How to Blend Medical Writing and the Locum Life

Podcast Editing & Production Services are provided by Oscar Hamilton.

Today's PNC Podcast Transcript

Email Download New Tab

Transcription PNC Podcast Episode 361

Shifting from Medical Writing to the Locum Life

- Interview with Dr. Andrew Wilner

John: Welcome to the PNC podcast. Doctor Andrew Wilner, thanks for being here today.

Andrew: Thanks, John. It's a pleasure to be here.

John: I am really happy to have you here today. I've been looking forward to this since Heidi Moawad introduced us a while back. She's another book author and writer and so, since we've been connecting since then, I've just been looking forward to this podcast and this ability to hear about your story.

Andrew: Well, thanks very much. Actually, I met Heidi at a panel discussion that we did at the American Academy of Neurology where there were three of us talking about non-clinical careers. I think it was the first time the Academy ever did anything like that and the room was full. It was a very interesting experience to see the interest that physicians have in expanding their clinical careers and branching out. I think physicians are a really talented group. They're looking for interesting things to do.

John: Absolutely. There's some really altruistic reasons for doing that. Although, I will say that there's this epidemic of burnout which is driving some of that activity as well. Yeah, it's becoming a very popular topic and people are just very interested in learning new things. I love it when we have people like yourself out here that can teach us something new.

Andrew: Well, I'm really excited because what I want to talk about is clinical careers and one way to preserve your clinical career and have work-life balance, which I think is everyone's goal. I've been able to do that using locum tenens, something not every physician is aware of.

John: No, I think that's an absolutely important topic because even though I focus most of my efforts on helping teach and inform physicians about non-clinical careers, I'm certainly in favor of being able to find balance and continue in a clinical career, whatever it might be, whether it's telehealth or cutting back or locum tenens like we're going to talk about today. This is going to be right up my listener's alley, so this will be great.

Andrew: Excellent.

John: Now, why don't you tell us a little bit about basically your educational background and how your career got started out. I have put a fairly comprehensive intro that will go with this, but I'd like to hear it from your own perspective as to the course you followed with your career and your writing and so forth.

Andrew: Yeah, okay. Well, I think probably important to start with my writing. Ever since I can remember, I loved to write. I would write, in high school, poetry. I wrote a couple of plays that were performed. In college, I published a short story in the Yale Review. Writing was always sort of integral to me and so I always had a non-clinical career from the very, very beginning. At the same time, I think I was passionate about biology and I became very interested in medicine and what makes people tick.

Andrew: It was clear to me that I wanted to pursue both of these paths. Not everyone understood that including some of the gentlemen I interviewed with in medical schools. In those days, you're just going to be a doctor. That's very demanding and it certainly is. I think it's partially responsible for this burnout epidemic. For me, it was never one versus the other. It had to be both. That guided me quite a bit.

Andrew: After medical school, I did my internship at the Long Beach Veteran's Hospital in Long Beach, California and I was exposed to everything. At the end of the year, I thought, "Oh, this is fascinating, but I don't know where to go with this." During my internship year, I cut myself a break. I said, "You know what? Internship is pretty hard. It's demanding. Don't knock yourself out and try and write part-time." So, I really didn't.

Andrew: Then, I had a book inside of me and I said, "You know what? It's time to write the book now." I got a job as an emergency room physician, which back in those days, ER docs, there was no specialty in ER medicine. It was just sort of anybody who showed up. I worked 30 hours a week in a small emergency room. I could probably write a book about that and I took the time and wrote another book. That was actually locum tenens. I never knew of it as such and that was way back in 1982.

Andrew: It not only allowed me to write this book and continue my clinical work, but it was while I worked in the emergency room that I discovered that it was neurologic cases that really interested me. In my internships, I loved everything, but nothing really stood out. In the ER, people would come in with paralysis or tingling or visual changes and every now and then a neurologist would actually come in. I was in a tiny hospital. It's tough to get them in, but they come in and do consult with all these fancy examination things that I had never really seen. I said, "Wow, the brain. That is really cool." That sort of year off, some might call it, really allowed me to focus on my future.

John: Very, very, interesting. I think a lot of us go through that process, but most of the people I know didn't decide to choose neurology 'cause they found it so challenging I guess. No, that's very interesting. That use of locums or that experience where you really weren't sure what you were going to do, but you just observed and that helped you decide your next career path I guess.

Andrew: I went back, I was still in internal medicine training and so I finished my internal medicine residency. Because, in those days, the internists were really the model of the physician with wisdom to me. The doctors that I knew that I grew up with that were friends of my parents, they were all internists. That, to me, seemed the pinnacle. I finished my internal medicine, but I still had this thing about, gee, this neurology thing, that's kind of interesting.

