Accepted: Keeping Up with Dr. Andrea Tooley – Ophthalmology Resident and Soon-To-Be-Fellow [Episode 244]

Dr. Andrea Tooley is currently an ophthalmology resident at the Mayo Clinic who will soon start a fellowship in oculoplastics in NYC.

I know you’re a returning guest, but can you tell us a little about yourself? Your background, where you grew up, went to college and medical school? [1:22]

I am originally from Sarasota, Florida, and lived there until I was 16, when my family moved to Indiana. I stayed in Indiana for college, going to Butler University in Indianapolis, with a double major in English literature and chemistry. I then went to Indiana University for medical school, followed by the Mayo Clinic for residency. I did my intern year at Mayo and now I’m in my final year of ophthalmology residency at Mayo.

When we last spoke in Winter 2015 you were starting your ophthalmology residency, how has it been for you? [2:13]

It’s been so great. I feel like a different person than I was as a first year. It is such a transformative residency. You don’t learn much in medical school about the eye, and so coming into an ophthalmology residency you just know nothing! I have loved my residency experience at Mayo and am going to be sad to leave.

What did you like best and least about your residency experience at the Mayo Clinic? [2:54]

The culture is very unique – it’s very collaborative and focused on patient care, but also on research and innovation. It is a tremendous institution, and I feel very lucky to be a resident where I have so much support for doing research, attending conferences, and so forth. I feel like working at a place like Mayo has made me want to be better, to do better, and the department of ophthalmology is a really happy environment. All the attendings are great, and you also get a lot of autonomy, which is important to me. I’ve grown a lot, gotten to do a lot of stuff on my own, and become my own ophthalmologist.

What do you think could be improved about the residency program? [5:23]

No residency is perfect, but I think generally it is a really well-rounded residency. I think it is all about fit and where you think you are the best version of yourself.

What were you looking for in a program? [7:01]

I was looking for a resident-run clinic. There aren’t many programs that offer that. With ophthalmology you really need to do it to learn it. So much of it is pattern recognition, and you need lots of exam and technical skills – to look at the eye and know how to do it. I wanted a lot of responsibility because I knew that would make me better, and watching someone else wouldn’t work for me, so all of the programs I ranked had resident-run clinics. I also wanted to go somewhere I felt challenged, and to feel lucky I was matched there. I wanted to go to a reach school. I was so nervous with my Mayo interview, thinking I wasn’t good enough to be there, but it made me want to be better, being somewhere that would push me.

Did you ever adjust to primary call? [9:08]

Primary call is rough. With some programs you take it all three years, but at Mayo you only do it your first year. What primary call means is you are the first person on a pager, so any time of the night 24/7/365 if someone needs an ophthalmology consult in your area you are getting the page. It is divided between the residents, but at Mayo there are only four residents, so every fourth day you’re the one. You are being woken up at night – it’s incredibly rare to sleep through the night, and you take a weekend at a time. Some programs are much busier than we are, but I’d say Mayo is right on the edge, so not so busy that we can’t actually do it all in one year, but busy enough that it really takes it out of you. You’re tired, you have no consistent schedule, and there is a real psychological toll of holding that pager. It’s harder to relax and get a good night sleep. It’s like needing to make sure you don’t sleep through an alarm to get to an important meeting or to catch a plane – you just can’t get good rest. It physically affected me – I felt it in my body for however long I held that pager. What’s strange is that by being paged you are going to see a patient, doing what you love. I was never mad about that, but I never got used to it. It is not an easy year. The only good thing is it’s only a year and you never have to do it again (at least at Mayo).

After that first year, second years are on back up so available for questions first years have, which is just so much better than not holding the pager. The first year has already done the leg work, you are just providing support. Third years only come in for surgery typically. You might be asked a question but it’s so much easier when not the first line of communication.

How much of your decision to pursue ophthalmology was a matter of interest and how much of it was lifestyle driven? [14:23]

It was zero lifestyle driven. I really fell in love with the eye and the idea of eye surgery. I wanted to be a surgeon first and foremost. I didn’t want to just do medicine. It seemed like a really interesting and rewarding career, and I was also really interested in international work. It’s really gratifying to help people with their vision. I know some people need to think about lifestyle who have families or other circumstances, but I didn’t.

You announced last spring that you have been accepted to an oculoplastics residency in NYC starting in Summer 2018. What is oculoplastics? Why did you choose it? [15:31]

Oculoplastics is one of the fellowships within ophthalmology. It is a two-year fellowship and the official name is Ophthalmic Plastics and Reconstructive Surgery. It’s the one fellowship that’s different than all the others in that you focus on the tissue around the eyes, so you will treat any disease affecting the orbit eye socket and skin around the eye – eyelids, tissue around the eye, cheek, forehead, the tear drainage system into your nose. I had no idea I wanted to do this going into residency. It wasn’t until I did my first rotation in plastics my first year that I fell in love with it. I tried to keep an open mind in my first year, but I kept coming back to it. I didn’t love intraocular surgery as much as I thought I would. I felt I was missing anatomy and principles of macroscopic surgery. I love the surgical creativity you can have with reconstruction, like refashioning an eyelid. It’s like the art of plastic surgery and I love that. There is a cosmetic component, you could do eyelid lifts, botox and fillers and such, and you can do a lot of functional things like droopy eyelids from nerve damage. You can also do orbital surgery – all kinds of things can go wrong with the eye socket – tumors, bulgy eyes, and craniofacial abnormalities, for example. You also can work in combination with neurosurgeons or ENT surgeons.

