In it for the Long Haul

In a career that can span 40, even 50 years, a decade can make a difference

31 Years Out: Mr Hilal Bahia

Mr Hilal Bahia, Class of 1991. Consultant in plastics and burns, reconstructive and aesthetic surgeon, Edinburgh, Scotland.

"As Senior Lead Surgeon of the Wallace Burns Unit, oncoplastic breast surgeon and aesthetic surgeon, a typical week involves a full day operating on Monday, either at St John’s Hospital plastic surgery unit, or at the Western General Hospital, Edinburgh Breast Unit with alternate Tuesday mornings taken up with private work, while Tuesday and Wednesday afernoons are outpatient clinics and Tuesday evening is a private clinic. Wednesday mornings are for burns trauma operating. I also carry out an adult exceptional referral pathway multidisciplinary team (MDT) on Wednesday lunchtimes, for assessing eligibility for cosmetic procedures to be approved for surgery on the NHS. Thursdays are dedicated to private clinics and surgery; Friday mornings are for NHS operating and the afternoon for teaching."

Looking back, what were the best decisions you made?

"Having opted to follow a career path in the UK after graduating in 1991, getting appointed to a run-through training programme was a challenge. In the 1990s, as an SHO, you were still able to apply for standalone jobs, and so I would apply for a new surgical specialty post every six to twelve months and move hospital. However, despite becoming an experienced and senior SHO in plastic surgery, I found I still wasn’t being shortlisted for registrar interviews. I decided that I needed to do something radical in order to reinvent myself. I applied for a research job in breast cancer genetics (while I was a SHO in plastic surgery in Hull), with the assistance of my consultant at the time Mr Michael Kerin (now Professor of Surgery in Galway). I was offered the job, but was afraid that it was too laboratory-based and initially declined it, but was convinced to rethink my decision. I think this was the best career decision that I ever made, as I gained a MD degree for my work over a period of 18 months, which led to my being shortlisted for every registrar job thereafter, before finally being appointed to a training number in Edinburgh."

What advice would you give your younger self?

"With hindsight, perhaps I might have gone for a research post sooner in my career, but I would have had a much less diverse journey and gained less experience in other useful surgical subspecialties. Run-through training has changed all that now, and made it easier for trainees to progress through their chosen specialty, although this is at the expense of a breadth of surgical experience."

20 Years Out: Dr Victor Peña-Araujo

Dr Victor Peña-Araujo, Class of 2002. Health Coaching Manager, MiSalud.ai, Texas, USA

"My ambition was always to be a surgeon so I trained in surgery for more than eight years but in 2010, during my surgical fellowship in London, I discovered the little-known field of lifestyle medicine (LM), which aims to prevent and mitigate lifestyle-related chronic diseases through behaviour modification of the individual."

"Having seen how dramatic surgical interventions failed to address the root causes of underlying disease, LM intrigued me sufficiently to try a radical experiment; leave my surgical training, move with my French wife and infant twins to the US, and start a completely new career path in LM health coaching. I spent two years of intensive, self-directed study to re-skill, devouring all the best courses on LM (from Harvard, Yale, among others), trained as a health coach, and established a virtual, boutique health coaching company (ELITE Personalized Health, LLC). I coach clients and tutor medical students (teaching is another passion of mine). I have recently been enjoying private corporate consulting on the topics of LM, digital health and innovation."

"As the Health Coaching Program Manager at MiSalud.ai, the only telehealth platform that provides immediate, affordable and private access to Spanish-speaking doctors, I am implementing LM to help the underserved Hispanic population. I work remotely with a close-knit team across time zones, with no more than an hour or two of live meetings each day."

Key challenges of the last decade?

"Taking a great leap of faith when I voluntarily abandoned my beloved surgery for something completely unknown that simply felt so right. The transition was tough: studying on my own and living off life savings with no certainty of employment in the future. When I started coaching our family of four was living on about a quarter of the income I enjoyed as a bachelor surgical registrar. Learning how to run a business and use digital technology was a challenge yet, remarkably, I never regretted my decision. It always felt right and invigorating and it allowed me to spend so much more quality time with my wife and daughters than surgical training would have allowed."

What’s next?

"I am currently applying my love for teaching by developing the LM training programme for the new health coaches we are hiring. I continue to immerse myself in digital health, artificial intelligence and machine learning because our goal at MiSalud is to put these amazing technologies to use to revolutionise healthcare in the 21st century by better serving our users, and hopefully keep them from ever becoming patients in the first place."

