Creating Community by Fostering Growth & Between Medical Specialties
Boise, Idaho, USA, August 2023
Author: Caroline W. Vargason, MD PhD
credit: Deneen L Trebel via Pexel
Arriving
When I arrived in Boise on July 4, 2018, I stepped off the plane with my two-year-old daughter in tow, a small rollerboard suitcase, and a diaper bag. The city was new to me and filled with possibility. I was leaving behind familiarity and a professional network built over the final two years of my surgical training in Cincinnati, Ohio. Beginning my journey as a practicing surgeon in a new place felt both energizing and daunting. Even then, I felt that connection over certainty was my goal. As with winding career paths like mine, it would take at least five years to return to that grounded truth.
A month later, on August 1st, I began my first job in “the real world.” As part of the job application, I’d been asked to write a five-year plan. At the time, I thought I knew where I wanted to go. I wanted to be collaborative, respected, and connected. Although I had almost no concept of what it really meant to build a practice from scratch in a new city, while balancing life as a parent and partner, I understood the connection piece instinctively.
Arriving in a new community forces you to slow down, whether intended or not. New eyes on a medical community will identify quickly what is missing and what is present. I was able to observe colleagues who are collaborative and gaps in care to fill. Most importantly, I slowly found people quietly carrying forward the medical culture with which I felt most aligned.
What I Thought I Was Building
You might wonder what exactly it is that I do? I am an Oculofacial Plastic Surgeon. To break that down, I am a board-certified Ophthalmologist, an eye surgeon, who completed two additional years of fellowship training in oculofacial surgery. My path required ten years of medical training after college: four years of medical school, a one-year internship in internal medicine, three years of ophthalmology (eye surgery) residency, and at last a two-year fellowship focused on my specialty, oculofacial surgery. There are a lot of names for what I do. Ophthalmic Plastic & Reconstructive Surgery is the official specialty, or oculoplastics is a shorter version. If you haven’t heard of this specialty, you’re in good company. About 700 of us practice in the United States, and only a handful are in Idaho’s Treasure Valley. Our specialty interfaces with many others, including ophthalmology, dermatology, plastic surgery, and otolaryngology (ear nose and throat, ENT). We specialize in the area immediately surrounding the eye, which includes the eyelids, tear ducts, and the eye socket itself. Much of our work focuses on tired, heavy, or sleepy-looking eyes. As “around the eye” surgeons, we restore the eye area when it has been affected by age or injury.
The road to be trained in this specialty is long and purposeful. By the time I started my first attending job, I had spent the majority of my life as a student and apprentice. At the conclusion of surgical training, a surgeon is fully equipped to perform the procedures they’ve mastered and brings their own values and personal strengths to practice. However, they receive little to no training in the business of medicine or in leadership.
And I knew from the beginning that technical skill alone would not define my practice. In my 2017 job application, I wrote:
“First, I am seeking [mentors with whom I can] share ideas to constantly improve surgical technique and patient care. Second, I will continue learning from other specialists and plan to become an established, collaborative physician within my community.”
At the time, that felt aspirational yet abstract. I understood how to turn curiosity into connection. I didn’t yet understand how to turn this instinct into a business.
Learning From Dermatology
One of the first lessons Boise reinforced in me was the importance of simply picking up the phone, or in today’s terms, sending a text message. Connection is not automatic in the practice of medicine. Our default is often efficiency to protect our own time, which favors separation, not collaboration.
I remember an elderly, frail patient, who presented with a painful eye that would not close. On examination, part of the eyelid was missing. As a result, the eye had dried out so much it had cracked and ruptured open. Remarkably, the wound had partially healed on its own. At first glance, the situation looked dire. I was at a local hospital, and the patient was unable to give much history.
