Balancing your life with Dr Alexandra Dresel (General Surgery)

Then it was surgery, and everyone said, you're gonna hate it. They're mean. They make you wake up at 4am I did have to get up at 4am But I absolutely found my people.

Did you make it through without crying?

I did.

Oh, I cannot say the same.

I truly found my people.

Hi, everybody. This is Generations md. My name is Stephanie. I'm joined here by my colleague, Dr. Sarah Davis, who's also my mother. And your. Do you want to give an introduction?

We have a very Special guest today, Dr. Alexandra Dressel, who is a fantastic general surgeon here in Dallas. I send her any patient that I possibly can because she does a great job, takes wonderful care of my patients. But we're really excited to talk to somebody who is a woman in surgery and who was able to have children and apparently have some sort of outside life. So we just kind of want to hear. Hear about your story. So welcome.

Welcome to the pod.

Thank you.

Yeah, we were talking a little bit before. It sounds like. So you have one daughter or.

So we're blended. My husband had kids when we got married, and then we had two more. So we have five total.

Wow. Okay.

And the two youngest are. One is a senior in high school, and one's a sophomore in high school.

Okay, gotcha.

And then the other three have all flown the cooperation.

Yeah.

And your husband's a doctor too?

He is.

He's a trauma surgeon.

Okay.

So just going way back, like, where did you go to college? And then how did you decide that you wanted to go into medicine and then into surgery? Kind of give us your spiel on your background.

I will. So I went to UC Berkeley, and for undergrad, with the knowledge that I wanted to be a doctor, I wanted to go to medical school. No great explanation why there are no doctors in my immediate family. Some of it was a television show called Quincy, which was the one show. My mom would let me stay at the launch with her, and he was a, you know, the medical examiner who would solve mysteries. And I was like, I. I'm gonna do that. And so was pre med at Berkeley, again with really no good foundation. And then went back. I grew up in Madison, Wisconsin, Went back there for medical school in state. Tuition was much more reasonable to go back as a resident. And there I kind of had a little existential crisis because I think I sort of thought I'd be a pediatrician growing up. Loved babysitting, loved kids, Just, you know, thought that was exactly where I would be, a perfect fit. And then third year of med school, you start Doing your rotations and peds was one of my first ones, and I hated it.

Oh, dear.

Wow.

Really didn't know what that meant for me. Still loved the kids. But in Madison, Wisconsin, this was sort of the yuppie, the term that they called people. Before you could Google that you were smarter than your doctor, you just knew you were smarter than your doctor. And so I just would watch these interactions with these parents, and was. Was totally turned off.

Yeah.

So then it was ob. I was like, okay, I think I could do this.

Wait, was that the next rotation? Like, each rotation. Okay, this is what I'm gonna be.

All right. And I loved. I loved the gyn. The OB was okay, but the. The. I have to say, that group of residents that I was put in with were so catty. It was all women. They were mean to each other. They would. Would say mean things behind each other's backs, and I was completely turned off there. I was like, I can't spend four years with a bunch of women that don't seem to like each other, so. And I know that doesn't apply to every OB program, but where I was at the time, that was very, very much the feel.

And you can definitely be swayed by the people that you're with too.

Absolutely.

Yeah.

So then it was surgery, and everyone said, you're gonna hate it. They're mean. They make you wake up at 4am, which they do, and you know they're gonna try to make you cry. It' and I did have to get up at 4am but I absolutely found my people.

Did you make it through without crying?

I did.

Oh, I cannot say the same.

I truly found my people, and I think that's something that every specialty sort of has. Has a personality type, and you find that group of people that you really do mesh with. And again, I think program to program is very different. Wisconsin did not have a malignant surgery program. They weren't. Their job description did not include making everyone cry, which I know that there were some surgery programs, especially in that time frame, that really didn't care how they treated you. But I felt very, very treated very well. There was plenty of women in the program, so I had mentors, and, you know, again, we spent most days laughing. So then I even went back and did a sub I in vascular. They're like, if you can go back and do a month of vascular and they don't make you cry, then you should be a surgeon.

