The Scientist: Robert Kirsner, MD, PhD

Transcript

[0:00] That piece of skin was appli graph which is an engineered skin this was in 1992 it was eventually FDA approved in 1999 as the first organic typic skin substitute.

[0:14] Music.

[0:20] Paging dr. cook paging dr. cook dr. cook you’re wanted in the o.r. dr. Koh.

[0:27] Music.

[0:50] Hello everyone and welcome to the prescription for Success podcast I’m dr. Randy cook and I’ll be your host.

[0:58] Our podcast is a production of MD coaches providing leadership and Executive coaching for Physicians by physicians.
To overcome burnout transition your career.
Develop as a leader or whatever your goal might be visit MD coaches on the web at my MD coaches.com.
Because you’re not in this alone my guest today is the chairman and endowed Harvey blank professor.
In the Phillip Frost Department of Dermatology and Catania surgery at the University of Miami Miller School of Medicine.
He is also one of the most recognized names in the emerging specialty of wound care and chronic wound healing so let’s hear my conversation with dr. Rob kerzner.

[1:48] Music.

[1:54] Pleasure it is to be talking again with my old friend and colleague dr. Robert kerzner from University of Miami School of Medicine Rob thanks so much for being here it’s really good to talk to you again.
Really it’s great to be here looking forward to this immensely
thank you for the the first name recognition this is a very informal program and so if it’s okay with you we’ll make it on a first-name basis and it looks like you’re ready for that
probably like to do on prescription for success is beginning to beginning and it occurred to me when I was looking over your by graphical information that I have.
No idea about your earliest Origins where did you grow up so I was born in Brooklyn New York I had a feeling.
Yes still have a little bit of the accent but just a touch I moved to New Jersey when I was 7 years old.
And I spent my,
time from 7 years old to going off to college in a Suburban town of East Brunswick New Jersey which was kind of a bedroom community for New York City I see,
and were there any medical influencers in your life or did this journey into medicine was that entirely your idea,
well my parents valued education
they valued the chance for people to write their own story of their life so they would encourage me and tell me you could do whatever you want to do in life as long as you.

[3:24] Work.
Hard enough to succeed so so while they weren’t in medicine my parents were both teachers my father was a,
phys ed teacher and that influence a lot of the no curly part of my life yeah he was I did that as well,
yeah and he was a coach as well and that,
he was a basketball coach in Brooklyn New York and had very very excellent teams and it was fairly renowned,
in the area yeah and so when it came time for.
College I know that you started your college career at Southern Illinois University did that have anything to do with the basketball connection,
well it did it turns out that well I had moved to New Jersey in the town that I grew up the basketball there wasn’t as good as it was in New York city so my Junior and Senior year of high school.
I commuted every day with my father to go to a public high school in Brooklyn New York,
did you really yeah to play basketball and he came back and coached in New York City they,
if you are the chairman of the department you have to let other people coach if they want to but you worked it out so he was able to coach me my last two years.
And and in fact I went to college on a basketball scholarship yeah.

[4:49] My dad was a great believer that being a good athlete was a.

[4:55] Reliable and substantial character builder would you would you go along with that yeah I think the the process of practicing for something.
I think the process of failing and then understanding why you failed,
and then trying to correct it and then then going on to succeed I think is a is is important life lessons,
I also participate in a team sport so working within a team
learning how to deal with coaches and different styles of coaching
I think is very important because it in life you’ll deal with lots of different people from lots of different backgrounds and I think the better you are equipped to deal with those people I think the more successful you will be,
spoken like the son of a coach so you were only at Southern Illinois for a year is that correct.

[5:49] That’s right so it turns out that I was very successful at Southern Illinois personally I
I started as a freshman and my first college game I hit the winning basket against Memphis in a tornado engine providing yeah it was a front of 10,000 people which was a which was great,
but the but the coach left the coach who was my coach my freshman year left the new coach came in and,
I was just an 18 year old kid and I didn’t you know I thought I was all that and he came in and I didn’t like him as much he as my original coach so I decided to transfer,
and did you play basketball at A&M as well yeah so I transferred to Texas A&M.

[6:34] And I played it am I red shirted my next year,
and then I played my Junior and senior years I had another year of Eligibility left to play but I realized my future was in medicine and not in basketball so I decided to.
Forego my last year of Eligibility which would have been my fifth year in college,
and go on to medical school but but it was really a very interesting experiences going to two different colleges.

