Dr. Hilary Fairbrother (Emergency Medicine)

Yeah, Allah a la Marvel Comics.

Right.

One, I'm a, I'm a urologist. And in one, I'm me here with you today. And in one I'm a, you know, I don't know. I don't even know. Yeah, maybe I'm selling art in Paris. I don't know.

That's right.

Hi, everybody, and welcome to the podcast. My name is Stephanie and I'm joined here by my colleague, Dr. Sarah Davis, who's also my mother. And today we have a very special guest, Dr. Hillary Fairbrother. Dr. Fairbrother is a board certified emergency medicine physician. She also has a master's in public health and is the vice chair of education at McGovern Medical School and a professor at McGovern Medical School. So we are so excited to have Dr. Fairbrother here with us. Welcome to the podcast.

Welcome.

Thank you both. I'm very excited to be here.

Yeah, that was just kind of a briefing, but I kind of want to go in a little bit more about where you grew up and how you chose the path towards medicine. I know that you trained in Atlanta and New York City kind of all over the map. Tell us a little bit about your story and, like, how you got to where you are.

Sure. So I grew up in Montana with my mom and my grandparents and my aunt and uncle and four cousins and two siblings, all as like my nuclear family unit. I grew up in Helena, Montana, and came time to go to college and I applied widely and went to the place that gave me the best scholarship, which was Bryn Mawr College. I wish I chose it for some other reason than that. It's such a wonderful school and I got such a great education there. But that's, that's real life. So I went to Bryn Mawr and got a bachelor's in chemistry and a minor in French. I lived in France, Minnesota, my third year. And I had always been interested in medicine. I found myself in my friend group, in my siblings. I was always the person who people seemed to come to when they were sick or hurt, even though I had no real knowledge. I, I remember my friend Tyler fell off his mountain bike going down the hill like a gazillion miles an hour and like sliced open his leg. And he was like, well, I mean, can you, like, can't you just fix it? I was like, no. When we went to the emergency department and they sewed him up, I think he had like 27 stitches or something. Insane. But I always felt like that was my role is. I, I, I would try to make people feel better. And I liked taking care of people. And then, you know, you go to college. And I was like, oh, I love science. This is great. I've always loved science. And I also loved France and I loved speaking French. And I was like, maybe I'll sell art, but I guess I'll take my mcat. And my mom was like, you know, practical things, practical things are important. I'm sure she was thinking, like, you just got a challenging and expensive degree to go sell art. Like, wait, wait, wait, wait, wait, wait. Not that there's anything wrong with selling art. It's wonderful career. But she was like, what about your science? So I did. I took my MCAT really early and, and kind of always had it in my back pocket and then got to my senior year and I was a live in nanny and I just, I really enjoyed again, this like, caretaking aspect of, of taking care of two little girls and was like, well, I guess I'll apply to med school. The of the family that I was nannying for, both parents were physicians. And, you know, I just had this really positive perspective on like, what it was to be a physician, what it was to be a physician parent, all of those things. I absolutely applied to med school and really enjoyed that whole process. Kind of traveled all around the country interviewing at different medical schools, and I did. I ended up at Emory again, first scholarship. I, I'm not gonna lie, I'm so thankful that I went to Emory. It was definitely the perfect place for me, but I had no idea what I was doing. And so I was just kind of applying all over and ended up at Emory and did five years there. I did my MD and my MPH between my third and fourth year there. Along the way, fell in love with public health and fell in love with emergency medicine. Matched residency in New York City. So after five years in Atlanta, moved to New York City for residency, and then I stayed there as an attending for another nine years. And then my husband and I were starting our family and we really wanted to be close to family. And his whole family was here in Houston, and my family's in Montana, which is great, but there's no med school, no residency, and I have really married myself to this academic medical career and I really wanted to stay in it. And so we were looking in Houston, and Houston has such a wonderful, amazing med center and now three medical schools. But back then, two medical schools and there were just really great job opportunities. And so we moved to Houston now over seven years ago. And the rest is, the rest is History now. I've been here ever since.

That's amazing. Yeah, I love that story. And, well, that was kind of similar to you with going abroad.

Oh, well, that's kind of interesting. I was. I was an exchange student in Spain when I was a senior in high school, and both my host parents there were doctors, which was kind of funny because at the time, I had no idea that I was going to be a doctor. I didn't know anybody that was a doctor or anything. And so, like, I saw that. But they. He was an orthopedic surgeon, and she was a pediatric surgeon. They had a very nice life, like, you know, hours wise and everything. I think it would be a little bit different if it were here, but. Yeah, that was. That was interesting. Also my. Yeah, same thing. As far as, like, where I went to med school, I was like, oh, I went to the cheapest med school where I got in first. And it's like, you know, hey, that's. That's where I'm going. And finances are a big factor in all of these decisions.

You really are. They. I mean, I also did the. I did the public loan forgiveness. And so, you know, 10 years after starting residency, my loans were gone. Right. Like. Like, this is great.

Yeah. Yeah. Well, I'm just interested of, like, how you got really interested in academics. Is that something that you always thought you would do, or was it just sort of you were there doing residency and then just. And decided to stay on or like, I. I guess. Did it just happen or was it like a conscious decision?

