Dr. Elizabeth Nielsen '16 on pulmonary & critical care work in WI

UMHS 2016 graduate Dr. Elizabeth Nielsen currently works as a pulmonary and critical care physician at ProHealth Care in the Milwaukee, WI suburbs, as well as SCP Health, an ICU in the area.

The UMHS Endeavour spoke to Dr. Nielsen about her medical education at UMHS and her post-graduate work, including completing a pulmonary and critical care fellowship at Southern Illinois University School of Medicine (SIU). After graduating in 2016, Dr. Nielsen did her residency in internal medicine at Southern Illinois University in Springfield, IL until 2019. She matched into a Pulmonary and Critical Care fellowship at SIU and finished in the fall of 2022. “Medicine is a long road of hard work, but it pays off when the training is finished,” she said.

She started her medical career as a locum physician in Pulmonary and Critical Care in various places in Illinois near her home. She recently moved to the Milwaukee area and started with ProHealth Care  in Waukesha, WI and Oconomowoc Memorial Hospitals in August 2023. When she’s not busy working, she said she “enjoys being outdoors, going to the gym, listening to live music, painting, traveling and visiting family and friends in my free time.” UMHS recently interviewed this gifted young doctor on a busy weekday morning right after Labor Day, when she was on a break and had a few spare moments to talk about her amazing career.

UMHS Endeavour: Today we are speaking with UMHS 2016 graduate Dr. Elizabeth Nielsen.  Dr. Nielsen, you're currently working as a pulmonary and critical care physician. Can you please tell us a little bit about where you're currently working?

Dr. Elizabeth Nielsen: Yes. I'm actually in the suburbs of Milwaukee in Waukesha and Oconomowoc at a health system called ProHealth. They are also partnered with an organization called SCP Health, an organization which is a team of clinicians and operations specialists that help run ER and Crit Care teams. So, I am an employee for ProHealth part time west of Milwaukee.

EXCELLENCE IN TEACHING AWARD: Dr. Elizabeth Nielsen received an Excellence in Teaching Award at Southern Illinois School of Medicine, Department of Medicine for 2021-2022 at her fellowship graduation. The award was given to Dr. Nielsen from residents. Photo: Courtesy of Dr. Nielsen.

Okay, great. And you recently completed a pulmonary and critical care fellowship at Southern Illinois University School of Medicine. Can you tell us a little bit about that?

Yeah, last year. Yeah, last summer/fall. I took some time off to be with family, and then I started as a locum [temporary] doctor in Illinois. I went to Decatur, Illinois and then Bloomington, Illinois through a private locum company and did that for about seven months and then I started at ProHealth up here.

Didn't you win a teaching award during your time there?

I did. I really have a lot of passion for teaching, which is kind of interesting because I didn't go into academics right away. But there are residents that I teach from time to time in family medicine here at ProHealth. The teaching award was something very awesome to get at SIU. That's what I love about ICU and pulmonary when getting to teach even the patients and their family members about what's going on with them, but as well as the learners that are on the team.

You also completed your internal medicine residency at Southern Illinois University School of Medicine. What was one of the best things about that particular residency?

When you're in medical school and at UMHS doing your rotations at different places, sometimes you can do them all in one area, but I chose to do mine in different areas. I was in different places every few months. Being at Southern Illinois was close to home, and it's pretty cool to be at a place that you know the area around there and you know where patients are coming from, you can kind of relate to them based on where they came from, or where they work, or maybe the doctors in their area. I think the best thing about residency there is the community-based feel even though it's an academic center. Everyone feels like a family, and I think that's probably the best part about it.

Getting back to UMHS, can you think about one or two things about your medical school journey studying at UMHS that helped you become the doctor that you are today?

I think one of the biggest things is being adaptable. I feel that when you go to a Caribbean medical school in St. Kitts, you already have to adapt to a new culture and the way of life, how life is there, and then you go to Maine and then you go to different areas for your rotations. I think adapting to new places and health systems really makes you a well-rounded person to become the physician I have become. As well as being able to relate to the patients and their family members and different cultures and the types of people you see along the way.

Another thing is probably just like any med school, but mostly being at UMHS, I feel like I really had the work ethic from right at the beginning with the professors that we had on the island. In particular, I remember Dr. McCracken and Dr. Purcell in anatomy. I really loved anatomy. And those two people really had an impact on my work ethic and how to get through things when it's really hard.

