In today’s episode, we have Dr. Tuvia Marciano. Dr. Marciano is a pediatric gastroenterologist at NYU Langone on Long Island. He graduated from the New York Institute of Technology in 2000 and completed his pediatrics residency at Downstate Medical Center before moving on to finish his pediatric gastroenterology fellowship in 2007 at the prestigious Montefiore Medical Center. Dr. Marciano has won several awards for his excellent care and is featured in multiple regional guides including Newsday and New York Magazine. We hope you enjoy this episode.
Edited by Thomas Jasionwski
In today’s episode, we have Dr. Tuvia Marciano. Dr. Marciano is a pediatric gastroenterologist at NYU Langone on Long Island. He graduated from the New York Institute of Technology in 2000 and completed his pediatrics residency at Downstate Medical Center before moving on to finish his pediatric gastroenterology fellowship in 2007 at the prestigious Montefiore Medical Center. Dr. Marciano has won several awards for his excellent care and is featured in multiple regional guides including Newsday and New York Magazine. We hope you enjoy this episode.
Edited by Thomas Jasionwski
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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We hope you enjoy this episode. On today's episode, we have Dr. Tuvia Marciano. Dr. Marciano
is a pediatric gastroenterologist at NYU Langone on Long Island. He graduated from the New
York Institute of Technology in 2000 and completed his residency at Downstate Medical Center
before moving on to finish his pediatric gastroenterology fellowship in 2007 at the prestigious Montefiore
Medical Center. Dr. Marciano has won several awards for his excellent care and is featured
in multiple regional guides, including Newsday and New York Magazine. We hope you enjoy this
episode. Dr. Marciano, thank you again so much for taking the time out of your busy
schedule to come talk to us. I just wanted to start by asking you how your day was and
what an average day for you looks like. Today is Sunday. It's one of my slower days.
This morning, I saw patients in Brooklyn, which I do about two Sundays a month. That's
usually slow in the summer. It was a slow morning. I saw 10 patients this morning and
then I have been actually going over biopsy reports from the prior week and calling patients
to go over the reports with them. That's pretty much what I've been doing this afternoon.
Then by two o'clock, I usually finish up and try to have a halfway normal Sunday like the
rest of everybody else. Were there any interesting cases you saw today?
Always interesting. I saw an 18-year-old with 10 pounds of weight loss, which we will work
up for inflammatory bowel disease. Then I saw an eight-month-old who had bloody diarrhea
and failure to thrive, who we will work up for that. Those were two new patients that
I saw this morning in the office. How did you get interested in pediatric gastroenterology?
Were you originally interested in just pediatrics or were you always interested in pediatric
GI? I got interested in pediatric GI really by
chance. When I was a resident, the vice chair of the department is a pediatric gastroenterologist,
a guy by the name of Barry Warshall, who's now the chief of GI Chicago. He basically
came over to me one day and said, I'm going to make you into a gastroenterologist. I said,
okay, that sounds pretty cool. I think I would like that. I knew I liked procedures, but
I also liked to think about the disease state and not just practice surgery. I felt that
there was a nice balance of medicine and procedures. I said, okay, that works for me. That's really
how I ended up doing GI. Are there any other pediatric subspecialties
that you were maybe considering that had procedures? I was considering emergency medicine and pediatric
ICU as well. Everything I considered was really procedure oriented.
Can I ask how you got interested in pediatrics in the first place?
I always liked kids, but it goes back to medical school. I couldn't stand the smell of the
medicine floors. I knew I didn't want to do internal medicine. In fact, recently I was
working COVID floors during the pandemic and all of a sudden that smell brought back such
memories to me. I was taking care of 90 year old patients, which I haven't done in over
probably 20 years. I found myself taking care of 90 year old patients and the medicine smell
came back to me. I was like, I really can't do internal medicine.
