Ask Me Anything (AMA) With Endocrine Surgeon: Dr. Simon Holoubek

This is a transcript of the Ask Me Anything with the Endocrine Surgeon: Dr. Simon Holoubeck. We encourage you to watch the entire conversation here.

We welcome you to this Ask Me Anything (AMA) live stream with an endocrine surgeon, Dr. Simon Holoubek. This is hosted by Samantha Mellinger, the former director of marketing and partnerships at the Health Professional Student Association (HPSA), which publishes the Student Doctor Network (SDN) forums. Our mission is simple. We help students from underserved communities increase their chances of admission to health professional schools, and we do this by offering donor-supported guidance, advising, and assistance to students, regardless of background or financial means. We invite you to check out all the many donor-supported resources that we have available at student doctor.net. A few housekeeping items before we get started tonight. First, this live stream is being recorded. So you will be able to go back and rewatch it or forward it to a friend who was unable to attend tonight on our YouTube channel, also to submit a question, please enter it into the comment section of YouTube or Facebook, wherever you might be watching. We do answer questions after the webinars, so please feel free to respond whenever you are watching it!

Samantha Mellinger: And we’ll pull it on this screen for Dr. Holoubek to answer. And tonight I’m especially excited to introduce Dr. Holoubek because we actually went to high school together. So we’ve known each other for a long time now, so it is an honor to get to do this live stream with him. Dr. Holoubek is an assistant professor of surgery at the University of Wisconsin, Madison in the division of endocrine surgery. His research focuses on aggressive variants of thyroid cancer and health disparities, and surgery. He graduated from the University of Iowa with a bachelor’s in psychology and premed and received his master public health in occupational environmental global health at the University of Iowa with a thesis on minority health disparities in Slovakia. He attended medical school at Des Moines University and was a general surgery resident at Franciscan Health in Chicago. And he recently completed his endocrine surgery fellowship at the Medical College of Georgia at Augusta University. And we are so excited to have him with us tonight to answer any questions that you have. So before we jump into some specific questions, why don’t you share just a little bit more about yourself and any initial thoughts you’d like to share?

Dr. Simon Holoubek: Well, thank you so much for the lovely introduction. Yes, it is true that we went to high school together a long, long time ago. So it seems, yeah, a few different things. So this is fun. A couple of things that are important to me are health inequalities and having better representation in medicine because not all your doctors should look just like me. Okay. And even though I am a white male, I like to champion people who aren’t white males, because many of the patients that I take care of and have been taken care of for the last many years don’t look exactly like me. And I think, you know, a lot of different reasons for why these disparities, in health as well as in health providers that exist, and so I think, you know, the first thing to do is always to talk about them, and then to move forward with trying to figure out ways to address them. Some of the things that I like to do, clinically are, pretty focused actually. So even though I am a general surgeon and do some general surgery, you know, which basically means, adult abdominal surgery, the majority of my practice is focused on the thyroid, parathyroid, and adrenal disease. It’s a very small specialty, and only about 25 of us come out of fellowship a year. So it’s a tiny, tiny specialty, that not everyone has heard of, particularly academically focused. So you’ll find many of us in larger university settings, but it’s a really rewarding career for many patients, who do very well. The surgery is very delicate. We have inspiring colleagues, and a lot of people are doing research. My research, as Samantha was mentioning, focuses on aggressive, thyroid cancers, and how to best treat those cancers. In the past, a lot of these cancers have been taken care of with aggressive surgeries, and for us, it usually just, if you just think of it as more surgery, so whether or not you need to take half the thyroid, the entire thyroid, and if you stop there or if you continue on and take lymph nodes. And more’s not always better is what we’ve found out over time. That’s just kind of a general trend in endocrine surgery, as well as I like to look at health inequalities. Most recently it’s been looking at health inequalities with, regard to adrenal disease. I really just started my career. So I’ve been, you know, doing a lot of things over the last several years as noted in the introduction. But, just started my career, fresh out of residency and fellowship, and just started up at the University of Wisconsin, Madison, and, you know looking forward to answering questions for those who are, you know, 10, 12 years behind me.

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Samantha Mellinger: Yeah. So just one more quick reminder, if you have questions, please insert them into the chat, and we will pull them on the screen to be answered. At any point in the conversation, feel free to put those in there, and we will pull it on the screen as appropriate. So let’s get started. We’re going to go kind of way back to the beginning. When did you decide to be a physician and why?