Since you started your journey to becoming a physician, have you ever thought you made a mistake? Wanted to quit? [20:57]

No. There have been months or semesters that have been really rough and I wouldn’t want to relive them, but I never thought of quitting ever. I’ve always had the mindset of one foot in front of the other, and I’ll get through it. To say you can get through medical school without any difficulties is unrealistic. Everyone struggles in different ways, and lots of people think about quitting or rethinking their path but I really wanted to be an ophthalmologist, and I’ve always been able to see the light at the end of the tunnel. I never lost sight of the end goal. You have to find joy in the things you do every day. For me there was always enough joy to get through it.

I was poking around on your Instagram page and saw pictures of you on Capitol Hill. You indicated you were involved in advocacy. How did you get involved and what were you doing? [24:17]

I was able to travel to DC last spring with the American Academy of Ophthalmology. They choose residents or fellows to be part of their advocacy efforts one day out of the year. On that day we go speak with state senators and legislators about bills that affect our patients or that can help us. We talked about NIH grant funding for ophthalmology research from the Department of Defense. There are lots of traumatic injuries to the eye, and we need more research for that. We also talked about medication expenses for our patients, and other legislation that makes it harder for us to treat our patients every day. The Academy selects as a whole the issues and trains us on why they’re important and how they’re affecting our patients. Anybody in a medical training environment is so focused on learning the medicine that the big picture things are not even on your radar. I have no background in politics so was completely clueless, and it was so wonderful to have this experience. The Academy also used it as a time to talk about being involved in leadership in ophthalmology in a national organization. I want to go this year and continue to be involved. I really encourage students to do this type of thing, even with the AMA.

Are you keeping up with your fitness, food, and fashion interests? [28:37]

Yes, I don’t know so much about my fashion interests since I am always in scrubs, but fitness and staying healthy is super important to me. Whenever I let that fall to the wayside I can tell in my mood, energy, and productivity. I eat lots of fruits and vegetables and keep up with my fitness routine. Lately I’ve been going to the gym first thing in the morning.

You’ve now applied successfully to medical school, residency and a fellowship. How do those application processes differ, other than the obvious stuff? [31:04]

I don’t have many things to say about my medical school application since I did early decision at IU. I knew I wanted to stay in state, felt I was a pretty competitive applicant, and only had one interview. I didn’t have the whole experience of applying to many. For residency, looking back on the whole process I think I was pretty naïve. I wanted my letter writers to be people who knew me really well. I didn’t think about using a big name. People nobody knew wrote my letters. I had no real strategy, I just wrote a heartfelt personal statement. At least for ophthalmology, to have a successful application experience you really need to show your interest. Looking at my resume it was easy to see that was what I was passionate about. I loved everywhere I interviewed, and feel really lucky that it worked out so well. I think I had a strong application, but wasn’t very strategic about it at all.

Linda: You are illustrating an important point. The real interest in the field is clearly the most important thing. That is one of the biggest mistakes we see residency applicants make. You can’t adapt your med school personal statement which we’ve seen people do. It’s not so much about the big names, it is the demonstrated interest in the field.

How about your fellowship application experience? [36:22]

Fellowship was different. One reason is that oculoplastics is tiny. There are only 500 certified surgeons ever, so everybody knows everybody. There are only about 25 fellowships per year and each have one spot. I was really lucky since at Mayo we have three surgeons who are super well-connected, so my letters just happened to come from really big names. I had great people vouching for me. In general my application was pretty straightforward, I was a little unique with my social media stuff, and I want to be a residency program director. I also was slightly more strategic with my fellowship applications. I did have my mentors make phone calls for me, and I told my number one program they were my number one program. I was very direct about that, which worked in my favor as well. I also really feel that letting them know I was ready to work hard, was passionate about oculoplastics, and being specific about my career goals was important – this is who you are going to get as a fellow. In my field, if the fellowship director I am matched with decides to move, I would be moving with that doctor, so being true to yourself and who you are is important.

What do you wish I had asked you? [41:07]

Your listeners are motivated great people and they need to know they should work hard, follow their heart, and take opportunities. I really believe that whatever is coming my way is leading me to the end point where I am supposed to be, and things have evolved for me over time. Saying yes to new opportunities and being 100% into what I do gets me to where I want to be. So don’t be scared about the future – it will work out.