Man with a plan

Want to succeed in DO, MD worlds? A sports psychiatrist shares his story

David Baron, DO, rose to prominence in the MD realm while retaining—and celebrating—his osteopathic heritage. Here’s what he did.

The son and grandson of psychiatrists, David A. Baron, DO, knew as a young boy that he would choose the same profession and became interested specifically in academic psychiatry as a teenager. He wanted a well-rounded medical education like his father, an osteopathic physician. But Dr. Baron also realized that to be a thought leader in the psychiatry world, he would need to contribute to the discipline’s knowledge base. Fulfilling that aspiration would require rigorous training in research, perhaps at a large academic medical center.

So after graduating from the Philadelphia College of Osteopathic Medicine (PCOM) in 1978 and completing a traditional rotating internship, he served an allopathic psychiatry residency through Los Angeles County and University of Southern California (USC) Medical Center in Los Angeles. As a resident, he received two major national psychiatric research awards. This was just the first step in his attaining recognition in the broader field of psychiatry, which was very MD-dominated at the time.

Besides the grounding in research, Dr. Baron’s allopathic graduate medical education exposed him to more career opportunities at a time when DOs faced discrimination and a lack of recognition. One breakthrough opportunity came early in his career: He served as the deputy clinical director of the National Institute of Mental Health (NIMH) for five years in the late ’80s and early ’90s.

Appointed in 1998 to chair the Department of Psychiatry at the Temple University School of Medicine in Philadelphia, Dr. Baron, to his knowledge, was the first DO to lead a department at an allopathic medical school. Since 2010, he has been the senior vice chair and a professor of psychiatry at the USC Keck School of Medicine, the school’s assistant dean for international health, and psychiatrist-in-chief for the USC health system.

Dr. Baron has made a name for himself in three major areas of interest: sports psychiatry, attention-deficit/hyperactivity disorder, and the integration of mental health treatment into primary care. In the following edited remarks, he describes how he developed these interests and how he created opportunities for himself in the MD world while remaining true to his osteopathic heritage.

How did you become interested in sports psychiatry, and what are some of your achievements in this realm?

My interest in sports psychiatry grew out of my love for sports. I competed in swimming in high school, college and medical school, and I played a bunch of other sports.

When I was an intern in the Philadelphia area, many of my peers were former serious athletes like myself. So for fun and the experience, we volunteered to be team physicians for the local high school football and wrestling teams. When I was a resident, I continued to work as a team physician while conducting research on drug addiction among athletes. At the time, sports psychology was an emerging field, so I had to constantly explain that sports psychiatry is a different discipline. Sports psychologists are concerned with athletic performance enhancement, while sports psychiatrists deal with athletes’ psychopathology—depression, anxiety, addiction, psychosis and so forth.

The field of sports psychiatry was tiny back then, so I was able to get noticed. I met people, lectured, wrote papers. When I was at the NIMH during the Reagan administration, I worked on drug-free workplace legislation. That led to my involvement in legislation pertaining to doping in sports. As a result, I was asked to serve as a doping control officer at a number of Olympic Games. Back then, “ ’roid rage” was making headlines.

Today, the equivalent issue would be head trauma, an area I’ve been involved in for many years. I’ve taken care of a number of Olympic boxers, some of whom had been mislabeled with psychiatric disorders they didn’t have. I observed the cumulative impact of mild, repetitive concussions. For years, the medical community had been concerned with major traumatic brain injury while smaller blows to the head went largely unnoticed.

But I did notice the little dings to the head that athletes experienced, whether they were playing football, hockey or volleyball. The players got a little stunned but they didn’t lose consciousness, and they continued to stay in the game.

In studying this issue, I’ve conducted laboratory research with rats, looking at the effect of mild repetitive dings, which can not only impair memory but also cause the expression of abnormal proteins in the brain.

When I give lectures on this topic, I present what I call the Baron Sunburn Analogy: No one gets skin cancer from one sunburn, and no one gets severe brain damage from one little ding. But the effect of multiple sunburns puts you at a much higher risk for developing skin cancer. That’s the way we should be looking at concussion. An athlete may feel better 15 minutes after getting dinged and think everything is OK. But that is not the case. Bruising your brain is not the same as bruising your ankle.

