Introduction
Dr. Marino is an Assistant Professor in the Department of Surgery and a thoracic surgeon at UAMS. Listen to learn more about how she narrowed down her interests to decide in pursuing a career in medicine, as well as how she approaches mentoring and what she calls “sponsoring” a student. Other topics mentioned include being a female in this field, her lifestyle, what changes she would love to see within health care, as well as her advice for students.
Transcript
Weijia: Welcome to the next episode of Mentor Spotlight, your very own UAMS-led podcast to help connect students to faculty mentors. We are Weijia,
Jasmine: Jasmine
Hannah: and Hannah
Weijia: …your hosts for this episode. Today we have Dr. Katy Marino, a thoracic surgeon in the Surgical Oncology department of the UAMS Cancer Institute.
Hannah: Dr. Marino completed medical school at Louisiana State University Health in Shreveport, completed residency at the University of Tennessee Health Science Center in Memphis, and completed a fellowship at the University of Louisville School of Medicine.
Jasmine: Dr. Marino is currently my mentor, Jasmine, for a summer along NIH-funded cancer research program called the Partnership in Cancer Research Program. So I’ve been looking forward to having Dr. Marino on this podcast throughout this entire summer. She has shown me the ropes of clinical research and has served to be such an amazing and supporting mentor to me as I work through my first clinical research project. So I thought it would be perfect to have her on this podcast.
So without further ado, let’s welcome Dr. Marino! Hi, Dr. Marino.
Dr. Marino: Hi! Thank you all. That was a great introduction.
Weijia: Haha. Thank you. Well, so we’ve talked a little bit about your educational background, but would you mind telling us a little bit more about yourself and what made you decide to pursue in this career path?
Dr. Marino: Absolutely. I think I became interested in medicine in my high school years, and I was trying to decide which path I was more interested in- policy and politics, or medicine. And I got the opportunity to go to two different leadership camps, one in D.C. on policy and one on healthcare in Boston.
And you probably have come to realize that things can happen at two different paces in those two different fields. So I knew from those two experiences, I liked the immediate gratification and change that you could get in healthcare. And I think that early recognition is what really led me to want to do surgery as well. So many of us love the immediate change and improvement that we can see in our patients’ lives from surgical procedure. And then in medical school, when I was in your shoes, I really was able to figure that out, exactly what field of surgery I wanted to do – that I wanted to do general surgery for the breadth that it carries. It has a lot of different pathologies that we can see, whether it’s benign, whether it’s malignant, vascular, trauma, and that really kind of potpourri approach to healthcare is what really attracted me to the field of surgery.
Hannah: Very cool. So as a young, well, rising M2, but I still feel like a little baby M1, a lot of students come in not knowing anything about any of the specialties. Or the only things they hear about are those stereotypes or what they hear on TV. And as we all know, TV medicine is very different from in real life medicine. So how would you pitch your specialty to a student, or what are the big points that you would say, these are the highlights? Maybe these are the not so great highlights, not so great, like the not so sugar coated version of your specialty? Just a quick rundown.
Dr. Marino: Sounds great. Let’s do the non-highlight reels and reality, we will call it of surgery, specifically thoracic surgery. As you know from your introduction, I went a lot of places and trained for a long time. And I think that’s one of the potential drawbacks depending on how you view your training, is that it requires many years. It often requires years in addition for things like research to build your CV and make yourself more competitive and to stand out in the field.
And then the potential that you might move, especially with it being a more competitive match, you’re not always in control of where you’re going to be. So those are things that just getting into the field might be an obstacle or a deterrent for some applicants. I think you have to balance that with what the benefits of pursuing a field like this. And for me, they’re very numerable.
I love the complexity of my patients that I see. And that’s what I would pitch to somebody interested. Is that I have a very broad field that covers a lot of complex patient disease. I do everything from cancer operations to what you might consider orthopedic operations. I do benign problems like reflux and achalasia. And I like that I can see outpatients who are healthy. I can see inpatients who are the sickest of the sick come in with emergencies like esophageal perforation.
