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Q&A with Physician-Author with Michael Collins, MD

Created August 8, 2016 by Brent Schnipke
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Tell me about yourself – who you are, what you do, where you practice.
I am an orthopedic surgeon in Hinsdale, Illinois. I’m with the same practice I started with after residency in 1983. Our group has grown to include around 30 orthopedic surgeons. I used to do everything – I did not do a fellowship because when I came out most people didn’t. Now, most people do, and I see why – it’s hard to stay up to date on everything. I’ve slowly narrowed my practice down. I now mostly work on knees and shoulders.

Tell me about your background – where you are from, where you did college, medical school, residency.
I grew up on the west side of Chicago, where my father and grandfather and great-grandfather lived. I’m one of eight brothers, and my wife is one of seven, and most of our families still live here in Chicago. I went to Notre Dame, where I played hockey. The team didn’t miss me much when I left, but I had a lot of fun playing. I decided to go back to medicine later, and I went to Loyola medical school. When I went it was three years; now they’ve gone back to four. It was good for me, because I got out a year sooner, but I think going back to four years is a good thing – three years was trying to do too much in too little time. For example, when I went for the Match I was between pediatrics and general surgery. I chose pediatrics at the Mayo Clinic. I had already matched in pediatrics when I had my first ortho experience, and I decided I wanted to do that. Luckily, back then ortho was four years of residency after a year in anything else. I did a year of pediatrics at Mayo and then switched over to orthopedics for four years.

How did you choose medicine in general and orthopedics in particular?
I think I was immature in college. I had a great time, and I lost focus on the future because I was enjoying being in the present so much. After college I tried different things, and I went back and forth a lot – I thought about the Peace Corps, I thought about becoming a teacher. Once I decided on medicine, I had to go back and take almost two years of pre-med courses.

I chose to become an orthopod because of the positive feedback. In a sense you ‘fix what’s wrong.’ If someone comes in with a broken arm, we set it. It’s hard for me to imagine other specialties where you manage things over long periods of time. I like the immediate feedback.

What do you like most about your specialty?
The positive feedback, as I already mentioned, would be one. The other has been taking care of people over long periods of time. As I said, I am in the same place I was when I came out of residency. I’ve never left the practice, and I still live in the town I practice in. I am now getting to see patients’ kids and sometimes grandkids, and that’s rewarding for me.

When I joined this practice my senior partner, who has long since retired, asked me where I was going to live. I told him [Hinsdale], where the practice is. He told me, “if you’re going to do that, you better be good. When you go to the grocery store or wherever, you’ll see patients and it will be awkward if you’re bad. But it will be great if you’re good.”

What do you dislike or like least about your specialty?
I don’t dislike things about orthopedics specifically as much as things about medicine. These are mostly the things we all know about – public perception of physicians, too much government involvement, and the like.

Also, doctors are now paid less than they were a generation ago. There are some people who think that maybe before, doctors were paid too much, and I probably agree with that. For me, money was never an issue in the early days. I didn’t know how much any given procedure cost – if someone asked me, “How much do you charge for a joint replacement?” I would have had no idea. And if someone couldn’t pay for a surgery they needed I’d do it for free. I didn’t care because I was making enough to have a good living. Some of those things have changed now, and I regret that. I regret the loss of altruism that we have had in medicine.

Orthopedics has many stereotypes, one of which is that it is a very competitive specialty. Have you found that to be true? 
It’s funny for you to ask me that, because orthopods used to be the butt of many jokes. “All orthopods are ex-jocks,” “You have to be strong as an ox and twice as smart,” etc. It has changed a lot – it’s now difficult to get into. I think some changes account for that, changes which happened right before I started residency. Those things are mainly joint replacements and arthroscopy. So many problems are now fixable.

I saw a friend whose daughter wanted to go to medical school, and I told her I think that’s great. I’m a big proponent of medicine as a career. Anyway, she asked me my specialty and when I told her she said, “Wow!” I thought, “Here we go, she’s going to make these jokes,” but she literally meant “Wow”. “That’s the hardest specialty there is!”

Another thing that I sort of regret, and maybe it’s not completely true, but it has become known as one of the highest paying specialties. I sincerely hope people don’t choose it for that reason.

What was the process like during residency / job interviews?
I didn’t do any visiting rotations at all, and not at the Mayo Clinic, where I went to residency. I don’t even remember interviewing there for pediatrics. I got into the orthopedics residency because I played hockey with a guy who was high up in the department, and he liked me so he got me in. It has changed so much – I was at a conference recently, and I saw a poster about the number of programs and cost that students apply to now. It frightened me a little bit, seeing how much it costs medical students to apply and interview at so many different programs. Medical students have enough financial concerns as it is.

How did you decide what type of medicine you wanted to practice – academic, private, large group, etc.?
I do private practice, with little bit of academic – the hospital I’m at has a family medicine residency. I loved clinical medicine, so that’s all I do and wanted to do medically. I think for most people, me included, you have a perception of what it means to be a doctor – that can mean different things for different people. For me it was treating patients. I respect the people who want to do research – they are the ones curing diseases and answering all these questions we have. But it was never for me.

Many physicians talk about feeling overwhelmed, burned out, and disillusioned with medicine. Do you or have you felt this way?
No. I love what I do. I am a great proponent of medicine as a career for young people. Never regretted it for a minute. Things may not have been as rosy when I first started, and I don’t want to kid myself about some of the downsides, but I’ve never felt burned out by it.

