Survive & Thrive: Today's Resident

In the first episode of Off the Grid's Survive & Thrive series, contributors Cherie Fathy, MD, and Dave Felsted, DO, offer insight on what it is like to be an ophthalmology resident in the current era.

Gary Wörtz, MD: Open, outspoken, it's Ophthalmology off the Grid, an honest look at controversial topics in the field, I'm Gary Wörtz.

Gary: Welcome to a very special episode of Ophthalmology off the Grid. This is Dr. Gary Wörtz. And we are starting a new program that I'm very excited about. We've teased this in an episode a week or so ago, and it's really about surviving and thriving. We're going to talk about trying to survive and thrive in training.

Speaker 2: Ophthalmology off the Grid is an independent podcast produced by Bryn Mawr Communications and supported by advertising from Johnson and Johnson Surgical Vision. For a full listing of podcasts for eye care professionals, go to eyetube.net/podcasts.

Gary: Today I have with me Dr. Cherie Fathy, who is a PGY-3 resident, along with Dr. David Felsted, who is a PGY-4 resident. So, we're going to actually dive into what is residency like nowadays.

I have my own preconceived notions. I think when you've been out of training for a while you kind of think that things are always like they were when and where you trained. But the reality is, life moves on, and the current era we're living in I feel like things are changing at a really exponential clip. Today I'm really excited to have my co-moderators, Cherie and Dave, to help talk about what it's like being a resident nowadays. And maybe together we can talk about some strategies for making this journey as being a resident a little bit more enjoyable.

Cherie, I'll just start with you. If you don't mind, why don't you tell us a little bit about where you're from, a little on your background, and where you're training at this point.

Cherie Fathy, MD: Yeah, for sure. I'm Cherie. I'm from Knoxville, Tennessee originally, and went to medical school and undergraduate actually both at Vanderbilt. And then ended up in Philadelphia at Wills for residency. I went into ophthalmology for the ability to provide direct concrete answers to patients for the most part and be able to deliver results. That to me was the most exciting part of doing ophthalmology in medical school.

Gary: What was your, besides ophthalmology, what was...well, let me ask this a different way. What was your least favorite rotation in medical school?

Cherie: Ironically, general surgery. I just was not that into waking up that early and doing the rounds and having that kind of environment, so to speak. So that was my least favorite. But then I rotated on ophthalmology during that rotation and just felt like I had found my people.

Gary: Yeah, I know that feeling. And let's ask this question, if you couldn't be an ophthalmologist, what do you think you would do?

Cherie: I think I would probably, if I had to stay in medicine, it would have been pediatrics. I really enjoyed working with the little kiddos, so I don't know that I could say the same about pediatric ophthalmology, but that's a different talent. But definitely pediatrics, and then if I didn't do ophthalmology and didn't stay in medicine, I'd probably do journalism or something like that. That was actually a big passion of mine before getting into medical school.

Gary: Excellent. Well you know it's interesting with publications and things like this, you can still scratch that itch.

Cherie: Absolutely.

Gary: Dave, I want to switch over to you. And why don't you tell us kind of the same story, where are you from, where did you grow up, and where are you now?

David Felsted, DO: Thanks, Gary. My name is Dave Felsted. I'm a PGY-4 currently at the Medical College of Georgia down in Augusta. Some of you may know it by the Masters Golf Tournament. I grew up in South Bend, Indiana, right near Notre Dame, and when I was about 13, we moved to Salt Lake City, Utah. I'm sort of a nontraditional in the sense that I did accounting right out of high school, and about halfway through the program I decided that just was not for me. I kind of went into it because my dad was a corporate accountant, and that was kind of the role model I looked toward. But as I got into the field, I decided you know what I like working with my hands, and I like talking to people, and spreadsheets don't really fulfill either of those roles. So just kind of out of luck, my parents went golfing one day, and they were paired up on a course with Bob Cionni.

Gary: Wow.

