D.O. or Do Not: The Osteopathic Physician's Journey for Premed & Medical Students

Episode 36: Cindy Hoffman D.O. Dermatologist

March 02, 2021 Season 1 Episode 36
D.O. or Do Not: The Osteopathic Physician's Journey for Premed & Medical Students
Episode 36: Cindy Hoffman D.O. Dermatologist
Show Notes Transcript

In today’s episode, we have Dr. Cindy Hoffman. Dr. Hoffman graduated from the New York College of Osteopathic Medicine in 1985 and completed both family medicine and dermatology residencies by 1990.

Dr. Hoffman's practice ranges from general dermatology to Mohs surgery and even cosmetic and laser treatments. She rounds out her busy schedule by acting as the dermatology residency director at St. Barnabas Hospital in the Bronx and is the course director of the dermatology department at the New York College of Osteopathic Medicine.

In episode 19, we spoke with her about how DO students can be competitive for dermatology residency positions. Today, we will learn more about the competitive field of dermatology through her own private journey. We hope you enjoy this episode.

Edited by Thomas Jasionowski

My name is Dr. Ian Storch. I'm a board-certified gastroenterologist and osteopathic physician,

and you are listening to DO or DO NOT. If you are interested in joining our team or

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you enjoy this episode.

On today's episode, we have Dr. Cindy Hoffman. Dr. Hoffman graduated from the New York College

of Osteopathic Medicine in 1985 and completed both a family practice and dermatology residency

by 1990. Dr. Hoffman's practice ranges from general dermatology to Mohs surgery and even

cosmetic and laser treatments. She round out her busy schedule by acting as a dermatology

residency director at St. Barnabas Hospital in the Bronx and is the course director of

the dermatology department at the New York College of Osteopathic Medicine.

In episode 19, we spoke with her about how DO students can be competitive for dermatology

residency positions. Today, we will learn more about the competitive field of dermatology

through her own private journey. We hope you enjoy this episode.

Dr. Hoffman, thank you again so much for taking the time out of your busy schedule to come

talk to us today.

You're welcome. Anytime.

So I guess I just wanted to start you being the program director of a residency. You must

be very busy in addition to your own practice. What does a normal day look like for you?

I do have my own practice. I have three offices. And so I wake up in the morning and depending

on the day will depend on which office I'm going to. And I go into the office and I see

patients in each of the offices and I review charts and review mail and things like that.

And then at the end of the day, I don't have my residents with me every single day. I don't

have them with me every single day. The residents split their time between the hospital and my

office. So when I'm with the residents, I'm teaching besides seeing patients on my own

as well. And when I'm not with the residents, I'm just seeing patients. And then at the end

of the day, I'm not done yet because I run my own practice. I do have emails and mail

that I have to open. So besides seeing patients, I'm also doing the business aspect of my office.

What about hospital work? Do you only go to the hospital some days?

So I do not go to the hospital. Another physician, the chairman of the department at St. Barnabas,

actually runs the clinics at the hospital. So I just run my office. The residents rotate

between my office and the hospital clinics with the other attending at the hospital.

Now, I used to go to the hospital and I used to have clinics at the hospital as well. And that

was probably about 10, 15 years ago. But the program kind of changed since then. We used to

have five residents. So I used to run clinics at the hospital and do consults with the residents.

And now we only have three residents. So my time is just strictly at the office and the other

physician is just strictly at the hospital. I understand. And do you kind of miss that

hospital work a little bit maybe? You know, what I miss is the pathology

that you see at the hospital because you see a lot of interesting cases at the hospital.

But, you know, since as you kind of get older and I wanted to expand my office,

there was no way for me to get back to the hospital because I can't really split my time

between three offices and the hospital setting. I used to also work at Coney Island Hospital

and the residents used to rotate with me there. And that was also a great experience for the

residents because again, there's a lot of pathology at the hospital, which I really enjoyed.

I do see pathology in my office, don't get me wrong, but it's just a different setting.

