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Doctors at Work Podcast.

Episode #64

What’s a career in oculoplastic surgery like?

Mat Daniel

16/02/2024

In this episode, Lorraine tells me about her career journey into oculoplastic surgery. She describes the types of patients she sees and the procedures she performs, and shares both challenges and her most satisfying moments. Her career tips are to work hard and be nice to people, which is a good tip for whatever specialty one works in.

You can also watch on www.youtube.com/@dr-coach/videos.
Production: Shot by Polachek

Podcast Transcript

Mat: [00:00:00] Welcome to Doctors at Work. My name is Mat Daniel, and this podcast is about doctors’ careers. Today, we’re discussing what’s a career in oculoplastic surgery like. Lorraine Abercrombie tells me about her career journey into oculoplastic surgery. She describes the types of patients she sees and the procedures she performs, and shares both challenges and her most satisfying moments.

Her career tips are to work hard, advertise to people, which is a good tip for whatever specialty 1 works in

Mat: Welcome, Lorraine. Tell me a little bit about yourself.

Lorraine: So I’m an oculoplastic surgeon, and I’m a consultant that’s worked at the Queen’s Medical Center in Nottingham for the past 23 years. Um, I am married, and I am the mother to 3 children.

And I suppose [00:01:00] as a result of that, I have few actual Really keen hobbies. I do have some interests, um, gardening, walking, and I’m very keen at road cyclists. And that’s probably about all I’ve Mhmm. About myself, really.

Mat: What is oculoplastic surgery?

Lorraine: So oculoplastic surgery is a subspecialty of ophthalmology. And if you were going to be an oculoplastic surgeon, you were trained first as an ophthalmologist such that you have an understanding of of the eye and the surface of the eye and its needs. And so the oculoplastic surgery is Surgery of the eyelids and also surgery of the nasolacrimal system and surgery For some osteopathic surgeons, it’s surgery of the orbit. Um, but it varies depending on the center that you working [00:02:00] as to how much or how little of those 3 things that you will be doing. Mhmm.

Mat: And how did you end up being an oculoplastic surgeon?

Lorraine: So as a basic, um, thought I had always wanted to be a doctor from being a very small child, and I’m not sure really why that was because I didn’t have any doctors in my family. And then when I went to medical school And it got to I got to be in the fourth year and start career choice. I was drawn to surgery. And at that time, when I looked at the female role models in Mersey region where I was training, There were actually only 2 female surgeons.

1 was a consultant urologist, And the other was senior registrar in general surgery, [00:03:00] um, and that was it in the whole of Mesi region. And I looked at that, and I thought, Gosh. I can’t imagine, um, having a career in general surgery, plastic surgery. Um, it was very male orientated. And more than that, within my medical school, the people who were were inclined to follow general surgery seems to be very, very alpha male.

And, um, I’d done ophthalmology. Or in the fifth year, we went to Saint Paul’s, which was the standalone eye hospital in Liverpool at that time, and went down to Saint Paul’s and enjoyed ophthalmology. I’d also done ophthalmology as an elective in third year. And, um, and It occurred to me that there there were 3 or 4 senior registrars at Saint Paul’s who were female, and I and I went and had a meeting with 1 of them And had a chat about what what it had been like for her with her training and what her hopes and expectations were from a career in the future. And and [00:04:00] I just thought as a pragmatic approach, this would seem to be something that I think I could, um, be successful in compared to all the other branches of surgery that were available at that time.

And so when I, uh, finished my house jobs, I went and, um, taught, um, anatomy and leisure and passed the fellowship, um, which was actually only the third sitting of the Primary ophthalmology, FRCR. Um, and then after that, I got a fantastic job because, um, 1 of the ophthalmologists in Leeds, it was quite encouraging for me to join the Leeds’ ophthalmology rotation. They were going to just set up as a as as a brand new 4 year rotation. You said to me, you know, before you go into ophthalmology and become very channeled in ophthalmology, you should get some exposure in other parts of medicine. So do a 6 month job in something like neurology, general medicine, neurosurgery, a and [00:05:00] e, whatever.