That's how I ended up in pediatrics. I like the kids. I enjoy it. I think it's nice to
be able to work with young people that you can really have an impact on their life from
the get go. That makes sense. In my opinion, pediatric
GI is a little more rare compared to adult GI. Can you maybe tell us a little about the
differences between the two fields other than one is adult and one is pediatrics?
Well, the nice thing is that we use smaller scope. That's a nice thing. We don't see
any of the cancer stuff that they see in the adult world. Most adult gastroenterologists
are taking care of what we take care of and then some, they take care of the cancer stuff.
On the flip side, we take care of the failure to thrive and the younger kids, which they
don't see in adult GI. We see a lot of reflux. I see a lot of inflammatory bowel disease,
ulcerative colitis, Crohn's disease, which I guess the adult GIs also see. There is some
overlap there, but for instance, cow milk protein allergy and other types of things
that happen in neonates, obviously the adult GIs don't take care of.
I've heard that adult GI is kind of 75% functional, stress-related, and 25% organic or more serious
conditions. What do you think about that in terms of pediatrics GI?
That's probably a lot true by us as well. For the most part, there are very good studies
out there that show that teenagers with reflux tend to have underlying functional issues,
the same thing with the IBS that we see. There is a lot of, as my staff calls me, I'm a psychiatrist
most of the time and a medicine doctor the rest of the time.
Are there any challenges that pertain to pediatrics, especially when you're dealing with kids who
might be scared of things like scopes?
There are a lot of challenges when it comes to pediatrics. First and foremost, you're
taking care of somebody's most treasured possession and that's really important. Parents really
have to trust you. That's very, very important. It's important to remember that it's actually
a privilege to do that, to take care of somebody's child. There's a lot of reassurance that goes
on and there's a lot of opportunity to really, like I said earlier, impact somebody's life.
Every year around this time when I get together with my adolescent patients who are going
off to college to sit down and have a conversation with them and talk about where they want to
go in life. I think that that's really, really a nice part of pediatrics. On the flip side,
we have to deal with the parents who sometimes can be very difficult and many times can play
an active role in that functional abdominal pain.
On a previous episode, we had an anesthesiologist who said that she would have loved to go into
pediatrics, but she ultimately couldn't take the parents. Do you think that part is the
hardest part of the field and if not, what do you think is?
I think that is one of the hard parts of the field. I completely agree with that, although
anesthesia is very nice. You just put the patient to sleep, they don't talk back to
you. It's almost as good as radiology when you don't have to leave a dark room. You get
to develop really nice relationships with the families and sometimes the parents can
be a lot of fun, but yes, sometimes the parents can be very difficult. If you do adult medicine,
well then you're dealing with the children of the patient. I think every specialty has
its pluses and minuses.
I think it's great that you can influence the children from an early age. In addition
to your clinical duties, I see that you're the Vice President of the Institutional Review
Board and Chief of Endoscopy. Can you tell us about these positions at Winthrop, correct?
So I am Chief of Pediatric Endoscopy, so that really means that I handle a lot of the issues
that come up within pediatric endoscopy for the institution. I also happen to be the proceduralist
in my group and so when it comes to pediatric procedures at Winthrop, I tend to do a lot
of the more technically advanced stuff. As far as being the Vice Chair of the IRB, I
sit on the Institutional Review Board where we review all the research that's going on
within the institution. It's really a great opportunity to learn what everybody's doing
and sort of play a role in it. It allows me to stay up to date on a lot of the latest
research and what's going on in the world of research, and so I really enjoy that.
Is there a pediatric GI fellowship at Winthrop?
There is no pediatric GI fellowship currently at Winthrop now. We've discussed that in the
past, but at this point in time, there is not a pediatric GI fellowship.
If there was in your interview in a candidate for a theoretical position, what attributes
would you look for in a candidate?