So as Jasmine and I were talking about with research, it tickles a lot of the different parts of my brain. The other thing that’s great about thoracic surgery, and compared to other surgical fields, is the amount of technology we have at our disposal. And if you’re a tech geek, I don’t think there’s a better field for you. We have advanced software for three-dimensional planning. We have robotics. We have other minimally invasive platforms like VATS, which is a lot like laparoscopic surgery. We do endoscopic work with EGD scopes and bronchoscopes. We use everything from lasers to staplers, cryoablation. And we also just do bread and butter really big operations and make big holes sometimes. And that’s really attractive to some people too. Is just we have a whole platform of tools, and probably one of the specialties most dedicated to furthering those technological advancements. We actually have our own shark tank at one of our national meetings where people pitch ideas for new medical devices. Ans so I think that’s one thing that really stands out about thoracic surgery.
Jasmine: That’s amazing. Very innovative. Very innovative.
Weijia: Good for tech geeks.
Dr. Marino: Yeah.
Jasmine: So, you’ve talked a bit about all the different types of procedures and machines that you use. And you’ve also talked about how much you love research and policy. So how do you balance all these responsibilities? What is your typical day to day, or typical work-week look like?
Dr. Marino: That’s a great question and I think it can vary depending on where you are at- whether you’re in private practice or an academic institution like this, and what stage in your career. I’m very early in my career. I’ve only been out three years, and so I’m really trying to use my youth and energy while I have it to tackle as many problems out there. I’d say probably 80 percent of my time is devoted directly to patient care, whether I’m in the clinic or seeing them in the hospital or the operating room. Or the flip side of patient care is the charting, and billing, and recording notes that has to go on. That other 20 percent of time I split between education with students and residents, whether it’s a simulation experience or a lecture. And then, time devoted to research with folks like Jasmine, probably a couple hours a week. And it can be hard to fit all that in. Obviously I’m going to have weeks where like today, for example, I’m not operating. I’ve seen my patients in the hospital. I got to get to work at eight this morning, which is sleeping in for me, and I have had four meetings on my docket for today that are everything from administrative to quality improvement research, and this time that I’m spending with you guys. The flip side of that is some days, I get here at 6:30 to see the patient in pre-op before surgery and if I leave and I call my mom, because I call my mom every day, okay, she goes, “wow, it’s 6:30,” that’s a good day. So I’ve spent 12 hours here already. So, it’s a give and take, it’s a balance, and that’s kind of how I look at it. I take advantage of the time that I’m not operating to do things like this.
Jasmine: Awesome. I think this is, I think work-life balance is one of the main challenges that a lot of like healthcare providers have to go through. So I think it’s really important that the listeners to this podcast kind of like realize that, and especially its always changes with each specialty. So that’s why we try to ask this question a lot.
Hannah: We like the non-sugar-coated version because typically that’s the only, we only get the sugar-coated version. And we’re like, what’s it really like?
Weijia: And that’s only after you completed your training with residency and fellowship. So I was wondering what does residency and fellowship look like for you? How many years is it? What do you do? What’s the schedule like?
Dr. Marino: So the shortest track that you can take from a traditional training standpoint, which is what I did, is five years of general surgery and two years of thoracic training. There are also three-year thoracic fellowships. So now we’re looking at eight years. And there are many people who stop to do research along the way, so that can bump your total sometimes up to 10. There’s a joke for the folks that train at one of the East Coast cardiothoracic programs that we won’t name on the podcast. But it’s a joke that you spend a decade with Dan, and we’re going to change Dan’s name, obviously, because that’s how long the training is.
Hannah: That is quite the commitment… Okay, so shifting a little bit from medicine and what has led you here today with education and current life, but more to dreams and beliefs. So what are your current frustrations that you have within the field of thoracic surgery or just with medicine, health care in general? And how do you think, like what, what would be your dream, like either solution or like outcome?
Jasmine: Especially since like you’re so passionate, I think about policy, healthcare policy. This is amazing- we would love to hear that.
