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When I Grow Up

Exploring opportunities beyond traditional patient care. Pros and cons from those on the front-line.
With Jonathan Sykes, MD, Neil Reisman, MD, JD, and Paul Lizzul, MD, PhD, MPH, MBA


Graduating from Academia

Jonathan Sykes, MD

After serving on the full time faculty as a Professor and Director of Facial Plastic Surgery for the bulk of his career, Jonathan Sykes, MD left the University of California, Davis last year to pursue private practice opportunities. The consequences—primarily felt in terms of decision-making and economics—have been generally good, he says, but he retains goodwill for his roots. “I don’t look at private practice as being perfect or the University as being bad, or vice versa,” he says. “I think they both have their benefits and drawbacks.”

Dr. Sykes highlights the benefits of an academic setting: “The ability to teach is wonderful, and I still enjoy that very much. The ability to operate and to practice every day with people that are inquisitive and always making you sort of expand your boundaries and do better is wonderful.” However, the academician always cedes some control. “You’re answering to your department chairman, your department itself, the dean, the regulations, etc.”

Seeking a change, Dr. Sykes left his academic appointment—though he still sees patients at UC Davis at least one day a week. Not desiring to take on a lot of personal overhead and day-to-day practice management, Dr. Sykes instead treats patients in “a couple practices that value my services. And in essence, they make money, as do I, when I get busier.” He does not have the autonomy he would if he had opened his own practice, but the result is “a little bit better balance in my life,” Dr. Sykes says. “I’ve gained some control. I’ve gained some incentives. And I’ve gained some decision making control, which I really like,” he observes.

“We all answer to something,” Dr. Sykes says. “We all have certain things that we have to step in line to, so I knew that going into private practice wasn’t going to be perfection.” The mix of cases that Dr. Sykes sees has changed in the private practice setting, with fewer reconstructive and many more aesthetic cases now, which he welcomes. “I don’t see as many congenital plastic surgery cases and cleft lip and palate and so forth as I did when I was at University,” he adds.

Leaving a full-time academic appointment doesn’t mean leaving academic pursuits behind. Dr. Sykes still writes articles and chapters and teaches. Perhaps surprisingly, Dr. Sykes says his ability to conduct research is increased in the private setting. “Doing research studies with companies was very difficult to do within the setting of the University because of their regulations and constraints.” Universities can be bureaucratic. “The decision making is much different inside and outside of institutions,” Dr. Sykes observes. One example: in the years before he left academic practice, Dr. Sykes had requested an equipment purchase that took eight months to complete. At his private practice, he requested the same device and had it within three weeks.

“I guess the biggest change for me in the private setting is primarily decision making and economic,” Dr. Sykes says. “Now I have a voice based on what makes sense to me. I get to make my own decisions. That feels pretty good to me.”

For Dr. Sykes, the constant has been his commitment to medicine, no matter where he is seeing or treating patients. “I could actually see practicing into my 80s just because I love doing medicine every day…I think as you go on in life, if you’re a keen observer and you care about it, your observational skills and your judgment get better and better. I really enjoy practicing medicine now.”

TV GUIDE

Thoughts on “Celebrity Medicine”

Being a doctor in the media spotlight is no easy task. The benefits are showcased by the opportunity to share patients’ happiness and ecstatic reactions following their procedures. It is also nice to share your talents that come from years of training and an innate ability to make changes during surgery that are both aesthetic and functional. The downsides are highlighted by potential negative reactions from patients that may be fueled by body dysmorphic disorder oriented dissatisfactions that become publicized. In addition, privacy is lost, outside judgement is an ongoing issue, and complications that are beyond the control of the surgeon are shared with the public.

Although challenging, being a physician in the media spotlight has been a rewarding endeavor that has allowed me to share my knowledge and expertise with patients from all around the world. I’m always happy to serve as a role model to other doctors, and welcome the opportunity to educate potential patients on the life changing alterations made possible through reconstructive surgery.

—Paul Nassif, MD

Legal Ease?

Neil Reisman, MD, JD

Neil Reisman, MD, JD doesn’t take offense at the line in Shakespeare’s 2 Henry VI, calling for the demise of all lawyers. It’s not about hating lawyers, he says. Rather, the line is based on a realization “that lawyers run cities, run companies, kind of run the world,” Dr. Reisman observes. The same rationale drove Dr. Reisman to obtain his law degree after he began practicing medicine.

