Episode
This episode features Dr. Adam Milam, a cardiothoracic anesthesiologist and public health researcher. He joins us to talk about his journey into health disparities research, medical school and the specialty of anesthesiology. Dr. Milam took a very unique route to medical school. A route that includes an incredible amount of work for disadvantaged communities.
He talks about completing a fellowship in Cardiac Anesthesiology at the prestigious Cleveland Clinic. In his “spare time” Dr. Milam has produced over 70 peer-reviewed publications. He sees it as his duty to give back and help others learn how to critically evaluate and produce research. He is involved in several non-profit organizations, including Reach Out To Youth , which provides mentorship for students interested in STEM.
If you or someone you know is interested in becoming an anesthesiologist or getting involved in public health, please listen to and share this episode. If you receive value from the show, please share, subscribe and leave a comment.
TBDP is a volunteer passion project with the goal of inspiring all who listen. In-house music and audio production, so any ideas for improvements or suggestions for future guests are welcome. Visit www.StevenBradleyMD.com to learn more about our host. He is available for consultations or speaking engagements regarding health equity and medical ethics.
Transcription:
The left of his podcast, I like the stories of minori professionals with the goal of inspiring others. You like we, you hear to subscribe and share with others. The next generation can be. You don’t see in every Monday to hear our stories. I welcome back to black doctor’s PODCAST, I’m Steve in your host this week so have to be speaking with Dr Adam Milam. He is a fellow and is Seselis. He is wrapping up a Cardan grazing Seseley Polishin at the Cleveland Lini and before then he finished his residency and Solgier sign. I, Dr Milam, thank you so much for joining us on the show. Thank you for having me on the show. I’m really excited to join man. I’m excited to hear your story because you have been everywhere. You’ve done a bit of everything. So once you start the beginning and let us know, when did you decide to go into medicine that was right before high school really enjoyed science, and I knew I wanted to to do medicine. My Rod was in a straight a straight road to medicine, but I think you know back before high school. I know definitely want to pursue medicine yeah, so so after high school. Where do you go to college going to college at Johns Hopkins? So literally less than a mile from my high school, I could see the Hopkins campus from my high school so ended up going to Hopkins and strangely enough started out doing chemical and by over, like Er Engineering. So I thought I was going to be an engineer, develop medical equipment and then going to medicine a little bit later, really didn’t enjoy engineering at all. I did for semesters of it realize it wasn’t for me, then switch to chemistry and then landed in public health, and I finished at Hopkins with the degree in public at Your Baltimore born and rains born and raised with the public schools. calcimine city, Public School City College, which got a shot out, is the third oldest public high school in the country, and then yeah went to Hopkins afterwards and it spent eight years that happening eight years, a half. So what were you doing? What happens you? You did Undergrad and then you stayed on for a Master’s yeah. So I was. I was there for my public of degree, it the Undergrad public health degree I applied to medical school traditionally, the summer between junior and tenor year, just like everyone else was accepted, but the fired for a year to do my masters at the School of Public Health, and I did my masters. You know half way through my masters. They suggested applied for the PhD program, which I wasn’t considering. It was on my radar at all. I was planning on going to medical school, but applied to the PC program was accepted and they attached funding to it. So it was pretty hard to turn that down. I decided not to go to medical school and complete the PhD at Hopkins Switch, which I did, and I think I was it was a great experience for me. I think, altered my career traducte, so going back to when you start at that public health degree. What led you in that direction? A lot of people will kind of do other degrees to get in the medical school. He had t opton go to medical school, but you chose to do the public health. Absolutely I took a class of a community house class and the good aspect about the classes. You were paring with a organization within Baltimore, and so I work with the organization called Project Heath that help address some of the psycho social issues the patients go through. They aren’t addressed to the hospital, so things like housing and food and security, and also started doing some public health research at the same time, and so this is a whole new film. For me, I knew nothing about you know public health per se before I started that Major. So, given all the problems in Baltimore and a lot of a lot of them fall under public health, that was my way of giving back and learning more about ways to fix. Some of the you know major problems in Baltimore, so it was a good degree for me to learn more about my city and learn more how I could adjust some of those those issues that were plaguin the city and kept it close to home. Yes and then, as you were finishing that up, I started talking about this PhD. So what did you get your PhD in and how did they kind of convince you or what was the carrot that led you into the PhD Versus Medical School? So I was accepted into it and it