Dr. Shane Quinonez is a Clinical Assistant Professor and the Associate Program Director of the Pediatric Residency Program at The University of Michigan. He earned his MD at The University of Michigan and then completed his pediatrics, medical genetics, and biochemical genetics training there as well.
When did you first decide to become a physician? Why?
I wish I could answer this question by showing a childhood picture of myself with a toy stethoscope around my neck. The truth is not nearly as cute. As an undergraduate student at The University of Toledo, I initially enrolled in pharmacy school, thinking I would become a pharmacist. Around my sophomore year I began reflecting on what truly gave me fulfillment in all of my previous jobs, educational experiences, and extracurricular activities. I quickly realized that I was most happy when I was interacting directly with people and was presented with opportunities to improve their lives. While these elements were clearly available in pharmacy, I felt that I would be best able to explore these interests as a physician. Though my decision was fairly calculated, I do not think I would be nearly as fulfilled and happy with my choice had I not made that decision based on the person I truly am rather than the person I wanted to be.
How/why did you choose the medical school you attended?
I grew up in the Toledo, Ohio area and attended undergrad at The University of Toledo, which is 10 minutes from the house I grew up in. When I was choosing a medical school I very much wanted to balance my drive to learn at a top-tier institution with my desire to maintain a support system. The University of Michigan was the perfect choice as it was, and remains, an exceptional medical school and was only 1 hour from my hometown. Again, these were very conscious decisions that I made prior to interviewing. The interview day solidified this decision for me as I fell in love with the curriculum, educational leadership, culture, and overall feel of the institution.
What surprised you the most about your medical studies?
I would have to say I was most surprised by the intellect, drive, and accomplishments of my fellow medical students. Most people who attend medical school are used to being the smartest and most accomplished individual at their undergraduate school and/or program. As a result, entering medical school can be a very humbling experience at first. In my case I had gone straight through, meaning I had taken no time off in-between high school or undergrad before attending medical school. Consequently, when compared to my classmates, who had been involved in The Peace Corp or taught in foreign countries for example, I was left feeling quite limited in my prior educational and life experiences. Importantly, I am a firm believer in the quote, “You are the average of the five people you most associate with.” With that in mind, what started as a feeling of inadequacy eventually turned into a drive to better myself through friendships with these people and seeking out my own set of experiences that have come to define who I am today.
Why did you decide to specialize in pediatrics?
Going into my clinical rotations I can say with complete honesty that I had no idea what I wanted to specialize in. I loved the “fix it” aspect of surgery but also loved the quality of life aspect of more outpatient-focused fields. Throughout my 3rd year of med school while on rotations I maintained an open mind and really looked for what “felt right.” After each clerkship I would reflect on how I felt on each rotation, specifically asking myself if I had been excited to go to work each day. After my pediatrics clerkship I realized that peds just felt right. I enjoyed being in the hospital and clinic every day. A massive part of that feeling, which continues today, is my love of the people who go into the field. As mentioned before, the reason I went into medicine was my desire to regularly interact with others. While this clearly includes patients and their families, co-workers clearly fall under this umbrella as well. There is just something about the people who go into pediatrics that makes them great to work with. This includes physicians but also extends to the nurses, respiratory therapists, medical assistants, clerks, and everyone else that makes a children’s hospital run. Collectively, this group of people make being at the hospital at 2 am a much more enjoyable experience.
What do you do as a pediatric geneticist, and what led you to subspecialize?
As a pediatric geneticist no two days are the same. This is the main reason I went into the field. Medical genetics is relatively young when compared to areas of medicine like cardiology or endocrinology. As a consequence we have an incredible amount of growth potential in terms of medical knowledge, education, patient care, and research. My career very much embodies this diversity and is made up of clinical care, clinical laboratory responsibilities, medical education, patient outreach, and research. I was initially exposed to pediatric genetics through an elective I took while a pediatrics resident. I fell in love with the patient population, and the ability to take a deep dive into a patient’s genetic diagnosis. This allowed me to gain unparalleled insight into a patient’s problems on a level that no other field offered. As a geneticist I am also able to look at a patient’s whole history, not just a single organ-system problem. A lot of the patients I see have diagnoses that affect multiple organ systems requiring follow-up by multiple subspecialists. These subspecialists are a vital part of these patients’ management but often can only focus on one organ, such as the heart in a patient with a congenital heart defect or the kidney in a patient with an urogenital malformation. As a geneticist I get to ask about a patient’s entire health history which puts me in a unique, and often very much appreciated, position in a patient’s workup and management. This unique position in a patient’s care team combined with the previously mentioned diverse day-to-day activities is what ultimately solidified my decision to enter pediatric genetics.