“I love plastic surgery. The goal was never to replace that,” Dr. Reisman maintains. However, as he pursued his entrepreneurial spirit and started new business ventures, Dr. Reisman saw a benefit to knowing the law. “I could hire MBA’s,” he says, “but you really had to have, in my mind, an understanding legally of the structure and inter-company relationships, and that came down to law.”

Dr. Reisman went to law school in the evening for almost five years to earn his JD, keeping up his practice as usual. While his intent was always to keep medicine as his primary focus, the legal training seeps in, he says. “Any extra activities change how you think,” he observes. “Understanding the law has a huge impact on the practice of medicine. Especially in this regulatory age we live in. So there are positive benefits.”

Still, Dr. Reisman notes, his doesn’t expend much of his legal expertise on dealing with regulation, although his legal background certainly helps as he works with advisors, consultants, and managers to stay compliant. Similarly, Dr. Reisman is better equipped to review lease agreements and other contracts, even if he works with other experts on these issues, too.

Legal expertise can also prove helpful when advocating for patients. Dr. Reisman explains, “Many years ago I had a patient with a cleft lip—most of which were covered by third party insurances. And it was a revision. Well, one of the initial insurance authorizations said, ‘No we don’t think that there’s a functional issue with this’ and denied it. Sending a very thorough and appropriate legal threatening letter got that resolved pretty quickly.”

All in all, having a “JD” after your name can prove beneficial, Dr. Reisman suggests. “People are afraid of lawyers. And it’s sad; you shouldn’t have to threaten people to do what’s right, or honor contracts. Having a JD after your name and understanding how the law works sometimes gets folks to function in an appropriate way.”

Dr. Reisman has no regrets about his decision to become a lawyer. It was the right decision for his career goals and, he said, was a decision that worked for his family. He urges anyone considering an additional degree to consider the impact on family/personal relationships to assure mutual buy-in. For him, a JD degree made more sense than an MBA or other management training.

“It really comes down to what your goal is,” Dr. Reisman stresses. “If you’re going to leave the practice side and go to the administration side, perhaps an MBA, which is a lot easier, time and commitment, might be a better ticket as you progress. There are a lot of MBAs.”

And he offers a word of caution about pursuing a degree to “fall back on,” without having a clear idea how the degree could be beneficial to one’s current or future career opportunities. “Then you’re just jumping around and you really don’t have a business or life plan,” Dr. Reisman says. “Life takes many curves sometimes and even with the best plans. But really be introspective...what do you like? Take personality tests, see where you really are on Myers-Briggs. Talk to family, those who sacrifice the most when you’re out at night, or adding more stress to what you’re doing. Is it worth it at that point?...It doesn’t matter whether it’s an MBA law or whatever, if you’re going to be really unhappy. If you’re unhappy, your family’s unhappy, your patients suffer. Many of those are not worth it in the long run.”

THE WRITE STUFF

Why an entrepreneur became a novelist.

Author of The Medical Entrepreneur, Steven Hacker, MD recently published his first novel, The Caduceus and the Swastika. “I was interested in the history of that time period and wanted to see if I had the discipline to finish this sort of project,” he says. “I enjoy writing so it wasn’t difficult to find the time to do it. I usually write early in mornings before work.”

Publishing the novel has opened new opportunities: “Speaking opportunities at non-medical meetings and meeting with non-medical people who share a common interest in history.”

Of his many ventures, Dr. Hacker says creating new apps was his favorite. “I enjoy the creative side of architecting technology, or inventing a new device and seeing it through to completion, and then watching others use it,” he says. “There have been many rewards over the years for these endeavors but the most satisfying is the sense of completion.”

Industry Insights

Paul Lizzul, MD, PhD, MPH, MBA

The “fascinating field” of dermatology appealed to Paul Lizzul, MD as a medical student in part because of its variety of opportunities. Dermatology would “allow one to not only do clinical practice, but also allow one to do things in basic science as well as translational work…because with schedules around dermatology not being up 24 hours a day, and having flexibility in terms of clinical requirements.”

“Easy access to the skin is conducive to doing research to understand molecular mechanisms,” Dr. Lizzul says. “You have a very clear view of clinical outcomes as well with the patients which is quite appealing and quite satisfying. So whereas if you’re treating blood pressure for instance, you see numbers, if you’re treating psoriasis for example, you very clearly see an improvement in that patient before your eyes.”

