Approach it with a good attitude, defined as:
Dr. David Elkowitz comes from a line of physicians, with his father being one of the founders of NYITCOM. He trained as a pathologist and found early on in his career that he had a passion and skill for teaching students.
For years, he was a professor at NYITCOM and was ultimately recruited by the progressive Zucker School of Medicine at Hofstra University. Zucker is an MD institution where he now holds the title of Associate Dean. Dr. Elkowitz wins teaching awards almost yearly and has inspired and mentored thousands of students over the years.
Approach it with a good attitude, defined as:
Dr. David Elkowitz comes from a line of physicians, with his father being one of the founders of NYITCOM. He trained as a pathologist and found early on in his career that he had a passion and skill for teaching students.
For years, he was a professor at NYITCOM and was ultimately recruited by the progressive Zucker School of Medicine at Hofstra University. Zucker is an MD institution where he now holds the title of Associate Dean. Dr. Elkowitz wins teaching awards almost yearly and has inspired and mentored thousands of students over the years.
Hi, my name is Tianyu She.I'm a third year medical student at the New York Institute
of Technology, and you're listening to Do or Do Not.
Welcome to our fifth episode.
Today we have a very special episode where I will interview Dr. David Alkowitz.
Dr. David Alkowitz comes from a line of physicians, with his father being one of the founders
of NYITCOM.
He trained as a pathologist and found early on in his career that he had a passion and
skill for teaching students.
For years he was a professor at NYITCOM and was ultimately recruited by the progressive
Zucker School of Medicine at Hofstra University.
Zucker is an MD institution where he now holds the title of associate dean.
Dr. Alkowitz wins teaching awards almost yearly and has inspired and mentored thousands of
students over the years.
I felt it a privilege to interview him and found it one of the most inspiring to date.
We will speak to Dr. Alkowitz about his journey from an anatomy teaching assistant at NYITCOM
to teaching consultant to MD and DO schools.
We will ask him for insight into what the change of step one to pass fail means and
what he thinks its effect will be on osteopathic medical students trying to get into a residency.
He will also comment on how he feels medical education will be affected by the COVID-19
pandemic.
We hope that you enjoyed this episode.
When and how did you become interested in medicine and decided that you wanted to become
a physician?
It was a pretty serpentinous route.
As a kid, even going through college, I went to a military college so I certainly didn't
have medicine on my radar.
That being said, I come from a family of doctors, three generations of doctors and I think a
total of seven or eight relatives in medicine.
So it was always probably in the back of my mind.
And as I progressed through life in my early 20s, I started to investigate, well, maybe
this is something that I should pursue.
Started to retake some science classes that I didn't take in my college years and with
a little maturity, a little perspective, it became very apparent to me that I actually
enjoy the science when it's something that's forced down your throat, but you actually
do it for yourself.
Started to enjoy it and my dad was an osteopath, gerontologist for 45 years.
He actually headed up the Allopathic Gerontology Society.
So he graduated from Chicago.
So growing up, I never actually kind of made the connection between MD or DO because my
dad as a DO had a thriving practice, had an appointment at Downstate with all these societies.
So it never really occurred to me the difference, it's the same thing as going to your dentist.
Do you know if your dentist is a DDS or a DMD?
I'm not really sure anybody actually cares or certainly I didn't.
So when it came time for me to apply to medical school, applying to a DO school or MD school,
my way of thinking was essentially the same.
I didn't see much of a difference.
The end result would be becoming a physician and interestingly enough, it wasn't until
I became or it wasn't until I entered the DO school is when it became apparent that
there was such a seismic difference in the perception, but it took me to become a student
in the DO world to realize this perception because as a person outside, I didn't see
it.
And then the rest is history.
So that was kind of my journey into medicine.
Can you speak a little about your father and your family's influence on you becoming a
physician?
Yeah, I would say that there's a chronic and an acute answer to that.
The chronic answer would be that coming from a family of physicians, whether it's my dad,
my grandfather, my uncles, my cousins, medicine was the trade language that was always spoken
about at gatherings, going into a gathering, hearing Dr. Ilkowitz and eight people are
answering.
This was a kind of a chronic thing that I grew up with.
I think that my dad, who was a DO and very, very successful, very, very burgeoning practice
really had a great influence on kind of the way I looked at medicine.
You know, I originally went thinking about going to medicine as a family doctor, working
on one of my ranches in primary care.
My grandfather, on the other hand, an M.D. and had a flourishing practice as a radiologist
and was also involved in academic medicine as well and had a tremendous amount of influence
on me as well.
So I kind of feel blessed in a way that I had influence from an M.D. and DO.
I had influence from a clinician and a diagnostician and I've also had influences, you know, chronically.
It's just going through life and seeing how my family interacted with society and their
colleagues.
Kind of just ingrained from you, like from an early point on.
Gotcha.
Exactly.
So what made you ultimately choose NYIT Com?
Well, that's actually pretty easy.
As many of you know, applied to many schools, got interviews at many schools, got accepted.
