Bill Klaproth (Host): This is an AAOMS On the Go podcast. I'm Bill Klaproth. And with me is Dr. Mark Miller as we talk about FEDA: Inspiring OMSs to expand their horizons. Dr. Miller, thanks for being here.

Dr. Mark Miller: Thanks, Bill. Thanks for having me. I'm looking forward to our discussion today.

Host: Yeah, me too. I always love learning about people like yourself. So, could you tell us what is your background and what drew you to oral and maxillofacial surgery?

Dr. Mark Miller: Yeah, absolutely. It's a little bit of a convoluted journey here, but I couldn't be happier with the choices I've made in my life and the events have kind of gotten me here. You know, I went to the University of Kentucky to dental school, got out and did a general practice residency and then practiced general dentistry for a few years. That entire time, though, I had joined the U.S. Army Reserve, now this was pre-9/11 in 1999. Then, of course, after 9/11, had the opportunity to get to visit some other places, right? And one of those was when I got to be deployed with the U.S. Army in Afghanistan for about a year. And I was actually on a civil affairs psychological operations team. So, basically, we did a lot of Hearts and Minds Missions with the local nationals there. And that included mostly working with kids. And I hadn't had the opportunity to do a lot of that at that point in my career, but I think it was at that point that, you know, there was almost a switch that flipped with me. And I knew that the things I'd been doing previously weren't necessarily the things that I was getting the most life satisfaction, if you will, from. And I kind of had this bug at that point to figure out something else I could do with my life that might give me a little bit more meaning and make things just that much more meaningful when I got home.

So, when I got home, I did some other work with the U.S. Army and then got deployed to Iraq shortly thereafter and met a gentleman named Barry Steinberg, Colonel Barry Steinberg, who was a pediatric craniomaxillofacial surgeon in Jacksonville, Florida, and I served with him in Iraq and really had the opportunity to see exactly what oral and maxillofacial specialty, you know, was all about and surgery in general. And he was really the itis for change in my career path and encouraged me to apply to programs, which is what I did. And then had that real focus on children with craniofacial anomalies, having come from Afghanistan, where I was working with the local national kids, and seeing what Colonel Steinberg got to do. 

So, I think it was really at that point after working with Barry Steinberg and having the opportunity to care for kids all over Afghanistan and just that unique situation of knowing that we're influencing the lives of these kids and really changing them forever was just something that was the itis for me applying to oral and maxillofacial surgery and eventually becoming a pediatric craniomaxillofacial surgeon.

Host: Yeah. Well, you said that switch was flipped. That was an important switch. So, was there something special or unique? Or what inspired you to help children, specifically those with craniofacial anomalies?

Dr. Mark Miller: Yeah, that's a great question, Bill. And when I look back on my career, there were certain points in my training where I really knew this was the right thing for me. And one of those was getting to work with the kids that we worked with at the University of Florida, Jacksonville, in residency through Dr. Steinberg's clinic. But also, I had the opportunity to work with head and neck cancer patients and really get a broad view of what our specialty had to offer. And I saw our cancer surgeons, and they had the ability to save people's lives, which was a unique and unbelievable talent and things that really contributed to the community.

But then, I saw our kids in craniofacial clinic, right? And I got to see us get involved with those kids, oftentimes before they were even born. You know, in prenatal consults and things, and then being able to care for those children and truly change their lives throughout the course of my training. And knowing that, I got to see Dr. Steinberg, you know, meet these families this young, but also see him getting invitations to high school graduations, right? And I remember Dr. Steinberg looking at me one day saying those exact things. You know, he said, "Hey, our head and neck guys, yeah, they do amazing work and they really save people's lives. But look at what we do. We change children's lives forever." And what an amazing opportunity. And really, it's truly just a privilege to treat people's children much more than even treating themselves. And that's where that kind of came from for me.

Host: I imagine that's got to be very satisfactory, especially when you say you're able to change the course of someone's life. So, Dr. Miller, what does a typical case look like?

