5. From Pharmacist to Cardiothoracic Surgeon with Dr. Thomas Melvin

🎙️ In today's captivating episode, we sit down with Dr. Thomas Melvin, a Chief General Surgery Resident at a prestigious academic hospital. Dr. Melvin's unique journey from pharmacy education to becoming a top surgeon is a testament to the diverse paths one can take in the world of medicine. Join us as we uncover the pivotal role his pharmacy background played in shaping his career and explore the demanding yet rewarding world of surgical residency training.

📕 Our insightful conversation with Dr. Melvin delves into various aspects of his remarkable journey:

1. 📒 Medical School Experience: Discover the challenges and triumphs Dr. Melvin encountered during his medical school years, and learn how his pharmacy education provided a strong foundation for his medical studies.

2. 📒 Surviving the Rigors of Surgical Residency: Gain valuable insights into the demanding lifestyle of a surgical resident. Dr. Melvin shares tips on maintaining a work-life balance and excelling in the high-pressure environment of surgical training.

3. 📒 A Glimpse into General Surgery: Get an overview of the fascinating world of general surgery. Dr. Melvin provides a glimpse into the diverse cases and procedures that make up this dynamic field.

4. 📒 USMLE STEP 3 Exam: Learn about the importance of the USMLE STEP 3 exam in a surgeon's career progression and how to prepare effectively for success.

5. 📒 Advanced Surgical Fellowship Training: Dr. Melvin discusses the opportunities and challenges of pursuing advanced surgical fellowship training and how it shapes one's surgical career.

6. 📒 Life as an Attending: Explore the transition from residency to becoming an attending surgeon. Dr. Melvin offers valuable insights into the responsibilities and rewards of this pivotal role in healthcare.

📕 Whether you're an aspiring medical professional, a pharmacy student with dreams of a surgical career, or simply curious about the journey from pharmacist to top surgeon, this conversation with Dr. Thomas Melvin is a must-listen. Join us as we uncover the secrets to success in the world of surgery and gain a deeper appreciation for the role of pharmacy education in shaping a brilliant surgical career. Don't miss this opportunity to learn from one of the best in the field!

⚡️For more resources to get started, check out some of our other blog post content!

• The MCAT: Everything You Need To Know

• How Hard is Medical School

• Can you work while in Medical School? The Physician Pharmacist Do's and Don'ts

• 6 Most Common Questions About Transitioning From Pharmacy to Medicine

• The Art of Applying to Medical School (The Pharmacy Student Edition)!

🧠 Enjoying the podcast and want to listen to more? Visit The Physician Pharmacist Podcast for a list of episodes. Here's a featured episode below!

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🥼 Complete Transcript of "From Pharmacist to Cardiothoracic Surgeon with Dr. Thomas Melvin"

Nathan Gartland

Welcome to the physician pharmacist podcast, a show designed to shed some light on a very unusual pathway into medicine. I'm your host, Nathan Gartland. I'm a licensed pharmacist and second year medical student. I'm also the author of farm D to MD and the owner of the physician pharmacist company. Most pharmacy students and professional graduates are aware of the possibility of going to medical school, but very few actually take the leap. We're here to unpack some of these details and open your eyes to the possibility of a career in both pharmacy and medicine. In today's show, we will be briefly cover medical school life, but primarily focus on topics relating to post medical residency training. This will include the resident lifestyle, balancing work and personal time, a brief overview of general surgery as well as the USMLE Step Three exam. We will finish out by introducing advanced surgical fellowship training and lastly life as an attending. I'm very excited for our fifth episode of the physician pharmacist podcast miniseries, where we will be interviewing Dr. Thomas Melvin. Dr. Melvin received his pharmacy doctorate from Duquesne University in 2013. Upon graduation, he immediately matriculated into the Marshall University School of Medicine in West Virginia, and completed his education into 2017. He is currently in his fifth and final year of general surgery residency in Pennsylvania, where he serves as one of the chief surgical residents. Upon graduation, he plans to undergo a two year fellowship in cardiothoracic surgery, and subsequently become an attending. Thanks for being with us today, Dr. Melvin, and welcome to the show.

Thomas Melvin

Thanks for having me, Nathan. It's a pleasure to be here.

Nathan Gartland

Fantastic. Well, based off of that background that I just gave, you know, let's start out with a few general questions to unpack some of that information. So it probably feels like a lifetime ago. But um, how did you get started with pharmacy in the first place?

Thomas Melvin

Ah, yeah, that's a interesting question. I was an undergraduate student, finishing up a degree in biology. And I didn't quite know what I wanted to do. I was curious about just about everything. And a friend of mine, brought up pharmacy, and we researched at the last minute and applied to pharmacy school at the last minute kind of on a whim. And it was a pleasant surprise, because I, I knew I loved the application of science. So probably pharmacy school, medical school, veterinary school, dental school, any of those type of professional schools would have worked for me. And I end up falling in love with pharmacy. So I don't regret that decision at all.