And so now another attending kind of runs those clinics.

Definitely, definitely. These are some underserved areas that we're talking about.

How did you get interested in all of this in the first place?

How did I get interested in medicine or how did I get interested in running a program or how did

I get interested in doing dermatology? Well, I want to talk about all of these.

Let's start with medicine, I guess. Okay. And as far as medicine, well,

I actually went to college. I was a sociology major and music minor, and I never thought that

I was going to ever go into medicine. It wasn't even on the radar. No one in my family was a

physician. And I actually went to college thinking I was going to be a kindergarten teacher.

My mother was a first grade teacher and I love art and I love art projects. And I figured

if I'm a kindergarten teacher, I can do that aspect. I like that aspect of being a kindergarten

teacher, doing art projects and things like that. And also it was close enough to being a first

grade teacher, teaching them how to read and things like that. So I really had no interest

in medicine. And then I decided after college to go for my master's in business administration.

So I do have an MBA from George Washington University. And while I was doing my MBA,

I actually worked doing EKGs at GWU hospital. And while I was doing EKGs, I was in the hospital

and I really enjoyed it. So I decided that, and at the time I did have an ex-boyfriend

who was actually going into medicine. So at that time I decided maybe I would like to go into medicine.

Wow. So it's kind of like, we had one interview where the person talked about how it was similar.

It wasn't on their radar at all. And it was like they were in a fog. And when they came out,

they could see exactly the direction that they were going in. So when you came out of that fog

and you knew that you were interested in medicine, did you know exactly what you wanted to do?

Well, it's funny that you asked that because I do remember when I was in the middle of getting my MBA,

one of my friends came down to visit and we both decided that we wanted to pursue something

different. And I said to her, really randomly, let's apply to medical school. Let's apply to

dental school. Let's apply to podiatry school. And in honesty, I really didn't know which

direction I wanted to go, but I ended up applying to medical school and getting in. So that's the

direction I went. As I said, nobody in my family was a physician. I had no idea. I was a sociology

music, you know, I went into that in college. And it was just, I guess I was kind of in a fog,

as you would say. I really just decided to go in that direction and see if I could do it.

And when you were applying to these medical schools, did you apply to both

allopathic and osteopathic schools or just one type?

I really did love the osteopathic philosophy and I did apply to mostly osteopathic schools. I did

apply to a couple of allopathic schools in New York, but my ex-boyfriend at the time was going

into medicine and did go to NICOM. So that's how I found out about NICOM. But what's really funny is

when I was at GW and I was in Washington, I had done a lot of volunteering for my legislatures,

the senators and congressmen. And I was invited to Reagan's inauguration on January 20th,

because I was so involved. And that same day was my NICOM interview. So I had to go to my NICOM

interview. Wow. Must've been a busy day, huh? I never got to go to the inauguration,

I never got to go to the inauguration because I ended up having an interview at NICOM. And of

course that was more important. Right. So I'm guessing that that person introduced you to the

idea of osteopathic school. Was that your first interaction with it? Yes, that was my first

interaction with it. And I also did love the philosophy of osteopathic medicine. So that's

why I mainly applied to osteopathic schools. I understand. And how did you get interested

in dermatology while you were in medical school? Well, while I was in medical school,

I was actually more interested in psychiatry and I did a rotation at Long Island Jewish in psych.

And I did love psychiatry. And then I started doing some dermatology rotations and I did like

that even more. My mother had psoriasis. I, like most teenagers, had acne. So I always went to a

dermatologist and I was used to bring my mother to a dermatologist. And I just happened to fall in

love with that field. Were there any ex-curriculars or any clubs, any research that you were involved

with in medical school that pushed you in that direction a little bit? Well, while I was in

medical school, I worked at the NICOM library to make some extra money because I did have loans

to take out, that I took out. And I also like being involved in different organizations. So

I got involved in the Student Osteopathic Medical Association. I was on some of the committees.

