Episode 56: Dr. Andrew Little D.O. Associate Residency Director at AdventHealth East Orlando Emergency Medicine Residency

Dr. Andrew Little, D.O., emergency medicine physician at AdventHealth East Orlando Hospital, joins host Amir Khiabani, OMS-IV, in this episode of D.O. or Do Not. Dr. Little serves as the associate residency director for the emergency medicine residency at AdventHealth East Orlando. In addition to this role, Dr. Little is the co-founder and host of "EM Over Easy," the official podcast of the American College of Osteopathic Emergency Physicians (ACOEP). Recently, Dr. Little was nominated and selected for the Emergency Medicine Residents’ Association’s (EMRA) "45 under 45" award!

In today’s episode, Dr. Little speaks about his childhood in rural Montana and his experiences with osteopathic medicine, and why he chose his path. He speaks about his experiences throughout his premedical years, his time at Ohio University Heritage College of Osteopathic Medicine as a medical student, as well as his time as a medical resident in Ohio. Dr. Little reflects on his path and provides guidance to students of all tiers in addition to advice on the application process. He also provides a glimpse into what he, as an emergency medicine associate program director, looks for during the residency interview trail!

The team here at D.O. or Do Not Podcast hope you enjoy this episode!

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're 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, I, Amir Kibani, a fourth year medical student, will be interviewing

Dr. Andrew Little, D.O., an emergency medicine physician and associate program director at

the Advent Health East Orlando Hospital.

Dr. Little attended Shawnee State University in Portsmouth, Ohio for his bachelor's degree

in biology and later found his way to the Ohio University Heritage College of Osteopathic

Medicine for Medical School.

During his time as a medical student and resident, Dr. Little became heavily involved in advocacy

and held many roles within the American College of Osteopathic Emergency Physicians.

Dr. Little continued on after residency and became a core faculty member at the Ohio Health

Emergency Medicine Residency.

Now he continues to serve as the Emergency Medicine Associate Program Director at Advent

Health East Orlando.

Outside of the hospital, Dr. Little remains a dedicated educator and mentor on the EM

Over Easy podcast, which he co-founded and hosts.

I hope you enjoy today's episode.

All right, guys.

Welcome to another episode of the DO or Do Not Podcast.

Today, we have a really special episode with Dr. Andrew Little, D.O.

Welcome.

Hey, thanks for having me.

I'm excited to be here.

How are you doing today?

Good.

I'm actually glad that you spelled out how to say your podcast.

I would have just said the do or do not podcast, but I love that you guys make a D.O. or do

not.

We have to hashtag D.O.

proud.

Yeah, that's right.

D.O. proud.

So I did want to start, you know, it was really exciting.

I saw Dr. Andrew Little do a presentation at EFCEP, the Florida College of Emergency Physicians,

the symposium by the sea, I think it was a couple weeks ago.

And the presentation topic was train yourself.

And it really, really was awesome to me because you just worked with these low fidelity models

made these low fidelity models for medical professionals.

And they were cheap.

Like the canthotomy model was awesome.

It was like $3.

Yeah, $3.

That's all said and done.

100%.

That's awesome.

I just mentioned that because I know we have pre med students, med students, you know,

just look up the YouTube videos, we'll put them in the description, send you some links.

Awesome.

And you know, you guys can make it at home and practice for your rotations.

So now that we talked about the present a little bit, let's talk a little bit about

the past, your past.

So from what I gathered, you grew up in rural Montana.

Yeah, I'm number five or six kids.

I lived in Montana until eighth grade.

And then my parents moved me to the Midwest.

Okay.

Yeah.

That's awesome.

How do you think that influenced your decision to go into medicine?

It was huge.

My dad growing up ran a transportation company.

And so I told people he was a truck driver and he did drive truck, but he managed a trucking

company called Little Montana Transportation there in Bozeman.

And when I was seven or eight, he became a volunteer firefighter.

