Charting Your Own Career Path in Academic Medicine with Dr. Resa Lewiss

“ Emergency medicine, you're supposed to be quick. You're supposed to be efficient and you're supposed to be good and you're not supposed to make mistakes and fill in all the blanks. And if there is something that's going to help us do all those things better, gosh, I'm on board.”

Dr. Resa Lewiss is an emergency physician, academic leader, and pioneer in point-of-care ultrasound (POCUS), with an impressive career spanning traditional academic roles and innovative ventures.

In addition to her clinical work, Resa is the host of The Visible Voices podcast, as well as the author of MicroSkills: Small Actions, Big Impact, a self-help book to help physicians navigate many of the challenges of practicing medicine in the modern workplace.

In this episode of How I Doctor, she joins Offcall co-founder Dr. Graham Walker to discuss how she’s managed to enjoy such a fulfilling and non-traditional career in academic medicine, and her advice to other physicians about breaking out of the standard “mold” and charting your own path, particularly in academic medicine.

From her groundbreaking work in ultrasound to co-authoring Microskills, Resa truly exemplifies how to put together a multifaceted medical career. Here are several of her lessons learned for fellow physicians.

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1. The Transformative Power of Mentorship in Medicine

“True mentorship isn’t about giving advice based on your own path. It’s about guiding someone based on who they are and what they need.”

Mentorship has been central to Resa’s journey. She highlights the importance of finding mentors who align with your values and goals rather than those who push you to replicate their own career paths. Building a personal “board of directors” helped Resa make strategic decisions, navigate challenges, and remain grounded in her purpose. She suggests that fellow physicians use this same model to find individuals who can support you through both traditional and non-traditional career paths.

2. Be Willing to Change Institutions to Get Promoted

“Every time I moved institutions, more opportunities opened up, and I expanded my network significantly.”

Resa candidly discusses her experiences navigating the traditional pathways of academic medicine and how she broke the mold to create new opportunities. “I was brainwashed academic,” she shared. “There was a well-worn path, and few people stepped off it. But I realized the advice I was given wasn’t tailored to me.”

Breaking away from traditional career advice, Resa carved her own path in academic medicine by seeking out opportunities that aligned with her skills and aspirations. She explains how moving between institutions can actually accelerate promotions, expand your professional network, and create new chances to innovate.

3. Embrace Publishing in Non-Traditional Outlets

“There are so many positive reasons to write for more mainstream outlets. Number one, the turnaround time is much quicker. You find out whether it's accepted or rejected much sooner. You also reach a broader audience and you de-silo, de-mystify what's happening in healthcare.”

Resa discusses the importance of breaking the model set before physicians when it comes to publishing. Instead of going the traditional journal route, she decided to write for more mainstream outlets and talks about the benefits of doing it this way, from the faster turnaround time to reaching a broader audience. That is also where the idea for her book MicroSkills came from: she began by writing proof of concept articles, and based on the popularity of those articles, ended up turning them into a book. “We are two women, two emergency physicians, different upbringings, different life experiences professionally and also a lot of overlapping experiences, and we wanted to write a book that would speak to a general audience,” she shared.

To connect further with Resa, connect with her on LinkedIn here or on her website https://www.resalewiss.com/.

To make sure you don’t miss an episode of How I Doctor, subscribe to the show wherever you listen to podcasts. You can also read the full transcript of the episode below. Previous episodes of How I Doctor include interviews with Dr. Glaucomflecken, Dr. Tina Shah and Dr. Eric Bricker.

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Transcript

Resa Lewiss:

I found a lot of the advice that I was given often wasn't Resa-focused or Resa-centric. It was more people advising me to do what they had done almost as a self-fulfilling prophecy because if I followed their path and I followed what they did, then that reaffirms their path. I was very aware in the moment I'm like, "They're not making Resa advice. They're not telling me based on what they know of me. They just want me to do what they've done," and you and I both know that's not true mentorship.

