Chapters Transcript Video From hidden gem to regional referral center: The evolution of ENT at UCI Health Over the past 5 years, we've almost doubled our faculty. We're at 19 faculty now, um, and as we grow our clinical faculty, we generate more, um, you know, opportunities for collaboration so that we can also grow our research faculty at the same time and overall providing our patients. Access to world-class research through our clinicians and their relationship with our researchers, um, really has, has kind of expanded the whole mission of what our department can do within the, the UCI health system. Hi, I'm Lindsay Carrillo, director of business development at UCI Health. Hi, I'm Doctor Sunil Verma, Associate Chief Medical Officer for ambulatory and a practicing laryngologist here at UCI Health. Welcome to Physician Huddle by UCI Health. Today we're joined by Doctor Joson Joa, the chair of otolaryngology, head and neck Surgery. Welcome, Doctor Joa. Thank you. Thank you for having me. Nothing like having your boss on the show. I know I'm, I'm, I'm a little bit nervous. A lot of pressure. Doctor Choa, take us through your career here at UCI. Uh, what brought you here and then how has your career evolved? Yeah, um, so yeah, my career started here actually as a resident, uh, trainee right out of medical school. Um, my wife, she's from Southern California, and so there's a lot of factors that go into why we choose a place, um, but this ended up being meant to be. Um, we, we ranked UCI highly at the time. Bill Armstrong was the chair, and, uh, I greatly appreciated his mentorship. I greatly appreciated meeting him at the interview and, and I did my residency here, trained, um, with Doctor Verma, um, teaching me everything I know about laryngology, which is getting to be smaller and smaller over time. As my practice becomes more and more subspecialized, but, um, I loved my time here as a, as a trainee and I liked the fact that UC Irvine is a very strong, powerful hospital. It's, it's, it's got a really strong otolaryngology department, um, but it's kind of a hidden gem in that it's, it has that very kind of familial. Feel I, I did medical school in the South and at Virginia Commonwealth University, and that's a university that has a very kind of hometown feel even though it's a huge hospital system. The hospital's got over 1000 beds, but everyone feels very familiar there and I like that feel about UC UCI health as well. Um, so I went to fellowship, um, did, uh, specialized training in head and neck cancer and microvascular reconstruction, um, in Boston, and then when I was looking for jobs, um. This just felt like home and I think it has to do with that, again, that, that feeling that everybody's collegial here, everybody understands we're all on the same page. There aren't a lot of kind of turf battles and, and I really liked that feel, so I ended up coming back here, um, building a practice. I was a, I was a solo microvascular surgeon doing head and neck cancer and reconstruction, um, which is a tough practice, um, but, uh, uh, another one of my mentors, uh, Doctor Hamid Jalilian, who's also in our department now, he, um, his advice early on was. The three A's are most important in practice building, and those are in order of importance availability, affability, and ability, and I took those words to heart and recognized that, you know, as the only person doing head and neck cancer, I had to be available. So I was available, you know, 24/7, helped build the referral network to use business development at UCI Health, which has been, you know, instrumental in helping build the practice. Oh thank you for the shout out. Um, and, uh, you know, visited community practice physicians, um, made myself available, and, and, and slowly built the practice over time to the point where, you know, our head and neck cancer volume was high enough that we could hire a second person and, and That decision was very important to me because it, it made, you know, the, the practice grow in a way that um if you find the right person, the practice can grow by more than double if you find the right partner um and I found that person in, in Yara Haydar, um, and together over the past, you know, 67 years we've built a, a pretty, pretty robust head and neck practice here and it's been pretty enjoyable to see. One of your uh first leadership roles here was the, uh, as a residency program director, um, and I know teaching residents and, and educating learners is really. Core to your mission, but can you reflect on your time with being given that role and what you learned and what you expect of the people that take that role after you? Yeah, sure, um, yeah, you know, I feel like everyone goes into academics for different reasons. One is to be kind of the, the be all end all tertiary care center for whatever the subspecialty is that you practice. Another is to be involved in the learning environment and to be a part of, you know, people's career development and their training. Um, another is, if you want to be involved in, in world-class research, and I think it's, even though you come here for different reasons, it's hard not to be involved in all three because the three of those things are so intertwined and um for me, Surgical training was key and, and again, as, as I talk, I always think about certain people along the way that had an effect on me and I think that's how everyone is in surgical training cause even when you're at the operating room, you're thinking of things and, and you're making decisions, but you have voices in your head that, that were people training you along the way. And so, To me, I think the, the core of why I do what I do is, is to be a part of that, and it keeps me excited about surgery. It keeps me always on my toes cause questions get asked and I, I need to be able to answer them and sometimes questions come out of left field and it's, it's thinking about things in a way you haven't thought about. And so that kind of invigorates me about being here