Training Ground

Photos by John Luke

Never marry a doctor.” That was the age-old wisdom of countless mothers whose hope for their daughters—and occasionally sons—included a spouse who didn’t spend most of his waking, and some of his sleeping, hours at work.

Today, the road to becoming a doctor is still grueling. And the educational demands are arguably more complex, thanks to the incredible rate at which medical knowledge is advancing. What students learn today might be out of date by the time they’re practicing, requiring them not only to stay on top of the medical literature but also to be able to make sophisticated judgment calls about when to introduce the latest and greatest treatment to their patients. A lifelong love of learning and a burning desire for knowledge may turn out to be the modern physician’s most important skills.

One thing that hasn’t changed is the competitiveness of medical school. For every one of the 82 seats at the U’s School of Medicine freshman class, there are more than 13 qualified applicants. Even a spectacular undergraduate career will not guarantee admittance. Successful candidates will also have done community service, worked in research labs, and found ways to gain experience interacting with patients. And then there are important character considerations. “A student who is not caring and compassionate will not be a good physician,” says David Bjorkman, dean of the School of Medicine.

Supplying a physician workforce for the state of Utah is Bjorkman’s other job—an especially daunting task given that Utah ranks an abysmal 47th out of 50 for the number of physicians per state population. While the national average is 235 physicians per 100,000 people, Utah has 165 per 100,000. Complicating matters is that last year, the medical school lost $10 million in annual federal funding, forcing a reduction in class size from 102 to 82 students.

That’s why Bjorkman hopes that some of the U’s medical students will stick around and those who went to medical school out of state will think about returning to Utah for their residencies. “We know that the best indication of where a physician will practice is where they do their terminal training,” says Bjorkman. “So we try to make each of our residency programs so stellar that they’ll attract the best and the brightest physicians to Utah.” Because even with the medical school at capacity and the U’s 690 intern, resident, and fellow positions filled, Bjorkman notes, the physician workforce demands of the state still won’t be met.

Cynthia Newberry

It’s hard to believe that the last four years of Cynthia Newberry’s life were anything other than a blur. She married in 2006, started medical school a month later, had two daughters over the next three years, and on May 22, graduated with Alpha Omega Alpha honors from the University of Utah School of Medicine.

But Newberry doesn’t seem the least bit frazzled as she makes rounds on patients in the lock-down unit of the University Neuropsychiatric Institute, where she is finishing her final four-week clinical medical school rotation. Her demeanor is quiet and calm as she, the attending physician, a resident, and a social worker talk with patients who are being treated for addictions to heroin, alcohol, or prescription drugs.

Newberry’s calmness may have something to do with her experience working down in the trenches, fighting forest fires in Alaska and Utah for four summers, or having taken five years between graduating from college and starting medical school at the U. “I’d lived an exciting and playful life in my early twenties and didn’t feel like I was missing out on anything,” she says. It may also have something to do with knowing that her husband, Mike, was at home caring for their two daughters, Caroline (3) and Megan (1). But probably most of it has to do with just being Cynthia Newberry.

Growing up the oldest of five children, Newberry didn’t have a childhood ambition of becoming a doctor. She just liked math and science. By default, she ended up taking all the pre-med requirements in college and graduated with a bachelor’s degree in biology. Unsure medicine was her calling, she wisely decided to take some time off and experience the world.

In her final weeks of medical school, Newberry reflects on what a huge juggling act the past four years have been. “There’s really no great time for a female physician to have a baby,” she says. Fortunately, her husband was willing to go from being a working, single guy and avid recreationalist to a stay-at-home father of two girls with a wife in medical school. The latter turned out to be the bigger jolt of the two. “He really had no idea about how long of a road medical school is, the huge commitment, and how little control you have over your own time,” says Newberry.

The U School of Medicine’s curriculum has recently been redesigned so that students can begin interacting with patients in their first year. But for Newberry, the first two years of medical school involved a manageable 50 hours a week of attending lectures and labs—and studying. Her third year was a huge wake-up call: She began her clinical rotations, which typically involved 12-hour days, six days a week. In addition, once or twice a week, Newberry would report to the hospital for a 30-hour, in-house call—arriving at the hospital at 6 a.m. and returning home the next day at noon or whenever everything was wrapped up—whichever came last. “It’s really a shock to your system,” says Newberry, who was pregnant with Megan for the second half of the year. “Adjusting to the lack of control over your own time is the hardest part.”

By the end of the third year, students are expected to choose a specialty—a complicated decision that involves factoring in the type of medicine, patient population, length of residency, hours, compensation, and the hard reality of whether they would make the cut for some of the most competitive residencies. Newberry had done well enough that the field was wide open. After great deliberation, she chose anesthesia, and in the fall of her fourth year, she began applying to and visiting anesthesiology residency programs around the country.

With newborn Megan and her mother in tow, Newberry traveled to seven academic medical centers, carefully considering the strength of each program, its reputation, the location, and the personal connection she felt with the residents and attending physicians. At the end of what she describes as “a recruiting adventure,” she ranked Utah as her first choice. “The U’s program has a top-notch reputation and is nationally known for its training in some important subspecialties of anesthesiology,” says Newberry. Plus, she loves the location. “I can’t really think of a better place to live,” says Newberry. “We have all the benefits of the city and a great medical center without the traffic and stress.”

On June 24, Newberry will report for her first day of work to the general internal medicine service, where she will complete her internship year—the first year of her residency. She knows it will be a steep learning curve but feels well prepared.

