Episode 54: Dr. Lawrence Sands D.O. Preventative Medicine Doctor & Co-Chair of Family Medicine at AZCOM

Dr. Lawrence Sands has spent over 25 years working as a public health physician. He has led a variety of local and state-level teams in community health services, biodefense preparedness, and epidemiology. Dr. Sands was introduced to medicine by working in his father’s primary care practice in Michigan before going on to earn a Master of Public Health from the University of Michigan. He then received his D.O. degree from the Chicago College of Osteopathic Medicine, became board-certified in General Preventative Medicine and Public Health, and then earned a fellowship in clinical administration.

Dr. Sands is currently the vice-chair of the Department of Osteopathic Family and Community Medicine, Clinical Associate Professor at the Arizona College of Osteopathic Medicine, and Associate Professor in Public Health at Midwestern University. He has held various board positions in the past, including president of the Arizona Osteopathic Medical Association and Adelante Healthcare board chair.

We hope you enjoy his story of becoming an osteopathic medical practitioner with a focus on health policy, prevention education, population health management, addressing the social determinants of health, and promoting health equity.

Transcript

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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're interested in joining our team or have suggestions or comments, please contact

us at DoOrDoNotPodcast.com.

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Instagram.

We hope you enjoy this episode.

Hi, I'm Tiffany Carlson, a third year medical student hailing from the Midwest, and you're

listening to DO or Do Not.

On today's episode of DO or Do Not, I interview Dr. Lawrence Sands.

Dr. Sands has spent over 25 years working as a public health physician.

He's led a variety of local and state level teams in community health services, biodefense

preparedness and epidemiology.

Dr. Sands is a board certified in general preventative medicine and public health.

He received his doctor of osteopathic medicine from the Chicago College of Osteopathic Medicine.

He originally worked in his father's primary care practice in Michigan before going on

to earn a master of public health from the University of Michigan and complete a residency

in preventative medicine and public health.

Dr. Sands then earned a fellowship in clinical administration.

Dr. Sands is currently the vice chair of the Department of Osteopathic Family and Community

Medicine, clinical associate professor at the Arizona College of Osteopathic Medicine,

and associate professor in public health at Midwestern University.

He has held various board positions to include past president of the Arizona Osteopathic

Medical Association and the Atalanta Healthcare as a board chairman.

We hope you enjoy his story as an osteopathic medical practitioner focused on health policy,

prevention, education, population health management, and addressing the social determinants of

health and promoting health equity.

Thanks for listening.

Thank you, Dr. Sands, for joining us today on the DO or Do Not podcast.

Really appreciate your time.

Great, well, I'm glad to be here and thank you for inviting me.

I think this is terrific that you're doing this for students because one of the things

I learned later after graduating and after internship and everything is that, gee, there

are a lot of different pathways in medicine that they never talk to you about when you're

going through medical school.

So I think this is great that you're doing this.

Awesome.

So I know that you have an atypical practice, but can you just kind of walk us through what

you do on a daily basis?

Well, you know, I teach now at Midwestern University at the Arizona College of Osteopathic

Medicine.

So my days here are different than when I was in a public health department, but a lot

of my work is administrative, both here and there.

But now we're doing a lot more teaching.

But usually the days are as described, it's a lot of blocking and tasseling because you

deal with, particularly when you're doing management administration, you're making sure

that things run smoothly and helping to solve problems and deal with, you know, any worries

from personnel issues to budget issues to policy issues.

So right now as the vice chair for osteopathic family community medicine, you know, our big

focus is always on rotations and preceptors, and because right now, because of COVID, we

have students that are going, coming on in and out of quarantine.

And when they go into quarantine, then we, you know, have to, you know, come up with

a plan about how they're going to continue forward and what work we'll do while they're

in quarantine, while they're on rotation, so they can meet the rotation requirements.

So that's what's taking up a lot of time right now with working with students, both individually

that way, as well as planning for rotations for the coming year when we start back again

with rotations in June and July.