David: And he was talking to them about what he does, and they told him, "Hey I've got a son that doesn't really like accounting." And he said, "Well why don't you have him come see what I do for a day?" And so, I remember getting into his clinic and going upstairs to his ASE and watching all his cataract surgeries. And my mind was just blow away, I just really fell in love with it. And so that same time, I decided to finish my accounting degree, and at the same time go to medical school. And so I got very, very busy, and I got accepted to Arizona College of Osteopathic Medicine in Glendale, and the rest is kind of history from there.

Gary: Excellent. And same question for you, what was your least favorite rotation in medical school?

David: For me, I'm a doer, I'm always tinkering, I like working with my hands. I like anything I can do to be proactive, and so for me psychiatry was a very difficult rotation. I did it at the VA up in Northern Arizona, and so I just didn't see a whole lot of variable pathology, and I couldn't get myself engaged enough in that rotation. I think all the other ones I fell in love with and I had a hard time not wanting to go into some of those things, like pediatrics, or family med, internal. I found most of those rotations were pretty enjoyable. If I wouldn't have matched in ophthalmology, I think emergency medicine would have been my backup. I like the variety, I like the pathology, I sort of like some of the acute nature of things. But I'm just so grateful that I matched in ophthalmology.

Gary: Yeah, well we're grateful that you're in ophthalmology as well.

David: Thanks, Gary.

Gary: I'm excited to get a little bit of a perspective from you all on what it's like nowadays. You both have had a number of years of experience as residents. The first question I might ask is, and I'm sure this sort of varies from residency to residency, but do you feel like in your program, and Cherie I'll start with you, do you feel like there's more competition or collaboration between yourself and other residents? And what I mean by that is, when I was in residency, there was sort of this sense of competitiveness. And you don't get into ophthalmology without having a little bit of a competitive edge, it's a hard residency to get.

Sometimes you don't check that at the door, and there can still be some competitive nature. Some of that's healthy, where you want to do your best, and it's not necessarily at the expense of others. But there can also be an unhealthy nature to competition if it's not held in check. And the converse would be the collaborative effort, where the rising tide is floating all boats, people are trying to help each other. The senior residents are looking after the younger residents and trying to show them the ropes. I'm just curious in your experience, do you find there to be a good balance of that in today's landscape?

Cherie: Yeah, I would say the best part of Wills, which is a very difficult residency, has been the collaborative nature among our co-residents. I don't think we would really be able to function or stay efficient without us working together. For example, at Wills in the second year, beginning of your second year, end of your first year, it's just the second-year residents, the newly minted second-year residents, who are running the emergency room. So that's eight people seeing a different eyeball pathology throughout the day. And sometimes it's just one resident there during the morning, and then it really is dependent upon all other seven residents forsaking their lunch breaks, or forsaking time after work, to come and help clean up the ER.

So, we are very heavily reliant on each other to keep us doing well and feeling well. And similarly, we don't leave Wills without every clinic being done. So, we have a no resident left behind policy. We are extremely fortunate here that our co-residents, they always have our backs, they're always checking in. Similarly, when you're a first year in the emergency room you're paired with second years, so they are to be your mentors, to help you walk through difficult patients, to help double check your exams. And so, it's an extremely collaborative environment here, it's what I'm most thankful for.

Gary: That's great to hear. Dave, has your experience been similar?

David: Yeah, I think Gary I can definitely speak to what you said earlier that our profession attracts a certain personality, I think to a large extent, and we are all very competitive and it is very hard getting into ophthalmology. But I felt like as soon as I matched, so much of that went away. And as I started into residency all I felt was an overwhelming sense of community with my residents. My training program is small, there's three residents per year, nine total. And we're basically in one main hospital with a bunch of connections to the VA, the children's…

For our residents, we have to be collaborative, we have to rely on each other. And we pride ourselves on our friendliness and our sense of community. We take buddy call when we first start, and so you're really connected at the hip to your senior resident, and he is showing you the ropes, or she is showing you the ropes for those first couple months. And then they're always there throughout the first year as you take primary Q3 call. And I just remember being up so many nights with really complex cases and needing to call my senior resident to ask a question, and they were always so nice and helpful, never ever gave me backlash or difficulty. I just feel like, I think as soon as we got into ophthalmology the mindset changes, and I felt that as I go to conferences as well.

