Dr. Jennifer A. Villwock is the current Rhinology and Skull Base Fellow at the University of Kansas Medical Center. After graduating in 2011 from the Michigan State College of Human Medicine, she completed her ENT residency at the State University of New York (SUNY) Upstate Medical University. Dr. Villwock is active in the American Academy of Otolaryngology and serves on the Ethics Committee of the American Rhinologic Society. You can reach her on Twitter @docwock
1. Why did you want to be a physician?
To be honest, I was not always sure that I wanted to be a physician. My family immigrated to the United States when I was small. My father is a cardiologist and was in the midst of completing training, finding a practice, and fulfilling family obligations back home during my formative years. As a result, my understanding of medicine for many years was mostly related to long hours, time away from family, high stakes and high stress. My dad often joked that his job is his hobby so I had a vague idea that it was not as painful as it appeared from the outside. Nonetheless, while I admired my dad greatly, I did not think that this was the life I wanted for myself. As I progressed through college, I did keep medical school as a thought in the back of my mind. There was something inexplicable drawing me towards it, but and also potentially to law school or grad school. I was undecided about a future career path until after I graduated from college!
I worked in a cancer research lab through the Undergraduate Research Opportunity Program at the University of Michigan, and it was there that I met a woman who I continue to consider a mentor today – Dr. Valerie Castle. She has been an unflinching supporter of my circuitous journey to medicine. Dr. Castle largely led by example, fostering my curious scientific mind while showing me that, just as there are numerous ways to be a good person, so too are there many ways to be a good physician. I worked and learned in Dr. Castle’s lab throughout all four years of undergrad and for a year after graduating college to consider my options. During this time I applied and interviewed for medical school. I was accepted to two places, but remained unsure. I was only allowed to defer my admission at one institution, and so I hung on to this acceptance as I transitioned to a new job in marketing.
I took that marketing job because it sounded interesting, but also because it was important for me to not have any what ifs about embarking on the journey to become a physician. I wanted to have first hand knowledge that, no matter how bad medicine or medical training was, I made the decision with my eyes wide open and that medicine was better than anything else I could be doing. After 4 months, that the corporate job was definitively waaaaay worse than anything medicine could possibly throw at me. In retrospect, while the corporate culture itself was toxic for me, I think I was also missing professional fulfillment. All of these factors allowed me to finally hear the little voice that had been continuously whispering for years to my deaf and resistant ears, “Come to medicine. It is what you were born to do. You are a healer.” And so I did.
2. Did you know coming into medical school what specialty you wanted?
I had no idea what specialty I wanted to pursue. I went to Michigan State University College of Human Medicine (allopathic program), which has a very heavy primary care emphasis. I was, and remain, interested in holistic and integrative medicine so I initially thought I would pursue Family Medicine. Ironically, it was my fantastic family medicine preceptor Dr. Teresa Sherman, who caused me to pursue a surgical sub-specialty. Dr. Sherman did lots of procedures as part of her practice. One of the first ones I did with her was a C-section! She also did lots of skin lesion biopsies/excisions, colposcopies, etc. This is where I learned that I loved procedural things. Following this rotation was my surgery rotation and I knew I had found home!
3. What experiences in medical school drew you towards your specialty?
I loved my general surgery rotation. There were months leading up to it of dread since horror stories abound. All that lost sleep was for naught as I thrived in that environment. Even waking up at 4:30 was not an issue. When you wake up that early, you get to eat TWO BREAKFASTS! The exacting nature of the surgeons I worked with made me want to be better. I was never treated cruelly or belittled. I was very impressed with the residents. During a call shift I took with one of the residents, she had to confront some people about an issue I no longer remember. What I remember afterwards is that she didn’t care if she got in trouble for this confrontation because it was what was best for her patient. She turned to me exasperated and said, “I love my job and I wish everyone else here did just as much too!”
However, I was not enthused about the typical operative cases done by general surgeons. Bowels and bellies did not do it for me 