He did that out of, you know, our, some church leaders have pushed our entire membership

to get involved in the community.

And my dad being who my dad is, is very methodical and went to the county and they, here's the

ways you can volunteer.

And the one that stuck out to my dad was to become a volunteer firefighter.

And then over the, the next five or six years, he became an EMT and then a paramedic in the

state of Montana.

And then when I was 11, he sold his trucking company and went to college full-time at the

age of 40.

Okay.

So originally with the goal to go to medical school, but then when I was 13, he was accepted

to PA school in Ohio and at the time it was just, I mean, he was 42, had five of us still

at home.

Yeah.

And so couldn't take the, you know, the 10 or 12 year break to go to med school.

So at that time went to PA school, got a two year PA certificate and then started working.

So it was a transformational for my family, not only for me, cause I can tell you up until

that point, education was always on the list of things we needed to do, but it wasn't until

my dad went back to college and proved that like, this is really important.

And so it kind of not only changed my trajectory, but my other siblings trajectories who, to

be honest, might've not gone to college.

And so, but that transformation for my dad going from being a regular community member

to a PA in about seven years and then watching him go through that experience and then really

seeing emergency medicine upfront really was one of the driving forces why I wanted to

go to medical school.

Okay.

Okay.

Did any of your other siblings?

I have a little brother that's a nurse and my other siblings all work at regular jobs.

Okay.

And from all of that and your history, where did osteopathic medicine come from?

So, you know, it's, it's interesting.

So I, again, growing up, like most people did not know there was a distinction between

a DO and MD.

And when we moved to Ohio, we moved to a small little community outside of Dayton called

Bellbrook.

And I remember the first time realizing, at least recognizing that there was a difference.

The family doctor there also did all the sports teams.

And so I remember I played football and we got fitted for special mouthpieces and we

went to his office, Dr. Mike Murphy DO.

And I remember asking my dad, I was like, what's this DO thing?

And he was like, oh, he's a doctor.

And then I didn't think much of it until, you know, the next year when I was in my freshman

year of high school, I was wrestling and I had the concussion with a neck injury and

he did OMT on me.

I was a freshman in high school and again was like, this is what all doctors do.

I didn't know.

There wasn't any difference.

I just thought all doctors did OMT because my first experience seeing a sports medicine

physician was somebody that was a DO.

And so I got OMT in high school and then we moved and we moved to a different town in

Ohio where our sports medicine physician did not do OMT.

And I was like, why don't you do OMT?

And he's like, well, I'm an MD.

And I was like, I don't know what that means.

And so I was introduced to it in high school.

It is this kind of new thing.

And of course living in Montana where I think when I did, you know, again, this number could

be completely off, but it was like less than 50 DOs in the whole state.

And then moving to Ohio, which has been, had a rich history with osteopathy since the sixties

was one of the first States to give DOs full practice rights.

And then that kind of led to when I was an undergrad, had a couple of really good advisors,

a couple of MDs, a couple of DOs.

But then when I, when I started looking at medical schools, not that I didn't apply,

I did apply to MD schools.

I felt more at home at DO schools, nothing else, just because it was definitely family

oriented.

It was whole person oriented.

And I still remember I interviewed a handful and I'll never forget when I went to OU where

I ended up going for med school and something just felt right.

This was the place to be.

And it didn't matter.

I was going to be a DO because I was excited to be at OU and work with the people there

and be a part of their family.

So that's awesome.

Yeah.

I'm glad you hit all those points.

Cause those were most of my questions, but just rewinding a little bit back to your undergraduate

school, just cause you know, most of our audience is pre-med.

What did you do ultimately during undergrad that you thought, Hmm, this made me a great

applicant for the DO school.

Yeah.

So I did stuff that showed that I was a person.

I still remember when I, when you know, you interviewed for med school and they cared

about my grades, they cared about my scores, but almost all of my interviews were about

my two year LDS mission, my experience working as a unit secretary in an emergency department,

the limited research I did in undergrad with rats, which that was still like to this day.

