Ophthalmology off the Grid
Episode 88

Survive & Thrive: The Transition to Practice

Gary Wörtz, MD, is joined by contributors Nandini Venkateswaran, MD, and Dagny Zhu, MD. Listen as they describe their experiences in ophthalmology training and discuss the challenges of navigating the transition to practice.

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

Speaker 2: Welcome to another episode of Ophthalmology off the Grid’s Survive and Thrive series.

Today, our host Dr. Gary Wörtz is joined by Drs. Nandini Venkateswaran and Dagny Zhu. Listen as they discuss succeeding through fellowship and transitioning into the first years of practice.

Coming up, on Off the Grid.

Speaker 2: Survive & Thrive is an independent program produced by Bryn Mawr Communications, and supported by advertising from Johnson & Johnson Vision.

Gary: Welcome to another special edition of Ophthalmology off the Grid. This is Dr. Gary Wörtz, and we're continuing our theme of Surviving & Thriving. Last episode we talked about surviving and thriving throughout residency. This time we're going to pick that up and talk a little bit about residency. We're also going to be talking about surviving and thriving throughout fellowship and also into the first years of practice.

Dagny and Nandini are with me as co-hosts of this special podcast. And so, before we get started, let me start with Dagny. Why don't you introduce yourself, give us a little bit of your background, and then we'll switch to Nandini.

Dagny Zhu, MD: Yeah, sure. I'm Dagny Zhu. I'm a board-certified cornea cataract refractive surgeon. I just finished my second year in private practice, where I'm actually a partner and medical director in Southern California. I did my residency at USC Doheny, and then I did my cornea fellowship, where I actually had the privilege of being Nandini's fellow when she was a resident there, at Bascom Palmer in Miami. So, I'm really happy to talk about...well, I guess I graduated from residency about 4 years ago now and fellowship 3 years ago, so it's still fresh in my mind, so, I'm happy to talk about my experiences there, but also the transition from training into those early years of practice.

Gary: Yeah. That is fantastic. OK. A couple of questions for you, and then we'll switch over. What was your least favorite rotation in medical school?

Dagny: Oh, we're going way back to medical school.

Gary: We're going back. Yeah.

Dagny: Honestly, I really dislike general surgery.

Gary: Interesting. Why?

Dagny: Well, for the obvious reasons of…the rotation is probably the most emotionally and mentally stressful in terms of the hours and the personalities that we had to deal with. I do think there is some truth in some of the stereotypes that we think about when we think about different specialties, and general surgeons are definitely tough. And I just remember I was exposed to a lot of attendings who just didn't seem very happy with what they were doing, and a lot of females in that field seemed very unhappy, and it just didn't give me a good sense of work/life balance and whether that would be a possibility. So, that was really disheartening to me and probably one of the many reasons that I ended up choosing ophthalmology.

Gary: I agree with you 100%. We could have a whole podcast on why I didn't do general surgery and why you didn't do general surgery.

Dagny: Yeah.

Gary: If you couldn't do ophthalmology, what would you be doing right now, either inside or outside of medicine?

Dagny: Oh, that's a great question. You know, I actually was for some time thinking about doing hand surgery. I actually did a lot of orthopedic surgery research when I was a premed, mostly looking at spinal fusion, but I loved the possibility of specializing in that field to do something more delicate and more microsurgery-related. And hand surgery really fascinated me at the time because you can make such a big difference in people's quality of life, and it's such a crucial part of people's function. So, actually very similar why I ended up choosing ophthalmology, I guess. They're both microsurgery. I really enjoy the delicate surgeries involved in each. And then ultimately, I chose ophthalmology because I did not want to go through orthopedic residency.

Gary: Yeah. That was a smart call. One thing I've thought of, and this is how my weird brain works, but neurosurgeons, hand surgeons, and ophthalmologists all have one thing in common, and it's that we're using our organ system to fix the organ system of the other person. So, a neurosurgeon has to use their brain to fix to fix another person's brain, a hand surgeon has to use their hand to fix another person's hand, ophthalmologists use their eyes to fix someone else's eyes. So, I don't know what the significance of that is, but I've always found that to be weirdly interesting.

Dagny: That is so very true. Yes.

Gary: Let’s switch gears to Nandini. I'd love for you to introduce yourself and give us a little bit of background.