Dr. Simon Holoubek: Yeah, a good question. So and I think you get a variety of answers, and everyone talks about that, especially as they’re getting into medical school, but it’s something that still comes up. Someone asked that question today of like, why a doctor, why a surgeon, why an endocrine surgeon? I think a lot of it comes down to mentors. So you know, in college, I went in with the idea that maybe I wanted to do something in health sciences. A physician was somewhere on the top of the list, but I know a lot of people come in pre-med and a lot of people leave not pre-med, and there’s a lot of reasons for that. And I think that’s okay because, you know, being a doctor is one of those professions where, you know, you can be like 15 or 16 and you ACE a chemistry test in high school, and then you’re convinced that you should be a doctor, and then as you get a little bit closer to it, you start realizing like, oh, that’s like a lot of work. It’s a lot of years, it’s a lot of money to go to medical school, I think, which is an important consideration, you know, there are some issues when it comes to men versus women and the amount of encouragement they get, especially if they’re interested in having a family and so you’ll find that oftentimes you know, a male will be mentored differently than a female, even if they have the same grades, even if they have the same background, even if they have the same goals. So I think that’s kind of multifactorial. That being said, when I was 18, I was looking to shadow a physician, and I was really fortunate to, put my name into shadowing a cranial facial plastic surgeon at the University of Iowa who was a fantastic mentor. His name was John Kennedy and, he was the former president of the American Society of Plastic Surgery, so you know, the short, you know, kind of version of this is he was a big wig. He was very highly respected, but he was also one of the friendliest surgeons I’ve ever met. I still talk to him, from time to time. And I got to see the way that he took care of patients, which for him was mostly, small kids and they’re worried parents when they saw the, you know, their kids were born with a facial abnormality, and even though that wasn’t my path, you know, to become a cranial facial plastic surgeon, I saw the way he took care of patients, and I saw how inspiring it was that his science background led him to a career where, he could take care of, you know, frightened patients, frightened families, and although it wasn’t always something like cancer, there’s all these other things that can have either social ramifications or lifestyle ramifications and he was able to hold their hands through the entire process, tke care of them, ad see them on the other side he frequently had patients who would come back years later, and you’d see the excellent results of the surgery, you’d see how thankful they were, you know, you’d see a hug from a 16 year old and you couldn’t, you know, barely tell that they had had, you know, many countless surgeries over the years, correcting both cleft lip, pallet, dental, you know, nasal deformities and that definitely inspired me not only to become a physician with, the science training, I was, you know, undergoing at that time, but to look into something like surgery and to see if I could, you know, be that kind of surgeon, from medical students who are, you know, out there, they may know that there’s this stereotype of the, of the mean surgeon and for, you know, pre-meds out there, there’s sometimes the stereotype of the, you know, just technically excellent surgeon and they’re always curing cancer or something like that you know, but I would say that this mentor didn’t necessarily fit into either of those roles, he was curing all kinds of other things other than just, you know, curing cancer, which is a good line on a TV show or something like that, but he was also really gentle, ad you know, really caring and you could tell he really cared about his patients and he really cared about, hs mentorship role with me and that’s been something that always stuck with me and, you know, whenever possible, I’ve tried to do similar things for people younger than me there, you know, people aren’t as far along on this process in order to, you know, help guide them through the process and realize that, yo know, there’s, a lt of different careers in medicine, you know, ranging from psychiatry, family medicine, pediatrics, all the way to something, you know, really specialized and technical like cardiac surgery or, you know, other surgical sub-specialties. I suppose there’s a lot of different personalities in medicine you know, and, and there are a lot of different types of providers, a lot of different types of physicians and, and that does get, you know, incrementally, you now, more heterogeneous every year at you know, more and more, medical schools are focusing on trying to have a physician, population or a medical school class that better represents the United States.

Samantha Mellinger: Absolutely. So we’ve got a question here from the audience. How does the DO background impact, or how has it impacted your outlook on specialty choice challenges in general surgery, residency programs, and specifically fellowship given such a small niche? I know this is something we talked about before we went live, so this is the perfect question.

Dr. Simon Holoubek: Yeah, perfect. I was gonna, I was gonna address this in case no one asks, but I think it’s one of the obvious questions, especially for people who have contemplated going to an osteopathic school I will say it didn’t help. But there are more DO’s who are going into subspecialty care, although, you know, with the, you know, recent ACG merger, I think there are some questions about what that will look like in the long-term. I can’t speak to that a lot. I did go to a historically osteopathic general surgery residency, that did merge during my residency, so that was, you know, something, where I got to, ee the changes and I, thought a lot of those changes were for the better, but I will say that it matters somewhat who the candidate is like, you know, not every DO is going to have great opportunities coming out of a DO program but you know, that’s also true of people at a, at an MD program. So it kind of depends on which school you go to, how you do in that school and it still comes down to a lot of your personal interests and, you know, if you really want to be a surgeon and you have the, you know, the grades, you know, the research background in order to do it, and then you go to a general surgery program that allows you to, you know, really flourish and not only develop your clinical skills but also, take place, take part in meaningful research projects. I think it is possible, to do almost anything and I will say that you know, two people from my class of three in residency, you know, became endocrine surgeons. So I think that you know, that says something about my residency program and it just tells you that, you know, just because there aren’t a lot of DO you know, subspecialty surgeons out there and it doesn’t mean it happen and so, you know, I think you just have to ask, like, who am I, who am I going to be when I’m in medical school? Am I going to focus on something more surgically oriented?, and you know, so overall I’d say it is possible I don’t think I’m, you know, the biggest exception. I don’t think that there’s anything particularly special about me, but I will say that I took research blocks during medical school, networked really aggressively in both medical school and residency, did quite a bit of research in residency as well I wasn’t able to take research years, so I just did it, you know, during nights and weekends, and did have some time built into my schedule, based on a program director that was championing my research interests as well as allowing me to go to conferences that I was presenting at, but I think that the issue as to why it’s harder for a DO versus your average DO versus your average MD to be a kind of a surgical subspecialist is that there’s going to be less focused on research and subspecialties during medical school. So, you know, there’s bottleneck kind of number one during residency, you’re probably not going to have a great research network or a lot of sub-specialty surgeons offering mentorship in the residency. And then there’s oftentimes going to be a little less initiative to do quality research during residency and when you kind of add all those things up, you find that there’s not a lot of DOs applying to some of those small, fellowships.

