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Becker’s Healthcare Podcast
Advancing Orthopaedics and Championing Women’s Sports Medicine with Dr. Kiera Kingston
00:24:02
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- [00:00]
Scott Becker
This is Scott Becker with the Becker Healthcare podcast. We're thrilled today to be joined by Dr. Kiera Kingston. Dr. Kingston is a brilliant physician leader. She's dual fellowship trained in sports medicine and foot and ankle surgery. For people that are not familiar, Endeavor Healthcare has built one of the. One of the great sports, orthopedic and spine institutes in the country. They've done an incredible job with it. It's become, I think, the busiest orthopedic place of practice in the state of Illinois. Dr. Kingston also did a fellowship at the Hospital for Special Surgery, which has always been ranked the number one musculoskeletal place in the country for a long time running. So she's got an amazing background, and I will hasten to add, she also spent some time at Brigham and Women's Hospital, which is connected to the Harvard system. So. Remarkable, remarkable background. Dr. Kingsley, could you take a moment and tell us a bit about yourself and. And where you're most focused today?
- [01:00]
Dr. Kiera Kingston
Yeah, thanks. Thanks, Scott, for the introduction and, you know, the opportunity to be on the podcast. You know, I'm excited to be a part of Endeavor. I was a resident at the University of Chicago, and as you heard, left for two years for my two fellowships and excited to be back in the Chicago area. A lot of folks asked me why, why I did the second fellowship in foot and ankle surgery. And I think for me, I always thought that there was a ton of crossover between sports medicine and foot and ankle surgery and an opportunity to really use this skill set from my sports fellowship to become a leader in ankle arthroscopy, cartilage instability, and more sporty foot and ankle. So I was given the opportunity to be a sort of dual division person at Endeavor Health and the opportunity to build that practice over time. Excited to be a part of that. Another huge thing for me is my interest in women's sports and in building a women's sports medicine center. I was an athlete in college at Boston College, played four years of ice hockey there. And I think female athletes are. And working with female athletes is a huge passion of mine. I think we've shown in the literature and throughout research the importance of athletics in our young girls and women, keeping them involved in sports longer to build incredible life skills, but confidence in themselves and the ability to sort of, you know, thrive in a workplace environment when they've been on teams throughout childhood and adolescence. So I have some phenomenal partners at Endeavor. We are, you know, looking to build a sort of all female women's sports medicine team. And I Have some incredible partners from the primary care sports medicine division. And all of us together are really hoping to provide sort of care for all of our female patients, everything from adolescents to sort of perimenopausal care. And we're trying to integrate some subspecialties as well, including ob, gyn, bone health, endocrinology, rheumatology, to really make sure that we're taking care of our whole patient. And there's certain medical things that affect our female patients, things like reds or stress fractures or stress reactions and really being able to look at our patients holistically, be able to offer nutritional support, psychologists, bone health experts, to really sort of create a huge benefit to our patients and something that hasn't been created here in the Chicagoland area.
- [03:41]
Scott Becker
So truly fantastic. And let me ask you a couple questions. Now I look at the NHL now I'll talk to you about my daughter who was an ice hockey player. And I just want a little bit of your feedback first. What position in hockey did you play? Forward, defense, center or goalie? Where were you at on the ice?
- [04:00]
Dr. Kiera Kingston
Yeah, I was, I was a goalie. I played one game as a forward in my in house hockey and made the switch to goalie after that and always enjoyed the pressure cooker type, you know, position that it was. And you know, I think that sort of translated, you know, into sort of my career passions as well and very similar to, you know, being in the OR and working on patients there.
- [04:25]
Scott Becker
So simply amazing what people might not know if you ever played sort of adult hockey, very few people, everybody's scared to play goalie. So in the adult hockey leagues that I played until about 10 years ago, goalies played for free and it would be very expensive to play, but goalies played for free because everybody needed goalies and because people were so scared to play golf. So God bless you. I remember my daughter playing goal one day and deciding that was enough for her. Now she was a great little travel hockey player, played with the boys at some point, gave it up and focused on tennis. Holy. And she knows that I did my best to never let her. She's fine with that decision, was thrilled to change to tennis, but she always felt pressure from her father who played hockey, who always wanted her to stick with hockey. Now I want to ask you this question as a parent. Do I need to get over that and just let that go and let her enjoy her life versus continuing to tell her she's got four years of eligibility left? Do I need to let that go?
- [05:26]
Dr. Kiera Kingston
Yeah, I mean, I think you know, parents obviously have their, you know, interests and their hobbies as well. And I think it's only natural that, you know, we get our kids involved in, you know, the things that we enjoy doing. And, you know, I think everyone has their own passions and interests in life, though. And, you know, I think if she's happy with that decision and has found fulfillment and tennis and sort of other endeavors, you know, I think we got to do our best to sort of support her in that. And, you know, maybe she'll come around to hockey eventually.