Nandini V., MD: Sure. So, I'm Nandini Venkateswaran. I'm currently a cornea fellow at Duke University here in Durham, North Carolina. I did my residency in Miami at Bascom Palmer. Dagny was my cornea fellow when I was a first-year resident, and I still remember really fun times that we had. And I just joined faculty at Mass Eye and Ear in Boston, so I'm slowly moving up north back to the snow, so I'm very excited about that. I'm in the midst of finishing fellowship, I was just in residency last year, so I hope that I can provide the insight into the trials and tribulations of training, which is both exciting and very challenging.

Gary: You are not kidding. All right. The same questions for you. What was your least favorite rotation in medical school?

Nandini: The least favorite was actually pediatrics. I love kids, but I really struggled being their doctor. I just end up playing with them all the time, I don't focus on the exam, and sometimes it's just heart-rending to see them cry, the family would get so upset. So, for me it was just an area that I feel like I just ended up being more of an emotional support to the kids than doing a lot of medicine.

Gary: I thought peds was way too close to veterinary medicine.

Nandini: Fair enough.

Gary: I know that sounds bad, but, anyways. All right. If you couldn't be an ophthalmologist what would you do?

Nandini: I think in medicine, I loved ob/gyn. I was actually very much thinking I could be...I liked gyno onc a lot. I really liked the pathology. I loved obstetrics, kind of the high acuity, bringing a new life into the world was all really exciting. I think it’s kind of a challenging field too, with malpractice, etc., and some of the surgeries were so long, but I think with my personality, I felt like I could have had a lot of fun in that field. But outside of medicine, I have always loved to write, and I secretly always wanted to be a journalist throughout high school and college.

Gary: Well, the nice thing about ophthalmology is you still get that chance, with venues like this and other things. If you like to write you will have plenty of opportunities.

Nandini: Definitely.

Gary: Well, great. I'm glad that you guys have given me a little bit of an intro. One thing I want to talk about is really the training process, and then we'll switch gears a little bit into transitioning into practice. So, Nandini, I'd like to start with you if that's OK.

Nandini: Sure.

Gary: One thing I've thought about for a while is this balance or lack of balance between being just a worker, someone who is going in and doing necessary things to get a job done but not necessarily valuable work, or high-value work, versus being an apprentice where you're working alongside of an expert and really learning your craft, versus being a student where I feel like as a student you're more learning from afar, so you're maybe observing but not hands-on. You're reading about something, but you're not actually seeing it in real life. Where do you feel like that balance is in residency today, in your experience?

Nandini: Well, I actually think in residency, I don't think I was a worker per se, but you really are kind of a protected student, but you're a very active student. When I was at Bascom Palmer, we had our 24-hour emergency room, and as a first-year resident you're literally thrown in. I still remember my first day, I walk in, your patient has a BRVO, I couldn't even look at the retina, but the best part was I couldn't even speak Spanish, and so, I'm sitting there in utter fear trying to figure out how I'm supposed to communicate with my patient and how I'm supposed to examine her at the same time.

But you learn to get over that, and I think you become a very hands-on learner. You just try different things, you figure out how things work, you learn when to ask for help, and you get the job done. And you also become a worker. You have to get through an X-number of patients in the 8 hours you're in the emergency room to get things moving, because patients are there, they're sick, and they're waiting.

Gary: Dagny, same question for you. Tell me where you think that balance was in your experience and maybe where it should be, if it wasn’t ideal.

Dagny: I think I was really fortunate to train on a program where I didn't really feel like just a worker bee. I actually was really hands-on and felt like I had control and autonomy over my patients. So, I trained at USC Doheny, and the majority of our training is at the Los Angeles County Hospital. It's a huge hospital, and we see the most underprivileged patients with the most advanced diseases. And the unique thing about our program was that we would see patients from day one of our first-year residency and continued to see them and treat them until the last day of our residency. So, it wasn't one of those programs where all the residents would share patients. We literally had our own clinic. Those patients were only seen by us, not even by an attending sometimes or when we felt comfortable enough.

So, in that sense I felt like I had autonomy from day one, and like Nandini was saying, we were thrown in from day one. I watched my senior do a PRP, an Avastin injection, and then I did the next one right away the same day. And so, I think because of that, I just felt like I was always fascinated by what I was doing and just fascinated by what I was learning, and it just didn't feel like work to me. It was more like an apprenticeship. I didn't feel like I was doing too much busy work. That changed a little bit when I went to fellowship, though.