Dr. Marino: Yeah, this is a great topic. So, I think from a, if we look at patient problems, and to me, patient problems are my problems. Those are the ones that I should and do care the most about. From kind of a day-to-day standpoint, what they see is, gosh, I had to go to this doctor to get this record and this doctor to get this record, and nobody’s electronic health system actually talks to each other. You have things that are getting fax, things that are pushing through the cloud. So I think, if we had more resources to streamline that for patients, that it would probably expedite their care, but just in general, improve their impression of our care, and how fragmented it can be sometimes. I think from a policy standpoint, continuing to look at patient outcomes, specifically for lung cancer and the work, for example, that Jasmine is doing with LOTO screening and how do we distribute that to populations in an equitable way, focusing on disadvantaged populations, we have so many opportunities for that. So I think in a dream world, patients are able to get their LOTO CT easily, and then I’m able to get those records and work up and evaluate that patient for surgery, with fewer steps.
Jasmine: It’s all about, I think the logistical standpoint of medicine can get very complicating. Especially working, you know, in a rural population state, having that, I mean, lots of places don’t even have internet access. So much less, how are they going to know how to use these programs? How are they going to know how to get these certain records from all these different hospitals that they’re being seen at, and get a complete medical history of your patient, you know? Because you have to grab this record from this small family clinic in this part of Arkansas, and yeah. I could definitely see how that’s really, really complicating.
Hannah: Communication is a skill.
Dr. Marino: Absolutely.
Jasmine: Yes. Something more specific, I think, to our state. I mean there’s lots of other rural states but I feel like that’s like a specific challenge with Arkansas, especially since this podcast is, you know, for UAMS.
So being young in the medical field, you hear a lot about the different types of specialties, and it’s hard to differentiate between what’s true- I think we kind of talked about this right?
Hannah: Yeah.
Jasmine: What to take with a grain of salt. Would you mind telling us a little bit about your lifestyle as a surgeon, and what your working environment is like?
Dr. Marino: Sure. So lifestyle wise, I think I have a good lifestyle. I think I have a good work-life balance. There was periods before COVID when I was, you know, going to the same gym class, making the same friends all the time. Of course that kind of tapered off with the pandemic and all. But I’m able to engage in things like the Arkansas Museum of Fine Arts that’s coming, I like to go see the ballet, I like to travel to the lake and whatnot. So from a lifestyle standpoint, I make time and find time to do things that I love. Things that are difficult about my lifestyle that I’ve had to troubleshoot for example, dog care, right? Do I do the majority of the grocery shopping for my household? No. So if you’re, you know, have needs for household care, dog care, child care, those can become challenges and it’s important to have your community around you, or other ways to get those things done. And you do feel guilty sometimes. I have a dog, and I feel guilty about it, I can only imagine how, how moms in my shoes feel, but they’re friends and colleagues of mine that do it and excel at it.
Jasmine: So like transitioning to that – of how moms, female surgeon moms may feel, what is it like to be a female surgeon in a traditionally male dominated field? Would you say it has its own specific set of challenges?
Dr. Marino: Certainly. I think one of my favorite stories to tell about this topic is I was interviewing for thoracic fellowship and I was with two interviewers, a male and a female. And I got asked when did I think there were going to be enough women in thoracic surgery? And I said, “Well, when I stopped getting asked that question.” And I really do believe, and hope that every woman who’s able and interested in thoracic surgery has the potential to have a career in thoracic surgery. I think part of the biggest part of that is we have to be each other’s own cheerleaders. So when you see opportunities, invite another woman to it. When you have somebody like Jasmine, who’s my student, to make sure that I’ve done every opportunity to kind of advance her career, I think that’s the difference between a mentor and a sponsor. A mentor is willing to give you advice, the sponsor’s willing to go out on a limb and give you an opportunity.
Weijia: So on that note, do you have any advice for women wanting to become a cardiothoracic surgeon, or just surgeon in general?