“The issue as to why it’s harder for a DO versus your average MD to be a surgical subspecialist is that there’s going to be less focus on research and subspecialties during medical school.”

Samantha Mellinger: Well, and I just love that you talk about networking and the importance of that you know, that’s one of the big pieces of advice a lot of our experts within the confidential consult section of our site often gives to, you know, pre-meds medical students interested in all of these things. It’s, you’ve got to network, you’ve got to ask these, you know, put yourself out there. So I love that you talked about that. A great follow-up question that we have is what advice do you have for a DO general surgery applicant who has that below-average step one score?

Dr. Simon Holoubek: Yeah it’s, it’s been a while since I applied in the match, but I will say apply to more places definitely try to put yourself out there. I will say, you know, sending emails is relatively low yield, but sending an email to say, Hey, I’m really interested in your program. I will say that’s something I found to be helpful over the course of networking and trying to stand out is sending a headshot and a well-groomed CV every time you send an email. So you don’t just say an email saying, Hey, I think your program’s the best and then copy paste and send it to the other hundred programs or rather trying to send something to maybe 10 or 20 programs and, you know, use their first, you know, your use their name use a few features of the program and then add your CV and a headshot. And if you can go there for a day or if you can you know, possibly have someone make a phone call for you, I think that’s all helpful.

Samantha Mellinger: Absolutely. So another question we’ve received, what can you do during medical school to increase your chances to get into a top choice residency?

Dr. Simon Holoubek: Other than all the typical things people talk about, get good grades, get good scores, get good letters something that isn’t really popular to say, but I know people have done it as they take a year off to do research during medical school seems really aggressive you know, a lot of people do that kind of thing in residency they get paid for it. It seems to be a good time to be able to really contribute and do high-quality research. You know, if you’re like a third-year resident and you’re already kind of plugged in with mentors that can be useful, but I do know a few people who did that during medical school and they applied for jobs and they got research jobs got the 40 or $50,000 for the year and they put out three or four or five papers. It definitely makes you stand out because it’s unusual. I think it’s a little risky to give up a year to do that but you have to realize if you take an entire year to do research in medical school, you have to have something to show for it. I will say that’s kind of true in residency, but some people are just forced into it. And so you’ll see at some programs, let’s say everyone has to take one year off. You’ll find that some people, you know, either they or a spouse has a kid that year, or, you know, they work on other things in life and they may publish one paper or something like that but during medical school, if you’re taking a year off, you need to, you need to have something to show for it.

Samantha Mellinger: So what is your schedule like these days?

