D., Ph.D., Professor of Surgery, Cell, and Developmental Biology as one of the Goodpasture College Advisors; and, two surgery residents, Carolina Pinzon-Guzman, M.D., Ph.D., and Vance Albaugh, M.D., Ph.D., as Associate College Advisors]

What advice would you have for trainees in the MSTP interested in pursuing surgical careers; how can one best prepare?

  • “Just do what you want to do. The more you can eventually bring to your specialty, the more you are worth.”

  • “You have to have realistic expectations of how your clinical and research careers can look and understand that your priorities are very likely to change over time. I had really good advice from a mentor that you can only do two things in life really well (on the scale that type-A MSTP students will hold themselves to) and medicine and basic research are two entities, so if you want to do a third well (e.g. family/personal time), you need to be realistic on the scale of the other two).”

  • “Everybody has an idea about what an ideal MD-PhD should be and the mold that s/he should be cast from. There really shouldn’t be a mold. You have to do what you love. You won’t succeed if you follow some sort of pre-conceived notion. Many MD-PhDs are doing surgery and not many are doing science; there’s a reality to that. That being said, those that make it work tend to be incredibly productive; don’t let the nay-sayers get in the way.”

  • “If one were interested in continuing basic science research, I would echo a presentation to a room of students, residents and faculty given recently by the current chair of Duke, Allan Kirk. In paraphase of this talk, keep reading the primary literature; keep writing grants. At the same time, develop a solid foundation of surgical skills, because time wasted doing an operation badly is time not doing those two things.”

  • “A strong letter of recommendation from the chair (or residency director) of your surgical department of interest is essential for matching at a top tier surgical residency. As such, you should get involved with a project that affords you direct interaction with the chair. If your surgical department of interest at Vanderbilt is not a nationally renowned department, then you may need to do a sub-internship at another institution with a stronger department to get the more influential letter of recommendation.”

  • “Work on what you are passionate on in graduate school. I would identify your clinical specialty as early as possible in medical school, then begin to build connections within that discipline.”

After communicating with these alumni, I felt a sense of relief. My angst during graduate school was normal, as is my current contrarian career approach—I’m not the only one taking the path less travelled, in spite of all the hard work to come. Better yet, the clinical years of the MSTP should only soothe my ennui and provide plenty of career opportunities. Perhaps the best part of this conversation was hearing how the MSTP has changed: with the addition of surgical College Advisors and the willingness to support trainees on whatever unique path they want to take, now appears to be the best time to be a surgeon-scientist trainee in the Vanderbilt MSTP.

References
1. Keswani, S. G. et al. The Future of Basic Science in Academic Surgery. Ann. Surg. 265, 1053–1059 (2017).
2. NIH. Physician-Scientist Workforce Working Group Report. 1–143 (2014).