EP221: Finding Your Path: A Conversation with Dr. Anna Stagner

Finding Your Niche in Medicine with Ophthalmic and Dermatopathologist Dr. Anna Stagner

Christine interviews Dr. Anna Stagner, a Harvard Associate Professor and Massachusetts Eye and Ear director who is board certified in ophthalmology, anatomic pathology, and dermatopathology and has authored nearly 100 publications. Stagner shares her background growing up in a small town in northern Arizona and her path from ophthalmology to ocular pathology, anatomic pathology, and dermatopathology. She advises exploring interests even if unconventional, prioritizing what you enjoy over what you’re merely good at, and not fearing major training changes. For productivity, she recommends saying yes to meaningful projects, changing environments to work effectively, and using daily Post-it task lists. She discusses aligning career choices with personality, seeking helpers, her trainee-focused sign-out workday, and cautions that choosing a subspecialty makes you the destination for difficult cases in that area.

00:00 Welcome and Guest Intro

01:12 Podcast Chit Chat

01:32 Small Town Origins

02:38 Finding Your Passion

04:24 Productivity Habits

07:08 Changing Paths and Self Insight

09:18 Choosing the Unconventional Route

10:38 Specialty Planning Resources

12:18 A Day in Ocular Pathology

14:14 Picking Your Niche Wisely

15:45 Wrap Up and Thanks

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. Today I'm very happy to be with Dr. Anna Stagner, MD. Dr. Stagner is an Associate Professor at Harvard University and a nationally recognized expert in ophthalmic pathology. She is one of the very few physicians in the country who is board certified in ophthalmology, anatomic pathology, and dermatopathology. As a member of the Eye Pathology Service and Director of the David G. Kogan Laboratory of Ophthalmic Pathology at Massachusetts Eye and Ear, she brings exceptional expertise in the diagnosis of neoplastic and inflammatory diseases of the eye, ocular adnexa, and eyelid skin. She also serves as an attending dermatopathologist at Massachusetts General Hospital and contributes to system-wide quality improvement initiatives across Mass General Brigham. An accomplished scholar, Dr. Stagner has authored nearly 100 peer-reviewed publications spanning melanocytic tumors, orbital inflammatory disease, and pediatric pathology. [00:01:00] She is also a highly respected educator and mentor recognized with the 2021 Anatomic Pathology Excellence in Teaching Award for her outstanding dedication to trainee education.

Welcome to Anna. 

Anna Stagner: Thank you so much for having me. I'm very excited to be here. I love podcasts.

Christine Ko: Oh, awesome.

Anna Stagner: I have a wide range from weird reality TV recaps to more science or medicine. 

Christine Ko: Yeah. I like the podcast format too, 'cause you can listen when you're doing other things.

Anna Stagner: Yeah, when you're doing other things especially, yeah. 

Christine Ko: Yeah. All right. First, can you share a personal anecdote? 

Anna Stagner: Yeah. I grew up in a really small town in northern Arizona on Route 66. That's probably the only reason anyone's ever been there. And in high school I worked at a gas station that was called Gas N' Grub, like N apostrophe. And they said I was their, the best employee, and they tried to get me to not go off to college but stay there. They said they'd give me a raise to $7 an hour if I stayed, but I moved on from there. We [00:02:00] had a drive through liquor window and everything. It was quite the interstate gas station.

Christine Ko: How many years did you work there?

Anna Stagner: Just a couple, like in the summers before high school and college.

Christine Ko: So you were in Arizona and then you moved to the midwest, right?

Anna Stagner: Actually, first to the Pacific Northwest for medical school. So I went from west to mid to east.

Christine Ko: So it sounds like working in the gas station wasn't gonna be your ultimate passion. First you did ophthalmology, then a fellowship in ocular pathology, and then anatomic pathology residency, and then dermatopathology fellowship. 

Anna Stagner: Yeah. 

Christine Ko: So do you have tips on finding something to be passionate about? 

Anna Stagner: Yeah. I think one of them is that you should explore things that you get really excited about or pique your interest, even if they seem weird, or surprise you, or seem odd to you, or you think, "Oh, that's not the trajectory I thought I was going on," [00:03:00] to explore those anyway, 'cause that's how I found my weird niche too.

Also focusing on those things that you feel something deep inside about, rather than necessarily what you're good at. Like I felt that I was a good surgeon, and my attendings would tell me I was a really good surgeon, and, " You're gonna do pathology? You wanna stop doing surgery?" And it was like, "But I don't like it." So I think really separating what you really care about and what's important to you from what might come naturally to you, even that you're quite skilled, at is important. It happened to me in high school even. I was on cross country and track because that came natural to me. That was the sport that I was best at with the least amount of effort. But I never really liked it. I hated it. I hated running. And so I never excelled at it. I was pretty good, but I didn't push myself because I hated doing it. So I think that's really important. 