Gary: Yeah, I'll be honest, when I got into ophthalmology, I mean to be honest, I kind of felt like, I'm getting into this field where everyone is smarter than me and I'm going to have to pretend that I'm smart and just hope that no one finds out. And I guess until now, until I admitted it, no one has really found it. It is funny how you get into a field and it feels overwhelming, and then you're welcomed in and you feel like you're part of it before you know it. I had sort of the same experience with the three person per year residency at UK.

And I just remember the way that the Chief Resident sort of took me under his wing, how the rest of the residents really sheltered us as first years and showed us the ropes, and showed us how to use an indirect, and showed us how to refract. And even doing little things like lasers, etc., there's such a comradery that's built among healthy training programs. And yeah, it's tough and it's stressful, but you kind of feel like a band of brothers or I'm sure a sisterhood, fraternity, sorority kind of deal. And it's really fantastic to have that feeling, even when it's really stressful. Any other comments on that?

David: Can I just add, I think you bring up such an important mindset. I felt the same way coming in, like “oh, I must be the dumbest person out of this huge group of people that are smarter than me, more gifted, more talented.” And then that really changed as I began looking at applications this year as a senior resident, and just seeing that everybody's application that came in was just glowing. We just have so many smart people, and yet they're all talented in so many different ways. And that was the fun part for me, is just to see where people's strengths are at. And it helped me realize, “wow look what I can bring to the table compared to this person. They're better at this, but maybe I'm better at that.” And so, it really does become a growing experience for us as we look at each other’s strengths.

As Step 1 just changed from a scored scale to pass/fail, it's going to be interesting to see how does that translate into how we evaluate each other? And I think before we looked at each other’s strengths as a score, “oh I got this score on that test,” or “my Step 2 is this, so I must be better or worse than the next person.” But what I realize in medicine is we're all smart, we all work hard, and we all care. And so, I think that's going to change the landscape dramatically.

Gary: Yeah, Cherie what do you think about that? I'll reserve my opinion. I want to hear what you think about this. Do you think it's a good thing, a bad thing, or a net neutral thing that the Step 1 has changed to pass/fail starting in 2022?

Cherie: I thought studying for Step 1 was such a miserable experience, and so high yield…or so low yield, did I just say so high yield? That's my subconscious trying to make me feel like some part of that was worth it to study for it. But it's one of those things that there have been studies that have sort of inconclusively seen, does it help with your OKAP scores? Does it help if you scored highly on Step 1, does it then help you in retaining this minutia that can help you pick up on rarer things for patients? And I mean, I guess thankfully they've been mostly inconclusive to my knowledge.

And so, I honestly think that Step 1 was very low yield and don't mind it switching to pass/fail. I do think this is going to switch to then programs focusing on Step 2. So, I think it's going to trade one beast in for the other, but hopefully at least Step 2's a little bit more clinically useful. I think it's going to end up being a net neutral. Step 2's going to be more meaningful now and people have to take it earlier.

Gary: I sort of see us all as rats in a maze that we're not designing, but we have to live within. And so, as soon as you change the incentive from one thing to another, you're just going to find a new quicker route through the maze to the reward. I think that you guys are exactly right. I also worry a little bit about whether class rank in medical school prestige is going to have a higher weight in regard to who gets certain residencies. For me, I went to...I mean I'm very proud of my medical school, but I went to a very average, state medical school that no one is going to be too impressed with necessarily. I mean, I'm very proud of it, but it's not like it's going to be super impressive on an application.

My Step 1 score was something that helped me, I feel like, get access to something like an ophthalmology residency. For me, I look at this as something that really probably helped me. But at the same time, I'm sure the same number of people it helps, it may hurt a greater percentage. So, I'm kind of with you all, I do think that it's kind of a low yield test in terms of predicting who is going to be ultimately successful in what profession. But it is just redesigning the maze, if you will. I think that's something that remains to be seen how it's actually going to affect our profession.

