Medical

Q&A with Suzanne Tharin, MD/PhD, Neurosurgery

Dr. Suzanne Tharin, MD/PhD,  is an Assistant Professor of Neurosurgery at Stanford University and a spinal neurosurgeon at the Palo Alto VA.

suzanne tharin

Following a Bachelor of Science in Physiology (1991), and a Master of Science in Anatomy and Cell Biology (1993), Dr. Tharin obtained her PhD in Genetics at Stony Brook University (2000) from work done at the Cold Spring Harbor Laboratory, before earning her medical degree from Columbia University College of Physicians and Surgeons (2004).

Dr. Tharin has received several awards for her work in advancing the field of regenerative neuroscience: the NIH K08 Clinical Scientist Research Career Development Award (2015), the Stanford McCormick Faculty Award (2015), and two Young Investigator Research Grant Awards from AO Spine North America (2014 and 2015).

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She has been published in Clinical Spine Surgery, Cureus, Head and Neck, Integrative Biology, Journal of Biology, and World Neurosurgery.

When did you first decide to become a doctor? Why?
I was on the home stretch in my PhD in genetics when I decided I wanted to become a doctor. It was one of the most viscerally driven decisions I’d made. I was just at a point in my PhD where all of my experiments were working, after a good few years of absolutely nothing working! I was then seized by this desire to look after patients, so I started doing some volunteer work to explore what medicine might be like. I was living in the suburbs of New York City in Cold Spring Harbor, where I was doing my PhD. I volunteered with recreation therapy with the Rusk Institute at NYU, working with kids who were in rehabilitation. I also volunteered with the psychiatry department at Columbia had a homeless outreach program with the goal of keeping track of and helping the homeless mentally ill in Washington Heights in a very boots-on-the-ground fashion. I thematically chose those things because I was working on nervous system development and was ultimately interested in working in a field that was allied to my already established scientific interest in the nervous system. I cast a very wide net, because I thought that I could wind up working in rehabilitation, in spinal cord injury, in traumatic brain injury, developmental disorders, neurology, psychiatry. Psychiatry, for instance, is particularly rich with discoveries yet to be made and good opportunities to have an academic career. The more I explored this, and the more I worked with patients, the more I loved it and came to feel that this was something I would regret not pursuing for the rest of my life. So I took my entrance exams and went through the application process.

How/why did you choose the medical school you attended?
I think I chose the med school, and the med school chose me. They had welcomed me as a volunteer in the homeless outreach program, and I’d become very connected to the university and the med school.

Columbia University represented for me this perfect intersection of my long abiding interest in neuroscience and my love affair with New York City. The school is so strong in neurology, in neurosurgery, in psychiatry, in basic neuroscience. At the time, Eric Kandel had just won his Nobel Prize, or was about to.

What surprised you the most about your medical studies?
This is a very specific answer, but I was very surprised by diabetes as a disease entity. I had come in with a completely inaccurate understanding of what it meant to be diabetic and what the potentially devastating complications were. I was just surprised over and over again, once I hit the wards in third and fourth years of medical school. I came to really understand that people lost their limbs to this, their vision to this, kidneys to this. I understood that my previous understanding of what diabetes meant medically was very sheltered and globally inaccurate.

I was surprised at how much I loved surgery, and loved the acute and critical care setting, and how rewarding and motivating I found it to take care of critically ill surgical patients. I think that wasn’t necessarily how I saw myself when I started med school. That was a personal—and career-relevant—surprise.

What information/advice do you wish you had known when you were beginning your medical studies?
I feel like I went into it with my eyes wide open. Some parts of the “wish I’d known” list are so specific. I wish I’d known, when I took a job as a full-time VA employee, that I would lose my NIH loan repayment grant, but saying this now might help one person in a thousand!

Drawing from this, I will say it’s important to talk about money, to negotiate around it, and to not see that economic reality as something to ignore, especially in the American system. If you think about money in a long-term way, and if you feel empowered to negotiate around it, you are freed up to pursue the academic and humanitarian goals which send most of us to med school in the first place. Ironically, those are the things that get crushed if you don’t want to talk about money, because you think talking about money is dirty. You need to talk about it if you want to be able to protect these extremely important, but non-revenue generating parts of your professional life.

Why did you decide to specialize in neurosurgery?
I think what got me into surgery were my 6-8 weeks in colorectal surgery. I loved the pace and the acuity of the interventions. I loved the nature of the decision making. I felt like I was part of the team. I felt that I’d found my tribe in the surgeons, as these were the kinds of personalities I would really enjoy working with. After that, whenever I did an outpatient clinic-based rotation, I felt like I was missing out on something.