So that's a lot of it.

Today we had some meeting with the dean and my department chair and one of our faculty

who supervises our osteopathic scholars program and talking about some, you know, doing some

planning about some, you know, changes in that program next year.

And then later after this, I have, you know, we have a chairs meeting that follows this.

So we'll be, all the department chairs will be meeting with the associate team for clinical

education and we'll be dealing with issues that concern, you know, that we all share

and help.

And as I said before, you know, much of what we're trying to do is make sure that, you

know, students have rotation sites to go to as well as that we have ways to continue to

keep them moving forward in their program so that they can both complete the licensure

examinations for part one and part two before they leave and be able to graduate on time.

I like how you use the football analogy of blocking and tackling because I think that

is kind of what administration is to me.

So puts it into perspective.

So just going back to the beginning of your journey, when and how did you become interested

in medicine and ultimately decide that you wanted to become a physician?

Well, I'll tell you my earliest experience or memory was back in kindergarten and they

given the assignment, you know, draw a picture of what you, you know, what you want to be

or what you think you're going to want to be.

And I drew a picture of me as a physician.

And a lot of that had to do with that.

I grew up in a physician family.

My dad was an osteopathic physician, a general practitioner, and had practiced for well over

30 years in Dearborn, Michigan, and also was a CCOM graduate.

So DO is really all I really knew.

I didn't really know there was a difference until later in life, but that's kind of how

I found medicine as an interest as well as osteopathic medicine as a potential pathway

in medicine.

So you're from the town where one of my favorite museums is growing up in Michigan, where did

you decide to go to undergraduate?

And then you alluded that you didn't know the difference between medicine and osteopathic

medicine, but when did you make that decision to apply to CCOM?

Right.

I went to the University of Michigan at Ann Arbor, and, you know, they have a very good

pre-med program.

And, you know, it was never really a question.

I mean, I, you know, when it came time to take my MCATs and do my application, I applied,

I did apply to both allopathic and, you know, and osteopathic schools, but I really only

applied to really one allopathic school, and that was Wayne State University, only because

it was close by and my brother was going there at the time, and I had a lot of friends that

were going there, and really more for both, you know, the financial and, you know, factors

and, you know, and that was the only reason why I applied as well, is that it is a very

good school and produces a lot of good physicians.

But other than that, I applied only to osteopathic schools and had my interview at Chicago when

I was still in Hyde Park, and before there was a Midwestern University, and I got accepted

right away, and there really was, you know, no question, I was excited to go to Chicago.

Yeah, so can you kind of, I guess for posterity, talk about your experience at Hyde Park and

just kind of what you did there during your time at CCOM?

Mostly study, a lot, well, a couple things.

My mother actually and her family lived in Hyde Park when they, when my mom was growing

up before, you know, she met my dad and moved to Michigan.

So it was kind of like kind of going home in some ways, I didn't have any family that

still lived in Hyde Park, but at the time that I went to school there, it was the year

that they opened up, the big news was the big outpatient clinic building next to, you

know, the hospital, and that was a big deal because up to that time, basically the family

medicine clinic or the primary care clinic was in the hospital, and it was like a dispensary.

Didn't have any real walls, and so you hear all these stories from, you know, the upperclassmen

who had, you know, had trained in that environment as well as some of the faculty had trained

there and just, you know, just some of the stories about just how, you know, different

it was to practice there, so it was a big deal to actually have offices and individual

exam rooms with real walls and doors and privacy, and as well as that they had a lot of different

levels.

They had the specialty clinics and the procedure room, so it was really exciting because you

were able to really get at that time, you know, this kind of state of the art experience

and exposure to medicine, you know, in this new facility, which is great, and my understanding

now is that building, which is well over 40 years old, was converted into condominiums,

which I think is really kind of funny to think about today, but that's kind of the experience

there.

You know, we had, you know, 100 students in my class pretty much within the first month.