Both of those gentlemen are really great, especially Dr. Purcell. I know him very well. Is there anything else that you'd like to say about current or prospective UMHS students thinking about a career in pulmonology or just medicine in general and considering UMHS?

I think the biggest thing is that no matter what your journey is—just knowing that having the work ethic and the determination to keep going is going to get you where you want to be. I think when I first started at UMHS, at that time, as a med student, you don't feel like you're ever going to get to that goal.  It's a lot of work to become a physician, but if you keep going and you keep your support group of people that you know and your family, of course you're not going to be with the same people all the time. But I think that that's what kind of gets you through to never giving up.

I know it sounds cliché, but that's kind of what makes you keep going. And I think that there's a lot of things in medicine or in just the corporate world that get you bogged down with at points. But I think when you have that patient that may say thank you to you, I think that's what keep those things in your head and your heart and remember those parts and the little things that kind of get you through and keep you remembering and reminding yourself that, "This is why I went into medicine and this is why I want this."

I think I chose pulmonary and critical care for many reasons.  I went into medicine because the surgical field just wasn't my thing,  I loved the procedures I do at the bedside and I saw the attendings in Pulmonary and Critical Care enjoying and being compassionate about it.  That got me excited.  It sort of fits my personality, too.  I love working with a team and a group of people in the ICU and things are kind of regimented, but at the same time, you never know what's going to come in the door similar to ER, but ICU is a bit different compared to ER.  I love working with the ER docs to then take over care and figure out more about the diagnosis.  They do an awesome job of stabilizing and rule out the worst diagnosis; that's their job.  Pulmonology kind of goes along with critical care with ventilator management and the many causes of shortness of breath, cough, etc. 

But the lungs, I will say that while at UMHS and the basic science, pulmonology was not my forte, and I never thought that that was something I was going to go into. But I think seeing my attendings interested and excited about the field, got me into it.  So, I would encourage people to go into it, but I'm a little biased.

BETH & BETTY: Dr. Elizabeth "Beth" Nielsen & her 99 years young Grandma Betty. Photo: Courtesy of Dr. Nielsen.

Okay, great. Anything else that you want to say to alumni or prospective or current students out there?

Let's just keep going UMHS strong and keep talking together. I hope we can all keep do a reunion someday. That would be pretty cool. But it's very cool to talk to people that are in prospective students or people that are there going through each part of this journey. Don't look too far ahead. It's okay. You'll get there with the determination.

ILLINOIS STATE FAIR (from left): Dr. Nielsen with her parents & residency friend Dr. Hannah Purseglove. Photo: Courtesy of Dr. Nielsen. 

Undergraduate in physiology

You did your undergrad at SIU in physiology, right?

Yes. Physiology. I originally went into math in undergrad. I thought I was going to maybe work for the CIA, doing coding or something like that. I took a class called linear algebra, and it just wasn't math to me anymore. It's too abstract and it just wasn't what I wanted to pursue anymore. So, I switched a physiology and from there, I felt, "Well, what else do I want to do with this?" I like teaching, but I didn't necessarily want to be a professor at a college or something like that. I wanted to do more and be around more people. I worked in a lab as well, which was awesome, an awesome experience, but it just wasn't me. I had to be with more people and that's kind of what led me to being in medicine after that.

You grew up in Illinois, right?

I grew up in Bloomington-Normal, Illinois. Normal, Illinois is where I was born and Bloomington is where I lived. They're kind of a twin cities in Central Illinois. And then Southern Illinois University, Carbondale is where I went to undergrad, and the med school there actually is where my parents went. So, it's interesting that SIU is kind of part of my family, and I kind of found it again later on. But yeah, Illinois is where I was at.

For those who aren't aware, can you just explain a little bit in layman's terms what exactly a pulmonologist and critical care doctor do on a daily basis as a specialized physician?

Pulmonology is the study of the respiratory system or from where you take in a breath and where it goes down to. So, nose back of the mouth, pharynx like your windpipe that you would think of your trachea into your lungs, the big airways, the tiny little air sacks and different diseases that are caused in those areas and affect those areas. As a pulmonologist, you can do both inpatient medicines. So, you'd see consultations in the hospital. There's adult and children's. I do adult care, so anyone 18 and over with a respiratory issue, I get consulted inpatient in the hospital. And then you can also do clinic medicine as well. So, outpatient, like you go to your pulmonologist, maybe you have asthma, COPD, lung cancer, you have a lung nodule found on a CT. Lots of different things you can do with pulmonology.