Then I became editor of the SOMA newsletter and magazine. And then I actually became national

president of SOMA. So while I was national president of SOMA, I went around to different

conferences and conventions and things like that. And I met different people and I talked

to different people. And also kind of knowing about the field of dermatology, I decided that

I don't know what really kind of pushed me in that direction. I think it was probably the rotations

and the fact that in dermatology, there's just so much variety. You do a little medicine,

you do a little surgery, and I really like that. I like that aspect of it.

Yeah, I agree. There's so many ways to branch out with dermatology, more than some people actually

believe. What about rotations? Did you get to do any rotations in dermatology and psychiatry?

How did you end up balancing what you wanted to do?

Yeah. So back then, the school was only four years old. And we really didn't have any rotations in

New York. We had very, very few. There were just a couple of hospitals that allow us to do rotations.

And most of my friends, actually, most of us, actually for all of our rotations, many of our

rotations had to leave New York. I did OBGYN in Pennsylvania. I did surgery and medicine in New

Jersey. And then I ended up doing a dermatology rotation in New Jersey. And once I did my

dermatology rotation, I really fell in love with it.

Wow. I wanted to move on to your residency. You told me that there were no dermatology

residencies back then per se. Can you tell me about what happened there?

Yeah, sure. Back then, for the osteopathic students, there was really only one residency

in the country, and that was in Michigan. And there were only a couple of spots available.

And because of that, we created, or the Organization of Dermatology, the college,

created what we call preceptor ships. Preceptor ships is when a student, now resident, rotated

with a dermatologist for three years and just worked with one dermatologist for three years.

And that's what was available during that time, just preceptor ships. So a lot of my friends

had done a preceptor ship. There were no real residency programs. Plus it was really impossible

to get into an allopathic dermatology residency, which were hospital-based. And so there were no

preceptor ships in New York. And I wanted to stay in New York. And the AOA had allowed us to develop

our own preceptor ship. So I found a doctor in New Jersey, the same doctor that I had rotated with

as a student, and I asked him if he would be my preceptor. And I created a program with that

physician to have a preceptor ship for dermatology. Wow. So it sounds like you really paved your own

way when there was no other option available. I did. I had no choice. I kind of had to. But

I also, when I created this preceptor ship, I kind of had the best of both worlds because

in the osteopathic profession, the residents were only kind of working in an office.

And in the allopathic profession in dermatology, the residents were working in a hospital.

So what I created for myself is a combination of both. I worked with this preceptor in his office,

and I also worked at Coney Island Hospital in the hospital. So I kind of got the best of both worlds.

And was it only just you in this preceptor ship? Were there any other residents that came with you

or after you? It was just me in this preceptor ship because I developed it. And it was just one

person that most of the preceptor ships were just one at the most two people. And there was only one

resident after me that went through this preceptor ship. Preceptor ships ended

right after I ended my program. The preceptor ships kind of ended in 1990. I finished my program

in 1990. And I think they ended in 91 or 92. Wow. Wow. That's amazing. So I guess for the future

dermatologist, if you had to choose between kind of a large or small institution and private or

public institution for training, how would you advise them to choose? Well, it's difficult. I

was the only resident, so it was difficult for me because when you're the only resident, you have to

really discipline yourself. You have to discipline yourself to study and seeing patients with one

other attending. And it's much easier if you're in a bigger program where you have other residents

to kind of bounce things off of and you work with multiple, multiple attendings and you have a chief

resident above you. So it's a little bit easier in that regard. But then if you're the only resident,

you get to do everything. So it's kind of which direction you feel most comfortable in. So it

sounds like you were the intern and the senior at the same time. I certainly was. I was the intern

and the senior. So that probably made for a really unique experience, I would say. Yeah, it did. And

I got to do, I really did get to do a lot. I'm not saying that it was the best way, but it was

really the only way. And I was so dedicated to becoming a dermatologist. That's what you had to

do. Do you have any stories from residency that I'm sure are amazing, but do you have any stories

that come to mind being yourself as the only resident? For me in particular, I don't have any

stories, but I will tell you that a couple of my friends being the only resident, I have a

person who did their program in the Midwest and his preceptor went on vacation. And he was left

alone to do a surgery in the office. And he had his patient lie on his stomach. He was telling me

the story. And then he had a book on the myostand and he was kind of reading how to take out a cyst

while the patient was on his stomach. I mean, I'm not bragging about this. This is not the best way

to learn, but this is the kind of things that some of the preceptees had to do while they were

training. Fortunately, my preceptor was with me at all times, so I didn't have that kind of training.