Andrew: On a lark, I applied to the neurology program at McGill. I had a friend there who was the smartest person I knew. She was doing pediatric neurology and she had been a resident when I was a medical student. In those days, the Montreal Neurological Institute did not participate in the match. I just went up there and interviewed and I kind of forgot about it. Three years later I got a phone call, "Hey, you're accepted into the neurology program."

John: Oh, man.

Andrew: No kidding. I figured, well, I'll go. I'll do it for a year. Worst case scenario, I'll be an internist who knows more neurology, right?

John: Yep.

Andrew: I viewed it as a fellowship and I would go back into my internal medicine practice. I took my exams in internal medicine and got boarded and went up to Montreal, which is a fascinating place to live by the way. The more neurology I did, the more I realized it was like, "Whoa, there's a whole world of neurology here that I never even knew existed." Of course, the MNI, Montreal Neurological Institute, is where Doctor Penfield started doing epilepsy surgery and mapped out the homunculus that all of us studied in medical school. I got very inspired and I stayed for three years. Then, I stayed another year and did an epilepsy fellowship. I really got kind of sucked into neurology.

John: Yeah, you went through the whole gamut.

Andrew: Then, I was doubled boarded in neurology and I passed the neurophysiology boards. In those days, I just gave a lecture to the residents here, what were your options in 1989? You either went into private practice or you became an academic. Maybe you worked for a drug company, although that wasn't very desirable. It was looked down upon by the people who trained us. Or, maybe you went and worked for the CDC or NIH or something. That was pretty much it.

Andrew: So, I went into private practice in Charlotte, North Carolina. I joined five neurologists who all really were great guys and loved patients and good at their ... They had clinical skills. I was going to be the epilepsy guy. Over the next eight years, we developed a true national epilepsy program where we did epilepsy surgery and drug trials. It was very, very, exciting.

John: Very cool.

Andrew: I'm still frustrated because I want to be writing. Writing medical publications doesn't really count. They talk about the literature-

John: Right, right.

Andrew: I've always thought that that was a real, not even a euphemism, it's just wrong. There's not much literature in the literature that we use for science. Writing a scientific paper is just a skill and pure drudgery.

John: Not really a creative endeavor using the so-called other side of the brain.

Andrew: Yeah, not for me anyway. Although, I did try and publish one abstract or paper every year in epilepsy on the side of my clinical practice. It occurred to me one of the tenets of writing is you've got to write something you know something about. Or, at the very least, if you're going to write about it, you got to go learn about it.

Andrew: I said, "Well, what do I know about? I need to write something." I said, "Well, you know, I know a lot about epilepsy," because I developed a pure epilepsy practice. My whole practice in Charlotte evolved into people with epilepsy or suspected epilepsy or some unexplained alteration of consciousness. It was pretty interesting. I ought to write a book about epilepsy. This was pre-internet. It wasn't that easy to get information for a patient.

John: Right.

Andrew: [inaudible 00:11:22] had to Google. I wrote a book called 'Epilepsy, 199 Answers', which were all the common questions that patients would ask. What is epilepsy? Will I have to take medicines all my life? Is it contagious? What's an EEG?

John: Can I drive a car?

Andrew: Right. Can you drive a car? We just dealt with that in the hospital just the other day. That continues to be a very naughty issue for patients, driving for sure.

Andrew: That kind of got that book out of my system and then I wrote another one for physicians on how to manage epilepsy, epilepsy in clinical practice. Both of those were with a traditional publisher and a lot of work but satisfied my need to write at least a little bit. I carried on a full-time clinical practice. After eight years of that, I said, "You know, I'm really an academic guy." You sort of self-discover over time.

Andrew: My partners, well, we were in regular clinical practice and all of whatever time I would put into my academic pursuits trying to write papers ... I was spending time reviewing charts and putting together the patient's story for an abstract or an article. My partners admired it on the one hand, 'cause they liked having an academic guy in the practice, but frankly, on the other hand, I could tell they ... You know, why don't you just see a few more patients?

John: Right, right.

Andrew: And, help with the overhead. There was a tension there. I tried taking an afternoon off a week to create writing time. We could talk about that later, about work-life balance, but it didn't work very well. I ended up being there until about 2:00.

John: Oh, boy.

Andrew: I ended up with two extra hours a week and it cost me about 25% of my salary.

John: Oh, man.

Andrew: That I've learned, is kind of the norm. So, I took an academic job, my first academic job, which on paper looked great and in reality, it turned out not to be so great. I left after one year. I didn't know what I was going to do, but I could stay there. They really didn't have the same quality metrics that I did and I wasn't happy.

Andrew: I moved. I moved back to my hometown in Rhode Island. All of a sudden, I found myself in Rhode Island, perfectly happy, next to the ocean, which I love with no job.

John: Yeah. Now, you had to get creative.