Dr. Simon Holoubek: Yeah. So a good question for an endocrine surgeon because an endocrine surgery schedule is better than most schedules. So the current schedule, because I’m new to attending life I’ll kind of give you the broad outline although mine will be changing a little bit and then the outline of my schedule last year, and then maybe a little bit of my schedule during general surgery, which was very different so now I take calls about once a week, a little bit less than once a week for a primary 24-hour call with a level two trauma and then I also take one backup call about once a week. So then that meaning about every four days or so, I’m either on color on backup call for 24 hours at a time when I’m not on call, my basic schedule is operate Monday, Tuesday, Wednesday, full day office Thursday, and then research on Friday and if I’m not on call for the weekend, then I don’t have weekend responsibilities unless I patients in the hospital, which case I had to arrange either me or the on call person would round on them, last year I would say is a little more typical and I was mostly operating Tuesday, Wednesday, and then variably on Friday and that was based on fellowship schedule And then in the office, usually on Monday and Thursday, and then Thursday was an independent VA clinic or operating room experience for me as a fellow And then the rest of the time,meaning Monday, Tuesday, Wednesday, and Friday, I was with either my fellowship director or my associate fellowship director and I had no call responsibilities, but if there were patients in the hospital, I’d round on them. And then in general surgery residency, the typical schedule is about 80 hours a week and usually having about four to six days off a month and usually doing about five, 24-hour calls. But, you know, when you’re a junior resident, there’ll be as much as every third day. So I’ve taken calls as much as 11 times in a month, which is quite a bit, and I was at a level one trauma center in Chicago so that was really busy and so, you know, it’s definitely, definitely different to be a, an endocrine surgeon versus a junior general surgery resident and so I think that’s just important to have in perspective, because your lifestyle can change over time, depending on what you do for fellowship, which kind of like what kind of hospital or at what kind of group you’re at, is it a large group? Is it a two-person group? So those are all the different things that people need to consider as they go through the process because I know a lot of people are very frustrated when they’re second-year residents working 80 plus hours a week on call every third day. But if your end goal is to be the same, then, then, you know, maybe you need to think about that. Or if your end goal is to be a breast surgeon working more like 40 to 50 hours a week on call, maybe all the time, but on call for breasts means, you know, a few phone calls a week about pain meds and very little else, that can be, you know, worth we’re thinking about, you know, just like, what do you want out of the lifestyle? What do you want out of a career? Because I think it’s important to balance both what you and your family can endure schedule-wise with, what do you want to do? Like who do you want to take care of, you know, what kind of skillset do you want to have? And do you want to be using on a regular basis because if you really want to be a heart surgeon, you’re not going to be satisfied doing breast surgery Monday through Friday and so I think that that’s something that people have to think about once they become a surgery resident, you know, what do you, what do you want at the end of the day and who do you want to be taking care of?

Samantha Mellinger: So a good follow-up question to this, because this is, you know, a lot of questions we get, especially speaking with specific specialties or subspecialties is, do you have enough time to spend with your family? You know, what does that look like for you?

Dr. Simon Holoubek: Yeah, yeah, I think I guess the short answer is yes. I will say that it helps that my wife and I don’t have kids yet, so that’s a different, you know, hurdle that everyone decides to go through or not go through overtime, but yes, in general, I do that was at least a part of you know, how I chose my program, how I chose my fellowship was having that in mind at least. But I will say that wasn’t the primary focus of my specialty, but I think it’s important along the way to at least you know, think about all the things you want out of life when you’re choosing your career and whether or not that means becoming a physician versus a dentist versus, you know, a financial advisor or, you know, becoming a family medicine doctor versus a surgeon or you know, becoming a heart surgeon, you know, versus a general surgeon and all those things are a little bit different and there’s no right or wrong answer but in general you know, endocrine surgery is one of the more, I would say, light to moderate schedules within the surgery world. So it’s still busy, it’s still stressful, but it allows me to have enough time.

Samantha Mellinger: And so another follow-up to that, how do you balance your work, your hobbies outside of work? How do you find that balance and how has that changed from maybe general surgery to now practicing?

Dr. Simon Holoubek: Yeah, I will say sometimes it’s just making a list and then putting something fun on that list. Like, I will go for a run today. I will hang out with friends tomorrow and, and trying to just force at least, you know, one, one fun activity in there. It’s definitely gotten better over the last couple of years but I think how it helps to either have someone along for the ride with you, who’s going to help force you into doing something other than you know, just medicine, but you really have to understand that you can give time to medicine all day and all night, and there’s never going to be a reason to stop studying or stop reading or stop doing research. I mean, if I wanted to, I could, I could do research, you know, all night until tomorrow morning at 7:00 AM. Like there’s stuff to do. There’s stuff on my plate. Like if I really wanted to do that, sure, you know, I could read a thousand-page book, you know, next week if I, if I wanted to, so instead what I do is I say, I’m going to read this many pages a night, or I’m gonna, you know, work on three PowerPoint slides of a research presentation, and you have to kind of just budget your time, budget it towards you know, surgery, budget it towards, you know, the research I’m doing budget it towards my family budget it towards just myself if I want to, you know, go for a run or ride a bike or something like that, but it is hard because you’re not, you’re not going through life bored trying to figure out stuff to do. You’re, you’re rather you know, busy most of the time. You know, my mind is oftentimes thinking about something clinical or thinking about something, you know, a research idea or a meeting I have tomorrow or, something like that. So you definitely have to prioritize, having something else to or else you’ll never get to it. And along the way, you do meet those people where they’ve not thought about anything other than, you know, their specialty for the last few years. And, you know, you ask them about interests and they said, I haven’t watched TV in 10 years, or, you know, like you like point out something on the news or like something on Netflix, everyone else’s watching and they give you the stare and they’re like, I haven’t watched that, you know, like I’ve never heard of the Simpsons or I’ve never heard of, you know, like something and you’re like, but that’s been around for decades. Like, how have you been, how have you missed, like, you know, as you’ve never seen one episode of, of this, or like, did you know that you know, like Elon Musk, you know, was, was doing stuff a couple of weeks ago and talking a lot, you know, like, and they’re like, I have no clue who this is like, you have to pay attention to the news and you have to, you have to kind of be engaged in the world too and I think that’s part of like trying to relate to patients too. Like it helps if you know what the weather is and it helps if, you know, you know, what’s going on in the community or else you know, what you may be gaining in, you know, one aspect you’re losing in another aspect by being an unrelatable human and that ends up being an important part of being a physician as well.

