Episode 42: Gerard Baltazar D.O. Critical Care Surgeon

In today’s episode, we have the privilege of speaking with Dr. Gerard Baltazar, with whom I will be working in the future at my residency. Dr. Baltazar is a trauma and intensive care surgeon at NYU Langone Health. He obtained his undergraduate degree in biology and fine arts from Georgetown University and his D.O. degree from Touro University in 2007.

Dr. Baltazar completed his general surgical residency at Wyckoff Heights Medical Center in Brooklyn, NY, and finished a fellowship in trauma and surgical critical care at Rutgers University Hospital in Newark, NJ. He has received several regional, state, and national awards for scientific research, writing, and community service. His research interests include traumatic brain injury, international medicine, and osteopathic manipulative treatment for surgical patients. He has volunteered for surgical missions on three continents and was the recipient of the 2015 Oriens Award from the Eastern Association for the Surgery of Trauma. Before joining NYU Long Island School of Medicine, Dr. Baltazar was Director of Surgical Critical Care at a safety-net hospital in the Bronx.

Transcript

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

have suggestions or comments, please contact us at doordonotpodcast.com. Share our link

with your friends and like us on Apple Podcasts, Facebook, Twitter, and Instagram. We hope

you enjoy this episode. On today's episode, we have the privilege

of speaking with Dr. Gerard Baltazar, who I will be working with in the future at my

residency. Dr. Baltazar is a trauma and intensive care surgeon at NYU Langone Health. Dr. Baltazar

obtained his undergraduate degree in biology and fine arts from Georgetown University and

his DO degree from Terle University in 2007. He completed his general surgical residency

at Wyckoff Heights Medical Center in Brooklyn, New York, and finished a fellowship in trauma

and surgical critical care at Rutgers University Hospital in Newark, New Jersey. He has received

several regional, state, and national awards for scientific research, writing, and community

service. His research interests include traumatic brain injury, international medicine, and

osteopathic manipulative treatment for surgical patients. He has volunteered for surgical

missions on three continents and was the recipient of the 2015 Oriens Award from the East End

Association for the Surgery of Trauma. Before joining NYU Long Island School of Medicine,

Dr. Baltazar was the director of surgical critical care at a safety net hospital in

the Bronx. We hope you enjoyed this episode. Gerard, thank you so much for being with us

tonight. Thank you. This is really a pleasure. I've been looking forward to this. We're

over 40 episodes at this point, and I think the exciting thing for the team is that we're

having awesome DOs like yourself listen to us and reach out and talk to us about being

on the show. Our whole team is so excited that you reached out to us. We're really happy

to have you on. I'm honored, and it's going to be a pleasure, I'm sure. So Gerard, your

a general surgeon, is that correct? Trauma and critical care is my subspecialty. You're

at NYU Long Island, is that right? That's correct. So for our listeners, tell us a little

bit about what a trauma surgeon is and does, and then a little bit about NYU Long Island.

A trauma surgeon specializes in surgical critical care as the fellowship, and if you have a

particular interest in doing more trauma, you can do a critical care fellowship where

you are involved in a lot of injured patient care. So my particular interest is in injured

patients and the intensive care, but the overall picture of what they're calling an acute care

surgeon is today involves managing the emergency general surgery that comes through the ER,

the trauma surgery that comes through the trauma bay, and the intensive care unit on

a rotating basis. So Gerard, for me, I haven't done any of this stuff in a long time. So

we talk about trauma. Are we mostly talking about motor vehicle accidents or gunshot wounds

or mechanical injuries? What type of things would you take care of? It very much depends

on the trauma center that you're participating in. There are trauma centers that see a lot

more violent trauma and others that see mostly blunt trauma, and by violent trauma, I'm pointing

towards the penetrating type of trauma. In my career, I've done both. At the moment,

Long Island is a, NYU Long Island tends to be more of a blunt trauma center, although

we do get our share of penetrating trauma and violent trauma. Okay, that sounds very

stressful. It is, it is. You know, there are three specialties that tend to have the highest

rates of burnout. There's emergency medicine, there's general surgery, and then there is

intensive care. And at my specialty has, we choose to do all three. So indeed it is one

of the most stressful specialties you can be part of. Yeah, I can absolutely imagine

why. I mean, there's not a lot to think about why you would get burnt out doing all that.

