Q&A: 2014 DO grads talk specialties, policy and work-life balance

When Chesley B. (Sully) Sullenberger III, the pilot who famously pulled off an emergency plane landing on New York’s Hudson River in 2009, addressed this year’s graduates at Nova Southeastern University (NSU) in Fort Lauderdale, Fla., he championed perseverance and perspective.

“No matter how dire your situation may be, know that further action is almost always possible. At the end of our lives, we may simply ask ourselves a question, ‘Did I make a difference?’ My wish for each of you is that your answer will be ‘yes,’ ” he said.

For Alberto Panero, DO, who graduated from the NSU College of Osteopathic Medicine in 2009 and was a passenger on the Hudson River flight, the answer is already yes. Dr. Panero, who surprised Sullenberger at the ceremony to thank him for saving his life, is now a physical medicine and rehabilitation specialist in Sacramento, Calif., where he helps patients recover from injuries.

Across the country, nearly 4,970 osteopathic medical students from 29 osteopathic medical schools became DOs this year, according to preliminary data from the American Association of Colleges of Osteopathic Medicine. Many new osteopathic medical school graduates have already changed the lives of patients as well. Kabeer K. Shah, DO, who just graduated from the Rocky Vista University College of Osteopathic Medicine (RVUCOM) in Parker, Colo., worked with a patient with a form of treatment-refractory systemic mastocytosis during medical school. He helped the patient finally find a drug that worked for her.

“I’m really interested in personalized therapy,” says Dr. Shah, who just started a pathology residency at the Mayo Clinic in Rochester, Minn.

The DO recently spoke with Dr. Shah and four other freshly minted DOs also poised to make a difference, including a Pakistani physician who attended medical school for the second time and one half of the first African-American parent-child duo to attend the University of North Texas Health Science Center Texas College of Osteopathic Medicine in Fort Worth (UNTHSC/TCOM). The new DOs shared their insights on choosing a residency, their thoughts on the current state of medicine and their advice for students. Here’s what they had to say.

Soham U. Dave, DO

How did you choose your specialty and program?

My first rotation last year was in wilderness medicine. I worked at the National Boy Scouts Jamboree near Beckley, W.Va. Forty thousand boy scouts from around the country and around the world were BMX bike-riding, mountain biking, camping outside and hiking up to 15 miles a day. My preceptor on that rotation was trained in internal medicine and pediatrics. I saw how comfortable he was working with patients of all ages.

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Trainees in internal medicine and pediatrics get the opportunity to do inpatient medicine and inpatient pediatrics, and they work with high-acuity patients. Access to these experiences drew me to the specialty more than anything else.

My program offers a diverse set of experiences through different hospitals. I’m going to get Veterans Affairs hospital experience, community medical center experience and private hospital experience. On the pediatrics side, I’ll be working in a large pediatrics research hospital. I was looking for a residency that would offer me this diverse training because I want to help out different communities in the future.

You did a clinical rotation in India during your third year. What did you learn there?

I spent a month in India. The first two weeks, I was in a very rural area in western India in the state of Gujarat. The town was called Mangrol. It’s largely centered on banana plantations and other agriculture. Much of the labor is migrant labor. My preceptor opened a health clinic there in 1985. He is the only physician, and all of the care in the clinic is free.

While I was there, I really focused on what patients’ work and home environments were like and how they affected their health. I did field visits. I picked bananas alongside the folks who visited our clinic, and I went into their homes. By homes I mean tents, because they are migrant workers. They were traveling from the next state over, Madhya Pradesh, and spending the week on a banana plantation.

I learned that, as a physician, in addition to knowing a patient’s pharmacology, physiology and anatomy, you should also understand how societal and economic factors and your patient’s background affect his or her health.

The second half of my trip, I worked with a physician in the largest slum in Ahmedabad, another city in Gujarat. Here, I further grasped the importance of understanding not just the complaint, but the background behind the complaint. For instance, if a patient has a cough, you have to ask not only how long he or she has been coughing but also about the home environment. “Do you have a natural gas stove, or do you use charcoal-based products? What smoke in your home could be contributing to your cough?” And I found that this skill was very applicable when I came back to my rural rotations in West Virginia.

What patient encounter from the rotation most sticks out to you?

In medical school, we learn about snake bites, but it’s very rare for a U.S. physician to ever work with a patient who has one. Snake bites are more common, and much more severe, in India. King cobras roam in the banana plantations around our clinic, and the farmers who work the land don’t immediately think to get medical treatment when they get bit. They usually go to the temple and pray. So every day around 1 p.m., my preceptor would ride either his bicycle or his Vespa 10 miles to the temple with his cooler of antivenom and make sure there were no snake bite victims there.