How do you keep from burning out? What advice would you give to young doctors entering the field of medicine?
I think burnout occurs when there is a disconnect between expectations and reality. It’s important to go into things with an understanding of what it’s going to be like. There are negatives: you probably won’t make as much money as a generation ago, plus the other things like paperwork, and the business of medicine. These are all true, and they are a problem. But I think if you focus as a clinical practitioner, basic things haven’t changed in thousands of years. You go into a room, talk to the patient, figure out the patient’s problem, and do whatever you can to help them. Helping people with their problems is the greatest thing about medicine. If you focus on that instead of the paperwork you have to do, you’re less likely to burn out.

How many hours a week do you work?
It’s on the decline – it’s now 33 years after residency, and I’m 67 years old. I’m working much less than I used to. Our group is larger (around 30) and a few years ago they voted me off call. That was huge – now I have no nights or weekends. That’s obviously a great improvement from years ago.

How do you balance work and life?
It’s a matter of commitment. Family is number one. My attention has not always reflected that, maybe. My wife is wonderful. She used to be a nurse, so she gets it that doctors don’t always get to do what they want to do. Sometimes our hands are tied. My kids understand that too. If you sit down your sixteen-year-old son and explain that there is a lady who’s bleeding and needs my help, but he has a soccer game, he’s going to understand the priority. But if you choose to go to the bar with friends instead of your kid’s graduation, that’s a different story. I say pick a good spouse. Many people don’t realize that the spouse has to make sacrifices too. Many physician marriages fail because of this, because of the strain of the non-physician spouse also sacrificing.

What are your thoughts on the changing landscape of healthcare? How has it changed since you began practicing?
There’s an intrusion of industry into medicine. Medicine is an industry now. Everything is now tainted by financial considerations. That’s a huge worry to me.

The other part that I find difficult to deal with is that so many things can be done but we don’t have the resources to do them. The specter of rationing looms large. It’s already happening – a 102 year old with chest pain won’t get a quadruple coronary bypass. How do we decide this rationing as a society? Do I give this person a kidney transplant vs. housing kids in poverty? These are hard decisions to make.

What do you see as the biggest problem facing American healthcare today? Can you identify any potential solutions?
We can do more than the country can afford. The question is how to decide who gets what. We need recognition by everyone that there is a limit of what can be done for us. Many people now want to have more done for them than even a generation ago. I think people used to be more OK with dying because they thought, “It’s OK, I’ll go to heaven.” Less people think that way now. But there is a limit of what should be done, especially if someone else is paying.

How did you get into writing?
I wanted to be a writer first. I have all along. You know, like in college, friends would have me write their papers for them. After college I free-lanced, wrote articles, up until medical school. I started having really moving experiences and I began jotting notes down. That was when I knew I wanted to write a book. In med school, you’re often sleep-deprived, and so your memory’s not very good, so I made notes. I was 15 years into practice before I started to write the book. When I started, I assumed I was a good writer, but it turned out I wasn’t. Some of my early drafts of Hot Lights, Cold Steel were bad, and even I could tell that. So I took courses to improve my craft, went to conferences, and really learned how to write.

Can you talk about your writing process?
I do not have a set schedule, for example, “I write from 6am to 8am every day.” I worked on my book today for the first time in a couple weeks. I’m at a conference this week, so I’m doing several hours every day this week. As a physician, you’re busy, and a lot of it is about appropriate use of time. I have the mindset to get things done when I can. When I first started, I would sometimes be waiting for a case to start and maybe have an hour. I realized that instead of just sitting around thinking about writing, I could get some actual writing done. It’s difficult, but I’ve come to enjoy the process. I like the creative process. For me, family is first, medicine is second, and I’m a writer after that.

What practices do you use to be more reflective?
I wish I were more introspective than I am. I am content with myself, so I don’t always dig deeper. I haven’t felt the need for it, but some people do and I definitely understand that.

Do you find it difficult to write about your work, patients, colleagues, etc.?
The rights of the patients come first. You cannot infringe upon your patients’ privacy. I think it’s the same thing with family. When I wrote my first two books, my publisher and agent wanted me to write a sequel about my first years in clinical practice. I’ve never wanted to do that, because it seemed too personal to write about my family, my partners, and my patients. Thinking about it now, it seems more possible – not about recent years but 20-30 years ago.

Do you feel that writing and medicine complement each other, or maybe they are at odds with each other?
I would say they complement each other. As a physician who has written some things, I get asked to give talks, and I have talked a lot about the affinity between literature and medicine. As we both know there are many physician authors, and that’s not a coincidence. As a doctor you need to be able to see things in others’ eyes. You develop empathy. It helps you with reading people, you know, like the patient who complains of one thing but it’s actually something else. That analytical thought process helps you a lot in the literary sphere.

Do you write any poetry?
I love to read poetry, and I have written a few that I would not consider publishing. I wouldn’t kid myself that mine are any good. I love the old poets. Poems speak to us in ways that literality cannot.

Do you have any new projects in the works?
I am working on another book, and it’s fiction. It’s much more difficult than I thought it would be. Before, when I was writing nonfiction, I felt constrained by facts – I could only write about what really happened. I sort of thought in fiction, you can make up whatever you want, so it is easier. But it’s hard.

I’m a ‘medical writer’. It’s fiction, but it’s about a doctor, talking about the high and low points of his life and career. I still feel the same desire in the first two books. Basically I want to encourage young people to go into medicine. I think it’s an affirmation in the delight of medicine.

Any closing remarks?
To medical students: hang in there! It’s a wonderful life. There are tough times ahead, but it’s going to be great.

Michael Collins is an orthopedic surgeon on the west side of Chicago. He is also a writer and has published two memoirs, Hot Lights, Cold Steel and Blue Collar, Blue Scrubs. Read more at www.michaeljcollinsmd.com.

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