Andrew: Yeah, so now I had to get creative. I remembered I used to go to a lot of American Academy of Neurology meetings, America Epilepsy Society. Every now then, some guy would show up and want to interview you about your poster. I did a number of those interviews and I had met some of the editors. So, I followed up with one. I said, "you know, I've done that as a speaker. You think I could be an interviewer? Could I go to a conference and interview some people and write little summaries? I think I could do that."

Andrew: The guys said, "Sure. Why don't you give it a try." Well, the next thing I know, I'm going to about a dozen conferences a year, so I'm writing literally hundreds of news articles for magazines like, well, what became Medscape.com, Neurology [inaudible 00:15:17] Times, Neurology Reviews, CNS News, Long-Term Care. These, what we used to call in the trade, throw-aways.

John: Right, right. I remember those.

Andrew: [inaudible 00:15:28] them on your desk. What I found, and I was really stunned ... Well, two things. One, I was actually able to earn a living, which I never suspected. The second year I did this, my income doubled and the third year I did it, it doubled again. Then, it leveled out, but I was doing almost as well as I was doing as a physician. I had to hustle.

John: A question for you, the income, was that from the writing? Was it from doing the interviews or was it a combination?

Andrew: You get paid by the word, so the more words you write, the more you get paid. If you hustle and you write a lot ... I would discover that I would see other journalists, they could come to a meeting and spend three days and they would write six articles. I would come to a meeting and I would spend three days and I would write 20 articles.

John: Wow.

Andrew: Because, well, that's my nature to work hard and also I had an edge because, as a physician, I understood what the whole thing was about. As a journalist, if you're not a physician, you can say, "Well, what did you do and why was it interesting?" You can ask all the basic questions, but it's very hard to read in between the lines. As a physician, you already know what the limitations of the study were and why it was difficult, so you can really push and make the interview quicker. You can get right to it and also maybe a little deeper.

Andrew: Although, I will say, many non-physician journalists, I work with a lot of them, do an excellent job. I think you can't argue that being a physician does give you an edge to get the work done.

John: So, how long did you do it?

Andrew: I did that for 10 years.

John: Oh, okay.

Andrew: For 10 years. I was not seeing patients. I was doing some medical consulting for a company I still work with. Disease Management, on the side where I would get clinical cases and give my recommendations. That was all done remotely, so that was pretty easy. At the beginning, I did a lot of lectures for the pharmaceutical companies on the epilepsy drugs, but I discovered that as I became more and more distant from the clinic and from seeing patients, my knowledge was less relevant and I was less desirable as a speaker.

Andrew: That kind of faded out, but the writing allowed me to ... Blogs kind of exploded on the world and I started writing blogs for Medscape. I have a wonderful editor there who likes what I write and likes my creativity and my particular view of the world. He gave me a blog that I would write twice a month. I wrote probably a few hundred blogs over the years for Medscape on whatever showed up on the news or something that I read that had to do with neurology that I thought laypeople would be interested in.

Andrew: Those blogs became collected in my first sort of non-epilepsy book called, 'Bullets and Brains'. The title of that has to do with ... I wrote about Gabrielle Giffords. I remember when Gabrielle Giffords was shot in Arizona and I followed the news. Now, I'm a medical journalist, so I'm just watching the new every day. Of course, all the new media carried this story, but the story that they carried was that she was rushed to the hospital and in the operating room in 38 minutes and had a world-class surgeon there from the military. She was getting the best of care.

Andrew: It was a great story, but it just struck me that that was the wrong story. That's not really the story. The story was is that this very capable, high-performing women, a Congresswoman, was shot in the brain and that she, despite whatever we do, is never going to be the same and is probably going to lose her job, even if she recovers miraculously, may lose her marriage because that's what happens in these situations, and that we have so little to help the brain heal.

Andrew: Apart from the antibiotics, the neurosurgeons are doing the same thing that they did in the Civil War. You just stop the bleeding and rinse it out. Pour some antibiotics in and pray. That's what we do. That's the real story. The real story is the limitations that we have in helping the brain heal. So, I wrote an essay about that called 'Bullets and Brains', that they don't mix. That's followed by about another 102 essays, I believe, in that book.

Andrew: That was a lot of fun and researching topics. I wrote a lot about head injury in the early days when CTE, chronic traumatic encephalopathy, wasn't really well-known. That struck me as kind of a no-brainer, if you will, that getting beat up and hit in the head and knocked out cannot possibly be good for the brain. I didn't know that it would cause CTE, no one did, but it just didn't seem to make a lot of sense that this was a healthy thing and I pursued it.

Andrew: The other aspect of all this writing was, this is when the internet happened and all of a sudden, you could work from anywhere. I had my little desk and file cabinets and bookshelves. All of sudden, I realized I didn't have to be there. Rhode Island in the winter is kind of dark most of the time and cold and not very social.

John: Yes, it is.