Christine Ko: Yeah, I think you're making a good [00:04:00] distinction 'cause it's the age-old debate, right? Especially in sports or music. Is it innate talent versus hard work? And the answer seems to always be: it's good to have innate talent and then also work hard on top of that. I think you're saying anyone can be really good at something, but if you're not really interested in it, you're not gonna, over a long period of time, put in a lot of effort into something you're just not that into.

Anna Stagner: Yeah. Exactly.

Christine Ko: So you have already written like 100 articles, and you're still, I would say, early in your career. So do you have advice on how to be productive like that?

Anna Stagner: I think tying a little bit into the passion side of things. Of course, we all have to do things we don't wanna do sometimes in life or many times in life and work. But especially when choosing things to say yes to that are non-clinical, I really try to say yes to things that I am interested or excited about, or I think they would be really useful for someone or really [00:05:00] meaningful for an audience because especially when you're really busy, it's hard to get yourself to work on something that you didn't really wanna do in the first place. So that's one thing.

And then something I've discovered a bit later, like in the last maybe four or five years, is that if I'm really struggling to be productive I need to relocate myself to somewhere that makes me happy. So one example was like, I think it was two years ago, it was December in Massachusetts, and I had an overdue review article that I was the sole author on that I'd agreed to on a topic I know a lot about and I'm interested in, but I just could not get started.

So I drove to Cape Cod in the winter, checked myself into a little inn that was decorated for Christmas, and locked myself there for the weekend and wrote the whole thing. 'cause it was so beautiful and cozy, and it had a fireplace. And in Boston there's this really famous old library, The Athenaeum that's just beautiful. I got a membership there. If I am really [00:06:00] struggling, and I go there and just set up my little workspace, it's really a lot more helpful than being in your standard day-to-day office space or at home. So, I like that. 

Christine Ko: Yeah. That's nice. I think it's true that our environment influences more than I realize.

Anna Stagner: Something I've kinda discovered more recently, and it's been very helpful. 

I know one of my mentors in dermatopathology does this too. I have little Post-its for what I have to do each day. So I have some kind of longer to-do list and goal list, but I have daily little Post-its, like this needs to be done today, and then I can throw that one away.

Christine Ko: When do you write those Post-Its?

Anna Stagner: In the morning usually. Like when I'm getting my coffee and getting ready to leave.

Christine Ko: Okay. Okay. Yeah, because I find I'll lose my Post-Its. 

Anna Stagner: Yeah. My colleague, sometimes I would find her Post-Its scattered about occasionally. Yes. But I was like, "That's a good idea." My best friend from college is so organized. She has [00:07:00] beautiful, highlighted everything, beautiful handwriting and lists, and that's not me. But my little Post-Its do the trick. 

Christine Ko: That's cool. So in your career, I mean, you've navigated different parts of the country, and you did two different residencies, two different fellowships. Through all of that, is there certain things you've learned that you wish you had known earlier? 

Anna Stagner: I would say, first of all, don't be afraid to change your mind about even something as big as a residency choice or doing another residency. I think everyone I talked to was like, "What? You're crazy," and I think I maybe made the transition later than I would have. But it's hard to tell your family, if you're supporting a family, "I'm gonna do another residency." I don't have children, but I think that's important.

I wish I had maybe understood myself better when I was early on in my career, or even just in school. For example, I'm pretty introverted. [00:08:00] Talking to patients all day - I can do it, but it takes a lot out of me, and I'm really exhausted. Or I'm pretty overall anxious and really Type A, and so I wanna know every little thing about what I'm doing, and not be a jack-of-all-trades because that's not the way my brain works. And so I'm gonna have to do something relatively specialized to fit with my personality. Thinking about that when you're choosing a path is something I wish I had maybe done earlier as well.

And then my mom, who passed away when I was in my mid-20s, wonderful woman. She used to say-- One of the only shows she let me watch as a child was Mr. Rogers, and he used to say, "Look for the helpers." And I found, even in a really intense academic environment, there's always people willing to help you or to talk to you about maybe an unconventional choice you're considering or things like that. Approach people for help. 

Christine Ko: Yeah. That's all good advice. It is really [00:09:00] hard to not listen to the people around us and not follow, especially I think in medicine, to not follow the conventional path. It's laid out. It's almost like you can't not do it, in a lot of ways. To really do something a little different is not easy. So how did you eventually convince yourself, find the inner guidance to just go ahead and do it? 

Anna Stagner: Yeah. I think it was just really realizing what my day-to-day life would be like. Going back to the what you're good at versus what you like. Ophthalmology and dermatology are incredibly competitive specialties in medicine. They're hard to get into. They can be quite lucrative, and so it's like people are saying, "What do you mean? You're an ophthalmologist. You are a great surgeon. You're gonna make a bunch of money. You wanna do twice as much training for less money?" And I'm like, "That does sound crazy." But when I thought about what I would be doing every day ultimately and if I'd be [00:10:00] okay with that, it wasn't something that was gonna fit with my personality and goals. So it is hard though, especially we love positive feedback. I know I do. Someone telling you did a great job or you're really good at something. Everybody likes that, of course. It's hard to separate that and say, "I'm gonna veer away from that into something that makes me happier or I'm more interested in."