Nathan Gartland

Wonderful, and I as well. And so the next question, I guess, was going to be you know, was medical school, always one of your plans? And how did you transition into that particular? You know, how did that mindset shift from pharmacy into medicine?

Thomas Melvin

No, not at all. It was kind of the opposite. I had rolled out medical school, I had a family friend who I was interested, or I was introduced to early on in my undergraduate education and kind of deterred me away from medical school. So I never really thought about it after that. It wasn't until I was in pharmacy school, while I was initially exposed to clinical pharmacy and kind of hospital pharmacy and in medicine, that I had, like a robust exposure to the field of medicine. And then one of my pharmacy mentors asked me if I wanted to observe a surgery, which I've never seen before. And I took him up on the opportunity and, and I thought to myself, Wow, this is really what I want to do. It was probably in my late second year of Pharmacy School, where I was first exposed. So I wasn't interested in medicine, probably until about that time.

Nathan Gartland

Yeah, that's what a lot of the guests on the show have been saying as well as, as we transition into that more clinical based pharmacy period of time. You know, later in the education process, we start to see how physicians and residents and hold the whole healthcare team interacts with each other. But that's awesome that you got to see the O R. And because that's something I personally haven't even seen yet. I'm actually starting out surgical rotations in a couple of weeks, or I guess, a couple months. But that's my first set of third year rotation. So I'm very looking forward to that quite a bit.

Thomas Melvin

Oh, that's great. Alrighty, so

Nathan Gartland

I recognize that, you know, it's been some time since your medical school application period. And the process has has already changed changed dramatically over that time period. You know, what was that like for you and how did you handle it during pharmacy school?

Thomas Melvin

I do remember this and it was difficult. I was on some clinical rotations in pharmacy school. In some areas that I was highly interested in because I was still pondering on whether or not I wanted to To pursue Clinical Pharmacy as a career, so, you know, I was, you know, working hard, and at the same time, you know, studying for the MCAT. And, you know, to balance those two things was not easy. But you know, like anything in life that's worth doing, you know, you'll find a way to do it. And, and that's probably what most of us would do. So it wasn't easy, but certainly doable.

Nathan Gartland

Exactly. And you kind of just have to put your head down and push through with some of that, but if it's something you're super passionate about, then it kind of works itself out regardless. And, you know, to kind of accelerate through this while in medical school, how did your pharmacy education help with your academic and clinical success?

Thomas Melvin

I'd say it helped tremendously. Not only I mean, everybody knows, in pharmacy school, you you learn not only, you know, therapeutics and pharmaceutics and pharmacokinetics. But you have a, you get a very deep depth understanding of physiology, which really helps you in medical school and, and you learn the physiology, again, the medical school and you learn the pharmacology, again, in medical school, so provides an extra layer. So your general understanding of most of these topics is is very robust, I would say compared to the traditional medical students. In terms of clinical clinical success to I mean, you've you've already been exposed a hospital environment, you've worked with clinical pharmacist, so a lot of these things aren't new to you. So, yeah, it definitely helps in both of those aspects, I would say,

Nathan Gartland

Yeah, I definitely agree with that. Because just within the first two years of school, I still haven't, you know, transitioned to rotations quite yet. But I've utilized, you know, extensive pharmacy knowledge. And a lot of my education has been very helpful, a lot of my peers are frustrated with me, because I have this unique background. But I am looking forward to two rotations, I think that's going to be a great opportunity to really, I guess, utilize that that background, even more so than just on standardized tests. So something I'm really looking forward to, but kind of carrying through that with that question. You know, I found it, when I found out that you were PharmD turned surgeon, I was very curious to learn how you chose this field, you mentioned your or experience a little bit, and how that first, you know, exposed you to, I guess the idea of going into medicine. But you know, as a layman, I initially thought that you had chosen a field that uses very little pharmacy, and I'm just curious to know how you came to that realization that there is a lot of pharmacy still involved in a surgical specialty.

Thomas Melvin

Yeah, this was actually important to me, when I was looking at different fields of medicine, I didn't want to completely, you know, waste my pharmacy education, because I worked hard to get it and I enjoyed it. And I do enjoy, you know, pharmacy and medicine in general. So, a lot of research went into looking at all of the different aspects and fields that you can explore in medicine. And I quickly realized that, you know, general surgery, although, you know, they operate on, you know, mostly the abdomen, and you know, actually they can operate anywhere in the body, but they also have a heavy education and medicine and, and manage their patients, you know, very sick and complicated patients postoperatively to, they manage their entire patient. So that is what really drew me to general surgery is you know, not only the challenge of, of surgery, wearing the dexterity and the different techniques of surgery, but also, you know, the extensive medical education you get into surgical residency, that probably a lot of people aren't aware of, just like you said, but that's certainly not the case. I would say general surgery has a lot of medicine involved in it.

