By: Zack Merhavy
Interview with Dr. Kyle Morgan, MD, Pediatric Anesthesiologist
Dr. Kyle Morgan, MD is a 2010 RUSM graduate. He was formerly a pediatric anesthesiologist at St. Jude Children’s Research Hospital and is currently a pediatric dental anesthesiologist working in private practice. I had the pleasure of speaking with him on some of his recent research experiences, his journey as a pediatric anesthesiologist, and as a Ross alumnus.
What are some of the reasons you chose pediatric anesthesia, specifically?
All along I thought I was going to go into palliative care. I thought I was going to go into internal medicine and go into a fellowship in palliative care and go that route. I liked the genuine human interaction of end-of-life patients and just the realness of that relationship. So, I thought about palliative care and realized that if I did internal medicine and then palliative care, I would just be learning the medication management side of things. So, then I thought anesthesia would give me the medication side of pain management, but then also interventional as well. I then thought I was going to do adult anesthesia and adult pain medicine and then go into palliative care that way.
It was just a time in my life where I was doing my first peds rotation at the children’s hospital in Milwaukee, and then I had my first child at that same time. Then, people at church asked me to start serving in the children’s area because I think my wife was getting plugged in there. So, all of a sudden at one point in my life, I was inundated with kids; personal, professional, and at church too, so I was thinking ‘man I think I could work with kids’. My only real exposure to kids before that was in my peds rotation and I thought ‘man, I just can’t do baby talk with kids and I’m just not good at that kind of outpatient kids approach’. It wasn’t until I had kids and started working with kids more regularly and doing that rotation at the children’s hospital that I realized you can be a good peds doctor without having to do baby talk. I also realized that people who tend to go into pediatric fields generally seem to be a little softer and more relational and a little more easy-going. So, the atmosphere, at least in Milwaukee, was a lot better and a lot nicer in the children’s hospital than it was in the adult hospital. I think all those reasons made me realize peds is for me.
Did you find it challenging or more difficult trying to match into a residency like anesthesia, coming from a Caribbean school?
I mean, I set my expectations and tailored them appropriately I would say. I didn’t apply to what would be considered the top-tier anesthesia programs. I knew I was a competitive applicant from a Caribbean school, meaning I had high Step scores and a high GPA and all that. But I figured that just coming from a Caribbean school would limit me a little bit, so yeah, I didn’t apply to your UCSFs and Mayo Clinics and Mass General programs. I applied to kind of middle-tier programs and set my expectations there, but then did end up getting interviews at most places I applied. I do think I was ranked fairly favorably at places where I interviewed, so I felt once I was at the interview phase, I was on a level footing with everyone else with everyone I was interviewing with. I think that seemed to be the case because I matched at my top ranked program and felt like I would’ve matched at my second and third ranked programs as well. But those were all probably middle-tiered programs.
By the time you were ready to apply for fellowship, did it not matter what med school you went to?
Absolutely; by that time, I applied to every competitive peds fellowship that was out there – Boston Children’s and Seattle Children’s and Cincinnati Children’s, Johns Hopkins, and I had interviews at all of those places and they were all like ‘please come here’. You know, I don’t think it was necessarily me like I’m some awesome guy, but I was a Chief Resident at our program and had good letters of recommendation and good in-training exam scores. Really, I think it’s just once you get to the fellowship level, it’s more like you’ve proven that you’re competent and it doesn’t really matter as much where you’ve done most of your pre-anesthesia training or where you obtain that knowledge.
After practicing pediatric anesthesia for almost 6 years, what made you want to get board certified in pain management? Was it difficult to get dual certification? What was that process like?
The American Board of Medical Specialties, ABMS, certified programs are pretty much all fellowship-mandated board certification programs. Because I practiced – and you’ll find this in a lot of pediatric sub-specialties, in anesthesia in particular – there’s very few, if any, sub-specialists within a pediatric sub-specialty. The level of training at the sub-specialist level is in peds, so to break it down beyond that is pretty rare or unusual.
So, I knew I wanted to do some peds pain management and pretty much everywhere I applied to for jobs said ‘you can do peds pain management without doing a peds pain fellowship’ because there really were no peds pain fellowships at that time; there might be a few now. So, I took a job at St. Jude knowing that I would do a fair amount of pediatric pain management even though I hadn’t done a pediatric pain fellowship or any pain fellowship. I just focused on pain during my peds anesthesia fellowship.
So, after a couple years of working in pain management at St. Jude, I found out that there was another way to get board certified that’s not fellowship-trained through the Board of Pain Medicine. It’s an accredited certification pathway; just not one that’s fellowship trained. You could call it a little bit of a back-door route, but it is important to go through the certification process. It is legitimate; you have to fill out this very lengthy application and then pass a board exam.
There are definitely other pathways that exist in other specialties too.