Once Newberry finishes her educational odyssey in four to five years, she hopes to find a way to reciprocate for the opportunity. “I feel an obligation to patient care but also to give back to the students and residents,” she says. “Medical education is such a unique learning structure, because you learn through your interaction with senior physicians. Teaching challenges you to be at the forefront of the literature and provide the best care for your patients. I’d love to be a part of that system down the road.”

Ramin Eskandari

Ever since Ramin Eskandari was a young child growing up in Iran, he knew he wanted to become a surgeon. It hasn’t been an easy road to arrive at his ambitious childhood goal. When the Iran-Iraq War broke out in 1980, the Eskandari family fled, abandoning their house on the border and taking turns living with whichever relatives could squeeze in a family of four. In 1984, they received a green card to come to the U.S. and started their lives over in Ann Arbor, Mich. Ramin was seven years old.

Eskandari remained laser-focused on his career goal, taking any class that had to do with the brain, and working in the lab of a pediatric neuroendocrinologist during college at the University of Michigan at Ann Arbor. Although his first two attempts to get into medical school were unsuccessful, he was determined. He enrolled in a master’s program in basic medical sciences at Wayne State University in Detroit and found a job at a hydrocephalus research lab. On his third attempt, he was accepted to the Wayne State University School of Medicine.

At the beginning of Eskandari’s fourth year of medical school, the late chair of the Department of Neurosurgery at the University of Michigan, Julian “Buzz” Hoff, an esteemed surgeon and researcher, recommended that he check out Utah’s program, which Hoff described as “one of the best.” After just one visit to the U, Eskandari felt at home with the program, the mountains, and the positive attitude of the residents and attending physicians.

“Thrilled” is generally not a word used to describe someone in the middle of one of the most grueling and competitive surgical residencies, but Eskandari appears to be an anomaly. Four years into the six- to seven-year program, he still looks forward to taking his 30-hour call every other weekend. “People think I must go home and kick the cat,” he says. “But I love what I do.”

Eskandari feels fortunate that his wife, Aline, who’s in an MBA program at the U, is very independent. “I think your happiness in residency has a lot to do with expectations,” he says. “If people expect to have all sorts of free time in residency, they’ll become very disillusioned.”

At 5:15 a.m. on a Friday, Eskandari arrives at the 24-bed neurocritical care unit at University Hospital, where he’ll be for the next 30 hours. By 10 a.m., he’s twice made rounds on each of the patients, many of whom are unconscious, sedated, or intubated. They range from a 14-year-old girl who has been there for two months, to a 60-year-old man who suffered a paralyzing spinal cord injury in a car accident, to a woman with a massive brain hemorrhage flown in the night before from Price, Utah.

At 10:30 a.m., a group that includes Eskandari, a nurse, a second-year ER resident, a stroke fellow, a nutritionist, and a pharmacist gather around the attending physician, a neurologist and neurointensivist (a physician specially trained in neurocritical care). The rapport among the group is direct but collaborative. They disagree with one another, push back, and request clarification. At one point, the attending physician has Eskandari elaborate on a diagnosis, and then counters, “You can just throw that logic down the drain.” Eskandari seems to appreciate her directness. “Okay, flushed,” he responds.

As the day progresses, Eskandari is likely to be called to see a trauma patient. A Level One Trauma Center, University Hospital is required to have a neurosurgeon available at all times. “We need to be the fastest at seeing patients when we’re called, because the potential for disaster is high,” says Eskandari. “Very few things kill faster than an enlarging hemorrhage in the enclosed skull.”

Although most neurosurgeons choose to live very close to the hospital, having a neurosurgery resident in-house can save lives. Eskandari tells the story of doing a rotation at Primary Children’s Medical Center when a young boy with hydrocephalus arrived in the Emergency Department (ED). The tip of his catheter—the tube that drained excess spinal fluid into his belly—had malfunctioned. As a result, so much fluid had collected in the child’s skull that he was comatose and his pupils were dilated, a sign of impending death. The attending pediatric neurosurgeon and division chief, John Kestle, hurried immediately to the hospital but first spoke to Eskandari, explaining what he had to do to save the boy’s life. With the ED staff gathered around and his heart pounding, Eskandari inserted the longest needle he could find through the child’s skull. Immediately, he began drawing fluid, and within minutes the boy began regaining consciousness. Soon after, Kestle arrived, and the child was taken into surgery and the catheter replaced.

But most of Eskandari’s days are far less dramatic. His fourth year of residency is his research year, so he spends most of his time in the lab of Pat McAllister, who came to the U from Wayne State a year after Eskandari. McAllister is now a professor of neurosurgery and director of the U’s highly regarded Basic Hydrocephalus Research Program. For most of the year, Eskandari has been investigating surgical treatments for neonatal hydrocephalus, a condition that is fatal without surgical intervention. The past month, however, he’s spent 15 hours a day studying for his neurosurgery board exams.

In July, Eskandari will begin his fifth year of residency, which will involve more surgery and more complex cases. His sixth and final year will be one of the most intense. As chief resident, he will be involved in all the major surgical cases, along with having the added responsibility of overseeing the residents.

True to form, Eskandari is excited at the prospect. “I’ve had so many good role models, people who are very balanced, such as Dr. Kestle. He practices, does research, and serves as program director of the residency program. I’d like to be that kind of role model someday.”

— Amy Albo is a writer and editor with the Office of Public Affairs for University of Utah Health Care.

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