thirty two training grant, and so what that is the little pay for your tuition, help support. You know things like equipment, conference travel and you also get a monthly stipend, and so I did the PhD in a Department of Mental Health at the School of Public Health and attached to an I training grant through the Thews, a child, mental health services, training grant and so fully funded, and so, like I said it’s hard to turn down free money to do a PhD at the you know: Number one school public cot in the world, so I decided to do that instead of going straight to medical school. I know these different grants have these crazy, numbersthese, ks and teas, and so a t, thirty, two grand. How do you get that? How you sign up for it or apply? What was that process so for the ten thirty two, and also for a post stock row? Training Grand Award the institution actually applied for, and they have a certain number of slits, and so they can award it to train these that they see fit, and so it’s an institutional right. I need trying to fund their their pet work, but you you’re it’s essentially funded through the nit, but the institution actually applies for. So how long did it take you to complete the requirement for the PhD so given it? I took all my classes and all my degrees were at the same institution when I was you know, completing my undergrad degree. I started taking some of my master’s level classes and same thing when I was in my masters degree, I started taking some of my p program classes. So I finish the p the masters degree in one year in to my PhD, I finished in two and a half years, so I finished the PC program March of two thousand and twelve and I had finished. You know my bachelor’s degree and you know, may a t two thousand and eight so go under four years for the masses, MPC for Ram wow and then at that point, you’d already had an acceptance to medical school yeah. So before I defended my dissertation, I reafed to medical school got accepted to medical school and then the first for another year to complete my PhD program. So I defended my dissertation March Two Thousand and twelve graduated May of two thousand and twelve and then started medical school July. Two Thousand and twelve so went right through and went to medical school Wan State in Detroit Yeah ca at you, man, yeah you’re, getting after it. So how was the the experience of Medical School? You Got Out of Your Beloved Baltimore. You saw some different stuff. How was Michigan a transition there? It was. It was a big invitin just from the PC program to to medical school and then a totally different city. Like you mentioned, I have been in Baltimore all my life and so now I’m twenty six starting at a new institution in a new city, but the trot was, it was amazing. Experience for me reminded me a lot of Baltimore something o the same public health problems. Roughly the same demographics Detroit is about. Eighty Percent African American Baltimore is about sixty percent, so you had that same type of field in Detroit, but it was. It was a good experience. I enjoyed my time at Wayne State. I really got a good cinico experience and my classmates were amazing and made the you know, experience even better awesome and at some point you realize that in Syslog was the field for you. So what drew you into this special day? Yes, so I knew I want to be in the operating room, so I was actually considering surgery during my third year of medical school actually did the extra month of surgery back in Baltimore side in a hospital. In addition to my two month, block of surgery really enjoyed it and really thought I was going to apply for surgery because of the procedures like. I said I love being in the operating room, but the personality wasn’t a good fit for me and realized that Antissa, I could still be in the operating room, do a lot of procedures and it felt right. The the atmosphere was more conducive to how I operate and so ended up applying to and Sysoy it’s M anses a research, my fourth year of medical school and then transition to see the Sindin Los Angeles Peresians. So when are you man you’re, making a way west across the country? Yes, how was that transition to La Yeah? So I never considered myself. You know living on the west coast. I always thought I would you know always be in like the northeast, but la was everything that you see on TV. Everything that you hear the weather was amazing, which is a big part, so hot to do a lot outside the hospital which I think helped out with with the residency with all the stresses were residency. I I got to bake a lie, lot hike a lot and I was at an amazing hospital, so Cedar Sidis located right in Beverly Hills. It’s the hospital for the stars, so it’s a very fancy hospital y have every kind of resource that you could imagine and it was a small residency program. So when I started there were only eight residents, it was five fellows for you know. CARDIAC FOR FOR REGIONAL! So is a small like Moman pop program, and you were one to one with your attending, which is pretty Ivan, heard out for a residency program. So you got a lot of attention with the program and, like I said it was, I learned a lot and it was clinically heavy heavy. So I got to do every type of case that you could imagine yeah and and thinking back what stuck out to you. What specialties did you really enjoy the most? So for me I was critical care and Cardiac Cedars does a lot of cardia cases and you spend most of your time in the cardiac surgery. Is U, and so my first case was my first cardie case was a long transplant. What there was all yeah, it was a Awfu lung transplant and at the beginning of the case, the CT surgeon said this is going to be like a mini cold