Nathan Gartland

Yeah, that's that's something that's super reassuring to hear as well, just because I haven't been in or yet. So I'm very excited to start out like I mentioned this summer, but I was a little nervous. You know, what happens if I fall in love with this? Am I going to completely forego my pharmacy education? And that's it's good to hear that that's not the case. I'm curious to know, you know, if you couldn't be a surgeon, what other specialty would you have considered? Was anesthesia ever on the table at some point I know that has a strong pharmacy background. Were there other things, you know, that you had as your second or third line that you were curious about?

Thomas Melvin

So anesthesia was one of the first fields I looked at, just for the reason you said and I liked it. I think the field of anesthesia is very interesting. You're still in the operating too so and but I would say I will get every single field everything you could do at a for a medical profession. And I just I came down to the loving field of general surgery. But there's an old adage they say in medicine, where they say you shouldn't become a surgeon unless If you don't like anything else, because the training can be grueling, the hours are long. So I don't find that the case at all. I think that's probably an outdated, saying, it's definitely I would base any of your decision making based off that at all. That's kind of kind of where I am with.

Nathan Gartland

Yeah, no, that's great to hear. Because that's kind of like an antiquated, you know, saying that, Oh, if you don't, you know, if you're not in totally in love with surgery, then you're gonna have a miserable time because of the reputation of having long, horrible hours. And we'll unpack some of that, and we'll have you potentially debunk some of these myths or just give it to a straight. But um, yeah, let's talk a little bit about residency, then let's take some time to explore the surgical theater and what it takes to survive in a surgical residency. The field certainly, like I said, has a reputation for long hours and many sleepless nights. So what has it been like for you know, it's now that you're coming towards the end of that, that period of training?

Thomas Melvin

So I would, you know, I'd say all residency is hard, regardless of the profession, or the specialty that you choose, but yeah, I would, it's probably still true that surgical residency is harder than most others. But for me, I can tell you that it's been a pleasant surprise. You know, the hours are strictly regulated by the ACGME. And I would say, you know, most, if not all, surgical residency, strictly abide by these. So, I don't think ours are much of an issue, at least they're not for me, I was, didn't really have to give up really anything in my life. You know, I, I married, I have a wife, I get to spend a lot of time with her and my family, we own a home with a big yard and a dog. So you could still have a normal life as a surgical resident. And I feel like I really haven't given anything up at all. What else? Did you ask Nathan about it? Oh, no,

Nathan Gartland

you answered the question right there. And I can kind of spin it into our next question, which was, you know, for actually, for our audience first, for those of you who don't know, general surgery residency begins after the completion of medical school, obviously, and last five years. So um, my question for you is, I'm curious to know which years were the most challenging? Which ones were the most enjoyable? Could you just walk us through maybe the last five years just at a, you know, bird's eye view?

Thomas Melvin

Sure, sure. I would say it's five years at a minimum, there are a lot of programs out there that incorporate research, some, some programs between, you know, one to three additional years of research are built into your training. So it is five years at a minimum. But in terms of, you know, a brief overview of what it's like I, I would say that the hardest time I had during my training, was my first month as an intern, I started off on the trauma service. And you know, where I trained, it's very busy trauma service, with a, you know, a very robust patient census. So it was a very difficult adjustment to make. from medical school, to residency where you are, sir, you're given a large amount of responsibility. And you have to quickly learn how to apply all the nerve, the knowledge that you gain, in medical school, to taking care patients. And that's a hard transition to make. I think regardless of what specialty you choose from, that you that you choose, in terms of the other years of trading, you know, and as you become more senior through a surgical residency, you're, you're off operative experience changes dramatically. You're what's expected of you in the operating room, from the attending surgeons changes, you're expected to be able to do more and the operations to be more autonomous. And usually, by the time, you know, you're a fourth year resident, and especially while you're a chief resident, you should be able to do the majority of the bread and butter operations on your own. So that's kind of how it works. As you transition more and more senior surgical resident, you operate a lot more

Nathan Gartland

awesome. And that kind of transitions nicely into our next question, too, was is that you know, can you walk me through your, your average day on the job? You know, what time do you start? When do you normally finish? How many procedures do you end up doing per day? Just kind of curious to get, you know, some more information on that.