8 Years Out: Dr Kerac Falk

Dr Kerac Falk, Class of 2014. Assistant Professor, School of Medicine, University of Nevada, Reno, USA.

"As a urogynecologist (a subspecialty of obstetrics and gynaecology), I focus exclusively on the treatment of female pelvic floor disorders, which encompass many common but infrequently discussed conditions that significantly impact women’s quality of life. These include complex disorders such as urinary and bowel incontinence, pelvic organ prolapse, childbirth injury, genital fistulas, recurrent urinary tract infection, bladder pain, and sexual dysfunction. I offer patients a wide range of treatment options, from non-invasive conservative therapies to complex reconstructive surgeries, including all-vaginal surgery, laparoscopic and robotic surgery, and neuromodulation."

"A typical week involves one to two days in the OR performing surgeries, with the remainder of the week seeing patients in my outpatient clinic and teaching medical students. Clinic days are a mix of new consults, follow-up of chronic conditions, and various office-based procedures including urodynamic testing, cystoscopy, bladder Botox, and nerve modulation therapies."

Highlights of the last decade?

"It’s hard to believe that it has already been twelve years since I started as an RCSI GEM! While the last decade has been full of study, exams, hard work and long hours, it has been a fantastic journey. RCSI truly built a foundation for compassionate and sharply observational clinical care, which I carried over into ob/gyn residency training, urogynecology fellowship and current practice. Among the highlights were RCSI weekend trips to Galway, the privilege of a good work/play balance during residency training in NYC and successfully building up a new subspecialty practice from the ground up. Getting married was also a plus. But mostly, the people I’ve met along the way have formed a second family, spread across the globe."

What do you hope the next decade will bring?

"Professionally, I hope to build and expand the academic programmes at our medical school, including building a new ob/gyn residency programme to serve the Reno-Tahoe region. I also hope to build additional sub-internship opportunities for RCSI students seeking to match in the US/Canada."

26 Years Out: Dr Mary Behan

Dr Mary Behan, Class of 1996. Owner, Calderwood Family Clinic, Drumcondra, Dublin, Ireland.

"I qualified as a GP 20 years ago and after working as a GP partner in Dublin for ten years, I set up Calderwood Family Clinic in 2012. I started as a single-handed GP with four staff and within five years we had grown to three GPs, a GP registrar from an RCSI scheme, two nurses, a physiotherapist and four administration staff. I was very lucky to get a lot of help from my husband and practice manager Georgie Sliney McCormack."

"A typical week consists of three long days and two shorter days. You never know what clinical scenarios are going to walk through your door. We have a mix of GMS and private patients with lots of children and elderly patients."

"I specialise in women’s health, contraception and menopause consultations, also sports medicine and joint injections. I completed the ICPG diploma in musculoskeletal medicine in 2016, the ICGP menopause certificate in 2018 and am currently doing the new community gynaecology certificate. ere have been enormous changes over the last 20 years including IT changes, electronic prescriptions, electronic consultant referrals and the introduction of a formal Chronic Disease Management scheme. We have had great support from the ICGP and IMO with pandemic updates and Chronic Disease Management implementation."

"I am also a GP trainer on the RCSI scheme so am available for my registrar to ask questions and for a weekly tutorial. I really enjoy this – it’s a great opportunity to re ect on more complex patient cases. Twice a year, a medical student from UCD sits in with me for a week."

"I have also been an ICGP CME group leader for the past five years. We meet once a month to go through interesting cases and the educational needs of the group. This is a great way to get to know local GPs, and has helped us all to have that support. I may also do a house call, paperwork, results, some telephone consultations and some COVID-19 consultations. I have a great team around me and we all support each other. Being a member of DDOC out-of-hours service for north Dublin has been an enormous help as a GP co-op – we share the burden."

"I’m married with two teenage girls and two dogs. I love walking the dogs on the beach close to me, going to the gym, yoga and meeting up with friends."

Looking back, what were the best decisions you made?

"One of the best decisions was to set up my own practice. It was very daunting, but professionally very positive. Becoming a GP trainer on the RCSI scheme really enriched my day-to-day work. is group is a great source of knowledge and the collegiality really makes a big difference."

What advice would you give your younger self?

"Change is how we grow professionally and personally – we are capable of more than we think. I would tell my younger self that general practice is about lifelong learning and it keeps it interesting and invigorates us to continue learning."