Dr. Marino: Yes, I think especially now that you guys are hopefully having fewer and fewer Zoom opportunities, and more real-life opportunities to…not be afraid and reach out. I think when I was a medical student, the culture was a little bit different. I was probably terrified to reach out to any female surgeons, and at the time I knew one cardiothoracic surgeon. She was, I think, the Associate Dean of my college. So I definitely was not going to email her and say “hey, can I come hang out.” I think nowadays, it’s much more accepted, and welcomed, when students reach out and say “hey, can I come and shadow you and spend some time.” And what I try to do is find opportunities for you all to meet with me in clinic so that I can give you a little bit more one-on-one intention. While it’s cool to come watch what I do in the OR, I can’t really have this conversation about lifestyle, or my pathway, or you know, even what kind of places I like to go shopping or traveling to, right. Things that kind of help you get to know that person, when I’m in the operating room and think of a procedure. So, reach out, don’t be afraid.
Jasmine: Persistence. Cause I mean, I think we’ve all experienced that at every level, like pre-med, medical student, of just getting, of cold calling people, cold emailing people-
Hannha: -making connections-
Jasmine: -and like, it was a really a challenge for me, like when I didn’t get like a response, or if I’m like being persistent, I’m just like “oh.” I tend to like internalize, that but I think it’s very important to just like, brush it off, and just keep persisting.
Dr. Marino: Right. Surgeons are busy. We are all guilty of mentally responding to your text message or your email, and then forgetting to hit the actual send button.
Hannha: I do that all the time in my own personal life, so I definitely don’t take it personally cause I have been the one accidentally ignoring others.. but anyways, so staying on the topic of advice, what is one piece of advice you would just give to medical students in general, overall. It doesn’t have to be, maybe necessarily about like medicine, but just one piece of advice that either you wish you got, or was like the best advice that you were given as a medical student.
Dr. Marino: I think, attach a patient to every learning point that you can. And take every opportunity to learn as much as you can from a patient. You will carry that with you. And that’s whether it’s a learning point you read in a book, or something you learned the hard way because something didn’t go well for the patient. And looking at those problems from a patient standpoint, you will take that with you, you will remember it the next time, and you’ll learn from it and grow more than you would if you just read it in a book chapter.
Jasmine: I think that’s why clinical experience and volunteering is like really important too. Because like when we see patients at Harmony, it’s like, oh, you’re able to finally attach-
Hannah: – always remebered those patients more.
Jasmine: Yeah.
Hannah: Yes.
Weijia: Yeah. I feel like medical education, some of the concepts you learn are not that complicated, but they’re just abstract. You know, without seeing someone, you can’t imagine-
Jasmine: -like conceptualize it.
Weijia: Right you can’t conceptualize it properly. Yeah.
Hannah: All right. So what is your most memorable experience, from either med school, residency, or like, as an attending? Just in your medical journey. Either the one that you have enjoyed the most, or it was just the coolest experience for you, or maybe, you know, it wasn’t a cool experience- but just your most memorable experience.
Dr. Marino: I think one of the first and most formative experiences I had was traveling for an organ donation.
Jasmine: Wow.
Dr. Marino: And I was a medical student. I went with my attendings. There weren’t any residents, so I really had a close view of the surgery. And I remember thinking, well, this is such great anatomy. I can see everything. And the case progresses. And of course, at the conclusion of the case, it’s time to take the donor off of the ventilator. And at that moment, it kind of hit me. And I think it’s a piece that not everyone will experience. Not everyone will get to go on a procurement, but exactly how final and how tough of a decision that had to be for the family to make. For their loved one to come to that operating room, and leave with a completely different scenario than they went in with. I think was one that made me really appreciate transplant, and really enjoy being a part of every donor and every transplant recipient that I was a part of for the, you know, five years of residency and two years of fellowship that I still did transplant. So I have a big appreciation for what the OPOs, the organ procurement groups, do, for what families do, and for what surgeons do, for donation.