And there was just a question at that time was called NYCOM.
And my family's from the North Shore of Long Island.
I had a lot of support.
I knew the campus well.
It was only seven miles away from my house.
I passed by it constantly.
So when making the final decision, it was kind of a no-brainer for me that it was so
close to home.
I had all the support that I needed at home.
I lived at home at the time.
The fact that I knew the campus so well, I used to drive past it going out east, took
away a lot of the angst that a lot of students coming from other places have trying to figure
out the campus, trying to figure out the community, trying to figure out all the other stuff,
non-academic.
I didn't have to worry about that.
So when I came on board the very first day, I hit the academics running, I didn't have
to kind of get myself acquainted and looking for housing and looking where to go for lunch
or whatever that was.
I kind of hit the ground running.
So there was kind of a no-brainer for me.
I understand.
And also, and then the other thing is my father had a lot to do with at least the thought
behind NICOM coming to fruition.
I think NICOM started in 1978, 77.
And my father and a lot of the DOs of the 70s had a lot of say into putting NICOM on
the map.
So certainly there was a family background as well.
What was your experience after you got into the school?
I know you mentioned that you didn't realize there was even a discrepancy until you became
a student.
How was your overall experience at the school and what are these things that made you realize
that there was a discrepancy?
Well, I think that what ended up happening is that students have friends at other institutions.
And you start comparing your curriculum versus theirs, what you're doing, what they're doing.
You start understanding what's actually out there in the community as far as opportunities
for MDs, opportunities for DOs, the separate residencies at the time, the separate fellowships
at the time.
It became very apparent to me that there was definitely a separation.
It certainly was a lot more integrated 25, 30 years ago than even it was back in the
60s when my father went to medical school.
But that being said, it was palpable as far as that type of separation.
But as far as my education, there was a very traditional type of education, very, very
lecture based, you know, second year systems, first year general, you know, concepts.
The class at that time was probably about 130 students per class, which I understand
is probably small compared to what NYIT COM has today.
Yeah, it's like 400 to 500.
Yeah, yeah.
So it was definitely a much different field than it probably was today.
But it was a, listen, it was good.
And you know, I enjoyed my stay time there.
I learned a lot and I credit NYIT COM for giving me the opportunity to become a physician
and to make the most out of my career as I can.
That's great.
You know, we'd like to reaffirm for a lot of the people listening, you know, the students,
the pre-meds that there's very little difference in the quality of education between these
MD and DO schools.
Did you do any extracurriculars, anything like research or any special people that you
met in the school that, you know, influenced you a lot?
Well, it was a very traditional setting.
So there was no, of course there were student affairs, but this stuff took really a backseat
to essentially delivery of content.
I was an anatomy fellow.
I spent an extra year at NYIT COM, you know, essentially TA-ing in the anatomy lab, in
the pathology labs, in the histology labs.
I was the first anatomy, just a little trivia, the first anatomy fellow NYIT COM ever had.
Now I understand they morphed into a whole master's level, you know, fellowship program.
That's a wonderful thing.
So I spent an extra year teaching and, you know, that year, you know, really influenced
me as far as the trajectory of where I wanted to go for my career.
I would say that year, that fellowship year was probably the single most significant thing
to happen to me at NYIT COM.
And would you say that year helped you decide that you wanted to pursue a career in pathology?
Yeah, yeah, yeah, yeah.
Oh, no, no doubt about it.
You have to understand back then, when we were talking about 30 years ago, people went
to DO schools not to become pathologists.
In fact, I would say people go to medical school not to become pathologists.
You know, pathology, maybe two, 3% of the class into going into path, but certainly
in the DO world, especially back then, I mean, it was very primary care centric, very primary
care oriented.
And so for me, to actually pursue pathology out of NYIT COM, back, you know, thinking
about in 96 and 97 was, you know, really, really big deal.
You know, I say 30 years ago really meant about 25 years, you know, when I first started
medical school.
So I think that that year was a very significant year as a turning point in the way that I
wanted to approach and practice medicine.
And what about that year exactly made you want to do pathology?
Well, so I kind of backed my way into pathology.
That year was a very heavy teaching year.
I taught in every anatomy lab.
I taught in every histology lab, in every pathology lab.
I was very, very influential with the student body as far as not only teaching and facilitating
learning from the learners from those students, but also learned assessment, learned mentorship.
So there was a lot of stuff that I learned academically in that type of environment.
I excelled at it.
I loved it.
And then I started to think to myself, well, if I really wanted to make this a career,
how can I become marketable?
You know, if I went into a clinical based type of profession, at least the way I was
thinking, yeah, I'd be able to practice internal medicine or pediatrics, family medicine, but
would I be marketable to be an instructor in the first two year curriculum at a medical
school?
And so then I started to think, well, what residency would be most applicable for me
to be able to come back and teach in the first two years?
And pathology was kind of a no-brainer, you know, as a pathologist, I was qualified to
teach, you know, histology, pathology, anatomy, some phys, you know, and also as a physician
understanding how to correlate that with the clinical skills.