Gary: Yeah. And I understand that. I don't know who told me this, but it made sense to me. He said, "If your attending is more efficient with a student on a rotation, then that's actually a bad sign.” So, you should be helpful. It's not that you shouldn't be helpful as a resident, but you should actually slow your attending down a little bit, perhaps, if they're teaching and doing enough to develop you as an ophthalmologist. And I don't think that's always the case, but I think having that in the back of everyone's mind...I remember attendings at times saying, "How am I going to make it through the day? My resident is gone."

I think when things like that are said, maybe it's a reality in certain situations in certain days, but I think really focusing on the fact that residents are there to learn, they're not there just to do all of the scut work that a technician could be doing, or otherwise, I think that's important. I also do think it's important that you do know how to do scut work, and there's a role for that of learning the job from the ground up. So, I'm not necessarily saying that residents should be protected from all forms of non-educational labor. There's some learning that goes on with doing the things that are mundane. But I do think that that helps.

Dagny: I absolutely agree with you on that. Because we were in a county setting, we basically did everything on our own. We checked visions, pressures, we took our own photos, we did all our own refractions. We didn't have techs to help us. And so, it would be stressful at times because of all that extra work we had to do, we would feel stressed and short on time, but now I'm so grateful to just even have those skills. And now that I'm spoiled in private practice and I have all these amazing techs to do my A scans and B scans for me, and they do it so well and better than me, I know that if I had to I could still step in and double-check their work, and I'd still double-check refractions and all of that. So, it just makes you that much more confident when you need training to practice on your own.

Gary: Yeah. I 100% agree. There is something to be said. Actually, before I started my ophthalmology residency, I took all the time that I had, all my vacation time, and actually applied to be a technician at my residency program 2 months early. So, I actually worked for 8 weeks as a technician prior to my intern year, and I got to learn. First of all, it was great because all the techs knew that I was willing to work in the trenches, and so they really helped me the rest of my time as a resident. But just like you said, learning each thing from the ground up, from taking photos, to doing the refractions, to doing pressure checks, etc., it's so valuable.

And I think also demonstrating to everyone around you that you're willing to do whatever is needed just speaks volumes and really opens a lot of doors potentially, if not professionally, at least in the hearts and minds of the people that you're working with.

Dagny: I totally agree. I wanted to say also that the difference between residency and fellowship can be really big in terms of the stresses that you faced. So, when I was a fellow, I felt more of sort of what you were describing, in which you were just doing more of the scut work. Because we were working more with attendings, we would be the ones, as fellows, to return patients' phone calls and messages, call pharmacies, get pre-authorizations for drugs and things like that, things that you didn't really feel like you were learning clinical medicine at all. And a lot of times we could help attendings de-clog their own clinics by seeing urgent patients who would call in with a blepharitis flare up and things like that, that would be a little bit frustrating.

But in return we got access to amazing clinical cases. They would let us do a lot of their cases with them, and we would get maybe preceptors from all of them, so it's definitely a trade-off there, but I definitely can see how fellowship can feel a little bit frustrating in terms of some of the scut work that we're assigned.

Gary: Yeah. So, Nandini, talk to me about your decision to pursue an anterior segment fellowship. When did you decide that that was a direction you wanted to go, and talk to me a little bit about your fellowship.

Nandini V., MD: So, I actually, funny enough, I too was a technician for 6 months, before I even went to medical school. It was a very serendipitous thing. I had graduated from college early 6 months ago, and I needed a job. So, all of that groundwork in terms of learning what ophthalmology entails was really in those 6 months. And my mentors in medical school were actually in cornea, so when I went to residency I was pretty set on doing anterior segment. And for me, the reason I wanted to do fellowship is because at Bascom Palmer we're very lucky, we get to do so many different types of surgeries and work with attendings in so many specialties and really dive into the details of each of them, but there comes a time when you're like, "OK. I feel really confident about doing X, Y, and Z, but I just want to make sure that I can translate skills to the area that I'm interested in.