Near the end of my stay, we went to the temple as usual, and a man there had been bitten by a snake about four hours earlier and was praying. My preceptor said, “Let’s finish your prayers, then get you to the medical center.” And the man very willingly accepted treatment. But had my preceptor not gone those 10 miles to the temple, the patient would likely have died from his injury. I strive to have that kind of devotion to my patient population someday.

What are your thoughts about the state of medicine in 2014?

At this point five years ago, I was interning in Congress for Representative Frank Kratovil of Maryland. I was on Capitol Hill when the Affordable Care Act passed. It’s been interesting to follow the law from its passing to its current state. I remain excited about the future and the profession. Some physicians gripe about the change to electronic health records, but I’m still excited about them. I’ve worked in a system that had EHRs and a system that didn’t. In my experience, EHRs benefit patients and physicians.

The changes in the Affordable Care Act are going to be difficult to implement. But in the long term, I think health care will improve and we’ll see better patient outcomes.

Jessica I. Edwards, DO

You and your dad, D.G. Edwards, DO, are the first African-American parent and child to attend TCOM. What is the significance of that to you?

Our story is a good example for young people who may be interested in medicine. There’s so much negative news that comes out about the African-American community and the Latino community. It’s good to highlight positive news.

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My dad was the only African-American on campus in his day. Another student transferred to TCOM from another school while he was there, but he was mostly out on rotations. Recently, some African-American groups on campus hosted a diversity pipeline event where we honored previous minority graduates of the different schools. My dad came to the event, and when he saw how many African-American and Latino students there were on campus, he was almost in tears. He said, “Wow, I’m glad I hung in there.” It was a really riveting moment for him and for me.

How was your experience as an African-American student?

My experience was great, and my dad told me he had a great time at TCOM as well. Academically, you get everything you could ask for. Out of 203 students in my class, I was one of seven African-Americans. We were very close. And outside of our circle, my group of friends was very diverse. I had Jewish friends, Hispanic friends and white friends. Our school wasn’t cliquish at all. Nobody was disrespectful.

But at times, some of our classmates had trouble understanding certain cultural differences. I was talking to one classmate once about diet and she said, “If the food is unhealthy, why would people eat that?” And I had to explain that, on the poorer side of town, you don’t see grocery stores where people can buy fresh fruit and vegetables. And if you did, they probably couldn’t afford to buy them.

What are your thoughts about the state of medicine in 2014?

I’m glad to see hospitals and clinics are starting to do quality assessments to see how patients feel about their experience. And it’s great that more people have insurance. Fewer people are going to be sitting in the emergency room just to get antibiotics for their child’s cold or flu. When more people have insurance, physicians are going to have to work harder, but I’m prepared to do that. Is there still work to do? Yes, especially in cost reduction, but we’re headed in a positive direction.

What advice would you give to medical students?

Have a life. Medicine is your career. It’s what you do, it’s not who you are. I’ve seen a lot of people neglect their family and their friends for medical school. I made sure that my family saw me at least once every couple weeks. And I still hung out with my best friends.

Brittany McClure, DO

How did you choose your specialty and program?

I wanted to do pediatrics, but I didn’t match into a pediatrics residency. Only two people in my class did. To still be able to work with kids, family medicine was the next best option for me. My program in East Liverpool is relatively new—I believe this is its second year—so I’ll have the opportunity to tailor my residency based on my interests. I plan to do elective rotations with pediatric-related specialties.

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What are your plans after residency?

I’d like to do a women’s health fellowship.

What was it like to be in the inaugural class of medical students at William Carey?

It was an honor, but there were difficult times as well. We didn’t have other students who came before us to talk to. There was no one to tell us, “This is what you should expect from this class or this professor.” We had to figure things out on our own. And it was the same case with the match process. But it was a great honor to be part of the first class and to be the pioneer group.

Did you have a chance to help shape the curriculum?

We did. My classmates and I were able to give input on the structure of the classes. We would suggest teachers cover topics in a certain order to help classes flow better in the future.

For instance, in our pharmacology class, we learned drugs based on the class they were in. We had two tests that covered different drugs that were in the same class, and we suggested combining them onto one test because that would have made it easier for us to learn them.

What are your thoughts about the state of medicine in 2014?

Once my classmates and I started rotating with physicians, we would ask them what they thought about the Affordable Care Act. I talked to physicians who were for and against the law. I found it interesting that physicians’ opinions didn’t necessarily align with their political party.

Personally, I saw the hassles of implementing electronic health records on my rotations. Nurses were trying to complete orders that physicians were putting into the system, but they couldn’t because they needed an override from another department that had nothing to do with the department they were working in. Or a nurse would need a physician to approve something, but he would be in another room working with a patient at that time. EHRs seemed to slow everything down.

Kabeer K. Shah, DO

How did you choose pathology, and how did you end up at the Mayo Clinic?

