Scrubs to Scalpels

Our 23rd episode is an interview with Dr. Evan Propst in which he discusses his path to otolaryngology and sheds light on routes to practice after residency which can involve fellowships, community practice and academic otolaryngology.

Interview Transcript

Interviewer: Hello listeners, and welcome to this episode of the OtoApproach. Today we're honored to have Doctor Evan Propst with us today. Doctor Propst is a distinguished professor in the Department of Otolaryngology at the University of Toronto. He's not only an accomplished otolaryngologist at the Hospital for Sick Children, but also serves as the fellowship director, guiding the next generation of otolaryngology trainees. Today, we'll be taking a deeper dive into the doctor's approach to otolaryngology paths to research and explore the exciting fellowship avenues available after residency. For starters, thank you so much for joining us today and it's great to have you with us today!

Dr. Propst: Thanks so much for having me.

Interviewer: So the first question we have for you is, can you share a little bit about your journey in the field of otolaryngology and what inspired you to choose this specialty?

Dr. Propst: Yeah, sure. So, I had, I did my undergraduate at what's now Western Ontario University and then medical school at the University of Toronto. And then at the end of my first year, they had applications for a summer studentship program, and I applied right at the end of the deadline. It was a Sunnybrook rotation, and they were looking for someone who's interested in music and who likes children, and, as it said they needed a new shortstop for our baseball team. And so I phoned and I said, you know - 'Hi', just wondering I know today is the last day, and the administrative assistant checked with, Blake Patterson, who had posted the job, and, he said, well, if tell him if he can be down here in an hour, then I'll interview him. It was like a Friday afternoon and so I was still at Sunnybrook, and, you know what it's like with traffic to get down from Sunnybrook to downtown Toronto. So I literally, you know, just gunned it and parked in my spot, which was not close to the hospital at all, and then sprinted and got here totally winded and, I had probably run about 12 blocks or 15 blocks and, yeah so basically, I walked down the hallway, like perhaps, and asked me sort of, you know, what my interests were, and, what my experience with children was and that was it. So I started as a summer student doing research in the cochlear implant program. And then, I mean, it inspired me to choose a specialty. So, you know, he was one of the main people, and then, from a research point of view, I was working with Bob Harrison and Karen Gordon and, you know, they were all just so amazing - nothing seemed like work. It was all fun. It was all fun quest. Well, this is a problem we're having - how do we solve it? You know, and, and I love music and I play guitar. I've played guitar forever, pretty much. And, my first project was on was determining if people with cochlear implants can hear music. And how could that be? And can they discriminate between two different frequencies that are fairly close to each other if, in theory, they are stimulating the same electrode? And so that was the first, you know, my, my first introduction to, to the specialty. And then, you know, I pursued electives and, and met Pat Gillen and, you know, so many other of the big heavyweights in our profession who really just seem to love what they were doing. And, the surgery was totally fascinating, and the patients were really interesting, and that's that's how I became interested.

Interviewer: Thank you so much for sharing. And in the line of research, something substantial about your career that we didn't mention in the introduction was your passion and dedication to research even today. So your research focused is primarily on airway and head and neck anomalies, particularly in pediatric airways. So what sparked your interest in that to continue throughout your residency training and beyond as well?

Dr. Propst: Yeah. So it's interesting. I mean, I think it's important to always keep an open mind. I thought that I was going to be an ear person and my research had been ear-related. But then during residency, I did my master's degree in the genetics of deafness, again, ear-related, and then everything was fascinating to me. And, you know, whenever, you know, something interesting came up, I would pursue that, whether it was head and neck or what have you. The airway thing really came about during fellowship. So I was told that you know, there were no guarantees about positions at SickKids, but that, if I was to have any chance of working here, then, it would not be in the ear realm, but it would be in the sort of head and neck airway, realm. And that if I was interested in that, then I should, go and look at Cincinnati Children's Hospital and see what they're up to. And ideally, you know, it was well, you know, you would need to go do a fellowship there and learn everything that, that they do, which is a really tall order because it is a fantastic institution. So I went, before, you know, it's a two-year fellowship. So before going there, before applying for a fellowship, I wanted to see if I liked it. So I went to do an elective and followed them around for a few weeks, and really loved it. I mean, you know, the center is run by Robin Gorton and, Chuck Meier and Mike Rutter and Paul Willging and Sally Schott and, you know, all the big heavy hitters in the names of pediatric otolaryngology head and neck surgery and Dan Chu. They had ear and ear-related, cochlear implant surgery, etc. So I went and watched them and it was fascinating. They were doing so many things that were new and innovative and it was, they were creative how they were solving their problems and so, and really, you know, the world is sort of your oyster there, you have unlimited funding, unlimited support, unlimited anything. So, that's where I really became interested in, in the airway, and had a next step.

