I had the pleasure of interviewing Dr. David Almeida, a Canadian doctor currently working with a group called VitreoRetinal Surgery in Minnesota. He has a Ph.D. in Pharmaceutical Drug Research from the University of Szeged in Hungary, an MD from the Queen’s University in Ontario where he also completed his residency, and an MBA from George Washington University in Washington DC. Following that, he did a two-year vitreoretinal disease and surgery fellowship at the University of Iowa. Lastly, he has his own blog Sunday Surgical Scrubs, which is quite thought-provoking and motivational, so please follow it at http://davidalmeidamd.com/sunday-surgical-scrub/.
How were your medical school and residency experiences?
I was at Queen’s University, which is in Kingston, Ontario, Canada. For geography purposes, it is across from Syracuse, New York. It was excellent training, and I enjoyed being in the university town. I did four years of medical school and five years of residency as we do a one-year internship and then four years of ophthalmology. At medical school, we were a class of one hundred, so it was really nice comradery and a good family feels with a lot of exposure to the clinical side of medicine. For example, we were out there doing clinical skills really early on; that was definitely a fun memory that helped me start to work on physician-patient rapport really early on. What also was great about Queen’s was that it had a very liberal arts approach to it. You cover all the specialties, you shadow people, and you go around. Early on, I knew I liked ophthalmology, so I started doing ophthalmology research and getting into that, which is what led me to the ophthalmology residency. The residency was really high-volume and had lots of surgeries, which is really great for something like ophthalmology and I thoroughly enjoyed it.
Why did you specialize in ophthalmology, and why did you further specialize in vitreoretinal diseases and surgery fellowship at the University of Iowa Hospitals and Clinics?
I realized early that I liked ambulatory medicine, which is that I liked being in the clinic and outpatient medicine. I did not want to be in the hospital all the time. For some things like internal medicine or general surgery, they have a lot of hospital rotations. Another thing too is that from really early on when I shadowed doctors at medical school, ophthalmologists seemed so happy. They were really happy with their careers. They had a good mix of clinics and surgeries. They seemed to have a really high quality of life. Not to perpetuate stereotypes, but whereas a lot of other doctors were bogged down, more cynical, and jaded, ophthalmologists seemed to be enjoying their work and their life. That was a really big eye-opener for me. Then, I specialized in vitreoretinal diseases and surgery since the retina is a really exciting ophthalmology subspecialty with lots of exciting therapeutics and with really heavy surgery, which I like. Moreover, the University of Iowa has one of the top ten vitreoretinal fellowships in the country, which is what made me leave Canada for that great opportunity.
Could you walk us through a regular day at your practice? What other avenues in medicine, besides your clinical and surgical work, do you pursue?
I’m in the clinic three-and-a-half days a week, and I operate the other day-and-a-half a week. When I’m in the clinic, we see a lot of patients with really blinding conditions, which is what makes it really rewarding. You are always working on very serious eye diseases, so in a typical clinic day, it will be a fairly busy day of seeing lots of patients and treating a lot of people with intravitreal injections, which help deliver the medicine to the therapeutic target in the eye. Then on a surgery day, it will also be pretty high volume, creating a lot of patients with retinal detachment, macular disease, and diabetic retinopathy. In regards to the second question, I’m part of a group called VitreoRetinal Surgery, and we have a fellowship program. Thus, we have a lot of research with our fellows where we are working on things from clinical trials to smaller studies. Research has been something that I have enjoyed for a really long time as I actually did a Ph.D. in chemistry and drug design before I went to medical school,. Since my background is in that, I still enjoy and do a lot of it. I also did an MBA in healthcare administration, so I like that aspect of healthcare with administration and resource utilization. Then, as an entrepreneur, we have a drug company where we are trying to use new methods for drug design and use drugs that are being developed that target multiple therapeutic targets. Lastly, I have my blog Sunday Surgical Scrubs that is fun to do.
David Almeida Embolectomy Video
What kind of surgeries do you perform? Do you have any especially memorable surgeries that you would like to share?
Probably the most common surgeries I do is retinal detachment repair. Retinal detachment is the separation of the neurosensory retina from the retinal pigment epithelium. It is a blinding condition if you don’t do surgery in a relatively emergent amount of time. It is not an emergency like a gunshot wound, but it is an urgent condition that needs appropriate surgery. I really like these since no two are quite alike, and their differences make them interesting. Also, it is exceptionally rewarding since you can take someone that was blind and give most of their vision back. We also do macular surgery, which is things like epiretinal membranes, macular holes, vitreomacular traction, and diabetic retinopathy with vitreous hemorrhage. Personal research interest of mine is something called endophthalmitis, which is basically infections of the eye. This can cause really bad inflammatory pictures, and those are a lot of fun to do as well. For the especially memorable surgeries, the first one that comes to mind was a one from this past summer when a young guy got traumatic endophthalmitis. He suffered an injury to his eye and developed a bad infection. Essentially, he had an eye full of pus, so I took him to emergency surgery, cleaned out all of the eyes, lasered it all down, and took his lens. We were really planning on having to enucleate the eye, which is removing the eye from the socket, because of the risk of the infection progressing and the eye not being in use. However, he stabilized and actually had some useful vision. To this day, I still see him, and he is doing well. He doesn’t have great vision, but he has his own eye still. He can still have peripheral vision, and he’s done really well.
