Volunteer Profile: Kimberli S. Cox, M.D.

There was a time when Kimberli S. Cox, M.D., never thought she’d be volunteering for the Student Doctor Network. Then again, there was a time she never thought she’d be a doctor.

After being dissuaded (for such reasons as not having any family in medicine and not being extremely wealthy) by her high school counselor when the discussion of medical school came up, Cox instead pursued what she figured was as close as she’d ever get, a degree in psychology.

Then, while Cox was in graduate school studying psychology, she lived with residents, and everything changed.

“They basically said, ‘If I can do it, so can you’ to every excuse I had, and one by one, the barriers I had created over going to medical school fell to the wayside,” Cox recalls.

So during graduate school, she completed some premed courses in preparation for what was now on her horizon.

Then fate stepped in.

In the interim between research grants, while playing intramural volleyball, she became acquainted with an Infectious Disease fellow from Australia who was in need of researchers for a project he was working on

”I knew I didn’t want to pursue my Ph.D. in psychology, and I needed a job while I finished my medical school prerequisites, so I moved to Australia to help him with his research,” she explains. That was 1996, and Cox ended up staying there for six years.

While Cox was in Australia, she says she decided to go to medical school and pursue an internal medicine subspecialty, partly because the price was right at the time, as school was inexpensive there compared to the U.S., and partly because she was considering staying in the “Land of Oz”.

Then, during her third year, fate again intervened.

“I did my Core general surgery rotation, and I just knew I wouldn’t be interested in it, but I actually found that I really enjoyed doing work with my hands and the decisive nature of the field,” Cox remembers, adding that it (surgery) appealed to the “type A” impatient American in her, rather than the “no worries”, laid-back nature typical of the Aussies.

Cox adds, “The final nail in my Internal Medicine career coffin came when I did my Core IM rotation and hated it. I couldn’t stand the indecisive nature, the delay in diagnosis and treatment, and the endless rounds and mental ‘one-upmanship’ that I experienced during my medicine rotation.” So after working closely with the plastic surgery residents in Australia, she then decided to pursue that as her field and keep general surgery as her “backup” plan.

“But I didn’t match into Integrated plastics, and it was also becoming less interesting to me as I learned more about oncology,” she adds.

“Eventually, I realized I would have to leave Australia and complete my residency in the U.S. so I would not have to repeat one to work here,” she continues. “So I applied to several plastic and general surgery residencies in the U.S., eventually matching to General Surgery at Penn State in Hershey. This was close to family in Virginia and I already knew two people doing residency at Penn State, so I felt very comfortable there.”

And it was there, at Penn State, that fate played its final hand.

“The Chair of the Surgery Department mentioned a breast oncological fellowship, and I had never heard of it,” Cox laughs. “But it seemed to fit for me—I like to talk to patients, which a lot of surgeons don’t, and I’m interested in women’s health and oncology, including oncoplastics….All of which led to where I am now in New Jersey.”

As a Breast Surgery Fellow at The Cancer Institute of New Jersey, Cox says, “You would not be hard pressed to find recent or current breast fellows who were going to be something else and had the experience of enjoying the decisiveness of this and wanting to see their patients again after the O.R. Many had originally planned a career in Family Practice or Medicine, like I did.”

And while being the “bearer of bad news” might turn some people away from this career path, Cox says she prefers the relationships she develops with patients.

“We have a different relationship with our patients than the typical general surgery population,” she explains. “I will see them frequently, sometimes for years after surgery or for High Risk Surveillance. And they refer their friends and family members to us; it’s not unusual to spend part of the office visit asking patients how their sister with cancer is doing, or looking at pictures of new babies delivered after systemic treatment for breast cancer.”

“I hear from other MDs that the field is unappealing to those who don’t like the dealing with the possibility of death, especially in younger people, or those who don’t like to spend time talking with and educating patients, because there’s lots of both involve. There’s also an emotional aspect—for many women and their partners, the aspect of losing all or part of a breast is traumatic.”

Cox adds that unlike the stereotypical surgeon, in her career “you have to be a team player and be comfortable in a multidisciplinary environment.”

“I focus on good relationships with other team members, such as plastic surgeons, social workers, genetic counselors, radiation oncologists and medical oncologists,” she notes. “There are a lot of fingers in the pie, and as a surgeon, you can’t believe you are the only important part of the equation. There is little room for ego here. I like that…I’m used to being in an academic environment, and I like to see things from different disciplinary perspectives. If you decide this is your avenue, there doesn’t seem to be a lot of burn out.”

The Student Doctor Network has also played an important role in Cox’s career path.

Like most people, she says she found SDN by doing some sort of Internet search.

She had already been active on a friend’s website started when he was a third year medical student, and Cox had helped him moderate a forum. But, as is often the case, she says he got busy and stopped working on the site.

“I was interested in learning and sharing, and I was also figuring out how to get back to the U.S. and find a residency [while I was in med school],” recalls Cox of her impetus for stumbling across SDN.

That was about eight years ago, and Cox says she posted fairly frequently on SDN and became a regular member a year later.

“Lee asked me to become a moderator, because I suppose I was seen as active and was posting often and giving reasonable advice,” Cox says. “And as the site became more popular, Lee needed help with administrative work and I’ve been helping with that for three years now.”

“As time has passed, my role has changed. Now that I am more senior in my training career, I’m not as up to date with medical students’ needs and requirements, so I have to stay out of some stuff, such as the premed and med student forums, because I don’t want to lead anyone astray. So I stick to the residency forums for the most part,” she continues.

Cox is an example of using SDN to its fullest potential, as she says she’s now using her SDN contacts to help in finding an attending job as a Breast Oncologic Surgeon, and asking others questions such as, “What I should ask for in a contract?” or “Is It inappropriate to ask if they have any single men on faculty when I come to interview?” (It’s clear her sense of humor has remained intact through the process as well.)

“I’ve come out the other end of SDN, and I hope to still be of use to the newer or more junior members,” she adds. “I can see the forums have changed, too, because there are a lot more members in senior residency or fellowships now. Even some attendings. Sometimes I see the common post from a surgical intern that says ‘I’m going to quit!’ and I can say, ‘Hey, we’ve all been there and here’s how I made it through.’”

Cox says her forum moderating duties require about half an hour per day on the general surgery and general residency forums, which she adds are “almost self moderated and don’t require that much oversight.”

“I do catch trolls form time to time, which does engender complaints, but helps keep the conversation on-topic and civil,” she notes. “That’s the goal—you want it to be self moderated. The moderator should just be resolving conflicts and disagreements.”

She says that moderating time spent does depend on the volume of posts on threads, but that on the two she oversees there average about 10 new posts per day.

In addition to her work and SDN involvement, Cox says she enjoys reading about Middle Eastern religion and travel and has traveled to Morocco, Turkey and Israel, as well as Thailand and Southeast Asia.

One of the biggest transitions for Cox has probably been dealing with New Jersey itself. Cox, who was born in Florida, spent most of her life in California and had never even been to New Jersey before starting her fellowship.

“I’m getting used to the humidity here. We’re 40 minutes outside Manhattan, so I’m getting used to the people and their accents too,” she laughs.

Fortunately, the ability to adapt to any situation seems to come naturally to Cox.