We pretty much knew everybody in the class, it was the same process as it is both at CCOM

and here in ASCOM where students are, you know, every Monday morning you have an exam

and what you were supposed to learn the previous week, but I also just remember, you know,

having that kind of accessibility to the professors and the faculty there and having much more

of an intimate kind of experience or, you know, small college experience coming from

a big public university where you'd be in lecture halls with anywhere from 300 to 600

students, you know, to be able to be someplace where, you know, it's only 100 students and

you're in lecture hall and you pretty much know everybody, it was a much greater sense

of community and that we're all in this together and it was all about, you know, no longer

about getting into medical school, it was all about just graduating and helping everybody

and helping each other, you know, make it to the end.

Yeah, that does seem to be the culture at CCOM.

Did you just do your clinical rotations at that clinic or did you go to other places

in Chicago during the clinical years?

Sure.

Well, you know, at that time I spent about, I think, six months in the family medicine

clinic there, the way they had it set up, and then you did rotations through each of

the different services in the hospital and then you'd have some electives, but I did

have the opportunity to go and do my psych over at the Hinsdale VA as well as to spend

some time at the Rehab Institute of Chicago for Physical Medicine and Rehabilitation where

there are a couple of the CCOM graduates who are residents there and that was really, that

was really an interesting and exciting place to learn.

Yeah, and they still have elevator operators there too, which is kind of cool.

Oh, do they?

Interesting.

Yeah, so how did you ultimately decide on your specialty and kind of walk us through

that path because it seems to be very eclectic?

Yeah, it was, it was very eclectic.

So and what doesn't show up on my CV is that I came timed for internship because the whole

internship at that time when I graduated, you did an internship and then you went to

residency if you wanted to go into a specialty, but most people did their internship and that

satisfied licensure requirements and a lot of people just went into general practice

or primary care.

So at the time, you know, my thoughts were either, I was either going to stay in Chicago,

go back to Detroit or I was going to choose someplace I really wanted to be and so, and

I wanted to be someplace warm.

So it's like, so it came down to like Florida and Arizona and had been to Arizona before

I loved the state and the whole environment loved, you know, the desert, I just loved

the desert beauty and I had spent for my first year in medical school, spent a month at Phoenix

General Hospital, you know, shadowing, you know, one of the docs there and his partners

that my dad had known when he was, he was a resident in Michigan when, when I was growing

up.

And so I got to experience more of what goes on in a hospital, but also to learn more about

Phoenix General because that was something that I was, you know, it was a potential for

me to apply for internship, had a really good experience, you know, applied there as well

as to Detroit Osteopathic in Chicago.

And at the end, when I finally came down to it, I chose to go to Phoenix because I wanted

to try something, you know, wanted to get outside my bubble and experience the West.

Before I had left Chicago, though, I did an interview for residency at the Rehab Institute

in Chicago and was accepted.

And so, so when I started my internship, I already knew where I was going to go afterwards.

But during my internship, I really loved being, you know, being in Phoenix, I really enjoyed

the people at the hospital, had a really good experience.

And so I was trying to find a way to stay there, there's something, you know, something

else that would, you know, that would take the place of going to, back to Chicago.

You know, ends up, long story short, I did go back for a month, but then during my internship,

you know, I also got exposed to ophthalmology, really got interested in that, applied for

an ophthalmology residency, and then about, you know, a couple weeks after I got back

to Chicago, you know, at the Rehab Institute, I got a call to say that they had a space,

place for, for an ophthalmology resident, resident at the Pontiac, Pontiac Osteopathic

Hospital at that time in Michigan.

And I made, you know, the fateful decision to take that and then spent a year doing that

and realized that, yeah, I just wasn't cut out to be a surgeon.

And so at that time, I went into practice with my father and his practice in Dearborn

for a couple of years.

And during that time, you know, I kind of, you know, was kind of assessed, like, well,

what are some of my options and things I could do?

One of the biggest influencers were during that time, that's in managed care was starting

to become much more dominant in Michigan at that time.