No, it kind of just happened. Again, I would love to say I had this big plan. I knew everything that. No, I just. I was finishing residency and I had signed a contract for my first job in community emergency medicine on Staten island, where, like, the opioid epidemic was thriving and going strong. And I had a colleague who had graduated a year prior, and she was working at this hospital, and so I had, like, kind of knowledge that the group was really great. I had. I had interviewed at a couple different places, and this really. I wanted to stay in New York City. And I like the idea of working in a place like Staten Island's kind of this cool place within New York City. Right. It's. First of all, it's another island, but it's just every neighborhood in New York is different, and Staten island kind of felt in some ways a lot like Montana. So it was like Montana in. In New York City. Don't tell them that. They probably wouldn't like that. But for me, it felt like it was a lot of really real people. And sometimes New York can feel pretty plastic, artificial. Everyone's transient. No one was from there. No one stays there for that long. They kind of go. There's. There's not a ton of families. And once you start leaving Manhattan, I think you see a lot more people that have been there for generations, different types of people. And so I just. Living in Manhattan, Staten island just seemed really, really cool. So I had this job, and then my chair of the place where I had done residency was like, hey, rather unexpectedly, I have a job opening, but it's in pediatric emergency medicine. And I need somebody who's really good at peds, and I really want someone who's really good at teaching. And I think you would be really great. And I was like, I've already signed a contract. And he was like, yeah, whatever. Contracts are whatever. And. And you know, I, I started looking into it and of course, you know, I signed for more hours and less pay. So all, all around my decision making was, was flawed, but I got, I started thinking about what it might be to be in education, and I was like, well, I'll give it a year. And. And then I just, I. I loved it. They really invested in me, the program. They had all these specific needs. So, like, they needed somebody in pediatrics, but I wasn't fellow trained in pediatrics. So they sent me for these like, advanced courses in pediatric critical care and resuscitation. And so I got to like build that element of my, of myself and my practice. I got all this experience within high definition simulation. And they set. Sent me to courses and they let me buy one of these like crazy $30,000 high definition mannequins so I could teach the residents. And. And then it was really just one thing after another. The academic faculty were really dynamic, and there was just a lot of opportunity at my first job in Brooklyn where I could just develop myself. And I kind of. I mean, I know there was that movie with Jim Carrey, but I just. My rule for myself was, unless it seemed like an absolutely terrible prospect, my job was to say yes. And people would say, can you do this? And I would say yes. And. And if I really didn't like it, then that was something different, but I just said yes. And so I totally went back on that contract. I signed in Staten Island. I stayed where I did residency. I had also received a lot of feedback from my ancillary team, like my nurses and my respiratory therapists and the technicians, like, that they were really excited about me staying and part of me was like, well, if I stay here, are they always going to see me as a trainee? And that, you know, they were like, no, please stay. Please stay. We want you to stay. And that there's. I think there's nothing more wonderful than your team, you know, really being supportive and really being happy that you're there. It's nice when we do it for each other as colleagues, but it somehow feels. Well, Dr. Davis, you could probably say this. It just feels different when it's from somebody who isn't even another physician. It's. It's another member of your multidisciplinary team.

Yeah. Well, I think you're doing a lot right when the rest of your team really feels that way about you, because it's just not always like that in those situations. So I think that's. I think that says. That probably says a lot about you and your character and work ethic and the way you treat other people and all that. So I think that's. I do think that's lovely and something you should feel good about. Yeah.

I want to touch on one thing that you said about just like, saying yes to everything. I can see how that led you to discover more things that you wanted to do, like saying yes. Having the opportunity to go into a wonderful work environment and learn that you really liked education throughout your life. Do you feel like now that you're a mom and like, raising a family and also doing academics and also like, still working in the emergency department, like, do you feel like that's shifted to being like, I need to say no more? Do you ever feel like you're saying yes to too much over committing?

Oh, I've definitely over committed. And, you know, you. You stretch yourself too thin, you get too tired, you start, you know, not being as reliable as you want to be. It's. It's always going to be a risk. I think the beauty for me, you know, when I started out my career, it was just my path. My path was that I was. I was not married and I did not have kids until later. A lot of women in medicine do this. I would really strongly advocate that if you are partnered and you are ready to have a family, I would tell any woman in medicine, doesn't really matter whether you're in med school or a resident or early faculty. It's just never easy. And I encourage people not to wait. I waited, but that was my process. I didn't get married until I was in my 30s. I didn't necessarily even know that I wanted to have kids. So my process was that my first years of my career, when I was really focused on my career, the most thing I ever was to any other person was I was a partner to my husband. So not that that's not nothing. But he was also living that New York lifestyle. We were both working like crazy work hours. He was first a lawyer and then in small businesses and business development in New York City. So like we were both working like crazy. We had two little dogs and that was the, that was all the dependence that we could take care of. And my dogs went to daycare because like we weren't home. And that allowed me the time and the space to say yes and really focus on my career. And not everyone's going to not, that's not going to work for everyone. And I don't think that especially as women with everything that we do, we should feel pressured into to one mold or another. That's just that that's worked for me and I, and I certainly overextended at various points in time and I'm sure I probably will again. I've gotten much better and it, I think it is easier as you develop yourself in a space. So I said yes and did like everything. And I moved around within education for like the first six years of being in attending. And then I realized what I really loved was teaching medical students and that's what I wanted to focus on. So then I pivoted, I moved to NYU and I really focused. And the only work that I did really besides practicing emergency medicine and teaching residents on shift, was education of my medical students. And I supervised that for NYU and I taught within the medical school there. And then when I came here to McGovern, I did a lot of the same thing where I was doing the doctoring course with Dr. Toy as his assistant, what Dr. Tyrasina is doing now. And I really, I, you know, I really enjoyed that. But again, narrowing all the things that I was saying yes to and I, I still try to say yes as much as I can. I feel like people say no a lot and they, they want to be mindful and, and like deliberate about the way that they spend time. But sometimes that can be really self limiting. And so one of the things I've noticed is that like not as many people are willing to teach, whether it's lead a problem based learning session or teach my residents a procedure. And so that is something that brings me a lot of joy is that direct teaching. And I like to keep that incorporated. So I still say yes to that now when somebody asks me to be on another committee, I have worked really hard and I already made my professor status. So unless that committee is about what I want to work on, I usually say no. Because I'm like, listen, there's, there's other people that need to be on these committees or should be on these committees. This is not, this is not the time for me. I don't need to sit on every committee. I don't need to be part of every, you know, every level of everything. So I think we all should be deliberate about what we say yes to. But I, I do worry that in that focus of being more deliberate and more mindful of time spending, that people are really missing out. I would have not known that I loved teaching medical students had I not said yes. When somebody asked me to be the clerkship director for the emergency medicine rotation at my hospital, I was already doing the simulation and that was with the residents and I loved it and I enjoyed it. And then somebody, my chair came to me again, said, hey, would you be the clerkship director? I really only need you to do it for a year. Going to hire somebody to do it, but I need somebody to cover this year. And I was like, yeah, sure. And I did it. And then I went on and I was an assistant program director for the, for the residency. And I was like, I like this, but I really loved that. And I don't know that I would have just, I don't know that I would have just known that. And I, I talked to a lot of young faculty and I'm like, how do you, how is it that you know what you want to do? You say you want to do this, but a lot of times we make those decisions because we see somebody doing it and we really want to be like that person. But it might not be the actual job itself that we love so much. Like, it's hard to know and maybe it is and maybe it isn't. So there's a balance there. I don't always strike the perfect one. I tend to err on probably being too over committed and better. Now kids will teach you that.