Why did you choose to get both your Ph.D. and MBA, and how were your experiences getting those degrees? Would you suggest that others do the same?
The Ph.D. in chemistry and drug design was something I started with after my undergraduate. It was really lot of fun since you are trying to get drugs to fit little targets. It’s a really great intellectual exercise. The only thing is that in the end, you start realizing that to design really good drugs it would be nice to know all the medical aspects of it, which is what led me to medical school. In regards to the MBA from George Washington, I was training in Canada, and I got really interested in the ability to think about resource utilization: how do you appropriate analyses or limit a resource like healthcare, which is very expensive, to serve the most people in the best possible manner. It let me get a reasonable skill set to approach some of those challenges. For other people, it is a tough question because it depends on what your career goals are and what you like to do. Unless you really love it and are interested in those aspects, I probably wouldn’t recommend going after it. If you are interested in those things, it is great since you can greatly increase your skillset and have the ability to be proficient in multiple spheres, which I think is really relevant.
Would you do this entire journey again if you had to start all over? If yes, what, if anything, would you change? If not, what would you do instead?
The answer is definitely yes. I’m happy about where I am and how I got here. I mean I have always been into surgery and the ability to really heal with a procedure. To be able to impact disability and morbidity with a surgical procedure and be able to fix/move on from it. Medicine really affords you that, and it is a wonderful privilege to practice medicine. Although the landscape is changing with insurance companies and regulations, which have hurt the quality of life and our ability to do our job, I think that overwhelmingly it is a fertile and bright field with an ability to help a lot of people. What I would change though would be when I did my MBA as I did it during the clerkship years of my medical school (years three and four). That was really tough since essentially it is a busy clerkship from Monday-Friday with the weekends on call. I was doing anywhere from 7-15 hours of MBA work on the weekends, and because I was on call, it was really challenging. That was before I got married or had children, so obviously, I had more time. Still, that was a really tough 2 years. That’s the only thing I would have changed. Maybe I would have done an executive MBA after my residency or fellowship. In terms of the Ph.D., if you are really interested in research, a Ph.D. before medical school or a combined MD/Ph.D. program are really good ideas if you want to do that and have that as a big part of your career. Navigating the literature and conducting studies are fun and important contributions to your field. The other thing I would say is that it takes a long time. That’s a long road with a lot of years. That has its own costs. If you could streamline it and do things as much as you can at the same time—simultaneously instead of sequentially—you could save a lot of time, which is really important.
Do you have any “words of wisdom” or inspiration for kids like myself who want to go into the medical field?
One, I love how proactive and self-directed you are. You got to find out what you like and what you don’t like. Going back to my point about being efficient with your time, I think the earlier you do that, the better. You have done an outstanding and impressive job, mobilizing some of these thoughts and interests as a high school student; I think that is wonderful. Second, find something you are passionate about whether it be diagnostics, surgery, business, entrepreneurship, or whatever. Find something with passion since that will sustain your drive in the times when you feel like quitting when there is not enough time, when there are complications, and when there is heartache. Don’t do something for prestige, money, or recognition. Those things may or may not come, but they are not really important. Focus on your duty to do something you are passionate about, and you will be richly rewarded.
David Almeida. School for Startups Radio, schoolforstartupsradio.com/2017/06/best_team_wins/. Accessed 2 Jan. 2018.
Faculty Affairs: Office of the Provost. George Washington University, facultyaffairs.gwu.edu/. Accessed 2 Jan. 2018.
Passion Is the Difference between Having a Job or Having a Career. Twitter, twitter.com/rovinach/status/764677680000176128. Accessed 2 Jan. 2018.
Queen’s University. Queen’s University, www.queensu.ca/about/visit. Accessed 2 Jan. 2018.
Szegedi Tudományegyetem. University of Szeged Faculty of Medicine, Faculty of Dentistry, Faculty of Pharmacy, Foreign Language Programs, www.med.u-Szeged.hu/fs. Accessed 2 Jan. 2018.
University of Iowa Hospitals & Clinics. University of Iowa Hospitals & Clinics, uihc.org/locations/university-iowa-hospitals-and-clinics. Accessed 2 Jan. 2018.