[7:05] Yeah bad and two different Geographic locations that’s a big change yes and one was a basketball school Southern Illinois was a basketball school at Texas A&M was really a football school but Texas A&M was a bigger
you know bigger time sure that was a great experience and it helped me in life beyond the think of the reasons I mentioned is because most of the time in life.
People are trying to stop you so you’re really your opponent is yourself in life,
you have to you have to you know succeed based on how hard you put in but there’s nobody trying to stop you but I think in sports it’s one of the unique times,
maybe that’s singular but certainly unique where there’s somebody trying to prevent you from succeeding,
you know they’re working is hard to prevent you from scoring or they’re working as hard as trying to score as you are trying to defend them so it made it easier later in life to know that I could try to accomplish something without somebody actively trying to stop me.
That’s interesting I’ve never really looked at it that way so you mentioned that by that time you had made up your mind that you were headed for.
Career in medicine and I’m curious about a couple of things I see that your undergraduate major was chemistry.
Which graduated with a Bachelor of Arts and how do you get a ba in chemistry.

[8:26] Yeah so it has to do with the amount of courses you take and so if you’re going to be a scientist at Texas A&M,
then you go ahead and get a Bachelor of Science but if you’re going to,
to go into medical school you can get a Bachelor of Arts in chemistry and it’s just one or two
fewer classes and it gives you the opportunity to take some other classes and Humanities that perhaps you find interesting or make you a well-rounded,
sounds like sort of similar to the.
Even though I had a BS my undergraduate school was very committed to Liberal Arts and so I kind of had to take it all so I get the idea but back to the question of your future when.

[9:14] Did that plan to enter a medical career.
Take shape in your mind was it way back when you were a teenager or later on what’s the story yeah it started when I was pretty young I was I was very good in math and science.
And my family was interested you know was was was supporting me to be an educated person so it kind of my whole youth I always thought I was going to be a doctor.
And.
I interestingly I was not a sick kid so I didn’t spend a lot of time in Doctor Who was off offices I didn’t really know a lot of doctors but it was something that I kind of was in my mind and.
And I kind of grew into it is in contrast to my wife who’s a third-generation physician,
I don’t really know she grew up her grandfather was a doctor a father was a doctor and she was kind of almost born with it,
where I had to really work hard to become a physician it didn’t it wasn’t something that was inherent or natural to me.

[10:24] I get it so were there a lot of challenges in undergraduate school or was it only when you got into medical school that you really felt that you were,
involved in the struggle,
so I would say that an undergraduate biggest issues were learning how to study because in high school it was pretty easy to be successful when I got to college the the time constraints,
of playing being a varsity athlete where it was a challenge and especially the travel associated with it we would we would leave on a Monday and come and play games away and different states on Tuesday and Thursday nights and you lose a whole week school and so I really I had to develop a discipline, to make sure that I studied so that was the challenge is, in undergraduate what I got to medical school the challenge was we’re different challenges were to really take on,
the Persona and the personality of a physician to your kind of learn how to to be that part and,
and it was a you know it was I remember the first time we went to the wards and we were taking blood pressure as just a.
In our white coats and how nervous I was and I would break out and sweats like I was playing a full-court game of basketball you know because but fortunately that is improved over the years and in that hole.

[11:52] Medical School application process did you.

[11:58] Did that turn out to be different did you have lots of offers to consider or
how it came that you ended up in Miami yeah so it turns it’s an interesting situation because in college it was easy I never applied to any colleges I when I decided to go to
Southern Illinois has filled out one application because I was recruited and I had a number of different offers and and turned down going to,
Ivy League schools like Harvard and Yale because they weren’t offering scholarships and that that was one of my goals was to get a college scholarship but when I went to when I would apply to medical school I applied to a lots of places and only got in a few,
and I chose Miami because when I went off to college my parents moved to South Florida to I Really chose South Florida because it was close to my parents and.