The medical record provided some context. There was a history of aggressive skin cancer, squamous cell carcinoma, treated with radiation. I called a plastic surgeon colleague to discuss potential reconstructive options. These were extensive and risky for a patient of advanced age. Then I called a Mohs surgeon colleague, who immediately advised me to contact the radiation oncologist who had treated the patient. That doctor shared pre-treatment photographs, which revealed a far more severe initial condition than I had imagined. The patient was, in relative terms, doing remarkably well.
In that moment, I saw how connection transforms care. Each specialty holds a “sphere of connection,” meaning knowledge, networks, and perspective, that, when shared, expands the possibilities for patient outcomes. The Mohs surgeon had shared part of their sphere with me, enlarging mine. I rediscovered what I already knew, that connection isn’t just social, it sharpens and expands clinical judgement.
Sharing With Dermatology
Years earlier, during my fellowship in Cincinnati, I learned a similar lesson about looking beyond the obvious. A patient presented with eyelids that did not close, the usual suspect being thyroid disease. Her examination told a different story: red skin scattered with pale patches across her body. A biopsy later revealed cutaneous T-cell lymphoma, a rare skin-related blood cancer. Treating the skin disease resolved her systemic symptoms, while a straightforward surgery to implant an eyelid weight restored function. The case stayed with me, a reminder that even in a highly focused specialty, the most important answers may live outside our expected field of view. I shared the case with my Dermatology colleagues to illuminate an unexpected conversation between the skin and the eyelids.
The Spaces Between Us
Both of these experiences underscore a truth I didn’t learn in textbooks: connection is an active practice. Throughout my surgery training in residency and fellowship, I became known as someone who could make introductions and offer practical advice. I found myself drawn to the quiet work of connection by making introductions, sharing unique insights, and helping colleagues find their way through complex moments. Over time, I came to understand that teaching through connection, by linking someone to the right person, the right idea, or the right resource, was as meaningful as any technical surgical technique I could master.
While connection is cultivated and intentional, it is also uncomfortable at times. When I opened my own practice in September 2022, I was honest about my fear of reaching out after a difficult job transition three years earlier. I needed to remind myself continually that isolation weakens care. Slowly, I built relationships, invited colleagues to gather, and remained open to phone calls and messages, regardless of how inconvenient. That willingness to connect became central to my practice culture.
Breaking down silos doesn’t require grand gestures. It starts with noticing the gaps, and then choosing to bridge them. Sometimes that is a phone call or text. Sometimes it’s a conversation about what my fellowship teacher called the “Aunt Minnies.” Your friend wouldn’t know your “Aunt Minnie” by sight unless they had met her before. These are the unusual diagnoses you don’t recognize unless you’ve met them before. Recognizing these cases often depends on having trusted colleagues to consult, whose observations and experience enlarge your own sphere of knowledge.
Medicine is relational as much as it is technical. Even with the most advanced testing and surgical skill, outcomes improve when professionals share knowledge, curiosity, and attention. This is not a theory. Rather it is constant practice. Over the years, I have carried this lesson forward: each connection adds a layer of safety, insight, and perspective. This improves outcomes for both our patients and our own professional growth.
Closing Reflection
Connection is not about networking or self-promotion. It is about courage, humility, and care. It requires that we step out of our immediate responsibilities, reach toward others, and trust in the shared goal of improving patient care.
I am continually learning how to do this better. Each procedure, each patient, each colleague teaches me something new. And that, ultimately, is why we must be willing to connect, break down the silos, expand our spheres, and honor the patients who rely on us across specialties.
Note: This piece grew out of a lecture I gave to the Boise Valley Dermatology Group in August 2023, during a meeting hosted at Ada West Dermatology. My practice, NAVA Face & Eye, supported the gathering. The theme was: something I learned from Dermatology & something Dermatology learned from me. Any clinical images shared were used with patient permission. All other identifying details have been thoughtfully altered to protect patient privacy.
Writing across seasons. Staying grounded. Thriving together. — c.w.frosting writes
Like what you read? Subscribe below via Substack, to receive essays & reflections delivered to your inbox.