Expert Opinions: Dr. George A. Scangas MD

Expert Opinions: Dr. George A. Scangas MD

Instructor, Department of Otolaryngology -

Head and Neck Surgery

Massachusetts Eye and Ear Infirmary (MEEI) - 

Harvard Medical School (USA)

George A. Scangas MD graduated from the University of Pennsylvania (undergraduate and medical degrees)  and was trained in Otolaryngology -Head and Neck Surgery at Massachusetts Eye and Ear (MEE) / Harvard Medical School (HMS). He completed a rhinology/skull base fellowship at Harvard. At present Dr. Scangas serves as Instructor in Otolaryngology (MEEI/HMS). He has published extensively in the fields of rhinology and sinus/skull base surgery. Dr. Scangas’s primary research interests include chronic rhinosinusitis, anterior skull base surgery, endoscopic sinus surgery, patient-reported outcome measures, and healthcare economics.

                            

Read below, his very interesting answers  to 

  THE HEAD AND NECK BLOG!

Dr. Scangas, why did you choose to specialize in Otolaryngology? What attracted you in the field then and what attracts you now?

It all began in medical school at Penn in the anatomy lab. While most students preferred the anatomy of the heart or GI tract, I was fascinated by the complexity of the cranial nerves and the anterior skull base. Soon after I shadowed Dr. David Kennedy, the pioneer of endoscopic sinus surgery in the US, and was further drawn to the field of Otolaryngology and specificially Rhinology. His mentorship was invaluable to me during my medical school years. At Harvard, Dr. Ralph Metson took me under his wing during residency and fellowship and really helped me identify my research interests. Aside from the interesting disease processes and the joy of taking care of patients, the wonderful aspect of Otolaryngology remains the camaraderie in the field between surgeons, residents and medical students. It is truly a pleasure to work and teach in this field.  

You are subspecialized in Rhinology and Skull Base Surgery. What makes it special for you? Could you briefly describe a typical working week of yours?

An incredibly rewarding aspect of my subspecialty is that 50% of my practice involves treating non-terminal diseases and improving patient quality of life, while the other 50% is more focused on malignancies of the anterior skull base and requires working closely with Neurosurgery and Ophthalmology. Both types of patients are incredibly rewarding to treat, and the variety helps keep things interesting both in clinic and in the OR. In a typical week, I usually have 2 days of seeing patients in clinic, 1 or 2 days of anterior skull base surgery, 1 day of endoscopic sinus surgery, and 0-1 academic days.

    You have a significant number of contributions in the scientific literature of your field (314 citations as of March 2019). How are you combining research activity and clinical practice and how has it helped your career so far? How do you see the role of Surgeon-Scientists in modern healthcare?

Research is critical in my opinion for an academic surgeon. Not only does it keep you up to date on new discoveries and findings in the literature, it gives you a focus outside of patient care and helps connect you with clinicians and researchers from around the globe. The key is to find something that truly interests you. That is hard to do as a medical student and even sometimes as a resident, as productivity sometimes trumps true interest. However, at some point, transitioning to a focus project / area which truly excites you and motivates you will be paramount. The life of an academic surgeon is extremely busy, and I have found that for most individuals, only the truly important endeavors have lasting power. For me, the answer was not in the lab, but using my engineering and mathematics background to study cost effectiveness and health care economics. 

   You are an Academic Otolaryngologist. What in your opinion makes a competitive applicant? What are you looking for in an applicant?

To me, a competitive applicant is genuine. Most applicants in this day and age have published extensively and have excellent grades and marks throughout their schooling. What really sets people apart in my mind is motivation, enthusiasm, and a track record / story to match. This is why interviews are so important for residency. Beyond residency, reputation matter most. What well respected physicians write and say about you carries the most weight. Honestly and dedication are two qualities that all admissions committees look for in Otolaryngology applicants.

   What would you advise a medical student, aspiring to pursue a career in Otolaryngology? How important is it to have proper mentoring during Medical School and residency training?

As I mentioned above, mentoring is critical in all phases of medical training. This shouldn’t just be defined by a forced relationship with a high-ranking physician (although having a mentor who is well known does help), rather ideally it should be someone who you feel has an interest in seeing you succeed and someone that you get along with well. Mentors come in all forms. Some you will count on for clinical guidance, others for research. Mentors are like windows into a specialty for medical students, revealing the true day-to-day life of a clinician within a specialty you are considering and offering critical advice when making important decisions along the way. I am still in close contact with some of my mentors from medical school.

   Skull Base surgery is heavily dependent on medical technology and has evolved remarkably during the last decades (e.g. the endoscopic trans-nasal sphenoid approach). Could you name 1-2 important turning points in your field in the 21^st century? How do you see the field in the next years?

 Some major technological advancements that allowed endoscopic skull base surgery to flourish were high resolution, small caliber endoscopes in combination with accurate and sophisticated image-guidance systems. Improving visualization and surgical access led to confidence among surgeons that endoscopic surgery could achieve expected goals in a safe manner. Just as important as technology however was the evolution of endoscopic reconstructive techniques. Before that, it did not matter if tumors could be resected endoscopically if a CSF leak could not adequately repaired without an open approach and a peri-cranial flap. The nasoseptal flap in particular was critical for endoscopic reconstruction.  Endoscopic skull base surgery has a bright future. Techniques and surgical approaches are being refined and adapted to access difficult to reach sites such as the infratemporal fossa, petrous apex, middle cranial fossa, etc. I think in the next 20 years we will appreciate the limitations of the endoscopic approach and refine techniques and reconstructive techniques to improve not only mortality rates for skull base malignancies but also long term quality of life for patients.

   Could you please share one of your most rewarding and one of your most challenging moments in your career?

It is important to understand that challenging moments are inevitable as a surgeon. I have learned this from my mentors as well as through my own experience. It is critical to never become over-confident in your ability or lose the attention to detail that will make you a great surgeon. An easy way to never lose that is to truly treat each patient is if they were family. In that sense, any complication or sub-optimal outcome, whether it be due to forces you can control or not, weighs heavily on a surgeon. Always reflect on those situations and try to learn from complications, both in training and as an attending. A mentor of mine once said “You learn more from a single complication than from 100 cases that go well.”

In terms of rewarding moments, a career as a surgeon is filled with them. From achieving surgical excellence and independence to watching your students do the same, there are countless daily moments that are inspiring and fulfilling. Nothing however surpasses the gratitude of a patient and their family after you have treated and improved life for them. That never gets old. My advice would be to chase that feeling.