Graham Walker:

Welcome to How I Doctor, where we're bringing joy back to medicine. Today, I am honored to speak with Dr. Resa Lewiss, an emergency physician and my former attending. Resa had both a very traditional academic career as well as a very non-traditional career as well from practicing emergency medicine, leading the charge on point-of-care ultrasound in all of medicine, and now hosting not one, but two podcasts and writing a book. To me, Dr. Lewiss seems like a time traveler. She somehow knows the direction of medicine and her own life, and just follows that path. Welcome to the show, Dr. Resa Lewiss.

RL:

Graham, it's wonderful to be in conversation with you.

The Role of Ultrasound in Transforming Patient Care Across Specialties

GW:

Thank you, Resa. Thank you. I first got to know you in 2008, when I started in residency, and you were already just the guru of ultrasound. Maybe you could just tell me where your ultrasound passion came from.

RL:

When I started residency in 1997, there was no ultrasound. I did not learn ultrasound, and when I completed residency in 2001, I had not learned ultrasound. Now that being said, there were three huge figures in my clinical experience in my mentorship life that used this technology. All three stood out as amazing patient-centered, safety-centered clinicians. They're just good doctors and good human beings with good hearts and good minds, so I'm like, "They seem like good people to follow."

One woman was a year above me in residency and she had done disaster work in Kosovo, and she used this thing called ultrasound. Another is someone who was a brand new attending. He had just finished his training in New Orleans and had done a lot of moonlighting in rural emergency departments in Louisiana. He also was using this technology called ultrasound.

Finally, there was an older attending that had started the residency program at the Brigham and Women's Hospital in Boston, and he had trained in emergency medicine in the 1980s at LA County USC. And he famously said to me, when I was going to go spend a year doing ultrasound fellowship in New York City, "Resa Lewiss, ultrasound has never gone anywhere, and it's not going to go anywhere. Why are you going to New York City to spend a year more of training?" He's still a dear, dear friend and a mentor. He's one of my personal board of directors, and he has circled back and said, "Resa, I was wrong. I was wrong."

GW:

I missed the boat on that one. You were really just finding people that you trusted and liked the way they practiced medicine and understood from them like, "Hey, I think this is a thing that could be helpful."

RL:

Yeah. I referenced this personal board of directors and because you've read our book that launched this year called Microskills. Chapter one is Microskills for Self-Care, and the reason my co-author and I started with that is, gosh, medicine and even particularly academic medicine does not teach us how to take care of ourselves. It doesn't model it. It doesn't loud it, and in fact you are rewarded and you're considered strong if you actually don't take care of yourself. But don't die because you potentially could die if for example, you don't sleep and then you drive home after a night shift, for example.

The point is that I surrounded myself by people who I knew were just smart, good people with good hearts and good minds, and were trying to make a positive contribution in this world. I clung to those people, I sought those people out. I surround myself with those people and it's definitely not about quantity, it's about quality.

And those three that I just mentioned, all three of them, they were good people and they were amazing clinician physicians who I would let take care of me any single time, any day of the week.

Emergency medicine, you're supposed to be quick, you're supposed to be efficient, and you're supposed to be good and you're not supposed to make mistakes and fill in all the blanks. If there is something that's going to help us do all those things better, gosh, I'm on board.

GW:

POCUS or point-of-care ultrasound is a fairly common term now. I think when I was in training, we were calling it bedside ultrasound, but I think POCUS is a one in terms of the most common phrase. Now we're seeing other specialties use it. I now will often talk with an internal medicine resident who maybe is just an intern who learned ultrasound during their medical school training and they're asking, "Were there B-lines on the ultrasound?" They know this terminology. Did you know it was going to expand outside of emergency medicine and grow as a field more broadly?

RL:

Here's what I knew: I knew that ultrasound was known to be of use within radiology, OBGYN, cardiology, and in the 1990s, trauma surgeons started talking about the fast exam. Initially it was called the focused abdominal sonography and trauma, and then it became the focused assessment. It's not just the abdomen. And then all of a sudden it went quiet in the late 1990s, early 2000s, it was emergency medicine that really said, "This is important for diagnoses and for procedures." So we're not the only specialty in the house of medicine that makes diagnoses or performs procedures. What is such a pleasure to see is that someone asked you about B-lines. It is spread into fields that aren't particularly procedure oriented, so internal medicine or hospital medicine, we want to be equipped, we want to have the technology to be set up to be the best at what we're trying to do, and in this case provide care and be doctors.