I think that the most important thing that a candidate can bring to the table is somebody
who is very conscientious, who really cares about their patients, who realizes that medicine
is not a nine-to-five job, but is really some... Like I said earlier, somebody has entrusted
you with their child, and I think that that's a very, very big deal, and you need to take
that responsibility seriously. Your day doesn't end at five o'clock when the bell rings, and
I think that that's very important. I think research is important as well, and so most
people who are applying for pediatric GI fellowship are probably coming in with some research
experience.
Thank you. I think that's great advice. I'd like to take a step back and go back to the
roots. When did you first become interested in medicine and decide that you wanted to
become a doctor?
When my mother told me so.
Was that from a really young age?
I would like to say... I think in my medical school essay, I wrote something about the
Fisher Price doctor's kit. I think they even still make it, the stethoscope, and they've
got an otoscope in there. It's hard to remember how long ago I wanted to be a doctor, but
it's sort of been, I guess, ingrained in me. I have other siblings who are in healthcare.
I come from a large family, and there are two pediatricians and two dentists, one of
whom is a pediatric dentist. So in my family, I think healthcare was always pushed pretty
strongly.
Where did you go to undergraduate school?
I went to Hopkins for undergrad.
Johns Hopkins, that's a great place. Can you tell us about how you did from Hopkins and
what was the application to medical school like?
I think when I applied, it was a pretty competitive year, although I think that if you ask every
physician, they'll tell you, oh yeah, their year was the most competitive. I don't know
how true that was. But I really needed, for family reasons, to be in New York for medical
school. I was sort of limited with that, really in metro New York. And so that was when I
was applying. I had only applied to a couple of schools within the metro area.
And what was your experience like while you were in medical school? Did you enjoy it?
Did you hate it?
I actually enjoyed medical school. I had this thing where I... So I went to Nikon and back
then, I think it was called The Pit. And I would sit, I would occupy, everybody knew
my seat. I would occupy the last seat in the aisle on the right side. And I was there every
day at 8 a.m. and we used to have a test every Monday. And so I would take the test Monday
morning and then from Tuesday onward, I would sit there and just study for the next test
on Monday, no matter what was going on in class. So that's where I did all my studying.
And I was always there. I was always around. I always got the lecture sheets and everything
like that. And I would sit there and study from, I guess, Tuesday until Monday and then
start all over again. But I always left school at like four or five o'clock and never really
studied in the evenings. I did all my studying during the daytime. And then I would come
to school on Sunday and study Sunday mornings, I guess, until around 12. I would get to school
like really early, like 730 and study from 730 till around 12 o'clock. And that was pretty
much all I did throughout my first two years of medical school. And that's how I sort of
got everything done. And then the last two years of medical school were great. I really
enjoyed my rotations. I thought my rotations were really just a great part of my medical
school experience. It was fantastic.
And how was your pediatric rotation that released? Made your decision to go in?
So I did pediatrics at Maimonides. It was really a great rotation. Steve Shaloff was
the chairman at the time. And it's funny that Steve Shaloff just became the dean of the
NYU Long Island School of Medicine at Winthrop. So it's nice to see him again. And I interact
with him now on a totally different level. He still remembers me from when I was a medical
student, which is funny. Going back, that was like I had him as my, you know, I did
my medical school rotation at Maimonides in 1998. So here we are 22 years later and, you
know, still working with him. He was a great teacher. And I did enjoy my time at Maimonides.
I found that it had a lot of pathology there.
And after that, can you tell us about your road to residency? How did you decide on which
program that you wanted to go to?
So, you know, I always tell, I sort of learn for myself and I always tell people who are
applying in the process, you know, things seem to sort of like fall into place. If you
want to become a dermatologist and you really, really want to become a dermatologist, well,
then you're probably going to become a dermatologist. And I found that that was true for most of
my class. I wanted to be a pediatrician. And, you know, I was offered a spot at Maimonides,
but then I had a friend of mine who did, who is the chief resident at Downstate. And he
really encouraged me to come to Downstate. So I ended up going to Downstate for my residency.