And we started experiencing the effects of that in our practice.

And I made a decision that I'd much rather be on the policymaking side than on the policy

receiving side and consider a lot of different paths, even going to like the business school.

But what ended up happening is I ended up going to a CME program in Phoenix in February

to get out of the snow and see some of my friends.

But it was the American Osteopathic College of Occupational and Preventive Medicine.

And it was there, I came in contact with people and learned more about occupational and preventive

medicine and really learned that this is something that I was really interested in because a

lot of my practice, I focused more on prevention and more interest in prevention.

And so after that, I began exploring that and I discovered that the University of Michigan

School of Public Health had a preventive medicine residency program.

And so I applied to that, got accepted.

The best part about that was that there are grants to train physicians to be in preventive

medicine and public health.

The focus of the program at the University of Michigan Public Health School was to train

physicians to work and stay in the local public health departments.

And so the best part about that, because there was a grant, I actually got paid to go to

school and they paid for my tuition.

And the cherry on top of that was classes were only Monday through Thursday, so I can

work Friday and Saturday on the weekends and during breaks to make a little extra money.

So it was win, win, win all the way around from that.

So that's kind of how I found myself into preventive medicine and public health.

And I've been very happy with it ever since.

Not all of the students know what opportunities are out there for preventative med doctors.

Can you just talk about your experience and then maybe also with public health, you have

a little zoology background.

So how does that also inform your practice?

The zoology background, well, zoology was as a major, was really a convenience because

after you completed your pre-med requirements, you just needed one or two more classes to

take to get the zoology degree.

So it was really more of convenience.

But I would say, I think it influenced more though of how I looked at and my approach

to osteopathic medicine because I think when the last year in undergraduate, I took a comparative

anatomy course and that informed a lot because then when I got into our osteopathic manipulative

medicine classes, I really began to understand better what we were doing and how it's different

from other kind of manual techniques and that it's really applied biomechanics, which

is what we were doing and studying in the comparative anatomy course.

So it did a lot to help inform that.

The other part is just that it's more of that adaptive part of anatomy that just like

your body's anatomy shapes, form and function in a lot of ways and that the same thing with

when you think about communities, how communities are structured and everyone's structured a

little bit differently.

So maybe some things work better in some communities than others because of the way they're structured.

It's a lot of the similarities that way but on a much bigger macro level if that makes

any kind of sense to you.

That does.

So you finished your public health degree and then what were your thought process in

looking for that job after you finish?

My number one thought process was I just wanted to get back to Arizona to be really honest

about it.

I mean I pretty much knew by the time I was in high school in Michigan that I was not

going to stay in Michigan and I just really enjoyed the community and the environment

in the West and in Arizona and the people that I worked with.

But I was looking for something where I could really have an impact on policy to be able

to kind of work in a group that much like a group practice where you rely on each other

or you can learn from each other.

And so in other words I knew that I didn't know everything I needed to know in public

health but I was looking for that opportunity to be able to practice and to learn as I went

along and have some mentorship along the way.

And when I ended up finally applying to the Arizona Department of Health Services where

I had my first really real full-time paid public health job, it was like that.

It was like working in a group practice in a way even though I was in a governmental

agency.

My boss who hired me, who was the division director and the state epidemiologist, he

was an MD, MPH.

We had an epidemiologist in our HIV AIDS program at the time and you've got to understand

this is the late 80s so this is like very early on in the response to HIV AIDS.

He was also a public health physician, we had another public health physician who worked

in occupational and chronic disease control.

The deputy director was a physician.

So it's all this line so it was like it was really nice even though it wasn't a medical

model as you would think about like in a hospital or a clinic but we all had different leadership

roles within the agency for our particular areas working with people who were epidemiologists

or health educators or administrators or disease investigators, environmental health specialists.

Just a whole different variety of disciplines working together to achieve a particular goal.

