MedicalPhysician Q&A

20 Questions: Joseph Riad Mikhael, MD, Hematology

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Dr. Joseph Riad Mikhael is associate professor of medicine in the College of Medicine at the Mayo Clinic in Scottsdale, as well as a consultant in the division of hematology/oncology, department of internal medicine at the same facility. He studied biology at University of Ottawa, going on to receive his MD from the University of Ottawa Faculty of Medicine (1997). He completed a residency in internal medicine at University of Ottawa (1997-2000), followed by a residency in hematology at University of Toronto (2000-2003). Dr. Mikhael went on to become chief resident in the adult hematology program a University of Toronto (2001-2002), then earned a Master’s degree in education from Ontario Institute for Studies in Education, University of Toronto (2003). Lastly, he completed a fellowship at Princess Margaret Hospital (2003-2004).
Dr. Mikhael’s prior work history includes staff physician at Toronto General Hospital, assistant professor in the department of medicine at University of Toronto, and staff hematologist at Princess Margaret Hospital in Toronto. He is a member of the American Society of Hematology, and he has been published in numerous journals, including the Canadian Journal of Infectious Diseases, Bone Marrow Transplant, Journal of Clinical Oncology, Journal of General Internal Medicine, Geriatrics and Aging, American Journal of Hematology, Journal of Blood Medicine, and Journal of Cancer Epidemiology.

When did you first decide to become a doctor? Why?

While in undergraduate sciences. I wanted to connect with people at a deeper level, exercise my mind and genuinely make a difference in people’s lives. The level of connection as a physician is considerably more intimate, profound and generally longer term than any other profession. My “addiction” is people, and I genuinely enjoy connecting to patients and their families – it happens quickly and it often contributes to their confidence in me and indeed their outcomes.

How/why did you choose the medical school you attended?

I lived in that city and it was highly rated with a new more “hands on” curriculum. At that time, I had only completed 2 years of biology and the only two schools who accepted applications from students with less than 3 years of training were Ottawa and Toronto and I applied to both, being accepted into University of Ottawa.

What surprised you the most about your medical school studies?

The outstanding people who ended up in medicine and how much they could do for science and their patients. I remember meeting so many faculty who cared genuinely for their patients, were outstanding teachers, did effective research and loved their families. I was awed at how they could do it all and wanted to reproduce that in my life.
Why did you decide to specialize in hematology?
Great mentors, ability to care for genuinely sick patients, but with a broad range of ages and disease types.

If you had it to do all over again, would you still specialize in hematology? (Why or why not? What would you have done instead?)

Wouldn’t change a thing – love my work, balancing patient care, education and research. I do “save lives” and enjoy it.
Has being a hematologist met your expectations? Why?
In general yes – always wish we could do more, and that there would be more lay understanding of what a hematologist is, but that is minor in big picture. I think the average person hears hematologist and thinks we live in a lab and constantly look at blood. Although we do some of that, most of us are very clinically oriented and caring for patients (often like an oncologist, but focused on complex blood cancers). Furthermore, we interact with nearly every other type of physician (as the blood is so prolific to each disease and specialty) so we have a hand in many, many more patients. So, I try to demonstrate to my patients the value of the “bench to bedside” modality of making discoveries in the lab affecting the way we treat patients in real time.

What do you like most about being a hematologist?

Being specialized while remaining in touch with general medicine (I am not just a technician in a uber narrow field) while caring for patients. I love bridging research and patient care by introducing cutting edge research to the clinic. I am very involved in clinical trials with new cancer drugs – so to be able to test these in the lab, in our mouse model, then directly in patients is rewarding. Furthermore, in my field in myeloma, we have nearly tripled the average survival of patients in the last decade because of that approach.
What do you like least about being a hematologist?
Always challenging to match patient expectations and remuneration should be better. Understandably and appropriately, all of patients want to be treated quickly, effectively, with no side effects and great quality of life. We are clearly moving in that direction with better therapies for cancer, but many times we still see our patients become very sick, suffer side effects, and sadly many of them die prematurely. Patients also want their physician 24/7 – although I make myself incredibly accessible, this is simply not always possible.

What was it like finding a job in your chosen career field? What were your options and why did you decide what you did?

I thankfully had many options, but wanted to remain in academics. I had to do more benign heme to match the job description (as opposed to focusing exclusively in myeloma) but I ended up liking it and remain doing both. I had many offers to pursue a career in different specialties, and even within hematology there were options across North America for me. I was very thankful to have choices and remain in the field I wanted to. I was very committed to academics as I wanted to balance clinical work with teaching and research. I love the academic environment of scientific inquiry, research and being a part of the force that moves the field forward.

Describe a typical day at work.

I wake up at 5 a.m., go the gym 5:15 to 6:15 a.m., return home to see my girls, then leave at 6:45 a.m. to start my day at 7 a.m., when I either see a patient or have a meeting. In a typical day I will see patients for half of the day and the other half I will have administrative, education or research meetings/teleconferences, give a lecture, spend time reviewing papers for a journal, spend time writing a paper or mentor others in doing so. I like to leave soon after 6 p.m. to be home for dinner at 6:30 p.m. Ten to 12 weeks a year I am on hospital service where I see patients at the hospital all day. I also give about 40 talks per year around the world (in addition to local talks).

On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?

I work 10 hours a day during week, sleep about seven hours a night, take four weeks per year on genuine vacation

Are you satisfied with your income? Explain.

Yes – at my institution, I have a good salary and outstanding benefits – could make more in community but would not have collegiality, academic pursuits nor lifestyle I have now.
If you took out educational loans, is/was paying them back a financial strain? Explain.
I had fewer loans than most – I was able to pay them off early.
In your position now, knowing what you do – what would you say to yourself when you started your medical career?
Always be sure you take care of yourself, the patient is paramount, and you can achieve more than you think.

What information/advice do you wish you had known when you were beginning your medical studies?

Medicine is a team sport – respect and include all elements of allied health, but also learn to lead. My father, who was a physician, gave me wonderful advice about the importance of nurses in medicine and how to treat everyone with respect. However, one must not only know it but also be able to put it into practice, and I am thankful for having the chance to do so.
From your perspective, what is the biggest problem in health care today?
Unfair question as there are too many – perhaps an expectation that we can keep spending the way we do and remain sustainable – it is simply not and others countries have proved it. We all have to pay more.
Where do you see hematology in five to 10 years?
As it is now, a prominent field in medicine, with greater prominence with the aging of population and the pace of hematology research.

What types of outreach/volunteer work do you do, if any?

Less now, but for many years I helped run a homeless clinic. I now do a lot of work with patient groups and community outreach – all pro bono. I previously helped establish a clinic in a homeless shelter for men and women in Canada. I now do a number of patient meetings, on average one per month. These are often educational meetings or patient support groups, and are nationwide.
Do you have family? If so, do you have enough time to spend with them? How do you balance work and life outside of work?
My family is my life – I always want more time with them, but I believe that I am only indispensable at home (not work!) so I work every day to maintain that balance. It is both an attitude and a deliberate practice of being crazy-organized to schedule my time to be with them.
Do you have any final piece of advice for students interested in pursuing hematology as a career?
Spend time with people that do it, but carve your own path – it is your life and you can be unique. It is a wonderful field with many open areas for younger hematologists to make a difference and a mark.
 

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