Yeah.

And so I did, and I still loved it. And my biggest problem was, though, get people Telling you that you're never gonna. Because I was single at the time. You're never gonna meet anyone if you go into surgery. So that was really my biggest intimidation, was that people had head.

You're not going to get a husband.

Gosh, that's.

Yeah.

Never say that to the men.

But. Yeah.

But. Yeah. So that was kind of my path to surgery. And then I matched in Dallas, here at Baylor. Nice. And. And that's where I met my now husband.

Nice.

So is. So he does trauma. You said trauma surgery.

Okay. Okay. Wow.

That's.

Now, was he in attending when you were a resident? Okay, we have another scan. Happened with another. Except that the man was. He was. Yeah, he was a med student. She was the resident.

Yeah.

Yeah.

When they met. So he tried to keep it on the down low when we kind of pressed him on it, but these things happen.

They do. I mean, again, we're at the end of the day, that's where you're gonna meet someone I think is hospital, especially.

When you're in surgery.

But, yeah, so we met there. He's still a baler. And then I opened my practice at Presby.

Okay.

And how did you be. Because you're in solo practice there, correct? Yeah. How were you able to do that?

So I joined a surgeon who was probably five years out from retirement. And he was the most. He was a great mentor. He was so fair, so honest. Everyone refers to him as a gentleman because he really was a gentleman. His name was John Cottey, and he brought me in to share expenses. So we split the overhead. We shared an employee. We split all the costs of running the practice. But then we did not share patients. So I was. You know, I needed to go meet internists, meet endocrinologists, meet gynecologists so that I could secure my own flow of patients. But what he was great about was when he did retire is he called all his endocrinologists. I do a lot of thyroid and parathyroid surgery, and so did he. And he said, I'm retiring, but I want you to keep sending all of your patients to my associate. And so that was really a huge benefit for me.

Yeah. That's awesome.

And that was really the hardest part, is just building up a referral base when you're going completely by yourself. And I would offer to give grand rounds at the hospital thyroid nodules and how to work up a thyroid nodule. So that allowed me to bring in some internists and some family practice doctors and some gynecologists who maybe wouldn't have thought to send that to me. Would have sent to an endocrinologist first, but I offered to kind of cut the middleman out for some of these issues that really don't need an endocrinologist to work it up. So a lot of just go into the lunchroom at Presbyterian. I don't know if you've spent any time there, but a lot of doctors just go have lunch there, and you can just sit at a table and meet some people and introduce yourself and try to make referrals that way.

Yeah, that's great.

How did you get interested in thyroid stuff?

So during residency, it's interesting because in different cities, thyroid and parathyroid surgery are managed by different specialties. So some places it's all ent. Some places it's general surgery. And Dallas Lucky is mostly general surgery. There's some ents that do it, too. And so I was lucky to have a lot of exposure as a resident to those types of cases and just realized that that was something that I really enjoyed and wanted to focus on that.

And did you have to subspecialize in something else or just general?

I didn't. I still was in the. Not 80 hour work week.

Okay.

And so we. We just got to operate a ton.

Yeah.

And I was able to do enough cases that I didn't feel like I needed to do a fellowship.

Okay. Yeah.

I know now that's really not the case, that most of the residents coming out after five years are really feeling like they have to do an extra one or two years. And so I think most do.

Do you feel like that was because of the size of your residency program, too? Do you think that, like, was it.

No, because we were big. We had. We. I mean, we had seven, which.

Okay.

And now I think they're up to over. I know they're over 11 in the program, so. But I think. I really do think it was because we. We just had so many attendings. Cause it was a private program that you could scrub with and the opportunity to. And we took a lot of call.

But you still do other stuff. I mean, I think you did an appendectomy on one of my patients, didn't you?