“I will say sometimes it’s just making a list and then putting something fun on that list. Like, I will go for a run today. I will hang out with friends tomorrow and, and trying to just force at least, you know, one fun activity in there.”

Samantha Mellinger: Great so some more questions in addition to the organs that you specialize in, what are your thoughts on the pancreas and its relationship to type two DM and its relevance to health and inequity?

Dr. Simon Holoubek: Okay I will say that that diabetes falls completely outside the realm of integrant surgery. However, some people do operate on the pancreas who are integrant surgeons, although my program didn’t do that and most don’t do that. I do think that type two diabetes does have relevance when it comes to health inequalities again kind of falls outside of what I do on a day-to-day basis. But I think in the larger picture, I think you can look at you know, you can look at obesity, you can look at access to care and you know, outcomes for people with diabetes and the follow up care they get. And I do think that you know there’s research to suggest that, you know, health inequalities exist across the board pretty much and that also pertains to people who have type two diabetes. And so, you know, I guess I, it falls a little bit outside of my wheelhouse, but I do think that it’s one of many important you know, factors in health inequalities.

Samantha Mellinger: How would you characterize the current job market as it pertains to general surgery, fellowship pathways? You know this is a big question we get for just about every one of these questions is what is the job market looks like?

Dr. Simon Holoubek: Yeah for general surgery it’s strong and is pretty much always strong. COVID definitely had some hiring freezes at some hospitals but if you didn’t do a fellowship, it was pretty much always strong because it’s such a broad skill set that someone will find something for you to do and call is pretty stressful. And there’s always someone, you know, either retiring or always someone who says if we just had one more general surgeon in the call pool that would help. Fellowship specifically narrows your job market quite a bit. If you’re an endocrine surgeon and you’re willing to go anywhere and do mostly general surgery, and then kind of in the back of your pocket, you can say I’m an, I’m an endocrine surgeon. So, you know, if there’s a thyroid, I’m going to, I’m going to do that and not refer it out to someone else. That’s still a pretty healthy job market. Once you decide though, that you want to be a very focused endocrine surgeon who may take some general call or possibly not even take a general call you start narrowing down your search to places that have a long list of thyroids that people aren’t fighting over when it comes to the kind of like turf wars within surgery so even though there were about 25 plus or minus a few fellows this year I will say not everyone has found a job even though, you know, we graduated like three months ago, which is abnormal. You know, if you’re coming out of general surgery, many people have jobs lined up six months in advance, some people years in advance and out of the people who did find jobs, that’ll say only about half of them are practicing, you know, greater than 50% endocrine surgery and so many of the jobs went to people who were happy to do, you know, 50% or more general surgery and, oh, by the way, I also like to do some endocrine versus you know, my situation where I’m planning on doing the vast majority endocrine and then only general surgery when on call, you know, or if, you know, other situations make us like, you know, there’s a patient who had their thyroid out last year and they came back to my office and they now have a hernia or something like that, that situation can exist, but I’m in that kind of a small niche category where the job market can be quite difficult. Colorectal, I will say is generally better. Many colorectal surgeons will do general surgery and they’ll just try to get, you know, more colon cancer referrals than their colleagues in the general surgery group. So I would say in general, their job market is stronger than the endocrine job market, but I guess if you specifically wanted to do, colorectal like minimally invasive colorectal all the time at a major university would still be a pretty tight job market but again, not quite as tight as an endocrine surgery job market and then hepatic biliary probably somewhere in between. I don’t have a lot of HPB trained friends, but the ones I do have, you know, they have jobs and I’ll say that the person that comes to mind was pretty flexible as to what location they work in and they are doing some general surgery, I’ll say probably closer to 50% general surgery. So again, if you want to do HPB and you only wanted to do HPB, it would be probably a little bit tricky, but again, somewhere in between endocrine and colorectal surgery, as far as how good the job market is with the endocrine job market, being the smallest. So even though there are about 25 graduates, I will say there are, you know, only maybe 15 endocrine surgery jobs for those 25 graduates. And the other 10 will decide to do general surgery jobs, and a few people end up doing another fellowship. So a lot of people if they’re going to do another fellowship, will consider something like minimally invasive surgery or breasts those, are popular ones where they basically combine another one-year fellowship on top of an endocrine surgery fellowship, which is usually one, but sometimes two years.

Samantha Mellinger: Great. So this viewer wanted to know how they can get involved in research with you.