Cherie: I hope that the AUPO, the Association for Ophthalmology Residencies, does let us know how they hope to incorporate, or suggest that programs incorporate new things to help evaluate potential residents. Because if it's something we can all get on board and make it a fruitful decision and a more effective way to evaluate candidates for the residency, then it may actually end up being a helpful thing. But it does need to be transparent, or I hope it is.

Gary: We need to eliminate the guess work. As medical students we're so stressed out and it's kind of a...it's a tough time as we can all remember.

I want to actually sort of continue on this topic a little bit, I guess it's a tangent in some ways, but personal life versus professional life. We've talked a little bit in other venues about work-life balance as physicians, how do we avoid burnout?

I will be very honest, for me in residency, it's stressful in and of itself, as I recall. But it's also being stacked on a very intense undergrad experience, in my case, and probably most of our cases, a very intense medical school experience. And then you're starting off as a resident not really knowing anything about ophthalmology. So, you're already sort of coming in as a resident with little reserve in the tank, and sort of pre-burned out. And I think that that course to burnout is much, much shorter. How are you all holding up as residents? And Cherie, please take it away. I'd love to know how you feel like you're doing, and maybe do you have ways of keeping a little piece of yourself from being, sort of, saturated from medical training?

Cherie: Yeah. I can definitely sympathize with you so much. I think the first year of my residency was probably one of the toughest years in my life, in terms of just trying to balance being a busy resident, a very fulfilling but also demanding personal and family life, and then just trying to learn ophthalmology, which you don't get much exposure to in medical school, and we're getting even less exposure to with our new curriculums, and trying to do well. That was just so incredibly stressful in that first year.

I think it was the second half of the year when you start to feel a little bit more comfortable. And then when I reminded myself that, at the end of the day, I'm still supposedly a fully functionable human being, so I should be able to remember to do the things that made me happy. So, it was setting up the time for myself to be able to cook myself some of my favorite meals or rejoining a gym. I really like to read, and I made that a priority for myself to still incorporate reading for pleasure.

And I think being a second year also makes things so much better. The environment is not new, your faculty know you and trust you at this point in your exam, which allows you to have much more fruitful conversations about management, versus just learning things about the exam. So definitely being in residency longer helps, just feeling more comfortable. But the initial stress of being a first year is something that I hope gets more attention, and hopefully gets better with this addition of the integrated residency, so the integrated intern year.

I think that will be a great way to get early, soon-to-be ophthalmology residents involved in the more high-anxiety things, while perhaps in a buddy system earlier on, or the opportunity to partake in wet labs to help just decrease some of that anxiety before you come in. Because I can think of so many call nights as a first year where you're asking, “Am I going to get my first canthotomy tonight? I've never done that before,” watching YouTube videos. So, any way to decrease that stress would be so helpful. And I think that would really help in decreasing burnout, at least in my case it would have.

Gary: Cherie, tell me a little bit about the integrated internship. And just for those who don't know, just explain that a little bit, because I think that is a big shift that's coming.

Cherie: Sure. So, I believe eventually all residencies will be required to have an intern year that is built into their current ophthalmology residency. So that means either linking with their general surgery intern years, or a general medicine intern year. Some programs have a mix of both, but some are choosing to either link a few months of ophthalmology residency with general surgery wards, or with rotations on internal medicine. I think ideally a mix of both would be awesome. So, having your exposure to the general surgery residents and also the common problems that can happen in taking care of postoperative patients would be very crucial for ophthalmology residents. So, you still have that exposure.

And similarly, with internal medicine, to get your feet wet in important clinical problems that you should be expected to know as a physician. That's what puts us apart from other specialties, or other non-healthcare providers that are not MDs. And at the same time, now you get a few months of ophthalmology so that you can basically learn the basics of the examination. I think some integrated intern years provide some buddy calls that you take at the time, or some wet labs to get you essentially get your feet wet in the basics of surgery, or the basics of clinical rotations, so that you're not completely new when you're stepping into your first year of ophthalmology residency.