Andrew: I discovered that I could travel. One of my passions is scuba diving, so I went off to the Philippines. I discovered that I could sit there with my little laptop and I could write my articles. I had access at that time, to the Harvard library through the internet. I could download articles and read them and I could email the experts. I thought, "Gee, people are going to wonder. Are they going to call me and I'm not going to be there?" Nobody cared! Nobody cared.

Andrew: This became a lifestyle and it was a lot of fun. I got to write and I got to travel and see the world. I was always interested in photography and so I was able to develop some pretty good expertise in underwater video and make some award-winning movies.

John: Very [crosstalk 00:22:56].

Andrew: That was my attempt at work-life balance.

John: When did the clinical come back in?

Andrew: Right, so I think this happens. I certainly wasn't retired, but I was non-clinical. That whole world, that constant tumult of the hospital and the demand of minute-to-minute and the pager and people coming and going and crises, started drifting away. It became more and more distant. I thought, "You know, probably, unless I want to retire," and I gave it some consideration, retire from clinical medicine. I was doing fine as a writer and consultant and I liked that. Then, I think I want to give this another whirl.

Andrew: I also felt like I wasn't lecturing anymore and I wanted to start doing that again. So, I looked around and it actually was, this is another topic, but it was not that easy to get back into clinical medicine. Not because I'd forgotten anything, if anything I knew more medicine after writing about it on a daily basis then I knew when I left, but the system is very inflexible and I would caution anyone who wants to sail around the world or take time off from clinical medicine and go back, be very, very careful and make sure that they do not lose continuity for more than two years.

Andrew: Because it's the malpractice people who say, "Oh, you've been out of here two years, you don't know what you're doing." I always thought that was insulting. I don't think if I stayed away for 50 years I would forget how to examine a patient and take a history, but that's not what everyone else thinks. It was very difficult for me to get back in until I found a hospital, frankly, that was so desperate to get a neurologist that they figured out a way to get me a letter of recommendation. I had to do a little extra clinical work under supervision for a few weeks and get me back on staff.

John: It can be hard.

Andrew: It was very difficult, the paperwork. It took a day. I was a little rusty. I do admit to that, but it's like riding a bike. I think if you've been a dedicated clinician, taking some time off is only a good thing.

Andrew: Yeah, so next thing you know, I'm working full-time again as a clinician and this is when they invented the every-other-week kind of thing. It was 24-7. I had no interns or residents or nurse practitioners. It was just me doing neurology on a 300-bed hospital every other week. The one saving grace was they did have telemedicine for stroke. Strokes at 2:00 AM were done via telemedicine. They went to Yale, I believe, and they didn't wake me up for those. I'd pick them up the next day. That was the one break I had, but otherwise, everything was mine.

Andrew: It was fun. It was so much fun because I'd been out for a while. In the meantime, they had invented computers. Now, the hospital is full of computers and you can get the x-rays on your desktop. You didn't have to traipse down to radiology and the labs would come quicker. Boy, it was like all of a sudden, I had stepped into the future. Of course, the patients were the same.

John: Yeah.

Andrew: Studies got done a lot faster because of DRGs. The hospital just can't wait to send people home. I'd go and I traipse down to the ER to see the patient, maybe it's a TIA or stroke, and say, "You know, we probably ought to get an MRI or a CTA and an echo. Oh, all done."

John: Yeah, pretty quick.

Andrew: It's like, "Well, I don't know if they really needed all those things." Well, they're done. People got stuff very ... You had to get down there quick if you wanted to stop the train from leaving the station. I really enjoyed it, but it was also ... Then, a Monday on my week off, I just rested and go shopping or something, get food. Couldn't really think and then pick it up again. I continued writing and going to conferences.

Andrew: I thought, "This is really tough." Then, I discovered again locum tenens.

075 Combined Tracks for Transcript and Show Note... (Completed 02/16/19)

Transcript by Rev.com

Page 1 of 2

Scroll back to top

Sign up to receive email reminders, news, and free stuff every week!

Enter your name and email address below and I'll send you reminders each podcast episode, notices about nonclinical jobs, information about free and paid courses, and other curated information just for you.

powered by

–

Disclaimers:

Many of the links that I refer you to are affiliate links. That means that I receive a payment from the seller if you purchase the affiliate item using my link. Doing so has no effect on the price you are charged. I only promote products and services that I believe are of high quality and will be useful to you.

The opinions expressed here are mine and my guest’s. While the information provided on the podcast is true and accurate to the best of my knowledge, there is no express or implied guarantee that using the methods discussed here will lead to success in your career, life, or business.

The information presented on this blog and related podcast is for entertainment and/or informational purposes only. I do not provide medical, legal, tax, or emotional advice. If you take action on the information provided on the blog or podcast, it is at your own risk. Always consult an attorney, accountant, career counselor, or other professional before making any major decisions about your career.