GW:

Resa, where do you think ultrasound goes next? Do you see more specialties adopting it? Are there more indications and what do you think are going to drive those changes in medicine?

RL:

I feel it's not if it's when, that for every cardiac arrest, every code, we are dropping a TEE probe and performing a transesophageal echo. I think procedural sedation is going to slowly go away and we are going to be doing nerve blocks. It's efficient, it's resource smart, and it just provides really good patient-centered care in terms of side effects of pain medications and sedation effects of pain medications, as well as just really good pain control for our patients.

I think that every specialty will find a use for ultrasound except save psychiatry, but every other specialty, I've thought a lot about this, is increasingly seeing the use of ultrasound. We can carry it in our pocket now. When I was starting out, it was a lot of pounds and I had to put my full body behind it to roll it around the emergency department and it took up a lot of room at the patient's bedside. It's not like that anymore.

GW:

We do nerve blocks. I do a fascia iliaca block for every single hip fracture. We could certainly do more nerve blocks. I find it to be one of the most satisfying procedures I do now because I just have years and years of remembering these older patients who are often quite frail. They're either moaning and in significant pain and distress from the pain of a broken hip, or they're sedated and hypoxic and it's such an easy procedure. If you can put a central line, you can do this procedure within 10 minutes, you take somebody from excruciating pain they're like... It's actually quite reasonable. It's incredible.

How to Navigate and Succeed in Academic Medicine

I think you've really climbed the ladder of academics very successfully. When we met an assistant professor at St. Luke's Roosevelt, which is now technically Mount Sinai West, and then you were an associate professor, and now you're a full professor. How did you make those career decisions changing institutions, how to negotiate for the assistant to associate to full professor?

RL:

When I arrived to medical school, I couldn't believe it. I was so excited. I was like a kid in a candy shop or a kid in the toy store. No one in my family is a physician, and I thought, "This is amazing. I can't believe I'm allowed to do this. This is what my job is." The level of responsibility, I loved it.

I went to med school at the University of Pennsylvania, and then I did my residency training at Harvard Emergency Medicine. These are very traditional, historic academic places, so when I say I was brainwashed academic, I truly believe I was brainwashed academic. There was this way of doing things and there was a very well-worn path and very few people stepped off that path. And in fact, I found a lot of the advice that I was given often wasn't Resa-focused or Resa-centric, it was more people advising me to do what they had done almost as a self-fulfilling prophecy because if I followed their path and I followed what they did, then that reaffirms their path.

But I was very aware in the moment I'm like, "They're not making Resa advice. They're not telling you based on what they know of me, and they just want me to do what they've done," and you and I both know that's not true mentorship. I did not know how to get an academic appointment. I literally had to ask and have a lot of meetings from within emergency medicine to, because we fell under internal medicine and the person from internal medicine, I met with him, we had a lovely meeting. He's like, "Here's what you have to do, and as soon as I receive these items, I will put your application up to the Med School of Columbia." Eventually it got pushed through, but it took a very long period of time.

Actually, by that time, I was well on my way to doing all the "academic things." I was publishing in peer reviewed journals, I was speaking, I was starting to have national level positions in the emergency medicine organizations underneath the ultrasound hat, and people said, "Resa, why aren't you getting promoted?" As things were turning over, I was recruited to go to the University of Colorado, and it was part of that recruitment that they said you would come in as an associate. So just by making that move, I was promoted because my CV spoke to someone that was an associate. It's just that the system I was currently in New York City wasn't moving me along the way I would've moved along in another system.

So then when I was recruited to Jefferson within three years, it was similar, "You're already an associate. We will bring you in as a full professor." And again, my CV and my package spoke to someone that was full professor level, and I did have a lot of colleagues around the country. They were like, "Resa, you're publishing all the time. Why aren't you a full professor? You're publishing all the time."