So, being very proficient in corneal transplants and complex anterior segment reconstruction and refractive surgery, you have exposure in residency, but you don't have that in-depth exposure that you get in fellowship, and that's why I chose one. And I found that those were the cases that got me excited. When I did one, I really loved it and wanted to go home and read more about it. I wanted to see how my patients did post-op. And we were lucky because also at Miami, we had our own clinic, so these patients whom I operated on as a resident, I saw them throughout their entire postoperative course until I graduated. So, there was so much learning in that that I want to, I guess, do it for another year.

Gary: Was academia always on your mind as your future professional track?

Nandini: I think so. I think sometimes I tend to surprise myself in how academic I can be. I think I like to think about things very critically. I enjoy teaching, I really enjoy writing, and academics gives you that variety and that collaboration to be able to do those things pretty easily because those opportunities are at your fingertips. People are always around you, you can bounce ideas between each other, or you can say, "Hey, why don't we write this up?" "Can you just join me in the OR and watch me when I do this? What do you think?"

And so, I think, some of the advice that I've received from mentors is that it's great to start in academics because you get a sense of how it runs, and you can see if long term it’s is fit for you. And hey, if it isn't then in the future you could consider private practice or even consider more of a hybrid model. And so, with my personality, I was like, "All right. Let me give academics a shot. I think I could be great at it. I think I could be an asset to an institution, but let's see if it's a mutually agreeable fit."

Gary: Yeah. So, Dagny, I'd love to hear about your transition from fellowship into private practice. Was that harder than you thought? Easier than you thought? Just plain different? Walk me through that.

Dagny: I would say it was probably harder than I thought. I had been blessed up to that point to have everything go according to plan. I went to a 4-year college, went straight to med school, went straight through residency and fellowship and never took any time off. And everything just happened back-to-back-to-back, and a lot of us, I think, in this field are like that. We like to have everything planned out. We're really type A that way.

Gary: Yes.

Dagny: But coming near graduation day for fellowship, I think I was one of the very few who did not have anything lined up yet.

Gary: Really?

Dagny: Yes. So, most people, they're looking for jobs at the beginning of fellowship, they probably have something already set up, laid out in stone for 6 months before they graduate. For me, maybe because I had a little bit more of, I guess, specific expectations in terms of location, my family is from Southern California, my long-distance husband at the time is also from Southern California, and our goal was to go back to Southern California. And as you know, there are certain markets in this country which just have really limited opportunities compared to other parts of the country, and you have to give up some things in order to work in those areas.

But for me, location was really important to me. And unfortunately, when I was looking during fellowship, I just didn't find any great opportunities in that area that I wanted to be. A lot of it was really disappointing in terms of the opportunities that were out there. There were a lot of practices who were looking for associates who were really just…they were just looking to basically help the senior doctor but not really...there wasn't really a plan for partnership, there was really no mentorship, it seemed, and it seemed like a revolving door almost where you would have a one new associate one year, and then the next year another one would come in. And so, that was a red flag that I kept seeing.

And so, I basically took a step back and prioritized what was important to me in a practice. And so, instead of just jumping on to the first contract that a practice would offer me, I actually turned down quite a few, and I waited a long time. And I guess I entered a negotiating process with my current position for a long time because I wanted to make sure that it was right for me. And so, it actually ended up taking almost 9 months before I started where I am now, and that was 9 months of where I wasn't paying back my loans and I wasn't making any money. And so, it was a worrisome time now that I look back on it, but now that I'm here I'm so happy that I made that decision and took the time to find what was right for me.

Gary: You know, Dagny, that takes an incredible amount of fortitude and also a realization that you are worth it. I don't know if I'm saying that the right way. When I was finishing my residency, I had to get a job. I had a wife and two kids, and we were in debt up to our eyeballs, and it's just the reality of the situation. I probably could not have even afforded to do a fellowship. I knew that, so I needed to get out there and...it was like Jerry Maguire, “Show me the money,” will work for food. And so, I didn't really have that, but at the same time, I don't know that I had the idea that I was really something that was a unique talent or [that] it would have been worth my time to have negotiated with someone.

So, I congratulate you in the sense that you were willing to say, "I'm going to be patient," at the exact moment when you're so done with being patient. There's a little bit of this sense of, "Some day things will get better. Some day I'm going to be financially independent. Some day I'll be getting paid for doing all of this." And it's at that exact moment when you're probably the hungriest for all those things that you were willing to wait even longer to do something that was a little bit different and give yourself a better long-term outcome, and there are very few people I know that have the fortitude to do that. So, you should be congratulated for that.