Yeah.

So I fix hernias. I take out gallbladders, lumps, bumps, skin cancers. The theme of my practice is you need to go home on the day of your surgery. So as long as you can go home, you can do it. If I need to see you in the hospital, then I'm not your person. I will find you A great person. But I really, for me, having an outpatient surgery practice has been the difference in lifestyle. With my husband having a purely inpatient surgery practice. And then when we wanted to have more kids, it made the most sense for me to be able to really tailor an outpatient practice. And it has worked out great. I still have a full operating schedule every week, but I'm rarely there till five. Some days I'm there till five, but most of the time, you know, if you start at 7:30 and you do each surgery takes one to two hours, you can still do a lot of surgery and be done by three or four.

And you operate mostly at that. At an outpatient surgery center?

I do, yeah. We opened it in 2011, I think. And every year they've allowed for, like, Medicare has allowed for more and more surgeries to be done in an outpatient surgery center, including thyroids and parathyroids. And so now I'm almost exclusively in that center.

Now, once in a while, somebody must do poorly and have to get transferred to the hospital or that kind of thing.

But the nice thing is our surgery center is literally, it's in Professional Building 3. So you roll down the hall and you're in the main hospital if that happens. And it happens here and there.

Yeah.

But I think that's one of the benefits of having a surgery center on campus is we don't have to call 911, we don't have to wait for an ambulance. We literally just put them in a bed and roll down either to the ER to the main hospital in those situations when somebody has to be transferred.

Okay. Yeah.

How does your lifestyle compare to your peers that are like, in inpatient? I guess you kind of touched on that a little bit.

We've never had a nanny. We did use daycare when they were little. Little. And my mom was able to come help. My stepmom was able to come help. But once they went to school and they both went to esd, I have been able to do all the carpooling myself. My husband always took Thursdays, and Thursday's always been my big OR day. And he has because his schedule, it's predictably unpredictable. So we can schedule which days he's going to be on call and when he's on call. He has no idea what he's going to do, but he knows that those are the days that he can't help. So we never let him take Thursday calls when the kids were little, so he would always be available, and that was his day to make him breakfast. Take him to school, pick him up from school. And that gave me one guaranteed all day or day. And then every other day, I scheduled my patients around purple.

Yeah.

And I feel like, I guess you guys are kind of similar in that, right?

Yeah, Yeah. I mean, same thing. Kind of had some flexibility and, you know, so her dad. My husband's a hospitalist. And so same thing. Even though you can have emergencies, you also can say, oh, okay, well, you know, I can go see those patients a little bit on my own time.

Yeah.

His big thing was biking you guys to school in the morning.

We would have to bike to school every day. And it was like, if it was like, if it was below freezing, then we didn't have to bike.

But it was.

Yeah, but if it was just above.

Freezing and if it was raining.

Oh, yeah.

If it was thundering or like lightning, then we didn't have to. But yeah, he'd be like, it's just a little drizzle. I'd show up to school, like, soaking wet.

Yeah. I don't know the school, a few times I thought they were going to report us a CPS or something, you know, I don't know. I think Stephanie's coughing. I think it's because, you know, she rides her bike to school in the cold. And I was like, eh, you don't get a cold from being cold. But look how tough she is now.

Builds character.

But, yeah, I was just like, that is a similar lifestyle of just being able to kind of see patients when.

You want to and just being like, yeah, kind of the kids thing. We just had to be like, sort of in constant communication with each other of like, okay, you gonna do that? Oh, and then, of course, you know, you'd get those things like, oh, there's a Valentine party in the middle of the day. And he never really went to that stuff. But, you know, if I could, I wanted to go, which is. I mean, it's nice if you can go. Sometimes it's like, okay, no, I just can't really make that happen.

Did you.

When you were going through. Because we like to talk to people in more private practice, too, on this podcast, because I feel like you're not exposed to that as much in the medical training. And so did you know that this was an option? Is this kind of how you envision things? Or like, when did you. Or did you envision, okay, I'm just going to do inpatient and, like, working in a big hospital.