Yeah, you gotta be there.

Yeah, you gotta be there. There's just no not being there. Right. Like you, I have a three year old and a six year old. Like, there's no not being there. You need to be there. You need to feed them. Like, can't leave them in the house by themselves.

Like, it's just, it is not yet.

24,7 gig that either you're there or your Partner's there or your family's there, like someone's there.

Yeah. I was just curious because you kind of have all of these different roles. I was curious, like what percentage of your time do you spend doing those different things? And then when you are in the emergency department, you're doing shifts when you're, you're kind of there supervising the residents or. I'm just, I'm just curious how all of that, you know, kind of what your, what your job is really like.

Sure. So, and this somewhat recently changed, right, because I was the newly appointed dean of pre clerkship education. So I'm in charge of the first two years of med school. And so that is 50% of my time is the curriculum and the innovation and administration and the accreditation and the quality control and all of the things for the first two years at McGovern. So that's a relatively new role for me. And when I switched to that role, I actually, I still practice the 30% of the time. So I work one clinical eight hour shift a week. And because of our schedule, that could either be the Sunday overnight shift into Monday, that could be the Monday day shift, or that could be the Monday evening shift. So always that Sunday, Monday time is my clinical time and then Tuesday through Friday is my, is my rest of my job. I like to say I have a full time job and then I, I get to practice emergency medicine. And then 20% of my time I spend now being then. And again, this is just last week the vice chair of faculty development, so the Vice chair of education. I've switched that role to another colleague here in the department of Emergency Medicine. And now I'm going to focus on faculty development, which is something that we have long really wanted to be more deliberate about in the emergency department. And so now we're gonna. That's, that's gonna be my gig. I'm the first one though, so I've gotta figure it out and, you know, set some, set some programming in motion.

Wow. Boy, that is, that's a lot. That's a really, I mean, that's just interesting how you kind of go from, you know, being, being a resident as an emergency department to, you know, being on faculty and then kind of moving through these different roles until you're now designing all the curriculum for the first two years. I mean, that's really, it's really interesting.

It's a lot of fun. It's. And it's great privilege and it's very humbling and it's a huge honor to be in these roles, the easier time I've had when I've had mentors and coaches and sponsors and people to help me develop myself, it's, you know, really can make someone's career, especially, I think, especially for women, because we're not always. We're not always equally promoted or equally seen as candidates for leadership just on our very, you know, on our very lonesome. So having. Having my history and having all the people that coached me and developed me and mentored me, now this is like, all right, now I get to kind of put a lot of that in motion for my whole department. And that is just really, it's. It's pretty awesome. I'm pretty excited about it. And there's just nothing better than spending time with all of you in the med school, especially, like, these first two years. No one goes to med school to learn the foundational material, and there's so much space for us to innovate and create in that. In that area, to like, really make your education, like, so much more. So it's just. It's an exciting time to be in that space.

Yeah.

And, like, we all love you. And that's definitely one of the reasons, like, I want to have you on the podcast too. I'm sure so, so many of my classmates will be so excited to listen and hear your story and everything.

Don't they get enough of me already? I. I feel like. I feel like at some point it will be Hillary overdose. It would be, like, too much.

Well, we get you in that context, but, you know, we don't get to hear the background and other. Other sides of things. So I think that'll be nice. I want to go back to what you're talking about, about just like, how saying yes, everything led you to being able. It sounds like you had space in your life to be able to say yes to things, and that led you to kind of like, figuring out what you wanted to do and, like, what you kind of wanted your career to look like in that time. But, like, even just going back prior to that, how did you figure out that you wanted to do emergency medicine?