In medical school, we were exclusively in the classroom for the first two years, and on wards for the last two years. Third year was very structured with a set of defined rotations that included some subspecialties, like urology or neurosurgery, but really we spent most of our time doing medicine and general surgery. I also had a great experience on neurosurgery at Columbia. It was a brief experience, but then I got to spend more time with them in my fourth year. The residents were happy; the attendings were happy. They were pursuing productive and satisfying academic careers.

If you had it to do all over again, would you still specialize in neurosurgery? Why or why not?
I would make the exact same choices. A couple of my orthopedic colleagues and buddies have affectionately nicknamed me a “neuropod”, some kind of a hybrid figure between a neurosurgeon and an orthopedic surgeon. It’s a high compliment, of which I hope I continue to be worthy. Some of them pointed out to me that I could have shaved a couple of years off the training process by training in orthopaedic surgery instead of neurosurgery, and gotten to the exact same place.

The one major difference is that as neurosurgeons, we treat intradural pathology, tumours and lesions within or just outside the spinal cord and nerve roots. These are traditionally and overwhelmingly not treated by orthopedic surgeons. Intradural surgery is, however, a minority of most spinal neurosurgeons’ practice. Certainly orthopedics is a fine field and is a great route to spine.

Has being a neurosurgeon met your expectations? Why?
My experience has been wonderful; it’s met and exceeded my expectations. I think part of that comes from my decision to specialize in spine surgery. Once I was a neurosurgery resident, and I discovered the spine community, I really found my tribe. Though it was an unlikely career choice at the time, going into medicine is a decision I’ve never regretted. I feel the exact same way about having gone into spinal surgery. I feel like I’m really a part of the community. It’s not a traditional field for women, but it is a great field for me.

My mentors and my partners in neurosurgery and orthopedic spine surgery have been overwhelmingly positive. We do big surgery, we transform people’s lives. There’s awesome research to be had, and we’re still in the Wild West stage of figuring out how to treat spinal cord injury.

What do you like most about being a neurosurgeon? Explain.
I love taking care of veterans! I never had the opportunity to work at a veterans’ hospital in medical school or in residency. People warned me that I would hate the paperwork, but they did tell me that I would love the patients, and boy, the patients are wonderful! They are incredibly interesting people, who have been through so much. I feel really privileged to look after them. There’s also lots of big pathology for spine surgeons at the VA. We take care of wear-and-tear change, and I think the military service involves considerable wear and tear.

What do you like least about being a neurosurgeon? Explain.
I think most doctors will tell you that the part they like least is documentation: having to sign a lot of things, write a lot of notes, fill in a lot of templates. It seems to be a contributor to physician burnout. I am lucky to work not only with great residents at Stanford and an excellent spine fellow, but also with three outstanding nurse practitioners at the VA. I still write notes and document things, but we are really well-supported in that regard by our nurse practitioners.

What’s your typical clinical work week like?
Every other week, I have a mostly clinical week at the veterans’ hospital where I am on call, and I have two days of operating room time, 1.5 days of clinic, radiology conferences and OR meetings. My tour of duty at the VA is from 7am to 7.30pm, so it’s very regimented. Most of my practice is spine surgery, and within this most of what I care for is degenerative disease. A large part of my practice is treating cervical myelopathy, a chronic form of spinal cord injury which causes degenerative narrowing of the spinal cord of the neck.

What’s your typical research work week like?
In the intervening weeks, I’m in the lab at Stanford. I supervise my graduate student and my lab manager, and usually at least one high school student or undergraduate. We work on development of cortical projection neurons, both from endogenous progenitors and from stem cells, to try to figure out novel regenerative strategies.

Tell me more about how you first got involved with research.
I was way over on the basic translational side to begin with, because I feel like the life science community needs a really granular, molecular, mechanistic understanding of development and generation in order to leverage for regeneration, and I wanted to contribute to that. As a basic scientist, starting out with studying worms, I loved having circuits that I could wrap my arms around. I certainly carried on with research through medical school, and have done so beyond as well.

What do you like most about being a researcher?
I get to do science as a job! I get to work with incredibly cool and motivated students and post-docs. How the brain works is inherently interesting. It remains a field that is wide open for big discoveries. I find so many parts of neuroscience to be endlessly compelling. Of course, clinically, that plays out as many unmet needs and many as yet unmet opportunities to transform the way we take care of many diseases and injuries.