Dagny: Thank you. Yeah, it was really hard, especially seeing my colleagues starting their jobs and making money while I was still a little bit lost. But I was really fortunate to be where I was, because my husband was at least working at that time, so he was supporting us. And I did end up taking on some per diem jobs here and there, working at an HMO clinic or even doing bedside nursing home exams. So, I did what I could to survive that time. And I could probably do a whole other episode on my whole job contract negotiations, but it ended up being a unique opportunity in my home town, and it was an opportunity for me to actually jump in as a partner right away and to basically purchase this very successful practice.

And now I'm just really happy where I am because I feel like I have a lot of autonomy and I get to do a lot of procedures that anyone else this early in my career probably would not be able to do, so I'm feeling very fortunate where I am now. My lawyer definitely thought I was crazy at the time.

Gary: Yeah. I've been there, done that, also. So, I get that.

Nandini, I want to ask a little bit of a different question. It's somewhat related to what we're talking about, but I found that it was very difficult in medical school and then also in residency to maintain a piece of myself. I felt like you're a hollow shelled-out person working so much and just dedicating so much of your life and time to this profession that we love. And also at the same time you see your friends who didn't go to medical school, who are at mid-career at this point, really skyrocketing, and I remember feeling like, "I'm still not even at the starting blocks yet. I'm still just waiting to round the race." Has that been hard for you? It was really hard for me, I'll be honest.

Nandini: No. I think it's still really hard for me. We've just been in training for so long. And I remember talking to someone about this, in the sense that they were advising me that, especially at this juncture in fellowship that, at some point your job doesn't bring you as much fulfillment as it once did, when you were younger and earlier, and that it's really important to build yourself and become yourself and find those things that give you peace of mind outside of your career. I think throughout medical school and residency and even fellowship, it's always been go, go, go. My priority has been, "How do I take care of my patients? How do I learn surgery? How do I find my job? What's my next step?" Just like Dagny was saying, we're very organized, we're very type A, we're very proactive in that sense, but I have really been challenging myself, at least in the last few months of fellowship, to make time for myself.

If I have a free day, instead of trying to do something academic, you take it off. Go enjoy yourself, do something that you don't get the chance to do during the week. Try to work out a little bit more actively throughout the week, maybe a few days, as opposed to just being tired all the time. Travel, go see your friends, find things outside of work that make you happy. It's tough. There are just not enough hours in the day. And I would always be so impressed by my classmates in medical school and even residency, who had children, who were taking care of so many people outside of their training. And I'm like, "I don't know how you guys do it. How do you balance it all? It's so hard just as a single person."

Gary: Well, I will say this. I do feel like responsibility fills the container you put it in. So, your time, if you have a certain amount of time, you will stretch it or it will expand to fill that. So, we can become a little more efficient when we have to be. But one thing I said in the last episode, and I'll say it again is, residency and fellowship, and honestly even the beginning of practice, because it doesn't necessarily get easier, I think in some ways it's easier, but in ways you had not expected or anticipated it becomes harder, so, it's another gear shift when you start practice, but you're running at red line for a long time, and you're running a red line for so long, we have little capacity for if anything goes wrong in your life to actually deal successfully with that and not let everything fall down and start missing things.

Nandini: Sure.

Gary: But you've done that for so long that it feels like it's your new baseline. If, at the end of the day you have an ounce of energy left, that somehow you have not been productive or even just managed yourself. And so, I would encourage both of you to learn a lesson I learned the hard way, that if you go to bed every night completely exhausted without an ounce of energy, you're doing something wrong. You need to have a little bit left in the tank, because there are going to be stressors that come up and there are going to be times when you'll need to take care of things just beyond residency and fellowship and your practice students. So, that's something to just file away, a lesson from someone who's been there, done that.

I want to talk to Dagny a little bit about what it was like operating for the first time when you were by yourself. How was that? What was that experience like for you? You were done with fellowship and maybe not even in your locum's experience, but you got your own practice and now you're the one, you're holding all of the responsibility in your hands. What was that experience like?