That's crazy. We are really excited that one of our producers, Tian Yu, actually just matched

for medicine at NYU Long Island and he could not be more thrilled. I think they were really

lucky to have him and he's really lucky to be there. Can you just tell us a little bit

about the hospital? The hospital is actually a really interesting place. It has this history

of being a community hospital with a lot of high quality care delivered to the patients.

With NYU coming in and bringing its us, its abilities and resources, it's the quality

of the care I think has gone up and it's become much more world-class in the type of care

you can provide and the diversity of specialties that they can provide as well. The, in terms

of the trauma center, the trauma center has grown tremendously in the two years that I've

been there because the NYU team has brought in myself and others who have kind of a broader

experience than I think that when it was NYU Winthrop, they had as a trauma center. So

we're really expanding our reach as trauma surgeons, acute care surgeons, and the intensive

care as well has gotten more advanced. Gerard, part of the reason, and again, we're going

to come full circle and talk more about you and your journey and how you got here, but

part of the reason why we're so excited to have you on the podcast is your contributions

and thoughts on osteopathic manipulative therapy, specifically as an osteopathic surgeon. Now

it's interesting, you know, obviously we've had some people on the podcast before that

specialize in osteopathic manipulative therapy and a lot of primary care docs incorporated

into their practice. It's always interesting for us to speak to different specialties where

you would think that maybe there wouldn't be a role for osteopathic therapy and then

we find out that there is. And even when I was looking you up on the internet and reading

up your bio, I found an course that you were giving at the American College of Osteopathic

Surgeons called Evidence-Based OMT for Surgical Patients. So I was hoping that we could just

start really at the back end. And again, I know this is not the main part of what you

do, but talk to us about osteopathic manipulative therapy and how you incorporate that and how

a surgeon would incorporate that into their practice.

Well, I don't want to go too far back into my history just yet, but it really does start

from the very beginning of my education and my career. I have always felt akin to multiple

different types of approaches to everything. And when I first discovered osteopathic medicine,

it clicked. I remember picking up that really thick book of medical schools, which, you

know, back in the day, that's what we had to find out what medical schools were. It

doesn't exist. But in the back of that book, there's a thinner section that had these osteopathic

schools. And once I finally got there, after flipping through all these schools and saying,

not really, not really, I suddenly something dawned on me. This made sense. It was a combination

of the traditional Western way of doing medicine and this odd, fantastic, holistic thing. And

I chose to go to osteopathic medical school because I wanted to make sure that I kept

that kind of combination of abilities and thoughts and principles alive within me. And

so when I went forward to surgery, it was not like I'm doing osteopathic manipulation

and I'm doing surgery on the other, there are two different things. I aimed to make

sure I could do them both at the same time and find the best way to do that. So as, as

you kind of put it, maybe this isn't the thing I do the most, but it's something I do on

the regular. So if there's ever a situation that I find myself in where I think that osteopathic

manipulation would be useful for my surgical patients, my trauma patients in the intensive

care unit, I do it. It's, it's, I think of it as an extra tool and an extra way of approaching

a clinical care. And I'm constantly applying it as often as I can and find it appropriate.

George, can you give us some examples of places in your practice where you feel that osteopathic

manipulation really makes a difference or adds to conventional therapy?

Pain control would be the, one of the most easy ones to understand. I think the literature

also supports that doing manipulation is evidence-based for pain management. I find that especially

in the trauma world, that there's a lot of somatic dysfunctions that contribute to patient's

pain, especially after they've, some force has been applied to their body or they've

undergone an operation and all the trauma that comes along with having an operation.