[12:49] Only by luck that it turned out that it was a perfect medical school for me and that it had a really strong.
Dermatology Department but at that point I had no idea that I was interested in dermatology and it was only after I became interested that I,
I had fallen into a lucky circumstance and
to be in a situation and I like and did actually we could talk more about that a little bit but I liken that to maybe having the opportunity of playing basketball in Brooklyn New York which was a hotbed of.
Of great high school basketball sure in a similar fashion going to Miami I fell into a hotbed of great Dermatology.
Of excellence and achievement and really you know obviously partially by luck and that definitely leads into the next question and that is at the time that you started Medical School were you already.

[13:46] Leaning toward Dermatology that would be an honor that would be an early pick for someone with really no substantial
exposure to medicine so was it there already or did it develop along with your medical education.
It really developed along with my medical education I came into medical school
wanting to be a generalist you know an internist or family doctor because that was what I was talking about welding right exactly you know and some of the supporters in college the boosters.
Word.
Doctors that I had met in general doctors so that’s what I thought I was going to be a nose only during medical school that I kind of realized.
That I wanted to have a great depth of knowledge as opposed to a breadth of knowledge and did that come along during your basic science years or was it after you really began to see patients,
I think it was really when I started to see patients I realized that I like the idea of having a deep knowledge about a smaller area,
then just less deep knowledge about a broad area,
and so what I started to consider what I would do I look for certain Specialties and Miami was very strong in Ophthalmology and as I learned Dermatology.

[15:09] And and I also thought that patients were going to be very appreciative,
if you could restore their Vision in Ophthalmology or and they can actually see the skin diseases could see the result of your work so if you fix somebody’s blood pressure,
they see a.
Number on the machine but they don’t see the actual disease and writing the actual disease turned out to be very attractive to me and the ability to,
to really see that the results of your work hi I’m Rhonda Crowe founder and CEO Forum D coaches
here on rx4s 6s we interview a lot of great medical professionals on how they grew their careers how they overcame challenges.
And how they handle day-to-day work.

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[17:47] And now let’s get back to today’s interview.

[17:50] Music.

[17:56] To do at least a couple of years I guess two or three years and internal medicine before you actually started your.

[18:05] Dermatology training was that were you equally fascinated with the pathophysiology and natural history of,
of all diseases or was it a matter of man I can’t wait to get this over with because I want to do some Dermatology what was your mindset.

[18:22] No so it turned out that.
I want to be a dermatologist even in medical school and unfortunately I didn’t succeed right off the bat Dermatology was a very competitive specialty and I didn’t match into Dermatology,
so I continued on in doing internal medicine for a couple years and then there was this opportunity.
To be at least board eligible through which called the clinical investigator pathway where you do two years of.
Clinical medicine in two years of research and the research was in,
in dermatology and wound healing but I was I was fascinated by pathophysiology of the disease,
and I think that stayed with me whether it was congestive heart failure or inflammatory bowel disease that you might see in Internal Medicine and you know kind of understanding how the.

[19:18] The the disease process leads to disease manifestations and then applying treatments that you know work on the mechanism of disease to fix the problem I always thought were were fascinated and and I was intrigued by it.
That little lag that little delay between when you first began to apply for.

[19:39] Dermatology did that have any effect on your.
Decision to pursue a PhD in epidemiology what that failure did for me.

[19:49] When I didn’t get into Dermatology was it put a little chip on my shoulder.

[19:56] And that’s a recipe for Success right there yes it is an a.
At that point I began to kind of really evolve and I made a conscious effort.
To and I told myself I can’t definitively know if I’m going to become a Dermatologist or not.

[20:18] All I can control is how hard I work to become a Dermatologist and I said if I bust my butt.

[20:28] And work tremendously hard.
If I don’t succeed at least I’ll never look back and say what if what if I would have worked harder what if I would have done this and what if I would have done that.
So from that point on nobody worked harder than I did and you know trying to succeed.
And and I could live with failure as long as I knew that I had given my every effort so that was a transformative time where I really committed myself,
you know kind of Body Mind and Spirit into accomplishing what I’d want to do accomplish.
That’s a lot of wisdom packed into a relatively young man when I when I think about my state of mind at that age.

[21:21] I’m not altogether sure I.
I quite possessed that kind of wisdom but it certainly you probably say it all the time Highway you probably succeeded all the time,
oh far from it my friend I you interview me for for your show and I’ll tell you some things about earlier so it’s a really interesting story and.
Yeah you taught him a lesson they turned you down and now you’re the boss.
I think that’s absolutely fascinating so continuing to explore the path of your career.
I find it fascinating that you are just profoundly unique among all the dermatologist that I’ve ever known and that may only be because I don’t hang around Miami but.

