My Scope of Practice: A (Lone) Star Wound Care Practitioner

OWM recently spoke with Andrew J. Applewhite, MD, CWS, UHM, and Today’s Wound Clinic editorial board member, to learn about his academic and professional journey in wound care and his most recent accomplishment — ie, being named Medical Director of the Comprehensive Wound Care Center at Baylor Dallas (Dallas, Tex).

OWM: You attended the University of Texas at Austin and the University of Texas Medical School in Houston. What are some of your most significant experiences as a student?
Dr. A: The things I remember most about UT Austin were the large, but well taught classes that demanded concentration and independent work. Austin is a great city and provides a great atmosphere to go to college. At the UT Health Science Center at Houston, the quality of the faculty and their interactions with the students impressed me from the beginning. In fact, my biochemistry professor, who was also an Episcopalian priest, presided over my wedding. I also remember being on trauma call with Dr. Red Duke, Chief of Trauma Surgery, Hermann Hospital, UT Health Science Center, Houston, where I had to think quickly and never be surprised by anything.

OWM: Was there anything in particular at the University of Texas Medical Branch at Conroe that inspired your involvement with wounds — eg, did you have any mentors who guided you along the way?
Dr. A: There was a large wound and hyperbaric center at Conroe Regional Medical Center that worked closely with the medical residents. I rotated through the wound center and was in awe of the wounds that seemed horrific yet could be healed. Two physicians at the Center — Dr. Robert Warriner and Dr. Brad Pontani — introduced me to wound care and hyperbaric medicine. They have mentored me throughout my career and I am proud to call them both colleagues and friends.

OWM: After your residency, you moved to Chicago to practice family medicine in the northwest suburbs. There you were involved in the local community by serving as the team physician for three area high school football teams in addition to teaching prenatal classes to expectant parents. What were some things this experience taught you?
Dr. A: Family medicine taught me to look at the whole patient, including social and family interactions, which has helped me become a better wound doctor. As the team doctor and through teaching educational classes, I learned how I could have an impact on the entire community. I have carried that over into my current practice by giving educational talks to diabetic and hospice groups, volunteering at diabetic fairs, and performing foot screenings. Just as in family medicine, prevention is a key component to wound care.

OWM: You returned to Dallas in 2003 to devote your full-time practice to the specialty of wounds and HBOT. What successes followed?
Dr. A: After arriving in Dallas, I was named the first Medical Director of the Methodist Hospital of Dallas Wound Care and Hyperbaric Center, based on my past experiences and ability. As the result of a great team, the center grew in volume, requiring additional exam rooms and a third monoplace chamber by the end of the first year. The team at Methodist strived for excellent healing outcomes and we were able to sustain a greater than 88% heal rate. I earned Certified Wound Specialist status in 2005 and became Board Certified in Undersea and Hyperbaric Medicine in 2006. In 2008, Baylor University Medical Center asked me to become its second Medical Director for their Comprehensive Wound Care and Hyperbaric Center.

OWM: Please explain what your newest role as Medical Director requires and how you anticipate your responsibilities will evolve.
Dr. A: The job at Baylor is not much different than the previous one at Methodist except I have more administrative duties. Baylor also has asked me to streamline inpatient wound care, so I will be working closely with the WOCNs. Improvements will facilitate a smoother transition from the inpatient to outpatient side. Because Baylor is a much larger hospital than Methodist, there are more floors to cover and more meetings to attend. I also have a bigger role in determining the different protocols and products used in the entire Baylor System.     

OWM: What does it mean to be the only physician in Dallas/Fort Worth to be board certified in undersea and hyperbaric medicine by the American Board of Preventative Medicine?
Dr. A: That is one of my proudest professional achievements. It took a great deal of time and preparation and exemplifies my dedication to the field. Being board certified encourages me to promote the specialty for approved indications and to discourage misuse of hyperbaric oxygen therapy for nonapproved and erroneous uses (ie, where it has not been clinically proven to be of benefit, yet is advertised to help with conditions such as autism, cerebral palsy, and the late effects of stroke).   

OWM: You have lectured around the globe on HBOT and comprehensive wound care. What are some of the perks and challenges — eg, how do you juggle clinical and educational duties?
Dr. A: The best thing about those events is meeting different practitioners and colleagues and learning from them. I always come away from conferences, whether I am a speaker or participant, with something new. I am always amazed by the quality and true dedication of the professionals in this field.

  Juggling my clinical and educational responsibilities is a challenge that usually requires me to get to the hospital early or stay late. Another advantage to coming to Baylor is that I am provided more back-up on the clinical side when I need it. This has allowed me to balance my duties, as well as my home life, a little better.

OWM: You are a diplomate of the American Academy of Family Physicians and the American Academy of Wound Management. How does one achieve that status?
Dr. A: Family medicine requires a 3-year residency after medical school and passing the board examination. I re-certified (passed the re-certification exam) in 2007. Wound Management required 2 years of experience, an advanced degree, and passing the Certified Wound Specialist Exam. Diplomate status is earned by meeting all the requirements (time in the field, education, and specific training) and by passing the exams.

OWM: What do you find most fascinating about wound care and the evolution of the discipline?
Dr. A: I enjoy investigating why a wound does not heal properly, then devising a treatment plan and getting the wound better. The visual feedback of watching a wound and the patient’s quality of life improve is very satisfying to me. The discipline has evolved so fast and become so specialized as a result of the newer high-tech dressings, modalities, and extensive research.

OWM: What are the most significant things your patients teach you?
Dr. A: I have learned a great deal from my patients. I have learned to never give up, to enjoy life, and (indirectly) to take care of my own health and well being.

OWM: What are some of your future professional goals?
Dr. A: I really want to start a fellowship in wound care and hyperbarics and teach others how exciting and satisfying wound care and hyperbaric medicine can be. I also would like to have time to do some research projects that examine the effectiveness of certain dressings and wound care techniques on the “typical wound clinic patient.” Most of the studies and research projects that examine wound care products exclude these patients (ie, the ones with uncontrolled diabetes, steroid dependence, inoperable vascular disease, malnourishment, and so on). These not healthy patients are who we see typically in the wound care center. I also would like to examine new applications for hyperbaric oxygen therapy, possibly adding more approved indications based on quality evidence of benefits.

OWM: Why is wound care so critically important in today’s medical arena?
Dr. A: Wounds are becoming more common as the population ages and other areas of medicine increase life expectancy. The skin (the largest organ in the body) can fail just like any other organ, and with all the new dressings available, it takes a specialist to understand the intricacies involved as wounds can severely limit a patient’s quality of life. We need more of us in this scope of practice!