And then also in ICU or critical care doctor, we work usually shifts or time in the ICU, their critical care unit of the hospital. So, when people are very ill either maybe on ventilators or they're having a GI bleed, lots of different things that come in that you see. It's kind of like what you go to the ER for. And if you're very, very sick, you get admitted to the ICU. So, kind of a “day in the life” of a critical care doc is maybe a 12-hour shift, seven days a week, and full-time would be kind of seven days on, seven days off, seven days on, seven days off. So, you go back and forth, but usually when you get there, you get sign off from the night team.

You round on your patients with everyone. And then after that, you do interdisciplinary rounds at 10:00 AM, which is you have social workers, the nursing staff, the physicians, maybe your APPs that you may work with like nurse practitioners and PAs. And then you have pharmacy, sometimes social work, I mentioned that, but palliative care and then physical therapy, occupational therapy and dietary. So, all these people talk about the patient and we go down and talk about it. It’s very organized and I think that's why I went into it.

What interests you the most about this area of medicine?

I think just to piggyback on that is probably the organization and the way that you work with a team. Everyone has different education in medicine. Say you have the clerks that are there, they understand, they help you out with certain things when someone's not doing well in the ICU. You have the nursing staff; they went to nursing school. That's a different type of education than a physician has. And then you have the techs that help out with changing the patient, getting the supplies we need here and there. I mean, we all are one big group and I really like that. I think that's why I went into it. And also, the shift work I really enjoyed because when you're done, you're done. You get to go home and leave that part of work at work.

MICKEY & FRIENDS (far right): Dr. Nielsen at Disney World with boyfriend Nick (far left) & his daughters, Maddie & Hailey, with Mickey. Photo: Courtesy of Dr. Nielsen.

That's good. So, you have a good work-life balance in that respect?

Yes. And I think that after fellowship, after the pandemic, obviously the pandemic was all about pulmonary and critical care medicine, and we were really busy, and I think I realized that that work-life balance is—people talk about that a lot, but it's hard to find that balance. And I don't know whether I really even have the balance all the time, but I think I've started a part-time job in each side. So, I work a couple weeks a month because it's one week on, one week off. I think that makes me really care about it more when I'm there.

That leads us into my next question. What are some of the biggest challenges of being a pulmonologist and a critical care physician today?

After the pandemic, I thought that it would be easy to find the job that I wanted, being in this type of medicine because of a big need for it. Never thought there would be that lull after a pandemic. Everyone kind of overdid [things] during the pandemic and they needed all these physicians. Now it's kind of like, well, if I want to be in this one area in the country, there may not be that exact thing that I wanted. But I did find that, so that's cool. And I liked how working as a locum here and there was pretty cool, to get your feet wet at first. But I think overall, the challenge is probably just working with family members and patients that may not understand what's going on because it is very complex. Not every patient is textbook. You learn a lot of things in medicine, but not every patient follows the books.

And when they do, it's kind of interesting. It's like, "Whoa, this is what the book tells us and this is exactly what we're seeing." But every patient is different. And I think the biggest challenge is reminding yourself, "Well, this is what I learned, but how do I apply it now and help this patient and know what to do?" I think overall in medicine, we don't always know the answers right away, but we know what to do for patients and as time goes on, that's why in the hospital medicine setting or even an outpatient, you follow the patient. That's what you see what happens when you give them the appropriate treatments.

What are some of the most promising new medical breakthroughs and treatments in pulmonology and critical care?

I would say that it's interesting going into pulmonology. There are a couple procedures that we do called a bronchoscopy and then an EBUS or endobronchial ultrasound. These are two procedures that, using a little tiny scope, you go down into the lungs, and you can either wash things out, you can take a biopsy of something, take cultures of something, send it to the lab and see what it grows—say for pneumonia. There's a new type of thing. It's been out for a while, but it's kind of new, not to every place, called navigational bronchoscopy, which is a way that you can map out if you see a tiny lung nodule. Sometimes when we do a bronchoscopy or an EBUS, we can't always get to the little nodules that are way out in the periphery of the lung because our scope is too big or doesn't go all the way out.

So, a navigational bronchoscopy allows you to get to those tiny ones based on the way it maps out where the nodule is, and then you kind of follow that with the robotic type thing, bronchoscopy. So that's pretty cool. I would say also for lung cancers, we're doing a lot of chemo immunology-type immunotherapy that targets a certain receptor or gene that's found in that tumor that we can then target that and give that medicine or that treatment for the patients in lung cancer, which is really interesting too. So yeah, those two things I think are pretty interesting right now so far.