15 Years Out: Dr Denis Gilmore

Dr Denis Gilmore, Class of 2007. Thoracic Surgeon, Centennial Hospital, Nashville, USA.

"I specialise in robotic surgery for pulmonary resections, benign and malignant esophageal surgery, thymus gland disorders, and chest wall resection/ reconstruction. As a private practice thoracic surgeon, a typical week involves two days of operative block time and two days of clinic. Additional add-on cases are fitted in where the schedule allows."

Key challenges of the last decade?

"Within the last decade, we have seen a dynamic shift in healthcare from large academic medical centres located within cities, to delivering the same specialised care at community level. Healthcare systems are purchasing small community hospitals to allow for a “hub and spoke” model. is system gives health networks more negotiating power with insurance companies. ese networks are utilising specialised physicians to conduct satellite clinics within the community and select procedures. e challenges of such a system centre on monopolising patient care while minimising autonomy of community hospitals. In addition, logistics of satellite clinics, physician coverage and travel of multiple facilities and decentralised specialty care may impact patient care."

"COVID-19 has had a significant impact; healthcare systems have been exposed, revealing shortages of nurses, operative staff, therapists and ancillary staff as well as supply chains. We are faced by new challenges of conducting and billing for telehealth visits."

"Lastly, the cost of new innovations, equipment, medications are rising. New medical devices, robotic surgery, and minimally invasive techniques are improving patient care but the cost is rising dramatically. Personalised cancer care with liquid biopsies, molecular tumour sequencing and targeted chemotherapy/immunotherapy all have high costs. The industry will have to decide how to pay for the testing, medications and procedures."

What’s next?

"The future of medicine is exciting, with advancements in all aspects of patient care from the initial visit through diagnosis, treatment and palliation. Utilisation of technology will bring specialised care to more individuals. Blood, urine, and sputum testing for biomarkers may limit more invasive testing for cancers, autoimmune disorders and inflammatory conditions. Advanced imaging techniques will allow for more precise visualisation. New medications will have a targeted approach, limiting side effects and increasing efficacy. Less invasive procedures and expansion of robotic surgery will lead to shorter hospital stays and quicker recovery."

12 Years Out: Ms Muirna Hamill

Ms Muirna Hamill, Class of 2010. Senior Pelvic Floor Physiotherapist, Perth, Australia.

"I work three days a week as part of a multidisciplinary team at St John of God Hospital Midland, a public hospital supporting men and women with pelvic floor dysfunction. e other two days I work for a not-for-profit paediatric continence service. Outside of this I have been developing a mobile application that supports women with pelvic floor dysfunction. When I get home, my second work day begins although it doesn’t feel like work at the moment as I am enjoying the new challenge. In my spare time, I love to spend time with friends outdoors enjoying the famous Australian weather and beaches."

Highlights of the last decade?

"The last ten years have been incredible and I don’t think I can list just one highlight! Travelling alone, moving to Australia, living with a close girlfriend who I met at RCSI, the birth of my niece and nephew, completing my masters, meeting my husband, growing our family, starting my business … It has been a great ten years."

What do you hope the next decade will bring?

"I hope to grow the reach of my mobile app and complete research on its efficacy. I am currently in the process of an ethics application. I also hope to grow our family and now that travel has resumed, spend more time with my extended family."

30 Years Out: Mr David Galvin

Mr David Galvin, Class of 1996. Consultant Urologist, Mater University & St Vincent’s University Hospitals, Dublin, Ireland.

"Following my urological training in Ireland, I completed the Urological Oncology Fellowship at Memorial Sloan Kettering Cancer Center in New York. This is the oldest urology cancer fellowship in the world and it allowed me to work with many of the best surgeons in the world. The main focus was on major cancer surgery for kidney, bladder, prostate and testis cancer. After a short posting in the NHS, I was appointed to a split consultant post, dividing my time equally between the Mater and St Vincent’s. The post was focused on supporting the role of the national Rapid Access Prostate cancer clinics, assessing men at risk of prostate cancer, diagnostic work-up and treatment."