Jasmine: Wow. I think that’s one of the coolest stories I’ve heard-
Hannah: Yes.
Jasmine: Actually, honestly. Okay, so I think, how can a student contact you if they wish to ask you a question, shadow you, or want to have you as a mentor, or a sponsor as you say. So the best thing to do is to send me an email, kamarino@uams.edu. What I typically will do is give you my cell phone number, say my clinic is on Tuesday afternoons. You come to clinic on Tuesday afternoon. We see patients together, you shadow right behind me, and we spend some time one-on-one looking at CT scans, and talking about the patient’s diagnosis and their treatment. And ideally, I like to find the date that that patient is going to have surgery and have you come on that day so you get some continuity of care and you get to actually see that patient’s operation.
Hannah: That’s really cool. As someone who appreciates continuity, I think that is the best way to do it.
Jasmine: Right, I think-
Hannah: It drives home the experience more.
Jasmine: That’s my number one pet peeve. Or not pet peeve, but like, when I shadow, I always wonder, like-
Hannah: Where are they now?
Jasmine: I hope they’re doing okay. Sometimes randomly at home, I’m like washing dishes, I’m like, hmm, I wonder if they’re doing okay. Just a random thought.
So, is there anything that we have not covered that you want to make sure our students/listeners know?
Weijia: I guess, I have, sorry-
Jasmine: Yes, yes go ahead.
Weijia: I have one more question, and this is more for people interested in cardiothoracic surgery. Because it’s a pretty competitive field, what do you think resident programs look for in a student? Like what things should a student work towards?
Dr. Marino: Right, so I think every competitive field comes with the, you need to have good grades. I think your grades come first in your, in your medical school training. Other things that I think you can do to make yourself stand out are participating in research, if you can make time too. I think that’s becoming more and more looked upon, and those are kind of the compulsory, get you through the door. I think the type of mentality that people are looking for, is somebody who is willing to be a life-long learner. I think earlier, we talked a lot about the technology in thoracic surgery, how it’s continuing to evolve. And that willingness to be a lifelong learner, whether it’s both education and skill set, is important for the field of thoracic surgery. So really being eager to learn and improve your skill set, be in the operating room as much as possible, read things of interest to you in thoracic surgery. For example, my partner, Dr. Steliga, when he finished training, there wasn’t a whole lot of VATS, or minimally invasive lobectomies, being done. And he’s a perfect example of what it takes to be a lifelong learner in thoracic surgery. He acquired that skill set later in his practice, and brought that to Arkansas, and instituted that here and has become a leader in the field.
Jasmine: And I think, I guess during residency interviews or when they have their, your application open, they can like see if you have, like, extensive research. They, I guess they see that you’re always willing to like learn and commit to a project, especially since like one project- bringing it from like abstract to manuscript and all the way to like publication- that takes so much commitment.
Dr. Marino: Right.
Jasmine: So I think, you know if you show that you have all those research projects, it shows that you have that willingness and commitment, and that you can carry it over to like a career.
Dr. Marino: Agreed. Everybody in medical school, we’re always trying to just get from one test to the next and one test to the next. And we don’t really look at that ten thousand foot view of what’s going to happen with my career ten years from now, twenty years from now. Well, as a medical student, ten years from now, did I think, “Gosh, I’m going to be studying every night that I come home from work to take my American Board of Thoracic Surgery exam”? No I didn’t, but that’s the reality. So you never stop learning, and never stop improving.
Weijia: That’s good advice in general, I feel like for any field of medicine.
Dr. Marino: Yeah, it’s what you would want your doctor to do for you or your loved one.
Weijia: For sure. For sure. All right, well thank you so much for being available for this podcast Dr. Marino. And is there anything else that you would like to share with us?
Dr. Marino: Well, it was a pleasure, good luck to all of you and I look forward to seeing what your class is going to do.
[all laughing]
Weijia: Us too.
Hannha: Us too. Yes, yes. And listeners, as always reach out to us and let us know your thoughts, concerns, questions, and we’ll see you in the next episode!