So that experience was kind of like my job was almost like running a little local health

department without actually having all the other issues with running a local health department

because much of what my area was doing was working with the local health departments

and you know and be able to organize statewide program in coordination with the local health

departments and be able to meet their needs in particular areas that I had authority in.

Can you kind of share how like what's the difference between working at that state level

and then going down to work at a county?

Well I wouldn't say going down, they're definitely different.

You know I'm very grateful for any of my experience at the state level and working in the state

health department which is also where I did my practicum for my residency at the state

health department in Indiana.

So that's what I came with and that's what I knew when I first started.

Working at a local health department is really, I enjoyed the most, I liked local public health

because you're so much closer to the people in your community and so and you really get

to learn about different aspects of a community that way because you're not just working just

with doctor's offices and hospitals but you're working with the school district or school

districts as we have many of them here just in the Phoenix area.

But others, service agencies, nonprofits, voluntary organizations that all have a role

in proving and protecting and promoting the health of the community.

And so from that part I just, it is definitely a different pace or different rhythm than

working at the state health department.

But it also helps having worked at the state health department to know like oh this is

how I need to interact, here's where I can interact with the people at the state health

department, here's the things I know the questions that I need to ask my state health department

people because I used to be one of them.

Or understanding what's driving their decisions and so that helped to work better.

The other part of it is, and just to be really blunt about it, is that working in state government,

the budget is prepared by the governor's office with input from obviously all the agencies

but it has to get passed through a legislature.

And so getting pay increases for yourself and for others is very challenging.

So read a lot, if you track this a lot in your own state, state government workers may

go years without having any kind of pay increase or only very small incremental increases.

The difference working for a county was in our county there were only five county commissioners

or supervisors in our county.

They only had to get five people to agree on the budget and you have a county manager

and the health coordinator and all that.

So it's a lot, so at the local level, local salary increases and benefits at the local

level improve much more quickly than they do at the state level in most cases.

Thank you for kind of explaining some of that.

So now you are mostly academic and you've taught at many different institutions.

Can you just kind of describe your experience in academia?

Sure.

I recognized early on in my career that academia was definitely an option.

I mean, kind of like, you know, when you came down to and looking for a job, it's either

I can work for a state or local public health department.

I can work for a health, you know, some sort of health organization, particularly like

a health plan or managed care plan or hospital system or in academia.

I'm sure that there's probably there's other routes, but those are the three main things

I was looking at.

And so I always recognized that academics was something that I was interested in, that

I took whatever opportunity that was offered to me to to either do faculty development

or to be part of an academic or partner with an academic program to do that, to start building

that kind of academic portfolio so so I can get experience with that, but also with the

idea that someday, you know, I might want to transition into an academic position.

And it helps to have shown that, you know, that you prepared for that or that you have

experience for that.

So a lot of ways was implicit to my job.

It was often necessary to speak at conferences or small groups and prepare presentations

to talk about things that are happening currently, you know, in public health.

So like right now, if I was still working in the state or local health department, I'd

probably be talking, having a talk every day about COVID or some aspect of COVID every

day.

So you do a lot of education in your job that way as well.

And in shaping that based on the particular audience that you're talking to.

The other is that there are opportunities to do work, CDC has what's known as the Epidemic

Intelligence Service Officer Program, which basically they're training largely physicians

but other health professionals in investigating outbreaks and training them in epidemiology.

And many of them are often assigned to state and some local health departments for that

program.

So I've had people that have had to supervise that were in that program or in a prevent

or supervised prevention specialist from CDC.

And so you supervise it, you're also responsible for their, you know, development in that.

So you're doing education or mentoring there.

The other was that the University of Arizona has a faculty development program.

And so I was recommended for that one year by a colleague.

So I did that, CCLM has what's known as the Costin Institute.

And so when that first was initiated, I was in the first cohort with Dr. Nichols who created

the Costin Institute.

And so that was another way for me to get more experience and understanding about, you

know, what does it mean to be working in an academic setting.

