Interview with Dr. Simon Kirby - Otolaryngologist, Facial Plastic Surgeon, and Pathologist
Join us for our 14th episode, for an exciting interview with Dr. Simon Kirby! Dr. Simon Kirby is a board certified otolaryngologist and facial plastic surgeon, who retrained in the field of anatomical pathology. You won't want to miss this insightful episode, full of personal anecdotes and life experiences.
Show Notes
Alieen: Hi everyone and welcome to the Oto Approach, a podcast made by medical students for medical students to teach you about all things otolaryngology. You are here today with Alieen and Hannah and we are having a chat with Dr. Kirby. Dr. Kirby completed an undergraduate degree in electrical engineering and then completed medical school at memorial university. He then completed a residency in Otolaryngology Head and Neck Surgery at the University of Western Ontario. He then did a fellowship in microvascular reconstruction in Philadelphia and then went on to Los Angeles for Facial plastics training. Later Dr. Kirby retrained as an anatomical pathologist and is currently a faculty member at Memorial University of Newfoundland.
Please tell us a bit about yourself Dr. Kirby.
Dr. Kirby: It’s lovely to be with you and thanks for the introduction. Just listening to you talk about that I get tired thinking about it. It’s been a wonderful ride the whole way along. And to be honest with you, this was not planned. I kind of evolved with this as it went along. So we will talk a little about the steps along the way, but the truth is when I was done with fellowship training I really missed Newfoundland and Labrador. So I wanted to come back here, I started a practice here that combined both the micro recon and facial plastics and it worked out very well. So I will say to you guys as we go along- there’s only so much of this we can plan, some of this will kind of have to fall in line and free will.
You highlighted some points along the path, but the truth is that each chapter has been really fun. I’ve been very lucky to evollve in a direction I feel very comfortable in.
It’s lovely to be with you and maybe I can share a few things with you that viewers or readers or listeners can speak to.
Hannah: Absolutely, thank you for telling us about that. It’s interesting to hear about all the different chapters of your life and what brought you to where you are now. What initially drew you to otolaryngology?
Dr. Kirby: Well ENT or Otolaryngology is a really cool speciality and part of the initial attraction was part medicine part surgery. In the medicine world, it's part upper GI, neurology, upper section endocrinology, ophthalmology. On the surgery side, you got big stuff, cool plastics kind of flap stuff and you got a real microsurgery otoneurology or neuro-otology. So I think at the end of the day, it was a combination of all those things that really attracted me. I think as you guys look at this, you will find that within the field, proper, there’s an area for everybody. I think it's really undervalued in terms of its diversity. And I think that it really does provide you things that you can also tailor depending on where you are in your life cycle. So when you are a junior surgeon and you're really gung-ho you can go nuts and do big procedures. As you get more senior you can tailor your practice more say, to clinic and less call and so on and so forth. So it's really got all the elements you would want.
Aileen: Yeah absolutely. So you sort of said earlier that you can’t really plan your path entirely and sometimes things happen the way they happen and you go with it. So what drew you to then do a fellowship after you had done ENT, so like you said there are so many different avenues to go within otolaryngology. So how did you pursue a fellowship?
Dr. Kirby: So that’s a really good question because I put my mind back where it was in 1998 which is when I finished at Western. You could do general practice otolaryngology. But I really got interested in the cancers, in the reconstructions. I always said that if you are a trauma guru, you go the route of plastic surgery and if you are a pathology guru, tumor person, you go the route of ENT. That’s very true. I was very luckying in my training at Western to do a 3 month rotation in Pathology as a PGY2. And little did I know that that would foreshadow what happened to me 20 years later. To answer your question, at the end of my training I recall saying I really like this stuff, but you can’t do some of these big big procedures without subspecialty training. So I found a person named Dr. Hayden, who’s in Philadelphia, who was a world class person in this domain and I was lucky enough to spend time with him. That really set the stage. After that I was kind of foreshadowing myself, saying I could do this 5 or 10 years but I’d like to be able to down regulate in the world of rhinoplasty and face lifts. So even back then I was saying you can’t really do this forever, this being big flaps and big reconstructions. So that was kind of my mindset at the time.
Hannah: Absolutely. It sounds like the fellowship that you pursued allowed you to focus in on your area of interest and do the surgeries you were most interested in as well. I know that we mentioned some of the points along your journey in the introduction and how you transitioned into the field of anatomical pathology. Can you tell us a little bit about that transition from otolaryngology to anatomical pathology?