So it was kind of a no-brainer and I'm happy I went with my instinct on that.
What about after that?
What was your application process to residency like and how did you ultimately decide on
your program?
Well, so application process back then was very different than the application process
now.
Back then the application process was really predicated on you showcasing yourself during
these showcase interviews.
So you know, in your fourth year, you essentially have a series of electives.
Back then we were encouraged to, you know, take an elective at a place that you were
thinking or that you wanted to apply to as far as a residency.
So we did that and I did that, you know, I wanted to stay on the North Shore of Long
Island, so I applied to and did electives at Stony Brook and Winthrop and North Shore
and LIJ, some city hospitals, you know, that type of thing, just to make sure that I stayed,
had the best shot at showcasing myself and coming on board.
The other part of this is that I applied to MD residencies.
Back then it was very highly encouraged that we do an osteopathic internship and then,
you know, pursue whatever you wanted to do.
I went right into an MD residency, which, you know, one, there wasn't many DO pathology
residencies to begin with.
So you know, it's not that that was a dig at the DO profession, it just wasn't a lot
for me to choose from, certainly in this area.
But there was a very big advantage because I was able to sign out of the match.
I didn't have to wait for match day.
Back in those days that if the program after that month liked what you brought, you know,
brought to the table and you liked that program, they literally offered you a contract.
They offered me a contract that very last day of my rotation in October of my last year.
I signed it in October of that last year.
I knew exactly where it was going to be the following year.
Wow.
That's crazy to think about, you know, the comparison between now and then.
That's very, very, very strict, very, you know, institutionalized, very, like very regimented.
Wow.
Well, I think it's, I think it's going to eventually go back that way, you know, with
the changes of the USMLE, where it's going to be pastel, it's going to eventually work
its way back to that whole idea of showcasing and really showing your stuff on the clinical
round and making those personal connections rather than the way it has been essentially
the USMLE score is the gateway into certain residencies.
I mean, I think that one of the advantages from getting away from that is that you can
really put an emphasis again on the rotations and on your personal connections that you
develop.
I mean, since we're on the topic, I was going to talk a little about that at the end, but
since we're on the topic right now, you don't think that it will just change from a heavy
emphasis on step one to step two CK instead?
Well, I think short-term it probably will.
I think short-term it probably will, but I think that the trend is just my opinion.
I don't have any insight in it.
If I did, I couldn't disclose that to you.
I would say that the trend that I feel is that these steps are going to be competency
based steps that essentially end up in a licensure.
I think that step two eventually will go to a pastel, but that's just pure speculation.
I don't know that for a fact at all.
Yeah.
I just want to talk a little bit more about that at the end, if that's okay with you.
I wanted to ask, how would one choose between a small or large public or private institution
to go to residency?
Well, so every residency is very, very different, right?
In other words, you have academic-based centers, you have community-based centers, you have
academic centers that have a tremendous clinical type of population, you have academic centers
that put a lot of emphasis on research and academics, didactics.
You have community hospitals that don't have a tremendous didactic presence, but have a
very robust hands-on experience.
The other point that obviously that goes into play is where you eventually want to move
and settle.
Quite often you make a lot of your professional contacts during your residency, so if you
wanted to settle in an area, it would behoove you to maybe do a residency in that area.
You don't have to, obviously, people travel, but that was part of my thinking at least.
So how I picked the residency is, first, what was the area that I wanted to eventually settle
in?
If I wanted to settle in the North Shore of Long Island, which I am right now, I'm in
beautiful Smithtown, New York, right outside here, you can see the Nessequah River.
Beautiful area.
Yeah.
So I think that played a big role, but the other thing is that I wanted to make sure
that in my personal experience, that I get enough clinical, meaning enough specimens
that I'm actually grossing and reading out to at least have a lot of anecdotes in my
arsenal, if you will.
So when I am working with students, I can actually bring these examples into the classroom.
So that was one thought.
I also wanted a residency that did emphasize teaching.
North Shore at the time, now it's Northwell, emphasized teaching.
The very first week that I was there was running medical mortality rounds.
Every week there was two or three teaching sessions with residents from different departments,
which I became in charge of.
I enjoyed it and it was a really nice fit.
So I think the answer to your question is you kind of have to work backwards.
If for instance, you want to be a clinician that's seeing a tremendous amount of patients,
then I think that you have to go to a residency that's going to afford the opportunity for
you to see a lot of patients and get the most experience.
I think that if you are a person that wants to go into some type of research or academics,
then you might want to look at a name.
You might want to look at the different types of grants and research going on at that institution.
And I think that if you really are hard core wanting to settle in for instance, Southern
California, then it would probably behoove you to look for a residency in the area ultimately
that you want to settle in.
You don't have to, but I think it's going to be advantageous because again, if you're
going to spend four or five years in a residency in an area with a fellowship, you're going
to develop a tremendous amount of contacts.
And that's how I'd go about approaching that.
Thank you.
Yeah, that's really useful.
What was your residency experience like?
Do you have any highlights during this that you would like to share with us?