This is such a hot topic now, especially in the world of football. The NFL has made a lot of rule changes and has pumped a significant amount of money into research, as has the Obama administration. So we are starting to see a change in the culture away from the gladiator mentality of showing how tough you are and getting back in the game even if you were knocked out. Now you need a medical clearance. Return-to-play protocols must be followed. And the NFL says if you use your head to tackle, which used to be encouraged, you will get penalized.

Most of my research in this realm is described in my book Clinical Sports Psychiatry: An International Perspective. At present, I’m doing a lot of research in identifying and evaluating biomarkers for concussion in athletes.

I’ve also served the executive producer of two short films on sports psychiatry: Next Week’s Game on concussions in sports and Well Played on athletes with ADHD.

What led to your interest in ADHD?

When I was at the NIMH, PET scans were showing that the brains of children with ADHD function differently and are a little less efficient than normal ones. Kids with ADHD aren’t lazy or bad, as they were often labeled back then. At the NIMH, I got to participate in some ADHD studies led by a prominent child psychiatrist. And for a number of years, I was very active in educating primary care doctors that ADHD is a real disorder.

Through my involvement in the Olympic Games, I got to know Michael Phelps and wrote about his ADHD for the Journal of Attention Disorders.

When I first got interested in ADHD, physicians believed it was a kids’ disease. And it was thought to be way more common in boys than girls. That’s not the case, as we know now. Girls tend to be more inattentive; they daydream more. In contrast, boys tend to be more hyperactive, so they are noticed more and they disrupt classrooms. ADHD is also common in adults, though you don’t see as much of the hyperactivity.

Many people with ADHD have suffered in silence. They are every bit as smart as their classmates or colleagues, but they can’t sit down and read a book because after reading a paragraph, their mind starts drifting off. In our culture, these people are often viewed as lacking self-discipline. But they don’t choose to be the way they are any more than someone chooses to be hypertensive or diabetic. Fortunately, medications are available to help treat the core symptoms of ADHD, so patients can function at a higher level, enjoy life and be more productive.

I’ve done 40 or so international presentations on ADHD, particularly adolescent and adult ADHD. I’m pleased that I’ve been able to educate many physicians and policymakers about this disorder. ADHD frequently goes undiagnosed and untreated, and you see many adverse life events as a result: work problems, relationship issues, car crashes, drug abuse.

To become a leader in academic medicine, how did you structure your medical education?

When I was in medical school, there were very few osteopathic residencies in psychiatry. I wanted an academic, research-oriented career, so I gravitated toward allopathic residency training.

Fortunately, in my alma mater, I found a very supportive and collegial culture. The head of clinical education at PCOM was the late Archie Feinstein, DO, who later became the AOA’s 1982-83 president. He knew my career goals, and he allowed me to do most of my elective clinical rotations at institutions with strong research infrastructures.

What did you do to distinguish yourself during residency? Did you face any discrimination as a DO?

Back then, many MD psychiatry programs wouldn’t even consider a DO. You could have been Sigmund Freud himself and they weren’t going to consider you for their program. Fortunately, the University of Southern California, where I am now, was interested in taking me on as a psychiatry resident.

I may have been the first DO to go through the USC program. During residency and at other times in my career, I felt that I was representing not only myself but also the entire osteopathic medical profession. I felt a real sense of obligation to do not just OK but really well. By excelling, I knew I would open doors for other DOs.

At USC, I was the only resident to win back-to-back national research awards. In 1982, the American College of Psychiatrists named me a Laughlin fellow, which is a very prestigious and competitive award for psychiatry residents. Around the same time, the Group for the Advancement of Psychiatry (GAP), the oldest psychiatric think tank in the U.S., awarded me with an honorific fellowship for psychiatric residents. Recipients would get to go GAP meetings and interact with the psychiatry profession’s thought leaders. It was a great way to kick-start your career.

But these opportunities didn’t come automatically. I had to calculate where I wanted to go in my career and stretch myself. At the time, I was involved in research on integrating psychiatry into primary care from an evidence-based perspective. So I had found a niche, and I worked extremely hard. Part of my drive came from feeling that I was representing all DOs.