Gary: Yeah, that sounds fantastic. I think that's a wonderful, wonderful idea. Dave, you're a little bit longer in your path, you're a PGY-4. Talk to me a little bit about, how have you been able to balance your personal life with your professional life, and also maybe family life with that?

David: Yeah Gary, this one hits really home for me. And I think my situation is just so dramatically different from the majority of ophthalmology residents. And so, I hope what I say may help just a handful of residents that have kids at home, and a wife or a husband that they're trying to support. So, I have a wife that stays at home with my four little kids. My kids are 18 months apart, very close together, the oldest is seven. And when we moved from PGY-1 to PGY-2, my wife was pregnant. And we had just had our baby about 10 days before I started primary call as an ophthalmology resident, and I just remember being just so tired.

David: We took Q3 call our first year, and then when I came home, I had to be on baby duty, as well as study and help my wife out. And so, life balance for me for the first year probably didn't happen as much as I wanted it to. And I was trying to do probably too much and study a little bit too much. And looking back, I think I did the best I could. I think at the end of my first year, burnout was a pretty close call for me, and I started to make a lot of changes, and for me that included exercise.

Where we live in Georgia, there's a great trail system that takes you from my house to my work in about 30 minutes on a bike. And for me that became my safe haven, waking up in the morning and biking in to work. I could get right upstairs to a call room and shower and put on some scrubs. And my day just became so much better. And I found more balance as call kind of lightened up. For me that was just a major deal change, game changer. I think the training landscape, I think Cherie brings up so many good points about the integrated programs kind of easing residents into the process.

For me, I did not have an integrated program. I went to a transitional year up in Spokane, Washington. But I still got some ophthalmology experience under my belt before coming. And I will say that I think these new experiences, there's no easy way around them. They're going to come, and you're going to have to encounter them, and you have to be okay with not knowing everything. That's part of the learning process. And for me that was hard to accept, because I wanted to be the person that knew what they were doing at all times, and yet I wasn't. And looking back I realize that's just part of the learning process. Doing your first canthotomy cantholysis, or your first phaco, those are scary moments. But I look back on them with so much fondness because I learned so much during those first encounters.

Gary: Yeah Dave, you're preaching to the choir a little bit here. I have been married for almost 21 years now, I've got two kids, had two kids in medical school. And so, going through intern year and my early residency days, I had little ones at home. And I remember just feeling like...they say residency is a marathon not a sprint, but I just felt like it was a sprintathon, it was the pace of a sprint with the length of a marathon, and really not a lot of water breaks in between. So, I remember coming home and kind of the same thing, also trying to mix in some moonlighting just to try and keep the lights on, I was trying to do that as well.

And what I've learned from that process is a couple of things. Number one, you'll never work as hard as you work in residency. So, everything for the rest of your life is going to feel not as hard. So, there's an aspect of “I've done the hardest work I'm going to ever do in my life, and that's behind me, and everything is downhill.” So that's a good thing. But you can't let your red line become your new baseline. And what I mean by that is, work-life balance, I don't necessarily know if I love that term, I like to talk in terms of capacity. And what that means is we're all going to have something that happens, that comes along, whether it's an illness, whether it's a financial thing, whether it's a friend or family member who needs you in one capacity or another, that's going to take you out of whatever you're doing at the time.

If you're running with no margin and no capacity and something happens, the whole system has the potential to break down. Now you can do that for a while, and it's going to be expected and incumbent on a lot of residents to really work at their maximum capacity for a long time. But just remember when you're done, or when you have the opportunity, realize that your red line is not a safe and normal place to work for the rest of your life. Don't let your red line become your new baseline. And I would caution both of you, if it feels like you're superman and superwoman at this point in your life and you can do everything, it's wonderful, it's a wonderful feeling. But there is a time when gearing back is actually the smart thing to do…so I think that's something I'd just caution you. I've been there, I've done that and got the T-shirt.