Thomas Melvin

Sure, it really would change depending on what service you're on. I mean, so general surgery, rotate through, you know, trauma, surgery, all the abdominal subspecialties that you choose from critical care medicine as well. But I would say for an average day, most of our residents show up around 5am And they will get patient charts pre round. And then their team meets me around with the attending surgeon and then are usually around seven o'clock or 730. The teams We'll divide up cases, usually that's the senior residents responsibility, and then they'll go to the operating room. And that, that can vary types of cases you do, depending on what service you're on. But generally, it's, you know, maybe around, you know, four to five cases a day, or maybe you know, one or two big cases per day. And usually finish up in the operating room. You know, in the late afternoon, you finish up and see any consults that maybe you have, during the day, you follow up on any labs, or any, any imaging that you ordered any of your patients. And then typically the day ends around 5pm. And people go home, and then a call to takes over. That's the typical day in surgery. It different, like, if you're on a trauma service, you know, you're expected to go down and evaluate all the traumas that come into the hospital throughout the day. But I'd say you know, what I what I said at first is kind of a typical day in a surgical residency.

Nathan Gartland

Okay. And with trauma, if an individual was interested in doing like a trauma, I guess becoming a trauma surgeon, they would have to do a fellowship, and that afterwards, despite having exposure to it during general surgery, is that correct?

Thomas Melvin

That's not entirely correct, you could, you know, become a, you could be a trauma surgeon without a fellowship. But a lot of people that do want to be in the field of trauma, do pursue additional training. And actually, the training is surgical critical care, which is one to two years. And that is usually the pathway that a lot of people do for trauma surgery,

Nathan Gartland

just to fine tune everything to get a little bit more experience under their belt before they are thrown to the wolves as an attending.

Thomas Melvin

Absolutely, yes. But your surgical residency, trauma is a heavy focus on it. So you get an extensive training during your general surgery residency for that. Wonderful.

Nathan Gartland

So my next question was, you kind of prefaced it a little bit in your previous answer, but how frequently are you on call? You said it's very dependent on, you know, what service you're serving at the time period. But how frequently? Are you on call on a general per year? And how long are those shifts are, depending on let's say, worst case scenario, and then maybe best case scenario?

Thomas Melvin

Sure, well, I'll start by saying there are two different types of call that most programs do and we do where I train. Number one, the first one is in house call, where you know, you stay in the hospital, overnight, a cycle and the other one is home call, where you know, you can go home sleep in your own bed, you have to be available to field any questions from any other physicians, nurses, you may have to drive back in the hospital, you see consults, or if there's an emergency operation that needs done. So those are the two general types of call in terms of in house call, you know, your day would start again at 5am, like most days start, but instead of your shift ending at 5pm, you would stay overnight, and take another 12 hour shift essentially, from you know, 5pm to 5am. So that's kind of how that call shift we work early on in your training, like, maybe during your first year, so at least where I trained, Your call is a little bit lighter, we take around three to four calls per month, as you can become more senior in terms of in house call, take around maybe five to six calls a month, which averages out to maybe you want one in five or six days. And the day after your call, they have your in house call, we call that a POST call day where you're free of all clinical responsibility. So why did was take a nap, you know, wake up in the afternoon and kind of have the day off after that. So use it. You can use it however you want to catch up on, you know, life activities, study, spend time with family, but that's generally how a lot of programs handle call responsibility.

Nathan Gartland

Interesting. Thanks for that. So I'm curious to know also, just based off of like your experience, I know hospital pharmacists are getting more and more involved in the clinical realm. And based off of your day to day, you said you mentioned that you're in or for a good amount of time, but you're also doing a lot of clinic or a lot of rounding on the hospital wards to do follow up on post operative care. I'm curious to know do you have a lot of interaction with hospital pharmacist and what does that been like for you? Especially with your extensive pharmacy training in the background?

Thomas Melvin

Oh, absolutely. You know, as surgical residents Yeah, we do have quite a bit of interaction with hospital pharmacists. So the hospital staff pharmacists, especially early on into training, you know, when you're first getting used to, you know, putting in orders for patients, they'll become your best friends because a lot of the newly the new interns will we'll call them for dosing of certain medications, you know, antibiotic dosing, or even choosing the appropriate antibiotic. And then the clinical pharmacists will will run with some of the surgical teams and especially in the ICU team, so we have a dedicated trauma clinical farm misses that rounds with us that we have lots of interaction with and provides education for our, you know, our residents and the whole surgical staff. So, me being a pharmacist, you know, it was an easy icebreaker to meet everyone. And, yeah, it certainly helped make new establish new relationships without a doubt.

Nathan Gartland

Wonderful. And one of we have a couple more questions before we switch over to fellowship. But um, I'm curious to know, you know, as a chief resident, how are your responsibilities different from previous years? And how is this role prepared you to become a future attending? Do you feel far more prepared? Do you feel comfortable in the position that you're in right now.