Today, DO graduates face much less discrimination. But osteopathic physicians are still underrepresented in leadership positions outside of the profession. By having clear goals and competing for and winning notable honors and awards in the MD world, osteopathic graduates can earn recognition that will lead to incredible career opportunities. Such achievements will also lead to greater recognition for all DOs.

But osteopathic physicians must act on those opportunities and have a road map for where they want to go.

How have you shown your pride in being a DO?

During residency, I would sometimes be confused for an MD, and I would always dispel that misconception. When I won the GAP fellowship, I received a letter addressed to David A. Baron, MD. So I wrote back to the organization and said, “This isn’t me. With all due respect, I’m a DO.” Several years later, I became the first DO to be president of GAP.

Many DOs who’ve gone through allopathic GME programs don’t stay involved in the AOA or their osteopathic specialty society. But I’ve always loved the osteopathic profession. When I was fairly young, my dad would take me to meetings of what is now the American College of Osteopathic Neurologists and Psychiatrists (ACONP), and I got to know its leaders.

What’s more, I’ve always appreciated the broad-based training DOs receive and the emphasis on whole-person care. Osteopathic education is excellent preparation for psychiatry. So when I finished training at USC, I paid the AOA money out of my own pocket to have my training program examined and recognized as AOA-approved. And I sat for both the osteopathic and allopathic board-certification examinations in psychiatry.

Being dually board-certified has allowed me to pursue leadership roles in both the DO and MD professions. I served as president of the ACONP, and I became a fellow of the American Psychiatric Association and a board member of the American College of Psychiatrists. In addition, I’ve held academic appointments at both osteopathic and allopathic medical schools.

Although DOs are more respected now in the MD community, even today I sometimes hear disparaging comments about osteopathic training from MD psychiatrists. They’ll quickly say, “Of course, this doesn’t apply to you, David.” I use such moments to explain why I’m proud to be a DO.

I’d like to see other DOs who are successful in the MD world championing the benefits of osteopathic medicine and osteopathic medical education. DO schools produce some of the best clinicians in practice today.

In addition, I’ve always insisted that any identification badge or lab coat I wear have “DO” after my name. I’d like all osteopathic physicians to use “DO” after their names and not hide their identity behind the “Dr.” title.

What is the main way being a DO has helped you excel as a psychiatrist?

My osteopathic education prepared me to be a well-rounded physician—someone who looks at the whole body, not just diseased organs. Throughout my career, I’ve been involved in integrating mental health services into primary care practices. My osteopathic background has allowed me to see the big picture and incorporate it into my professional life. One of the most important things for me now is to be able to pay it forward to the next generation and mentor young osteopathic physicians who may be interested in research-oriented academic careers.

3 comments

  1. CONGRATULATIONS TO DAVID BARON, DO. !!

    I HAD THE PRIVILEGE AND HONOR TO BE A RESIDENT UNDER THE GUIDANCE

    OF NED BARON,DO. AS NOTED , DR. NED BARON WAS DAVID’S FATHER.

    DR. NED BARON WAS ALSO GROUND BREAKING IN HIS OWN RIGHT, TREATING

    DRUG ADDICTS WHEN THEY WERE SPURNED BY NEARLY EVERYONE! THIS

    LED ME INTO THE SUBSTANCE ABUSE FIELD WHERE I HAVE BEEN THE FIRST

    DIRECTOR OF PSYCHIATRY AT VALLEY FORGE MEDICAL CENTER AND

    HOSPITAL AND THE FIRST DO DEPARTMENT HEAD.. … ALL THANKS TO DR.

    NED BARON… BERNIE SOBEL

  2. Thank you for this wonderful article. I had the opportunity to meet Dr. Baron during a medical student fellowship at NIH. His insights about working in allopathic medicine as a DO were most helpful. He is a role model for our DO students, residents and academic faculty.

  3. I’ve known David for many years and served as a doping control officer for USADA with him. It was at the US National Rowing Championships at Lake Carnegie, Princeton, NJ. I have also heard David speak multiple times. His insight and personal research have always made me proud he is a DO.

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