The one great story that kind of illustrates how this tool becomes useful is I was making

rounds on my trauma, acute care surgery service, and I walked into a patient's room and there

was an elderly lady who had broken her hip and she was writhing in pain. Her family was

at the bedside distressed. Apparently this had been going on for the last 10 minutes

and they were concerned that she was in so much pain. I asked the nurse, can you bring

some pain meds? And she said, oh, it's got to come up from the pharmacy. So I went over

to her bedside. It was clear that she was having a spasm in the area of her fracture.

I got on my knees, picked up her leg, did some balanced ligamentous tension, a little

bit of myofascial release, and her spasm stopped. And she started to drift off to sleep saying,

thank you, thank you, thank you so much. And then after she fell asleep, the nurse comes

in the room and says, oh, the pain meds are here. So in that instant, there was an opportunity

to do something with OMT that without that ability, I would have just had to sit there

and wait for medicine to arrive.

That's an awesome story. I mean, I think that's just amazing. And it's something that you

had in your toolbox that a physician that didn't have that training obviously would

not have been able to give to their patient.

I find in trauma, in particular, there are a couple of realms where osmotic repulation

might play a role that is very distinct. One of them is in brain injury, and the other

is in rib somatic dysfunction. I put at NYU Langone, Long Island, I am the chest wall

trauma guy. I'm the one that has done most rib fixations and chest wall reconstructions

for people who have had bad injuries to their ribs or motor vehicle crashes and the like.

And what I find is treating patients osteopathically after a rib injury or chest wall injury or

after a video assisted thoracoscopic surgery or thoracotomy, that the patients actually

do better. They have better inspiratory abilities. They can take in more vital capacity. They

have less pain and they're more mobile as well. And actually this is born out in at

least one randomized controlled trial out of Italy where they looked at patients who

had sternotomies performed and randomized them after the sternotomy to either osteopathic

manipulation or not. And the osteopathic manipulation group had both significantly decreased pain

and not both, but three things, significantly decreased pain, significantly improved inspiratory

volume and significantly reduced hospital length of stay. So I am excited to pursue

research in that vein for chest wall injuries and to see if we can recreate some of those

same findings with doing manipulation in the trauma setting. And then when it comes to

brain injury, concussion and the like, we're finding that there's more opportunities to

treat patients where they're specifically for what the palpatory findings for their

cranium, their cervical spine, their upper extremities are that are contributing to the

post-concussive syndrome or the post-TBI syndrome. There are very few specific treatments that

we can give for just someone who has post-concussion syndrome, for example, and they're quite

scattershot. And the general rule of thumb is just wait and see what happens. That's

what you tell a patient when they've got the photophobia and it's been a week since they're

two weeks, three weeks, a month since their concussion. Oh, I get this. I'll get headaches.

Well, just wait and see. It should get better. Or maybe some painkillers or maybe even center

depressants. You can throw at a situation, but it's, it's a challenging thing. And when

I've treated patients who have these, these symptoms, they, they, they always have some

actus function, of course, and you treat them and they do do better. Uh, we've been, I've

had the opportunity to publish just some case studies on these patients and hopefully we're

going to build up into doing a larger study. We did, we do have a paper that's yet unpublished,

but we have the data already collected on a retrospective study looking at moderate

and severe traumatic brain injury patients who survived to discharge. And among that

patient, the cohort that had received osteopathic manipulation during their acute care of their

traumatic brain injuries, those patients had a significantly less likely chance of ending

up in a subacute rehab and a nearly significant trend towards going home. In other words,

that the patients who had received osteopathic manipulation and, and survived traumatic moderate

or severe traumatic brain injury were more likely to meet the metrics that made them

safe to go home. So there is an opportunity here to examine something that I think that

examined a realm of medicine, the cranium, uh, and the central nervous system that the

osteopaths have a very unique way of looking at and helping with.

Now, Gerard, you're obviously a well trained surgeon and you're at a high ranking quote

unquote allopathic institution. When you bring these things up to your MD colleagues and

the administration of NYU, do you find that they're supportive and interested in these

things or are they looking at you like, what the heck are you talking about?