You know, I, again, I wish I did not have the typical, like, oh, I was in EMS in college, and then I was a paramedic or an emt. I didn't have any of that or a really big emergency department story. I did really break a lot of bones as a kid, so I repeatedly went to the ER as a patient. I had no. I had no, like, fun filled memories. They were kind of pain filled memories. And you Know, it's. It was fine. I was fine. Orthopedic injuries are fixable. That's the best part about them. But, you know, I had always thought that I wanted to be like, I went to med school, and I was like, huh, I wonder what I will do with this? And then going through med school, I was like, you know, I think I'm really interested in surgery. And I did surgical research between my first and second year, and I loved it, and I loved my surgery mentors. It was. It was just such a wonderful experience. They were such kind and warm and, like, nurturing people. And I, like, had this very different perspective about what it must be like to be a surgeon. And they just. They had this great department, and they were just. They were fantastic. And so I was like, wow, I think. I think I'm going to be a surgeon. And then I. I had gotten involved in healthcare advocacy and organized medicine. And so I was part of my school's chapter representation to the Medical association of Georgia, which was part of the American Medical Association. And so then I started going to these national meetings because, like, man, if you're a med student and someone's like, hey, will pay for your hotel in New Orleans, if you go to this meeting, you have to go, and you have to talk about health care policy, but, like, don't you want to go? I was like, yes. So, you know, I went to New Orleans my second year of. Of medical school with, like, my roommate and bestie, and we have all these, like, super fun pictures and fell in love with health care policy and, like, what we could do on a. On a bigger level, on a macro level kind of thinking about health care not as. It just was the patient in front of me. And so then I still went into third year thinking surgery. And I did all my rotations, and I really did. I have to say, I liked everything. I liked all of my rotations. I liked taking care of all the different patient populations. I liked outpatient, like my. So my family practice rotation was one of the most formative experiences in med school. I spent a month with this. This woman who was an independent, solo practice, family practice doc in. In. In Georgia. And I learned more clinical skills and clinical, like, medicine than I did the rest of med school. Not to knock the rest of med school, because it was really great, but it was incredible, right? Like, so I had such a great time in all of these different rotations, and I was like, wow, I really loved everything, but I guess I'll still do surgery. And then I got. I Had somebody was like, you should run for office within the AMA and the national kind of level of medical student things. And I did. And I had no business running. I did not have enough experience. I did not have a plan. I did not have. I was, I was running against another woman who was just incredible in every way, shape or form. But for some reason, I won. And this is life, man. Sometimes you get things that you have no business getting, and sometimes you don't get things that you're like, I was the best person for that job. That is, I think that is just sometimes, like, there's just, it's just the way of the world. So I ended up getting elected and I was the member at large for the medical student section of the ama. And that year, childhood obesity had hit, like, had hit our communities and our awareness of it and how it was affecting our, the young people of our country in the systemic level. And it was, we really wanted to do something different with this position. And there was a bunch of grant money to support me, like, being part of all these national collaborations with these schools, with Duke University and this like, anti obesity program to try and get students in schools like, fit and, and exercising. And they needed me to travel every four to six weeks for the entire year. And I mean, Dr. Davis, can you imagine trying to be in your fourth year of med school, trying to match successfully in cardiothoracic surgery? That is what I decided I wanted to do. My dean was like, Hillary, he said, I think you're going to, either you're going to do this position well and you're not going to match very well, or you're going to, you're going to really sacrifice your fourth year and you're going to be constantly told you're not doing the right thing because you're, you're going to be traveling or you are going to just not do this position very well. You're going to miss out a bunch of opportunities there so that you could be an excellent fourth year student. He said, I don't really see how you can do both. And I said, well, what do I do? I want to do both. And he said, I think you need to take a year off, but I don't want you to just take a year off. I think you should get a master's in public health. It will complement all of this healthcare advocacy. You can do a healthcare policy master's in public health at the, at the School of Public Health, at my med school, at Rollins and at Emory. And this will build you up, you will be an even more competitive residency candidate once you're done. While it should surprise no one that he was an emergency physician with a master's in public health who was one of my closest mentors and guides and sponsors and, you know, just absolute coaches through, through the five years I spent at Emory in grad school and I got done with my mph and I was like, I don't know if I want to be a surgeon. And, and I tell people I think I would have been a really happy surgeon. I didn't have a mentor who showed me that I could be an advocate at the level that I was advocating for patients and be a cardiothoracic surgeon. Even just the 10 years of training that it takes to do that, I got a lot of feedback that, like, you cannot do these other things while you are becoming and then practicing as an early career, they said, you know, give it 20 years and you can get back to your healthcare advocacy. And that just did not, that didn't sit right. I was like, no, I want to do this now. This is, this is how I recharge my batteries. Like, this is, this is part of me now. I don't want to just put it on the shelf for two decades. And I think also when you're, when you're young, 20 years seems like whole lifetime. And now that I'm in my mid-40s, 20 years still, still is a long time, but it's like, it doesn't quite seem like a whole lifetime. Anyway, I, I took that and I, I was like, I don't, I don't want to. I want it all. How do I get it all? And again, my mentor said, well, you know, you know, medicine. And I started, I did a rotation right at the start of my fourth year, and I was like, oh, my gosh, this is procedurally based. It's resuscitation based. I get a lot of that critically ill. Do something to get someone better. I still got to practice a lot of the medicine. The only thing I really had to give up, of course, is patient continuity, which is a big thing to give up. It's an important thing to give up or to consider when going into em. And, and so I jumped and I was like, gosh, I hope I like this. And it was, it was the perfect, it was the perfect branch of medicine for me because that whole. Every patient, everywhere, every time, it doesn't matter what they need or who they are, that you're going to do your best to take care of them in their moment of wherever they Are at. Whatever they need is just. It really sings to me. Like, I jumped in and never looked back. And it was. It was definitely. It was the right decision for me.

That's good. I mean, I see it like. Yeah, that. That's a very interesting story. I think that's, you know, how you. How you got to choose that.

Well, I think we sometimes get this perspective that there's, like, this one thing, there's one thing, and we are meant to figure out what that one thing is. And I honestly, I think I would have been a really happy urologist. And people don't often think about women in urology, but there are so many women with urological issues, especially as they age or have more children. I think I. I would have been really happy in urology, focusing on our female population. I think I would have been a really happy cardiothoracic surgery. I think I probably would. Ended up in peds, though, still. Which is. Which is, you know, that Dr. Salazar here at UT is like, I. The closest thing to a magician that I've ever met in a surgeon. He. He does, like, miracles with these little baby hearts. I just don't know how he does it. And I am. I am just an incredibly happy and fulfilled emergency physician. I'm sure there's probably some other things in there that I think I might have been a pretty happy orthopedic surgeon. Like, I. I don't. I don't ever want. When medical students are trying to figure out what they want to do, I'm like, remember, you might have a couple of things that would be really good.