Thomas Melvin

So as a chief resident, your responsibilities are a little bit different. You're have a lot of administrative responsibilities, and a lot of educational responsibilities. So we generally as chief residents, we help teach and walk Junior residents through through some of the the operations we can we teach and lecture on certain surgical topics. And then in terms of the administration, you know, we usually have a call schedule assigned to our cases, handle any any issues in terms of, you know, for the general residency, and act as just leaders for our residency department. And this chief resident role, really does help prepare you for your final job as attended, because we also run our own chief resin clinic, you know, see our own patients will grow in cases. And I have to say that, you know, when I look back at when I was an intern, and where I am now, I thought when I first started, I don't know how I didn't know how I was going to be able to learn all these operations with all these different approaches in terms of you know, laparoscopic surgery, robotic surgery, endoscopy, open surgery, all the different approaches and all the dexterity and, and that you have to learn with your hands. I didn't think I'd ever get there. But you know, I think my advice, the people that go into the field, we just just trust the process. Because, you know, once I hit my chief resident, you're I look back, I'm like, wow, I I'm very comfortable with all this stuff now. So the process works, all you have to do is trust it.

Nathan Gartland

Awesome. And lastly, as chief, I'm confident that you're involved in the residency selection process. I'm curious to know what you look for in medical students who are applying to general surgery residency, and how important is a research background compared to just like raw skill, let's say a sobei, or something along those lines.

Thomas Melvin

So, yeah, we definitely are involved in the residence residency selection process. I'll answer your your last question first. So the overall skill thing, we certainly do notice it, you know, if somebody has a specific, you know, have has great dexterity, or you know, they're very good with their hands or pet right hand eye coordination is great in the operating room, it's certainly something that, you know, we may take into account, it's not a big factor in our selection process, because a lot of this stuff is learned. So, I'll just give you an example. For me in particular, I, I didn't have any specific, you know, natural talents or anything along those lines. So I came into residency, you know, pretty raw, and, you know, all this stuff that can be learned. So, it's not a huge factor for that. So, the other thing we look for is, you know, obviously, you know, academics how they do on their surgical subspecialties, you know, try to gauge their interest in surgery. And then, you know, one of the, you know, another important factor is, you know, their location or where they like to live in this area. You know, surgical residency is long, it's five to seven years of training, depending where you go. So, we have to make sure they that they will be happy, you know, living in this area, and they will fit in well with our attendings and our other residents. So we the research thing, it we certainly use, look at that as a as a big pro. Because you are expected to do research while you're in residency. And certainly, a lot of the hospitals you look for attending jobs are gonna expect you to do research to when you're done. So, it is a factor that we take, take into effect whenever we whenever we we rank our our list.

Nathan Gartland

Awesome. Alrighty, so let's take a few minutes and discuss fellowships now. So I know you've mentioned that you're continuing your training as a fellow in cardiothoracic surgery. First of all, I want to say you must be pretty crazy because I know that's hands down one of the hardest, if not most challenging, undertaking some medicine. So congrats and kudos to you. I take it you really love cardiac anatomy, but why did you choose CT surgery?

Thomas Melvin

So yeah, I mean, it it's a it is a challenging field, but I'd say it's maybe one of the most dynamic fields of all of medicine. So So I'll start off by saying so CT surgery in general. You whenever you do your fellowship, you get trained and usually it's congenital cardiac, adult cardiac and adult thoracic surgery. Those are the three big pillars of of CT surgery training. But a lot of surgeons usually branch off into one of those three, they focus on thoracic surgery, which is essentially no thoracic oncology and forget surgery, cardiac surgery or adult cardiac surgery or the congenital cardiac surgery. So a lot of surgeons will focus on one of those three. So me in particular, I'm interested in thoracic surgery, that's likely what I'll do most of my focus on and the reason why I got interested in it is through general surgery. So we do a lot of training and forgot surgery like things like anti reflux surgery for people that have GERD, soft fuel motility disorder, surgery, esophageal cancer, lung cancer and all the benign diseases of the lung. And a lot of the skills that you learn in general surgery directly translate over that. So general surgery, get extensive training and minimally invasive one laparoscopic surgery. And a lot of those skills translate directly over the thoracic surgery. So it's a natural transition. So it's yeah, it's I'm looking forward to it. It's going to be a big challenge. But I I'm, I couldn't be happier doing doing this field.