at an academic medical center. Um, and so that's something that I find super important for the department and so I, I put focus on trainees. One of my mentors when I was in fellowship, um, Thought about surgical training and that's kind of discrete things and the important thing about training for, for him, Doctor Dan Deschler, was um to recognize what the level of your trainee is and to always be aware of who's across from you and what they need to be able to learn. And so that's something I've taken with me in practice and I recognize, you know, even though we have 1st year residents all the way up to 5th year residents, you know, two different 5th year residents have very different levels of experience. They come with very different levels of comfort to the operating room, and it's important for me to recognize those levels and important for me to recognize your levels of comfort so that I can meet them where they are and, and recognize what they have to do to work on. And I think, um, you know, communication is part of that and. And bringing that, bringing that along and, and making sure the surgical trainees are getting the best of you every time, every time you're with them is important. And so, for the residency program director, you know, I took that to another level and, and from a programmatic level, it made me think about things outside of just being in the operating room across from a trainee and, you know, what the trainees need in order to really thrive in a, in an institution. We've tried to implement that in the department and uh what the department needs to provide them. Um, in order to really be our best selves so that we're putting out surgeons into the world that, you know, feel really competent and confident with what they're doing. You mentioned Doctor Bill Armstrong. He led the department for a long time, well known, great reputation. He did finally decide he was going to step down and take a break from that. And then you came in as interim chair, followed by just this last July named as permanent chair. Talk to us about that transition going from faculty member to leader. Um, you know, obviously you had some leadership roles along the way, but, you know, that's, that's. Kind of shoes to fill, impossible shoes to fill. Like I said, Bill Armstrong was the reason why I came to this and you know he saw something in me that allowed him to open the door for me to come back, and that's something, you know, I, I'm honored and privileged by something that I will never forget, uh, you know, I feel like I owe my career really to to who he is. So to to be asked to step into that role and And do what he was doing was, first of all, something I never ever imagined I would, I would do, you know, when I, when I started at an academic medical center here at UC Irvine, again, I came because I liked being the tertiary referral person for head and neck cancers. I liked the complex surgeries. I liked being that safety net for the community for those tough cases that the surgeons in the community can't do. And I also liked that interaction with the residents. And from that, you know, the research opportunities developed, but I never thought that I wanted to be, you know, in an administrative role running a department, not in my wildest dreams did I ever think that that would be part of my career trajectory, so. When I was asked to do it, uh, it was kind of one of those opportunities that you feel like you, you can't really refuse. Um, and, and, uh, I think that, the unique thing about it was that I had Bill Armstrong, who did it before me, who I thought did it in a way that I felt like Um, was very organic. He led very fairly, and he made decisions on the merit of each, each individual decision that had to be made, um, not taking into all the other things that can sometimes cloud decision making and judgment. And so I felt like I had a good model of how this job could be done moving forward. And so I think only because of that was I able to think, OK, this is something that you can transition from, even though I like the surgery, I like the teaching, I like the research. I have no experience whatsoever in administration or or leadership, but this is something that I do think I have the, the model in place for me to, to follow. So you and I talked a little bit about imposter syndrome. Um, I imagine that's pretty common even among medical students or surgical residents. And then As you go from being like a peer with your feather, uh, fellow faculty to, you know, moving up to being a leader and how have you dealt with that, uh, are there any lessons you've learned or that you feel like you could share? Yeah, I mean, even sitting in this chair, I feel like an imposter lights on me, there's a microphone, and you're asking about my, my, um, experience as if I have some experience to share darkest feelings. It's totally natural and normal. Um, but yeah, I, I think, uh, one thing that I found out, you know, I did the, um, Harvard Chairs course, which is a course that they put on at the Chan Public Health School at Harvard, um, for two weeks every year, and chairs from across the country do it. And one thing I found out there was that there's a very high rate of imposter syndrome among quote unquote high. Achieving people, um, and it makes sense because I think impostor syndrome is a syndrome where you are put in a position where, you know, you don't necessarily have all the tools, you don't necessarily have, you know, that feeling like I, I belong here, but you're asked to do things and it's natural if you want to do things well that you feel a little bit unprepared and I think at every step along the way, the interesting thing about medical training is that we feel like imposters, you know, we finished medical school and we've done book training, we've followed people in the hospital for, you know, a couple of years on our rotations, but then we're the person then at 2 in the morning that someone's calling saying, hey, this person's blood