So I mean, so all those things along with taking students as, you know, being a preceptor

and taking students and whether, you know, DO students, MD students, I've had PA students,

you know, and when I worked in the public health department.

I mean, all those things kind of build up, you know, your kind of academic portfolio,

as well as even volunteering to do admissions interviews, which I did at least a couple

times a year when it was with the county health department here in the Phoenix area.

So you're our first physician that teaches at Arizona College.

Can you just kind of highlight the Arizona school and then maybe also talk about your

new role with like the dual program MPH?

Sure.

Well, the ASCOM, let's see, it's approaching its 25th year since its inauguration.

It's out here just northwest of downtown Phoenix in Glendale, Arizona, which is a suburb, much

like Downers Grove is to Chicago.

And we have about 250, we started, they start out with 125 students and around 2007, I believe

it's when they increase enrollment to 250 students in each class.

So now we have about a thousand students on and off campus that we're, you know, that

we're educating here, you know, here in Arizona.

You know, it's separately accredited from, on its own.

It's not an offshoot of CCOM.

You know, we don't necessarily share curriculum, but, you know, we don't exactly have the exact

same curriculum.

We teach a lot of the same things, but how it's organized may be different here.

And but we, you know, I know that, you know, there's contact and, you know, discussion

going on back and forth between both deans and some of the staff here with our CCOM counterparts.

And students are, when they do their clinical rotations, we have several different regions.

We have students assigned here in the Phoenix area and what we call the East and West Valley

areas.

And we have cohortists and then some of them are organizing cohorts around a particular

hospital here in the Valley.

We have a cohort of students in Tucson as well as in LA and in San Diego.

And then we have a cohort in Chicago around, you know, based in Swedish covenant.

And then I'm trying to remember, the last one is I believe in Normal, Illinois.

We have a few students there as well.

So people are pretty spread out, certainly present a lot of challenges during, you know,

the shutdown, but we made up with that with a lot of online teaching during that time

and we still continue to do that when necessary.

What was that last part you asked about?

Just kind of asking for students as they make their decision about if they do a peer program

or, you know, some of them have a dual degree program.

So just wanted to talk about what you're doing at Arizona with that.

Yeah.

Okay.

Yeah.

Well, the dual degree, you know, DO MPH program is really exciting.

I'm really, you know, excited that Midwestern has started an MPH degree program because

I think we, you know, it's something that I know that when I've done admissions interviews

the last several years, usually I have at least two or three students, you know, each

year or applicants each year ask about whether, you know, Midwest will ever offer an MPH degree

program and then, and I think it is a big selling point for a lot of students that want

to have a little bit more, want to have a bigger view of health beyond just, you know,

the medical model.

So that program just got started last summer and it covers both campuses.

So we're working with students from both CCOM as well as ASCOM, but also we get students

from dental and ophthalmology and veterinarian school as part of the program.

We started out with 30 students in the first cohort and we're going to be reviewing applications

for the next cohort shortly.

But the program is really intended for design so that students can complete this during

their four years of medical school or whatever program they're in and where students can

start the degree program once they're accepted into their primary program during the summer

before they begin the primary program.

So we had DO students that were going to start in the fall in 2020 who last summer started

their MPH degree and then next summer between first and second year they'll take additional

courses and then they'll also complete a practicum and take some electives in order to complete

their degree program.

And then once they do that then they will be able to graduate with both their DO degree

and with their MPH degree at the same time and I think that will give them a big leg

up hopefully both for residency but also with whatever they decide to do in the future.

Looking back at all the things that you have done, what do you think is your proudest moment

in your osteopathic journey?

Oh, yeah.

Well I would say that I think the proudest thing is that early on was one of the things

that challenges was that was assigned to me and when I worked at the state health department

here in Arizona was to update the state immunization school requirement law.

And at that time basically the law just basically the way it was written a parent can just write

a note saying yes my child is immunized and that would account for as a requirement to

the law.

So we had no idea like are they immunized against this or that or the other thing and

there weren't any specific requirements.

