MEET THE FELLOWS: Ahad Khan
As UCSF Fresno’s first minimally invasive surgery fellow, Dr. Ahad Khan is more than three months into the program and says he feels blessed to be training with some of the foremost experts in bariatric surgery.
Dr. Khan is one of nine new UCSF Fresno fellows to start this year as the program partners with Community Medical Centers to train some of the most in-demand sub-specialists in health care.
As part of a series of stories introducing the new fellows, MedWatch Today sat down to meet Dr. Khan.
Hometown: Karachi, Pakistan
Education: Army Medical College (Rawalpindi, Pakistan), UCSF Fresno
With your specialty, what do you hope to do?
Dr. Ahad Khan is UCSF Fresno's first minimally invasive surgery fellow.
Well, it’s a pretty broad field. Laparoscopic surgery is actually done by all general surgeons now – at least basic laparoscopy is practiced by all general surgeons. It’s really the state-of-the-art surgery, and if you’re not trained in advanced laparoscopy you will lag behind in not just patients, but referring doctors who know that you have advanced laparoscopic skills want their patients to undergo minimally invasive procedures because there are thousands of benefits of doing it with laparoscopic technique.
So is that something that you’ve always been attracted to? The cutting edge?
Not always was I attracted to it. Once I got exposed to laparoscopic surgery, sure, I developed an interest. My second love for surgery was vascular surgery so I was tied between the two of them to decide which one to pursue as a career. The fun part of laparoscopic surgery is that it is still rapidly growing and everybody doesn’t possess the skills of being advanced laparoscopists... And the other advantage was I didn’t have to move out of town, I could stay in town and do the training.
What does this fellowship, and all of the fellowship programs starting to trickle in here, mean to the Valley?
It’s actually a huge improvement from recruiting residents, because people want to go to a place where they can complete their training... And the medical department has started their pulmonary fellowship and the cardiology fellowship, so with that I think we will attract many more residents applying to this program because they know they have other options to branch out to once they’re done doing their residency. So that’s a big advantage.
The second advantage is the people doing their residency [at UCSF Fresno] don’t have to relocate...
What do these fellowships mean to the people of the Valley, the patients?
The advantage for them is they don’t have to go out of town to get specialty care. Most people, not just because of the fellowship but before advanced things were being done in Fresno, people were going to Palo Alto or San Francisco or even Los Angeles to get their medical care, especially when it came to specialty care…
Do you see yourself eventually leaning toward one direction, one specialty?
It depends on what patient base I get. If I get bariatric-heavy at one point, I think I will concentrate with bariatrics because it’s a very devoted field. You need to do seminars, you need to have a dietitian on board, a psychologist on board and you have to spend a lot of time. Follow-up on these patients is very frequent. These patients need to be followed up quite frequently and make sure their weight loss is adequate and they’re not having nutritional deficiencies and they’re not going off the curve, so the follow up is so important that it will take up a lot of the time if that’s what ends up being my majority of work.
So are you assisting right now with those procedures?
Yes, there’s actually a very steep learning curve in learning how to do this operation. In the literature I’ve read they said about 70 cases is what it takes, when you’ve done 70 cases yourself, to get comfortable doing this laparoscopic gastric bypass. So this is my second month into the fellowship, the first month was basically getting to know the operation, getting to know the physiology and the anatomy of the operation, knowing the complications and how to follow the patients clinically. And now in my second month I’m getting to do more and more. I do probably about 20% of the operation now.
When you say 20% are you doing it yourself?
Yes, myself being supervised. The attending staff is in the room, and they’re directing me. And having seen already 100 cases now I know how the operation is done, it’s just getting the ergonomics of the surgery right and getting the techniques of the surgery right and learning how to suture inside the abdomen laparoscopically.
So what got you interested in bariatrics?
What got me interested was my fascination with minimally invasive surgery, and the fact that they can do an operation of this magnitude with five little holes was always intriguing.
And as I found out more about morbid obesity, the complications it has and the benefits you give to the patients by essentially curing their diabetes and getting them off their high-blood pressure medications, taking the weight off their joints so their arthritis doesn’t get any worse, curing their reflux if they have it, curing their sleep apnea if they have it – led me towards getting interested in this field and going about it.
So it sounds like you’re working with at least a couple of the surgeons who are very well known internationally for bariatric procedures. How does that impact you as far as wanting to be in that environment?
I feel blessed. The only thing I can say in one word to summarize it, I feel blessed to be working with Dr. [Kelvin] Higa and Dr. [Keith] Boone. They’re not laparoscopically trained, they’re not fellowship trained, so they’ve grandfathered into this field, and as far as I’m concerned are masters of the field nationally. Having operated with them and learning from them is such a privilege.
Before the fellowship began, were you working with minimally invasive surgery?
No. This is the newer thing actually. After starting this fellowship, we’ve added a rotation for fourth-year residents to come to see us operate... And once I get comfortable with the laparoscopic advanced techniques, such as suturing, I’ll be teaching the residents how to do it. So that’s the other advantage for these residencies, is as a senior resident, you get to see advanced laparoscopy, which we weren’t exposed to.
What were you mainly doing before the fellowship?
Most of our rotations as a fourth-year resident were concentrated on burns and plastics and trauma. So they have cut down on burns and plastics and trauma and have added an additional two months of minimally invasive surgery where the residents will be exposed to bariatric surgery.
This story was reported by Eddie Hughes. He can be reached at eddieh@communitymedical.org.