pressure. Hi, what, what medication do you want to give? And I think just about every single trainee outside when they're, when they first get that call in the middle of the night and they're the person who's responsible for someone's, for someone's life, um, feels that sense of imposter syndrome. And then you feel that way the first time you're in the operating room and then the first time. You're in fellowship at a new institution and the first time you're tasked with the responsibility of the patient on your own. Everyone, I think, feels that imposter syndrome and for me, it was no different transitioning into an administrative role because that's something like I said, I've spent, you know, 13 years in training, doing clinical things. I spent 10 years in practice doing it and now I'm asked to make decisions about budgeting and, and, you know, growth and look at business plans and um imposter syndrome, I think still comes at me on, on a regular basis, but I do think. The having the tools and, and recognition of that and, and having the tools and, and having the ability to kind of put the work in and understand that, yes, you're never going to feel comfortable with the information you have, but you do have the experience to, to use that, you feel a little bit more comfortable with it over time. You know, I think one of the things about imposter syndrome is that it, it prevents people probably from applying to other positions that they aspire to do because the reality is, is you're always taking somebody else's spot, well, for the most part, and that person who you, whose spot you're taking has more experience than you and then when you're in that spot, whatever it may be, I mean you just mentioned, um, training, right, when you're on the wards, there's a nurse who has more experience than you or there's a senior resident that does, but at the end of the day. The way that this institution will grow or any health system grows or just as we need to create more doctors is you have to step into roles that you're uncomfortable with both clinically and non-clinically, um, probably one of the, I, I would imagine something that's helped you succeed Doctor Joa is having a network. Um, how has the institution supported you in this transition or when you have that question of, I mean you just mentioned looking at a business plan, have you been, how, what support have you gone to seek for that? Yeah. And again, that's where the importance of UCI being not just an academic, I think, you know, Chad Leftres always says his goal is for, you know, our CEO, his goal is for us to be the friendliest and most accessible academic health system in the country, and I think both of those things are so key. To kind of our everyday here and I think um accessible, obviously we wanna be accessible for patients but friendly, we wanna be collegial with each other, we wanna be collegial with the community and I think that's happened organically here. And so, you know, when I came into this role, we have a whole network of clinical chairs um of the, of all the clinical departments, I think they're up to 19 now, um, clinical departments that have chairs and we meet twice a month, um, and it's almost like a little support group of You know, bounce ideas off each other. Hey, I've heard this from, you know, the, the institution and this is something that they're planning. How would you guys deal with this? And, and that's been really helpful. Um, you know, Sunil has a, has a, has a role within the, the medical center and, and, uh, you know, having him available to understand kind of what the enterprise view of growth is and how ENT fits into that has been extremely helpful as well. Um, but I do feel like The overall value there is that everyone is, is accessible and friendly and, and, you know, we, we are, we recognize that in order to grow as an institution, we have to grow together and we have to all be on the same page and I think um it's probably rare to find that in an academic health system, especially when we're dealing with so much change. Change is hard for people and we, we recognize that, but everyone here is kind of changing together and recognizing that in order for change to happen successfully, we all have to be on the same page. Yeah, there's, there's that element of we all have to row together in the same direction. And I've been fortunate enough to get to know health system leaders and other health systems, and I have to say UCI Health is unique in that. Um, there's not a lot of competing forces. Um, there's always gonna be a couple of ways to do things and people have their opinions, but, um, just this trajectory on of, of, and you mentioned growth, um, is some and, and, and excellence in care and quality of care, something that seems to resonate with all of our decisions, um, to that end, how do you, how is the department of otolaryngology, head and neck surgery grown? I know the answer obviously because I'm in it, but, um. I'd love for you to share uh what you've seen grow both from the clinical and non-clinical areas and where you want to see it go next. So when I started here, it's now 16 years ago as a resident, which is crazy that time flies that fast. But uh when I started here, we were a department of really 8 faculty, um, and it was necessarily so and, and the story I tell is, you know, we were a hospital that was in orange and it was 450 bed, I think fewer than 450 beds at the time. We had just grown because I think the, the quote unquote new hospital back in 2010 was just, you know, a year, a year and a half years old. Um, but that was new bed capacity and all the services were, you know, Not necessarily fighting, but all the services had needs in terms of OR time and ambulatory space. And so, you know, we had our clinic here at the Orange Medical Center and so we had our clinic space, we had our OR time and our faculty was stable for many, many years, you know, for, for my entire training here, we were basically the same size faculty and then I came back and