Yeah, no, I think that it was a wonderful experience.
They really gave the residents that they can earn the attendance trust, a lot of autonomy
in engrossing specimens and signing specimens out.
I was blessed to be working with a guy named Stephen Heidou who is considered the Babe
Ruth, if you will, of soft tissue pathology.
He was a chair at Memorial Sloan Kettering and they worked his way over to Northwell
at the end of his career.
I spent a lot of time learning from him, had a lot of funny stories about as far as having
very big ovarian cysts, I would always very early on I'd go in with a shirt and tie and
everybody would be laughing when this cyst came down and I was oblivious, I'd cut open
the cyst and the whole thing spill all over me.
Last time I ever wore a shirt and tie, I was in scrubs.
I had surgeons yell at me as a resident and then when I became an attending over there,
I had the exact same surgeon yell at me for a different reason and we became very, very
close, all of us, surgeons and the pathologists.
It was a very, very nice experience.
Listen, I spent four years as a resident and a year fellowship in Surge Path over there
as well and they also gave me the opportunity to go back to NICOM at that time and teach.
So at that time, NICOM had a pathologist who I would fill in as a resident and to make
a very long story short, I think that the students appreciated the type of approach
that I had in the classroom and after my fellowship, I was offered full-time position as an assistant
professor over at NICOM and that really started my academic career.
Did you experience any differences being an osteopathic physician in an allopathic residency?
Not at all.
I think that that's very easy for... I'm going to be very, very careful the way I phrase
this.
I think that if you're looking for an excuse that somehow your career is not going right
or somehow you're not advancing fast enough in an academic setting, it's very easy for
a DO to say, that's not happening because I'm a DO.
I am sitting here as a great example of a person that took proactive measures in an
allopathic institution to succeed in that institution for them to retain me as a fellow,
for them to retain me as an attending physician at the end of the training, for me then to
go to NICOM and then when Northwell opened up their medical school 10 years ago for them
to basically give me a call and say, hey, listen, would you head up our case-based curriculum
and at least help us develop that and then finally become dean or an associate dean at
an allopathic institution.
I think that I'm an excellent example of your hard work and your credibility, your knowledge,
your tenacity will ultimately dictate your career and if you wanted to use the excuse
that I'm a DO because you're not going far enough, I'd probably say, stop that, look
to what you're doing or not doing because that's probably where the real answer lives.
I just have never, I've been practicing now for 22 years.
I have never once, not once, ever experienced any type of holding back because I was a DO
and then just to kind of put some more meat on that bone, over the last five years I had
offers from the University of Texas, Dell School of Medicine, from Texas Christian University,
from Dartmouth, other institutions that have gave me firm offers to be one of their leaders
on a dean's level at those allopathic institutions.
So I have just never seen any evidence of some type of approach where I got held back
because I was a DO of anything.
I don't think people ever gave a second thought.
I really love that answer and I hope the pre-meds that are listening to this or people who are
yet to go into college and they hear this, that they really give a hard second thought
about going to these osteopathic schools that it's really, you can do whatever you want
to do.
Well, listen, I mean, you guys are very lucky today.
I mean, if I'm speaking to a pre-med right now and I counsel a lot of pre-meds looking
to go to DO or MD schools, back in my day, the question really was, should I go to a
Caribbean school or should I go to a DO school?
And back in that day, the answer wasn't as easy as it is today because back in those
days the residencies were separated, the fellowships were separated, and so essentially the path
that you wanted to take was really predicated on, in large part, the medical school you
ended up with in that degree.
So today, on the other hand, the answer is completely opposite.
It's a no-brainer.
I mean, you know, the fact that the MDs and DOs have unified their residencies, have unified
their fellowships, and essentially GME is completely unified, makes going to an MD or
DO school, the choice is an easy one, and in fact, many people apply to MD and DO schools
simultaneously now.
I mean, it's the fact that they unified the GME, the fact that you see leaders, DO leaders
in allopathic medical schools are an example of one, you know, kind of makes that choice
now, not a big one.
Do you think that trade-off is worth it?
Because in the past, osteopaths could apply to allopathic residencies, but MDs couldn't
apply to osteopathic residencies, but now our DO residencies aren't just limited to
us anymore.
Listen, my personal opinion is that unification is good.
I understand that there would be some DOs that actually disagree with me on that for
various reasons, but from my point of view, speaking as a physician, speaking as an academic
physician, speaking as a person that works in an allopathic institution, in an allopathic
medical school, I welcome that unification, but what that really means, though, is that
it's going to be up to the DO medical schools to make sure that they're keeping pace with
the type of curriculum, with the type of education, with the type of competencies, you know, along
with the MD schools, because now their students are directly competing with these MD students.
And I think that that just rises the excellence across the DO landscape.
So from my point of view, I think it's a wonderful thing that it's unified, and it really puts
again the control back into the student's hands.
You know, if a student wants to work hard, if a student wants to be tenacious, if a student
wants to have a good attitude, which means working diligently with a smile, if the student
does all of that and the student knows knowledge, right, has knowledge, then the student's going
to be able to basically write their own ticket.