And that's how, that's sort of how things got started. And from there, like I said,
Barry Werschel chose me to become a gastroenterologist. So I became a gastroenterologist. And I guess
things sort of just, you know, fell into place, which was really nice.
Can you tell us about your time at Downstate? And I believe you went to Montefiore for a
fellowship, correct?
Yes. So I did three years of residency at Downstate and one year of chief residency
at Downstate. I had a, I would say you really worked very hard at Downstate, but probably
some of the best years of my life were at Downstate. I had a great time. I had a great
group of friends. We all worked really hard. And I mean, it's, Downstate is sort of like
its own little country. You know, it doesn't play by the rules of anything else that you'll
ever experience. And you work really hard there as a resident, but you learn a tremendous
amount and you see some really amazing pathology. And that really prepared me to be a good doctor.
It taught me how to jump in there and take care of patients and not be afraid, not be
afraid to touch patients, to speak to patients, to interact on, you know, to interact on their
behalf. And it was really, really a great experience. I stayed on there for my chief
year because I really didn't want to leave. I felt like I had grown so much over there.
And looking back, even to this day, I still have good memories of the place. And then
I did my chief year there. And at that point in time, Barry Warshall had decided that he
was going to leave and go to Montefiore to be the chief of GI there. And well, when he
got to Montefiore, he called me up one day. I was still the chief resident. He said, Toby,
I just want to let you know that you're coming with me. You know that, right? And I said,
I don't know what you're talking about. I don't have a position there for GI at Montefiore.
He said, no, no, no, I'm here and you're going to be my fellow. I said, oh, okay, fine. And
so after I finished my chief year at Downstate, I packed my bags and I went to the Bronx where
I became a GI fellow. Fellowship was very different than residency. In certain ways,
you were much more independent. There was a lot of stuff to learn and you have to learn
the procedures as well. And I had a mentor there by the name of Larry Brandt, who's one
of the fathers of adult GI. And Larry Brandt really taught me how to scope, which is really
very important. For pediatric gastroenterologists, sometimes you don't get the same amount of
exposure to doing procedures as the adults do. And so by having an adult GI as a mentor,
especially somebody who's as world renowned as Larry Brandt, I really developed some very
good skills.
Definitely. For the pre-medical students that are listening, Montefiore is a top tier institution.
So we're very privileged to have Dr. Marciano talk to us today. Which is the best piece
of advice that you think you got throughout your education that you like to echo to the
people listening?
People who go into medicine for the right reasons really enjoy their time doing it and
it's not so much of a burden. And so you'll know that you were right for medicine when
you're sitting there at two o'clock in the morning studying for a test and you still
got a smile on your face. You really have to enjoy it. You have to love it. And it's
not really a career. It's a way of life. Being a physician is a way of life. We are entrusted
in taking care of people and helping them live long and prosperous lives. That's very
special and not everybody is given that opportunity. And if you have that opportunity, you should
be responsible and take full advantage of that opportunity.
I think that's great advice. Thank you, Dr. Marciano. I just wanted to go back a little
bit and talk about the process when you were deciding residency. For student applying to
residency, if they need to choose between a large or small institution, a private or
public institution, how should they decide? And what do you think are the pros and cons
of different programs?
That varies by person. At the time, that was before the North Shore LIJ merger. I think
it was the largest pediatric program in the country. It was like 120 residents or something
like that. So it was definitely a very large program, although you didn't necessarily feel
it, but it was really large. It really varies by your personality type. At Windsor, we have
a smaller program. The residents love it from my interaction with them. They love the residency
program at Winthrop. It's definitely a very nice place. The residency director, Dr. Levins
Moore, treats the residents as if they were her own children, and it's a very nice feel.
Downstate is probably not as touchy-feely as that, and you're expected to jump on the wagon
and get things done. I know that at Montefiore, it's probably a bigger residency program than
what we have at Winthrop, and it has certain expectations. So it's important that in your
fourth year, you make the rounds. If you're really interested in a program, then you should
do an elective there to get a feel for the place and see how everybody likes it. Are
the residents happy there? Are the attendings willing to teach? Are they willing to interact
with the residents, do research projects with the residents, and help them along in their
careers?
