My Career Course
By Luis Bolano, MD
A few days ago I ran across this image authored by Tim Urban (1) and saved it to my photos. I thought it was a great perspective and a very useful frame for how we navigate through life.
The next day, I was invited by ASSH PERSPECTIVES to submit on the topic “a fork in the road”…quite the strange coincidence.
I did not think I had much to contribute to the topic but this prescient message forced me to at least give it a try. Honestly, for all of us, there are countless forks in the road that beg the questions, “How did I get here? And are there any lessons? Is there a single event?”
I have been a practicing hand /upper extremity surgeon for 30 years. The course of my hand surgery career has been incredibly normal but the small instances and coincidences that steered it have been nothing short of remarkable. They seemed insignificant at the time but, in retrospect, certainly significant when placed in the context of how I got here.
The first fork in the road:
It starts with the transition from medical school to orthopedic residency at the University of Oklahoma. I wanted to be an orthopedic surgeon since I was 16. I had no back-up plan leaving medical school. It was orthopedics or nothing. The Orthopedic residency landscape was incredibly competitive. My friend and classmate Jeff Elkins suggested I do a rotation at the University of Oklahoma Orthopedic Department.
How? I asked. And is that even possible? He answered: “Well, my father is the Chief of Cardiothoracic Surgery so of course it’s possible…I’ll ask him!“
I visited OU, worked myself to death, had a very good rotation, and was selected in the match. Thank you, Jeff, thank you, Dr. Ronald Elkins.
Second fork in the road:
Fast forward to my residency. I was scrubbing for a total shoulder arthroplasty with my attending John Hunter. The hand surgery fellowship match was looming and I was unsure about my choices. The Hand Center of San Antonio fellowship, under the direction of Dr. David Green, was new, in its second year. I mentioned it to Dr. Hunter.
He told me, unequivocally, that I was brain dead if I did not rank it first, and that if I was lucky to get in, it would be a hand surgery education that most would envy. I was lucky to be accepted and off I went to San Antonio. Thank you, Dr. Hunter.
Third fork in the road:
Enter Drs. David Green, Tom O’brien, William Sanders, and Chris Pederson. The most eclectic, talented, and diverse group of hand surgeons one could put in a single practice. It was an experience to envy. One year of every-other night call and an introduction to a massive scope of hand /upper extremity surgery and microsurgery.
Dr. Pederson and Dr. Green suggested an initial academic job…just so I could do everything!
Fourth fork in the road:
The University of Kentucky, assistant professorship in the orthopedic Division. I did everything for 3 years…and I mean everything.
Thank you, Dr. Pederson and Dr. Green.
Fifth fork in the road:
I started to entertain the idea of private practice. I met Dr. Earl Foster, a former Riordan fellow, and he convinced me that private practice in his group would be equally challenging and professionally rewarding. He was the president of the group and quite the practice manager.
Under his leadership we opened a 28,000 square foot surgical hospital that was an absolute dream and the flagship of our practice. He was right about all of it!
I followed him as group president and have had a phenomenal 27 years in private practice, in the busiest, most diverse upper extremity practice I could have ever hoped for. Thank you, Earl.
Sixth fork in the road:
The complexity of private practice, the difficulty of recruiting in an environment where over 60% of orthopedists are employed, and the shrinking number of partners to support a high volume, high overhead practice led me to take the next fork in the road that I will start in March 2022.
Our group will join our local hospital and become employed. This was a bittersweet transition, considering our group is currently in its 93rd year of continuous private practice orthopedics.
Every professional opportunity is tied to a person. Opportunities do not float like clouds in the sky. They find you and you find them.
For all of us, the next fork in the road starts tomorrow.
Thank you, ASSH, for the opportunity to tell my hand surgery story…so far.
1) Urban T [@waitbutwhy]. “We think a lot about those black lines, forgetting that it’s all still in our hands.” Twitter, March 5, 2021, https://twitter.com/waitbutwhy/status/1367871165319049221?lang=en.