But any student that wants to take a shortcut and then use that whole DO label, it's just
never going to work out for them.
I like that answer a lot.
Thank you very much, Dr. Alkowitz.
Moving back to you for a little bit, did you take any loans?
And do you have any advice for the students that will and have loans?
Yeah, so no, I did not take any loans.
Partly, I was blessed with a family that could support me.
The other part of it is that, you know, being a anatomical or the scholarship program, the
last three years were paid for anyway, so I didn't have to take loans.
I lived at home, so no doubt, truly blessed.
Now, how would I advise?
I guess I have to kind of ask you a question.
Am I advising a student that's already in medical school with these loans or, in other
words, how do you want me to address this question?
Both ways, if you'd like, like in both instances for a pre-med and someone who's in medical
school, I guess.
Yeah, okay.
I think that, you know, I'll take first.
I think that, you know, if you look at medical school, the vast majority of medical schools
is an opportunity to become a physician and you really hold all the cards as far as what
you're going to get out of any medical school.
I would go to the option that gives you the best deal, MD or DO, period.
If you're comparing one MD school with a DO school and all things being equal as far as
reputation or whatever it is, I would just go to the most inexpensive option with the
understanding that it's your hard work, it's your tenacity, it's your good attitude, it's
your knowledge that ultimately will decide if you're successful or not.
So I would, so that's how I would answer an undergrad.
As far as somebody already in school, you know, that's a little bit harder question,
right?
Because now you're already in the middle of it.
You're accruing loans and that's really going to dictate what is going to happen moving
forward as far as residency and fellowship and how you're going to practice medicine.
I think that that's going to be a very, very individual thing.
I will say this though, that success in any field that you go into is predicated on your
enjoyment.
Let me repeat that.
Success is predicated on your enjoyment with the content of that field.
That's maybe the most important thing I can say to a current student now.
So let me give you an example.
If for instance you thought that a cardiovascular surgeon, as working as a cardiovascular surgeon,
you're going to make a tremendous amount of money or orthopedic surgeon, you're going
to make a tremendous amount of money and that is the reason why you went into that field
and that's the only reason why you went into that field.
You're not going to be as successful as a family doctor that went into that field and
they loved what they did.
Patients sense if a doctor went into a field for the right reasons.
Patients sense if a doctor truly loves what they do or they're doing it for another reason
and the person that's doing it for another reason will never be as successful as they
want to be.
So happiness, falling in love with the content of medicine, whatever it is, in my case it
was pathology, falling in love with pathology, ultimately made me extraordinarily successful
in my career.
One, my colleagues sense that I loved it.
Two, my patients did.
Most importantly, my students did.
So with that begets institutions going well, we want to have you here.
We want to have that type of atmosphere.
We want to have your expertise at this school, at that school and in my particular case it
worked out wonderfully that because I love what I do so much, I never was hard pressed
with being successful on that front, on the financial front, but it's because I fell in
love with the content of teaching and of pathology.
So I would advise you that I know that residency is a big thing on your minds and getting reimbursed
and making sure you pay down those loans, but the easiest way I think to pay down those
loans is to fall in love with a subject matter that's going to make you the most successful.
I think that's very important for a lot of students to hear because I personally know
plenty of students who are doing something or applying to something that they don't necessarily
like just because they're afraid that they can't pay back their loans.
I think that's very important.
So I understand that you said after residency you were offered a job at NYT, but how was
your experience looking for a job other than that?
How did, did you choose location, practice, hospital and what were the pros and cons of
your choice?
Well, again, I worked backwards, right?
If I knew I wanted to go into education, I kind of made sure that whatever I did set
me up for the next step.
In other words, I just didn't go through my career like a leaf blowing in the wind.
I had complete control over what I did.
So in other words, as a pathology resident, as a pathology fellow, I taught substituted
lectures at NYCOM during those times.
I've already set myself up to transition from the hospital to the classroom during the time
of my residency.
I set myself up with the knowledge of pathology during my time of residency.
So when I made that transition into teaching at NYCOM, it was a very seamless type of process
because I've been doing it anyway for four or five years backing up as a resident and
fellow.
So for me, it was seamless.
It was not one of these things where I had to really sit there and think to myself, do
I want to do this?
For me, getting a job was never really an issue because I think that I always loved
what I did.
And to this very day, when I go on talks nationally, the medical education talks, I have never
had any problems getting offered positions or having opportunities in front of me.
And when I say that, I wear my DO degree with a lot of pride.
In other words, if you were to come to my office at Zucker School of Medicine, right
outside my office is David Elkowitz, DO.
On my lab coat, when I teach Zucker School of Medicine students, it says David Elkowitz,
DO, Associate Dean, such and such.
So I never hid behind that.
And I'm very, very proud of my experience, my degree, and the transition from residency
to getting a position or a job academically, it was never an issue.
But I would say that you have to proactively think about the next steps.