Dr. Kirby: Right so that’s a big one. I don’t advocate that everyone in their 40s make changes like that, but I had a significant life event and I had to sit back and say okay well I might not be able to do microsurgery until I’m 60 given this. So I made the tough call of going back and retraining and as I just said to you, part of the initial attraction to ENT was the fact that if you are an ENT keener you tend to be a pathology gur-ru because pathology is a huge part of ENT, right from biopsy to terminal resections to reconstructions. So little did I know, the seeds of that change were sewn way back then in PGY2. So when I’m sitting there thinking of how to revector, I thought you know, pathology might be just the right answer and it turns out to be just the right answer, so I have been very lucky. But it’s not the kind of move that everybody makes after that, but in my particular case, it was a good choice.
Aileen: We are glad to hear it was a good choice. It seems like throughout all your education, you gained different skills and it seems like you are able to put it all together within anatomical pathology and still do lots of head and neck stuff. ANd it seems like it has been such a crazy journey but it’s so inspiring to listen to. We were wondering what sort of things you find interesting in terms of research or community engagement and what sort of things you do in terms of those.
Dr. Kirby: Well that’s a great question and there are a couple of things to talk about. Number 1, I guess I’m getting older but the truth is I really like hanging out with you guys cause a big part of where I’m at in my career is trying to inspire you people, the younger crowd to make the right choices, to get the work-life balance correct. And ENT ticks all those boxes, so does pathology by the way. So, I’m very lucky because the classic case where my background comes clear is in ENT Head and Neck frozen section. So I come down there and of course I know exactly what the game is, what the stakes are, and that makes it a very satisfying job because you know, you may not be a master of your domain but you are pretty darn close, like you really know the small size, and I know we don’t often think of healthcare this way but it really does a lot to bring value to the process. The other thing I really like, and this part goes back to my days as an electrical engineer, cause the truth is modern healthcare is becoming more like electrical engineering career science then it is about health care. And that’s not all good, but it is what it is. So I’m very involved in medtech. So my microscope will be gone within 5 years, and microscopes will be replaced by digital pathology. So all the slides will be digitalized and shown on high-res monitors. Now that does a couple of things, it allows us to share with our colleges around the world, so you get the point of crowd diagnosis right? So you get like a billion smart people looking at the same slide saying “I don’t think it’s this, I think it’s that.” So you have huge sharing, but also in the role of analytical microscopy, once you digitalize things you can begin to apply dimensions to the geometry, then all of a sudden you create a big data problem, then all of a sudden you get a bunch of AI involved, so it’s going to become really really cool. And if you aren’t involved in pathology, you will begin to have 3D pathological images and virtual reality, so no longer will you say ‘pile up the films for a CT scan’ and now you moved on to fax of course. And you will have immersive media where you will be inside the image, looking around the heart from below, from the back. So the same is going to happen to pathology, and the next bar- 3D microscopy will be within the cell. So now you are going to get down to the organelle level. So when I say that, patient X, Z, Y has mitochondrial pathology, you will be able to get right in there and see how the electron transport chain is not working properly. Now all that sounds kind of Buck Roger’s the next generation, but it really is coming. And it will be there, you remember this conversation, it will be there by the time you are done your fellowship training. So that’s the kind of stuff I’m really intrigued by research wise. I’m running the Eastern Heath end of digital pathology and through cross appointment with the engineering school, we have a fair bit of collaboration. So health care is no longer just healthcare, it’s going to medtech. It’s a long answer, but it’s a big question.
Hannah: Absolutely, it’s really interesting how the field of pathology is developing technologically, do you see these technological developments in otolaryngology as well.