- [05:57]
Scott Becker
So she's, she's 26. You know, if you keep a reminder that she has years of eligibility left, she gives me that look like I'm an insane father, which you write about. The one other. One other question. One of the extended family children is, is in med school now, a young woman athlete. Any advice that you would give to young woman physicians? She's in med school still, just in her second year about specialties, about careers, about how to try to figure out course because she had started actually she was a great gymnast and always wanted to be sort of orthopedics and so forth. By now, I think maybe moving towards anesthesia. Any thoughts or encouragement that you would give to a young emerging physician? Woman physician?
- [06:42]
Dr. Kiera Kingston
Yeah, I mean, I think incredible, incredible opportunity for her. And, you know, I think medicine is a wonderful field and there's a lot of great specialties, I think, for women in particular. I think for a long time we have sort of shied away from careers in surgery and in surgical specialties, particularly ones that have been male dominated, like orthopedic surgery, urology. You know, for orthopedic surgery, only about 10% of the applicants into residency programs are women. We need to do better. We need to do a better job being inclusive of medical students, recruiting from all walks of life, making sure we're getting more women interested from the beginning in a career. And I think part of that is that women don't always see someone that looks like them in that specialty. And I hope that that changes over time. And I know that there's, you know, a number of women in leadership positions, not just in, you know, our organization, but throughout, you know, hospital systems and private practices all over the country. Some of my mentors are now chairs at the University of Chicago. Dr. Jennifer Wolf. And so I think as we see more and more women in those leadership positions, more women who are program directors, you know, female medical students will see someone that looks like them and realize that I can do this. I don't need to be a 6 foot 5, 200 pound football player, to do orthopedic surgery. And there are plenty of women that have come through these programs. It's an incredible career. I think you have to find your people in medicine and that's true of any career path too. I think people gravitate towards people that are similar to them, have interests that are similar to them. But I think my, you know, I was one girl and four co residents in my class, all boys and they're some of my best friends still and you know, I love them to death and they're a great group of guys and you know, I think it's an incredible career. So hopefully she'll switch back from the dark side from anesthesia to orthopedic surgery.
- [08:45]
Scott Becker
Well, and we're going to have that discussion with her, I think. One other question, like the four guys that were in your residency spot and you called them boys, which I don't take offense to it, I'm okay with that. No, I'm just kidding. The question is, can you outskate all of them? Can you outskate all four of them?
- [09:01]
Dr. Kiera Kingston
Yes, I can. I can skate circles around all four of them. It's funny you mentioned that. One of my classmates played club hockey and I hope he's listening in to this podcast out in California. But his residency graduation speech from one of the attendings said that he was the second best hockey player in our class. So I'm glad that everyone else also recognized that as well.
- [09:25]
Scott Becker
We love that and we hope that when it's completed, when this is out and that you, you will share that with him because he was, he was a great number two. But not the best hockey player in his group.
- [09:36]
Dr. Kiera Kingston
Exactly.
- [09:38]
Scott Becker
Let me ask you another question. And, and, and you know, and I, and I feel bad because I'm going to use this all for personal advice today, but I appreciate you so much joining us, Dr. Kingsley, artificial intelligence. Where do you see artificial intelligence having the biggest potential negative impact on careers? When I, when I think about this, one of my best, best friends, my college roommate, I'll actually see him tonight. He's an anesthesiologist that practices at North Shore by chance or endeavor. So bear with me. One of my best friends and I have thought for 30 years that AI, you know, if there was any particular specialty that was ripe for artificial intelligence and machines to take over, it would have been anesthesia. And that has not been the case, obviously, as much as we thought it would be. You know, it seems like it, but he's a very smart guy, but I think a computer can do his job. He disagrees, and I say that jokingly, but is AI more likely to have a big impact in serving access problems in primary care? Anesthesia versus orthopedics? Any of your quick thoughts on that? And where do you see sort of artificial intelligence having the most impact and then maybe the most threat to physicians?