I've given grand rounds on this subject. I, I've voiced interest in research and the

support has been fantastic. There's been a, the, from the chairman down, they're interested.

They want to see more work product. And recently my, my team has given me a clinic to do osteopathic

manipulative treatment for post-injury and perioperative patients, which we're now in

our, going into our fourth month and it's always full.

Do you have MD residents that want to learn these techniques? Are they interested as well?

Some, they're, they're surgical residents, so they're quite busy. I think that the more

experience that I have and more publications that come out, the more interest that the

residents will have once they start seeing the, uh, once they start seeing what happens

and start to understand it more, uh, because they, I don't, I don't fault them for not

being interested off the bat. It's, even the DVO residents, uh, they haven't had experience

with someone doing this kind of work within the, the world of surgery. It's just, it's

not very often that they see that. So I understand that it's, there's, they have other interests

and this is an interest that I'm sure is somewhere in the back of some people's minds, but there's

so much else that they have to do first. And I think once more, it becomes more commonplace

at this institution and maybe even more, um, reputable at this institution that they'll

take more notice. Uh, I do know that in my group, in my, my, among my partners, uh, because

I've treated some of them and they've seen me treat patients that they have no idea why

the patients got better, but they did. They have nicknamed me magic fingers, magic fingers

balls. It's cool. I like it. Sure. Let me, let me ask you a little, uh, personal question

that I wasn't able to answer. So the DO or do not podcast crew was invited in August

to be on another podcast called the short code podcast. And we ended up having a lot

of discussion about osteopathic manipulation. And one of the questions that they asked us

was about osteopathic manipulation and post-operative ileus. Do you have any insight into that?

Yeah. Um, I find that there is some, uh, measurable improvement in patients in terms of their

overall function. And scientifically speaking, there is some evidence to support bowel function,

including the paper I published on it back in residency with my team from my general

surgery residency that where we found a statistically improved, uh, return to a bowel function and

improved left to stay of bowel resection patients. Yeah. I didn't have that at my fingertips

when they asked, but it sounds like it's something that makes physiologic sense. It does. I I'm

hedging just a bit because when you've got an overwhelming abdominal catastrophe, not

much is going to help you. And even if you want to try to modulate the autonomic nervous

system, sometimes the disease is just too intense and, and being someone who works in

kind of the extremes of illness, sometimes it's not, uh, you don't get the effect you

want. And it's, it's frustrating, but then again, that's just disease in general, right?

If disease is too powerful, no medicine, no manipulation is going to help. But in, if

you focus and look at a specific type of, uh, subset of patients, you can, as we showed

in our study, you can see a difference. Gerard, I'm going to shift gears and we're going to

go back to our sort of normal program and ask you to tell me, you know, in your normal

day, obviously you do a lot of different things in your position. Tell me what your normal

day looks like. Let just, we're going to focus on you. Tell me when you, what time you wake

up in the morning and what you do in a typical day and run us through till what time you

get home and go to bed. Oh, wow. That's a, that's a lot. We'll see. I get up around five

usually, and then I try and do my thing at home, maybe do a little bit of housework and

before I end up getting ready to go to the hospital, drive into the hospital. If we have

a meeting, usually the first meeting is six 50 attend that meeting. And then depending

on the week, there'll be a, a way we run rounds. So let's say I'll be covering the trauma service.

Then the trauma service starts at eight. We'll make, we'll have morning report, do some education,

uh, and then start making floor rounds. After the floor rounds are done, then we'll just

anticipate any traumas coming in. And whenever there's something comes through the trauma

service, they will deal with it. If there are consults for other types of cases, emergency

general surgery will attend to those. And while also managing the floors, there are

assorted administrative duties, research duties that are intermixed during that day in between

various cases. Uh, if I have to go to the operating room for any emergencies, I'll do

that as well. And that can be, you know, you got to throw off the whole schedule and whole

plan for the day, but it must be done. And then if there is a, uh, if things have cleared

out for the day, then by around 5 p.m. there's a handoff to the team member who's on overnight

or I'll be on for full 24, depending on the day. And then the night runs pretty much the

same except there's fewer people in house. And at the same time, we're managing the floors

and anything that comes in as an emergency. We're also managing the ICU. Yeah. Crazy day.