Yeah. Yeah.

A la Marvel comics. Like, there's, like, these divergent lifelines.

Right, right. And it said I should be a dermatologist.

There you go.

And family medicine was, like, 10th or 12th down on the list. I think it had me, like, had dermatology, it had emergency medicine in there, anesthesiology, a lot of other things that before family medicine, I'm like, well, see, I could have done all those things, but, you know, I'm perfectly happy with this one, too. So. Yeah, I think you're right. I think this idea that, like, okay, this is the one thing, and this is the only thing that's going to make me happy is, you know, I don't think that that's true at all.

I saw you send that. In our family group chat, she was like, I took a quiz on what specialty I should be, and it said dermatology. And I was like, is she just bored right now? Just, like, taking quizzes I was like.

I mean, I grew up taking quizzes. Like, there. We used to actually get paper magazines and there would be quizzes in them.

You.

All of the different things. Like.

Well, I was actually just.

What's your. What's your. This. What's your.

Yeah, I was curious if that. If there was like, a good tool like that that existed, because I was like, huh, that seems like something that should exist, you know, and how good is it? And this was. It was on like, it was from Student Doctor Network. And anyway, I was, you know, I just kind of googled it and I was like, I'm going to see what this is like. Because I don't know, I just thought, well, that would be good for you and your. Your friends to, like, look at stuff like that at some point as it comes along. I don't know. I think those things, when it. When it gives you the answer that you want, then you put a lot of stock in it. And when it doesn't give you the answer that you want, you just, like, throw it away. It's like, yeah, we used to do those quizzes, like the Cosmopolitan quiz, like, are you and your partner, you know. Yes. Yeah.

And then it'll be like, yeah, your boyfriend's great. He's perfect. And I, you know, or you know, or he's terr. And like, you should break up, like.

And you're like, these things. Don't know anything. He's the best.

Doesn't tell you what you want or what you.

Yeah. So we used to have.

I want to say the ACGME has. Has a. Like a tool that's like a quiz, but if you look to see, like, how accurate is. That was not the best. You know, we really have some students that start med school and they have a defined interest. They have a kind of like, I know I really like this. And I. I have to say, I really love the idea of going through third year and. And that a little bit of that, like, you know, you can't just say, oh, I really like this. You kind of need to live it a little bit because, like, really liking the OR for two hours on an afternoon and then really being willing to, you know, wake up early in the morning to be, you know, in the OR by, you know, and rounding on your patients and. And all of the things that our, you know, our surgery colleagues really do regularly is. Is very different. The 247 life is. Is very different for some, you know, for. For some of the different specialties. So, yeah, we don't have the Students take that. We used to have the everybody take it in the first week of class. That's that. I think that stopped a couple years.

Ago because yeah, I think it's probably a bad idea because it's a little premature.

Yeah.

And I think you just kind of conform biases. When Stephanie was able to bring I got to meet some of her friends from her class recently and people were starting to talk about what specialties they were interested in and all of that. And I was just like, oh, you know, it's nice to talk about that and think about it but like you don't really know what any of those things are yet. So hold your horses before you get too ground into some of these things.

Well, I don't know if you know this Dr. Peer review, but I actually took videos of most of the class. Like I think I got at least 150 people of them saying it was during orientation week of them saying what specialty they want to go into and I have it all in a file and then on match day I'm going to like do it again and I want to like make a big video comparing like what people said that and want to go into. Love it match too. Yeah. So it changes so much. But just talking about how like you don't know what the 247 life actually looks like. How has your specialty, like are you happy with your decision? What does that look like? Is emergency medicine what you expected it to be and are you happy with your choice?

I'm very happy with my choice. There are definitely elements that are what I expect it to be. So when, you know, when I get a call or when somebody comes in and CPR in progress and I need to resuscitate, I, I expected it to be that. I think all of us see that on the TV show, right. Like even the public, they think when they think of emergency medicine like that is what they think is like somebody's been in a car accident, someone's having a heart attack, someone's having an emergency and like I am doing life saving, life altering procedures, skills, etc. I also because of my public health background really hoped and expected it to be a lot of social determinants of health management and interaction with case managers and social workers because I was picking emergency medicine for that. Right. Like I wanted that really close relationship with a community that comes from being like so close to the, maybe some of the biggest problems in the committee in the community. Um, so those two things I think I very much expected and it absolutely is a lot, um I think, you know, part of being an emergency medicine physician, especially with eight hour shifts, is that means a third of your shifts are during the day, a third of your shifts are in the evening, and a third of your shifts are overnight. And so how that really looks is going to be different depending on how and where you practice knowing and understanding and feeling. The idea of working holidays from really like the start of your career till the end is very different, I don't think. I think it's very, it's very tough to anticipate what that's going to feel like. And that also feels different. When I was, you know, single versus married with no children versus now I've got two kids and, and my husband's, you know, parents who we take a lot of care of. So, you know, life and, and, and working holidays is different. When, you know, I used to, honestly, I don't, I, I actually really like spending holidays in the er. Patients are really vulnerable when they come in on a holiday that's important to them, especially if they really either they were, they wanted to be with their family and now they're not with their family because they're here with you and they're really, really sick or they have no people and they're, and they're with you, but they really don't have anybody. Like, if they weren't with you, they'd be alone. But this holiday is important to them and so you're dealing with some of that. So I actually, I used to love, I used to work like every, like Christmas and every Thanksgiving and like all these really big July 4th. I used to work all of those holidays, New Year's because I was like, well, I mean, I'm a social person, but like there wasn't anything I was too married to and if I wasn't with my family and again, I was in New York City, my family wasn't there. I was like, well, I'll go visit them. It's cheaper, it's easier to go travel like after Christmas or you know, before Thanksgiving, all of that kind of stuff.

