EP230: Adapt, Migrate, or Thrive: Lessons from Dr. Val Thomas

Identity, Endurance, and Choosing Your Path with Dr. Valencia Thomas

This episode of The Girl Doc Survival Guide features Dr. Valencia Thomas, a Black dermatologist and professor at UTHealth Houston and MD Anderson, who discusses her extensive training path and how identity shifts across places and career stages. She describes growing up in Fort Worth, being the only Black student in her class, and arriving at Harvard amid racial violence and inflammatory remarks, while valuing active dialogue and trusting an inner voice for safety and direction. Dr. Thomas emphasizes being race-conscious but not race-limited, and notes that people may say off-color things through ignorance rather than malice, sharing a story from Dr. Harley Haynes about learning respect and the “us vs. them” divide. She highlights lessons on communication from Ted Lasso, explains that about 16% of people are “never adopters,” and advises endurance—“adapt, migrate, or die”—and making decisions knowing they can often be changed.

00:00 Meet Dr Valencia Thomas

01:07 Texas Roots and Moving Around

01:53 Identity and Being Black

03:54 Harvard and Racial Reality Check

05:42 Learning Across Differences

06:50 Ted Lasso and Hard Conversations

07:53 One in Five Never Adopters

09:20 Endurance and Career Thriving

10:37 Changing Paths in Medicine

12:09 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. Valencia Thomas, MD. Dr. Thomas earned her undergraduate degree in Biochemical Sciences from Harvard College and her medical degree from the University of Chicago Pritzker School of Medicine. Following an internship in Reproductive Medicine at the University of California San Diego, she completed a research fellowship in Dermatology Clinical Trials at Massachusetts General Hospital and Dermatology residency training at Harvard Medical School, where she served as Chief Resident of Education. She subsequently completed fellowships in both Mohs and Dermatologic Surgery at Oregon Health & Science University and in Dermatopathology in her home state of Texas. Dr. Thomas is currently a Professor at the University of Texas Health Science Center at Houston and at MD Anderson Cancer Center. She is a Diplomate of the American Board of Dermatology, an Associate of the American College of Mohs Surgery, a fellow of the American Academy of Dermatology, and a member of several professional [00:01:00] dermatologic and medical societies.

Welcome to Val. 

Val Thomas: Hi, everybody. This is great. Happy to be here. Thank you for having me.

Christine Ko: One of the things I find impressive is your home state is Texas, but you've moved all over. Oregon, California, Boston, New Haven.

Val Thomas: I grew up in one city, in Fort Worth, Texas, which is a wonderful place to grow up. If you're ever gonna find someone who's most likely to take a tablecloth and turn it into a dress, they're from Fort Worth, okay? That's who we are. It's a really neat place where we talk, and we're very gregarious. When you walk down the street, you will not be able to get where you're going on time 'cause you're gonna run into somebody you know, and then you're gonna be late. So, I'm from that. And I was thirsty being from that, and I really wanted to go first to someplace old, and then I just kinda started hopping around, you know?

Christine Ko: I like that. I wanted to talk to you about identity, how it's felt for you being in different places and different [00:02:00] stages of training, too. Also for anyone who doesn't know, Dr. Thomas is a Black physician, and she's willing to talk about that identity as well. 

Val Thomas: Absolutely. This concept of identity. I believe that there are all these different lenses, and my being is a combination of everything. I'm a person who definitely believes in a race-conscious but not race-limited society. I don't want you to overlook anything about me. My history is everything, and I really embrace my own and others' shared history, ethnicities, and whatever identities are out there.

I went to the same school between kindergarten and 12th grade. I had an identity, right? I was the same person from kindergarten to 12th grade. For 13 years, I was gregarious, I was artsy. I was also the only Black person in my class. I've always had the identity of being Black [00:03:00] and being proud. Being in a society where sometimes people will treat you a certain way based on your looks, sometimes you can have fellowship within the community, but sometimes your best friends are outside. I've had this very inclusive family so that I never felt alone. I'm from a huge family on my dad's side. He was the youngest of 13. So we spent a lot of weekends with cousins and extended family. I always had this really multi-ethnic upbringing.

If you look through the racial lens, I may have been the first Black cheerleader. I was the first to hold a record in 300 hurdles, but it was because it was the first time it was ever run. I was terrible.

When I go to different places, I get to be different. When I first moved to Cambridge, I was so excited. I was just [00:04:00] a ball of energy. I was over the moon. And then right when I got to college, there had been a horrible racial incident where a young Black boy had tried to cut through Dorchester and was told he was in the wrong place and was actually beaten to death. That happened within months of my arrival. And then, I think, three to four weeks after, one of the Harvard professors, on grade inflation at Harvard, he said, "Well, of course, grade inflation is because we had the matriculation of Black students, because, you know, we let them in and they weren't qualified, so you have to give them Cs so everyone else gets As. So, to fix grade inflation, you have to stop admitting Blacks," basically. This is what I walked into freshman year. But the good thing about Harvard College is that it was a place of active dialogue, and it wasn't a violence-based dialogue.