Dr. Mark Miller: So, Bill, whenever I get a case that comes to my clinic, it'll come through one of a number of specialties oftentimes, and these are going to be children with some type of craniofacial difference, right? So, there's something in their congenital malformation, if you will, that comes to my clinic for repair. So, there's so many facets to what I do, and most of it kind of relates to where they are in growth. And one of the things I talk to my residents about is really understanding craniofacial growth and knowing the timing of different structures when the cranium's done growing. When is it at skeletal maturity? When is the midface done growing? When are the orbits done growing? So, understanding all those principles and knowing that we have to consider, okay, this tumor in the mandible and where is this child in their growth and development? And then, how are we going to go in and address that disease process and, at the same time, not hurt ourselves in a definitive reconstruction later, but get them to a point where they're able to function and live happy, healthy lives in the intermediate term. 

So, I know, unlike a lot of things that we love as surgeons, which is to be able to get condition A and treat it this way and be done with it, I think in what I do, my typical cases look like where are we on this growth spectrum and where are we going to be able to best impact this disease process or this malformation to a definitive reconstruction at what appropriate time. So, I use all kinds of things that help me do that, being patient-specific treatment plans and custom guides and plates, things that help me predict where they should be on their anatomy. For instance, a kid with craniosynostosis and knowing that, okay, this particular suture has held back this area of growth in this child, but being able to use our technologies now to really help me predict where that patient should be as I formulate a treatment plan for them is kind of paramount to the things I do.

Host: So then, Dr. Miller, you had another switch flip, if you will, towards academia. What was your inspiration for you to pursue academics?

Dr. Mark Miller: So, also a great question. I mean, I think, you know, I remember the first switch, Bill, being flipped. And then, I talked about that a little bit, but then there was this next piece, right? And that was when I was in medical school at the University of Florida. And I remember going to my pediatric clerkship, which is something we do in medical school as we rotate through all the different specialties. And when I got to the pediatric clerkship and I got to the floor of the children's hospital, and all of a sudden I was like, "Oh my gosh, this is home," right? And there was just this moment where I didn't care how early they asked me to come in in the morning. I didn't care how late they asked me to stay at night. I just loved being in the children's hospital, and having that opportunity to really impact these kids' lives. 

Now, that also carried over to the people that were training me there, right? And these are people that had really dedicated themselves also to not just treating kids, but also treating others how to care for children. And I think that was the point where I really knew that this was the direction I wanted to head with my life, because these are people that could have gone out into private practice and certainly done much better financially. But they saw that need as well, and they saw just how important it was to influence my life to be able to care for children. And I think that was by far for me the thing that I saw as not only do I want to care for children with craniofacial differences, but I want to do that in a setting where I can also teach the next generation to really do a great job with caring for children and understanding what a privilege it is to treat people’s children.

Host: That sure is. In listening to you talk, Dr. Miller, it sounds like Dr. Steinberg really may have had an impact on you and I'm wondering, that was such a great impact. That's another reason why you want to give back and help train the next generation as well. So, let me ask you this, working in academia, how do you then balance the treatment of patients and training the next generation of surgeons?

Dr. Mark Miller: Well, Bill, that's kind of the easy button for me. While I'm treating children and while I'm doing all these things, at the same time, I have residents working with me. So, this just becomes a very natural subset of what I do as an academic surgeon. So, every step of the way, it’s just I'm taking an extra moment, right, to look at my resident and say, "Okay, this is why this is important." When we walk out of the room with a patient and a mom is really being a mom, right? I mean, concern for her child, concern for the upcoming treatment. And that's the opportunity I have to really seize and say, "This is why it's important that we treat this patient this way. This is why it's important that we use these words, because look at what this poor mother is having to go through right now." And for my residents that have children, they get it. And for those of us that didn't have children when we were residents, I think there's a point where we start to feel that. And, for me, that was the thing that I wanted to make sure I could do. And that is to continue to treat children just like we had talked about, but also being able to bring my residents into that picture so that they could really learn from every aspect of what I do, whether it's the things that we always think about in surgical training: How do I hold this instrument? How do I handle this tissue? But also really, how do I care for these children and their families in a way that leaves a mark on them, that is going to be someone that cares, someone that's loving, someone that really is treating their child just like it was their own.