So.

I kind of, you know, that really changed, right? The, the reality of working a holiday when my kids know it's Christmas, they've got that little Advent calendar and they're like, tomorrow, tomorrow is the day. And that's when Santa comes and you're like, I had, I've got to be there. Well, okay, if I'm there at Christmas, then I've got to work Thanksgiving in the er. But honestly, so Thanksgiving being a non religious holiday, I Just moved Thanksgiving and our family Thanksgivings on Friday. Yeah. Then I work every Thanksgiving, which is our most sought after holiday, for our staff to have off. So that allows my staff to have that off or at least, you know, whoever's not. I, I work a 12 hour shift on that day, so whoever is working the other half of that day is with me, but everybody else gets that day off to be with their, to be with their loved ones.

So that's nice.

Well, it's, it's. Right, it's what, it's the reality of working holidays, which I think I, I did not necessarily understand until I had lived it.

Yeah, I think that's, I think that type of stuff is people just really need to really at least think about it and try to process it. Before that, people used to always say that emergency medicine, what they liked about it was that you, when you were on, you were on and then when you were done, you were done. That used to be kind of the big argument for it. Although when you're a dean of a medical school, I don't know, I don't think you're ever done. That's a different.

But yeah, you know, I will go home after, after I finish with you guys, I will go home. My son wants to go practice baseball. No one's going to, no one's going to call me and I'm going to have to run to the ER to, to see a patient and not play baseball with my, with my son. So like, yeah, in that sense it, it is absolutely compartmentalized, especially the clinical practice. You know, I'm not on call. I don't, I don't if I, I'm actually, I think sadly our whole society has become so addicted to our phones. It's, it can be a real barrier to us being well and having like, good relationships with everyone who's physically around us. And my husband hates this, but I, I'll put down my phone for like eight hours. Nice. Especially if I'm with my kids. I'm like, well, yeah, like, okay, I'm with, I'm, I, I am taking care of what I'm supposed to take care of. And you know, there's always a chance something has happened, but the reality of, you know, me needing to respond to that within the minute is, you know, it's just not there. And that is a really lovely part of my life. I think I get to be a really present parent for a physician parent. I get to be a really present partner for my, for my husband.

Yeah.

And, and you know, My little brother's a surgeon, so he, I mean, he has a really hard time with, that his wife has a really hard time with. Like, he can be pretty consistently. Like if there's somebody he operated on, even if he's not on call, a lot of times he'll go in if they're, if they're not okay. Like, and that's, that's, you know, that's different. He also makes a lot more money than I do, so.

Right. One thing just like talking about emergency medicine we were. When I was talking with these first year students, somebody was saying, well, you know, I want to do emergency medicine because I think it's like really exciting and the adrenaline will be rushing all the time. And I was, and I was just curious to get your perspective on that because I feel like once you've done anything for a long time, it's not really so exciting anymore. That doesn't mean it's not interesting, but that I was like, I don't know, I went. Do you feel, do you still get like an adrenaline rush when you're on a shift? Or is it more like ho hum, coding a patient? I don't know. What, what are your thoughts on that?

I mean, I, I am definitely an adrenaline junkie. I think a lot of us in em kind of are in the best way. Like, I was, I was walking from the med school to my office here, and the helicopter was landing on the building and I was like, I get a little happy. I'm like, o. I hear a siren and I immediately like, like screaming, squirrel. Like, you know, it's, it's. I definitely still get those endorphins and that adrenaline, especially with those critical moments. I'm, you know, I'm, I'm definitely less, I would say anxious or nervous about it, but it's still a big deal. Somebody comes in or they're coding or we're, you know, even if it's routine, because I've done it a bunch, it still is, it still feels something special when, especially when there's these tipping points for patients. So you can, you can tell they're either getting better or they're getting worse. You feel like you, you understand what's going on with them or you have no idea. I had a patient yesterday. I was like, I signed him out to the next team and I'm like, so this is my sickest patient. Please, you know, watch, watch this one. But this one, I have no idea what's going on. I've literally done all this testing, all this workup I have no clue. We've, this is our plan, this is where we are in our plan now. But like I, I got nothing and I'll look up to see kind of what happened with that, with that patient today or, and I'll, I'll text my colleague and see what happened. So I still get quite a bit of that adrenaline and I do really like it. I, you know, it's just that reaction to emergency. It. I, I, weirdly, they tracked us during COVID and you asked what it was like during COVID Covid was really bad. All right. So Covid really stressed our healthcare system, but it really stressed our ICUs and our ERs to the max. It was really tough and a lot of people decided to retire early across our country. And that included within medicine, and that included within emergency medicine. We've had a different looking match. You know, we used to be very competitive. Every spot filled. Now we always have spots that are into the soap and they go through the second match process. We'll see if that trend, you know, stays. But you know, for a minute there, nobody wanted to do emergency medicine. They were worried about burnout, which we have a lot of burnout. But they were worried about, you know, are there going to be jobs? Is everybody replaced by a nurse practitioner or pa? Turns out it's, there's a lot of private equity in medicine right now and PAs and NPS are more expensive. So as soon as private equity figured that out, they were like, yeah, okay, we're good, we'll hire the doctors.

I saw, I saw some studies about that. I thought that was, yeah, so it was something that intuitively we kind of knew. And, but it was, was really great to see that borne out in the studies.