What made you want to go into private practice pediatric dental anesthesia? That’s a very specific field I never knew existed.
It is a very specific thing, and it almost makes me a bit nervous because I’m still fairly early on in my career and I don’t want to be so pigeon-holed and forget all the skills I learned during residency doing general practice in anesthesia. Just for this time in my life when my kids are young, I just paid off all my loans – I did the public student loan forgiveness thing, so I just hit my 10-year payment like 2 months ago – so it just opened up a lot of flexibility. I had to be working under a 501(c)3 up until that time, so I had to be working full-time to be able to qualify for that. With pandemic stuff going on, kids being young and being home – my wife homeschools them – and then with the financial flexibility from the student loan stuff, I just thought ‘alright, it’s time for a bit of a change’.
This dental thing, I actually got an email about it probably 2 years ago and the Chief of my department and I looked at it together like ‘man, this sounds pretty intriguing’. It was like a no weekends, no call position where you could kind of like set your own hours, and it pays decently. We kind of laughed about it like ‘man, that would be something, wouldn’t it?’. As things kind of shifted over during the pandemic and during this time in my life where all these crosshairs align, it was actually my next door neighbor who’s a pediatric dentist and then 2 guys that I go to church with who are also pediatric dentists all 3 talked to me about this position because the anesthesiologist that was serving the area from Dallas was saying he wanted to focus on Dallas and didn’t want to keep coming up to Memphis to do this. So, these 3 pediatric dentists who were already using this service all asked me about it like ‘hey, would you ever consider doing dental anesthesia in our office?’ and I was like ‘well actually, yeah, it’s kind of the perfect time to do it’. So, that’s kind of how it all came about.
And the guy that was serving the Memphis area was the former President of the American Society of Anesthesiologists. So, as soon as I saw his name, I thought ‘oh, this guy’s involved, so this must be something legit’ because I saw this guy speak on the national level a number of times. He’s a smart guy and passionate speaker about physician’s rights against mid-level providers and scope of practice and all that stuff. It was like ‘if this guy’s doing this dental anesthesia thing, it must be legit’. So now, I’m working like 9 or 10 days a month, and I’m not making quite what I was making when I was working full-time at St. Jude, but fairly close to it. My goal is that I kind of build my book of business and grow this area a little bit and then hopefully work somewhere from 12-15 days a month, and then I’ll be making about what I was making at my other job.
Can you speak to how research has played a role in your everyday practice or how it shapes the way you see the world of anesthesia day-to-day?
I didn’t do any kind of research at all in medical school or even in residency. The residency program I went to didn’t emphasize research whatsoever. Then, I took a faculty position, like many, where you do have a publication requirement; and it was kind of sold to me as you don’t have to be doing ‘research’ research to publish things. You can write an editorial or do an interview at a newspaper; really anything that gets your name out there is what they’re looking for. And most places say they want you to put 1 or 2 things out per year or maybe 3 things in 5 years or something like that. So, that’s pretty much what St. Jude and Vanderbilt both said.
Getting into it, the biggest key was having a mentor. As soon as I started at St. Jude, there was an older faculty member who was pretty big into clinical research and anesthesia and pain management and she just kind of took me under her wing and let me be the first author on a paper that she already kind of teed up. It was a review paper about neuropathic pain assessment tools, and she had done a lot of the research and got done a lot of the literature reviews and gave me all the notes she had and said, ‘if you want to turn this into a manuscript, you can be the first author on it’. So, that was my first exposure to doing any kind of medical writing and I just learned so much from that process. I think it took me a year where if I did that project now, I could probably bang it out in 2 or 3 months, but that first year kind of acclimating as an attending for the first time, moving to a new state, and having another child, I was able to go at a pretty slow pace with it. There was really no timeline, and then her mentorship and guidance to just kind of critique it and fine-tune it and everything was instrumental.
And once you get that first paper out there and you see all those metrics they have now and ways to track it, you can say ‘wow, that paper got tweeted out 25 times and it was cited 4 times’. I don’t know, it’s just this little bit of positive reinforcement along the way like every time you see someone shared your article, you’re like ‘oh man, I made that; I put some effort into that and someone else saw it as something valuable’. So then, it just morphed from there into kind of having a desire to continue to work on something where I can look into my day-to-day practice like, ‘man, there’s a question that I have’. [For an idea I have], I could just do a small study with the kids I have, and once you kind of put those glasses on – research-minded or academic-minded glasses – you see a problem in your usual clinical practice. You start to think ‘I’m pretty well-suited to answer that question’.
The same kind of thing happened with the glucocorticoid paper I did for kids with adrenal insufficiency. I just wondered after giving a bunch of hydrocortisone to a bunch of kids that I feel didn’t really need it for like MRIs and things, do kids get adrenal crisis all because they’re adrenal insufficient for this very minor anesthetic? Well, the answer ended up being no, and that changed practice. In fact, I got emails from people from Ireland and England about that paper asking [questions]. It’s super cool and just keeps the ball rolling.