I also mention, just on the horizon, life gets a lot better. Life gets better once you're out and you have a lot more freedom and flexibility.

I'll start with Cherie on this question, how do you feel that ophthalmology as a residency is misunderstood? I have my thoughts on it, but how is it different than you thought it was going to be, or how do you feel like it is different than people on the outside of ophthalmology perceive it?

Cherie: Oh, my goodness, it's so much harder than I thought it would be. I think, definitely looking from the outside in, it looks like the specialty that is very nicely clinic based. And I think there's the perception that home call is this glorious thing where you get to be at home, and you're rarely called in. But I think it's especially unfortunate, again I already said this before, but as ophthalmology is cut out of medical school curricula, people are getting less exposed to any information about the eye, and as a result, I think we're seeing a lot of people who are very uncomfortable with eye problems.

And I think for that reason, our call is very misunderstood by a lot of people. I would say that our home calls are actually quite busy, we're called in quite often, and oftentimes for things that may not actually be ophthalmic emergencies, and that's really hard to convince people on the other side of the phone. A lot of that has to do with the fact that they're just not as comfortable around the eye, which is understandable, and that's what we're here for is to help address those questions. But it's definitely something that I didn't realize as much when I was a medical student, and definitely I don't think is very well understood by even my friends who, when they saw me starting my ophthalmology residency and my call, were quite shocked by the business of the call.

I think the other thing that's quite misunderstood is probably just the extent of that learning curve, especially the first few months when you're really learning about things that, unless you had a lot of prior exposure to ophthalmology, which I was very lucky to do a lot of ophthalmology rotations, but very much from the outside in. So, I felt like the first few months of ophthalmology residency were extremely difficult trying to learn the lingo, and the exam, and how to be efficient. And like Dave said earlier, just trying to be good at something when you really have no basis yet, no foundation for which to be good. I think that's oftentimes taken for granted just how difficult that initial hump can be.

Gary: Dave, what are your thoughts on that buddy?

David: Yeah, I think Cherie hit so many great points. For me we always read SDN, my wife and I, about optho residency. And the main point of the comments on the thread were that ophthalmology has a steep learning curve. And we thought to ourselves “Okay, well what's the big deal? We're just going to get through that hump.” But that hump is huge, and when you start out, I don't think residents or medical students understand the amount of volume of material that you have to learn. As you go through medical school, you're learning the foundations for internal, pediatrics, etc., but ophthalmology, you get maybe one or two lectures in medical school. And then the rest is through DCSC.

And so, there's just a huge amount of material. There is an infinite number of instruments and tests and equipment that you have to learn in a short space of time to take care of patients appropriately. And once you get through all of that, then the intraocular surgery kicks in, for us it's somewhere between first and second year. For other programs it's starting your third. But that is another huge gap, or huge hump that you have to get through. It can be very nerve-racking when you start out and think, “Oh, am I ever going to get good at this?”

And for me it took I would say at least 40 cases before I at least felt comfortable sitting at the scope. And it's taken another 100 to feel like, “Wow I'm really doing this. And so, there's just a huge leap.”

Gary: I think the problem, and I agree with 100% of what you have both said, I think part of the problem is we leave medical school, kind of tooting our own horn here, but among the most capable. Probably when we're through our internship, we're among the most capable interns. I mean, I did a general surgery year at the University of Kentucky and was busting it with the other general surgery residents, and I did have some transitional rotations in internal medicine, but it was medicine wards and doing all the crazy stuff. And I really embraced that because I felt like when I was done with that it was never really going to come back, I was always going to be in a subspecialty of medicine. And so, I really gave myself to my internship just because I wanted to have that experience.