Yeah. And, and you know, when Stanford puts their name on it, then everybody gets excited because this, you know, this institution. But the, I love that the first data really came from this multidisciplinary clinic and ER in Mississippi, Hattiesburg. And they were like, listen, we've been, we've been tracking this and it turns out that, you know, you might pay that person less to see patients, but, but they're not because of the way tests are ordered and the inaccuracy, the delayed diagnosis, the, the over testing. It's actually more expensive. The care delivered is more expensive. And private equity is really good at being like, well, we're not doing things that are more expensive. So, you know, right, right now there's no problem. There's tons of jobs, everyone's hiring. But I do think that all of these things have. Have changed us, you know, emergency medicine. So many of my colleagues, especially when the pandemic first hit, so many of my colleagues were like, I have nothing to do. You know, the whole country was like, what hobbies am I going to pick up? And I was working in a tent, you know, seeing hundreds of patients every day. And then I was pregnant with my second. Knowing that pregnant women, it wasn't high risk for Covid, but it was before the vaccine came out, and I knew that I had taken care of multiple pregnant women who had died or who had, like, been intubated. And I was pregnant, and I was in the tent taking care of COVID It was very stressful. Remember, like, everybody's washing groceries and, like. Right. And all of this stuff that until we knew, we didn't know that was really, really hard for emergency physicians across the country. And my. My colleagues in New York, because that hit first, right, for them. And Seattle, 20% of them got Covid in the first big wave, and some of them got really, really sick, right? We. We lost an ob GYN resident here in Houston. Like, it's not something that I think we've even fully appreciated yet, but it definitely had a big effect. And it had a. It had a big effect because, you know, all my neighbors were like, wow, I'm working from home. I'm so bored. All I do is walk all day. And I was like, all I do is go to the ER and work and tell people that, you know, and unless they're hypoxic, they need to go home until they get hypoxic and then they can come back because I don't have any resources for them. And, you know, we just had. Had a really. We had it really actually pretty decent. You know, the medical center has the ability to flex ICU beds like nowhere else in this country. And so we were okay, but all across Texas, we were not okay because people couldn't transfer anymore. So all these little places with, you know, a lot. Not a lot of resources that normally transfer here all the time, all. I mean, 100 miles from Houston in every direction, transfer to me regularly. And that was gone, right? Like, everything was full. Everything was stopped. We were having adults at Texas Children's, like, you know, it was. It was a. It was a moment, and. And nobody was allowed in the hospital, right? So not only were we taking care of people, we were scared of getting sick. But then we realized, you know, we weren't going to get sick. It's okay. Probably weren't going to get sick. But then we had to be people's family. I mean, the number of hands that I held while people died by themselves, our rule in rer was that no one dies by themselves. And so we would just kind of take turns and we would have shifts where, like, you know, 10 people would die. I mean, and it was awful. And so. But our rule was no one. No one dies by themselves. And so that's a hard thing to fulfill when there's, like, just you're by yourself. So it takes a toll. A lot of my nurses quit, and I don't blame them for a second, but it was. Now, in retrospect, I do think that it's brought the specialty kind of together in a different way. So it's a little bit of this special post pandemic. Even though we're. We still had a huge surge this summer. No. Right. Everyone had Covid. People started getting fevers again because now it's like the new. It's a new enough strain that, like, people got a little sick again, but not too bad.

Yeah, yeah, yeah.

Well, I think all this is just, like, important to consider. Thank you for talking about all that, because it really just gives a bigger picture about, like, what being an emergency medicine physician looks like. So, yeah. As we're kind of like, wrapping up here. Again, thank you so much, like, hearing your full story, and everything was amazing and definitely different than anybody that we've talked to. So thank you so much for, like, sharing your story and everything. This is a broad question, but I like to ask everybody this. Obviously, your job is to talk to medical students, so I'm sure you have a lot of advice to give, but if you want, if you can condense it a little bit, what advice would you have for somebody in my shoes who just started this journey, and to any of my other classmates maybe who are listening, what advice do you have for us?

Looking back, the things I wish I had done a little differently. I wish because, I mean, I. I love giving advice, but really, when we give advice, we're really just talking about, like, our. Our experience. And again, I've spent some time in Al Anon because I have a sibling who deals with addiction. And so in. In Al Anon, we say, you're not really giving advice, you're just really giving your story. So in my story, if I could talk to me as when I was starting med school, knowing, like, where I stumbled, I would say, like, listen, you're capable of great things. This is going to be a lot of hard work. It just is. And that's okay. The. The desire to be perfect might make you study harder, but you should really just figure out what's important to you. So at the end of the day, what was important to me is that I be an excellent physician, and I wanted to score well on the tests and do well on all the things. Again, I wanted to be a surgeon and. And all I was, I was headed towards a really competitive match. But in retrospect, what was really important to me was, like, learning, you know, for those future patients. Giving myself grace when I didn't perform well. I wasn't really good at that because I think all of us are going to stumble. You're going to do something not as well as you would have liked at some point or evaluated in a harsh way. Like, I think it's really hard when you be evaluated by someone, you know, maybe in third year or for a preceptorship, and they just don't. They're like, yeah, you were fine. And you're like, fine. I'm amazing. Like, just giving yourself grace when either the test score is low, figuring out how to be better the next time, as opposed to beating yourself up for not being as great as you wanted to be, and then also just remembering that it is a process and it's very important to preserve. You know, when you said, like, how did you know you wanted to be a doctor? Well, that, for me, that desire and the. The amazing feeling that I get when I help someone, not letting that spin out of focus as you're. As you're going through the schooling and then residency and then the practice, when I lose sight of that is when I start to feel really either unhappy or unfulfilled with my. With my job or, you know, really frustrated with something that's going on. If I. If I focus on taking care of people and how that makes them feel and how that makes me feel, it always kind of re centers me and it reminds me what's important because, like, at the end of the day, right, Like, I can do everything right, and a patient is still going to die of their terminal liver failure. I admitted a young man to the ICU yesterday who will be dead in the next, I don't know, maybe month, maybe six months. There was no. I made sure he didn't die then, but. Right. Like, there was nothing that I'm going to do. I can't get him a new liver, but I did take really good care of him, and it made him feel better. And I also spoke to his mom and I took extra time to get a translator because he spoke English, but his mom didn't. And that's the kind of stuff that even though it's hard to deal with the fact that I can't, I can't really help him, I can't fix what's wrong with him. I felt like I had done a really good job with his care and I had done a really good job as his physician and I felt like he, he did too. Like he felt cared for even though I, you know, he's still really sick and it's still, it's still not better. And that's just kind of the crux of medicine is that even when we do everything right, bad things happen to people, bad outcomes happen, and by the way, we do things wrong. I'm sure, I'm sure your mom can. I mean, that is hard to live with if the goal is perfect. And the only thing that's good enough is perfect. So I know for me, I just had to learn a little grace for myself and, and just again, that what is important to me here, why did, why did I, why did I apply to med school to begin with? Am I still remembering and focusing on that? Because the farther I get away from that, the harder it's going to be to be joyful and really happy and content with this long term career.