Going into medical school, I had a feeling that I’d be a surgeon. I liked the instant gratification and the technology. My first year, I did a lot of shadowing with a surgical group near our school. I did about 100 hours of shadowing, and I loved every minute of it. But as the hours passed, I found myself following specimens back to pathology. I wanted to know the diagnosis so I could know what the next step was and what the treatment was.

I landed a post-sophomore fellowship in pathology at the University of Kentucky. I was still focused on surgery at this point. I thought the fellowship would be a great segue into surgery. But by the end of the year, my eyes were opened to the idea of pursuing pathology.

As I went into my clinical rotations, I would compare each one to pathology. I would do a pros and cons table. Along the way, someone told me to consider what I was good at and what I enjoyed. For me, pathology was the winner.

The Mayo Clinic name is very well reputed, but I didn’t know much about it. I did learn that my grandfather brought his brother from India all the way to Rochester, Minn., to find a diagnosis when he had a rare form of cancer. I heard about the care they received. The Mayo Clinic uses a patient-centered model, which I was looking for in the institution I was going to work for.

Initially, I didn’t think I would have a chance there. I thought maybe my board scores weren’t good enough, or I wouldn’t have strong enough letters of recommendation, or I didn’t do enough research in my first two years. As fourth year rolled around it became clear that I did have a chance. I ranked it No. 1. Now, here I am.

How will your residency be unique?

In addition to the focus on patients, the Mayo Clinic is also very focused on education. Residents receive didactic directive teaching. That’s one-on-one teaching with consultants, who are the equivalent to attendings, and with the techs, who supervise the clinical laboratory. We will get a very hands-on approach to each rotation as we go through.

My residency is going to be in anatomic and clinical pathology. It’s a great fit for me because I’ll still have some patient interaction and I will also have the opportunity to work with the technology aspect of clinical pathology. Clinical pathology is all automation these days. There are massive platforms that take a blood sample, run it through a variety of analyzers, and give you output data based on the analysis you request.

You have done quite a bit of research as a medical student. What studies have you participated in that you’re most proud of?

I had the opportunity to work with a cutaneous oncology group at the University of Colorado. A patient there had a rare case of systemic mastocytosis. She had gone through a variety of cutaneous therapies, the ones that are more superficial, as well as systemic therapies and even chemotherapies as her mastocytosis progressed. Unfortunately, she was getting no relief from her symptoms and the disease was advancing. We opted to give her a personalized therapy by giving her a bone marrow biopsy, culturing those cells, and then treating those cells with a variety of available and soon-to-be available drugs. In our experimentation, we found a great drug that was a great fit for her mastocytosis. We brought our results back to the patient, and she’s now been disease-free for some time. I would love to have the opportunity to make a direct impact on a patient again.

What did you learn in medical school besides how to be a doctor?

Networking is key. We often forget that we are not only in medical school to learn, but also to make the best opportunity for ourselves. Often, that takes some networking. Every time you meet a physician, take his or her name and number.

Syed A. Gillani, DO

Dr. Gillani was a physician in Pakistan when a rare bone tumor brought him to the U.S. for treatment. Afterward, he enrolled in the Émigré Physician Program at the New York Institute of Technology College of Osteopathic Medicine (NYITCOM) in Old Westbury.

You’ve braved medical school not once, but twice, in two countries. How was your experience the second time around?

The basic principles of medicine are the same around the world. But at NYITCOM, my experience was different in that I had more freedom. I was able to make more of my own choices. Doing so helped me become a more confident physician.

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The faculty at NYITCOM really embraced me and encouraged me. I’ve never felt that kind of energy anywhere else.

What did you enjoy most about medical school? What are some memorable moments you can share?

Working with underserved kids made me realize how effective how I could be. I felt the same when I worked with the student government association.

At our fourth-year orientation, our dean, Wolfgang G. Gilliar, DO, said to the entire class, “You’re at the point in your life where you can go wherever you want to go. But you need to go where you are needed.”

His words made me see life differently. Now, I would rather go into an area where I am needed instead of going where I want to go.

You came to the U.S. for treatment for a rare bone tumor. How did your illness impact the way you practice medicine?

After experiencing my illness and treatment, I know the meaning of compassion. I’m more aware of the importance of relating to people. Now, I don’t hesitate to ask patients, “How did you get here?” Or I’ll sit with them and shed a tear, because it brings healing and it brings connection. Now I think more about how I can positively impact my patients’ lives. I learned from my physician that a patient is not just a person with a disease. A patient is a human being. There’s a whole lot going on in the background.

What advice would you give to medical students?

Remember that practicing medicine is a privilege, not a right. Know that patients put enormous trust in their physicians. Don’t take anything for granted. Hold on to your humanity, and remember your priorities. If your priority in medicine is making money, then you will make money but you will have no satisfaction.