If you have a chance to do rat research, find something else to do.

But it was, it was again that they were looking for the whole person.

They were, they were looking for the whole package.

Somebody that performed well academically, but was a member of the community and somebody

who would take that drive to be smart and to be thorough and to be academically minded

and take that back to a community that they're a part of.

And that's to this day, like, you know, I still remember my interviews at all the different

places and we didn't spend a ton of time looking at my grades.

We did talk about the F I got when I was a high school, high school junior in biology

that I had to retake when I was a high school freshman.

But outside of that, it was about community and people and that, that was always something

that really stuck out to me when, when I interviewed at both and when I even went and did visits

with both, you know, it was, it was about people.

Yeah.

It wasn't about numbers.

It wasn't about the, the stat sheet.

It was about taking good people and making them into good doctors.

I think that's definitely one thing that is hard for students, especially pre-med students

to wrap their head around is that grades aren't everything that you do need certain cutoffs

of course.

There's some minimums, a hundred percent.

But you know, as long as you are a whole unit, a whole person and show that you're that person,

you know, you'll be fine.

Yeah.

Yeah.

I mean, I still remember I, I won a service award when I was an undergrad called the bear

hug award from Shawnee state.

And that was literally everybody asked about that.

Yeah.

I was like, what was that about?

And so I explained that, you know, I was a scout master for my local church and then

I volunteered in the community as a tutor through my high school and just things that like, again,

showed that I was a person that they could make into a good doctor.

Exactly.

So just along the lines of undergraduate and everything, when it comes to scores, we talked

about scores.

Would you say that you were, you know, in the middle, top or anything?

I was in the middle.

I mean, I will, I mean, I don't want to sound cliche, but standardized tests have never

been my faux pas.

I've always been a middle performer.

So that's the, you know, the range to get into medical school.

The minimum when I, when I attended, it was 21 to 27.

If you got in that range, you had a, like a 95% chance of getting into somewhere in the

States.

And so I was in the middle.

You know, I got, I got, I got a 24 that was competitive enough to get me interviews at

most places.

And then of course, acceptance at a handful.

So I don't think anyone really knows what 24 is now because they use this new scale.

I have to admit that I knew that as I said that I was old because now I know it's between

like four 95 and five 30 and they got rid of the writing section and added another comprehensive

section the same.

Exactly.

It's a completely different test, but middle of the road score.

I got a fifth, a 50th percentile score.

You just aged yourself.

I just aged myself.

But speaking of age, we did, I did stumble upon an article.

We are sitting in front of one of Emra's 45 under 45.

I was hoping you wouldn't do research before we sat down.

I had to because you know what, while I was going through it, I saw that, you know, there

was a lot of amazing physicians.

I went through everyone's bio, but only three of them were DO and you're one of them.

And that's just amazing.

And I'm glad to have you on this podcast representing DOs.

Yeah.

If you want to talk about some instant imposter syndrome is when I won that award for two

reasons.

One, that list has a list of my heroes in medicine, including the other DOs that are

there.

Lauren Westifer and Rick Pescatore, two advocates for our specialty, great emergency physicians

and people who have done far and beyond more than I think I'll ever do.

But then other people that, you know, you truly respect and I appreciate you doing that

research.

Sorry, if you can't, I know I'm turning beet red because my beet red sense is going on

right now.

Yeah.

Yeah.

So now that we, you know, kind of talked about your undergrad, we do have audience members

that, you know, are med school going into residency and stuff.

I think what you said about pre-medical students kind of being that whole person kind of translates

over to medical students.

100%.

100%.

I mean, I will tell you that again, we care about scores, there are minimum cutoffs.

Those cutoffs, you know, because what do scores tell us?

Scores are a predictor of how well you'll do on board certification.

And from a residency standpoint, we really care about two things.