throughout the entire case and that it was, and so the excitement from that that, on case had me consider cardiac or fellowship, but I was still thinking about critical care because I just enjoy being in the IC you got to follow, follow up with your patients, got to you know, practice a little bit more medicine than just big in the operating room. But ultimately I decided on cardiac just because I love begin the operating room, and I knew that I wanted to do research when I started practicing and it would be hard to split my time between the or you know the ICU and doing research yeah. So you finished and Seseley residency. You ended up going to the Cleveland Clinic for your CT and is thysia fellowship, which you’re wrapping up as we record this episode. How was that one year experience? Can you explain what a Cardatas in is Teja is for our listeners? Definitely so for CT and a Segar Cardio thorician a Segar, you focus on the cardiac and thoracic cases and you really focus on learning Transita Gil Echo that year, and so you get familiar with the echo probe and interpreting images and using that to guide treatment for the the cardiac surgeon, and so we handle the heart transplants. The vice management, the Rascia, where you remove the lung, delibatis or lung transplants, and so it’s a busy year so Cleveland Clinic is the busiest cardiac center in the country, and so you definitely put in a lot of work, and I tell some of my mentis that first month of fellowship, I felt like an intern all over again, I was at a new hospital, a new system and they just do everything a little bit differently and you know they call it the clinic way. Everything is different. Like you know, traditionally you play central lines at the head of the bed. They put e central lines from the left of the patient. So but you know someone can start doing the echo. So it’s certain things it is. You have to get you to the you know. I have been accustomed to doing certain things from residency. Oh that first month of fellowship was was pretty challenging, just learning the new ways and getting used to a new system, but this year I’ve learned a lot. The cases that you see there you’ll never see anywhere else, and I think that will prepare me well for my next adventure. We’ve had you know five time rede. So she s a piece in if certain out of me, so yeah patens an no else to operate on. So it’s been a great learning experience from me and can you break down the year because you rotated kind of three different services? I know you did mostly cardiac, but what other specialties did you do so for the fellowship here? We just how they break the rotations down, it’s just based on different pathology or the different surgeries. So you do a rotation on a Ardita or we a rotation on a order where you know you’re dealing with a oric, dissections or AORTIC aneris. We do a rotation on Mitro Bow, which is you know, a pretty common surgery and they don’t a lot of robotic cases now, where you also do some regional blocks with rigid line Segur, and then you also do a critical care of mom spending time. You know managing the patients after they leave the operating room we spend. You know two weeks with the profusion, is learning the bypass machine and everything they do, while the patients on bypast, but mainly you’re in the operating room for about ten months and then the you know, those other rotations outside of the or I see you and by PAS. Yeah sounds like an incredible program, but a very, very busy year definitely a busy. I think I’m working a little bit more than residency but, like I said I’ve seen just about everything that you that you could want to see in a cardiac fellowship yeah. So your ideal job, if you had to put out together, because I know you’re close to letting everybody know where you’re going to go to work, but I ideally, how would you manage between Anastasia Cardachan Ist Gia your research? What does that look like for you sure, so that was a big consideration when I was started to apply for jobs? How much research do I want to do and how much clinical time? And for me all my research up until now has been done on my spare time and so going in? I probably go how they going to do ninety percent clinical and about ten percent research just to start off, and ideally I would still do big cases for all of that clinical time, and so my plan is to do fifty percent cardiac if to percent liver transplant, and then do my doing my research as I get more comfortable clinically being on my own as an attending I’ll start to carve out s some more research time and apply for some external funding. Oh Man, we got to talk to talk about work life balance. Yahye said you did this research in your spare time, yeah so throughout residency and fellowship, I would do research. You know on post call days, vacation time and any down time when I was in the hospital like it was a a light call shift. You know I would do research, so I always have my epan with me. I always have a folder with a stack of articles that I need to read or review or edit. So it’s always happy ing yeah. It’s not a good for quite balance at this time. Well, what let me break it down for the folks listening in and Dr Milam’s part time, research he’s published over seventy P reviewed publications more than seventy five national international presentations. Multiple media features multiple award, so not not bad for part time it’s. What is it a busy busy time man and, in addition to all of your medical training, you retained a part time faculty appointment at the John Hawkins School of Sorry, let me say it correctly that John’s Hawkins School of Public Health? Yes, so I always call myself a hopkins kid so, like I