So as a resident, what I would tell you is don't only look at the task at hand, but try
to look at where you want to be in a year from now.
How do I get there?
Take proactive steps to get there and not be so reactive.
If you had to choose another specialty and go back in time, can't do pathology, which
one would you think that you would end up doing?
Well, I laugh because this actually, I tell a lot of my medical school students this story.
It's about attitude.
The story is rooted in having a good attitude.
So back then, and I'm sure it's the same now, in my third year, I just was terrified and
did not look forward to my OB-GYN clerkship, just had no, they wanted no part of it.
Back in those days, I was at a public hospital, extraordinarily busy.
We had 36 hour shifts, a day off and then come back for another 36 hours.
It was just absolutely brutal.
And that was for six weeks.
And I remember thinking to myself, you know, I'm not going to be able to change this reality.
But I can control my attitude.
And I remember stepping foot in the doors of the hospital the very first day.
And I said to myself, either this is going to be the worst experience of my life or I
can make this the best experience of my life.
I chose to make it my best experience of my life.
I threw myself in it.
I proactively had a good attitude and threw myself into the rotation.
I went up the elevators.
I wound up on the floor.
I said, I want to be in the very first delivery.
The nurse in charge was going to room 12.
You'll meet the midwife in there.
And from that day on, I was just, I didn't transition into it.
I didn't take a tour around the hospital.
I didn't look for an excuse to get off the floor.
I didn't hide in the library.
I threw myself into that rotation.
It turns out that through this whole idea of having a good attitude and throwing myself
into this rotation, it dawned upon me that I really was good at it and I enjoyed OB.
And I really thought very long and hard about maybe going into OB.
So the very next year, I did a sub internship in OB at the same place and they offered me
an actual residency.
And at the time I turned it down and I'm happy I did because I really wanted to go into academics
for the reasons I talked to you in pathology.
But it's a very good example of how what I thought was going to be horrible turned out
to be one of the greatest experience of my life just because of a change in attitude.
And to answer your question directly, if I was a pathologist, I'd probably be an obstetrician.
So then with that being said, do you think that the success in your medical career is
secondary more to intelligence and hard work or to luck?
Persistence, persistence, persistence, persistence, coupled with a good attitude, period.
It's as simple as that.
It had nothing to do with luck.
There's no question about it that God played a big role personally and professionally in
my life.
But that being said, so I don't consider it luck, I consider it maybe God's work.
But that being said, you kind of have to meet God halfway, at least in my particular case.
And if you're going to wait around waiting for a good break to happen, it's never going
to get there.
If my career tells you anything, I'm a plotter.
In other words, I kind of plan a year or two and ahead every step of the way.
I mean, my career is riddled with these examples of something that I did today, translated
something else a year ago, a year from now, and something else from a year from now translates
to something else.
My career is riddled with that.
So no, it had nothing to do with luck.
It had everything to do with persistence, good attitude, knowledge, and making a plan
and sticking with it.
Really inspirational doctor, you make me want to go open a book right now.
Well, you should, because listen, great doctors have to fall in love with medicine.
Great doctors have to fall in love with the content of medicine.
So you have to fall in love with the content of what you're going to practice, and you
have to fall in love with the practice of medicine.
And if you don't fall in love with those two things, you're not going to be as successful
as you want to be.
You have to allow yourself to fall in love with it.
Is there any other advice besides what you said already that you would like to give to
medical students or pre-meds, you know, anyone who wants to do medicine for a living?
Well, I would say that when you're thinking about not studying something as hard as or
deep as you should, what I always advise my students over at Zucker is just pretend that
you have your future patients sitting on your shoulder, that they saw you essentially learning
dilated cardiomyopathy through a USMLE review book, versus learning about dilated cardiomyopathy
from Robbins, they're going to make certain judgments about you.
So the reality is that I think that, you know, you have a responsibility to learn as much
outside of what you think the instructor is going to test you on.
You have a responsibility to your future patient to learn as much about that material as possible.
Moving on to a few different questions.
I understand that you're the Dean of Hofstra Medical School.
Do you find it interesting or even ironic that you're a DO Dean of an MD school?
Not at all.
Back way before your time, I directed the problem-based learning curriculum at NYIT
Com, the DPC, I was a director of that back in 2007-ish, somewhere around there, 2006,
somewhere around there.
But before that, my approach to medical education was, all right, you're going to sit there,
I'm going to lecture to you, and you're going to remember everything that I said.
I had a mentor at NYCOM, he passed away, but his name was Ron Portanova, and he brought
in problem-based learning from Ohio.
He was Case Western trained, PhD, and he was one of the associate deans at Ohio back in
the early 2000s, and he brought problem-based learning over to NYCOM.
He suggested, it was a very funny story, and I'll tell you that in a second, but through
a series of events, I started to facilitate the DPC, became good at it, bought into it,
and the next thing I know, I started to direct the curriculum over there, and did that for
about four years.
Back in 2009, or I'm sorry, in 2007-2008, Hofstra and Northwell at that time were having
discussions on opening up their own medical school.