Yeah. Yeah, I think I appreciate that and I appreciate the advice, you know, staying centered and remembering, like why we went, like why we got into all of this. So thank you, thank you again for being here. Is there anything, do you have social media? Is there anything that you want to plug before we wrap up?

Sure. At Hillary Fair is my, pretty much my handle everywhere with one L, H I L A R Y F A I R. That's my Instagram, my Facebook that I'm never on because no one's on Facebook anymore. But that's my Instagram. I think that's my TikTok. But they don't really like us as UT employees to be on Tick Tock. So I don't, I don't really do Tick Tock, but I do Twitter and Instagram. I think I have a Snapchat, but I've never really used it. So whatever. There's like a discord thing that I heard about. I have my handle, but I also have never really used it. So mostly Twitter and Instagram.

Okay, great.

Or X. And I'm also really boring healthcare policy stuff. So.

Okay.

It's nothing super fun. Sometimes I'll post like something about my My kids, but I. I try to be pretty judicious because. Because, you know, they don't get to choose being online. And I know it's like, once you put it out there, it's. Yeah, it's there forever. And, you know, I just don't want to. I don't want to put too much out there for either of them before they get to choose how they want to be in this space.

So I kind of thought that. That what you were saying there about being centered, and as I was just kind of watching you, I think that would be a little. A good clip whether Stephanie puts it out there or not. Or maybe you just need to record that, Stephanie. And just kind of now and then when you're right through these tests and everything, I think you. It's very easy to get so in your head about little details. I mean, lots of little details about life. Right. It happens to me as well. And sometimes some patient is upset about some little thing, and I get all in my head about it, and then I'm like, it doesn't matter at all. It's not going to make any difference. It really has nothing to do with the care that I'm providing them. And you just. If you kind of just bring yourself back and get centered on that, then you're like, oh, yeah, right. This is actually a wonderful career. And so, anyway, I think that's. It'd be good. Put that in your pocket.

Yeah, for sure. Stephanie. I spent so much time comparing myself to others because that's how I had always. I, you know, did you get the best grade? Okay, who got the highest grade? Did I get the highest grade? Like, I had spent so much time doing that, and that helped me be really successful. All right. It's not that.

That.

It's not that striving for the best that you can be is. There's nothing wrong. We should all be doing that all the time. But when that comes at the. At the. At the cost of something else, like. Like who you are or why you're doing, especially with something as longitudinally challenging as. As medicine and taking care of patients, it's just not worth it. I. I don't think. And I. And I. I wish I had stopped comparing myself to others and just really focused on doing the best that I could. I could do. And. And again, if I felt like I wasn't learning the information and I wasn't going to be able to take care of my patients, that was a big deal. But if I was like, well, I could have missed two questions instead of five questions. And then I like, oh, come on. Like, in what world is that worth even a second of your. Of your focus?

Yeah.

And I. And I wish I had known that because I spent a lot of energy and I beat myself up a lot. And I just, again, I just got uncentered. And it took a while, it took that year that I took doing my masters to really focus and be like, why am I. Why are any of us doing this? Why are we? Why am I doing this? And now, honestly, being with all of you all the time, it is so easy to stay focused on what's important. All you have to do is spend any amount of time with a first year medical student. And everybody remembers, like, oh, yeah, I remember. I remember. I can see myself in that suit. Like, I remember what this was like. You are all the most wonderful, like, medicine for any physician who's burnt out. I just, like, want to stick them in a room with all of you and just be like, just soak it in.

Just listen to them.

Did you like that plus learning? Did you have a good plus learning day? I hope, I hope, yes.

Yeah.

So, like, my group was telling everybody in our little group, like, all the things like why we, why they went into medicine, what they wanted to do. And I was like, I just need to record this right now. Like he said, like, I just want you guys, like, whenever you're having a bad day, please remember this. Like, this is why we're doing this. Yeah.

I even, like, I started doing stuff for ambassadors and talking to, like, pre meds and people coming through. And even that reminds me of being like, oh, there's so many people who, like, want to be in this position. And like, I just. And I see myself in them. So I can definitely see how, like, you see yourself in us too. So that's really special. So you guys know where to find us on Instagram @Generations MD. Tick tock @Generations MD. If you have questions, podcast topics, or are interested in being a guest on the podcast, you can email us ataskgenerations mdmail.com and we will talk to you next week. Bye, guys.

Bye.