The Surgeon-Scientist: A Conversation With Alumni
Part 2: After the MSTP
A conversation with alumni, including:
- Charles Davis, MD PhD, Class of 1991, Professor of Orthopaedics and Rehabilitation, Penn State University
- David Poon, MD PhD, Class of 1996, general surgeon, Kaiser Permanente, San Diego
- Elizabeth Tyler-Kabara, MD PhD, Class of 1997, Associate Professor of Neurosurgery, University of Pittsburgh
- Zoe Stewart, MD PhD, Class of 2002, Associate Professor of Hepatobiliary and Transplant Surgery, University of Iowa
- William Tu, MD PhD, Class of 2005, Urologist, Kaiser Permanente, San Francisco
- Walter Jermakowicz, MD PhD, Class of 2012, Resident, Neurological Surgery, University of Miami
- Britney Grayson, MD PhD, Class of 2012, Resident, General Surgery, Vanderbilt University
- Kevin Kumar, MD PhD, Class of 2016, Resident, Neurological Surgery, Stanford University
- Pratik Talati, MD PhD, Class of 2017, Resident, Neurological Surgery, Harvard University
and others who wished to remain anonymous as not to bias the reader.
See Part 1 here.
I left the first part of my conversations with surgical alumni feeling relieved. My angst during graduate school was normal, as was my current contrarian career approach. Still, the road ahead seems more than daunting—how can one manage an 80 (theoretically) hour week and maintain one’s curiosity? How can one balance getting things done and being creative? How did these folks make it through? Turns out the answer was simpler than I thought: hard work and determination—no overthinking, brooding, or rumination. In talking to alumni, it became painfully clear that there simply was no other option. Those that responded, those that made it through, the surgeon-scientists, etc. simply put their head down and worked. They wouldn’t have it any other way and there was no other way. These alumni’s thoughts about their time after the MSTP, during residency, and as surgical attendings bear out this reality:
Is surgical training as demanding as mythicized?
- Yes, it is exhausting. You really need to have an excellent work ethic, to enjoy the clinical problems, and to thrive in the operating room under pressure. And you have to do this despite being on average 4-5 years older than your peers against whom you are evaluated. That being said, I have seen that most MSTP graduates are more emotionally mature and capable of absorbing the pressure and constant negative factors facing a trainee.
- Definitely better than I expected, though junior years were horrible (often 100+ hours a week) [NB: respondent from post-cap hour era]. But because as a neurosurgeon you are always doing your job by yourself and not as a team (as in medicine), you can do things on your own time/schedule.
- Yes, I trained in the ‘pre-80’ [hour capped] work era, but surgery is still very demanding and the scale of the emotional intensity with bad patient outcomes can be much higher in surgery versus a medical specialty.
Is it possible to do scientific research and be a competent surgeon?
- Yes, there are many role models of successful surgeon-scientists. Strangely enough, many of those I have encountered did not have MSTP training. The element of serendipity cannot be underestimated. There is a widely adopted model where PhDs are hired by MDs to do a lot of the grant writing, IRB management, and graduate student training, etc.
- It is possible, but I am not an example. If you want to do basic science research, then you need to be able to write and get grants. Remember that you are competing for funding against PhDs who do research full-time and likely have more experience from post-doctoral fellowship. If you want to do clinical or translational research, then you still need to be able to get grants or collaborate with others. During residency and especially clinical fellowship, you should get experience writing grants and choose a project that you could carry forward in your career.
- Yes, but you have to be more than competent—you need to be excellent. You owe this to your patients. The research should be complementary to your clinical focus.
- Yes, but it takes lots of careful planning, skilled ability to manage time, and ability to protect time.
- Of course. The more the better. If you are an academic surgeon who does no research, you essentially have a job similar to private practice, but you make less. If you can do surgery and research, however, there are many financial and lifestyle perks because these departments want to show that research is being done.