"So, my week is divided really into four equal parts. Each week, I run a clinic and theatre list in each of my three hospitals (the Mater, St Vincent’s University Hospital, St Vincent’s Private Hospital). I continue to focus my clinical practice on oncology, focusing mostly on prostate and bladder cancer. The Rapid Access Prostate clinics have been a phenomenal success, allowing rapid access to the latest diagnostic tests and treatment. There has been a significant down-staging of prostate cancer as a result, and mortality rates continue to fall. e last part of my week is spent fitting in my research work, mostly on the IPCOR Project and around my role in the NCCP. IPCOR is a major €1.75m project funded initially by the Irish Cancer Society and Movember to establish a national prostate cancer registry. We are now progressing IPCOR 2.0, which will allow Ireland to become part of a global prostate cancer registry and world leaders in outcomes research, value-based healthcare and patient-centred research."

Looking back, what were the best decisions you made?

"Having as full a college experience as possible is important. I certainly had a fantastic time in college, but I’m sure I le many opportunities behind me."

"Undoubtedly, my decisions to do surgery and subsequently urology were my biggest decisions, and the ones I am most happy about. I always enjoyed surgery and was attracted to it towards the end of my time in college. I had amazing mentors who supported my early development, Mr Broe, Mr Hickey and Mr Murphy in Beaumont were central to my and so many other careers in surgery. Finding a good support structure, and approachable mentors who successfully guide you through the choppy waters of surgical training is crucial."

With the benefit of hindsight, what advice would you give your younger self?

"I think as a student or a trainee you are in a unique position that is lost as your career progresses. All consultants are approachable and willing to help, especially in supporting careers. Don’t be afraid to ask. Spending your time on a summer elective is a great way of getting to know a service and specialty. I didn’t do one, but wished I had. Getting involved in research projects as a student lets others know you are a serious contender, and is always an impressive line on any CV."

30 Years Out: Dr Perry Mayer

Dr Perry Mayer, Class of 1990. Medical Director, e Mayer Institute, Ontario, Canada.

"The Mayer Institute (TMI) is a centre of excellence dedicated to the treatment of diabetic foot, located in Hamilton, Ontario, Canada. I began as a family physician in Kingston, Ontario, practising there for twelve years before giving up family practice and moving to Hamilton to focus on the treatment of the diabetic foot. I formed TMI in 2006 and since then, we have been busy trying to save the limbs of people with diabetic wounds."

"I work five days a week, seeing patients on four days with one day for administration and business. My day typically starts at 5:30am and ends at about 7pm. We see 65-75 patients a day with 80% being wound patients, the other 20% attending for preventative care."

"As an advanced diabetic wound centre, we treat high-risk diabetic patients with active wounds. We are fully involved in the management of diabetic wounds, with surgical debridement and the necessary operative procedures, such as tendon releases, toe amputations, ray re-sections and forefoot amputations done in our outpatient setting. We have attempted to replicate the pioneering Wide-Awake Hand Surgery of Canadian plastic surgeon, Dr Donald Lalonde, with our version of Wide-Awake Wound Surgery."

Best decision you made?

"The best decision I made was to leave home in Kingston, give up my family practice and move to Hamilton to follow my wife [Professor Karen Choong, see page 22] so she could embrace her passion of pediatric intensive care. I have only good things to say about the specialty of diabetic wound care. The practice has managed to combine the beauty of family medicine and relationship building, with an aggressive, evidence-based practice that is challenging both from a medical perspective, with active diabetic management being at the forefront, and exciting, high-stakes wound work that brings incredible gratification when one is successful. Despite the heartache of limb loss and death among our patients, I am still enamoured with the specialty, 30 years on."

10 Years Out: Dr Ruhail Kohli

Dr Ruhail Kohli, Class of 2012. Assistant Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.

"I am a gastroenterology/transplant hepatology attending physician and a clinician educator at the Johns Hopkins University School of Medicine in Baltimore. My clinical expertise is in liver disease and I manage patients with chronic liver disease and patients who have had a liver transplant. In addition, I am involved in training gastroenterology and hepatology fellows at Johns Hopkins. Approximately one week a month, I am the attending physician on the Mary Elizabeth Garrett liver service and see patients at the Johns Hopkins Hospital. The rest of the weeks, I have outpatient clinic at two different locations, perform endoscopies, participate in liver transplant meetings and attend various clinical conferences. I am board certified in internal medicine, gastroenterology and transplant hepatology."

Highlights of the last decade?

"Professionally, the highlight of the last decade has been training at some of the best hospitals in the world and starting my career at the Johns Hopkins University."

"I have been fortunate enough to be involved in medical education at every level of training, from medical students to gastroenterology and hepatology fellows and have had the opportunity to mentor some exceptional physicians."

"Personally, the highlight of the last decade was meeting my wonderful wife, Dr Shruti Chaturvedi, during my internal medicine residency at the Cleveland Clinic, and having our daughter, Diya, in June 2021."