said, I spent eight years there for a school and then, when I finished my PC program, I got an appointment later that year within the Department of Mental Health and I’ve worked with them. You know, since two thousand and twelve. So now you know almost a decade on the faculty after finishing my training, and so I still collaborate with a lot of folks at hogpens and a lot of folks in Baltimore, just because of the research that we started when I was in you know doing my masses program. A lot of that research has continued in. So I work with a lot of the Grad students, the PC students and a lot of the existing grants for people at a because Jeez. So if you can remember this far back, when did you publish your first paper? I definitely remember that my first paper was published in two thousand and ten and really enough. It was a paper that I had to write for a class just as like a final paper and my mentor always says it’s no point of writing for no reason, write the paper submitted for your class and then submit it for publication, and I did just that so after the class ended. I submitted that for publication, and that was my first publication and that was in two thousand and ten wow and if you can pick this is like choose between kids, what one or two or three papers would you say is your favorite that you’ve had published sure. So that was my first paper, I would say, was one of my favorites, and so I looked at perceive safety and academic achievement among elementary school students, so looked at violence within their neighborhoods and then subsceivae, and so that was my first paper paper that is recently published that I thought was pretty good. I was published in the American General Public Health, it looked at MIS classification of opioid overdose deaths and so with the OPIOID epidemic. You know over the over those deaths have been steadily increasing since Abou, one thousand nine hundred and ninety nine, and so the states classify the opin overdose tefts, and that has a lot of implications for funding for prevention and research, and over a ten year span they were mis, classifying o. We would overdose deaths for African Americans, and so the MIS classification was almost double among African Americans for about ten years and it’s a field where they call this health data disparities, and so we know that you know there’s a lot of health disparities throughout medicine, and so this is no goes even further, where even in death, there are disparities that continue to exist that have implications for prevention and intervention, and so we identified that health data disparity and obiit over those classification, and so that was just recently published and followed up another opio paper that we did to show that African Americans and now out pacing whites and opio overdose stuffs, and we think that it had something to do with preventin efforts and Africanamerican communities. Wow Yeah, that’s super interesting and I think one of the incredible things about you Adam is that you seek to lift as you climb and you’re available, to help other people that are we’re trying to do research. We collaborate on a paper by collaboration, I mean you wrote the paper. I think I wrote a sentence or two: we had that published last year about John Hamran Ism in medicine, but I can’t tell you how much I appreciate someone of your caliber helping me start to write. I tell everyone that I had a great men toward that assisted me throughout this process and she still meant towards me to this day and she started when I was a public health, major in college and now you know nearly fifteen years later we still collaborate and so seeing how impactful that relationship was. For me, I have no choice but to pay it forward and bring other people into research, and I think it’s an important avenue to create change, and so I try to collaborate with as many people as possible with my research and then mintmen touring in the for a clinical as well yeah and along the same line. So how does one break into this medical writing and the research? Where would you suggest they start? I think just reaching out when you’re a resident or even a medical student to get on pre existing projects? I think that’s the easiest option so there’s so many projects going on within every different specialty, and so it’s pretty easy to email, an attending or a reset and figure out what kind of research they they’re doing and see. If you can collaborate, so medical students that have worked with me have been grated, doing, literature, reviews and then I’ll go through the writing. An introduction with them go through the steps of analyzing and then preparing the paper for for submission, and so I have you know two or three papers under review now and I have a medical student on each paper at other ers with residents, and so it’s a difficult process to enter writing because you just don’t know the expectations for the journals and a lot of people just aren’t introduced to research in medical school, and so you really have to rely to on other residents who are doing research or mentors so to bring you into the fold well and I’m sure they’re appreciative of the the investment that you’re making into their lives and their careers. Like I said, I have no choice but to pay it for I, because so many people have helped me and given me opportunities to work on products, collaborate on projects and to write manuscripts and as you go forward in your career. Where do you think you’re going to continue to focus your research efforts? So my goal is to focus on health disparities, and I think that ‘ll bridge my public health and and medicine, and so within our field of an sysoy. Not many people have