It's about how you perform clinically and if you'll pass your board exams.

Yes, sir.

Because I want to make sure that when you graduate that you pass boards and you get

to be the full version of what you trained for.

Because if you can't pass boards, then you can't really do what you're trained for.

And so scores do kind of give us some predictors for that.

But that being said, I love seeing community service.

Now when I say that, don't do a hundred different things.

But if, you know, I remember an applicant a couple of years ago, not at my program now,

but it was at my previous program, you know, showed that they spent 10 weeks, they had

one polite thing that they did 10 weeks every week in med school.

And so they showed consistent community involvement in this one charity.

And then people who, you know, are willing to, you know, service.

And I say service outside of the community, service of national organizations.

That shows that you're invested in your specialty and the future of medicine.

And then just other things that are well-rounded.

I have to tell you that I love it when I see somebody who says they speak a foreign language,

they play semi-competitive sports, they're part of a podcast, they're part of a blog.

It shows that like you're more than just somebody who's going to come and work.

Because I have found, especially with an EM, which we can talk about how I think EM is

the perfect specialty for osteopaths, but it's really the, I'd rather take a really

good human being and train them to be an EM doc and take somebody who's just a stat sheet

with great boards and have to rub off some of their ineptitude or some of their social

awkwardness over a three year period.

So no, well-rounded people make great emergency physicians and that makes all DOs make great

emergency physicians.

Well said.

Yeah.

Well said.

Speaking of med school, did you, as an osteopath, take USMLA?

I did.

I took step one.

At the time when I applied to residency, it was not just me applying for residency.

And so I handed my wife kind of a map of across the country where we could live, cities that

had training programs.

And my wife really wanted to be within a couple hours of either her parents or my parents,

which at the time were in Louisville and Cincinnati.

And so that meant that I was going to, or I had a sister in Michigan.

So between kind of the Ohio, Michigan, Kentucky, Western Pennsylvania.

And so with that, I didn't want to limit myself and osteopathic physicians had matched well

into many of those programs, but some of them asked that you take USMLA step one.

And so I took USMLA step one.

I can tell you that I got an okay score.

I got a 50th percentile score on Comlex and on USMLA.

That's a common theme with me, a 50th percentile, like whatever the middle of the road score

is.

That's me.

But so I did take it.

I would tell you now, like at the time I took it because I didn't have a lot of good advice

or a lot of good information.

I am of the mantra now where, you know, the Comlex has been certified as an appropriate

exam.

It's been out for over 40 years.

They provide a two digit score so they can compare it directly with the two digit score

for USMLA.

So if a program is requiring you take USMLA, you have to question, are they going to question

everything?

Like, are they going to question this whole DO thing?

Are they going to have a history of dealing with somebody taking step three for Comlex?

Or are they going to know how to navigate getting you board certified in your state?

Because there are still some states as a DO.

It's a little harder to get a license in that state.

When I moved from Ohio to Florida, I had to petition to go through the Florida Osteopathic

Association, which was fine, but luckily I did an osteopathic residency.

So I had an osteopathic internship, but you know, there are some states that make it a

little harder if you're a DO, especially if you train in a three year program.

So to me, it's the, if I was to tell you broad strokes, take Comlex and kill it.

And then if the program won't accept that, then be okay not going to that program.

So and I will tell you that that also is changing to where the number of programs that require

USMLA is going down.

There's been a big national campaign, both within the AOA and MBO and me, and then also

at educational meetings where, you know, myself and other prominent DOs within different organizations

and different residency programs are pushing the conversation of why are we still doing

this?

Why are we requiring osteopaths to spend additional money, additional opportunities for failure,

all in the name of getting a two digit score that directly correlates with the USMLA two

digit score?

It's not like Comlex sends out your score and says, figure out what it means.

Like they give it, they give a two digit score.

That's a raw number that is equivalent to USMLA.