Dagny: It was absolutely frightening. Even just a basic cataract case that you've done a million times in residency and fellowship, it just feels that much more frightening when you're doing it in your own private practice, by yourself, knowing that if something were to happen, there's no one else you could fall back on. All the decisions are your own, all the responsibility is your own, this patient is yours. They are paying out of pocket sometimes to get that premium result, and so, the expectations are just that much higher. And it's not that the surgery is any more difficult or the techniques are any different. It's just the position, the new position that you're in with the newfound independence and responsibility.

In residency I think most of the stress and burnout comes from that steep learning curve where you're just learning how to do something the first time. But in your first years of private practice, you're learning how to do it very well, and you have to do it better than others in the community if you want to keep having patients come back to you. So, it's just refining that technique to a level that is beyond what you were used to.

Gary: Yeah. There's a certain gravity, I think, that comes with that. And it reminded me of, I guess, how someone would feel if they were walking across a tightrope, and then suddenly they take the net away. And it's like, if you fall or if you fail, it's just on you. It's your responsibility now, the good or the bad. And I definitely felt that. One thing I did was, I had all my settings for my phaco machine for residency imported, we have the same phaco machine, we have the same phaco tip, we had the same second instrument.

And I actually even had my Alcon rep, Kelly Miller, come, and she was with me in surgery a couple of times when I was a resident and knew how I operated, and she came down and was there for me and also talked to the staff and said, "You know, he's a pretty good surgeon and everything is going to be fine." And so, she was kind of this buffer for me. I've heard of other people having their attendings come and observe for a couple of OR sessions just as a little bit of a transition, which makes them feel a little bit better, and I think all those things are good ideas.

Dagny: Yeah. Those are great ideas.

Gary: Tell me a little bit about LASIK. I assume you're doing LASIK in your practice?

Dagny: Yes, I do a lot of LASIK as well.

Gary: And did you learn that in fellowship, in residency, or was this something that you had to pick up afterward?

Dagny: So, residency we had basically zero hands-on experience. All we had to do was observe an attending perform 10 cases, and you would check off that box. Fellowship is where I first got my hands-on experience. We had to recruit our own patients and you would give them a discount, as a fellow doing it to sort of incentivize patients, and so, I did a handful of cases there, but nowhere to the point where I was comfortable like I am now. So, I would say the first year of being in private practice or in practice in general, is almost like a second fellowship where you're learning everything and refining everything and just becoming comfortable. So, it took a little bit of time the first few months in the first year where I got more familiar with LASIK, but now it's just kind of like I can close my eyes and do it sort of thing. So, it takes time, but you can definitely get there.

And the great thing about my practice too is that it's part of a large group where there are other surgeons at other centers, and so I've had the opportunity to text them ahead of time about cases and what they thought, and some of them have sat with me as well in the beginning just to give me pointers here and there, and I've watched some of them as well and took some of their pointers. So, it's definitely something that you continue to learn, even in practice.

Gary: Yeah. I think that's a really tough thing, and I don't think it's been solved yet, in terms of giving residents experience with refractive surgery. There are some programs in my area that I think are starting to do better with that, giving residents more of a hands-on experience. But there's a lot of people in the community who have done 50,000 LASIK surgeries, and it's really hard...I felt this pressure starting off, like, "I've done five or 10. How can I really compare myself to these other folks who have done so much and then had such a head start?" And that's a lot of pressure, so I don't know really what the answer is, but I do know that there is an unmet need there.

I guess there are some refractive fellowships that are out there. I know Rob Weinstock and John Berdahl and Bill Wiley all have fantastic refractive fellowships, where they're actually giving their fellows quite a good experience in that. But I think those are a little bit harder to find, but maybe something like that is a little bit of an opportunity for the future.

So, Nandini, one last question I really would like your perspective on, and maybe this is probably more for either medical students who are thinking about ophthalmology as a future career or even out compatriots in other specialties who look on ophthalmology from the outside. How do you think that ophthalmology, I guess, on one level as a specialty is misunderstood, but I may be even more interested on how you think the residency experience is misunderstood?