There were plans for growth, there were plans for Irvine, and there was a takeover of the, um, or the, the acquisition of the community hospitals, and that kind of lifted all of these traditional constraints that were there previously, um, that were not necessarily preventing our growth, but, but. I guess, not allowing us to grow in the way we wanted to in terms of providing our provider space in the ambulatory clinics in the, in the operating room. And now with those constraints lifted. Um, it's allowed us to really right size our department for the community. Our community is a community of over 3.5 million people here in Orange County with a broader reach into the Inland Empire in Los Angeles County. And so there's a lot of needs for sinus disease and head and neck cancers and voice swallow problems and hearing problems, um, and we've been reliant on, you know, individuals to. Treat those, that, that huge community um because of the, the limitations in our space and time, um, but now with, with the acquisition of the new hospitals and the opening of the Irvine Hospital, we no longer have any of those constraints and so over the past 5 years we've almost doubled our faculty, we're at 19 faculty now, um, and as we grow our clinical faculty, we generate more, um, you know. Opportunities for collaboration so that we can also grow our research faculty at the same time and overall providing our patients. Access to world-class research through our clinicians and their relationship with our researchers, um, really has, has kind of expanded the whole mission of what our department can do within the, the UCI health system. And so I see that growth, you know, continuing. We have at least 2 sub-specialists in just about every single ENT now has 7 subspecialties, um, and now we've got at least 2 sub-specialists in every single one of those and I see it growing to 3 sub-specialists in the, in the very near future, and 3 sub-specialists again for a, for a community of 3.5 million people, I think is, is still not quite right size and so I think there's still a ton of opportunity for growth. Yeah, you did touch on research. Um, I know that you have really been looking for some superstars in that arena and some have joined the team. What are some areas that you think are really gonna be sort of revolutionary, uh, the work that's happening in the department? Yeah, and this is another thing where our clinical growth has kind of helped bridge that gap with our research because our researchers traditionally have been Centered in, in Irvine on the, on the main campus, which is about 20 minutes from the, the medical, our traditional medical center, but with the opening of the Irvine campus, we're now right across the road from our main campus. And so it's created a kind of a geographic connection with our, our researchers and, and a much closer ability to collaborate. And so, our research strength has always been in this department, our hearing research. And so we've got a hearing scientist who just a couple of years ago was elected into the National Academy of Engineering, Doctor Fen Gang Zhang, for his work on cochlear implantation. And so if you think about hearing, you've got your ear canal, then you've got your eardrum and then you've got the, the bones that conduct that hearing to your brain and then you've got the nerve that carries it to your brain. And so now at every single one of those steps from the ear canal to the eardrum to the bones or the obstacles of the ear to the auditory nerve, we have research in place to look at ways to improve that hearing. And so our clinicians led by Dr. Hamid Shalian and his, his collaboration with Fang Gang Zhang, he's developed a trans tympanic stimulation, electrical stimulation device that can help people with tinnitus, and he's also developed a device that can detect 98% of middle ear infections through the canal. Even if your ear is packed with earwax, this device can detect an ear infection through that. Um, and so, With that, we've, we've hired uh another researcher, Wei Dong. She just came, uh, she's a full professor who does research in um imaging. Technologies and she's developed an imaging device that can pinpoint with pretty good precision and it's pretty low cost to do, to pinpoint exactly where hearing loss occurs, whether it's in the canal, at the eardrum, or in the bones of the hearing. And then the ultimate goal is to kind of bridge the engineering and the clinical side, um, to do auditory nerve stimulation, and that's the furthest point of hearing loss, um, the, the last connection between the The inner ear and the brain. Cochlear implantation puts an electrode, uses, um, engineering to put an electrode into the, into the inner ear, but there's one step beyond that where you can actually stimulate the nerve and our researchers led by Harrison Linn and Fang Gang Zhang are working on that as well. Um, so, hearing loss has always been an area that we've been strong at and again led by Fang Gang Zhang. It's, it's really helped our department greatly. Um, and then now we're, we're building another line of research which is head and neck cancer research. And again, that could only be possible with a collaboration with our undergraduate researchers. We've got a collaboration that's been pretty strong over the past couple of years that we've built, um, with uh, the Department of Neurobiology and Anatomy, and that involves Sheng Ming Xu, who does a lot of work on spatial genomics and transcriptomics, which is basically looking at A tissue sample and finding out which genes are expressed exactly where on that tissue sample and what we're looking at is on the head and neck cancer samples that we have, we take a head and neck cancer sample, we Run it through their machine and and it allows us to see, OK, these genes are expressed in the cancer, these genes are expressed separately in the area right around the cancer, and these genes are expressed in the normal tissue and that's something that hasn't been done yet in