What do you like least about being a researcher?
The only negative is the constant pressure felt by most of us to get funding. I’ve been very lucky; I have some funding. The AO Spine Foundation Award was my first award as a professor, and it was really a show of faith in me for which I will remain forever grateful. However, my success rate in applying for grants has been maybe 10%. To get the funding I had, I had to get a lot of no’s. Rejection is part of it!

I do think that grant writing improves your thinking, your communication skills, helps you hone your ideas. There are many positives to that. But this constant background concern of “What happens if I run out of money?” is the part that a lot of scientists struggle with.

On average: How many hours a week do you work? How many weeks of vacation do you take?
I work a minimum of sixty hours a week, and some of that—i.e. my time at the VA—is very structured. I never really tracked my hours, but I have found myself working outside of 60-70 hours, not including calls taken from home.

When I was a resident, we got three weeks of vacation a year. I’ve struggled to take these as an attending, and I think that’s actually been a mistake. I aim to take 2-3 weeks a year of vacation. What actually happens is I take none, and then I start getting very stressed out, then my family intervenes with a last-minute vacation. My goal is ultimately to take three weeks of vacation a year; that’s my plan for 2018.

How do you balance work with life outside of work?
I think I would probably describe myself as happily imbalanced. I think it’s OK to work long hours, if that’s the nature of what you do, and you love what you do. I do things that I love that are important to me. I didn’t get to change every one of my daughter’s diapers, certainly, but I do make it a priority to spend time with her when I’m not at work. When I have to travel for work, which is not infrequently, I generally bring her with me along with our au pair, so that I can spend as much time with her as possible. In watching me take care of patients, I think she learns important things about mothers and women at work. I wouldn’t say my life is balanced, but hopefully, most of the time, I am imbalanced in a way that works for me and my family.

What types of outreach/volunteer work do you do, if any?
Not at the moment, but that’s a great and inspiring question! A life of service is incredibly satisfying and worth making time for, even when you’re busy. Volunteering is ultimately what set me on my current path to begin with.

I did give a talk at our local high school a few months ago for students interested in science, but I could do more. My husband, who is a fiction writer, is just embarking on a project with the Boys and Girls Club to help teach children to read, which is inspiring me to look into doing more outreach work myself.

From your perspective, what is the biggest problem in healthcare today?
In America, we have a major problem of access. We have a lot of people who are uninsured, we have people going broke because they get cancer. We’re an incredibly rich country, where many of us think it’s completely unacceptable to not have healthcare for everyone. Certainly, President Obama moved things in the right direction in many ways, with the passing of the Affordable Care Act. But as even he will acknowledge, that work isn’t complete. I can’t feel good about a healthcare system in which working people with bad luck go broke and bankrupt to pay for their cancer care.

Where do you see medicine at large in five years?
We need to continue to look at our outcomes and to be driven by outcomes in terms of some of our clinical decision-making. I have some colleagues at Stanford who are doing large-scale studies of outcomes in spine surgery. Outcomes-based care is a concept with a future, and one that stands to improve care.

Where do you see neurosurgery in five years?
Regenerative medicine is a major growth area. Moving beyond the five-year plan, I think that we are going to see new treatments for things like paralysis coming from multiple directions in my lifetime, from brain-machine interface and from the kind of developmental and stem cell-based work that I’m doing.

I think that minimal access surgery will probably continue to grow in ways that make sense, and the ways that don’t make sense will fall by the wayside. There are many minimal access techniques that have been transformative: endovascular treatment of aneurysms, percutaneous pedicle screw placement, endoscopic endonasal trans-sphenoidal resection of pituitary tumors.

What is your final piece of advice for students interested in pursuing a career in neurosurgery?
Pursue that interest. Spend time with a neurosurgical service, then spend some more time! Once you commit, I think it’s very important to be tenacious, to never give up. That’s a characteristic that’s important in all parts of surgery. I think it’s also a critical element to scientific success. Find what you love, and work extremely hard at it.

There is an imperative in many fields of surgery, and certainly in neurosurgery, to be as technically skilled as possible, to be extremely responsible, and to take the welfare of all of your patients very personally. It needs to matter to you from the start, then for your whole career: continually pursuing technical excellence, caring about every operation. Doing good by doing well.

You can follow Dr Tharin on Twitter @SpineTharin.