But as a student, Dr. Lizzul also had an interest in public health, business management, and the business of medicine. “I always had that in the back of my mind as somewhere where I wanted to go. I found it quite appealing to be able to, not only to treat patients one on one, but for the upside of potentially making that transition into Industry and having the ability to develop new products that could impact thousands...tens of thousands of lives.”

“I had an opportunity to go into business school as well,” Dr. Lizzul explains. Many physicians, while good at science, don’t necessarily have the benefit of training, kind of financial entrepreneurial marketing aspects of business. And I found that to be a quite interesting experience that introduced me to many people who were already in pharmaceutical biotech Industry.”

Dr. Lizzul’s first official role at a biotech company was with Kythera, during the development of what is now Kybella. “That was a fascinating project because it was time to bring a level of high evidence to an aesthetic indication in the aesthetic field of dermatology.”

The opportunity to be part of a startup had benefits, Dr. Lizzul says. “It was a nice opportunity for me to make that transition into Industry and it was a growing, small company. Which also meant that I was able to wear many hats from very early on. As opposed to potentially, if I joined a very large company, clearly would have gotten excellent training but likely would have been more in a silo dealing with fewer multifunctional interactions and a more homed in sense of expertise in a short period time.”

Today, Dr. Lizzul is Chief Medical Officer for Sienna Biopharmaceuticals, a clinical stage company focused on medical dermatology and aesthetics.

Working in industry is not the end of one’s clinical career. In fact, seeing patient is encouraged, Dr. Lizzul says. “I see patients half a day a week in a private setting which is very local to where our offices are, which is convenient. And then I also have a volunteer faculty appointment at UCLA where I do a resident teaching clinic once per month.”

On a day-to-day basis, the dermatologist working in industry will perform a mix of different activities. “t’s clinical development design of studies, safety monitoring, business development, translational research, working with our basic scientists, figuring out what’s coming next in the pipeline, identifying external assets or licensing opportunities outside of the company in terms of bringing in new pipeline candidates, talking to potential investors,” DR. Lizzul says. Then there’s liaising with colleagues, dermatology at meetings, giving presentations, regulatory interactions, and working on quality and compliance.

Like those in the practice setting, the dermatologist in industry always navigates regulatory oversight. “I completely can sympathize with my colleagues who are in clinical practice, the level of regulation insurance requirements, doctor-patient can be overwhelming,” Dr. Lizzul says. “We’re dealing with, first and foremost from a medical perspective, safety of patients. It’s clearly a highly regulated environment whether you’re dealing with FDA or other agencies as well. You have to accept what it is and you have to deal with the agencies in an appropriate way and work in a collaborative way I wouldn’t necessarily look to regulation as being a bad thing. I think it’s there for the right reasons, to protect the patients, and I think it’s our job to look at it from that perspective and then to also look to our regulatory agency partners in a collaborative way.”

Dr. Lizzul emphasizes that he does not see regulators as adversaries. “I don’t think they’re there to prevent innovation and drug development. They’re there to ensure the safety of patients and I think if we come at it from the same perspective and collaboratively we can get there in as quick a way as possible.” A spirit of collaboration supports success, he says. “I think the most important thing is looking at working with whoever you’re working with in a collaborative way to get over the finish line. Rather than looking at it as an obstruction.”

The best part of his job, Dr. Lizzul says, is, “definitely the science, it’s the innovation and coming up with new ideas. Progressing projects from basic science to analytic models to translation to the patients. And then closely related to that, is seeing the benefit on the patient themselves. And then also continuing interactions with many colleagues whether it’s within Industry or outside Industry, private practice, academia. Those three are very closely related and are the most fun.”

Finally, Dr. Lizzul emphasizes the team aspect of industry work. “You have to be willing to work in a team environment listen to other people’s opinions and expertise and put that altogether…I think the other important aspect is while success is very much valued it also should be recognized that you have to be able to fail quickly if you’re going to fail and make good decisions. If you’re able to quickly determine that something is not going to work and limit expenditures of time and resources on that that is also considered a victory and that provides you with an opportunity to work on other things.”

For those interested in working in industry, Dr. Lizzul highlights the range of opportunities. “Nothing is final; you have options, and if you want to explore something I would say go for it. You always have the opportunity to go back to practice if things aren’t as they seem or as you like.” Working in a consultant role is a good way to gain exposure, he adds.

PRACTICALLY SPEAKING

Want more Career Insights? Check out Practically Speaking, the new podcast from our sister publication, Practical Dermatology® magazine, to hear Brooke Jackson, MD discuss her recent career changes. Available from iTunes.