How sisterhood and mentorship help navigate a career in surgery

Kimiko Agari, D.D.S., M.D., and Kristi Agari, D.M.D., M.D., are sisters who received training in the same oral and maxillofacial surgery program. I interviewed both Drs. Agari to understand their journeys into a surgical career.

Dr. Hung: It’s rare to see sisters who pursued a career in oral and maxillofacial surgery together and in the same residency program. Could you talk about your journey?

Kristi: Growing up, we were influenced by many family friends in the profession who told us that dentistry is a very good field. We lived in Stockton, California, where there’s a special accelerated dental track at the University of the Pacific. In high school, I explored other fields, taking business and art classes at the local community college and volunteering in different professions, to come back and see that dentistry was what I wanted to pursue.

Kimiko: I always knew that I wanted to pursue a health care career. I was obsessed with the show “House” and wanted to be a doctor like him. I loved the sciences, and biology was always my favorite class. I ultimately decided to pursue health care because it was a good combination of all of my interests and a way that I could help people. Like Kristi said, we had many family friends in the dental field, and they seemed very satisfied with their careers, so I think that influenced us to pursue that route. We both attended the University of the Pacific and participated in their pre-dental program, and afterward, we continued on to different dental schools. I went to the University of California, San Francisco, where I first discovered my passion for surgery. During my first year of dental school, I attended an event called Passing the Scalpel dedicated to inspiring the next generation of oral surgeons. The event consisted of a cadaver dissection lab where oral surgery residents demonstrated various types of procedures that included surgical approaches, dentoalveolar procedures, orthognathic surgery and complex trauma. It was my first introduction to the scope of oral and maxillofacial surgery.

Dr. Hung: How were your experiences during oral and maxillofacial surgery training at the University of Southern California?

Kristi: Our experiences were very positive. Our attendings at USC did a very good job of treating us as individuals. They are also sensitive to having women in the program. The experiences might not have been as positive if we weren’t on top of our game, working and studying hard, but I also think that being in residency together helped us be even better residents. We always had each other to discuss cases, study oral surgery topics and navigate residency together.

Kimiko: Kristi and I are two years apart, in age and in training. We get along so well, and we are very supportive of one another. If that was not the case and, for example, if there had been interpersonal issues that had translated into residency, then that would have been very challenging for other residents and attendings to manage and perhaps our experiences would not have been positive. But yes, we could not speak more positively about our experiences training together as sisters at USC. Doing residency with Kristi was the best part of residency. I highly recommend doing residency with your sister.

Dr. Hung: What are your current and short-term goals?

Kimiko: After graduating from residency, I did a fellowship in Charlotte, North Carolina, with Brian Farrell, D.D.S., M.D., at Carolina Centers for Oral and Facial Surgery in a wide range of oral and maxillofacial surgery procedures and with a focus on orthognathic surgery. I enjoy being in the operating room, and I knew I wanted orthognathic surgery to be a large part of my practice. I recently started working at Kaiser Permanente in Riverside, California, which has allowed me to pursue these interests and build my orthognathic practice. I do also have an interest in academics and believe there is a strong need for women in academic positions to provide mentorship and teach this next generation of residents. There is a lot more that we need to do in terms of fulfilling that role for women who are going through the process.

Kristi: I am currently in my chief year at the University of Southern California. After graduating, I plan to join Beacon Oral Specialists in Las Vegas, Nevada. I want to ease into my position at one of the offices while preparing for the board certification exam. I plan to take trauma call with my University of Nevada, Las Vegas mentor, Daniel Orr, D.D.S., Ph.D., J.D., M.D., who also trained at USC. Through our training at USC, we are very comfortable with managing facial trauma.

Dr. Hung: What is your support system to deal with stress during residency?

Kristi: I am very fortunate to have the most supportive family behind me. I could not have gotten through this residency without them. I lived with Kimiko during my first four years of residency. If I was struggling with anything, I could always talk to her. She is my older sister and we were going through the same residency training, so she completely understood me and what I was going through. My parents have been a strong guiding light in my life and have always empowered me to live with my head high and strive to be the best me that I can be. They were not without their conditions, and they had high expectations, encouraging me to always do my best, never be lazy and have a concise plan for whatever I chose to pursue.

