Faculty Focus: Jennifer Kargel, MD

Jennifer Kargel, MD, is associate professor of surgery and associate program director for the Integrated and Independent Plastic Surgery programs at UT Southwestern Medical Center, Dallas. Dr. Kargel earned her medical degree and completed her plastic surgery residency at the University of Texas Medical Branch, Galveston, and followed that training by completing a fellowship in hand surgery and microsurgery at UT Southwestern. Her clinical interests include a sharp focus on hand surgery, striving to provide the highest care possible for pediatric patients – including repair of congenital hand and wrist deformity and brachial plexus injuries – and adult patients with hand and wrist conditions that include Dupuytren contracture and Reynaud's disease.

PSR: How did you prepare for a competitive fellowship?

Dr. Kargel: I looked for opportunities in my field of interest – in this case hand surgery – and worked with colleagues in plastic surgery and orthopedic surgery to get the most exposure and experience possible prior to fellowship. I asked attendings questions, made sure I knew the relevant anatomy and read papers and chapters reviewing techniques for surgeries I was scheduled to observe and scrub-in on. I found attending national meetings in the subspecialty also to be very helpful, as this allowed me to learn more about interesting topics led by leaders in that field, and to network with a large group of academic leaders from all parts of the United States and internationally under one roof.

PSR: What impact did your fellowship have on your career?

Dr. Kargel: I always wanted to be involved in academic medicine. I love to teach and to be challenged. When training medical students, residents and Fellows, you must stay on top of innovations and updates in the field. Participating in a hand and micro fellowship not only allowed me to sharpen my skills, it exposed me to a variety of conditions and procedures concentrated into a single year to establish a solid foundation in hand surgery fundamentals. It also provided me with a network of colleagues to help look for opportunities in academic centers. Additionally, a huge benefit of a fellowship is the long-term relationships you build with mentors to whom you can reach out throughout the years, if and when you need someone to bounce-off ideas for a particularly tricky patient presentation or surgical technique.

PSR: How important is a mentor – and how can we find one?

Dr. Kargel: Having a mentor is extremely important, and I think we can sometimes take it for granted in large academic centers. Mentorship can take many shapes, depending on where you are in training and career, and what resources you have available. This can be as simple as meeting with the head of plastics at your institution, seeking residents who you feel comfortable speaking to and asking advice of or meeting people at regional and national meetings that you can subsequently develop a relationship with over time. When I was a first-year medical student, Linda Phillips, MD, our plastic surgery division chief, gave a talk to the plastic surgery interest group. I remember listening to her speak while she showed us slide after slide of reconstructive surgery.

By the end, I knew I wanted to train under her. Additionally, during early elective rotations, research paper projects and subsequent scheduled surgical rotations, I had the opportunity to work with strong female residents who were facile in the O.R., led the resident and student teams efficiently and effectively throughout the workday, and portrayed excellent bedside manner. I modeled work practices and patient interactions after them, tweaking here and there as my own confidence and knowledge levels grew.

Even as an attending, it's important to have mentors who can provide insight and guidance, both surgical- and business-related. Finding the right mentor isn't always an automatic fit; sometimes it ends up looking like a mentorship team, rather than a mentor-mentee relationship.

PSR: What’s the most important attribute of a resident?

Dr. Kargel: The residents who are most impressive to me are the ones who treat the patients on service as their own. They listen to them in the clinic and on rounds, they advocate for them to ensure they are receiving the best care and they prepare for cases. These are the residents who are thorough and thoughtful, take initiative and make me excited to see they're coming on service. When they go out into the world, I make note of where they're practicing so I can refer patients, if needed.

PSR: How do you balance your professional and personal lives?

Dr. Kargel: Work-life balance or "integration" is a constant struggle and something we all deal with in our field. Since we don't work shifts, unless we're out of town and have handed-off our service to a colleague to babysit, we're never truly away from our work and our patients. However, since having my daughter, it's actually been a little easier to shut-off the computer, delay answering email and decline things, since I know it directly impacts her.

At work, I've looked for ways to be efficient – answering emails when I have a few minutes between cases, prepping notes and reviewing clinic lists prior to arriving in clinic and trying to set concrete deadlines for work assignments, so that I'm not working at the last minute to finish presentations and talks.

PSR: What was your greatest non-medical challenge of training?

Dr. Kargel: One of my greatest challenges was learning how to better communicate with my partner. Particularly early in residency, I'd call to let my husband know I was finishing up with work and would be on my way home soon, but then I'd get sidetracked taking care of a patient issue, putting in orders, speaking to a consulting service or helping with procedures. By the time I'd get home, it was much later than I'd initially said and my husband had been waiting for ages. We'd both end up frustrated – me because I'd been busy working, and him because he had no communication from me aside from the initial plan.

Over the years, we both improved. My husband learned to accept that certain days or procedures would likely mean I wouldn't be home for a while, and I learned to better anticipate my time estimates and to communicate updates if there were delays or changes.

PSR: What are some of the challenges you encounter on a regular basis?

Dr. Kargel: As with most people who utilize electronic medical records, it's always a race to ensure documentation is done appropriately and efficiently while still seeing patients in clinic in a timely fashion. I try to make sure I have everything completed before I leave at the end of the day, so that I'm not spending time at home finishing up charting.

Along with that, sitting down and spending enough time with each patient to explain their condition and surgical (and non-surgical) treatment options while not falling behind is something I try to be mindful of. When possible, I try to scan my schedule before clinic to have an idea of what I'm walking into in the room, and the staff I work with help by printing-out relevant imaging studies so that I can read, highlight relevant points and have a copy to go over and then give to the patient. The people you work with – including nurses, schedulers, MAs and APPs – have a huge impact on the success of your practice, and I've been very blessed to have strong partners in both my pediatric and adult practices who are vital to making sure everything runs smoothly.

PSR: What advice do you have for plastic surgery residents?

Dr. Kargel: It's important to realize that your surgical practice will evolve over time. Your 10-year plan as a resident may be completely different than the plan you form once you're out on your own. As they arise in residency and fellowship, make sure you take advantage of learning opportunities even on the rotations-focused aspects of plastic surgery that you think you may not need later in your career. In plastic surgery, we teach principles, not just techniques – and your patients will benefit from things you learn how to do well, whether it's communication style, bedside manner, clinical flow or surgical steps and things you learn may have less than desired outcomes.

PSR: Complete this sentence: "I knew I wanted to become a plastic surgeon when..."

Dr. Kargel: I realized that it allowed me to care for patients of all age ranges and almost all aspects of the body. The idea of being able to fixate bony trauma and in the next breath focus on delicate anastomoses under the microscope, followed by figuring out how to provide effective soft-tissue coverage with the end goal of achieving a functioning extremity, was thrilling to me. In the world of plastic surgery, innovations are constantly challenging us to do more for our patients, and I'm honored to be a part of the field and someone who gets to train the new generation of plastic surgeons.