I was lucky because the Baylor program was affiliated with Presby, so we rotated at Presby. And that was our private practice experience. So we got to spend several months with that group of surgeons who. That was their whole practice. And so we could visit with them and shadow them. They encouraged us to go spend some time in the office. And then another surgeon who actually, he was in my call group when I went into practice, Chuck Ruby, I don't know if you remember him, but he gave me some great advice. And one of the pieces of advice that he gave me was to take an afternoon off a week, but to completely stand by it. So his was for golf, but if it was raining, he said, I did not go to the office, I went to a movie or I went to the library, or I did something that was not at the hospital, so they could not see me and they could not tag me with something. And so that from, from the get go, I picked an afternoon, which has now morphed to a day, to block myself out, to not be available. And I think that was a really good piece of advice. And then he was actually the one who suggested that I reach out to Dr. Cottey because he knew he had some space in his office for another surgeon to share that space. And they were in a call group together, so they added me to the call group. And the other thing, though, that has really made a huge positive impact on my lifestyle, though, is not having to take ER call. And for the folks coming out of residency now, that's going to be pretty much, I think, built in, because now everything's so split into inpatient and outpatient. So once they started acute care, general surgery as a specialty, and they started taking all the call. My son was a baby, so he's 16 now. So for the last 15 plus years, I haven't had to take emergency room call. And that, that really, for me was the deal breaker in lifestyle. Because when you don't have that hanging over your head and you can really schedule your days according to, you know, I want to be out for the Valentine's party. I want to be able to do these things. It made a huge difference.

Yeah.

And so I do think when you said the difference between inpatient, outpatient, lifestyle, I think people who do purely inpatient can also have a great lifestyle. They have a certain number of shifts that they're expected to work a month. And if you can again work around that with your other half, if you, you have somebody else that you need to raise your kids with. And there was a couple of women that I used to see at the daycare who were OB hospitalists and they had to work. It was like 13 or 14 shifts a month. And that meant they were off for 17 or 18 days a month. And so there was, you know, the days they worked, they had to make sure they had childcare. But those 18 days, they didn't work. They didn't work.

Yeah, that's really a shift. That stuff really did not exist. Like, you know, when I was going through picking a specialty and everything, all that stuff, it was like, no, you just, that was just part of life is you operated and then you take an ER call and. Yeah, and having those OB hospitalists, I mean, that's really, that's a whole different. Or the laborists, I guess they, they call them. It's really, that's, that's pretty life altering.

I just, I am impressed. I feel like we've been talking to a lot of doctors who just talk about getting stuck in just like the grind and just like only seeing. Just working so hard and not like prioritizing their lifestyle at all. You know, we've talked to so many people who just haven't been focused on their life and haven't have only been focused on their career. Do you ever feel like there was a time, especially just in surgery when you're surrounded by all these other high achieving people that you felt like you were in kind of that tunnel vision of just your career or have you always prioritized life?

I think I've always prioritized my lifestyle. But I think for me the place where I've had some like, ooh, is serving on committees, being, you know, being on being in positions of more power and giving up those 6 or 7am.

Meetings.

At the same time as giving up that position because you wanted to be at home with your kids having breakfast or getting them ready for school. And so there were several years where I was no longer being asked to be part of the Dallas County Medical Society. Higher ups, and I was okay with that.

Didn't hurt your feelings too badly.

You just kind of, you have to sit there and think, what's the priority? And now it's kind of come back around. I'm now the chairman of the department of surgery at Presbyterian sort of by default because the person who was stepped down and we all didn't realize I had been the vice chair that whole time. And so, and I have time now. So, you know, I have teenagers, they drive themselves, they go to sports until dinner time. And so my afternoons are very different than they were when they were little. So I'm happy to serve on some of these committees again and get more involved in the other side of medicine that I really had to give up. But, yeah, I was never going to be on the track to be an academician. I'm not trying to publish papers. That's never been my choice of paths. I like operating. I like taking care of patients. And the more of that I can do, the happier I am. But I really do also value my time off.