Dr. Kirby: Yeah, one of the attractions to otolaryngology to begin with, is it’s highly technologically driven right. So a classical example is the FES- operation of the nose and sinuses. It’s all now CT- guided. Right so you have a CT scan and you put it in the machine and the CT scan keeps track of where your instruments are. So neurosurgeons call that zero tactic, but the truth is it’s really just image guided localization of where you are, so you don’t do bad things. Right so, you are going to see that continue. My estimation is that 10 years down the road we are talking, you will be in the OR, say, and you will have an engineer, plus minus a nurse around the OR, and they will be integral parts of the procedure. So I’ll give you a great example, and this will fall in the world of precision medicine or customizable medicine. Let’s say you have a person, who has a tumor that involves the jaw, take it out the real time image guided system will come in and image the contour of the remaining mandible. And in real time, they will 3D print a plate that fits customizable. That will be done in the OR, in real time. You can see how it really does change the game, right? And it really does allow, higher caliber and higher precision to what we do, because when I first started the truth is you took the saw then you had to with your eye kind of bend the plate to get the right convexity or concavity, which is fine it worked fine but it’s not as good as 3D printing in real time, that’s going to be the next level. So ENT is full of stuff like that, I could go on for hours about this but that’s part of why I got attracted to ENT, cause with the ear or sinus or head and neck, there is a lot of technology in the OR all the time and it’s only going to get bigger.
Aileen: It’s awesome as medical students to hear about the future of ENT, the future of medicine in general, and how much it is evolving. And hearing you say it will be different all of a sudden, by the time we are in fellowships is really cool and really awesome, especially when it leads to better patient outcomes, which it for sure will. Speaking of medical students Hannah and I have both had the privilege of having you as a professor before and we have gotten lots of clinical pearls through those lectures. We were hoping you could share some of the advice you have for medical students for our listeners.
Dr. Kirby: Well you know, that is a really good question, and again maybe it's a sign I’m getting older but when I look back, because I worked in 17 different teaching hospitals across North America and it is the same for me as it is for you guys. There’s a couple of big challenges as you go through this because it goes on for a long period of time, so it means it goes over life changes, right for all of us. So number one, it really isn’t what you pick, the challenge is to pick the thing that is right for you. And I always tell people the trick in life is very simple, what you do has to overlap with who you are. And once you get that right, it’s easy. But getting that right is hard. Because you really do have to think carefully about what you chose to care about, you are at this point where there are a whole bunch of choices and you are being asked to ask yourself what do I really want to do. Well, it’s hard to know because part of it is a leap of faith, you are jumping off the cliff and you are kind of hoping that you will like it along the way down. So my advice to you is whatever you pick, make sure that it- the tempo, the stakes, the lifestyle, overlaps with who you are. And the other thing that I will say to you, and this is important, because I have had some good friends along the way and there is always going to be some challenges, but I would say to you all, certainly all your listeners to not lose yourself along the way, because it is easy to. So along the ride, there may be marriages, divorces, kids, no kids whatever. But because it is such a wonderful area you can really lose yourself in it, it is very easy to lose yourself period. And the person that you started as a young doctor in Med1 is not going to be the person you are in PGY5, and that can be good or that can be not so good. So my advice to you, when we are all said and done is try not to lose yourself along the way and that is easier said than done.
Hannah: That’s a great piece of advice for those listeners going through CARMS, deciding on specialties and fellowships.
Dr. Kirby: You know, we throw the word resilience around a lot and it applies to not just doctors but people in general today. Certainly after COVID, we have all learned that. I can tell you in my humble view that when I look at all comers, the happiest people that I know are the ones that end up doing what they did overlapping with who they were. I don’t really mind what you do, but as a general rule those people seem to be the happiest, that’s all I’m saying.
Aileen: Thank you for that advice, that’s really helpful for those of us that are going through those difficult decisions of what we want to do and what are our values are and what the values are of those specialities. So we really appreciate the advice, and all your wisdom and your experience, and I think our listeners will appreciate that as well.
Dr. Kirby: Again I just want to thank you for having me on, it is always good fun. And like I said, I really enjoy hanging out with younger people- I guess I’m getting older now so I try and make myself available to all you folks on a regular basis. The one thing I’ll tell you, despite all the challenges we as a society have faced the last couple of years, the future is really exciting. Again it’s not really about what you do, it is about believing in yourself, don’t get too high, don’t get too low, don’t lose yourself and just carry on. In the end of the day it will all be fine. I joke because I look at my path, and no one could have predicted that, and I sit wondering you know, I’m not quite sure why but the world kind of unfolds the way it should and that’s very reassuring when you are staging down the barrel of a CARMS interview or whatever. Trust me when I say, and you won’t believe me right now but maybe you will in 10 years time, somehow it always works out just fine.
Hannah: Thank you so much Dr. Kirby, for your advice and talking about your experience and thank you to the listeners that have tuned in and we hope to see you back for our next episode.