It is. And it's strange to think sometimes when I have a moment of peace and I look back

and what did I do today? Or I'm with friends or family that don't do this kind of thing.

Even my wife, who's also a physician. But when I talk about my day, sometimes she just

looks at me and says, I don't know how you do it. And you get used to anything. So let's

take us back a little bit. Tell us a little bit about, you know, your parents and your

family growing up and when you became interested in medicine and decided that you wanted to

be a doctor. Well, I grew up in a family of medical people, a lot of nurses and some doctors.

My mom was an OBGYN. She's retired now. That's actually how I got my name. Gerard is the

patron saint of pregnant women. The idea of becoming a doctor was always brought up in

our household. But I'm the only one actually among my siblings who pursued medicine. And

I was determined to kind of pursue it in my own way, in a way that was focused kind of

on saving people, if you will. I always wanted to kind of do to take people, find people

at their worst and try and be there to support them. And so that idea was kind of was born

actually out of my some family trouble that we had. I am a survivor of domestic violence,

what they call intimate partner violence now. And it has informed my wish to pursue a career

where I can be there for people on their worst day. And that became how I planned to do medicine

and that led me into trauma surgery. That's deep. That's deep. I have more questions.

I wish I hadn't answered. That is some answer. My answer would not be that deep. That's amazing.

I'm going to, again, just a little bit of a lighter question. Tell us where you went

to undergraduate and were there any specific experiences in your undergraduate school that

led you into medicine and specifically into osteopathic school? I know you told us a little

bit about that Barron's book. I had that too. And a lot of our listeners probably don't

know about that, but I get that part too. Well, I went to Georgetown University in Washington,

D.C. And what I remember about that experience that led me into medicine and trauma surgery

was this, and osteopathic medicine actually in particular, was my attraction to doing

research in something that wasn't a standard biomedical type of research. I had received

a scholarship from the Howard Hughes Institute to do research. And we were really supposed

to be doing biomedical research, but I loved the idea of doing environmental conservation

type research. So I convinced them to let me do that. And because I was doing genetic

research in that field, they allowed me to apply my scholarship there. The idea of working

in a field where you're doing hard science, bench research, genetics, but you're also

examining the world as a whole was just so, felt beautifully poetic to me. And that sense

of poetry was built in me over the years of working in that field. And when I found osteopathic

medicine in the back of that Barron's book, I got the same kind of feeling.

So you applied to osteopathic school and how did you choose the school? What school did

you go to and how did you choose that school? And tell us a little bit about your experiences

in medical school. I ended up at Turo University in California and a bit by Providence, actually.

I did like the school. I liked the fact that they had a very strong osteopathic manipulative

medicine department. I also liked the fact that it was in California on the other side

of the world from where I grew up. And I was out, I was younger, younger. I wanted to have

some adventures and discover another part of the world. But I, and I also liked that

I ended up there by Providence. I was wait-listed initially. And at one point I was on an airplane

flying, I forget where now, but I was, I had an anatomy book and I was just for fun. I

was opening up an anatomy book and reading it. This guy, a couple of rows ahead of me,

he was walking to the bathroom. He's walking back. He sees me with this anatomy book. And

so he taps me on the shoulder and starts talking to me. Turns out he's one of the most, one

of the reputable professors at Turo, California. And yeah, what a story. Holy cow. We, we,

we have a conversation and I tell him, we have a conversation that we ended up talking

about Turo, California. He says who he is. I say who I am and that I'm wait-listed.

And he says, don't worry. And then the next thing I know, I get a letter of acceptance.