Dr. Simon Holoubek: So I’m not quite ready to be taking anyone for research that actually came up recently and there is a really nice program at the University of Wisconsin Madison that has basically tries to focus people from underserved backgrounds or more diverse backgrounds and, and tried to do research with mentors at the University, of Wisconsin so it’s nice to see some of those pathways exist that kind of get back to what we started this talk, discussing but getting involved in research with me remotely would be really hard at this time and so I don’t think I’d be able to offer you or anyone else here exactly what you’d be looking for, although I hope that changes over time and I will say that one of the learning curves going from a resident to fellow to attending is, you know, not only doing research independently but being able to guide someone on their own projects. And I feel like, you know, I only recently over the last couple of years moved from, you know, having mentors guide me through projects to me doing them independently and I’m still a little, little while off from being able to, I think, confidently and successfully guide someone below me through a really meaningful project, especially remotely. But I do think that over the last, you know, 18 months with the pandemic, I think it’s a great opportunity for people to reach out to mentors who may want to do research with people, you know, over zoom or different types of media like that and I think it’s worth, you know, trying to find people. And like I had mentioned earlier, send out your CV, send out a headshot and send out maybe a personal statement, you know, something that says what you’re interested in and you know, how you may be able to contribute to a project kind of you know, like something to add to that is many Do’s, including some people in my general surgery program, would be interested in, in research, however, they were having a more difficult time than me in networking to find quality mentors because they didn’t have prior research experience, which I think is always something that’s difficult you know, when you’re looking for a job, you know, in anything and you’re turned down because you don’t have the right experience. And so you’re like, well, how can you give me that first experience? Kind of just like what we’re talking about now, someone saying they’re interested in research. And I said, I, you know, I’m not quite ready to take on someone, especially, you know, during a pandemic but I think it’s always important if you want to have research be a meaningful part of your career to start, you know, with the sort of minimum wage equivalent. So duringundergrad, I was doing data input and then you know, during medical school, I was doing, you know, multiple research blocks in order to do something that was mostly data input, but then, you know, I started writing some abstracts too, and then in residency I was went all the way to, you know, writing manuscripts, presenting it at conferences nationally and internationally, you know, and then to recently you know, getting hired for a job that has a research component to it, but that trajectory was something that was slowly built over the course of, you know, 12 plus years and I spent a lot of time, you know, typing in Excel documents and, you know, in databases you know, kind of mindlessly plugging in, you know, yeses and no’s for years before I was, you know, ready to write my first manuscript and, you know, definitely before I was, you know, ready to, to speak in front of an audience of people, so I would encourage this person as well as other people to start on something if they haven’t already and try not to be frustrated if they don’t have the right experience because that’s just built over time.

Samantha Mellinger: Yes. I was going to ask you how do students get involved in research, but you did a wonderful job.

Dr. Simon Holoubek: Okay. I see. Yeah, I guess being open to not publishing, you know, not being on the publication and just doing small tasks. And, you know, I definitely had friends who joined a research team when they’re 18 years old and they were on a publication like 10 days later. And I applaud them for finding the right research team that was that you know, that proliferative, however, you know, I did research on and off for probably five years before I ever, you know, found my way onto a publication and then over time I wasn’t finding my way onto publications, but rather writing those publications and being the first author. So I think I didn’t have the quickest you know, sort of progression when it comes to research. But I think I had one that’s realistic that many people, if they’re interested in something academic that they can do, you know, basically it’s like the idea of you know, like you scrub the floors at the place and then you start, you know, making the food at the place and one day you own the place. Like not everyone gets to do that, but it’s definitely easier to do that model than to just own the place on the first day you know, and I’m quite impressed by people who are you know, publishing as the first author in medical school and stuff like that. Like I wasn’t ready for that and I didn’t have that background and oftentimes when you see those people who are doing that, they usually have some mentors who are really championing them, or they’ve been, you know, working towards this for several years before that. And you didn’t even know that you know, I knew someone who took you know, some time off after undergrad and just went to a research lab. And so, you know, as you can imagine, by the time he was in medical school, he was already, you know, publishing his first author because he had had a pretty robust experience in his early twenties already and was, was ready to do that once he was in medical school.

Samantha Mellinger: Okay. How does your osteopathic-specific training play a role in your surgical or other medical roles?

Dr. Simon Holoubek: I hate to disappoint my medical school professors, but not very much. I had this conversation with someone from my residency program recently, who’s is an MD, you know, trained 40 plus years ago, and we were talking about, you know, the difference between being an MD and a DO and you know, for some things, I think that there can be a difference and sometimes that’s a meaningful difference it’s really hard to have a meaningful difference between a DO and an MD when it comes to surgical care because someone has appendicitis, you do an appendectomy there, isn’t a question about like, I’m going to do something specific as an osteopathic physician. You know, and I will say I’m proud of my DO roots. However, I don’t think DO’s have you know, the monopoly on anything. So when it comes to, you know, patient-centered care or being nice or being holistic, or, you know, the idea of treating the whole person or putting your hands on a person, these are phrases that I often heard in medical school but working alongside, and these who are also thinking about all these things at the same time I can’t say that there’s anything specific about being a DO that allows me to care for someone differently. Again, that as an endocrine surgeon that might be different if you’re in the more primary care-focused specialty. I think at the end of the day, it’s, it’s virtually all these, all the same books more and more so it’s becoming the exact same test at the end of the day, it’s the same patients too. So, you know, if someone comes to you with a fever and a cough, you don’t treat them as a, as a DO versus an MD. You know, you have to work them up and decide what their ailment is and you know, and you kind of go from there and you know, in 2021, it’s probably COVID.

