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Hospital Heroes: Dr. Alp Sener, Chief of Urology

Contributor Simi Juriasingani 

Hospital Heroes is an interview series that will put a spotlight on the diverse career profiles of individuals who work in hospitals. The goal is to raise awareness about diverse career paths in medicine and healthcare that contribute to improving patients’ lives. Join us as we meet these heroes and learn how they contribute to improving healthcare.

“I think that you should only go into medicine if you really like people and you like taking care of people.”

“I chose urology because I saw that it involved both surgical procedures and managing patients long-term…”

“I don't do it because they pay me. I do it because I love it and I'm happy that they pay me for it.”

Hospital Hero: Dr. Alp Sener 

Positions: Chair and Chief of Urology, Director of the Kidney and Pancreas Transplant Fellowship Program, Schulich Clinician Scientist, Associate Professor of Surgery and Microbiology and Immunology

Motto:  In order to be successful at anything, you have to love what you do.

1. When did you know that you wanted to become a doctor and why did you pick medicine as a career? Did you consider any other career paths?

I can honestly say that I wanted to become a doctor probably at the age of eight or nine. At that point, I think I was enthralled with the idea of being a physician because what you see on TV looks exciting. I thought about it more as school went on. I had doubts about it in high school and early university. I wasn't sure if I wanted to put that much time into it. I was actually scared of making the wrong decision and getting someone hurt, which is understandable. I also had a time where I didn't want to do it and I wanted to go into architecture instead.

As I went through undergrad, I started really thinking about what I wanted to do in life. The science courses really spoke to me. I also loved interacting with people and I wasn't sure if I was going to get that if I became just a pure scientist. I wanted to help people directly, so I put my name into the hat to see if I could get into medical school.

2. Could you describe your post-secondary education journey leading up to getting accepted to University of Calgary for medicine?

I completed my undergraduate studies at the University of Texas in Austin, with a degree in Biology. Back then, there was an undergraduate degree geared towards medicine, which quite frankly, in retrospect, is a very bad idea. I'm so glad they got rid of it. It was geared towards medicine, assuming that everybody was going to get in. Considering that the rates of acceptance were no different than they are today, it seemed quite short sighted. But as a student, the appeal was certainly there. When I came back to Calgary, I applied a medical school and I didn't get in. I was surprised but I decided that I’d try again the next year. In the meantime, I volunteered in a laboratory where a good friend of mine was doing her MSc. It was a physiology lab and their research piqued my interest. I participated in lab meetings and my supervisor asked if I would want to do an MSc. I eagerly jumped at the prospect and started graduate school.

I really got into my project and eventually had to decide whether I was going to finish in two years and apply to med school or transfer to a PhD. I started leaning away from med school, so I did the PhD transfer exam. I had a lot of interactions with physicians during my PhD. Doing an MD/PhD wasn’t common back then, but I realized there was a gap between clinicians and scientists. I thought it would be really cool to be able to do both, as it would allow me to bridge that divide – based on this, I decided to give medicine another try.

Towards the end of my PhD, I had already started applying for post-doctoral fellowships and med school simultaneously. I received several great postdoc offers and also got waitlisted for the MD program at Calgary. I was going to take the postdoc because I thought science is really what I truly enjoyed. Interestingly, at that same time, our lab was not successful in receiving a major grant which we hoped to get. This made me realize that there would always be a chance that in basic sciences research, I would potentially be living from grant to grant. That's a lot of stress. Then, the University of Calgary called me and offered me a spot. I had spoken about being a “clinician scientist” and there was a really big buzz around that concept back then. I realized that I can always do research after med school, but that I likely would not get the opportunity to do it the other way around. I accepted the offer and I started med school a week after I defended my PhD thesis. 

3. How and why did you select Urology as your specialty?

Coming into medical school, I wanted to become either a nephrologist or a cardiologist based on my physiology background and the people that were on my advisory committee during my PhD. I was pretty set on that and I never thought about surgery. During our renal unit in medical school, we had a urologist, Dr. Gary Peers, a Western Urology graduate, give a talk on bladder cancer and surgical reconstruction. My initial thoughts were, "Wow, this is awesome, maybe I should give surgery a try."