Wow. That's really cool. So how was your experience after that? Did you get a job at

a residency? It's very easy for dermatologists to get a job at a residency. And I did. As I mentioned

in my residency, I was at Coney Island Hospital and I did work for a dermatologist right near the

hospital. And then after a year, I had my daughter. She was my first. And St. Barnabas at that time

was looking to start a program because as I mentioned, preceptor ships had dwindled down

and I think they were no longer after 1992 and 1991. And so residency were starting to pop up

and St. Barnabas wanted to start a residency. And since I developed my own program as a resident,

I really wanted to start a residency program because I wanted to start a residency program

because I wanted residents to get the kind of opportunity that I didn't get such as being

with other residents. And also I did a non-funded residency preceptor ship program. And most of my

friends were non-funded. The preceptor ships back there were not funded. And so being in a hospital

based program and starting a residency program for other residents would afford them to have funding

at least. So what you're telling me is that you went through residency or your preceptor ship

unpaid for those three years. Correct. I went through my preceptor ship non-funded. The way

I made money is before I started my dermatology residency, I did a year of family medicine.

Back then family medicine was your year of internship and a year of family medicine. So

I do have, I am boarded in family medicine. And as a family medicine resident, we had to work

two nights in the emergency department in the rapid room. They called it the rapid room where

we saw just basic stuff. Saw basic trauma. Somebody sprained their finger, rashes, things

like that, colds, coughs. So when I was a resident in dermatology, I continued my work two nights a

week in the emergency department to make money so that I can live because we were non-funded.

Wow. That's amazing dedication. So how did you balance all this with your lifestyle and

how do you balance it to this day? I'm sure you're very busy being the program director.

And even when you were first starting out, you just started residency and you had a child. How

did you balance all this? I can't say it's easy. It really is difficult. There was a time and,

and besides running the residency and having kids, there was a time between 2000 and 2003,

where I started my own practice in 2000. And I was also the residency director and I had three kids

and I became president of my dermatology college, the American Osteopathic College of Dermatology.

And so during those years, it was, it was really crazy. Every day I would go to work,

I'd run the residency, and then at night I would do all my work for being involved in the organization.

But I really did love it. And I can't even believe during that time, I really didn't have too much

time for myself, but I did it because I just loved giving back to the profession. And I always like

being busy. Wow, that's amazing. And here I am thinking that I'm too busy during my fourth year

doing nothing else. Yeah. Well, yeah. I mean, medical school, you're really busy too. Trust me.

So like you said, you had a, you know, a residency in family medicine while you were doing the

preceptorship. And I know you said you did take loans for medical school. Can you tell us about,

you know, we don't have to get too personal, but how did the finances ever affect your choice?

You know, did you ever have a thought in your mind that maybe you should do something else

if it pays more because of how many loans you have? And do you have any advice for students,

you know, that are worried about the cost of education? Yes. I, you know, I did have loans,

but my parents did help me with rent and I did do a non-funded residency, but I was able to offset

that by working in the emergency department two nights a week. And I just loved dermatology. There

was no way I was going to do anything different. And I figured at some point in the future,

I was going to probably make enough money to pay back the loans, which I actually did.