Interviewer: That's amazing. It's so fascinating to hear about the spark and how it can change your trajectory, and how you're mentioning how you were interested in the ears before and then going to this new training site changed your perspective. So it's wonderful to hear about, to go further into the line of research. So as a surgeon and as a scientist, how do you balance clinical practice with research?

Dr. Propst: Yeah, it's easier at a place like SickKids where, you know, on paper, we have protected research time. It wasn't really necessarily the case for the first sort of decade that I was working here. I've been here 13 years now, and, you know, if there's a block of open time, it kind of became research time. That's a time where we can, you know, throw in a large case or a few cases or something like that. So, research really took place on evenings and weekends for the most part, for the first many years. But, as I got, some partners here with similar interests that I have, I was, you know, we were able to share, all of our research projects, and, and we still do, so the three of us that share all of our work together. And that's just within our specialty within our department. And then, also, you know, sharing research with other departments, that we work with. And so that, you know, really made it easier to produce good research, and spend as much time at home on the weekends and evenings.

Interviewer: Absolutely. And do you find, there to be a stronger interlink between the research affecting your clinical practice or your clinical practice affecting your research?

Dr. Propst: Yeah. So, you know, it's interesting. It's, I, think the best research comes out of your clinical practice. So, you know, if you have an issue that you are experiencing and trying to get accomplished for your patients. Then, you try and improve it. Right? And that's to me, the best. Everyone talks about, you know, bench to bed, bench to bedside, etc. But really, I think it's bedside to bench and then back to bedside. And, because if if you spend a ton of time doing research, on something, perhaps, you know, some tiny little component, you might not see the benefit of it for many, many, many years. And that might not work for some people. I think for surgeons in general, we kind of want immediate gratification. I joke that sort of every, every problem we have kind of has to be finished by the end of the day. So I guess a downfall is that I always feel that way about research, too. So when I start writing a paper - I'll literally sit down and write the entire thing. I'll just sit down for 5 or 6 hours and write the entire thing because I want it done by the end of the day, which is probably not the best way to do things. There's a great, great quote from Richard Feynman who says that "science is the belief in the ignorance of the experts". So I mean, he was a little bit on one extreme. But, you know, I think keeping an open mind that there are probably ways to improve most things, is maybe a more subtle way to say it. And, and so why not? Right. If you're going to keep doing it every day, then why not try and improve it?

Interviewer: Absolutely. That's a great quote. And thank you so much for sharing. Jumping back a bit, you mentioned you were the fellowship director for ENT at SickKids, and you were talking about how you yourself perceived a fellowship in pediatric otolaryngology at the Cincinnati Children's Hospital. Could you share your experience of what led you to specialize in pediatrics and how this fellowship helped influence your career or your ability to get staff?

Dr. Propst: Sure. So, I had that role from 2012 to 2018 and then, two amazing people took, split up that role. And, they've done fantastic things with it since then Sharon Cushing took on the fellowship and, Nick Walter took on the residency. And so, sorry - what was the question again?

Interviewer: What led you to specialize in pediatrics as a fellowship and how did that influence your career?