Nathan Gartland

Yeah, and I love that you kind of like stratified it into the big three. I'm curious to know, is transplant one of those or does that fall under some of those one of those big three options there? Or is that a separate transplant surgery that focuses I'm referring more so to like cardiac transplant or lung

Thomas Melvin

Carolina? No Sure, sure. It's not, you know, generally one of the three pillars but yes, if you want to be a he want to transplant to be a transplant surgeon for heart, lungs, you would you would need to complete a fellowship in cardiothoracic surgery or in integrated, you know, cardiothoracic residency. And then, most of them, although it's not required, most Purdue do an additional one year in transplant surgery. Wow,

Nathan Gartland

that's, that's crazy long. It is. So as a as a CT surgeon, you know, a lot of these surgeries I can imagine are a little more complex or can be per se. When, like when it comes to like timing and time spent in the AOR and post operative follow up. So do you anticipate you're going to be in the or for longer, versus let's say your residency training, which might have had a better balance between clinic post op and or time?

Thomas Melvin

Yeah, it is a little different. So like, for a general thoracic surgeon, you know, that focuses on thoracic oncology. their bread and butter operations are going to be lung resections, like lobectomy. segmentectomy is new and activities. And a lot of Thoracic Surgeons operate in the foreground. So they do a subjective means. I can tell you that an esophagectomy has a long operation, especially it's done minimally invasively it could take upwards to eight or 12 hours. So, you know, you do have a long day in the operating room. But a lot of Thoracic Surgeons also have smaller cases too. So a lot of them do advanced endoscopy, like you know, EGD dilations. They do, you know, bronchoscopy, NAB, bronchoscopy, endo bronchial ultrasound, which are smaller procedures. So, there's a big there's a, there's a nice mix of longer procedures and, and smaller procedures. But like all surgeons, they, they do have responsibilities in their clinic. So they see their patients, you know, postoperatively usually they have about a day or day and a half of clinic per week.

Nathan Gartland

And I'm curious to know, as an aside, what's like the longest surgery that you've ever scrubbed in for and we're participating or leading?

Thomas Melvin

I'd say liver transplants can be can be very long, you know, I maybe around the 12 hour mark or so. But yeah, I'd say a soft gel perforations depending on how you manage that perforation. But sometimes when we we reset the esophagus and exclude it to the neck, that can be a long one. And in esophagectomy, again, depending on you know, obviously, patient's anatomy, when they got preoperative chemo or radiation therapy, work and make the your dissection planes you know, very difficult, you know, that operation can like I said, take upwards of eight or 12 hours. So, yeah, that's you can have long days, no doubt about

Nathan Gartland

kind of building off of that as well. I anticipate that your work life balance is going to suffer a little bit just based off of the reputation of CT surgery and the training that goes into it. How are you planning To maintain some semblance of a life outside of the OCR.

Thomas Melvin

So just like a general surgery, residency, thoracic surgery, or CT surgery fellowship is a ACGME accredited fellowship. So work hours are strict. And so there's an 80 Hour Work Week role that all residencies and all ACGME accredited risks and fellowships follow. So I don't anticipate that it will be much different. But I certainly will expect that I'm going to have other challenges in terms of, you know, learning an entire new field. So, but work life balance, I don't anticipate being a much much of an issue. Well, that's definitely reassuring

Nathan Gartland

then. And kind of, you know, building off that even further. I know that healthcare burnout is a major issue it just in, you know, all different fields of healthcare, whether it's pharmacy, medicine, nursing, you know, longer work hours, short staffing, declining reimbursement, and you know, limited PPE, especially during the COVID pandemic, has only made you know, burnout worse. Do you think healthcare professionals as a whole, I guess, how do you think healthcare professionals as a whole can combat burnout and maintain job satisfaction?

Thomas Melvin

That's a really good question. And I know, it's, it's discussed quite a bit in the field of medicine. But I think, you know, the big thing for burnout is, you know, choosing the field you love. And, you know, making sure that you enjoy what you do. And, and then, you know, probably, I would say, if you kind of nurture an environment that's collegial, friendly, and supportive, that's, I think, a great way to combat physician burnout. So, especially in terms of residency training, if you have, you know, your leadership up top that promotes, you know, you know, a friendly environment like that. I think it really, you know, decreases fifth edition burnout quite a bit. Love that.

Nathan Gartland

So, let's take a few minutes. I know we're getting through the episode, and we're getting close to the end. But let's take a few minutes and discuss this pharmacy Times article that will be linked in the description below eventually, but let's the article discusses pharmacists provider status, and I think it's just something interesting, especially with your pharmacy background that we could briefly chat about. And so this was a report from 2019. So I know it's a little dated by the AMC that was predicting that there would be a physician shortfall of up to 139,000 by the 2033. With this in mind, do you think pharmacist provider status should be explored a little more to help alleviate some of the primary care shortages?