Nandini: Hmm. That's a tough question. I think as a specialty, maybe to students, maybe to more of the public, I don't think everyone is aware that ophthalmologists are eye surgeons. I think that we are privileged in the sense that not only are we taking care of our patients in the clinic, but we have the opportunity to intervene for them surgically, to give them the visual result that they want. And so, I think for students that are looking for a surgical subspecialty, it's actually highly surgical. The best part, I think, of my training is to be in the operating room and to take care of patients there and to learn all of these exciting new techniques that we have that are constantly evolving. And I think that's what excites a lot of us, and I'm sure you would agree, about what we do.

Gary: Absolutely.

Nandini: In terms of residency training, I don't know what's necessarily misunderstood, but I think as a medical student or as a trainee, it becomes a process where you learn to compartmentalize your learning. There's one point in your residency where you're really focused on medical ophthalmology. You're trying to just learn the bread and butter of using the slit lamp, of being able to see the eye, of catching that pathology. And then there comes a time where you then transition to your minor procedures, you're starting to be hands-on. And then a lot of your latter training is you in the operating room, understanding surgery. And it's a lot to learn in 3 years. And that's why I recommend fellowship, because there's so much more in terms of refining your skill set.

And just like Dagny said, I think my first year of practice is going to be my second fellowship, where we're going to have the opportunity to still turn to all these amazing mentors I've had along the way to help me with all of my cases, my LASIK cases, my transplants, my secondary IOLs. I still text them, I'm like, "What would you do? Do you think this is the right plan?" In fact, my old fellows are people that I text all the time, even as a current fellow, asking for their advice, or calling them and being like, "What do you think? What would you have done in this scenario? Can you watch this video and tell me what you think?" So, I think there's a lot of collaboration in the community in ophthalmology, which I think is a nice kept secret, which is part of the fun of being part of a specialty, and I love it.

Gary: Yeah, absolutely. I think one of the things that really opened my eyes, when I think back on it, ophthalmology...there is obviously a huge neurology component to it. So, you have to really understand neurology. There's a huge anatomical...if you think about the implastics in both aesthetic and function, knowing the anatomy is huge. You've got a pediatric element to it. You've got a pathology element to it. You've got a rheumatology element. You've got infectious disease. Then you have all the optics and using lasers and microsurgery.

Obviously, I'm a little bit biased, but I would really...I would challenge others to find a subspecialty that encompasses more of general medicine or is as underappreciated, just because of all the various aspects of general medicine that impact the eye or vice versa, are seen in the eye impact the body. So, I think that's one of those things that is underappreciated because we are such a black hole of knowledge where no one, outside of ophthalmology, in medicine has any clue of what we do. They just are so thankful to see you when you show up in the ER, because they know that you will take care of it and not bother them with it anymore.

Nandini: I feel like you recited my personal statement of why I went into ophthalmology, because…

Gary: Ah, excellent.

Nandini: ...That's one of the reasons I loved it, because of how comprehensive it was and how it involved so many different parts of medicine. And I really feel like ophthalmology is given the short stick in medical school. Most people have a 2-week rotation on it on using the ophthalmoscope, which is not representative at all of what our specialty is like, and they have no idea how…

Gary: Yeah, I still can't use that thing.

Nandini: Me neither. And they have no idea how it's connected to medicine in general. So, I really wish they would dedicate more time to it.

Gary: Well, we'll make this podcast required listening for all future medical students. How does that sound?

Nandini: Perfect.

Gary: Are you guys okay with that?

Nandini: Yes.

Dagny: Yes.

Gary: OK. Excellent. Well, I think with that we will wrap it up. Thank you so much, Dagny and Nandini. I really appreciate your perspectives. This project is going to be really fun. And just as a teaser, coming up hopefully in the near future, we're going to be having a live podcast webinar. So, if you're interested in these topics about surviving and thriving in residency, fellowship, and beyond, we'd love to have you tune in and be part of that, where we'll have a live video broadcast. You can follow me on Twitter @cataractmd, where I'll be hosting various updates, along with probably cat videos and things I think that are hilarious about ophthalmology. But beyond that, thank you all for joining us at another episode of Ophthalmology off the Grid. Until next time.

Speaker 2: Thank you to our contributors for joining another episode of the Survive and Thrive series, and thanks to our listeners for tuning in.

This has been Ophthalmology off the Grid. Until next time.

Speaker 2: Survive and Thrive is an independent program produced by Bryn Mawr Communications, and supported by advertising from Johnson & Johnson Vision.

5/27/2020 | 40:24

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