What do you hope the next decade will bring?

"In the next decade, I would love to see advances in manufacturing artificial organs for transplantation. I wish for the scientific collaboration, and the rapid advances in medicine seen during the pandemic, to continue. I hope these developments will contribute in a positive way to the outcomes of patients with many other diseases."

14 Years Out: Dr Leena Rahmat

Dr Leena Rahmat, Class of 2008. Instructor of Oncology, Johns Hopkins University School of Medicine, Baltimore, USA.

"After completing an internship with Mr Moran and Mr Osborne and Drs Grogan and Breathnach and a six-month SHO rotation with Professor Hill at Beaumont Hospital from 2008-2010, it was time to relocate close to family in the US. I am currently an assistant professor in hematology and oncology at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center. I work at their two sites, in Washington DC and Maryland."

"I am currently working as a clinician with an interest in translational research. I focus on hematologic malignancies and benign hematology. A typical week is pretty high-tempo: a daily morning latte is followed by rounds in the hospital, then an afternoon clinic. In order to keep myself mentally and physically balanced and healthy, I usually pop into an evening Pilates class or go for an evening run a few times a week."

Key challenges of the last decade?

"The key challenges include trying to maintain a healthy work/life balance. The socio-economic barriers faced by physicians to provide optimal care to under-served regions, and navigating bureaucratic healthcare systems are challenging and I can’t talk about challenges without mentioning the COVID-19 pandemic, which presented tremendous challenges involving patient care. Witnessing the emotional and social isolation that the pandemic forced upon patients and families was heavy."

What’s next?

"Professionally, I have a few lymphoma-focused clinical trials in the pipeline. Personally, I am looking forward to getting back to my favorite hobby, equestrianism."

30 Years Out: Professor Karen Choong

Professor Karen Choong, Class of 1991. Pediatric Intensivist, McMaster University, Hamilton, Canada.

"As a clinician-scientist my week is split between research and clinical responsibilities. My clinical work is as a pediatric intensivist in the Pediatric Intensive Care Unit at the McMaster Children’s Hospital, a tertiary care academic hospital. A typical clinical service week involves the care of critically ill children with a broad range of medicalsurgical conditions, managing pediatric trauma, and running a pediatric ICU transport team service for our provincial region. These weeks are busy with a heavy call burden of sleepless nights. My research is focused on ICU-based rehabilitation and patient-centred outcomes. We pioneered PICU Liber8, an innovative, evidence-based rehabilitation bundle of care designed to reduce morbidity and improve functional outcomes in critically ill children. I currently lead multiple research projects including studies evaluating long-term outcomes following COVID-19, chronic critical illness, PICU delirium, septic shock interventions."

"I love the diversity of cases, the team dynamic and the excitement of the PICU. One must not only have expertise in critical care, but also in di cult conversations, end-of-life care and bioethics. I love practicing in the ICU despite and perhaps because of the demands of this subspecialty; it is high acuity and high reward and despite the workload and sleep deprivation, I wouldn’t do anything different."

Best decision you made?

"Perry [Dr Mayer, see page 21] and I first wrote our responses independently and when we read them together we realised that we had essentially written about the same things so I thought I’d share our combined response: The best decision we both made was to go to Ireland for our education. The medical training we received at RCSI was second to none and moulded us into the clinicians that we are today. We are grateful for how well we were taught; we have the highest respect for the art of presentation and emphasis on clinical acumen, and we endeavour to practice with the same disciplined approach that was deeply engrained in us by our RCSI professors more than 30 years ago. Attending RCSI allowed us to nd love – for each other, for Rice’s, for the beer-stained ceiling of e Swan, and Sean’s concern that we had no homes to go to, for intervarsities, for class trips, for Alan Johnson, and for the treasured friendships made that remain strong till this day."

What advice would you give your younger self?

"This is the advice we give to our own kids: work hard, play hard. Believe in yourself as you can achieve anything you set your mind to. Make time and protect your time. Enjoy life, do the things you love with the people that you love, and look after yourself."

"I would advise Perry’s younger (and current) self to learn how to cook, so he can feed his wife on her long weeks on service. Perry would advise his younger self to invest in land."

"We work hard and are proud of our achievements. We are eager to share what we’ve learned with others. With the bene t of hindsight, we wouldn’t change a single thing. We would do it all over again, especially our life at RCSI." ■