Thomas Melvin

Yeah, I'm surprised that, you know, it took this long to talk about this. I remember I think I was thinking about this when I was in pharmacy school, and I briefly looked into it, and I believe at the time, maybe a few states had a, an avenue for a pharmacist to become a prescriber. But I think this is a great idea. I mean, if you think about it, you know, pharmacists are readily available, and they have the training and the knowledge. And I think it would be a very good solution to the physician shortage in primary care. Absolutely.

Nathan Gartland

Wonderful. Yeah, I think we're definitely a little biased based off of our background. But um, you know, I think we have a sound footing to advocate for pharmacists to expand the role in healthcare, especially in these areas that are lacking a lot of resources. And I'd also argue, you know, that because of the advanced clinical residency training that a lot of pharmacists are undergoing, it's no longer just one year, it's two years, and I've even heard rumors of a three year post graduation residency program. So with all this additional training, it's hard to think that, you know, how are they how are these pharmacists exiting these fields and still not having the ability to prescribe medications? And I think that that can be resolved with potentially adjusting the pharmacy school curriculum a little bit to focus more on Diagnostics, because I know that's something that is missed, or I guess, is looked away because of the focus on training and optimizing care with medications. So I think it's just an interesting observation, I would say, especially, I think it'd be cool to see a residency program that maybe it was just a prescriber program or something along those lines, a one one year residency training and just prescriptive medicine for some diseases focus more on like chronic conditions. I think that'd be really cool. Any thoughts on that?

Thomas Melvin

No, I totally agree with you. I do think, you know, it probably wouldn't be hard to make a few adjustments to the career killed for pharmacy school to include, you know, more of a, like a, like a clinical therapeutics course. And yeah, even the postgraduate training for residency, I think that's a good idea what you brought up, you know, we only have a, you know, a clinical base, you know, residency where pharmacy, pharmacists are exposed to, you know, prescribing medications following patients, you know, longitudinally like that, think it's a great idea.

Nathan Gartland

Fantastic. Well, we are coming to the final few minutes of our show today, and I just want to ask you a few closing questions. So medicine is always changing and new technology, or medications continue to advance clinical outcomes. Are there any innovations in surgery or medical care on the horizon that excite you?

Thomas Melvin

Yeah, I guess I'll say two things. In terms of surgery, I, although it's probably not new anymore. But the field of robotic surgery, I think it's very exciting. And, you know, it makes a lot of the procedures that we do easier for the surgeon, and some of the preliminary studies that we have even better for the patients, too. So robotics is, I think, very exciting. And the applications of robotic surgery, I think, are gonna continue to grow, it's gonna be more ubiquitous in the field of surgery as a whole. Also, I would say, in terms of, you know, oncology, I'd say the field of targeted immunotherapy is, is very exciting on what it can do for cancer patients. So I really look forward to see what's going to happen with that as well.

Nathan Gartland

Yeah, let's unpack some of that robotic surgery real quick. I just wanted to comment and say that, I think it's gonna be crazy, and maybe not within the next 10 years, but within the next maybe 2030 years, you know, the surgeon will be able to just go down to their basement login and, you know, perform the surgery right there across the across the world. So I know that's, that's probably a little far fetched. But I think that's something that could be, you know, a possibility on line. Do you have any comments on that?

Thomas Melvin

I think we're already there. I think it's I think it's happened. I don't I don't know how how common it is. But I know it I'm pretty sure at least that remote. These remote types of surgeries have happened, especially if they were maybe consulted in or for training purposes. But we have the technology for it right now. Wow.

Nathan Gartland

That's incredible. And you said it's a little bit easier for surgeons as well, is it because of a lot of the the sensitivity of the controls can be adjusted. So a one inch movement is really one millimeter that's perfectly proportioned out through the computer software, or versus like a handheld, traditional surgery.

Thomas Melvin

I'd say compared to, like minimally invasive, let's say if you're comparing laparoscopic to robotic surgery, you're in terms of robotic surgery, the instruments that you're controlling are wristed so you have, you know, more degrees of freedom inside the body cavity. Also, you're, you have a greater depth of field with the camera you use in robotic surgery. And I'd say at least was my experience in talking to some of the other residents surgeons that I know is that you know, the the the I'd say the learning curve is not quite as steep with robotics as compared with laparoscopic surgery, that it starts scopic surgery can be difficult to learn. And I think robotics may be a little bit a little bit easier and quicker to pick up on.

Nathan Gartland

Absolutely, it definitely could be something that is super easy to train future residents on because they can just go to a Clinical Simulation Lab versus working on cadavers or something like that. So I think that's really cool. Additionally, I was curious to know do you have a perfect surgery or a surgery that you absolutely love doing? was one of those surgeries where you hear about it? It's on the or and you claim it immediately? It's on the or list?