And I got this year job, which was 6 months in a and e and 6 months in neurosurgery. And in some ways, it it was an absolutely fantastic opportunity. I went to the to, um, Sheffield, to the Northern General Hospital for 6 months after the Hillsborough disaster, and that that was a fantastic, um, Fantastic run a and e department with quite a lot of heavy industry to see. Um, it was a a really good experience I’ve seen patients quite quickly and coming to make a decision quite quickly. And then when I did neurosurgery, that that was a really challenging job, but in a very different way.

I got to work with 6 men very closely. So there were 3 consultants and there were 3 trainees, and then there was me as this new SHO. It was a the a new role that they were having as as an SHO. And, um, and we started off every day at [00:06:00] 8 o’clock, And we, as a group of 3 3, uh, trainees and the senior registrar tonight, the 4 of us would meet at 8 o’clock every day, and we would Go through all the CT scans of the patients that had come in in the night that may or may not have been operated on or Just the people that had, uh, subarachnoid hemorrhages that didn’t need an operation. And then we look at all the images that, um, for the patients that were being operated on for the day.

And then we’d go off, and we’d do do the day’s work. And for me, a lot of the time, it was actually assisting in theaters with with the with the, uh, bosses as as the sort of trainee or second assistant. And then at the end of the day, We met up again at half past 5, and we went through all the CT scans again. And we went through the CT scans of all the people that have been admitted during the day. And it was an absolutely fantastic experience for actually getting into the habit and having the confidence to look at your own CT scans and look at them [00:07:00] first and then get out the report to see what the report said and then sort of cross reference.

And subsequently, that became really important, um, for running an orbital service because actually, in orbital surgery, The, um, particularly when you’re on call, the reports are read by people that might have done a month, 6 months, 2 years radiology. Um, and and it’s a very, very small subset overall of neuroradiology. So it became very A great skill to have to be have the confidence to look at your own images. And then following on from that, I, uh, did a 4 year 4 year training rotation in the Yorkshire region. And that was quite difficult from the perspective that, um, At that point, of course, it was very pyramid shaped, wasn’t it, the training?

And it was a big jump to go from a senior registrar to registrar. And I passed all these exams as [00:08:00] quickly as you could pass them. And so after 2 years, I was looking for registrar’s job, except In that year when I was looking, there were only 8 jobs that weren’t in London. And and at that time, I had some difficult family circumstances such that I felt I wouldn’t want to be applying to a job in London. So the the actual scope of what I was applying to was really quite narrow, and it actually took me 2 years to actually get a registrar’s job.

Because every time I went for 1 of the jobs that I was getting shortlisted, but there’d be people with 3 or 4 years, um, experience, Um, 2 years more experience than me because, obviously, there was a bottleneck now with people that had passed the exams before me that were trying to get the jobs. But finally, when I I got a registrar’s job in Manchester, and that’s when the run through training came in. And, um, [00:09:00] so the Manchester was a very good training. And at that point, I was thinking I’d really like to do atrial retinal surgery. And I was making arrangements and getting everything ready to do this really good Vitreoretinal Fellowship in Manchester.

And then I and then I had my baby. And I had my baby, and I and I just thought, you know, realistically, this was this fellowship was a job where Every other weekend, you were operating on call as the fellow and every other night. And and I thought, realistically, I don’t think I can do that and and look after a a a baby. So I slightly changed tack at that point and thought, well, actually, Oculoplastics is probably going to be an easier rotation for training and as, again, another pragmatic approach. Mhmm.

Um, I managed to, um, become the first oculoplastic fellow in Newcastle on the new on Newcastle [00:10:00] training program and went with James to spend 6 years for 6 months in Newcastle, Um, doing a fellowship, and then I came back to Manchester and did another 12 months fellowship in Manchester, and then was fortunate enough to get my job in Nottingham. Congratulations. Thank you. It was quite, uh, it was quite a long time. I think it took from 19 88 until 2000.

So 12 years it was of of training to get to the end point.

Mat: And, um, I’m interested in just going back a few steps. You know, you talked about looking around and seeing the roles that that women were in and and how that influenced, um, career decision making. Um, I suppose, you know, think things have moved on, I’m sure. But how how how would you think things are at the moment, for for women surgeons seeing women role

Lorraine: [00:11:00] models.

So I think that it’s a lot more positive now. Um, when when I came to Nottingham, I was the only female and the first female consultant. Now I think there are 5 female consultants in, um, ophthalmology and also in general surgery. My husband was a a very successful general surgeon, Colorectal surgeon, and and he has always been very supportive of females. And for instance, female ENT surgeons.