4. What did you do in college to help you shine in medical school applications?
I was not the best of students in college. I came from a very under-resourced and underachieving high school. For my husband, who went to a very good private high school, most of his first two years of college were easy and essentially a repeat of high school. An entire semester of my statistics class in high school was spent playing cards because my teacher never received the books or calculators for the course. I cannot understate how much I struggled to maintain reasonable grades in college. I was going to every office hours for every class, attending tutoring and review sessions, and was sometimes still not able to get above a C. It was very demoralizing. But I kept at it and slowly after that first and horrible year, I hit my stride. I did better every semester and eventually graduated with a GPA of 3.5 or something like that. Of course, in the ultra-competitive world of medical school applications, a 3.5 isn’t so hot. I was directly asked at one interview if I would be willing to go to a post-bac program to increase my GPA. I told them no because more coursework wasn’t going to change the reality of my prior educational experience and struggle or be able to significantly alter my GPA. That same school later asked me if I would consider retaking the MCAT. I also said no. The only thing dragging my MCAT score down was a the physical sciences section, and even though I dedicated most of my studying to that subject matter, I remain terrible at physics and math. More studying was not going to help. I assumed I would be summarily rejected from that school, so was extremely surprised when I received my acceptance letter the next week. Moral of the story – sometimes luck and confidence can go a long way.
Also don’t be afraid to ask people to advocate for you. We all like to believe we live in a meritocracy, but this is not the case. Use the connections you have cultivated through your hard work.
5. What would you have liked to know during college?
For the sake of diversity and complexity of thought, if I were to go back in time, I may have pursued something like anthropology or organizational studies instead of a traditional science degree.
6. Would you do medicine over again?
Yes. But only if i knew I could still be an otolaryngologist. Anything less than what I love wouldn’t be worth it.
7. Would you chose the same specialty, or different, why?
Same. ENT is the best. The personality of the folks in this field is amazing. A little bit of surgeon, but mostly nice, kind hearted people. The operations range from simple in-office procedures to complex craniofacial reconstructions, and there are continually new advancements to keep you engaged and interested in the field.
Some people are discouraged from pursuing surgery or a surgical sub-specialty because of the time commitment. It’s a minimum of five years [in residency]. However, if you take into account that so many folks in primary care are doing fellowships, the time evens out. More importantly, your medical training isn’t just a stepping stone to some endpoint. It’s the launch pad to your career. If you are doing something that you love, that one year doesn’t make a difference. Also, I discovered as a student, I would much rather work 16 hour days doing what I enjoy (surgery) than 8 hours of something that is slowly killing me from the inside (endless medicine rounds)!
8. Can you tell us the path you took (time commitment) to enter your specialty?
I am currently on year 14 of training (4 years of college, 2 years of life experience, 4 years of medical school, 5 years of residency, and completing a year of fellowship).
9. What do you feel helped you stand out when you applied for residencies?
When I was applying for residency in ENT, honestly, a lot of programs were screening based on USMLE scores (stay tuned for my soon to be submitted paper “Beyond the USMLE” and how the University of Kansas does NOT screen solely based on Step scores) and I happened to make the cut off at some places. I had good letter writers, which is also helpful. I gave them the narrative feedback from each of my clinical rotations and literally highlighted with a highlighter the nice things other preceptors had written about me. With this feedback, I also gave them a copy of my personal statement and CV. That way, when I solicited my letters of recommendation, especially at places where I did away rotations, they had longitudinal and meaningful information about me, beyond what they could have gleaned from our interactions over a few short weeks. They could know that I was consistently a good medical student, my prior experiences, and why I wanted to go into ENT.
10. What is the best and worst part of your job?
The best part of my job is when I am able to improve a patient’s quality of life with a fairly minimal surgery. (Most of the surgery I do is endoscopic endonasal, i.e. through the nose with cameras.) The worst part of the job is all the documentation, paperwork and pre-authorizing procedures or medications. No one went into medicine to be put on hold for 30 minutes by an insurance company to try to get an imaging study approved for a patient with cancer and a clear indication for the scan that was denied!
11. What issues would you like future medical students to focus on or bring their awareness to?
Medicine is wonderful. It is a great opportunity and blessing to be a physician. That being said, you are not beholden to anyone for having started down this path. You do not owe the medical machine anything, certainly not your own health or well-being. You deserve to be happy now…not just once you finish college/medical school/residency/fellowship/are established in practice, etc. The days are long but the years are short. Be happy now and in this moment. If you are not, find people who also believe you deserve to be happy and help one another.
I was once having a theoretical conversation with one of my chief residents. This particular person was not renowned for his kind and gentle demeanor (although once you get to know him, he is indeed a very kind person). We were talking about kids – this was before I was even considering having a child – and he turned to me and said words I will remember for the rest of my life. “**** this place. You live your life.” Medicine and the life you want, whatever that is, do not have to be mutually exclusive. The call schedule, rotation schedule, etc will work itself out. The reality is, that we are all cogs in the institutions in which we train and ultimately work. My personal opinion is that while there are many fantastic individuals within those institutions that care deeply about us, the institutions themselves have other primary objectives. If I were to walk away from it all tomorrow, I am replaceable. So there is no reason to make sacrifices you do not wish to on the altar of the medical calling just because you feel obligated to… especially when, at the end of the day, the institution sure don’t feel an equal level of obligation to you.