Host: Yeah, it sounds like a very compassionate approach, and I know the parents, I'm sure, appreciate that. So, I understand you are a recipient of the Faculty Educator Development Award, or FEDA. So, what led you to apply for the FEDA Grant?

Dr. Mark Miller: Also, you know, something that I think came about from my academic career. So my chairman when I was at the University of Texas Health Sciences Center in San Antonio was Ed Ellis, who's well known in our specialty. And there was a day where Dr. Ellis called me in his office and we were just talking about career development and different things that he thought were going to be important as I made my commitment to an academic career.

And as we went through the checklist of things and his mentoring process, one of the things he mentioned to me was, you know, the Faculty Educator Development Award. And I was familiar somewhat with the award. I knew that from my time at UF Jacksonville with Dr. Fattahi, and then certainly, during my pediatric craniofacial fellowship with Dr. Ramon Ruiz, who was also just, you know, extremely instrumental in my life along with Dr. Steinberg. And Dr. Ruiz, I believe was in the very first group of recipients of the FEDA award. So, this was already on my radar a little bit. And when Dr. Ellis brought it up and said, "Okay, you're at a point now we need to make sure one of the next steps is to get you to apply for that award through AAOMS and the Foundation.”

Host: So then, how has the FEDA grant changed or helped shape your career, Miller?

Dr. Mark Miller: That, Bill, is something that is so multifaceted that people ask me a lot and I try to explain in as many granular level details as I can. So, there's certain things that just being a part of a community of people that have received this award brings me. So, there's automatically a connection with some of these people and as I was applying and looking at people that had received the award, reaching out to them and really getting mentorship from them. So, that's kind of the first piece, right? 

And then, as it moved into how it helped me in my academic career, well, there's this kind of lengthy process of applying that involves a multi-year application. So, it's not just you turn it in one time, and it's awarded to you. Typically, this is something that's going to be a multi-year application. And each year they want to see what I've done, what did I do during this past year that helped my residents, that helped my academic development, and it really pushed me. It pushed me to consider those things. Okay, what am I doing to improve my CV? What am I doing to put myself out there so that I know that I'm getting more national recognition, or that my residents are getting extra training in this, or that I'm becoming a little bit more specialized in this area? And doing those things. So, I think those are some of the paramount things that got me to the point where I received the award.

Now, Bill, as it moves into once I got the award and looking at that, well, that's a whole different discussion. You know, at that point, this really became not only an award that helped me look at how did I get here, what kind of steps did I take in order to be awarded the award, but now to, okay, there's obviously a financial piece to this as well. And it really freed me up in a lot of ways. I had been taking on second and third teaching jobs to do different things like teach ATLS and different things that were great for me and great for my specialty. But I'm also in the U.S. Army Reserve still, so you take one weekend out a month for that, you take another weekend out for teaching these additional classes to make a little bit of extra money, because our academic salaries were sometimes challenging in the amount that we received comparatively and with student loans and all the other things we have going on. The FEDA award really freed me up considerably to focus more on my work-life balance, to focus more on the things within my own institution and my own career that were super important and helped me become a better clinician and an academic surgeon overall.

Host: So, you said it was a lengthy process that it pushed you. So, would you say it was difficult and would you encourage others to apply?

Dr. Mark Miller: Bill, I certainly encourage anyone who's dedicating their life to academics or even considering staying in academics as a career choice to do this. And there are multiple reasons why. It's not a difficult application process. Yes, it takes a little bit of time. But certainly, reaching out to those of us that have received this award, and I don't know of anybody that I reached out to, Bill, that wasn't just willing and sat down with me and said, "Hey, Mark, here's what you need to do," right? 