Thomas Melvin

Yeah, I've been I'll tell you to like so one is, you know, I'm going to be a thoracic surgeon so I love a minimally invasive esophagectomy I probably scared a few listeners away when I said how long the operation was but it's it's it's it's unbelievable. You we reset the esophagus, we do minimally invasively and you're working in the abdomen to you know, mobilize the stomach and and you make a new esophagus from the stomach or a new esophagus where you staple off the stomach of a new conduit. And then you flip the patient over on their side and you operate in a thorax chest and you mobilize the esophagus off the heart off you know off the off the lungs spine and you completely remove it and then you bring up your new car undoing the stomach that you made, and you connect it with the cervical esophagus. So, you know, that seat is unbelievable to me. And, and it's generally done, although not exclusively, though, it's generally done for cancer. So, you know, you have the potential to really prolong someone's life. And then the other operation I'll mention, in the field of general surgery, I think that there's probably nothing more exciting than a trauma laparotomy. So you know, somebody that comes in, you know, as a level one trauma activation with, let's say, a gunshot wound to the abdomen. That is, you know, you know, he was an OP unstable done in emergency department, it's our job to get those patients up to the operating room as quickly as possible. And we do a midline incision and open up the ad, and quickly try to diagnose and fix the problem. So anyway, just imagine anything in the abdominal cavity can be injured from the abdominal aorta to the liver, it is clean, small bowel. And it's up to the trauma surgeon to be able to quickly fix those things, save that patient's life, it's extremely exhilarating and rewarding. So those are, those are the other two vastly different operations as to that I get really excited for.

Nathan Gartland

Wow, that's incredible. You're making me super excited to explore general surgery in the future. So last couple of questions here. So for individuals considering medical school after pharmacy, pharmacy school, what are some things you would share with them based on your experience thus far?

Thomas Melvin

So I'd say it's another financial commitment. So you do have to take that into consideration. So I always say like, you know, I, if pharmacy school wasn't cheap, for me, in medical school is expensive, too. So, you do have to, you know, take that into consideration that you are going to undergo, you know, a significant amount more debt, it is a time investment to because, you know, medical schools for years and residency training is at least three years long. But, you know, if it's truly what you want to do, I wouldn't let any of that stop you. Because I don't look back at anything that I did it, I would have done it all over again. So I'd say if you do think you have an interest, talk to other physicians that talk to people like us. So there's probably not a lot of people out there who have done both. And if truly what you want to do, I wouldn't let anything stop you.

Nathan Gartland

I love that. And the financial information is such a good point to bring up too, because that's probably the number one reason a lot of people reach out to me and say, Oh, I I can't do this though. Like I really want to go to medical school, but the finances, I can't justify turning down a six figure salary with all these pharmacy loans. So I helped them like talk through some of those situations, you have to think about, you know, the long term upside of doing that, and I definitely still have plenty of loans from pharmacy school. So no silver spoon here. But it's just an interesting, you know, thing that needs to be brought up and addressed. But like you said, you have to follow your passion. It's way better to go on and pursue the career ambition, whatever it is, versus burning out in a field that you might not be 100% Passionate About 10 years down the line.

Thomas Melvin

I think that's great advice.

Nathan Gartland

So as an attending, do you plan on precepting pharmacy students along with medical students?

Thomas Melvin

Yes, I'd love to, I'd certainly be open to it. And I would encourage pharmacy students to certainly rotate with me when I am an attending. I love to teach. And I think there's a lot to be gained, and then rotate on a CT surgery service.

Nathan Gartland

Yeah, even just getting that that one or exposure that was so influential in your decision to switch into medicine might be you know, exactly what one or two pharmacy students, you know, every single year needs to see to, you know, open their eyes to something that they weren't super, super aware about. So, I love that.

Thomas Melvin

Yeah, and we could use your help a lot of patients are on, you know, vasopressors, you know, the complicated antibiotic regimens. And they're, or even the ones that aren't quite as acute, they have an extensive medication history. So we could certainly use their help to

Nathan Gartland

wonderful. Alrighty, so we've come to the end of our interview, and I'd like to thank all of our listeners for their attention and interest in medicine. If you have additional questions about the medical school journey, check out my website, www dot physician pharmacist.com. Before we let you go, Dr. Melvin, how can our listeners get in touch with you?

Thomas Melvin

Probably the best way is email. shoot me an email and I'd be happy to get back to you.

Nathan Gartland

Alrighty, well, thank you so much for spending some time with us today. And best of luck with your trading. I look forward to keeping in touch and hearing about all your tremendous success and surgery. Sounds good. Thanks for having me. All right. Appreciate it. Have a great week you too

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