In 2009-2010, I found out that the school that they were going to open had a case-based
or DPC-like curriculum there, and the next thing I know, they brought me on to help them
develop their case-based curriculum.
I developed it with others, and then through a series of hard work, I not only directed
the case-based curriculum over there, what we call PEARLS, you call DPC, we call PEARLS,
Patient-Centered Exploration and Active Reasoning, Learning and Synthesis.
That's the acronym for our case-based curriculum.
We started to really, really excel and attain, in a very short time, national notoriety.
We had over 75 schools, either we went to or they visited us, looking at how we actually
are doing things over at Hofstra or the Zucker School of Medicine.
So at about five or six years, I, throughout this time, went to maybe three or four invited
talks a year around the country talking about curricular reform, positioning from lecture-based
to more student-centered curriculum, and I would be invited to speak to schools that
are opening, such as University of Texas Dell six years ago, Texas Christian University
just this last summer, some osteopathic schools, UIW down in San Antonio, and became, started
to become recognized nationally.
I was offered a position with Hofstra, matched about five or six years ago, and I became
an associate dean.
So I think it was very, very organic.
I don't think anybody ever gave it any second thought that I was an MD or a DO.
I think that my Dr. Smith and Pat and Ellie, the people that I answered to, just saw that
I was gaining a national reputation.
They saw value in what I was doing at the school, and they wanted to retain me.
And I'm blessed to be here and really give them a 100% effort in that, and their students
most importantly.
I can personally say the value of DPC is unrivaled, especially in your preclinical years where
you've been studying from a book, you know, from professors, and you haven't had that
clinical experience yet.
And it's a really good resource to give us experience before we go see real patients.
Well, that's one part of it.
But the other part is academically learning how to learn.
You know, I can sit and lecture to you.
So let me just give you this very funny anecdote of, you know, how I transitioned from pathology
to an associate dean of an academic, you know, case-based, this type of expertise in case-based
learning.
There was a transition there, and it all started with an aha moment.
You know, I always used to think that you can't learn pathology without me lecturing
to you, letting you know what I think is important, and then regurgitating that back onto an exam.
So I think that that's the way I kind of thought that medical students learned is I lecture
to you, you regurgitate back to me, very traditional way.
It turned out that, you know, the very first class, you know, that I took over for, when
I inherited them, I gave a very, very beautiful floor show.
The students loved what I was doing.
You know, I was using all the same materials as my predecessor.
I had probably about 230 out of 300 students show up for my sessions, where maybe 15 students
showed up for my predecessor's session.
So you know, everything was working great.
It came time for the class that actually took complex at that time, and the class that I
inherited actually did worse on the pathology part of the boards than my predecessor, who
they never showed up for.
It was a very aha moment.
So my mentor, you know, sat me down and asked me the question, why do you think this happened?
And I couldn't understand why.
You know, if you guys showed up, if you guys, if I use the same readings, the same questions,
the same everything, and you guys showed up for every session, then I don't know why you
did worse.
I mean, you guys didn't show up for anything, you know, for my predecessor, and not as much
for my predecessor, but yet you did better with them.
And I'm just curious, do you know why that happened?
Oh, I'm not sure.
Well, what ended up happening was, I'll so radically go through this with you.
I'll give you a little taste of what I put my Zucker students through.
So you know, if I said to you that learning happens at home, learning does not happen
in the classroom, then all the students that didn't show up for my predecessor had to learn
all the pathology on their own.
Dare I say they had to do the heavy lifting on their own.
The students that showed up for me thought they knew everything about pathology because
they were reinforced that in the classroom and on their exams, that they didn't study
for pathology as hard for their boards as my predecessors who had to do it because they
never showed up for.
You know, it was an aha moment in my career.
It was an aha moment that you as a student don't need me to learn material.
You need me to be an application to give you value added to your pathology, to give you
critical thinking, to ask you questions, but you don't need me to regurgitate Robbins back
to you.
And it was an aha moment and that's where my career really flourished.
It blossomed into a, you know, eventually an expert in student centered curriculum.
Yeah.
And that explains perfectly why I might understand something in class when learning it, but then
when I go home, it's like I never learned it at all.
So earlier we talked about how the USMLE is becoming pass fail.
How do you think that this affects osteopathic students?
So back then the boards were looked at as essentially vehicles to become licensed.
That was it.
So back in 96, whether you took the USMLEs or whether you took Comlex, you needed a vehicle
to become licensed.
The only thing North Shore really required out of us is to hold a medical license by
the time that you were a second year resident.
That was it.
So when I went for my interviews and when I went from my showcase rotations, the only
question I was asked is, did you pass step one?
That was it.
Did you pass step one?
Are you planning to take step two in time?
Are you going to be licensed on time?
That was the only thing they were concerned about.
Because if back in those days, if you were licensed, you wouldn't be able to become or
stick with a residency in your second and third year.
So whether you took the Comlex or whether you took USMLE, it made no difference because
the license is exactly the same.
The medical license for the state of New York and all the states are exactly the same.