Christine Ko: Yeah. Yeah. I agree with a lot of what you said. I didn't know myself very well when I was a medical student, for sure. And so choosing a specialty just seemed to be like what are you interested in or not?

Anna Stagner: Yeah. I remember at the end of med school, they had us do the the Myers-Briggs as a group. I think it was just becoming a thing, and we looked at a few tables of what specialties might fit with your personality type. But yeah, something, or at least even just an exercise to make you think about that.

Christine Ko: Exactly. I spoke to [00:11:00] two women who did training in the United Kingdom, and they wrote a book about how to choose a specialty. It's for registrars in the UK, but I read their book, and it does talk about what you're attracted to, like your personality. I'll put a link to that book in the show notes for this. It's called Career Planning for Doctors by Dr. Naomi Elton and Dr. Carolyn Elton. They both have the same name, but they're not actually related. They have some exercises in the book of things you can cut out and prioritize 'cause like you were saying, like people are like, "You can make a lot of money," and it's such a competitive specialty. And so they have things like that. Is it more important for you to make money, be stable? 'Cause that's not a bad thing, right?

Anna Stagner: Of course not. 

Christine Ko: Yeah. Is it more important to have something else, right? And depending on your answers...

Anna Stagner: It's also hard in specialties like ours. You don't really get that much exposure in medical school. So even if the topic, like I love the eye, it's fascinating. I still study it, and [00:12:00] I love it, but that's not the same as the day-to-day practice of a general ophthalmologist. So especially for things outside of internal medicine, pediatrics, and things like that, it can be very hard, I think, to get a sense of what your life might really be like without seeking it out specifically.

Christine Ko: Yeah. What is your day like now?

Anna Stagner: Usually I start the day signing out with trainees, which are, I would say, most often ophthalmology residents. I almost always have trainees with me, either ophtho, derm, or path, so-- or even neuro, so it's fun. I also have a fellow, so I'll do sign-out until lunch, and then a lot of times over lunch, I'm doing some kind of didactic teaching or working on just catching up on emails and stuff. And then the afternoon, I'm usually doing more independent sign-out of cases following up on cases from the morning, talking to clinicians if needed. That's my typical day. [00:13:00] And then at night, evening, sometimes I'll work on more writing type stuff. I'm more of a night person, so creative things like that I do better at night.

Christine Ko: Oh, cool. And so you don't see patients? 

Anna Stagner: I don't see patients, yeah. Only pictures of them. We actually have this whole integrated imaging system for slit lamp and fundus photographs embedded within the medical record system, so it's really nice. And then, of course, in dermatology, every single patient who's getting a biopsy has a photo. So they're both fun specialties to do with a group, a mixed group of clinicians and pathologists, to pull up each patient's clinical scenario and then look at the slide too.

Christine Ko: Yeah. That's awesome. It sounds like you really landed in fields that you completely enjoy.

Anna Stagner: Yeah. It's a funny niche, but I I do enjoy it. I was telling someone recently, I took my cat to the cardiologist and she was explaining something to me about the heart, and I just mentioned that I was a human doctor. And she's asked me what [00:14:00] type, and I said, "I do ophthalmic and dermatopathology." And she's, "Oh, that is really specific." And I said, "You're a cat cardiologist." So we all find our little space in the field.

Christine Ko: That's cool. Do you have any final thoughts?

Anna Stagner: In terms of something I was thinking about today when I had my pile of consults. A final thought for when you're picking your super, super sub-specialized niche, which this kind of applies to academic medicine where they want you to really focus and be the expert on one thing, that when you choose, that's what people are going to come to you with difficult cases of and or send you patients that have that they have tried to treat or diagnose.

And yeah, just to think about it from that aspect when you when you're really narrowing down on a super sub-specialized focus. I was thinking, "Oh, I have these really cool, interesting orbital inflammatory consults," and that's 'cause I've made that one of my things. And that's good 'cause I like looking at these [00:15:00] cases. But if it was maybe not something you wanted to see in practice that you were an expert in, that might be something to consider. 

Christine Ko: Yeah. I was at a meeting and someone was like, "Oh, I presented on this disease of when people have uncontrolled itching." And he said, "So now everyone in the area and even outside the area sends me these patients, and I never wanted to see them." 

Anna Stagner: Yes. Exactly. That's what I mean. It happened to me with infection-- I published a few papers on some funny infections in surgical pathology just because I happened to see them. They were little case series I did with residents. And then people started asking me questions about micro, which is really not my field of expertise. I'm like, no. Why is this happening?

Christine Ko: That's funny. Yeah. This has been great. Thank you so much for your time.

Anna Stagner: Thank you for having me. This was really fun.