Julie Sosa, MD, MA, FACS

Inspiration

I thought I wanted to be journalist, but became enamored with economics. I did a graduate degree outside of medicine and wrote a book about the labor market for academic PhDs; these were projections of my own career prospects (this was in the late 1980’s, when many PhDs were driving taxis and the median time to a PhD was 15 years). It was a wakeup call, and I switched gears and applied to medical school at Johns Hopkins, because they did not require an MCAT and I trusted I would always be able to find a job in medicine. In the last minute – September of my fourth year - I did a sub-internship in surgery and fell in love with it. Sometimes the longer path makes your life much richer, and it gives you a very different (and valuable!) perspective. Every day I build on my background in economics as a health services researcher.

Impact

I work nationally to both develop the evidence and the curriculum that informs national guidelines for thyroid surgery and the treatment of thyroid disorders, including thyroid nodules, thyroid cancer, and hyperthyroidism as well as neuroendocrine tumors. Demonstration of a surgeon-volume threshold for thyroidectomy, one of the 10 most common operations performed in the U.S. – can influence reimbursement and referral patterns supported by policy-makers and payers. Our demonstration of a real increase in incidence and incidence-based mortality for thyroid cancer suggests that there may have been a change in the biologic profile of the disease. Pursuant study of potentially modifiable risk factors such as flame-retardants and obesity helps to fill out the narrative and compel action in a number of different arenas, including environmental science and population health.

As a committed educator, it is also important to assure scholarship informs reform in surgical education. To this end, I have co-led a decade-long prospective cohort study (called NEARS, for National Study of Expectations and Attitudes of Residents in Surgery) of surgery learners that began in 2007. Our most recent publications identified how personalized interventions in training could reduce attrition, and how sociodemographic predictors of board passage could serve as potential barriers to diversification of the surgical work force.

Strategies

Assemble a team of collaborators with skill sets that complement my own.
Build a focused body of high-quality evidence using rigorous methodologies.
Diversify a research portfolio to build a body of research, tackling an important question from different perspective to provide a fuller narrative.
Publish in professional journals: document clinical practices and review standards of care
Apply understanding of academic research and training to the editorial decisions of journals
Execute evidence-based change as a leader in academic medicine. Science must inform policy, and it should be the engine for advocacy.

Timeline

While my great passion is conducting research to improve clinical outcomes of patients with benign and malignant diseases of the thyroid, parathyroid and adrenal glands, I long ago recognized that moving improvements out of the UCSF theatre and into standards of care is really the way to improve outcomes.

The opportunities that arise to move that needle are varied, and do not always immediately look like that will be what they do. By accepting opportunities to work on committees, and sit on expert panels, other doors begin to open. The committees become more robust, the invitation to review becomes an invitation to serve as editor. All of these opportunities are work, and they build your reputation as a content expert. Exposure to a diverse set of colleagues and collaborators facilitates serendipity as ignition for impactful innovation and discovery.

I currently serve as editor in chief of the World Journal of Surgery. I was deputy editor of JAMA-Surgery and associate editor of the Journal of Surgical Research. I am on editorial boards for the Annals of Surgery, Surgery, Annals of Surgical Oncology, Journal of the American College of Surgeons, Endocrine, Hormones and Cancer, Journal of Thyroid Research, and the International Journal of Endocrine Oncology. I am Treasurer of the American Thyroid Association (ATA) and serve on the Board of Directors/ Executive Council of the ATA, International Thyroid Oncology Group, and Association for Academic Surgery Foundation. I have served on ATA guidelines committees for hyperthyroidism, thyroid nodules and differentiated thyroid cancer (chair of the committee writing the next iteration), as well as on the NCCN guidelines committee for neuroendocrine tumors and the American Association of Endocrine Surgeons guidelines committee for thyroidectomy