Most definitely. And do you see a lot of patients with asthma and COPD or emphysema, and what are some of the things that you can do now to help these patients breathe better and live longer lives? Because I know having COPD today as to what it was 30 years ago, there's a lot more meds, a lot more procedures.

Right. And it's interesting you asked that, asthma, COPD, everyone thinks that that's the only thing that pulmonologists see. There are so many other things in pulmonology that we....You don't think about it when you go into it. But asthma, COPD, especially COPD, the certain treatments that help with survival is oxygen therapy, LVRS, which is lung volume reduction surgery. So, they take the areas of the big destructed bullae in the tops of the lungs, and they can surgically clip that part out so that the patient uses the rest of their lungs to exchange gas. It helps them breathe easier. Of course, lung transplant does. But the oxygen is a huge one that helps with long-term.

I think the biggest thing is that the inhalers that we use for symptom management in COPD and asthma, a lot of that doesn't always change the destruction that's already been done, but sometimes most of the time it's more for symptoms and then decreasing your exacerbations of having to go to the hospital or getting antibiotics and that kind of stuff.

Let's talk a little bit about some of the other conditions. Do you see a lot of patients with things like pulmonary hypertension, sleep apnea, and this is an old one, tuberculosis? I'm just curious if it's still around.

Pulmonary hypertension is a huge one. We see a lot of people with that. It's not always something you see in the hospital that is an acute problem, something that's severe right now, that's what they present with. It's usually because of other diseases. So, there's a lot of groups of pulmonary hypertension, like primary is the one that goes with hereditary type. Secondary, kind of, I look at the number two and it looks like you can make it look like a heart if you do the two on the other side, that's usually because of heart failure. The third goes along with different lung diseases and one of those being sleep apnea. So, there's all kinds of reasons for pulmonary hypertension. So, we do see that a lot. And you usually see it initially on an echocardiogram, picture the heart, you find it, and then we go into trying to find the reason why the person has it and what can we treat so that this pulmonary hypertension doesn't get worse

When it comes to sleep apnea, I will say, yes, that's the huge thing we see. I know also in the media it's becoming more widely known what it is and how to treat it. Of course, that's positive airway pressure, sorry. So, CPAP, continuous positive airway pressure, CPAP. There are so many different types of masks nowadays that it's not just the mask that goes over your face and mouth or nose and mouth. And there's ones that have swivels on the top. So then if you sleep on your back, sleep on your side and you're all over the place, it can still give this therapy.

And then tuberculosis—that’s good one to ask about. You do see it. It depends; it's usually from somewhere someone has traveled and then they come to the US and they might have it or they have these risk factors of being incarcerated or something like that, or immune compromised at baseline. But something we see a lot of is nontuberculous mycobacterium, which is NTM. It's just another type of bacteria that's not tuberculosis type, but you see a lot of chronic lung infections that are from NTM. So that's a huge thing that I started seeing more when I was in my fellowship, too.

I wanted to just talk briefly about smoking and lung health. Besides quitting smoking, what are some things that people can do to improve the health of their lungs in general?

The interesting thing is that exercise, like daily exercise and eating the right things is good for your heart that we know, but also good for your lungs. So, no matter what, keeping a healthy lifestyle and active lifestyle, of course not everyone is able, it's hard to do that every day, but if you commit yourself to just doing a little bit each day and then committing that as time goes on, it's always helpful.

And I would also say even just doing breathing exercises can help you use all the little parts of your lungs. It may take shallow breaths, so if you take a deeper breath—slow, deep breaths. A lot of people will probably know that if they know someone that's been in the hospital, we give people this contraption called an incentive spirometry, and you hold it with your hands and then there's a little tube on it that you kind of suck in a long, slow, deep breath. And that's what helps use every little, tiny air sac so that you don't have those aires [air sacs?] not being used with oxygen getting to them. So that's another thing.

And then obviously clean air and decreasing your exposure to things. So of course, stopping smoking, like you mentioned, not using e-cigarettes or any type of thing like that. Vaping is not good—I would say, don't replace it with from tobacco, but as well, it's hard to quit. And then I guess when you're around chemicals or dust, using a respirator or a mask is always a good idea.

Is there anything else that you'd like to add?

If people have any questions or even questions about what I do, where I'm at, or just how to get through med school and get through to getting to this point, I'm here to help.

Email Dr. Elizabeth Nielsen at bnielsen10@gmail.com

UMHS YouTube interview with Dr. Elizabeth Nielsen