- [10:52]
Dr. Kiera Kingston
Yeah, no, I think that's a great question. I think AIA is an incredible tool, and I think that's an important thing to sort of keep in mind. It's a tool that we have in our toolbox, and I think the huge benefit, and at least that I've seen in my practice, there's several companies that use your cell phone to help record a conversation with their patient, to help generate notes, so long as the patient agrees to that. I think minimizing the burden of sort of documentation for physicians and other healthcare providers is an incredible upside from AI. It also allows us to focus on the patient more instead of staring at a computer typing away and hopefully allows us a. To see more patients in the day. Decreases sort of the burnout that we have that we all have from the documentation burden of seeing many, many patients a week. So I think there's incredible upside there. I think from administrative standpoints as well. AI can be a very useful tool for physicians. I think the biggest threat to physicians. I think there's been some studies that have looked at using AI models, particularly in radiology, and there is a threat of almost unlearning the skills and the knowledge that we have acquired over our many, many years of training and using AI as too much of a crutch. The example that was published a number of years ago was particularly in breast imaging, looking at mammography and identifying breast cancer lesions within female patients. In those studies, they actually showed that when we started using AI to help identify suspicious lesions, it initially helped our radiologists do a better job, but over time, they became dependent on the model or the tool to help identify these. So that then when they had identified something that they thought was concerning but the model had not identified it, they lost confidence in their own knowledge and skill set and then reverted back to just using what the AI model had detected. So I think there are limitations in what AI can do, and I think it's going to continue to improve. And I think particularly in, like, rural areas or maybe underserved communities where access is an issue, you know, to have a quick read of an X ray or something like that in an emergency room or Urgent care. I think those models will continue to get better, but I think there's always a risk that we become too reliant on the tool and it becomes a crash for us. So I think it's important that, you know, we've trained for a long, long time and we do need to maintain some level of knowledge and skill set and, you know, confidence in our abilities. And while AI, I think, can be very helpful in doing our jobs and helping us do our jobs better, we do have to push back at times because it is, it's a computer model. It's really only fed certain data. It doesn't have the same sort of experience and sort of knowledge that our physicians have acquired over a lifetime.
- [14:07]
Scott Becker
Thank you so much. And picking up on that, as we look at access challenges in the country, there's a million 100,000 physicians, there's 5 million or so nurses. We are so short. Specialists and doctors. People talk about the shortage of primary care, but some of us would argue that the shortage of specialists is just as important or just as much a problem. We all know that to get to a specialist, increasingly, particularly in many areas of the country, you need to know somebody which is horrendous for access and health equity and so forth. What are some of your thoughts on how we solve some of the access problems? Any thoughts when you think about the technology, the number of physicians, the number of nurses and more? I mean, it's some combination of technology and people, but we need more doctors desperately, don't we? Or what are your thoughts on that?
- [15:02]
Dr. Kiera Kingston
Yeah, I mean, that's a million dollar question and a loaded one. But yeah, I think there's probably, there's no one easy solution to that. I think if, if there was, we probably already would, would have a solution to access and equity in our health care system. I think there's small things that we can do that definitely will improve access. I think use of telehealth definitely increases access, particularly for folks who may have limitations in transportation or, you know, ability to leave their home. Similarly with being able to get, you know, prescriptions delivered to patients home. And I think that that's not just physicians. That can be nurse practitioners, that can be physicians assistants, that can be our nurses that are doing a lot of the triage with our patients. I think that that could go a long way to sort of helping improve some access. It's not perfect, right? We're not able to sort of examine the patient fully or, you know, do a heart and lung exam remotely, but I think it can potentially Improve some access, particularly in like primary care type settings and maybe for some general orthopedic care. You certainly hit a point of we need more physicians in this country, particularly in primary care. I would also argue probably in a lot of specialties, including surgery, including psychiatry, basically across the board. Part of that stems with needing more medical schools and more medical school slots, creating more residency programs and more slots in residency programs. So it's sort of all the way from the beginning stages of creating, you know, more options for people, more slots in these highly competitive schools. And there's currently bottlenecks at certain points in that kind of career path. And one of them is with residency programs. You know, they are funded by the federal government and you can't just expand the number of residency slots you have just sort of unilaterally. So I think increasing the number of slots that we have available will help the throughput of our trainees here in the United States and even on sort of a ground level in high school and college, getting students more interested in careers in medicine and careers and science and technology as a whole. I think it's sort of something that I think we need to do a better job at. Physicians themselves, need to be engaged in surgeons. I was recently involved in a program here in Chicago that was getting high school and college and medical students interested in careers into foot and ankle surgery and orthopedics in general. I think that's a great way to give back to the community because we were all there once and we were all trying to figure out what we wanted to go into again. Was there someone that looked like me, that would be a mentor that I could call and ask for advice? And so I think that's also an important piece of this. So, you know, hard, hard question to answer, you know, quickly, but I think there's plenty of things that we could do better. And certainly access and equity and quality are huge problems in healthcare today.