looked at health disparities and how our management may contribute to health disparities. A lot of things are done in the operating room from the dictate or patients outcome and their course outside the outside of the operating room, and so I want to look at factors and things that happen in the operating room and how that might contribute to to some of the differences in mortality and hospital lenth of stay for patients. There’s a big disparity in African Americans and whites for outcomes. After cardiac surgery, there’s higher mortality among African American patients there’s a longer length of state within a hospital. More people have, you know just more and morbidity after Cardie more after Americans have you know greated morbidity after Cardiac Surgery, it’s so I want to look at what can we do within the hospital so affect some of these outcomes? We know you know the social determinants of health and people were handling that at a a a global level, but the low hanging fruit. What can I do in the hospital to change some of these outcomes? It’s awesome. I definitely be staying to to see what you find. I I’ll work to you know. If you take none o your wing, we can work together and maybe Claret on some of these issues definitely awesome well, Adam. I know in addition to all the stuff that you do, you do have a fair amount of work. Life balance because you do travel, get home to Baltimore, frequently and you’re. Always working out. Is that that that’s your stress, believer yeah? Definitely a stress Reliever! So I work out in the morning when I was doing my PhD program. I was close to three hundred pounds and so at the end of my PC program I said I will lose some weight before I started. Medical School I was like. I need to. You, know, maintain a healthy lifestyle. If I’m going to be a physician at S, you know encouraging my patience to live a healthy lifestyle and so the transition from my PhD program to Medical School. I lost about sixty pounds and two months and then have been. You know, losing weight each year since then, and so to keep that I work out in the mornings before work so up at around three and forty in the gyme for Agam every morning right before work and that’s how out a lot with staying saying with a residency and fellowship yeah. I bet- and I see the videos you posted and honestly for sure is a encouragement to see that you are able to keep everything and do it all the work out. Your consistent, your research, your clinical activities, definitely inspiring and traveling, is my other activity that I love to do and, to help take my mind off of medicine and research and take a little break. So, Dr Milan, what would you say to medical students or preme students that are considering a career Dan Sysoy? I would say you C N be the best clan you can be doing thirty or a lot of people will go into thirty of medical school. You know focused on one specialty and I think you should just explore everything and do well in all those different specialties and then forth year. If you don’t focus on the speciality that you’re most interested in, I think and Iteso we touch on every different specialty. So you need to know you know what happens with in your general surgery rotation. What happens in internal medicine? What happens I pediatrics, because you’re going to bring all of that together for your you know and a physiology residency, and you can get letters from each one of those specialties for Antisana. I think that’s pretty unique with our field that will take letters from any specialty, because we really need a well rounded physician for what we’re doing so. I would say you know, focus clinically your thirty or each rotation and do well and each rotation and you’ll be set yeah, and we touched earlier on doing research. I know, as applications are always getting more competitive changes the step one and other stuff research is becoming more and more of a thing that pomare looking at. Where would you recommend a medical student start with their research and how many papers, if you had to just put a number on it in terms of matching? What would you will be direct your recommendations? Yeah, that’s a good point that it is coming becoming more competitive, and so I think medical students are really should seek out case reports, they’re, pretty easy to get published so interesting case. You can email the attending that you’re with and say. Hey. Can I write this up and it’s usually you know a couple thousand words pretty quick turn over time. I would say one to two publications for a medical student upon a residency will make them competitive, but you know when your program, director interviews, you and you know- discusses this case report with you. They want you to know about the case report. Make sure that you had a hand in writing it and know about the case for the manuscript. So it’s important to really get involved in the research that you’re doing so you can talk about it when your interview process, but I think one or two papers and door presentations at national conferences will make you competitive for residency, AFFEC apricate at its very helpful, Dr Marlin. Thank you so much for joining us on the show I nor listener is going to be super thrilled and her a lock from this episode. Where can they go to find out more about you to find out what you’re up to and to follow your progress? Yeah I’m on Instagram my handle is a J Milan and Y la m d PhD same thing for twitter and then my website is Aj Malenco. You can just go this guy because about seventy five papers are going to pop of ee this day morning. A M, thank you. So much for going is. Let me take your brain. Thank you for. Have you really enjoyed the conversation?