- It is absolutely possible to be a competent surgeon while advancing science. However, in order to be a successful surgeon-scientist, you need to imagine a different type of research environment. Most surgeons can typically secure one or two days of research, and it's up to each person to decide how best to use this time. One model would be to lead a laboratory, which may be challenging given the significant time away due to clinical duties. I think a better model would be to co-lead a research laboratory with someone else and provide complementary skills to the co-investigator. Another feasible model could be to collaborate with a few colleagues who can further a scientific aim based on human data or specimen you can provide.
- Yes. The folks who do it, and do it well, have a clear formula: they are very focused clinically, have excellent delegation skills, have institutional support for true protected time, know how to say “no,” and have mentors that help them recognize how/when to do this.
- A key to thriving a surgical residency is "efficiency," which is the capability of managing many tasks well and in a timely manner. What this means is holding your instinctive curiosity at bay, applying many unjustified algorithms quickly, and knowing your limits so you know when to call for help. Some of these reflexes are counter to your training as a scientist, and I have found my training frustrating in that regard. I have learned to keep a journal of interesting ideas, patients, and potential projects to keep the scientist side of me alive.
What is the best part of a surgical career?
- Making patients better. Plain and simple.
- This is tough…at the end of it, I love the feeling after a long, hard case (e.g. redo liver transplant with arterial and venous jump grafts) where you have been going strong for hours. When it is done, the sense of satisfaction while closing skin and then talking to the family is truly one of the best feelings. My other favorite is the long relationships I’m privileged to have with my patients over the course of years pre- and post-transplant. I know my patients’ kids, grandkids, dogs, hobbies, etc. They even bake me cookies. This type of relationship isn’t unique to surgery, but it is an awesome aspect of my field!
- Saving a life gives me purpose. Plus, operating with your hands, endoscopy, laparoscopy, robotics, or lasers is fun.
- Really hard question! Gratification over the long term: from getting something that makes somebody better. It’s amazing to see kids running in the hallways years after I operated on them.
- You have a marketable skill that no one else (e.g. nurses) can do.
Are you happy with where you are; any regrets or things you would do differently?
- I am absolutely happy with where I am currently. [The top tier academic hospital where I work] has a robust clinical and academic infrastructure with research in areas that I find particularly appealing, including the interface between neurosurgery and psychiatry. While on a busy clinical service, I did not want to spend time building that infrastructure from scratch. Instead, I can build on my research career at Vanderbilt by applying for NIH R25 grants that have been awarded to the department while joining a productive research lab. Joining a residency with a robust research infrastructure can be quite instrumental for surgeons interested in maintaining a research career.
- Yes, but I learned a couple of things along the way:
1) During the training process, I kept thinking that when I have more control of my own time, that I’ll do “x.” The reality is that I am no less busy now.
2) I would not have thought of this 10 years ago, but the idea that it’s “okay” to take ten years to complete MD PhD training is insane.
- I am tremendously grateful for this opportunity. I would do nothing differently; Vanderbilt gave us an outstanding training in medical school.
- I am very happy. Doing neurosurgery was the best decision I ever made. I do wish my informatics and stats skills from grad school were better than they are.
Interestingly enough, almost every alumnus answered the question, “Is it possible to do scientific research and be a competent surgeon?” positively. That is, most everyone thought it was possible. I found this remarkably uplifting. Yes, it will take hard work; yes, it will take sacrifice; but, at the end, folks genuinely thought it was possible and looked upon the career positively. I was also happy that many respondents mentioned the long term patient relationships as a rewarding and meaningful aspect of their career. Too often the surgeon gets maligned as someone who sees patients as “one and done.” That longitudinal relationships exist in these fields, and that surgeons value such relationships, hopefully casts a humane light on these often outwardly callous professionals. I look forward to the work ahead and only hope to retain my humanity, curiosity, and satisfaction. Perhaps a decade or so from now, I too can write back some humanizing and uplifting thoughts to an aspiring surgeon-scientist.