So that was a two-year effort and took a lot of working with a lot of different stakeholders

and building a coalition and at the end you know we were able to get that stronger and

part of it was also that it was a challenge that you know from the schools that you know

they didn't want additional administrative requirements placed on them and so working

with my staff we had to do a demonstration to show you know that it would not require

that much more work or that basically you know school staffers were doing now to enforce

a fairly written law they would use the same efforts to enforce a more specific and better

written law that had teeth and so that has done a lot then that combined with developing

organizing a statewide immunization coalition that still exists today independently those

two things together as well as you know getting a state immunization registry up and running

did so much to improve immunization rates for children of all ages and to reduce vaccine

preventable diseases in Arizona.

So that part I'm very proud of that you know depending to be a part of that.

I can't imagine just having a parent say oh yeah they're all immunized and then they they

got flu and tetanus and no measles so right it right it was what we call it did not have

any documentary proof we just took people's words for it and when I first arrived on the

job you know it was it was in the middle of a big pertussis outbreak and that's all I

did for six months was work on pertussis outbreaks.

So I'm just going to transition a little to some personal questions you mentioned earlier

that you were able to get a grant for your MPH for your DO did you take out loans or

how did you finance it I know that I think back then they had some state grants for CCOM

and then since you're with students often now do you have any advice for students in

terms of financing and then choosing you know their residency.

Yeah yeah well I would say for my residency the school had health resources service administration

administers these grants for training in preventative medicine residency and so this University

of Michigan School of Public Health had applied for that you know and received that funding

for that so that was so that's what they use I guess largely to recruit me but basically

that's how they funded my position and paid for my tuition and as well as gave me a stipend.

Medical school the only time I took a loan off of medical school was after my first year

my mom had a very my mother had a very serious medical emergency and you know did put a lot

of strain and you know on the family at the time you know made it hard for my dad to work

because he had to look after my mom and stuff you know I was on my initiative initiative

I said you know I took out a loan and paid for you know part of my medical school for

that time tuition was high but not as high as it is now but you know but I was paying

that off in small amounts and you know and finally paid that out but that was about the

only time I took out a loan for for medical school or any schooling you know it's much

different landscape today for students and you know I think I think the best thing for

them is you know really to talk to the financial aid people here you know and come up with

a plan that makes the most sense for them and hopefully will minimize the amount of

financial stress that puts on them as well.

My feeling with any kind of loan is I never like having to pay interest on interest or

play interest on taxes so if anything I would say always make sure that you're paying the

interest so that you're not paying interest on the interest because it doesn't make sense

to me you know just it just digs you down further into the financial hole that's about

the best I can say for that from my experience and then you know I think you know people

have to decide for themselves what's really important for them and what and what they're

most comfortable with you know and investigate all the different options even a lot of students

here do you know loans through the military which is great because they give you access

to some great you know training but you know later on and residency and so forth I think

people do really respect as well as admire people who have trained and served in the

armed forces and that they're valued and later on for future employment so that's something

to think about but also think about community health centers and you know the different

the National Health Service for loans both either you know during medical school or for

after medical school for loan repayment there's a lot of benefits working in a community health

center and as well as can be very gratifying for doing that you may not make the same pay

as you would if you were out on your own or in a private practice but the other side of

it is there are other things that you're not having to worry about or or having or that

are other expenses that are covered by a community health center position that would not be otherwise.

Thank you for walking us through some of the things that students can be thinking about

with that you know daunting financial investment so we talked about this huge state immunization

program can you tell us one thing about you that has made you successful throughout your

career as I like to call it what is your superpower?