Yeah, that's good.

That's.

That's very good. Do you teach residents at all?

Not anymore.

They.

They shifted. So it used to be the Baylor residents that came to Presby, and while they were still coming, I maintained my affiliation, and now it's Parkland, and so. And they're really. They're not credentialed to come to the surgery center.

Okay.

So I just don't. I don't see them.

Yeah, yeah, yeah.

This is kind of a, like a specific question, but, like, how did you know you had those tactile skills to be a surgeon?

I did not.

Okay.

Again, I thought I was going to be a pediatrician.

Yeah.

So it just. I played piano, so I have my long fingers, and I just became experiencing it and trying it and realizing that I really enjoyed it. And yeah, I stumbled on it.

Yeah.

Wasn't the point.

Yeah. I mean, when did you find out that you really could do it? Not really. Until you were probably in residence.

So I was lucky. My fourth year of med school, I had got to do some sub eyes where they were much more willing to let us participate. And so I feel like that's when I really. And it was that vascular rotation, and they let me do quite a bit in the or, and I had an ER rotation. They knew I didn't really want to do the heart attacks, and so they would always try to find me somewhat suture or something, you know. And he had slammed his arm through a plate glass window, so he had a huge, huge laceration and a tattoo. And I spent hours putting that tattoo perfectly back together. I meticulously sewed this thing up. Well, then they took him to jail. And then an hour later, they were like, your friend's back. And I said, excuse me. And he got in a fight in jail and busted every one of my stitches. So I asked for the stapler, and I just went. And I was like, wow, all this time on you, man. Oh, my goodness.

That's like a whole art project that someone just.

Oh, yeah.

I had that thing perfectly together.

It's probably a good experience to put it.

So it was you know, things like that. That made me realize that that's what I'm really much happier doing. Yeah. Sewing and.

Gosh. See, that's just like my nightmare. Like, sitting there over that little thing with those little T stuff. Oh, no, that's what we all find our.

We find our people, we find our place. We, you know, it all. It all kind of works out. Yeah.

But I do think it's interesting. Surgery to me is just. I think there's some people who want to be a surgeon they love. They like the other surgeons, they like the lifestyle, but they don't actually have good hands. But they don't always realize that they don't have good hands until they have even started their surgery residency. And, I mean, once in a while, I read these things about a doctor who, like, you know, gets let go from their program because they just are not skilled. I think that's pretty uncommon. I mean, one of my friends who's an ENT says, oh, no, you know, you could learn it. You could just practice. I was like, eh, I don't know. But yeah, I mean, I do feel bad for that when that happens to people where they're just like, no, I'm just, you know, they find out kind of a little late that they're not good at it.

I think where what we see, it's more speed, and we kind of get the benefit of talking to the anesthesiologist and they will share some info on your colleagues. But, like, I have a couple colleagues who apparently are much slower, and they have great outcomes. Their patients do great. You know, there's never an issue with the technical part of it, but it takes them two to three times longer to do a procedure that everybody else does. And I think that's where sometimes it's not great. They're like, okay. And as we're seeing the effects of general anesthesia on our bodies, you know, being under anesthesia for three hours versus one hour does make a difference.

Yeah. Yeah.

Well, how can patients know who's a faster surgeon?

Ask the anesthesiologist. I mean, they really are the people that know the best.

Yeah.

So if you were to go back and do it all over again, would you still choose the same specialty?

I would, yes.

I really.

I feel like I found a great niche for myself in that I have. You know, there's good days and bad days, but for the most part, I have good days. And I feel like I have really captured very well the balance between being home, being there for my family, and being there for my patients.

Yeah.