So, I left my intern year with a really good reputation in the hospital, as a hard worker, someone who was a go-getter. I was presenting at rounds, and presenting cases, and those sorts of things. And I remember the first day of ophthalmology residency feeling completely lost. And it's a major ego hit, because you feel like you are capable, and you've achieved X, Y, and Z. And all of that, it's like none of it matters, because you're starting from scratch. And that is a very difficult transition to go through when it's already intimidating that you are a part of this new, very prestigious, highly respected field of very smart people, and you just don't even know the first thing. It's like the old joke, you can code someone and save someone's life, but for the life of you, you couldn't prescribe someone a pair of glasses. That's what it's really like. And it's very humbling, and it's really tough.

David: Can I just say that that is so true. As you enter medical school you think, “Oh I'm smart enough to get in.” And then as you get through Step 1 you think, “Oh, I was smart enough to get a good score.” And then as you match in ophthalmology you think, “Oh, I was smart enough to match in ophthalmology.” But then you look around and realize, well everyone else was smart too, and you've just self-selected yourself out into this really incredibly competitive and intelligent group of people that now you're competing against for OKAP scores and passing your boards. And so, the bar does just continue to get raised and raised. And I'm continually humbled by my colleagues every day for how gifted they are.

Cherie: Can I bring up a related point?

Gary: Please, Cherie.

Cherie: I also thought it was really interesting for me when I first started residency that, obviously, to get to this point you have to be a very both intrinsically motivated, but also extrinsically motivated person. So, I felt like when I was applying to medical school, I had a clear goal to get in. Then, when I was in medical school it was to get to match. And now that I'm in residency it's a little bit tough, especially if I don't know if I'm going to do fellowship or not, to really have this kind of extrinsic goal that I'm working toward. And that was actually quite difficult for me my first year because there wasn't this definite thing that I was working toward.

So instead of it being this run, it was this very nebulous marathon where I just wasn't sure what the end was for me that would make me most excited. And I think that was very humbling to get to a point where you say you can't really look at extrinsic ideals of achievement, and you have to find out on a day-to-day basis, or month-to-month basis, “What makes me happy? What makes me feel accomplished?” And not necessarily look at it as a what's going to get me to the next step. Because that next step could be really hard to define, especially as a first-year resident or someone who's not entirely sure what they want to do after residency.

Gary: Yeah, I think that I've had some similar thoughts on that. Medical school and becoming an ophthalmologist, it's a very well-defined path, it's just a very steep and dangerous climb to get there, it's perilous, not everyone makes it. Many are called and few are chosen. So, there is very little variability in terms of how you become an ophthalmologist, but it's a tough climb to get there. And the tough thing I think you're getting at is like, when you climb up a mountain and you get to the top, what do I do now? Do I just make that the new base camp and keep climbing to another peak of another mountain? And is there true satisfaction in the achievement?

And I remember very clearly when I graduated from medical school and became doctor, had the MD title, for about a week I was really into that. And literally, I remember after a week I was like, “I'm just Gary. Unless I'm cutting on you or I'm taking care of you, just please call me Gary.” That didn't necessarily mean something, or I didn't necessarily find that to be as fulfilling as I thought it would be. And that was the thing that was sort of driving me through medical school is, “I'm going to be a doctor someday, and this is going to be fantastic.” And then, “I'm going to be an ophthalmologist someday, and that's going to be wonderful.”

But when you're done, I think that you really hit on a very interesting point that we can be so extrinsically focused on achieving certain check marks that make us feel like we have spent our time wisely, investing it in ourselves and in our careers in professional development. But I do think having those intrinsic things where we say, “I took care of a person who now can see, and that's what is driving me is I really love impacting someone's quality of life because I know that that person is going to carry on seeing folks.”

I'll give a little story if you guys will indulge me. I was on a trip to Costa Rica about 2 weeks ago, and I was down there for basically doing charity surgery. And there was a lady who was about 78, and they have free health care in Costa Rica, actually wonderful country, wonderfully well-developed country, but in their system, if you want cataracts surgery, through their socialized system, it's a 4-year wait. And so, she was 78, she felt like she was probably going to die before she was able to have cataract surgery. And I went down and took care of her and saw her the next day, and I don't speak Spanish that well, but through the translator she said, "I now can see my grandchildren, and I'm not going to be blind until I die."