Yeah. If you believe in like a higher power, I think that's, that's about as close as you

get to evidence, right? Yeah. Yeah. And so I made the most out of it out there. I had

a, I had a really great time. I really invested a lot in, in pursuing the, the osteopathic

stuff, not just the manipulation, but the whole spirit of the profession. The things

that we talk about being at the heart of what we're trying to do, holistic medicine, if

you will, but really caring about the patient as a whole, caring about everything from top

to bottom and not trying to, not being overly focused on a specialty or subspecialty. And

I feel very, very lucky that I was in an institution that really held onto those. Part of it was

because of the Jewish tradition at Turo, that really, that Jewish tradition really intermingled

well with the osteopathic principles and practice. So it was, there was a lot of, more of that

feeling of poetry and spirit. You mentioned that you did research when you were an undergrad.

Were there things that you did while you were in medical school, like research or extracurricular

activities? And did you decide to take the USMLE before you applied to residency? I didn't

do research in, in medical school. Personally, I was going through a lot of change and exciting

change just really just kind of discovering myself outside of, you know, the, the world

I was most familiar. I did pursue, I did pursue some interesting things of which I, from which

I earned a couple of awards from medical school for community service and student life. And

I was, one of the things I did was I founded the Turo Clowns group, where I got some of

my students to dress up and act as clowns and go to the children's hospitals and such.

And I also worked on the newsletter and turned it into a full on little magazine with great,

with some excellent graphics and more dynamic writing. And it was, those were nice pursuits

and they were more aligned at that time of my life with what I think I needed, which

was exploring different parts of my above life, you know, clowning and clowning and

writing journalism. So it was, it made a nice balance to the hard work that you had to put

into study and succeed in medical school. And did you, did you take the USMLE or did

you just take the Comlex? I'm a bit of a, a bit of a, at the time I was a bit of a bit

pretentious about saying that we, why did you always have to do two different tests?

And so I opted only to take the Comlex. Gerard, for the, for the record, I did the same thing

and I felt the same way as you. So yeah, we're kindred spirits on that. I knew I liked you.

Yeah, exactly. We're friends. We started off as friends. So how did you decide? So surgery

is, you know, obviously you have to be passionate about surgery to choose surgery because it's

a big commitment. When, when did you decide that you wanted to do surgery? And can you

tell us a little bit about what your application process and how you picked your residency?

I decided to do surgery, I think it was September, September of my fourth year of medical school.

I had gone into medical school thinking I'm going to do emergency medicine. I had been

an EMT. I, it seemed to fit in that whole paradigm of wanting to help people on their,

at their worst moment in life. But what I found was I wanted to do more definitive work

and I wanted to work with my hands. I love being a DO because I worked with my hands

and I found that the more rotations I did in emergency medicine, the less I realized,

the more I realized I wasn't working with my hands as much. And so I started thinking

about surgery probably the end of my third year of medical school. And then I finally

decided to put in the application very late into my fourth year. And I luckily had a decent

enough application that I got several interviews and I decided that the, I wanted to go to

an osteopathic program, partly because again, I'm a little bit wanting to support the osteopathic

world. There's a bit of a brain drain, as I'm sure many people know about at least before

the merger, where the graduates with higher scores tended to matriculate to ACGME programs.

And I didn't want to be that. I had high scores, but I had a philosophy that I'm not going

to matriculate to an ACGME. I'm going to stay within the DO world. So I wanted to up the

level of the DO program that I'm in. So, and on top of that, I wanted to be in the center

of the universe, New York City. So I found an osteopathic program in New York City who

granted me an interview, liked my application, and it was in an underserved community in

Brooklyn, which fit with the poetry of what I thought my life was about and helped to

satisfy that passion of helping those on their worst days.

We recently interviewed a surgical resident and she kind of made light of it, but life

as a surgical resident is pretty tough, right? What kind of recommendations would you make

if someone was, some of our listeners are thinking about surgery? What was your residency

like and what kind of advice would you give for people thinking about surgery?