At the time, I didn’t know what a urologist did. Dr. Peers told me about the procedures that urologists do and I ended up shadowing him, which shifted my direction from medicine to surgery. I chose urology because I saw that it involved both surgical procedures and managing patients long-term, essentially combining surgery and medicine. Dr. Peers was almost like an internist and a surgeon at the same time. He raved about his time during his Urology residency at Western, so when it was time to pick my electives, I chose Western as my first choice for clerkship rotations. At the University of Calgary, clerkship starts with electives and my very first day of clerkship was on the Urology service at St. Joseph’s Hospital in London. I subsequently did rotations at other schools including Toronto, McGill and Ottawa. I was hooked, and I knew Urology was it for me. I ranked Western’s Urology residency program as my top choice and I matched here, so I was super excited!

4. What led to your decision to pursue a kidney-pancreas transplant fellowship in Baltimore after residency?

During medical school, they started encouraging medical students to do research. We had a Turkish general surgeon, Dr. Serdar Yilmaz, give a lecture on transplantation and research that could be done. He was an MD PhD who loved research and, at that time, was the Head of Calgary’s Transplant Program. His method of interacting with students and his teaching style rang true with me so I approached him for a research project. While I was working on an outcomes research project with him, I shadowed him on the wards and in the OR. This got me thinking about transplantation.

When I came to London, I put the thought of transplant aside for a little bit, as most urologists did not participate in transplantation surgery. However, I soon learned that the transplant program in London was unique in that urologists at Western were some of the leaders and pioneers of renal transplantation in Canada. One of our esteemed urologists, Dr. Patrick Luke, became my mentor during residency. He ran a basic sciences lab and had a mixed practice of urology and transplantation, which I truly enjoyed. So, by the midpoint of my residency, I knew that I wanted to have a urology practice with a major focus in multi-organ transplantation. I also knew that my PhD would be an asset in leading my own lab one day.

In my third year of residency, Dr. Doug Quan, the Director of the Liver Transplant Fellowship Program here at Western put me in touch with Dr. Ben Philosophe, the Director of the Multi-organ Transplant Program at the University of Maryland Medical Center. The University of Maryland is regarded as one of the premiere transplant programs in the world, in term of volumes, research, academic productivity and transplant firsts. They flew my wife and I down to Baltimore for an interview and I immediately knew that it was the right place for me. They were a group of fantastic and talented general surgeons who had previously trained several urologists in kidney, pancreas and liver transplantation. I was fortunate to be awarded the American Society of Transplant Surgeons Fellowship (only 2 awarded per year for North America; the first time it was awarded to a Canadian) for the duration of my training in Maryland.

5. Could you describe a day in your life during the clinical year of your transplant fellowship?

During my clinical year, each day was very busy. I was the only transplant fellow. We had an entire floor of transplant patients, up to 50 people in-house. The role was fly out, get organs, fly back, put them in, transplant organs that were flown in from other places - repeat. I don’t think I could quantify the number of hours. A typical day would start at 6:00am in the morning and end at 7:00 or 8:00pm at night, easily, and that's a light day. There would be multiple 24-hour periods, sometimes back to back. Yes, it was tough. Sometimes, I only saw my family every couple of days, or for like an hour or two a day. It was a very busy time, but I would go back and do it all over again. I wouldn't change a thing. I would not pick an easier fellowship. It helped establish a solid foundation that I still look back to and I think that that's very important.

6. You were recently appointed as Chair and Chief of Urology. Could you describe what you hope to achieve in this role?

I've always liked leadership roles. I love making changes and leaving things in a better position that when I took them on. There's a title that goes with it but the excitement only lasts a week or two, then the work comes. I didn't get into it for the title of Chief; I wanted to do it because it would allow me to collaborate with a fantastic group of colleagues with the common goal of making positive changes. The Division of Urology is already a high performance unit in terms of academic output, grant success, mentorship of students in residency and fellowship programs, etc. But this position gives me the opportunity to apply the knowledge I have gained in other leadership roles to continue to improve things within our Division. There is always room for improvement and we should never stay stagnant, otherwise we risk becoming obsolete. I plan on working with our faculty, hospital foundations, our industry partners and our supportive community to advance urological care not only for London but nationally and internationally.

