from the Experts at the Norman Parathyroid Center.
Interesting stories of hyperparathyroidism we see every day.
Joining the best parathyroid team in the world required a long training process: 4 years of college, 4 years of medical school, 6 years of surgical residency, and an additional year of endocrine surgery fellowship (one year dedicated to thyroid, adrenal, and parathyroid surgery training). I did not expect to end up in Tampa, but I’m happy I did, as I can finally become the surgeon I want to be. I want to be the best, so I’m joining surgeons who are unquestionably the best at treating parathyroid disease. Here is the story of how I ended up at the Norman Parathyroid Center, and what I plan to do now that I'm here.
Nearing the end of my endocrine surgery fellowship in Chicago, I had my future planned. My husband and I had lived in New York City for the previous decade and were ready to return there with our two young children. I had a job lined up at my former surgical residency institution and was excited about working again with the surgeons who had helped teach me.
I hadn't finalized these plans when I heard that the Norman Parathyroid Center was looking to add another surgeon to their staff. They said they needed another surgeon to keep up with the number of patients coming to their Parathyroid Center in Tampa. I knew of Dr James Norman (who goes by Jim). In 2012 he published an article on how his approach to parathyroid disease had evolved. He has published many articles, but I was especially impressed by this one. First, because the number of cases he had done seemed absurdly high – most surgeons won’t do a hundred parathyroid operations in their careers, and Dr. Norman had done fifteen thousand just in this one article. Second, because he openly admitted that his earliest assumptions were wrong and he had changed his mind and thus changed how he conducted parathyroid surgery. He had shown very convincingly that failing to check all four parathyroid glands resulted in much lower cure rates, which led to many people needing a second parathyroid operation either immediately or a few years down the line. Surgeons aren’t known for admitting their mistakes, although the best ones will do so throughout their careers. The best ones can admit they are getting better, learning, and evolving. The best ones don't let their egos get in the way of doing the right thing for their patients. Dr. Norman’s commitment to perfecting the management of hyperparathyroidism was obvious and his intellectual honesty was refreshing. And of course, I had seen his web site, parathyroid.com, where anyone looking for information on parathyroid disease is certain to end up. I had used that website as a resource for years.
When I heard that Dr Norman and his partners (Drs Doug Politz and Jose Lopez) were looking for another surgeon I knew I wanted to go down to Tampa and see their center, if only to confirm that Dr. Norman’s claims about his practice were true. He claimed to routinely perform a complete 4-gland parathyroid operation in under 20 minutes (I had already seen a video of him doing a 13 minute 4-gland parathyroid operation that everybody says is impossible) and they have a higher cure rate than anyone else. As about half of my fellowship cases were parathyroid operations, I thought that I understood the disease and pretty much had the operation down. But I had never seen anyone do a 4-gland operation in less than an hour; it usually took several hours or longer just to find all of the glands. The surgeons I had seen do this operation usually wanted to avoid examining all four parathyroid glands because it could take several hours and was often impossible for them to do. During my fellowship training to be a parathyroid (endocrine) surgeon, we rarely even attempted 4-gland operations, preferring instead to remove the single gland seen on our scans and quit the operation. And we certainly never scheduled 12 patients in one day, something that Dr. Norman claimed to do routinely. Even if we had that many patients to operate on (and we didn't), we would never schedule more than three parathyroid operations on the same day, because it might take the entire day to do two!
When I flew down to Tampa to visit the team at the Norman Parathyroid Center at Tampa General Hospital, I was still about 95% certain that I would take the job in New York, but thought maybe Jim Norman would have some tips on running a surgical practice or on operative techniques. I knew how to diagnose patients with hyperparathyroidism and I knew how to do a parathyroid operation (or so I thought), but I was always searching for ways to improve, and he might be able to impart some "parathyroid wisdom".
I spent one day with Jim and his partner Doug Politz, and I was blown away. There were none of the “little tricks” I was expecting to see. The Norman Parathyroid Center was not just a well-run surgical clinic, it was the most patient-oriented and efficient surgical practice one could imagine. Every aspect of the patient experience had been carefully planned, and everyone working at the center ensured that the patients received the best care possible. But the most astounding part of the visit was in the operating room. Jim and Doug weren’t merely doing the operation a little better; they were doing a different operation, a vastly superior one. As unbelievable as it may have seemed before, it was easy to see how they could cure more patients than anyone else, and with a faster operation.