And enjoying what I do. For me, when you were talking about people feeling bogged down. I still love operating, I still love seeing patients. The bureaucracy is what's slowly making being a doctor not nearly as fun.

It's nice being by myself. I mean, you just feel like somebody else just kind of bog you down a little bit.

If you had to go back and work for a big hospital, would you still choose the same path?

If they would let me have the autonomy that I have. So. So for me, I've always said I would join a group. As long though as I don't have somebody telling me, you have to work these hours, you have to see X number of patients. Surgery gives you the benefit of we're paid by procedure, not by patients in the office. So I can see fewer patients and still bring in the money that the group or the hospital, whoever it was, would want.

Yeah.

But I don't, I wouldn't want to be in a situation where somebody is telling me, you have to see this many patients, you have to see this many patients. And I love to talk. So when I'm seeing patients, a 30 minute visit can easily become an hour visit. Mostly because I'm just chit chatting.

Yeah.

And I. My patients tend to forgive me because they know that that's what I'm doing. They know they're going to get the same benefit. But I wouldn't want to be in a practice where they're dinging me for spending extra time chit chatting.

Yeah.

Yeah, for sure.

No chit chat penalty. That would hurt me quite a bit.

Yeah, that would definitely hurt her quite a bit. Sometimes when I have to do something, I want to give you a chit chat penalty.

My assistant that I had for years and years and years, she would come in and make up a doctor's name and say they were on the phone.

That's a good one.

We were just talking with ophthalmologist last week, Dr. McCall, and he was talking about how he wants to have his partners, kind of like as he gets older, scrub in with him sometimes, kind of watch him and make sure he's still at the top of his game. What do you think about that, as, you know, as we all get older and how do you make sure that you're still being the best surgeon you can be?

Yeah. I would reiterate that I don't have partners to call in, but there I would rely on my anesthesia physiologists, honestly. And if they feel like, you know, I'm all of a sudden taking twice as long or.

Yeah.

Little things are going wrong that they would say.

Yeah, you would kind of know that, don't you?

I would hope so. And honestly, I hope to be retired long before.

Long before you get pushed out.

One last thing. Just kind of wrapping up for somebody that's about to, like, start this process. I just asked everybody this. Do you have any advice, like going through medical school or residency or just, you know, well, what do you have for me as I begin this journey?

Keep an open mind. So if you right now think you're going to be a, you know, pulmonologist and then you go do the rotation and hate it.

Yeah, yeah.

That there are. There are plenty of other specialties that will appeal to you and so be willing to. To like the ones that you didn't think you were gonna like and to dislike the ones that you thought you were gonna love and be okay with that. And then I do think, though, from a. How am I gonna balance life and work? You do have to be choosy about your specialty. I think there are definitely specialties that are not going to be favorable for a woman who wants to balance a family and, and medicine. And it's okay and just. But if you pick one of those, know that you're probably not going to get the same life balance that she has.

Yeah.

And I know surgery sometimes is. Is thought to be one of those that doesn't have a good life balance, but I think again, it's. It's what you pick.

Yeah.

For sure. And picking something that doesn't involve a lot of call and a lot.

And it.

And it doesn't mean you're going to have to not do some of it. At first, I had to work my way into. To the lifestyle that I have now.

Yeah, yeah, yeah.

You just kind of have to be intentional about it.

I think that's a. That's a great way to put it.

That's great. And I love this discussion because I don't. She just emphasizes that like in medical training, just a lot of, I don't know, a lot of men don't kind of emphasize that about choosing something that aligns with your lifestyle or just people in general. Don't talk about that as much when, like, that is an important aspect because this is your life.

So.

Yeah, I appreciate that.

But.

Yeah.

If anybody listening needs their thyroid operated on.

Yeah, there you go.

That's the place to go.

Yeah.

And you know where to find us. Enerationsmd on TikTok arcities personalphysicians on Instagram and we will talk to you next week.

Bye.

Bye.