Believe it or not, we ended up refinancing 10 years after I, first of all, loans were able to

be paid off within 10 years for me. I actually refinanced my house to finish paying off my loans,

but you have to realize tuition back then was 10,500 and it didn't go up much from that. So I was

able to pay them back. Wow. I'm very jealous when I hear that number. My son currently, you know,

he is a resident. He went to NYCOM and he had to take out loans. And I know that the tuition's much

higher now and he had to take out more loans, but at some point he'll be able to pay them back. I

mean, it might take you 10 years to pay them back, but you'll be able to do it. So do you think that

finances should ever play a role in deciding what specialty that someone might want to pursue?

I don't think so because in any specialty you go into, you'll eventually be able to pay back your

loans. I think that you really need to do what you love to do. And I've been in practice for 30 years

and I still love doing what I do every day. Otherwise it would be difficult getting up in

the morning and going to work. So if you love what you do, then it's not like working.

I think that's great advice. Thank you. Do you think that your MBA helped at all with that process?

I don't know. Other people tell me they think it did, but I don't know about that. I'm not really

sure. I really did go for my MBA because I was interested in business. I've always been good in

business and that's why I run my own practice and I'm not part of a group. But whether my MBA

helped out or not, it's difficult to say. It might've just been what I've always read about

or knew about. And I can't say that. I mean, I guess it helped somewhat, but I don't know how

much it helped. Do you think it helped at all for the business aspect of opening up your own clinics

at all? I think I was just always interested in that and always had a good sense of that.

So I think that's what helped more than anything, but it doesn't ever hurt to go further in your

education. I agree. Can you tell us a little bit about owning clinics? A lot of students have this

in mind and can you tell us some of the pros and cons of owning your own clinic? So I don't call it

a clinic. We call the hospital clinics. It's my own practice. I love owning my own practice because

I get to do what I want in the practice. I hire my own staff. If I decide that I want

pharmaceutical companies to come in and leave samples for my patients, they're able to do that.

A lot of the other dermatologists in the area have joined groups. I am not particularly interested

in joining a group because then you're really not your own person. I didn't go into medicine to have

an administrator tell me how to run my practice, tell me how to see patients. I like the fact that

I am able to have samples in my office and patients love the fact that I can give them samples. I know

some of my friends don't have samples in their office or their practice because it's not allowed.

So I do love it. You have to be willing to do the business part of it. You have to be willing to

deal with the staff and there's a lot more to just seeing patients. It's running a business.

I understand. That makes perfect sense. Can you tell us what made you really successful

throughout this journey? Do you have a superpower? I think that I've always been seen

whatever I got involved in. So for instance, I didn't decide that I'm going to one day be

president of the American Osteopathic College of Dermatology or be president of the New York

State Osteopathic Medical Society or be president of the NICOM Alumni Association. And I was

president of all of them. And it's not that I had this idea that one day I'm going to be president.

I just always loved being involved in the profession and I always just loved being involved.

And so I always used to go to committee meetings. I always used to go to events and I always used

to be seen at these events and people used to say, who's that person? Because I always was involved

and because of that, by the time I was already, I had already worked in all these different

committees and I was a trustee and things like that, one of the past presidents of the OCD said,

we're going to nominate you for third vice presidents and you better say yes.

And so this is what led me into that direction. Just always being seen and always being involved.

Wow. Absolutely amazing. Absolutely. So I wanted to ask about your practice a little more.

Okay. Being a DO, we go through this whole training of OMM. Is that something that you

find that you can incorporate into your practice? Yes. And I always, I do love OMM and we always

adhere to osteopathic principles. The problem with me personally is when the school was only four

years old and that's when I entered the school and we didn't have rotations in New York, as many

rotations in New York and most of the physicians that were training us were MDs. We learned OMM

in our first two years, but then to bring it out into the clinic area and learn how to actually do

OMM in the clinics was difficult because I didn't have any mentors teaching me how to do it. Now

it's a different story. There are a lot of DOs in these hospitals that are able to teach,

so it's much easier now for you to actually perform OMM on patients. But my residents,

when they want to perform OMM on a patient, I actually encourage it. I think it's wonderful.