Samantha Mellinger: Alright, did you ever consider anesthesiology?

Dr. Simon Holoubek: I think I can imagine this question is because I’m a surgeon, so there’s a lot of people who are on the fence. Do I become a surgeon or an anesthesiologist? Yes, I did. That was something that was in my mind because I decided that I wanted to be in the operating room. I was pretty sure I wanted to be a surgeon. I wasn’t sure that I needed to be a surgeon at least for a little while and then I had an anesthesia rotation, which not everyone gets to do and when it comes back to mentorship, I will say you know, the mentorship experience I had and anesthesiology was not as strong as my mentorship experience in surgery. That being said, I intubate people, I feel very comfortable with intubation and I like to at least assist if, if not, you know, intubate people myself with my patients, because typically we start with the table backward if you’ve ever been in the operating room when I’m operating. And so it’s easier to operate if you have everything kind of flipped around for thyroid surgery. So not everyone is up by the anesthesia machine and that can make some anesthesiologists, a little nervous to have just the feet next to them. And so we help them secure the tube and we help them intubate the patient. But at the end of the day, I found myself not very interested in anything other than the initial intubation. And you’ll find yourself, you know, if this, if, if you’re in medical school, you’ll either be the surgeon who likes being up at, you know, at the head of the bed or the surgeon who’s kind of looking at the anesthesiologist in the same way around if you’re on an anesthesia rotation, you’re either like fascinated by the tube and the gases and the meds and the pharmacology of it, or you’re just going to be looking at the surgery the whole time and I found myself, you know, very engaged when I was on my surgery rotation. And I found myself very engaged in surgery when I was on my anesthesia rotation. And I think that kind of helps someone figure it out, but if you’re not sure, and you’re in medical school, I advise people to definitely do both rotations as soon as they can in order to figure that out. I will say they’re very, very different and so if you want to be a surgeon being an anesthesiologist isn’t a close second, it’s completely different. So I would, I would highly advise someone if they really want to be a surgeon, but don’t think it’s in the cards for them. I wouldn’t tell them to be an anesthesiologist. I’d tell them to be whatever else they want to do, because again, being an anesthesiologist isn’t, isn’t like being a surgeon it’s, it’s pretty different.

Samantha Mellinger: Hmm. Now, this is a great question, because, in general surgery residency, you mentioned working gosh, 80 hours a week. So how far from the hospital do you think one could reasonably live during that time?

Dr. Simon Holoubek: So because I lived in Chicago and we went to multiple hospitals, I lived really far away. So when I started residency, we had a hospital that was 55 minutes away. And when I started, that was the most common hospital I was going to. We merged with another hospital and that had already started to take place by the time I had chosen a place to live which was only 45 minutes away, but I still drove 45 minutes you know, every morning for the majority of residency. And then in the evening, when I’d be driving home, I’d be hitting rush hour traffic, and that would frequently be more than one hour. And that being said, I took in-house calls, so I wasn’t at homecoming back to the hospital and many general surgery programs will be set up that way. So, I mean, it doesn’t really matter how far you are from the hospital if you’re taking in-house calls. So for people who don’t know that distinction, meaning when I was on call in general surgery residency, I was sitting in the hospital for 24 plus hours at a time I wasn’t going home, you know, to take a shower and then run back to the hospital and I only took a home call very selectively in my program and I knew that, you know, going in when I chose to live, where I wanted to live it’s different if you’re taking a home call, in which case I would tell you probably 10, 15 minutes or figure out what the culture is with, you know, what the expectation is that your hospital depends a little bit on who else is in the hospital. Maybe you’re a chief who has to go in, but you have a first or second year that is in-house so that’s a consideration and you know, are you a level one trauma center, level two trauma center, like how to, like, what are the logistics of that? And what’s the traffic in the, in the city that you live in and you know, and winter is a thing in the Midwest. So your commute might be 10 minutes a day, but it might be 30 minutes tomorrow if it’s snowing and then, you know, typically when you’re an attending, you’re not going to be taking in-house calls, and typical response times are going to be less than 30 minutes. I currently live about 10 minutes from the hospital so, you know, that’s, that’s a little bit different for me.

Samantha Mellinger: So this is a great question to kind of wrap up this evening. Did you start out focused on becoming an osteopathic physician versus allopathic and how has that, and the other whole-person training influenced your trajectory?