In what ways has being a pediatric geneticist met your expectations? In what ways is it different than you expected?
I would say that I expected to never be bored as a pediatric geneticist. There is so much to learn and discover in the field of genetics and I can truly say that I have not been bored a single day of my career so far. The incredible clinical demand for the services of a medical geneticist had definitely exceeded my expectations. When I first entered the field I would often spend up to 90 minutes with a single patient and only see 3 patients per half-day. Currently I am seeing two-times that number per half-day. This is in large part due to the increased demand for medical genetics services and our fields’ desire to not make patients wait an unreasonable amount of time prior to being seen in clinic.
What do you like most about being a pediatric geneticist?
My answer to this question will probably change each year of my career but at this point my favorite aspect of genetics is how teachable it is. I often say that if a person knows 5% of all there is to know about genetics they know more than 95% of all physicians in the hospital. I use this as a motivator for the medical students and residents I interact with to show them that a little bit of knowledge can go a long way. There is nothing more satisfying to me than watching a medical student or resident rotate through our service. Day one of the rotation finds them often quite overwhelmed and intimidated by the sheer volume of information available regarding the numerous conditions we diagnose and treat. By the end of the rotation though they exhibit both confidence and competence with the general approach and principles of working-up and managing genetics patients seen in the clinic or in the hospital.
What do you like least about being a pediatric geneticist?
Without question the most frustrating aspect of my job is working with (or often against) insurance companies regarding coverage for genetic testing and medications.
Describe a typical day at work—walk me through a day in your shoes.
My days vary depending on if I am in clinic or not. A clinic day for me consists of seeing patients in the outpatient clinic. Typically, I start seeing patients at 7:30 am and see my last patient at 4 pm and will usually see between 5 and 8 patients per half-day (10-20 per day). I often work alongside a genetic counselor who assists with genetic counseling and obtaining a patient’s history and family history. Other times I work with a medical student or resident so get the opportunity to teach during clinic. Clinic days are usually pretty busy and are made up of the actual patient care but also documentation of the clinic visits which I do by phone dictation. I also am on-call for pediatric genetics about once every 5-6 weeks. This usually consists of inpatient consultations on the pediatrics floor, pediatric intensive care unit, and neonatal intensive care unit.
On days when I am not in clinic, I am usually involved in various other activities including medical education, running a biochemical genetics lab, and research. In my medical education role, I serve as an Associate Program Director for the pediatrics residency at The University of Michigan. This role consists of regular meetings with program leadership and pediatric residents. I am also co-director of the Biochemical Genetics laboratory which is part of the Michigan Medical Genetics Laboratory. The lab handles clinical samples that are used in the workup and management of patients with inborn errors of metabolism. I am also involved in global health research, medical education projects and outreach in Ethiopia and Ghana. These various non-clinical activities take up most of the days I am not seeing patients. The rest of the time I spend following up on test results, documentation, and other clinical responsibilities.
How is your job as an academic physician different than a physician working in other settings?
I should mention that I have not ever worked at a non-academic institution so my statements may be slightly one-sided. From my standpoint I feel that the opportunity to participate in non-clinical activities is greatly enhanced by working at an academic center. Caring for patients is the primary focus of my career as an academic pediatric geneticist but the medical education, research, and global health activities I am involved in make my job so much more fulfilling and interesting. While it would still be possible to participate somewhat in these things at a non-academic center, a place like The University of Michigan, with all of its resources, makes it much easier.
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?
In an average week I estimate that I work between 45-50 hours. Sleep is a priority for me and I regularly get 7-8 hours of sleep per night. I try to use all of my allotted vacation time which amounts to about 4 weeks of vacation per year.
How do you balance work and your hobbies/family/friends?