That's a good question I would say persistence you know it's the thing is they always say

that you know that everybody recognizes people for all their successes but people don't always

remember that inventors like Thomas Edison before we got the light bulb to work he had

a lot of failures you don't talk about those but the point is is that you know you don't

let those failures or those things or bumps in the road define who you are you know there's

just bumps in the road you know don't look at yourself as you know being the guy or gal

like oh gee you know I'm the one I had to repeat this course or had to you know I had

to take part one of the boards three times before I passed it's like that doesn't define

you that's just a bump your patients aren't going to know that necessarily unless you

tell them but again don't let that keep you from being persistent and keep moving forward

to towards your goal and I think that's what I think always helped me is not to be defined

by those bumps in the road is as much as by you know where I'm at now and what I'm trying

to do yeah not letting you be defined by failures and just pushing forward so I'm going to

touch the third rail about work life and family balance you just talk about how you balance

career and family and then what are your hobbies sure you know I mean I think the thing is

is you just intentionally have to you know you make time for doing that you know my feeling

was is that you know when I'm at work I'm at work when I'm at home I'm at home I get

you know started having kids and you know being a new father it's like you went through

that period where you know well when you're at home you're thinking about working when

you're at work you're thinking about home and you know you have to get out of that after

a while and so my feeling was that that was my boundary you know I'm at work I'm at work

I'm at home and you know I try not let the two intersect too much or as more than necessary

but that was much harder to do when I was at you know a health officer and I was ahead

of an agency but you try to carve out those times you know where it's like this is my

time to me you know right now I mean travel is a big thing I mean I wish I could do it

right now because of you know it's not possible because of COVID but you know definitely love

to travel taking some really great trips want to be more adventurous but also my wife and

I have gone into one of the other faculty members here that I'm friends with they turned

us on to going up to Sonoma in northern California into wine country and so we're really into

wine now and really enjoy that and then most recently we've gotten into playing pickleball

so that's that's kind of like the big thing to do out here right now and talking to other

people friends elsewhere but you know people are doing that elsewhere as well so so those

are kind of the things that right now are keeping me occupied outside of work now they've

actually taken out some tennis courts and added pickleball courts in some places around

here so I've heard that as well so with this idea of like biomechanics and just to close

us off about OMM is there any connection with osteopathic medicine in public health and

then use for OMM in that arena?

I would say more the principle okay and I always say is that I compare one of the tenets

of osteopathic medicine to the mission of public health you know the mission of public

health is to ensure the conditions in which people can be healthy and when you look at

osteopathic medicine our role as physicians is to create the conditions in which the body

can heal itself to me that you know those go together very well that you know it's not

always about trying to find the disease and and just fixing disease and injuries it's

like the quote from Still is like you know finding disease is easy you know you want

to find health and you know that's what I'm trying to do and you know public health is

really focus more on how do we create the conditions for wellness and help people stay

well as well as return people back to wellness if they fall out of wellness.

So I think that's where I see the connections is really more from that philosophical approach

between osteopathic medicine and and then the mission of public health.

That makes sense so I know you have to get back to blocking and tackling with your committee

meetings this afternoon but just want to thank you for your time and then close up with what

was the best piece of advice that you got throughout your journey can be from growing

up college medical school residency even you know in the health department that you always

think of and would like to pass on to our pre-med and medical students.

I think that the one thing I think about is someone worked with an executive coach for

a short time a while back and one of the things you know he said to me that you know he's

kind of assessing you know where I'm at and kind of my orientation was you know he said

you know it's like you know you should play to win because what he was saying is that

I was you know I was trying to play things safe you know playing not to get hurt and

that doesn't work say if you're playing a ball game you know you want to play to win

so it doesn't mean that you take unreasonable risks but it's more that orientation of like

what do I need to do to to get to what I really want to get the outcome I really need to achieve

versus thinking about how do I do this without getting hurt so and I think when we had that

discussion I think that really kind of changed kind of how I looked at things and then to

change how I approached my work.

I can definitely say that you played a win so thank you so much for coming on the DO

OR DO NOT podcast really appreciate your time.

This concludes our episode of DO OR DO NOT send all inquiries comments suggestions and

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of more interviews lined up and we're excited to share them with you this is Tianyu Shea

thank you guys so much for listening to DO OR DO NOT.