Dr. Simon Holoubek: All right, this is again, like, I don’t want to disappoint any of my professors, but I never really looked at it like a, I’m a DO instead of an MD. I entered medical school going to the DO program you know, that was 25 minutes away from home that had trained several people in my community, including my own family physician and I didn’t necessarily look at myself as a different kind of physician, I looked at myself as, you know, I’m a doctor and I’m, you know, in medical school to become a doctor. And then I was, you know, a medical student trying to become a surgeon. And then I was a surgeon just trying to be a good surgeon. And then that was the surgeon trying to focus on being an endocrine surgeon. So I didn’t really look at it as a, I’m an osteopathic physician focusing on osteopathic principles or focusing on manual medicine. I mean, these are things I learned along the way you know, and you know, try to embrace as much of the teachings that were in front of me at the time, but I think, I would say from my perspective, there’s not as much wiggle room in my mind, as some people make it out to be, I don’t see it as like, oh, I’m going to treat someone completely different because I’m in DO versus an MD. Like if I was an MD, I was going to give them a pill, but since I’m a DO I’m going to treat their whole person and I’m going to do something very different. I still look at medicine as relatively black and white, like there are right answers and wrong answers, and there’s a lot of, lot of, you know, gray area in between, but I have a lot of friends who are DO’s and a lot of friends who are MDs and they call me about difficult patients and I call them about difficult patients. And we don’t go through things in a, you know, a DO kind of way or an MD kind of way and we talk about the patient has thyroid cancer and, and how we’re going to safely take the thyroid out and what we’re going to do afterward and you know, honestly, if it, if we were talking about a heart attack or a stroke or high blood pressure, it would be the same thing where you’re just talking about, you know, who’s this patient what’s going on with them how do we best treat them? And yes, we are thinking about the whole patient. We’re thinking about whether or not they can afford the medicine, whether or not they’re in prison, whether or not they’re recently divorced or someone died in their family. And that, that is a consideration. And I think that that was focused on in, you know, in my DO program, but I also have friends who are MDs and I know that their schools also have taken an increasingly focused approach on those other aspects of the patient’s life that can be contributing you know, to their overall health picture. So, you know, I, I am a proud DO, but I will also say that being a DO doesn’t really influence the way I treat patients at least not knowingly, you know, maybe there are some subtle things, but for the most part, I think you know, MDs and DO’s are pretty similar.

“…we don’t go through things in a, you know, a DO kind of way or an MD kind of way…we talk about (how) the patient has thyroid cancer and, and how we’re going to safely take the thyroid out and what we’re going to do afterwards.”

Samantha Mellinger: So I like to end these with kind of one last question, in your position now, knowing all that you do, what is one piece of advice you would say back to yourself when you started?

Dr. Simon Holoubek: Have more fun, be a little more lighthearted maybe, I’m not quite sure, but, you know, I guess I’m glad that I’ve always been thinking about the next step and so I’m thankful that when I was in undergrad, I was thinking about how to get into medical school and how to locate good mentors and then, you know, same for the next step and same for the next step you know, for the most part, I’m where I wanted to be. And so I think that’s really exciting. But you know, making sure that you live life at the same time, because I think it’s very easy for people in any career, but I would say specifically in something like surgery to have that tunnel vision, and you wake up 10 or 15 years later and you start regretting that you haven’t done other things and so I’ve always taken that approach of make sure you’re doing other things in life other than just, you know, just medicine, because like I said earlier, you know, there’s always more that you can give medicine and it is important to take the responsibility very seriously but it’s also important to make sure that you’re living your life at the same time so, you know, make sure that while you’re honoring the importance of medicine, you’re also not so tunnel vision that you’re not having fun in your life along the way, and that you’re not making meaningful relationships because at the end of the day, your patients will notice that, not every patient, but you know, it, it comes across whether or not you’re a relatable person and I think that that at times can be just as important as all the other things you’re doing in order to be a good physician.

Samantha Mellinger: Well, great. Well, thank you so much for your time tonight. I know this was a great conversation. We had a lot of great questions. If we were not able to answer your specific question Dr. Holoubek was gracious enough to share his Twitter handle with us. So I believe that was shared out in the chat during tonight’s live stream. So feel free to ask him questions, extend those conversations there, as well as if you are watching this post the live stream, feel free to ask questions within the chat feature as well. And we will try to respond and provide whatever answers or information that you are asking. So thank you again for attending tonight’s ask me anything webinar. If you joined us late again, this will be available for viewing on our YouTube channel after tonight. And again, we would like to extend our gratitude to Dr. Holoubek for taking the time to answer your questions this evening. And just lastly, we’d like to remind you that we have many donor-supported tools and resources available at studentdoctor.net to help you with your journey to becoming a healthcare professional, and we invite you to check them out. Thank you so much and have a great evening.

Dr. Simon Holoubek: Thank you.

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