[22:10] I don’t think that I’ve ever personally met well I can’t think of one Canadian dermatologist this interesting,
interested in chronic wounds but apart from that you are the only dermatologist that I have ever met that has an interest in
in chronic wounds I mean these things are difficult it’s a completely different type of patient experience and yet it’s the thing that you chose and I’m really interested to know
how you got there.

[22:42] So part of it is circumstances and part of it is kind of through deep thought but but one of the strengths of Miami’s program when I was
going through in medical school and then,
as part of my early training was wound healing a fellow who was the second chairman of the Department of guy named Bill Eagle Stein was one of the Godfathers our grandfathers of,
wound healing he developed the porcine model of wound healing and he recruited a number of people to Miami,
such as Vince for Lang and Pat merge Oscar Alvarez Lisa Ovington these are names that you know Be Cops and they formed a nucleus of,
of a department that was tremendously strong in in wound healing so I have access to really.
Top people and when I decided to take on Research in as part of that two years to become,
for eligible and do this clinical investigator pathway and then LeapFrog into Dermatology I said I’m in a place where wound healing is,
strength I might as well.

[23:57] Focus on the strength of this department so that’s where I got I started to get into who kneeling but then over time.
It became kind of a parent to me several things the first is that it’s the ultimate.
A defect in the skin so there’s lots of skin diseases there’s thousands of skin diseases.
But having a hole in the skin and having trouble repairing that hole.
Is really a tremendous opportunity as a dermatologist because you’re my job
is to try to normalize the skin in some way shape or form or even maybe even better if colleges are interested in scar revision or Cosmetics or Aesthetics but this was an opportunity and I saw it is it kind of a real
part of Dermatology to heal skin defects and and of course as you know,
they may not just be skin they may be muscle herringbone and things of that nature but that really got me interested and I thought it was a really a natural continuation of,
understanding the pathophysiology of skin diseases was to understand why wound didn’t heal.

[25:11] You know that really Rings true to me and I’ll have to tell you that and I’ll try not to.
Make this all about me but I did General investigator surgery for well over 30 years before I was asked to take over the wound care center in my Hospital.

[25:27] Pand you know I saved a lot of lives from ruptured aortic aneurysms and gunshot wounds and things of that nature and I don’t think I’ve ever had any more grateful patient.
Then the ones that have recovered from diabetic foot ulcers and Venous stasis ulcers and things of that nature and that speaks to.
Exactly what you’re talking about I think yeah no doubt it’s a it’s a tremendously rewarding field,
the nurses to therapists that are involved with it are among the most passionate people you could ever work with its really a calling for for many people once they become involved with.
You know that’s a really good point it did it’s not just the feeling that you get from the patients but the colleagues that you work with is also very very rewarding I want to give you an opportunity to talk about a few things that you are.

[26:23] Particularly interested in right now I know that you’ve done some work with stem cells I know you’ve done some work with some living cell products but I’m just.
Curious if there’s anything right at the top of the list right now that you’re really excited about,
I’ve had a great opportunity I’ve been at the right place in the right time because when I was in training Bill Eagle Stein came to me and he says
I have this piece of skin
it’s never been applied to anybody would you put it on that piece of skin was appli graph which is an engineered skin this was in 1992,
it was eventually FDA approved in 1999 as the first organic typic skin substitute.

[27:07] And I was the first person to have little apply that piece of skin to to a patient I was in and I was it don’t mind Rob I would like for you to go ahead and tell our audience exactly what the seller origin was for that product.
Sure so it’s so the idea is that it went there what there was a desire to create an off-the-shelf product that you could take a product and put it on any patient.

[27:34] And help them heal the wound so with what they did was they used for skin neonatal foreskin and they would take a nail for skin as a donor,
somebody who would going to go see a circumcision,
and they would take the fiberglass from the skin and they would take the character besides from the skin and they would place the fibroblasts into a collagen Matrix and let that.
Give that about six days to kind of grow and then they would overlay the keratinocyte actually from a different donor let that grow for about four days and then,
change the media and change the way they grew it and then over the next 11 days over at stratified so over a three-week period,
you had a living by layered skin substitute.