This is an incredibly important question and I think will become more important as the field of medicine focuses more and more on preventing physician burnout. In my case, I continually remind myself that it’s not about “finding time” but rather “scheduling time” for certain things. There are a multitude of things that I am responsible for, both at work and at home, and just hoping that I’ll find time to do the things that keep me satisfied and sane is a pipe dream. When the rubber hits the road for me it is really about scheduling those things that I need rather than hoping I do them. This means I literally schedule things on my calendar that I want/need to do. Spending time with my wife, remaining physically fit, and eating healthy are priorities for me. To accomplish these things preparation is paramount. Regarding working out and eating healthy, I am a big fan of going to bed early and working out first thing in the morning before work. I also plan my meals out for the week and will prep them on the weekend so that I make “good” choices after a long day of work.
Do you feel that you are adequately compensated?
I absolutely do. I have come to realize job satisfaction/fulfillment is not simply a salary figure but rather the combination of career opportunities and salary. My current job provides this without question.
If you took out educational loans, is/was paying them back a strain? What financial advice do you have for future physicians?
I did take out education loans for medical school but was fortunate enough to not have anything to payback from undergrad. Paying them back so far has not been difficult in part as I am a fan of the “less is more” approach to life. Regarding advice, I would recommend that anybody taking out a loan be realistic with how much they are borrowing. It is very easy to take the maximum amount but for most people this is probably not necessary.
In your position now, knowing what you do, what would you say to yourself back when you started your medical career?
Find a good mentor. This is something that I had always heard but never really appreciated until I found a great mentor. It can seem from the outside that the path from medical school, to residency, to a job as an attending is fairly well established. What I have noticed though is the farther along a person travels on this path the more important mentorship becomes. There are so many aspects of a successful and satisfying career in medicine that are overwhelming and confusing to a soon-to-be graduating resident or junior faculty member. An excellent mentor has the potential to make this transition smoother and more fruitful.
What do you wish you had known prior to beginning medical school?
That being a good and easy to work with person is the easiest path to success.
From your perspective, what is the biggest problem with healthcare today? Please explain.
I think that we as a healthcare field need to increase our focus on the prevention of disease rather than the control of already developed conditions. I am a true believe in the quote, “an ounce of prevention is worth a pound of cure.” The ongoing management of conditions like type 2 diabetes, cancer, and cardiovascular disease is an absolute necessity, but I would love to see and increasing focus on prevention of these diseases for future generations.
Where do you see pediatric geneticist in five years?
I believe that genomic sequencing will be incorporated much earlier into a patient’s workup and the idea of personalized medicine will become more of a reality in the near future. The treatment and prevention of certain conditions will be at least partly determined by the genomic makeup of an individual and their tumor if dealing with a cancer patient. The use of genetic testing will also have to move outside of the genetics clinic and into other subspecialty and primary care clinics in order to accommodate the increasing number of patients in need of genetic testing and counseling.
What types of outreach/volunteer work do you do, if any?
I have active outreach projects in both Ethiopia and Ghana that aim to deliver medical genetics services to healthcare workers and patients in low- and middle-income countries. To date, the field of medical genetics has resulted in significant public health benefit for most high-income countries. The spread of these same services and technologies is becoming more and more important to underserved populations internationally and domestically. Low- and middle-income countries are experiencing a shift in the epidemiology of disease, whereby communicable diseases are decreasing in incidence with a rise in non-communicable diseases (NCDs). The introduction of medical genetics services has the potential to assist in the prevention, diagnosis, and treatment of many of these NCDs.
What’s your advice for students pursuing a career as a physician?
Be genuine. Far too often when applying for medical school, residency, or a job we find ourselves asking, “What does [insert name of interviewer, medical school, or residency program] want to hear?” We do this when writing our personal statements, answering a question during an interview, or talking to an attending or resident on a rotation. In my experience once a person asks this question they often give an answer that comes off as disingenuous and puts them in a worse position than had they just answered the question honestly. We sacrifice a lot by choosing a life in medicine including sleep, free time, weekends, and sometimes relationships. Sacrificing who we are as individuals in order to be satisfy an authority figure should be where we draw the line. The road to a satisfying career in medicine can be long and hard but is without question built upon being true to oneself.