So there's certain things that I didn't know and it took a while to figure out how to make it work in my system, and I will say one of the more common pathways is when people move institutions, they get promoted to the next as long as they've been doing academic work.

And within academics, we don't see a lot of movement, and what I found is with every single move, more opportunities happen for me and you have an opportunity to develop more professional relationships, create new sections, new programs. See, based on what worked or didn't work at one place, you can try something new, try something out that worked at the next place.

GW:

Many of your mentors had probably walked a very similar academic path as well. It almost reminded me of how things get taught in residency. So maybe your attending tells you, "Well, here's how you manage acute pulmonary edema. Here's how you manage a distal radius fracture," and then that trickles down to the resident who then learns, "Well, this is the way you manage this condition." Similarly, maybe your academic professor said, "Well, here's how you manage a career. You go through this pathway because that's how I've done it," and maybe didn't have as many mentors outside of the hardcore academic pathways as well.

RL:

Your observation is very astute. Because I was at an institution that wasn't, I would say, prioritizing getting an academic appointment, I had to ask around in other places. The people that you meet along the way stay with you through your professional career, and they're often very good resources to tell you how to get things done because every system is a little different.

GW:

You said so many great pearls there. It does sound like you're painting a picture where not only was it easier to get promoted, but you expanded your network. I mean, you probably know hundreds if not thousands more colleagues and have influenced many more people than if you had stayed at one facility, because now you know a much larger network of people that you are in touch with.

RL:

That's true, and I would say that there's this currency that I learned the hard way, and that currency was publishing. Because you end up growing your network sometimes indirectly because by publishing, people get to know you, people get to know your publications. I would say with ultrasound also because there was so much demand for ultrasound education locally, regionally, nationally, internationally, I have had the opportunity to travel to help teach ultrasound to try to create sustainable programs, and that has actually really expanded the network in a way that I wouldn't have imagined. It's just been an amazing experience to have that lens as well with ultrasound.

Microskills: Practical Tools for Thriving in Medicine and Beyond

GW:

We haven't even touched on the podcast that you do and you've written a book that's not even specifically around medical care, where does the drive come from?

RL:

I actually call it being hungry and part of it I'll say, the household in which I grew up, my father still is hungry, and what I mean by that is just someone that really, really, really is a hard worker, very strong work ethic. 

I feel that, and this is going to sound trite, with privilege comes responsibility. I think it's a responsibility to use our voices, and the name of my podcast is The Visible Voices, amplifying people that are doing amazing things in the healthcare equity and current trend spaces.

I also think it actually can all be umbrellaed under like I'm very, very, very much a liberal arts geek. I like many things, and I think we can do many things and I think we can do many hard things. And going back to academic medicine, we are led to believe that it should be one path, one way, and gosh, there are so many ways to do this.

GW:

You do such a great job of just setting an example of how you can live your life and not be necessarily defined by being a doctor.

RL:

You're right, this is not the model set before us and also along the way, I've met plenty of physicians who are authors. There are so many positive reasons to write for more mainstream outlets. Number one, the turnaround time is much quicker. You find out whether it's accepted or rejected much sooner. You also reach a broader audience and you de-silo, de-mystify what's happening in healthcare. Healthcare is not so different of an industry than all these other industries. Everybody thinks it's different. It's not. It's a business.

So my co-author and I wrote what I call proof of concept articles, “How to write a letter of recommendation for yourself,” “How to get paid for a speaking gig when a speaking gig doesn't pay,” and those titles speak to everybody in every work industry. So we realized we were onto something that we could write pieces that spoke to a mainstream audience. Enter Microskills, this book, we are two women, two emergency physicians, different upbringings, different life experiences professionally and also a lot of overlapping experiences, and we wanted to write a book that would speak to a general audience. And it's funny because people assume it's for women. People assume it's for doctors, but when people pick up James Clear's book, they don't assume it's just a book for white men.