So, I think the next piece of it was also seeking out not just the people who had done this before, who had received this award before, but the people who also are involved in some of that review of the materials. So, finding out the things that were important were an important part of my process. At the same time, Bill, those are the exact same things that made me a better academic surgeon, right? I'm presenting more. I'm going out and looking for opportunities to write abstracts and present at national meetings and do posters for different events that are showing some of our research, looking for research opportunities really, and certainly writing and looking at publications as a big portion of that.

So, not a difficult application, but more of a commitment, I guess, to looking at this from a multi-year standpoint. So, you turn in your application the first time, you turn in your CV with it. The next year, they're going to want to see what changed in your CV, right? What kind of things did you add this year? In fact, it's a separate sheet, basically, that I would turn in each year to say, yes, this is the next piece and the next piece and the next piece. And it really helped me identify, even with my chairman, to say, what are your goals for the next year? So, when I would sit down and do my goals, I knew that there were certain things that were also going to be looked at on the FEDA side. So, it helped me formulate a lot of my goals, and it was really just a mentoring event for me overall, that I just can't even be grateful enough for the people that really helped shape this for me and bring me along to get to this point.

Host: Well, it sounds like it certainly has been personally rewarding. So, let me ask you this. Do you feel the FEDA grant helps impact patient care?

Dr. Mark Miller: Well, Bill, I think it has to. I don't know how anybody can go through this process, certainly do the things it takes in order to be awarded the FEDA, and not become a better surgeon impacting our patients directly through the things that we've done in both our exposures, our research, academic teaching, and all the things that FEDA really looks at in this holistic approach to what is an academic surgeon and how do we bring this into our practices.

So, I think without a doubt, there are things that I was able to identify and really move towards in my academic practice, looking at different research opportunities, different things that I wanted to become, kind of a subspecialist in, right? And I think those things obviously sparked that interest in me to really things like neuroplastic reconstructive surgery, something that was kind of new out there, and my interest in that kind of was spawned from, "Okay, this was a research project that I thought I could look at, and the question hadn't been asked yet, and certainly hadn't been answered." And just going through that, I know that my patients received much better quality of care, and also satisfaction at the end of their treatment than they would have had I not been pursuing the FEDA award and had not had that grant to impact my life and allow me to do the things that I did as a result of receiving it.

Host: It's easy to see that it certainly does positively impact patient care with all of the training and research and educating going on. That just makes sense. Well, this has been fascinating. Dr. Miller, you're a whirling dervish of accomplishments. It's really amazing to get a chance to talk to you.

Before we wrap up, is there anything you want to add about the Faculty Educator Development Award or your journey?

Dr. Mark Miller: Well, yeah, I guess, Bill, if I had to say anything, number one is thank you to all the people who donate to the AAOMS Foundation. I'm now, you know, an annual donor as well. I've personally got to experience what that means to receive this award at such an influential point in my career. 

So, the other thing I would say is I would encourage all my colleagues regardless of what stage you're at to really just set that piece aside. The things the Foundation does through research, through development, is really, I think, can't even have a price put on it in our specialty. And I certainly think it's important for all of us to give back at this point to our specialty and know that we continue to shape the future and we have the control to really know what that future looks like. So, that would be my other thing that I would just say is thank you to everyone who contributed to the Foundation and to AAOMS for making this award possible. And also, it's my time to give back now and all of my colleagues to give back now and to ensure that this continues for educators in the future.

Host: Well, we appreciate you giving back. You certainly are an inspiration to the specialty and to your patients and obviously the next generation of surgeons. Dr. Miller, this has really been fascinating. Thank you for sharing some time with us today and telling us your story and about all of your accomplishments. It's really impressive. And thank you again for your time. We really appreciate it.

Dr. Mark Miller: Well, thank you, Bill. Thank you to AAOMS and to the Foundation, again, for getting me here. And certainly, I'm out here available to anybody who ever needs me and happy to continue to give back with those in the future that are applying for this award.

Host: Love it. Once again, that is Dr. Mark Miller. Thank you so much for your time. And for more information, visit aaoms.org. That's aaoms.org/feda, F-E-D-A. And if you found this podcast helpful, please share it on your social media. And don't forget to subscribe so you get every episode. Thanks for listening.