Dr. Propst: Yeah. So, pursuing pediatrics as a fellowship. As I had mentioned, that was sort of promoted to me, I guess, well, let me let me back up a little bit. First of all, I knew that I wanted to do pediatrics. And so, I was a, you know, camp kid. I went to summer camp, and, so I like being around children and I went from when I was a child until, being a counselor and staff, etc.. And so to me, taking care of kids has been natural. There are really two things. One is that, you know, they're just fun. They're adorable. They make your day so much more enjoyable and exciting, and you're laughing and, you know, smiling and having a good time with them and that's, I guess a benefit for me. The other nice thing is that if you can get to help them when they're young, then you can change the course of their health and hopefully their life for the rest of their life. So that's a huge difference. So those are sort of the two reasons why I wanted to go into pediatrics. I, you know, I joke nowadays that the highlight of the time that I spend in the clinic is when I give out stickers to them. We have stickers and I think I blew a huge amount of our budget, on stickers. But that really is the best part of the clinic day. And, so I knew I wanted to go into pediatrics. The other thing about pediatrics and doing a subspecialty in pediatrics is that you kind of get to do a subspecialty in almost every area. I was able to gain a lot of experience in airway surgery and very, you know, advanced airway surgery, but also advanced sinus surgery and also even cosmetic surgery or rhinoplasty or external approaches to rhinoplasty, etc... You get to do advanced, otology, you get to do, advanced head and neck, not, you know, not so much the free flaps and stuff like that, but you get to still partake in a lot of the oncology and a lot of the benign stuff as well. So it's really a nice, well-rounded specialty in that respect. Pursuing the fellowship at Cincinnati Children's was pretty much like being a kid in a candy shop. I mean, you know, the otolaryngology department itself had 8 to 10 hours every day running with three open airways every day. Its just an unlimited number of fantastic, exciting cases and new stuff coming in, from all over the world, and stuff that we hadn't seen, stuff that we had to figure out what to do with and so that was really, really exciting.

Interviewer: Oh, wow. That's amazing. And for listeners who may be less aware of what other fellowship avenues exist post-residency - what recommendations would you have for some of our more senior trainees listening to decide whether to stick to general practice or pursue a specific fellowship training?

Dr. Propst: Yeah. So I mean, for otolaryngology there are basically fellowships in every aspect of it. You can do otology and neurotology, with vestibular components if you want. You can do rhinology and skull base surgery. You can do, sleep disorder breathing. So there are otolaryngologists who are double board certified, it's more of an American thing, but to be double board certified in both otolaryngology and sleep, medicine and all the surgeries that follow from that there's, I mean, obviously the head and neck, the oncology free flaps, facial plastic surgery, and all that. I mean, there's so many. It's so diverse about what you can, sort of become an expert in a small area. The, you know, as far as advice about general practice, I think, you know, there has always been, at least, in Toronto and Ontario, you know, well, if a job comes up in general otolaryngology, then, you know, you better jump on it and take it and not pursue a fellowship. And I did have a similar offer - there were no jobs. There was no guarantee of a job here at SickKids. There were zero jobs anywhere in Ontario, definitely not in Toronto. And I was offered a job by a fantastic person who was an otolaryngologist and was also chief of surgery at the time. And, he said, you know, if you don't go to fellowship, then you can have a job here. And that was a very difficult, decision to make, I think. I think ultimately fellowship is 1 or 2 years, you know, and if it's something that you can do - it's a lot easier to do right when you graduate, and a lot harder to do if you go into general practice and then want to pursue a fellowship afterwards. I would say if there's any inclination for wanting to do a fellowship, pursue the fellowship. It gives you the ability to see all of those complex cases, to make the connections, to get interested, to have the spark to ignite, all of those things - it's really, such an amazing, chance for growth that I would say, don't give up that opportunity. And if you decide after fellowship that you don't want to work at an academic hospital, then you don't lose your skills. And almost every subspecialty that you would possibly consider doing a fellowship in those skills can be translated to even a general practice. And you can always, you know, specify that your practice will, you know, be general with a bent towards this and towards that specialty. So you're never going to lose that, especially with pediatrics. I mean, I remember when I came back from fellowship and there wasn't a job here at SickKids for three months, I worked, doing general otolaryngology, at what's now Mackenzie Health at York Central. And an elderly man came in - he had suffered a stroke and his palate was paralyzed, and, he couldn't communicate and he said the worst thing was that he couldn't speak on the telephone. No one could hear him. He would call people, and he would just have breath, breathiness, and nasal escape. And, I said, well, let's see, you know, I've done VPI surgery, pharyngeal flaps for children who have VPI nasal escape of air and food, etc.. And I said, would you be interested in trying this? He said -sure I'll try anything. And, you know, so sure that wasn't on a child, but it was the same skills, different situation, different scenario. And, got his voice back because he didn't have the nasal escape. He was able to call his family on the phone. And when people called him, you know, they were able to know that there was a human being on the other side who was speaking to them. So that ability to communicate was great for him. And I would never have known how to do that surgery if I hadn't gone to fellowship. So just, you know, there are always ways that you can take different approaches and use what you know and apply it somewhere else.