Um, I think when I came to the trust, there was only probably 2 females in the whole of the trust out of about 500 consultants. So it’s there are a lot more role models, and I think the role models are very positive role models as well. So I think there’s a lot more a lot more [00:12:00] opportunity that was on 1 hand. Of course, the lack of opportunity, I would say, comes from the changes that have occurred generically in the training system. So things like the the The hours that you that, uh, you spend in the working your skin you work in town barracks and things like that.

Mat: I hope you’re enjoying the show. Please click subscribe so you’ll be notified when new episodes become available. This podcast is part of my mission to help doctors create successful and meaningful careers. You can be part of that mission too by forwarding this show to 1 person who you think might benefit from listening. Thank you.

Now on with the

Lorraine: show. So

Mat: talk talk me through your week as an ocular plastic surgery consultant. What do you do in an average week?

Lorraine: So things have changed [00:13:00] slightly as I have evolved my career because I now have more management responsibilities than than I previously have. So now, for instance, on a Monday, I will be doing Um, work from home where I may be looking through a lot of results, looking at emails.

I would be doing other things like this or, um, I’m also 1 of the lead appraisers in our trust, so it it would be a day where I might be reading through people’s Appraisal documentation. Tuesday is the all day operating list, and that would start at half past 7 when I meet with Paul, who is my wait list coordinator. And Paul and I spent about half an hour going through the operating diary for the 6 weeks ahead And just, uh, confirming what we’re doing and making any adjustments that we might need to make. [00:14:00] And then at 8 o’clock, I would meet with my fellow or trainee if we have 1, and then we’ll go to the ward and we’ll cut the patients that we’re operating on today. Um, some of these patients may need consenting because they’ll have had, um, a type of surgery the day before such that today is the first time we’re seeing them after their, um, their surgery to excise their lesions, and so we would consent them on the day.

And then that that list starts at half past 8 with our huddle, and then it will finish anytime 5 o’clock, 5 36 o’clock. And, occasionally, it might change later than that. And then we would go to the ward, look at the patients, and then I would normally go back to my room and just make sure if there was anything important on my desk check. Wednesday’s all day clinic. Thursday would be, um, a virtual clinic that I would do.[00:15:00]

So that that tends to be telephone or, Occasionally, it might be video, but telephone works quite well, I would say, in office plastics for for a very selected group of patients. Um, then at lunchtime, there is the SkinMDT, where we discuss patients with skin cancer and formulate plans for them. Thursday afternoon would be an opportunity for me to actually meet appraisals and do Appraisals with appraisies. Um, Friday morning, I would be at my desk In the trust doing, um, things like appraiser feedback or, um, meetings to do with the Kaiser faculty, or sometimes I might find that somebody comes and finds me at my desk and says, hang up with these scans, or I’ve seen this patient this week in In a and e, what do you think about that? Or even can you come down and look at the cyst list?

Because somebody’s turned up to the [00:16:00] cyst list with this massive tumor. I’m gonna have a look at it. And then Friday is our teaching afternoon, M and M. But once in every 4 weeks on a Friday afternoon, we do the thyroid eye disease clinic, which is a very specialized tertiary A clinic with our endocrinology colleagues. Mhmm.

Mat: And what kind of patients do you have?

Lorraine: So And what the other support around them is. So the job here in Nottingham has always being very orientated towards treating patients with skin cancers. And that is partly because when I came to Nottingham, There were only about 5 centers in the country that did most surgery, which is a very is the Rolls Royce way of removing skin cancers. And And [00:17:00] so it it it it’s it was 1 of the first instances to have Mohs surgery, and that really hasn’t evolved in Nottingham.

So now I would expect more than 50 percent of my time to be taken up reconstructing patients with defects following their most surgery Or indeed treating patients where their their, um, lesion is not suitable for most of you. So for instance, if it was the skin cancer are stretched onto the eye itself, and they would need operations like accentuation where we remove all the optimal contents. Um, so a large part of the practice is with those patients. There’s quite a large practice of patients with lacrimal problems, so watery eye. We do a lot of external, a dachrocystostomy is where we made, um, a connection between the the lacrimal sac and the nose.