I think one of the most frustrating things for me is being really passionate about research in the stage I’m at is that I’m so limited to what I’m allowed to do. I have all these questions that I have on a document on my computer that I eventually one day want to be able to answer. It’s a weird place to be where you have all these questions, but not the knowledge to be able to connect it or to see patients to figure them out.
I did the same thing where I had a document going where I would say ‘this would be a good question for a research project’. And 2 years later, I look at that list and I’m like ‘oh man, that’s never a question and that would be such a waste of time to ask that question’ or ‘that’s totally infeasible to consider answering that question’, but maybe they would give me an idea for something else. Just having those questions and kicking those ideas around all the time is helpful because there were a couple projects that just came up.
I had a question when I was sitting at the ASA [American Society of Anesthesiologists] conference 4 or 5 years ago a question came up about ASA scores [metric to determine if someone is healthy enough to tolerate anesthesia and surgery] and what do we call cancer patients. So, I was like “man, what do we call patients with retinoblastoma? Why do we call them ASA III [a patient with a severe systematic disease with significant functional limitation]? It doesn’t really seem like they should be a III’. And I just was like ‘I’m probably never going to get to that problem’, but it’s a question I had. Then, I had a very motivated med student who just said ‘hey, do you have any projects that I can help out with?’; he just emailed me out of the blue. I was like ‘well here’s one I was thinking about’ and he was like ‘great, I’ll look into it’, and over the next 6 months, he did a bunch of the reading for it and I kind of gave him the direction and he ended up writing a manuscript and we got a paper out of it.
Just having that document and having some ideas in the ‘on-deck’ circle is a benefit because you never know when the opportunity strikes to carry that forward.
Do you often work with med students or residents or whomever is asking if you have anything?
In Memphis, there only recently is a residency program, but there used to be one a long time ago; they only recently brought it back in the past 2 or 3 years. So, I haven’t really worked with any residents because they’re all in their first year or two right now and they’re not based out of St. Jude; they would only do a rotation there. I didn’t really have much exposure to residents.
But I’ve probably had 5 projects in the past 5 years that a medical student essentially spurred on. I mean, they were all ideas I had, but it was all because a medical student asked ‘hey, do you have anything we could work on?’ and I would say ‘here’s the 4 or 5 things that I’m kicking around’ and they would say ‘oh, that one’s kind of interesting to me’, and they would take it and run with it. The best one of those being the post-dural puncture headache paper that got published in the British Journal of Anesthesia. That was a medical student that ended up not even going into anesthesia; he ended up going into radiology. But he did a rotation with me and said ‘hey, I want to work on something’ and we wrote that. In the world of anesthesia, the British Journal of Anesthesia is probably like a top 2, if not number 1, most impactful journal. None of my other things will ever be published in a journal like that, but now this medical student is a second author on a paper that was published in probably a top 2 journal in the world of anesthesia.
Is that something you actively seek out or is it something that’s kind of just passively brought to you of someone saying ‘hey, do you have anything’?
Yeah, it’s totally been passive. It’s been almost entirely medical student driven. Either because they did a rotation with us for whatever reason early in their third year, and they’re like ‘hey, I want to get something published before I start to apply. Before I send out my applications, I want to have something published. Do you have anything in mind?’.
Besides the post-dural puncture paper, all the others were friends of friends. One first year student emailed me and said, ‘can I work with you on something?’ and then it was like his friend and his younger brother that all kind of followed suit.
It’s a heck of a lot easier for me as their overseer to apply for privileges for them to access our medical record and not have to worry about getting them on campus ever. If you’re trying to get questions answered and enroll people in studies, you’ll probably need to be on campus, but a lot of those tasks are run through medical students due to the type of the study. But if it’s something retrospective where you’re really just reviewing charts or if it’s a literature review or something like that, it’s easier as the supervisor of the research rotation to not have the person on campus because then I don’t have to make sure their vaccinations are up to date and I don’t have to get them a parking security hangtags; all I have to do is ask for computer access, and that’s easy to get. At this point, it might almost be preferable to have someone that’s remote.
Do you have any advice for Ross students looking to pursue either a career in anesthesia, in research, or in both?