I think the most important thing, though, in going through any challenges of life is just to listen to that voice that has no [00:05:00] form, right? That kind of inner voice that we have that's like, "This feels right," or, "I'm gonna back away from this. This is creeping me out a little bit," or, "You know what? No, I'm just not going out. I've taken my socks off. I'm not going. Not going." But one must always be aware of these other kind of lenses where people may view you differently, especially if people are unfamiliar. Especially when around people who are not used to you, whatever that is, whatever that means, people may say things that may seem off-color, but their heart is in a really good place, and they may not know that this could come across as a little pointed. Dr. Harley Haynes, who was a professor at the Brigham. He had a beautiful soul. He told me this story about when he grew up in Ohio. He was a white man who grew up in a white environment, and when he got to the service, 'cause he fought in World War II, he was referring to his Black [00:06:00] soldier mates, basically with let's just say less than colorful terms because that's all he heard. That's all he knew. He did not know that that was offensive. He didn't even know it was wrong. He was just like, "This is just how you refer to this group," right? And he said, you know, "I almost got beat up," but some folks sat him down and told him, "Okay, this is not a show of respect." And he's like, "I had no idea, not a clue." And he said he started to look at that point at the concept of us and them. And he figured out over a lifetime that humans will always divide the world into us and them, and the question is, who's the us?

Christine Ko: You're right. We try to box people up. The other thing about your story about Dr. Haynes is, I think that's true that sometimes it's just, "Well, this is all I know." Sometimes we really don't know. 

Val Thomas: Definitely. I learned a lot from watching Ted Lasso. There is this one part that I found so powerful. One of the folks that worked for Ted Lasso was describing him as kind of [00:07:00] a loser and a failure and unfit. And he was a good friend to this guy, for years. And so when they finally saw each other face-to-face, Ted said to the betrayer, "What am I supposed to take from what you said?" It was the most simple, beautiful statement. That's what started the conversation of, "You got here, you did this. I was uncomfortable with this. This is how I felt." It was just the most productive, beautiful scene. I'm like, wow, I gotta integrate that into life. I can't imagine how many times I've offended people over the years, and I really didn't mean to, you know? I only can pray for their forgiveness and patience, and hopefully they knew that I just didn't know any better. Critical information can come at any time, right? I think we have the opportunity to learn more. 

Christine Ko: Is there anything you wish you had known earlier? 

Val Thomas: Oh, yeah. The one thing I wish [00:08:00] someone had told me early on, like truly. I took a marketing class somewhere along the way, and when you look at the adoption categories, of how people take in new information, you have very early adopters, late early adopters, late adopters, very late, and then the never adopters. And that never adopter group is 16% of the population. And I'm like, "Okay, so you're telling me roughly, one in five people just not gonna do it." If you told me that in sixth grade when we were trying to play basketball or do soccer or put together a birthday present for somebody or do any group activity, and you just told me, "Hey, human nature, super weird, not always the same person. One in five just not gonna do it. Never gonna do it, not gonna do it. Doesn't believe it, not gonna do it." If I knew that, that could've really helped a lot of the potential conflict that came up, you know, oh, this is all part of human nature. I wish [00:09:00] someone had just told me, don't be shocked if one in five people in your group is just going to be thinking differently. 

Christine Ko: Yeah. Oh, I like that. I didn't know that. Maybe one in five I'm not ever gonna be able to convince. 

Val Thomas: That's it. That's it, and that's okay, you know? It also gives you a little bit more tolerance or patience.

Christine Ko: I love that. Do you have any tips on thriving over a career? 

Val Thomas: Yeah, just keep going. There is this quote by Langston Hughes. "Talent is insignificant. I know a lot of talented ruins. Beyond talent lie all the usual words, discipline, love, luck, but most of all endurance." And I agree. Hang around long enough. Endurance, and you just keep going. My seventh grade biology teacher had a banner. Mrs. Foster, Sharon Foster, Fort Worth Country Day. She's wonderful. Anyway, a giant banner, and it said, "Adapt, migrate, or die." [00:10:00] That was it. It was printed on a dot matrix printer, and it was just right across our biology board for the year. And I mean, that's it, you know? Adapt, migrate, or die. If that area, wherever you are, you can endure it for a while, but once you realize adaptation is not optimal- then migration is your choice.

And that doesn't mean that you've given up anything or that you're any lesser. You just need a different environment. Sometimes that environment will help you thrive, and you'll achieve resonance.

Christine Ko: I like it. Do you have any final thoughts? 

Val Thomas: I have to say with identity, I have so many identities. When I was in med school, I thought I was gonna do surgery. I had imprinted on head and neck surgery. My identity in med school was surgeon, future surgeon. And then by the time I got to fourth year I was like, "I don't know." And then I decided I could do OB. [00:11:00] And then I got there and I was like, "Nah, I don't think this is for me either." My final thought. When I was at University of Chicago, and I had no idea what to go into. I decided it wasn't gonna be head and neck surgery, and I had nothing. I'd already applied for surgery intern year, head and neck surgery, general surgery just in case the ENT didn't work, general medicine just in case surgery didn't want me. And then, I was talking to the head of anesthesiology, and he was like, "So you're interested in anesthesiology?" And I said, "I have no idea. I have no idea. I'm completely lost." And he's like, "Well, listen, you're gonna make a decision, and no matter what choice you make, it's gonna be wrong, most likely." He's like, " There are very few decisions that you can't undo later. So just make a decision, own it, and change it when you know." And that was a relief, 'cause everyone up to that point had been saying to me, "Oh, you'll make the right decision." And I knew they were wrong. I knew they were all wrong. It's like, "That's wrong. I know I'm gonna make the wrong decision." And it was correct. I made the absolute wrong [00:12:00] decision. But, that's okay, because your path sometimes finds you. Just keep going. Use that endurance. So those are my final thoughts. 

Christine Ko: That's awesome. I love the way you explained all that, and thank you. It's been so fun to talk to you. 

Val Thomas: Absolutely. Thank you for having me. You're doing such wonderful work here.

Christine Ko: Thank you.