My residency was very, very challenging. It was a type of residency where you are constantly

working, where you're constantly fatigued, where you're being pushed to limit, which

is most surgical residencies. But in particular, because we didn't have the accoutrements you

might find in an institution that has a lot more resources, you had to do a lot more things

on your own. But I was able to get a lot of extra skill set from that. The nurses would

call me to put in IVs for instance, or I knew where all the equipment was and how to set

it up. If you choose to go to a residency like that, you have to be very prepared to

work hard and to be able after the work is done to find a way to enjoy the time you have

outside, which is going to be not a lot. And if you don't have an ability to create that

work-life balance when you start, you've got to figure it out right away after you start.

Because you can crash and burn very easily. And I've had colleagues that did. And with

the 15 of us that started in the, that were there when I started as an intern, I think

at least two dropped out. So, or pursued other things for a time and then came back, one

of them. But it's, it's very, it's a very difficult life. But it makes you a better

person if you apply yourself correctly to it.

Gerard, how did you, when did you decide that you wanted to do fellowship? How did you pick

your fellowship and where did you ultimately do your fellowship?

Well when I was, when I decided to move from emergency medicine to surgery, I knew I had

to pursue trauma surgery because of the intense emergency aspect to it. And I enjoyed the

intensive care too because again, you're standing there trying to keep somebody from the brink

of death a lot of the time. So I knew I was going to pursue trauma surgery. Some of my

colleagues tried to talk me out of it. They said, oh, you have, you have the scores to

go to this specialty or that more reputable specialty in surgery. And I said, this is

my passion. I wanted to do it. And I ended up in initially actually at a, at a two year

acute care surgery fellowship, which was one of these newer fellowships that was being

created at a, at a Hartford hospital in Connecticut. It wasn't a good match. The, I think that

I, at that time in my life, I wasn't ready for something that, that more strictly academic

with very little penetrating trauma. And really you're doing a lot of, it was more administrative

and that sort of thing. And I really want to be more in the thick of it. So I ended

up leaving that, that fellowship and pursuing a trauma heavy fellowship at Rutgers at University

Hospital in Newark, which was fantastic. I mean, you're on the, you're there in the middle

of essentially a war zone and you have great resources of people at least, and, and resources

in terms of technology to do your best to help them. And even then from that to do outreach

into the community to try to make a dent in the, in the cycle of violence.

So for the listeners that don't know Newark, if you're looking for trauma, I would think

Newark is a very good place to, to set up shop. If you want to find trauma patients,

that's right. Yes, absolutely.

Gerard, we're very excited that Tian Yu is going to NYU for, for his internal medicine

residency, but you are an attending at NYU, which is, you know, considered sort of an

elite allopathic institution. Can you tell us a little bit about applying for a position

there and how you felt you were received as a DO? Obviously you're working there and you're

doing a great job and you're doing all this research and it sounds awesome, but can you

tell me a little bit about when you got the job at NYU?

Yeah, well, I initially chose once again, after I finished fellowship to go to a osteopathic

traditionally osteopathic program. So I was in the Bronx working at a trauma center in

the Bronx in a high intensity, violent trauma part of the city. But after a while I knew

I needed to pursue something more. I wanted to make a deeper impact on my community and

also to give myself some space to pursue other things in my personal life and also in my

academic career. And at that time I had friends who were moving into take leadership roles

to take a leadership role at NYU and she recruited me. We've been friends for quite some time.

We actually met at Hartford and she was, we always had gotten along and she knew the quality

of my work through organizations like the Eastern Association for the Surgery of Trauma

and others. And we made a good fit as a team at NYU. So I ended up actually spending about

a year thinking about the position before deciding to matriculate there. The matriculation,

the beginning of it was challenging. My history of working in the inner city for so long was

a bit of a clash with a suburban culture. And I think I first blush being literally

the only DO in the division and I think only one of maybe a couple DOs in the entire department.

There was hesitance. It's just not a, I don't know why. I can't speak to anybody's thoughts

on the matter, but there was hesitance. But after a while you show your stuff, you prove

that you've got good skills, that you have a range of talents and that you have unique

talents. And that earned me respect and it's been since then quite a nice ride. I think

that's really a lesson that is true about a lot of osteopathic pursuits in life. If

you want to really stand out as an osteopath, you kind of have to push past discrimination.