I guess I would say that having the path that I did, I definitely was not someone that was very proactive and that was probably a major fault of mine. I was lucky to kind of be placed with a mentor when I took my first faculty job. I think now that the structure is pretty well set up, especially if Ross has an elective research rotation where you could be doing things remotely, I don’t think it’s out of the question to email various departments at places that you would like to match at for whatever your specialty is and just say ‘hey, I’m a medical student with 2 hours a week to give to a research project for the next 6 months. Does anyone in your department have anything?’. We got those requests at our small department kind of regularly over the past 2 years. Unfortunately, we weren’t a very productive department, so there was only a handful of us doing any kind of research; like, maybe 3 or 4 of us. So, we didn’t get to utilize those requests as often or inquiries as often as I think we would’ve liked to, but I’m sure there’s plenty of much more productive academic programs within anesthesia, and certainly within other specialties that would eat up a chance to use some free medical student brain power and labor.
All you’re really looking for is to 1, be exposed to the process. I didn’t even know that you first need to submit a concept to the Concept Review Committee, and then you need to get it IRB approved. I didn’t even know any of those steps, so getting exposed to those steps while you’re a medical student before you’re expected to have any kind of knowledge there is really beneficial just to get exposed to how to construct a medical paper or medical sentence. It’s not like any writing I’ve ever written in college; my only papers were for English class or for history or something. The medical language is unique, so just having exposure to it when you have the excuse of being naive as a medical student can only benefit you. You’ll likely get your name included as an author on a paper – and in fact, I think you should. Just getting that first one out of the way is so worthwhile because it just kind of opens the dam and it kind of snowballs from there.
I would also say just being proactive in sending out some blind emails to some programs in the specialty you might want to match to, or just even ones that are academically productive, and say ‘I’m so and so. I’m interested in getting into the specialty. I have this amount of time to give to your research project. Do you have anything?’. The worst thing they say is ‘no; sorry’ or ‘no; we don’t take medical students from Ross or from wherever’, and whatever, you wasted 5 minutes on an email. But if you get one person to say ‘yeah, send me your CV’. Just one is an in for that department for a potential connection for a match later down the road. But it’s also an opportunity to get exposed to all that; kind of the groundwork of what research can be – if you’re not already familiar with it like I wasn’t.
A huge thank you to Dr. Morgan for taking the time to speak with me and giving such great insight and advice! If any readers are curious to know what kind of research he’s been up to, check out some of his publications below:
· Morgan KJ, Figueroa JJ. An unusual postoperative neuropathy: Foot drop contralateral to the lateral decubitus position. A&A Case Reports 7:115–117, 2016. PMID: 27580410.
· Morgan KJ, Pribnow AK, Anghelescu DL. Propranolol use for a psychiatric indication contributing to intra-anesthetic hypotension: A case report. Annals of Psychiatry and Mental Health 5(2):1096, 2017.
· Morgan KJ. A Fresh Start. In Med School Uncensored: The Insider's Guide to Surviving Admissions, Exams, Residency, and Sleepless Nights in the Call Room. Emeryville, CA: Ten Speed Press, 2017.
· Morgan KJ. Med Students of the Caribbean. In Med School Uncensored: The Insider's Guide to Surviving Admissions, Exams, Residency, and Sleepless Nights in the Call Room. Emeryville, CA: Ten Speed Press, 2017.
· Morgan KJ, Anghelescu DL. A review of adult and pediatric neuropathic pain assessment tools. Clinical Journal of Pain 33(9):844-852, 2017. PMID: 28033158.
· Morgan KJ, Chemaitilly W, Rossi M, Li Y, Han Y, Merchant TE. Supplemental glucocorticoids and anesthesia for noninvasive indications in children with central adrenal insufficiency: A retrospective study. Pediatric Anesthesia 29(3): 292-294, 2019. PMID: 30632232.
· Morgan, K.J., Rossi, M. and Chemaitilly, W. The role of glucocorticoid supplementation in children with secondary adrenal insufficiency undergoing anaesthesia for imaging examinations. Anaesthesia 75: 1395‐ 6, 2020. PMID: 32578203.
· Ly EI, Brennan RC, Wilson MW, Sahr N, Sykes A, Morgan KJ. The impact of tumor excision on American Society of Anesthesiology-Physical Status scoring among pediatric anesthesiologists: A retrospective review. Pediatric Anesthesia 31(4): 491-493, 2021. PMID: 33340168.
· Morgan KJ, Mohan R, Karol SE, Flerlage J. Epidural blood patch for post-dural puncture headaches in adult and paediatric patients with malignancies: a review. British Journal of Anaesthesia 126(6): 1200-1207, 2021. PMID: 33612247.
· Mansfield S, Woodroof J, Murphy A, Davidoff A, Morgan KJ. Does epidural analgesia really enhance recovery in pediatric surgery patients? Pediatric Surgery International 37(9):1201-2016, 2021. PMID: 33830298.
· Anghelescu DA, Morgan KJ, Frett MJ, Wu D, Li Y, Han J, Hall L. Lidocaine Infusions and Reduced Opioid Consumption – Retrospective Experience in Pediatric Hematology and Oncology Patients with Refractory Pain. Pediatric Blood and Cancer. 2021 June.