[28:20] So if you cut the skin and heal because it was living and it’s secreted growth factors and cytokines and this was really a tremendous tremendous advance.
And his help you know.
Countless number of patients and we know from from the data that it not only helps heals wounds but it also prevents bone infections and reduces the likelihood of having amputations,
and probably saves lives as well because of all those things to be the first person to ever apply that skin substitute or any skin stuff you know that’s can substitute,
that was FDA-approved was really really lucky.
And I’ve been interested in skin grafting and skin substitutes and all those things throughout my career and as I kind of rose up through Administration and now of chairman of the Department of Dermatology.
We have the opportunity now to take things to the next level and so right before this phone call I was meeting with some of our investigators about using exosomes.
To speed healing and there the products.
Amazon camel stem cells that are harvested while you can get them from anywhere but our investigators take them from the bone marrow.

[29:38] And they found that the these exosomes these extracellular vesicles stimulate healing,
similar to the cells themselves so now you have a chemical that is as good as a cellular products.
And the idea of that is that it’s a lot more approachable meaning a lot more feasible to deliver chemical products than cells,
because of all the issues with rejection and things of that nature so so it’s really been a 30-year Adventure,
going from patient’s own skin to artificial skin through cellular therapy stem cell therapy and now we’re trying to use these extracellular vesicles to Expedia.
I would have to say if there was ever a story of being in the right place at the right time you seem to be.
That individual so good for you couldn’t happen to a nicer guy thank you.
I want to mention one other thing that I found in snooping through your life you also have a significant interest in disparities of care you want to talk about that for a minute.

[30:52] Yeah so it’s so as you mentioned earlier I did get a PhD during my training so I did it after I completed my residency training and when I was on faculty I decided to Purdue a pH pursue a PhD and,
it was part of this mentality I had of why do less when you could do more.
So I realized I didn’t want to be a laboratory-based research I want to be a people-oriented researcher and I said well maybe I’ll get a masters degree and you know and
masters of Public Health but I said why get a masters degree when I can get a PhD and so I embarked on an 8-year course to get a PhD and
as part of that PhD I said well how can I leverage some of this new information on learning,
and some of the things that are around me in Miami.
To make advances in science and what what we decided to do is I was looking at we have a large Hispanic population in South Florida.

[31:53] And I want you to understand skin cancer and how patients who are Hispanic do with skin cancer compared to people who are not ass panic and what we found.
Was and we use various groups we did we looked at black patients and Hispanic patients white patients and we looked at different geographic regions.
And several things we learned the first is that whether you were Black Or Hispanic the sun played a role in skin cancer,
so we often think of that being and that wasn’t known actually to this point they people thought that it was only important in light skin patients so we showed that the sun played a role in
in melanoma in in non-white populations as well.
And then we look further when we saw that these non-white populations Hispanics and blacks didn’t do well if they had melanoma they didn’t do as well.
And what we learned was that they were diagnosed later.

[32:54] Often because people didn’t even think of the possibility that darker-skinned populations could have could have melanoma.
So we found this disparity in care and then we started looking at other disparities we looked at disparities in gender
we looked at disparities in type of work you know white collar versus blue collar and things of that nature and we and we really did a mostly focused around cancer skin cancers and other cancers,
and it really provided an opportunity,
to to try to address these these disparities and try to improve the patient’s lives
what’s been the what’s been that outcome what what what how have we use that information to make care better for for those populations.

[33:49] So I think it’s so part of it has been the idea of Education educating both the patients.
To see care earlier educating the Physicians that these things happen.
And they should be attuned to them so I think we’ve made important strides and actually based on some of our work and then people other people got involved there has been slow,
but steady reduction of these disparities but some of them are real challenges because what we also learned was something that we probably all know but maybe don’t think about,
is that for a lot of these things,
something that underlie underlies the problem is poverty and we looked at the State of Florida and we looked at the factors that predict,
late stage melanoma diagnosis and we found that race and ethnicity was part of that but we also found that,
not having resources and living in poverty and we’re also a predictor of late-stage cancer diagnosis and so it really takes not only just educating patients educating
providers
but probably educating our our legislative leaders to should provide resources and because improving the lot and patients lives will also improve their health.