- [18:21]
Scott Becker
Well, no, you've done a tremendous job of answering. What I take it is that in terms of so many different pieces of this, all of the above are going to help technology and people and need residency spots that still tremendous opportunities. My anesthesiologist roommate from college shouldn't worry about his job just yet. Our daughter should look promisingly at surgical specialties as well as anesthesia so much there. One more question, Dr. Kingston. Well, I could ask you two more questions. I'm actually the first question is every middle aged athlete I know now ends up at some point, even if they're not really athletes, but we think we're athletes. Ends up either with meniscus tear, Achilles, you know, Achilles tear, Achilles problems for colleague that recently had his Achilles repaired. Is there hope for him to get back out and be a competitive athlete or is it going to depend a lot on his drive and determination? What's the sense post Achilles repair, Achilles tear repair?
- [19:23]
Dr. Kiera Kingston
Yeah, great question. I mean I think patients do well after Achilles repairs. You know, there's a number of ways to, to do an Achilles repair. So I don't know what was the technique was used in, in this particular case. But you know, patients do well. It's a long recovery. You know, I, I often tell my patients that can take up to a year to really feel like they're getting their calf strength and you know, muscle bulk back. But people are sort of returning more to higher impact activities, at least in my practice six month mark. But it is an incredibly common injury. It's what we call a weekend warrior injury in the orthopedic surgery world. Sort of the classic patient that goes out and plays basketball or pickleball feels a pop in the back of their calf. And it's not to say that they're not athletes. There are plenty of folks out there that are getting those same exact injuries. But I think the reason to fix it is to improve your push off strength and to get you back to an active lifestyle with a lower risk of re rupture. So I hope that your friend gets back out there and you know, is able to play his, his sport of choice soon.
- [20:35]
Scott Becker
He is a absolutely brilliant person. He is a warrior, maybe on the weekends and otherwise he's not a great athlete. So Dr. Kingston, if he's not a great athlete, is that going to make it harder for him to recover or just his pure athletic ability shouldn't have an impact on his ability to recover?
- [20:54]
Dr. Kiera Kingston
Yeah, no, I think, you know, it shouldn't have a direct impact. I think a lot of this is sort of dedication to, you know, the physical therapy and you know, shout out to, you know, all the therapists I work with. They are, they are miracle workers and they spend hours and hours with our patients rehabbing them. You know, I often tell my patients that my portion of, of this is much smaller than all the work and time that they're going to put in with physical therapy and with their therapist and that that is the bulk of this recovery. So I think so long as people are dedicated to that process, doing their physical therapy two to three times a week, doing their exercises daily, they have the motivation and the Willpower, they'll do well. But it definitely takes a lot of time and effort on patients part.
- [21:43]
Scott Becker
Thank you. I mean it's an amazing, amazing career that you built. I'll just give a quick shout out to him that, you know, between he is in his family, Zach, Ellie and Lynn are the three great athletes. And he's fine. But there's still great hope for him to recover though, and that's helpful. Dr. Kingston.
- [21:59]
Dr. Kiera Kingston
Yes, there's still hope. There's still hope.
- [22:01]
Scott Becker
There's great hope for him. Good, good. Dr. Kingston, let me ask you one more question. What are you most. I've enjoyed talking to you so much. I know I've kept you longer than I promised, so I apologize. Thank you. Take a moment. Dr. Kingston, what are you most focus on and excited about this year?
- [22:15]
Dr. Kiera Kingston
Yeah, I mean as I was talking about earlier, I think you know, what I'm most excited about is continuing to build a practice here in the Chicagoland area that is sort of sports and sporty foot and ankle, so to speak, and really work working together with my partners to build a women's sports medicine center. You know, the places that I've trained at HSS and the Harvard system. So Brigham and Women's Hospital and mgh, which are now, you know, one, one big system. They' had similar women's sports medicine programs that have been around for 20 plus years and very successful in providing care to our female patients and female athletes. And so I think this is an incredible opportunity for us to sort of leverage, you know, our experience in my experience in those programs to sort of recreate one here in the Chicagoland area that hopefully can help build some momentum and hopefully ours will be around for the next 20, 30 years as well.
- [23:12]
Scott Becker
Well, it's amazing what endeavor has built in the sports and orthopedic area. So I wish you great luck with it. I know it will do great. We're the biggest fans and I will talk to the kids in our family. That one doesn't have to worry about her hockey career. She shouldn't feel like she just born a dad. What shouldn't worry too much about what specialty. She'll be okay. The AI is not coming for her job. And then my friend who had the Achilles heel problem, he can bounce back if he's determined and sticks with therapy. Dr. Case, in all seriousness, what a magnificent pleasure to visit with you. So thrilled that you came back to Chicago and so thrilled that you were by far the best hockey player not even close out of your resident group. Fantastic.
- [23:56]
Dr. Kiera Kingston
Awesome. Well, thank you for the opportunity, Scott. I appreciate your time.