7. You were the first surgeon to receive the Schulich Clinician Scientist award. What inspires you to continue pursuing research and academia alongside your clinical responsibilities?

I think my primary job is being a surgeon. I have to take care of my patients. The balance between clinical work and research can be difficult, but I love the science. Clinical work is pretty predictable. Yes, you get a couple of curveballs once in a while, but it’s like a cookbook for the most part. Research is fun. It’s not a cookbook. It doesn’t work the way it's planned. Yes, we're always stressed about operating funds. Yes, we're always stressed about what we're going to do, where the papers will be submitted and whether they will get accepted. I think that's a part of the fun too. There's a bit of mystery because you're not sure what's going to happen. It's exciting.

My students also keep me going. I love working with them. I wish we had an endless pot of money, so I could take on more students. But we have to work within the confines and I want to make sure every student gets something out of their experience in the lab. If they don't have a project, if they're not actually actively doing something, I think it's probably not worth their while.

8. What part of your work do you enjoy the most?

I love kidney-pancreas transplant surgeries. They’re difficult and long operations, but I love them. With urology, I love the bread and butter cases. I like the transurethral resection of the prostate (TURP) cases where we go in endoscopically and open up a prostate. I find that really satisfying. I also love using the laser to break up big bladder or kidney stones. I take pride in the fact that we’re doing complex vascular surgeries and I want to teach our residents and fellows how to do those procedures. With research, I love seeing the data as it comes off the press! Sometimes things don’t work out, but I like the excitement of what it will look like at the end and the impact that it could have on our patients one day.

I don’t think I enjoy one role more than the others. I actually like all of them. I think you have to. In order to be successful at anything, you have to love what you do. I don't think of it like, "I'm only doing it because they're paying me." Every day, I think, "They pay me to do all this stuff. That's kind of cool." That's probably a good way to look at it. I don't do it because they pay me. I do it because I love it and I'm happy that they pay me for it.

9. What is your least favourite aspect of your work?

In terms of research, my least favourite thing to do is writing grants. Of my clinical responsibilities, my least favourite is the charting. People are getting older and they're getting sicker, so we have to see more patients in the clinic. I like spending time with people, so I don't rush my patients. If they come in and they need ten minutes, they get ten minutes. If they need twenty minutes, they get twenty minutes. Our clinics usually run late and at the end of day, the administrative part of the clinic ends up taking two to three more hours. You have to dictate and put the orders in, which is not a valuable use of time. If we can come up with a better way to update electronic medical records, I would have three hours to help patients instead of doing manual charting and ordering CT scans. It doesn't seem like much but three minutes of charting per patient for fifty patients is a lot of work after a full day in the clinic.

10. What advice would you give to someone who wants to follow in your footsteps?

I think that you should only go into medicine if you really like people and you like taking care of people. You should not go into it to make money because there are many other ways to make more money. To be successful at anything, you have to have a passion for it. You have to enjoy it. You also have to listen to people and you have to have mentors, regardless of what level you're at. I have been fortunate enough to have excellent mentors, whom I still look to on a day-to-day basis. One should never be ashamed to ask for advice or for help.

You should also listen to your inner voice. Your inner voice tells you what you're good at and what you're not good at. If your inner voice says you're not meant to be a researcher, it is probably not the right path for you. For medical or residency programs, I always tell trainees, "If your inner voice has been telling you that you should be an internist every day of your surgical residency, you should think about changing specialties." There's absolutely nothing wrong with that. I think we should be better as a community with helping people transition between these roles, because I think a lot of people get into it for the wrong reasons.

Always look at challenges as opportunities. Don't discount them because of what you think your personality is, whether you are an introvert or extrovert. Try to get out of your comfort zone. Sometimes, things aren't going to work out. That's okay, but you have to keep going. Ask yourself, "Why did it happen? Was it something I did or something external? If it's something I did, what can I change?" Change it and keep moving forward. You have to stay positive.

Choose your path based on what you are passionate about, listen to your inner voice, get mentors, be open to opportunities, smile and most importantly, stay happy!

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