You have to push past the stigma against you. There's a book called Doctor's Orders. I don't

know if you've had a chance to read it. Tanya Jenkins wrote it. And she talks about this.

This is a phenomenon well understood. The DOs are going to face discrimination not necessarily

because they have individual deficits, but because the system as a whole sometimes does

not support DO students and DO residents in the same way that systems for allopathic students

and allopathic residents have historically. That may be changing as we have come under

a unified ACGME. But because of that history, you have to work it a little bit harder. And

at first, I wanted to actually maybe take a step back. I thought why don't I just go

back to my osteopathic hospital where they know me. But that's not what you do. You face

a challenge. You step up your game. You make yourself better. You look at yourself. You

make yourself better. And you keep on fighting for what you believe in.

Yeah, that statement is 100% why we wanted you on this podcast. And I think that's amazing.

It's worked out well so far.

Jordan, I'm going to switch gears. I'm just going to ask you a few personal questions

if you're okay answering them. We're always interested in whether people took loans and

whether that affected their choice of residency.

However challenging my family has been, they have always been supportive financially. And

I was lucky enough that I did not have to take out loans for medical school. And I think

that has helped me in my career to pursue more broad ideas, if you will. Maybe even

you could say more idealistic ideas because I had the opportunity without having to worry

about some funding. But now I'm actually in the process of trying to figure out how to

do funding for grants and getting research funding, which is its own special challenge.

Jordan, are you married? And can you tell us what your spouse does and if they've always

been supportive of your career?

My wife is a PMNR physician. We actually met when I was a surgical resident and she was

a medical student. Yeah, clearly, yeah, she's been supportive of my career. She's been supportive

of me being a DO and my pursuit of combining the ideas of advanced surgery and osteopathic

manipulation. She's great. She's PMNR, which is physical medicine rehabilitation. So she

is interested in the musculoskeletal system. She doesn't have a background doing manual

treatments, but she does see the value in it. And I think she's very proud of continuing

to use those skills, even though I'm in a field that doesn't traditionally use them.

Gerard, first of all, thank you so much for your time. I mean, you have been absolutely

inspiring and great and I love talking to you. Our grand finale question is, it is a

tough one. Everybody has a problem with this one, but I think it's great. What was the

best piece of advice, and it could be more than one piece of advice, that you were given

from someone else throughout your education? And this could be, you know, from growing

up, medical school, residency, that you think really gave you value and you would like to

pass on to other students. Dr. Kellech Chendershaker, one of my mentors

and who really shepherded me through residency and especially during the tougher times of

residency. Great guy, really great heart. He was the resident academic or, you know,

he was the academic guy in the residency, attending-wise. And I admired him and I wanted

to be a scientific writer like him. I wanted to pursue that part of medicine. And so I

asked him one day, you know, how do I become a writer? And he said to me, you just write.

And then you're a writer. You may not be a good writer right away, but you're a writer.

And then you just work at it and you get better. And that's a lesson that I've seen reflect

and heard reflected in various things. I worked with landmark education at one point and that

idea of if you want to be something, you be it and then you get the results of it. And

I think that's something that is hard for many younger people in medicine to appreciate.

They think that there's some kind of pathway that you have to follow and there's certain

milestones you hit and then, okay, now you have achieved something. Now you are this.

The idea of that lesson is that if this is something that's true to your true self, it's

true to your heart and it's something you're passionate about, do it and then you are it.

And then all the other things that you think you want from it will flow from that. So if

I asked, I kept asking him, how do I be a writer? How do I be a writer? And he says, you just

write.

Good advice. Love it.

Jared, thank you so much for your time. I really appreciate you being with us tonight.

Thank you. This was a lot of fun and I look forward to building a friendship.

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 us to interview to do or do not podcast

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plenty of more interviews lined up and we're excited to share them with you.

This is Tanyu Shea. Thank you guys so much for listening to Do or Do Not.