head and neck cancer samples. And again, these things are all possible because of the, the growth of the institution and the intermingling now of the clinicians with our basic scientists. It sounds like, you know, and I've seen this and I'll echo this, the department has really grown from Clinically taking care of a subset of individuals to now as you've mentioned, taking care of people inside and outside of the county and now really making that connection to the training, uh, the residency program has grown, the research program has grown to really, um, I think offering the full breath and probably even more in your mind of what otolaryngology, head and neck surgery can do, um, and, and I, I imagine it feels pretty special to, to be at the helm of that. Yeah, I mean, obviously, like you said, like it's only possible because we're part of a larger system that supports us, but I do think the growth of the system has kind of Uncapped, you know, endless possibilities in terms of the clinical opportunities that we can provide patients and then the connections we can provide trainees to those clinical opportunities and patients to the research that backs all of this. Um, it really, really is an exciting time. Yeah, really unique, really hard to mimic that in any other climate or, you know, environment, right? Um, so we've touched on growth multiple times with the acquisition of these 4 hospitals, and we just opened our, you know, hospital campus in Irvine. Um, but ENT itself now has another site in Brea, which is North Orange County, um, you know, north of our region, and, um, I know you have a lot of people who are excited to build their practice there. Let's chat about that a little bit and then tell us what you want to see beyond that, yeah. So Orange, our Orange Medical Center is kind of right in the heart of Orange County and um that's where the population kind of has been based, but over time, as, as you guys know, Orange County has grown in every direction. Um, and so, Irvine helps us take care of the population that's south of here and we don't have a kind of a flagship area north of here to take care of, not just North Orange County patients, but patients outside the county that are looking for an academic. Medical Center nearby, so like Eastern Los Angeles County and Western San Bernardino and, and Inland Empire, um, and so Brea, our Brea clinic is the largest expansion of ENT services outside of Orange, really, I think that we've ever had. Um, we have, uh, 9 rooms dedicated for ENT and we're sharing the space with our ophthalmology colleagues who also have 9 rooms. So it's 18 ambulatory clinic rooms, um, and we're gonna have. Like I said, we've, we've grown in every subspecialty, and so we're going to have a subspecialist in every area providing care up there and Again, the, the goal here is just to provide easy access that's convenient for patients to be able to be seen by academic medical physicians who have access to world-class research behind them. I, I also, I just want to say I, what I love about the Brea clinic is that this is an area and especially the way otolaryngology has expanded, is doctors don't just show up there once a month. Like this is their home. This is a community they serve. They're there every single week, multiple times a week. The nurses are there. So that really changes the interaction between a patient um and the physician when they know that they're going to an actual ear, nose and throat, head and neck center, um, as opposed to just being a one-off. Yeah, and that's that, that brings up a point about growth that I feel like this is where kind of the nuance of growth and and how you grow, um, I feel very responsible for and that's as we're growing, we're looking for academic physicians who are kind of. Cut from the same cloth who recognize the value of having an accessible and friendly academic medical center. And so while we're looking for those physicians, I also feel a great responsibility to support those physicians and For me to ask a physician to be in 3 different places, 3 days a week and to be running all over the county, yes, it's possible and people do that all across the country. Um, but I feel like if we want really to increase our wellness and our satisfaction as well from the physician side, which creates better care for our patients, I feel like having people who are based in North County and having people who are based in South County and allowing them to really build, cause obviously we all do this. For our patients and for the community, but we also do this for a living and, and for our families. And so for them to be able to build a life for their family in a certain area where their, their, you know, their world is taking care of patients in North County at a clinic that they can bring to surgery at Placential Linda, which is also in North County, to me, that's very, very important. And so, um, it creates satisfaction in physicians and ultimately it creates a sense of belonging to a department and something bigger than. Um, I think they would have if they were asked to be in 3 different places all at once. And so I think the nuance and the trick with growing is to figure out how you can support physicians to have that attention to their family side and have that satisfaction on their family side, but also serve the needs of the institution and the community. Um, and I think that the answer there is continue to grow, continue to look for the right people, and, and to grow to the right size enough so that you have providers who are based in, in various areas. Smart. Thank you both so much for being with us today. Thank you. This was fun. This has been Physician Huddle by UCI Health. Thank you for joining us. This was an episode of the Physician Huddle podcast by UCI Health, produced by Brett Shahen, Angelica Yagubi, and Victor Ting. For more episodes, information on clinical trials at UCI Health, or to refer a patient, view the show notes or visit clinical connection. UCIhealth.org. Created by