Kimiko: Our residency program was our second family and a huge support system for me throughout my years at USC. I had one experience where a patient was very rude to me and directed many offensive comments to me, including “I don’t think women should be doctors,” “I want to speak with the other [male] doctor” and “if I find out you are part of my surgery, I’ll sue you.” I was a mix of incredibly angry, frustrated and upset. The next day, my senior resident gathered the team together to provide me encouragement and explain that this type of behavior was not to be tolerated from anyone, including patients. I was the only female resident on the team at that time. He was very supportive of me. That was probably the only major negative experience I have had as a woman in surgery. On a serendipitous note, I did a bedside drainage for a young woman later that same day, and afterwards she told me, “I’ve seen a lot of doctors, and you are the best doctor that I’ve ever had. Thank you so much for taking care of me and for being so caring and patient.”

My male colleagues were always very supportive, but at moments I struggled because at the time, I didn’t have many female mentors in surgery. If I had had that negative experience as a dental student, I would have been incredibly discouraged to pursue oral surgery. So, Kristi and I actually formed a group together we called Sisters in OMFS. We reached out to dental students at USC and other women in the oral surgery program. We gathered throughout the years for potlucks, dinners, social events and meetings to answer questions about oral surgery and provide guidance about the application process. The goal was simply to provide mentorship and support to other young women who were interested in oral surgery at various stages of training. A few of the sisters actually matched into oral and maxillofacial surgery this year.

Dr. Hung: What advice do you have for dental students who may be interested in surgery to prepare themselves to become better candidates?

Kimiko: Make sure you are truly passionate about oral and maxillofacial surgery. Residency is challenging, so if you don’t love it, it will wear you down and you may burn out. Make sure you do it for the right reasons and not because you are trying to prove something or because people are telling you to do it. Do as well on the Comprehensive Basic Science Examination as possible, as that can be a significant barrier for applicants. Then whatever you can to get your foot in the door. Go shadow, help out in the oral surgery clinic, meet residents and attendings. Sometimes people can be very cutthroat since it is a very competitive application process. But don’t be inconsiderate toward other applicants because those are your future colleagues. In (and after) residency, we are one big family, and we should be collaborative and supportive and kind to one another throughout the entire process, including during residency applications, because at the end of the day, we all have the same goal of taking care of patients in the best way possible.

Kristi: Put aside whether you are male or female. Every day, wake up in the morning and be the best individual you can be, regardless of your sex or gender. In my moments when I’ve felt beaten down by difficult cases, strenuous call schedules or lack of sleep, I remind myself that I chose to be here, I want to be here, and I try not to let the acute emotions make me forget how much I love what I do.

Dr. Hung: You mentioned mentorship earlier in the conversation. What is your take on finding good mentors?

Kimiko: There are a lot more resources available these days. The American Association of Oral and Maxillofacial Surgeons has a women’s mentorship program. You can find mentors through your own dental school’s oral surgery programs. There are many conferences you can attend. You can even find a mentor through social media or the ADA Member App; I have had dental students contact me through Instagram, for example. But it does take work — you need to put yourself out there and go through some trial and error to find a good mentor.

Kristi: They say half the battle is showing up. There are many oral surgery meetings and learning opportunities across the country besides the AAOMS National Conference. You can become involved in meetings and symposiums at a regional and state level as well. Like Kimiko said, many surgeons have social media profiles. A few times now, I have approached and met surgeons at conferences, then messaged them about, say, tissue engineering or the related topic they were discussing and asked them for technique or protocol advice. You’d be just as surprised as I was to find that they are very responsive and happy to answer my questions. Put yourself out there, show up, and you may be surprised what you find.

Dr. Hung: Drs. Kimiko and Kristi Agari navigate the world with a positive attitude as they build a strong support system around them and pay it forward to serve others with mentorship opportunities. Gender should not matter in pursuit of surgery. Only true passion, focus and relentless hard work prevail in reaching the ultimate goal of excellent patient care.