How was your experience looking for a job after you got a fellowship?
My experience was pretty good. I don't think that the job market is as big today as it
was when I graduated. At this point, there are a lot of pediatric gastroenterologists
in New York City or the New York metro area. There certainly is a need throughout the country
if you're willing to leave New York. Again, it all depends where you want to go geographically,
but there are certainly jobs out there. I did not have any difficulty at all.
And can you tell us how you ended up at your current position?
Sure. I came to Winthrop because the previous chief of GI, of pediatric GI at Winthrop,
was a guy named Fred Down, who just retired actually. I had known Fred from when I was
a resident. Actually, Fred Down used to run a Friday morning GPGI get together, like once
a month. And when I became interested in GI, I used to go to that once a month get together
at North Shore at the time. I got to know him through that, and Fred Down actually trained
under Larry Brandt. So when I was looking for a job, Larry Brandt, who was at Monty,
everybody likes it. Are the residents happy there? Are the attendings willing to teach?
Are they willing to interact with the residents, do research projects with the residents, and
help them along in their careers?
How was your experience looking for a job after you got a fellowship?
My experience was pretty good. I don't think that the job market is as big today as it
was when I graduated. At this point, there are a lot of pediatric gastroenterologists
in New York City or the New York metro area, but there certainly is a need throughout the
country if you're willing to leave New York. Again, it all depends where you want to go
geographically, but there are certainly jobs out there. I did not have any difficulty at
all.
Can you tell us how you ended up at your current position?
Sure. I came to Winthrop because the previous pediatric GI at Winthrop was a guy named Fred
Down who just retired, actually. I had known Fred from when I was a resident. Actually,
Fred Down used to run a Friday morning PGGI get-together once a month. When I became interested
in GI, I used to go to that once a month get-together at North Shore at the time. I got to know him
through that and Fred Down actually trained under Larry Brandt. When I was looking for
a job, Larry Brandt, who was at Monty, sort of pointed me in the direction of Fred Down
and that's how I ended up at Winthrop. It's all about who you know. You'd be surprised.
You meet people along the way and later on, they come back and they help you out.
Definitely. I think that's the motto of life.
Right. Always be nice to people because you never know. They may help you out one day.
If you couldn't do the specialty, if you couldn't do pediatrics and you had to go
back in time and choose a different one, which one do you think you would be doing?
I would consider – looking back now, I would consider doing general peds. I think it's
a really nice specialty. I think you can make your own hours. There's definitely a lot
of opportunity and it really allows you to be involved with people's lives and help
them out.
I think that's cheating a little bit, Dr. Marciano. Other than pediatrics, do you have
anything in mind?
Oh, other than pediatrics. What else would I have done other than peds? I don't think
I would do anything else. I love what I do. I get up every morning and I love it.
I think that's great. I think that's great that you're super happy and you enjoy every
day. Do you have any final advice for anyone who might want to do pediatric GI? I know
you gave us some earlier.
I think that it's important to figure this out early on. Reach out to pediatric gastroenterologists
that are in your institution. Work with them. See if you could do a research project. See
who they can put you in touch with. Perhaps go to the society meetings. I mean, now with
COVID, obviously, that's a little bit difficult, but every year, NASBGAM will sponsor residents
that are interested in going into pediatric GI for their meeting. They'll give them support
to attend the meeting, which is really good. So, if you're interested in going into pediatric
GI, you should definitely speak to your pediatric gastroenterologist at your institution about
the NASBGAM fellowships and getting support to attend the meeting so you can meet up with
other pediatric GIs throughout the country. Like I said earlier, you never know who you
bump into that can help you out.
Thank you so much, Dr. Mati. I know you're very busy. I won't take you for much longer.
Thank you for your time.
Thank you.
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