It's licensed to practice medicine and surgery in the state of New York.
So no, but what I would say is that I think this is my personal opinion.
I think it's a wonderful thing that they got away from the miracle score.
I think it helps MDs, NDOs, listen, I mean, the top 5% are going to have no problems no
matter what.
But for the vast majority of students, I think it really puts the emphasis not only in your
knowledge, but it also puts an emphasis on your integrity, on your work ethic.
It puts on your attitude.
You have full control over how you want to showcase yourself.
The other thing it does is you're going to have to critically think about, hey, what
type of student am I?
What type of application am I going to have?
Am I really going to showcase at Mass General or do I need to make sure that I start showcasing
at places that I have a legitimate shot of being competitive for?
I'm speaking very bluntly, very, very frankly, but it's really going to put the emphasis
back on the student to really think about what their strengths, what their weaknesses
are, where they want to practice medicine, what type of medicine they want to practice,
what type of institution, what the culture of that institution is, what your culture
is, do they match?
All these other things are going to be much more important rather than just a strict numerical
score because to be perfectly frank with you, somebody with a 260 USMLE score and somebody
with a 245 USMLE score, I have no idea what the difference is.
I just don't.
It's the exact same type of student.
In fact, I'll even go into it further.
I'm not really sure whether it's between an average score and a USMLE is a 230, let's
say.
I'm not really sure what the difference is between a 230 and a 260, right?
Because that really doesn't talk about all the other intangibles that are going to make
you successful.
So me personally, I think it's a wonderful thing.
I think it's going to liberate in some ways students, but most importantly, it's going
to liberate medical education because medical education will stop degenerating into essentially
Kaplan type programs just to get their students to do well on boards and medical education
is going to start thinking about what is really thinking about novel creative ways of having
their students be exposed to patients earlier on, maybe research, we're going to rethink
education.
It's my opinion.
I don't know this for a fact, but I think it's a wonderful thing that we're getting
away from a score.
So the last question I have today is regarding the COVID-19 situation.
I understand things are still changing from a day to day basis, but what advice do you
have for the medical students, especially the 2021 and 22 class for the uncertainty
they have in the future with regards to things like rotation cancellations, board testing
cancellations, things like that?
Yeah.
You know, there are certain things that we can control and there's certain things that
we can't control.
And there's no sense of spending one extra second in something that you can't control.
If you waste one bit of effort of worrying of energy in meditating over something that
you can't control, then it's time wasted from something that you can control.
So that is a very important concept that I need to get across to you.
You can't control if a testing center is going to be open or not.
You can't control what the policy of a medical school is going to be, whether you're going
to be able to rotate or not, or what type of rotations you're going to be on, or if
you are able to rotate what you're going to be able to do.
A lot of that stuff is out of your control.
In some ways, it's quite liberating.
If it's not in your control, it's not in your control.
And the other point is that it's not only affecting osteopathic students, it's affecting
every medical student.
So you're in the same boat.
In other words, our students over at Zucker are wondering the same exact thing you're
worrying.
When are they going to take their boards?
What is showcasing going to look like?
What are their rounds going to look like?
What is match going to look like for next year?
How is that going to get done?
So you're all in the same boat.
You're all equal because all the circumstances that you guys are worried about are completely
out of your control.
So I wouldn't give it a second more of thinking about it or worrying about it.
That's the first piece of advice.
The second piece of advice that I would give is I would meditate on what you can control.
At the end of the day, it's about falling in love with the content.
It's about learning medicine.
So if you have this time outside of rotations, you should be spending it on, you know what?
I know maybe I gave dilated cardiomyopathy a little bit of short shrift in the first
two years of medical school.
You know what?
I really need to learn this.
Or, you know what?
Maybe I thought I understood nephrotic versus nephrotic syndrome and glomerular nephropathies,
but do I really understand it?
I think that the advice that I would give you guys now is to really take time to formally
assess yourself in an honest way.
What do you know?
What don't you know?
How can I get better academically?
How can I get better physically?
How can I have better relationships?
Everything that is in your control, I would try to do it with excellence.
That would be my second piece of advice.
Thank you so much, Dr. Elkowitz.
Is there anything else you would like to say?
You know, I just wanted to wish all the EO and MD students, I'm sure that you have a
mix of students listening to this and certainly all the undergraduate students that are thinking
about pursuing a career in medicine.
This is a great time to become a physician.
I think there's no better profession in the world, MD or EO.
I think that you're very, very lucky to be able to apply to these institutions.
And just remember, everything is in your control.
And I think that if you approach something with a really good attitude, defined as working
with diligence and a smile, and trying to understand that the patient is always looking
to see what you're learning as far as content, I think if you keep that in mind, you're going
to have wonderful careers.
And I envy you a little bit.
I'd love to start over.
It's a wonderful time in medicine.
And I just wish all of you guys a tremendous amount of good luck.
This concludes our fifth episode of Do or Do Not.
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This is Tianyu Shei, OMS3.
Thank you guys so much for listening to Do or Do Not.