Also remember that it is not a suffering competition. When you start to find yourself absorbed in the rhetoric of one-upping “oh, you studied for 8 hours? well I studied for ten,” or “you had 6 consults on call? I had 10 and two had to be emergently taken to the OR and I haven’t slept in 12 days” it is time to take a step back. This mindset serves no one. At the very least, it detracts from the very real conversations we need to be having about physician wellness and it perpetuates a toxic medical culture. It also makes us forget that we are not the only ones who can be faced with less than ideal circumstances. Let us not forget our patients. Or the everyday heroes that go to jobs they dislike, that are unhealthy, or outright dangerous, because that is what they need to do to support themselves or their families. One of my good friends is a phenomenal art therapist. One of her first jobs was working with clients with sometimes severe behavioral issues. During a conversation about work life, she casually remarked, “I would just like a job where my clients aren’t physically aggressive and don’t ever start masturbating in front of me.” Yeah. As I said before, it’s not a contest. But if it was, she just won.
12. Do you feel like you are fairly compensated and have an appropriate work-life balance?
Yes. More than compensated, which reduces the sacred patient-physician relationship (and educator-student relationship for that matter) to a transaction, I think it is important to feel valued. What this means to different people varies widely. Personally, once I achieve a certain monetary amount (i.e. enough to pay off debt, live comfortably within my means), the money doesn’t matter anymore. Am I able to pursue my interests? Am I supported in my academic interests? Do I get to do the operative cases I trained for? Is call reasonable? Can I present my research at conferences and pursue additional educational opportunities as needed and desired? Do I get home at a reasonable hour? Can I accomplish my work at work and not take it home with me? Right now, the answers to these questions are yes and I am very happy.
Work-life balance is always a tricky subject, especially for women physicians/surgeons. Just like with compensation, everyone has a different idea of what the ideal picture is for them. Work is part of my life, so I need a happy work life to have a happy overall life. I have a small child (2.5 years old) to whom I am not the primary care giver. My husband stays at home with her and gives her all the love and attention any child could ever wish or hope for. I see her before work (thankfully toddlers wake up early. I’m probably only parent ever to have said this without sarcasm!) and for a few hours after work (I usually get home around 5 or 6) and add to the love and attention party. As a woman, socialized in a culture where statements like “being a mother is the most important job,” “you don’t know love until you have children,” and “having children completes you” are the norm, not being the primary care giver often feels wrong. Not fitting into this paradigm can be downright painful at times.
However, just because your experience is different, that doesn’t make it wrong. I love my child. But of my wealth of skills, the endless patience needed to be the full-time caretaker of a toddler is not among them. It is one of the skills her father possesses in spades. Our family dynamic is what works best for us. That isn’t to say that it’s easy to escape societal norms and your own unconscious biases. Another wonderful mentor of mine – Dr. Kara Kort – once told me, that there will come a time when your child has an injury or wakes up from a nightmare and you run in to comfort them and they only want Daddy. This will hurt. About a year ago that happened. My own child actively pushed me away upon opening her eyes and realizing I was not Daddy. I immediately texted Dr. Kort. “It happened. Ooooh it stings. It burns. My baby wants Daddy and not me!” She kindly reminded me that I was not a bad mother or making bad choices; I was not alone in the family life I was building.
13. Tell us a bit about your current position and daily responsibilities?
I am currently the Rhinology and Skull Base Surgery Fellow at the University of Kansas Medical Center. Beginning July 1, 2017, I will join the academic faculty as an Assistant Professor. I have an 80% clinical workload (including teaching medical students and residents) with 20% protected academic time for research and other academic endeavors. This will continue during my faculty appointment. I will also be going back to school again and be starting a Masters of Science in Health Informatics this fall. My clinical time is pretty evenly split between clinic and the OR, with about 2 days of clinic, and 2 days in the OR. The breakdown of my operative cases is about 80% inflammatory (i.e. chronic sinusitis, sinonasal polyps) and 20% skull base (i.e. pituitary tumors, sinonasal tumors).
Rafid Rahman will be a medical student at the University of Toledo and is the founder of MedSpeak, a YouTube channel capturing the journey to and through medical school. You can reach him on Twitter @Rafid__Rahman or by e-mail contactmedspeak@gmail.com for questions.