And she hugged me. And it's moments like that, and I don't get a lot of those moments, maybe it's our system that we're in we don't get that as much, but it was a really wonderful experience for me where I kind of recalibrated the “why.” “Why am I doing this, what is the big picture?” And it's really the hug I got from that wonderful woman just reminding me that what we do is highly meaningful. And it's not about the amount of money we make, or the letters after our name, or all those sorts of things, but there's someone in Costa Rica right now who is interacting in her community, seeing her grandchildren. And it's because of all of those other things that I did thinking that it was on this pathway toward success, when the real success is actually found in the interaction and the impact we have on our patients.

David: You know Gary, to piggyback off of what you just said, I had a similar experience, just for the first time did a mature white cataract this last week. And the guy came in not knowing what he was going to be able to see after the surgery, and as soon as we got done, I pulled the drapes off, he became emotional. And for me, that really did it for me. It made me look back on the last 3 years, and I said to myself, “That was worth it. That 15 minutes of time was worth it, all that pain.” And so, I think those experiences in our training are few and far between, but they are so powerful that they keep us going.

Gary: Yeah, definitely agree. Well, Cherie any final thoughts before we wrap up?

Cherie: Well first of all, thank you so much for letting me be a part of this. I'm so excited. I was a huge fan of Ophthalmology off the Grid and would listen to it on my drives in to actually observe cataract surgeries the first year, so I'm excited that I get to be a small part of it, thank you. I am, obviously, I'm very interested to see how residencies tackle the emerging importance of emotional wellbeing and productivity in residency. And actually, hopefully changing the frameship from being, we need to be 100% productive to be considered, or 100% efficient, or give 100% of ourselves to be considered effective doctors.

But also keeping in mind, what are the ways that we can be efficient, but also holistic in our approach. As in, you have the time to reflect, to feel well, to do the things that make you feel human as well in your residency. I think that's becoming an increasingly important issue across the field of medicine, and I think ophthalmology can definitely be a thought leader in this. I look forward to seeing how that goes.

Gary: Excellent. That's wonderful, and we're so happy that you've contributed. I'm looking forward to your perspectives moving forward. Dave, any final thoughts before we wrap up?

David: Yeah, I also just want to say thank you for letting me be a part of this. It's fun for me to be able to talk about these hot topics. And I hope that maybe my life experience can help somebody else coming up through the system. I think as we look forward to these next few episodes, there's so much to talk about. But I just want to make the point that mentors are so powerful. You don't need a perfect program, you just need a good program, and you can take it anywhere from there. I was lucky to match at my first choice. I know several people that didn't end up at their top choice, but they're doing well in their training because they're working hard and being proactive.

As these next several years and as the decade unfolds, more and more baby boomers are going to need our services. And as Cherie brought up, we are going to have to be more efficient and effective. And so, this leads to figuring out the balance and figuring out how to take care of ourselves amidst the sea and ocean of ophthalmic need. And so, it's an exciting time, it's a challenging time, but I've never been more excited and I'm very grateful to be a part of it.

Gary: Well, I couldn't agree more. I think that we've got a lot to be looking forward to.

That wraps it up for this episode of Ophthalmology off the Grid. We've got some really exciting programs coming up. I'll also mention that as you the listeners are interested in potentially being part of this program, we will likely be hosting some live webinar style podcasts, maybe even some video conferences, where our listeners can be part of the experience, can ask questions, can provide dialogue. So be looking for that. You can follow me on Twitter, my handle is @CataractMD, and I frequently will post updates to Ophthalmology off the Grid there. Otherwise, you can just check BMC or Eyetube for further updates.

Once again, this has been Dr. Gary Wörtz, along with Dr. Cherie Fathy and Dr. Dave Felsted for Ophthalmology off the Grid. Until next time.

Speaker 2: Ophthalmology off the Grid is an independent podcast produced by Bryn Mawr Communications and supported by advertising from Johnson and Johnson Surgical Vision. For a full listing of podcasts for eyec are professionals, go to eyetube.net/podcasts.