After seeing how they did it, and listening to Dr. Norman walk me through his approach and thought processes during his operations, I knew I could never again perform the operation the way I had been doing it-the way it was taught to me and the way that all other surgeons in the world are doing this operation. As I left the center on my one-day visit, I realized that if I continued to manage hyperparathyroidism the way I had been trained, the knowledge that someone else was giving parathyroid patients a far superior operation would haunt me. At the airport on my way back to Chicago, I called my husband and told him to stop looking for homes in New York, because we would be moving to Florida instead. What a 24 hours that was!
That was several months ago, in February 2014. It is now August and 3 weeks ago we moved to Tampa with our children. Since my first visit, Jim has become a great friend and mentor. We text and talk often, discussing interesting or difficult cases and planning for the research we will perform together.
My goals for the next few years are clear. The first, of course, is to extract as much wisdom about hyperparathyroidism and its treatment as possible from Jim, Doug, and Jose. These surgeons have an understanding of the disease and the operation that can only be obtained by treating many thousands of parathyroid patients. Fortunately, they also love to teach. And by working in pairs, rather than alone as most surgeons do, they are always learning from each other, always pushing each other to improve. They are still learning every day! As a side note, the fact that they work in pairs is lost on almost all patients and other doctors-these surgeons are by far the best at performing parathyroid surgery, but to give the patients the absolute highest chance of cure, they always work in pairs. No other surgeons do this! Patients often don't realize how fortunate they are to have two of the top 4 parathyroid surgeons in the world working on them at the same time.
My next goal is to dig into the vast amount of data that the Norman Center has accumulated. The center has treated and collected data for over 20,000 patients with hyperparathyroidism. To understand how significant this number is, consider that most of the published studies on the disease consist of a retrospective review of a hundred to several hundred patients, at most. We have information on thousands upon thousands. And because more parathyroid patients are treated every day, we can choose to study any aspect of the disease going forward, knowing that we can accumulate data for another thousand patients with hyperparathyroidism in less than six months. No one else can do this. No one else has this volume, and nobody understands this disease like these guys do. We have a unique opportunity, and perhaps obligation, to study and understand this disease better than anyone has before. One of the things I have been working on, even prior to officially starting work, is finding an epidemiologist to join our team, someone who can properly assess all of the information we already have and help us design future studies.
Finally, I want to educate. Parathyroid disease is frequently misunderstood. Even physicians, including many endocrinologists and surgeons, have difficulty diagnosing hyperparathyroidism and understanding how disabling the disease can be. It is much more than a high calcium number-it is a slowly lethal disease. By educating physicians and empowering patients to learn about their disease, Jim has helped many people get the diagnosis and the treatment they need. Not everyone can come to Tampa for their parathyroid operation, but anyone with Internet access can benefit from the Norman Parathyroid Center’s vast knowledge of parathyroid disease.
Patients are not the only ones who can benefit from our center’s expertise. Surgeons treating hyperparathyroidism also have a lot to learn. The techniques used at the Norman Center have been developed only after years of experience on tens of thousands of patients, but they can be taught. I hope to start a training program for surgeons who want to learn from the best.
I still think of myself as a New Yorker, though my husband and I are now buying a house in Tampa and we’re planning on staying here. I want to be the best, and know that to accomplish that, I have to surround myself with and learn from the best. I have been given the opportunity to learn from the masters.
Jim’s enthusiasm and passion is infectious. When I spoke about “my new job” in Tampa, Jim corrected me: “It’s not a job! It’s a calling.” And he’s right. We have the ability and even responsibility to change the way parathyroid disease is understood and treated. This isn’t just a new job, it’s a mission.
Since I joined the practice in 2014, we have added two more surgeons, Dr Jamie Mitchell, and Dr Kevin Parrack. Like me, they had at least 7 years of surgical training and between two and 6 years of parathyroid/thyroid surgery experience before they came here. Like me, they had to start all over because the way Dr Norman teaches us to perform parathyroid surgery is unlike the operation anybody else in the world. We really do have a much better mousetrap!