GW:

I'll read the tagline that I love. The promise of this book is simple. “If you buy this book on Friday, you will be better at your job by Monday.” All of your topics in Microskills are applicable to just being a modern human I think. Well, it really resonates with me as an ER doctor. It feels like you're breaking down big complex things into manageable chunks, and that's absolutely what we do in emergency medicine. And then you've just applied that to jobs and life in general.

RL:

100%. It's not by accident that the way we set up each chapter is with Microskills. We start with a story to draw people in human emotion, but also we as emergency physicians are storytellers. I think everybody doesn't identify as such, but we are witness to how many patient stories each patient encounters, and we have to collate it and get it down into a chart, often retell the story to a consultant or to a primary care physician. So we are actually natural storytellers by the nature of the work we do. We tell the reader how, and that how is what designates this book, we think, as different from all the other business self-help books. We march people through behavior changes, little fundamental building block behaviors that they can do to start being better at work.

GW:

For audience members that may be interested or piqued their curiosity about writing a book as well. It sounds like you two were ready and excited to do this regardless of if you had a publisher. You had this idea, you agreed you wanted to do it, and then you looked for a publisher when it was done or as you were writing it?

RL:

A lot of credit goes to my co-author, so Adaira was a part of many groups that talked about writing and physician author groups. So she actually had done quite a bit of the background in reading the deep dive into how to get a book published. We decided to go a traditional route. So we thought that we were onto something because our articles were being well received. Those articles were what informed what we decided the book was going to be. We put together a proposal and when the proposal is in a ready state, you send it out to literary agencies and then literary agencies get back to you and say, "We'd like to talk to you about this book," and putting together a proposal to the next level, to then taking you to what they call auction to get a publisher to bid on the rights to publish the book.

Strategies for Physicians to Create Sustainable and Fulfilling Careers

GW:

Well, Resa, in our final minutes here, I've got some rapid fire questions for you. What is the number one thing you wish your patients knew about you, Dr. Resa Lewiss?

RL:

They are the center of my care, and they are the center of my decision-making, and I want them to participate in that care.

GW:

Resa, what do you think are the best and worst parts of your specialty?

RL:

One of the best things about our specialty is its comprehensiveness, its practicality and its applicability. I wanted a specialty that when friends and family called me, I would have a way to navigate almost every single question. I may not know the answer, but I know how to start and I know where to help get them and I can go there with them. That's the best. 

One of the worst aspects I would say of our specialty is what many people know and read about, the high rates of burnout, the high rates of dying by suicide, the high rates of addiction, the high rates of people just not taking care of themselves because that is not prioritized, rewarded, lauded, et cetera.

GW:

What's one thing that you did not learn in medical school but is crucial to your daily practice?

RL:

I will say financial health.

GW:

Okay. Well, that's a perfect segue to my next question, which is what's the best financial advice you've received?

RL:

I wish someone had told me to contribute to a retirement account much earlier than I learned by reading in a book. I would've started contributing in college. Was I making money in college? No, I was paying out tuition. However, for what you spend in college to eat out or go do whatever recreationally per week, I would've had no problem contributing to a retirement account, and I love the slope of the curves if you start in your twenties. I knew that I did not know about finances and how to manage my finances, so I lived scared and what living scared looked like was I just always, always lived below my means, and that turns out to have been a really good habit to end up being financially healthy, but I think it probably didn't need to be as stressful as it was along the way.

GW:

Well, Resa, thank you so much for your time. I could not thank you enough. Where can listeners find you and support the work that you're doing?

RL:

Thanks for that. I really enjoy connecting with people, so please feel free to connect with me on LinkedIn or through my website. My website is Resa E. Lewiss MD. Please reach out. I'd love to hear from you and connect with you.

GW:

Thank you, Resa, for taking the time today. It's been fantastic to talk to one of my attendings as a colleague now. Thanks for joining me today.

For interviews with physicians creating meaningful change, check out offcall.com/podcast. You can find How I Doctor on Apple, Spotify, or wherever you listen to podcasts, we'll have new episodes weekly. This has been and continues to be Dr. Graham Walker. Stay well, stay inspired, and practice with purpose.