It's great. It's just, I personally don't do it. I just adhere to the principles.

I understand. You mentioned that a lot of the people that trained you were MDs.

We asked this question to our interviewees. Do you think that your path would have been easier

or better if you were an allopath rather than an osteopath?

I actually think my path was easier and better as a DO because DOs knew each other. It was a small

group, a small community, and everywhere I went, it was just everybody knew each other. So I don't

think if I was an MD, I would have been president of my allopathic organization because when I got

involved, everybody knew who I was and they steered me into the direction of, oh, you should be

president because you're so involved. I don't think that would have happened as an MD. I really

love being a DO and I love that camaraderie that the DOs have. I think that's a great point. The

DO community is often very tight knit, I feel like. Yes, absolutely. I wanted to switch gears

and talk a little about the profession of dermatology. I remember one of our previous

interviewees told us that their dad wanted them to become a dermatologist on Park Avenue when he was

like five years old. A lot of these people view dermatology as kind of like a golden specialty

and want to do it because of the lifestyle and the prestige rather than love for the field.

People think that it's kind of a nine to five workday with great earning ability.

Do you think that this is true and what are your thoughts on people that have these thoughts rather

than love for the field? Well, most people that I know do have love for the field. For me, it's not

a nine to five job because I'm running my own practice. So yes, even though I might be seeing

patients from nine to five or nine to six, I'm still on call 24 seven for all my patients,

even though there's not a lot of call. But there are patients that do call and have problems.

I also have employees. I also run a business. So I'm always taking care of bills and running

my practice. So it's not just a nine to five job. Now, I guess if you work for a group or

a corporation, I guess you can set your own hours. That is true. But you can do that in

other fields as well. I know what you're talking about and I've heard this, but I just love the

field because I love the field, not because of anything else. I agree. And I think that's

the way it should be for every field. It should be that for every field because

if you love what you do, you won't stop doing what you love. And my son, I did not try to sway him

to do dermatology, even though it would have been nice for somebody to take over my practice,

but he wanted to do emergency medicine. He loves emergency medicine and I'm sure he'll do it for

many years. And who knows in a couple of years, if he did dermatology, he might have been bored

with it after a couple of years. Definitely, definitely. And I remember when I was talking

to him, that was one of the things I said to him. I give him a lot of respect for that because

there's definitely a lot of people out there who would have taken the easy way out. Can you tell

us a little bit about the difference in dermatologists who do primarily cosmetics and those in academics?

Yeah. Most dermatologists do both. I do as well. I do mostly general dermatology. I do have

cosmetics in my office. I do fillers. I do Botox. I have laser hair removal. I do cool sculpting.

And that is a small part of my practice, maybe about 10% to 15% of my practice. I do mostly

general derm. And most people in dermatology either do more general derm and a little cosmetics or

more cosmetics and a little general derm. There are some people that do all cosmetics and that's

their choice. They prefer that. I find it more interesting to do a combination. And I feel

that patients really, really need you to see them for their skin care and their skin care.

Their skin cancers and their acne and their rashes. And yes, they also need fillers and Botox to make

them feel good, but I really like the variety of everything. Thank you. I just have one final

question. You've given us a lot of great advice already so far, but what was the best piece of

advice that you got throughout your education anytime that you always think of and would pass

on to other students? Again, love what you do because then you'll always love what you do

and you won't stop doing what you love. That is the best advice I can give anybody. I've had

candidates who want to dermatology, really love dermatology, but it's very difficult to get in.

And I said, don't stop trying. Do everything you can. Do a year of research, work in an office for

a year. Do as much as you can to get into the field that you want to get into. I think once

again, that's the best advice anyone could get. Thank you so much for your time, Dr. Hoffman. I

know you're very busy. Okay. Thank you so much. I appreciate it. This concludes our episode of Do

or Do Not. Send all inquiries, comments, suggestions, and even let us know if there's someone you want

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them with you. This is Tianyu Shea. Thank you guys so much for listening to Do or Do Not.