[35:16] Do you think we’ve made any discernible progress in that regard in the period of time that you’ve been in Miami.
I think yes I think we have not not what we need to do.
And I think that things are better now than they were but things are not as good now as they should be and I think it’s only through continued education continued perseverance.
Now we will continue we will make destroys that we need to make.
Yeah it’s just going to be an ongoing process like always right yes that’s that’s for sure.

[35:55] Rob I’ve really enjoyed talking to you about your history and we have come to the part of the program that I kind of enjoy the most and that’s what I get out of the way,
and I’ll let the guests take over so I’m going to close my mic for a few moments and I’m going to listen while
dr. Rob Kirchner gives us his personal prescriptions for Success okay well thank you thank you Randy and I have a few that the and I’ve kind of mentioned them throughout.
The last half an hour or so but the first is prescription for success is control what you can control.

[36:35] And don’t worry about the things you can control and one of the things that you can control is how hard you work.

[36:43] There is there is no easy way to success and and any person who is successful.
Has worked tremendously hard to achieve the success it may look easy to you you may see them at a point in their career where they put it all the work,
to get them to the point where they are my first prescription is,
control what you can control and one of those things is how how much effort how much desire you put into the task.
The second prescription is also another one I’ve mentioned persistence and that failure is part of success.
You going to fail and when you do fail you feel terrible about it.
But whether you fail in a sporting event or you fail trying to get a driver’s license or you fail trying to get past a test or fail getting into residency all those things I’ve done.
The the idea is you pick yourself up analyze why you failed and then dust yourself off and be persistent.

[37:52] So I think that in addition to our hard work persistence is one of the key prescriptions for success.

[38:01] The third prescription is that while we it’s important to have an end in mind.
What’s equally in probably more important is to enjoy the process enjoy the ride enjoy the adventure because that’s what life is.
So as you work hard as you’re persistent you want to take joy in what you do because people will see.
How much you like what you’re doing whether it’s learning whether it’s in my case helping people through research or education or mentorship.
And that will have a tremendous impact on them so hot work hard be persistent but enjoy the ride.

[38:46] And then the final one a prescription I want to share is the idea that we live in a community.

[38:54] And one of the things I would have told told my younger self is to be outgoing.
Be engaging because you’re building a network.
Of people and the more time you get you interact with people early in your life and early in your career.

[39:13] The greater Network you can call upon to accomplish things later in the career so every day someone asked me hey do you know someone here and you know a person there.
And it’s very rewarding the times what I could say yes I’m going to call somebody or I’m going to connect you with somebody or I’m going to reach out to somebody who I’ve met along the way.
And I only wish that I had done more of that and done it earlier.
Because it’s really just like you and I got the chance to meet each other during our careers and and now here we are in this situation,
getting to know people who share some of our common values is really one of the true joys of what I do so those are my four prescriptions for success,
hard work.
And control what you can persistence and to embrace failure as part of the success Journey enjoy the ride and be passionate be enthusiastic and.
Finally build the network be outgoing engage people and in the long run that’s going to serve you very well,
Rob that’s a great deal of wisdom and I knew you would have some wisdom for us and I appreciate you being here to share it with us.

[40:40] Before we go I suspect that having heard this conversation there may be some people that would like to either get in touch with you directly or possibly follow you so if you’d like to share.
Email addresses or websites or,
when you will be available on the speaking to her next please what have you got for us so I welcome anybody reaching out to me via email my emails for fairly easy it’s our kerzner rki arseniy are.
At Miami dot edu and our department has a spectacular social media presence both on Facebook.
Instagram and just search um Frost Dermatology.
Dr. Phillip Frost who’s donated money and named we named the department after is a world-famous,
dermatologist but also billionaire entrepreneur and billionaire and he gave back to the department he originally worked at so that others can share and success so I invite you to,
follow us at um Frost Dermatology.
Well once again dr. Robert kirschner it’s been a great having a great honor having you on prescription for a success and I thank you for being here.

[41:56] Thanks so much it’s been great fun.

[41:58] Thank you so much for listening today remember you can get more information about our guests as well as hear them face my rapid fire questions
at our patreon site and while you’re there you can also subscribe to the podcast give us a rating and hopefully offer suggestions on what you’d like to hear in future episodes.

[42:19] Also thanks very much to Ryan Jones who composed and performs out theme music that’s all we have for now so please be sure and fill your prescription for success with my next episode.

[42:33] Music.