Interviewer: Oh, that's a really beautiful story. And it really goes to show how surgery really is almost like an art. And the skills are so transferable. Even though you did a fellowship in pediatrics, this was a life-changing procedure for the patient you were just talking about. So it's actually quite a beautiful experience to think about.

Dr. Propst: Right? Yeah.

Interviewer: And just to flip the question to the other end of our listeners listening in for medical students who wish to pursue a career in ENT, what advice would you give them based on your experiences? And are there any insights you wish you had known earlier in your career?

Dr. Propst: Sure. So I would say perseverance is the main, I guess, of my career, perseverance would be the keyword. For me at least, nothing came easily. You know, if things don't work out initially, you have to just sit down, and reevaluate. Is that still what I want to do? And if it is, then you just keep going at it. And, you know, we're talking about a very, very small group of people, who, you know, get into medical school and then even a smaller group of people who get into the residency that they want to be in and then to be able to work at the hospital that you want to work in, to be able to work with the patients you want to work with and to be able to be surrounded by the people you want to be surrounded with. I mean, it really is, you just really have to persevere and keep going at it, if that's what you want. So perseverance, for sure. And when doors close, which they certainly did, all along the way, new doors open and, you know, the path kind of - it's a winding path to get where you want. But, I think just keep at it, if that's what you want to do. The other thing is to surround yourself with positive people. Surround yourself with people who, you know, will say, "Yeah, that's a great idea" or "how can I help you?". That's really, you know, the people that that got me where I am today. That's a great idea - How can I help you? But if they don't think it's a great idea, then they'll help you flush out - you know what parts of it would be a good idea? And then how can they help you get to that place? Also, think of yourself of being a 'yes person'. No one wants the no person, right? Someone has an idea and you're like, "man, whatever that's been done" - no one wants that, right? So be a yes person and help people, to accomplish what they want. But also, when it's too much for you, so you can't always say yes to everyone. Eventually, it will be detrimental to your own health. Right? So, I think, there are very polite ways to say, you know "Yes, that is a fantastic idea. That's a great project. You know, unfortunately, I've taken on too much stuff. I will not be able to, give you everything that I'd like to, but let me help you find someone who can help you work on that to achieve what you want." So, I think being honest with yourself and being honest with other people, I wish I had done more of that early on. Probably would have preserved me a little bit more, but, definitely, being a yes person has made a lot of great connections and friendships and it really makes the job so much more enjoyable. I think recognizing when you don't know something, being able to say, you know, "I know that. I just don't know anything about that." It came up when we needed to write a patent for a silicone model of the airway and people told me that, it costs $100,000 to have someone write a patent for you. So I said, "well, then I will be learning how to write a patent." You know, so... I didn't know where to start. And so I went to the people who knew how to write patents and asked them about what to do and said, "I don't know anything about this. Is it worth it? Right? How do I do it? How do I, where do I start, what do I do, etc.?" And then what came out of that is sort of a realization. There have been many realizations all along that most of the things if another person can do them, then you can eventually teach yourself to do them too. So, you know, and that goes for anything, right? I mean, fixing a garage door opener, learning how to do it on YouTube, fixing a washing machine to to learning how to do surgery to, you know, whatever it is. Right? To code programs, to make websites, to write, whatever it is, someone else has learned it. There's a way to learn it. If you approach it in the right way, then you also can learn how to do it and so, those are just some of the things that I've learned along the way. And also not everyone's going to love you. And I think learning to surround yourself with the positive people, that make you happy, that, is good for you, that are good influences and that, you know, you can maybe be a good influence on them - those are all great things. And the people if people aren't into that, then don't take it personally and just inch towards the other people that make you happy.

Interviewer: That's great advice and for early-career aspiring otolaryngologists, such as myself, we'll be sure to keep that in mind in our journey. That's actually all the questions we have for you today. But before we wrap up I want to thank you so so much for your time, your insight on navigating otolaryngology, your research, and the fellowship opportunities you shared have truly enriched the episode and I deeply appreciate your time and your expertise. To our listeners, thank you for listening, and stay tuned for more discussions on the latest in ENT. Until next time!

Interview conducted by: Rashi Ramchandani (MS2 at University of Ottawa)