And we also [00:18:00] do quite a lot of surgery for patients where the higher part of the nasal nasolactinal system is damaged such that A standard DCR would not work, and so we use a foreign a foreign body tube called a Lester Jones tube. And that we do in conjunction with our ENT colleagues, and, um, I do that with 1 of 1 of your colleagues, um, on an adult basis when we usually have 3 or 4 actions and do them on a list together. Mhmm. Um, then there is, um, a smaller But very interesting and challenging group of people to see who have orbital disease. And so these some of these patients have thyroid eye disease.

Some of them have orbital tumors. And for them, The challenge is trying to define, um, what you think the [00:19:00] the the type of tumor is likely to be and whether it’s appropriate to actually just do an incisional biopsy or whether or not an excisional biopsy is more suitable. Um, so, essentially, it’s it’s a repertoire of about 80 different operations. Mhmm. You know, We’ve not mentioned things like the eyelid malpositions that we do with on groupie eyelids or turned in, turned out eyelids, which are the local anesthetic procedures and a bit the sort of basic procedures that you could go and have done in most centers where they have.

So it’s a repertoire about 80 operations, and I think that’s part of what keeps you interested in it is that there is quite a lot of variation. Yeah.

Mat: What are the most challenging aspects of the job?

Lorraine: Um, so for me, I have [00:20:00] always found It it’s keeping a it’s keeping in your head a a list of patients who potentially could be an order of trouble because when we see these patients and you might order a CT scan on them or you might order you might biopsy them And you’re waiting for biopsy results. Um, it’s always thinking what’s happened to x, what’s happened to y, where’s that?

Check check that that results come back. Has that scan been done? Do we need to send a prompt or whatever? Um, because for some of these patients, if If they slip off the radar and they are lost, then some of these patients have diseases that, um, are life threatening, or others, it’s sight threatening, or others, um, loss of your eye. So it it’s it’s mainly it’s [00:21:00] mainly having the accountability, the ownership, and the responsibility for these patients and your way of trying to keep track of them, making sure that they don’t they don’t, um, slip slip away.

Mat: And what are the best bits of the job?

Lorraine: Well, the best bit of the job is the, um, Happy patient. You know, you hear a lot nowadays about how much doctors are paid and whether they’re paid too much, The right amount are not enough. And people people have compared Doctors’ salaries when they’re talking to me with, say, working for a hedge fund in London that their their people in their medical school now do or whatever. But for me, You know, to have a patient look in the mirror and, um, look at their eyelids that we’ve made new eyelids for and and feel really pleased [00:22:00] with And and and for these patients where they’ve got skin cancers, you know, the skin cancers are not attractive to start off with.

So for for many of these patients, they actually look much better afterwards than they did before we started, although many of them are really concerned that that they look much worse. But then for them to look at the mirror and say, I’m really pleased, doctor, and, um, my my my relatives don’t notice. My friends, they never they can’t see what what they’ve had done. You you can’t buy that appreciation and and the fact that people are pleased with what you’ve what you’ve done. And then

Mat: my final question for somebody who’s contemplating a career in oculoplastic surgery, what would be your top tips?

Lorraine: Well, my top tip for any doctor, which is a bit generic, is work hard and be kind to everybody because, You know, everybody, much as you want to do the best that you can, you’ll always there’s always a time when you need somebody else’s help. And if [00:23:00] you’re kind to everybody and you help others, others will help you when when you are in difficulty. And then on top of that, I think I’ve I’ve always believe that in otoplastics, if you are striving all the time to be the best possible that you can be and your standard to be very high and hold yourself to a high standard. Everybody has a day where the day doesn’t go well for them. Either they didn’t sleep well that night or something else happened, And the day is not as good as their average day.

If your standard is very high at all times, then even when you’ve had a bad day, The result is still going to be okay. So it it would be to strive for a high standard And, um, be resilient because it’s a long training to do The work [00:24:00] the range of work that my practice is would easily take 2 2 years of fellowships, Um, and and it takes quite a lot of resilience to keep going and and have the belief at the end of the day that that you will get a job because, you know, the it’s 1 of the subspecialties of ophthalmology where the jobs are scarcer. You know, there aren’t new jobs popping up for oculoplastic surgeons like they have been in other parts of ophthalmology. So it’s to remain resilient and determined And, um, and, yeah, it’s a great career. Wonderful.

Mat: Thank you very much, Lorraine.

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