And yeah, so to me it's the EM is more accepting than it's ever been to the Comlex.

And so don't have, oh, I didn't take the USMLA as a reason not to apply to emergency medicine.

I think that's what a lot of students right now, at least in my class as a fourth year,

we struggle with that, especially emergency medicine.

We do see that a lot of emergency medicine programs do require both.

I want to see both, but exactly what you said, they, you know, Comlex provides that percentile

how you did against your peers and everything.

So it should be viewed as the same.

And you know, it was a good, that's a good segue.

I do work closely with the Student Osteopathic Medical Association as well as the AOA.

And if medical students, if you're facing any sort of discrimination on any websites

or anything, please feel free to contact the podcast.

We do try to advocate for students that are undergoing that kind of discrimination.

So please feel free.

A hundred percent.

So yeah, getting back to kind of like your journey into this.

So talking about emergency medicine, you gave it away.

That's your specialty.

Did you know automatically, I know you talked about your father and his path and everything,

but was there any sort of like, Hey, I might want to do OB-GYN or anything else.

Yeah.

So anybody wants to reach out to my wife, let me know.

She will validate the story.

I think it was our third date.

We had casually talked about me wanting to go to medical school and the time she was

a pharmaceutical rep, usually mostly worked with primary care and she's like, Oh, you

could do family medicine.

I was like, no, I'm going to do emergency medicine.

Like early on for me, that was it.

I knew going in, I still remember the first day of med school, our dean being like, who

knows what they want to do?

And my arm just shot up and he's like, well, it could change.

And I was like, you don't know me buddy.

Like this is my entire life's been about doing this, but I will tell you that I was intrigued

about OB-GYN.

It's funny you brought that one up because it's the perfect mix of medicine and procedures

like medicine and surgery.

And so I remember going into third year, I got my core hospital assignment in my lottery

at OU.

They do a lottery and they reached out to the coordinator.

She's like, list the top three things you want to do.

And I put emergency medicine, emergency medicine, OB-GYN.

And so I did EM in the first half of my year and OB in the second half of my third year,

but early enough to where if I wanted to do OB, I could apply for away rotations.

And EM was a great month.

I loved it.

I was at a training program and then I did OB.

And I have to say that maybe the universe didn't want me to do OB because my rotation

was with a single coverage OB-GYN that covered three hospitals.

And there are no duty hours for medical students.

And so I remember I was on with an orthopedic and a general surgery resident who had duty

hours and they had duty hours and they had their own clinics they had to go to and they

had one operative day they had to go to their back to their main specialty.

So literally like, you know, I'd get a call from my attendant, he'd be at two o'clock

in the morning and be like, hello?

It's like, Andy, I got a lady laboring over at Mercy.

And I was like, I'll be over there.

And so like I, I don't remember sleeping that month.

I had two young kids at my house and I remember at the end of the month, I loved it.

I loved, I loved delivering babies.

I loved the OR mostly because GYN surgeries aren't, you know, seven hours long.

And it's very, it's, you know, kind of quick and dirty stuff.

But I remember the end of the month, I went to my wife, I was like, Hey, how are we feeling?

She was like, well, and she said something that was reminiscent of a quote my mom gave

to my dad when he wanted to go to medical school.

So my dad came home and said, Hey, I want to go to med school.

And then he brought up PA school.

And my mom was like, well, if you want to stay married to me, we're going to go to PA

school.

If you want to get married to somebody else, by all means you can become a doctor.

And while I paraphrase that and said, well, you know, if you want to stay married to me,

I think we should do emergency medicine.

But if OB-GYN is really that important to you, I'm sure we can find somebody else for

you to be.

But she said it tongue in cheek.

And at the same time, like even on OB, like I did in all my other rotations, I found myself

waiting for my pager to go off to get me to the emergency department.

Because I remember on ortho, gen surge, I am, man, we got a console in the ER, I'd be

like, all right.

And I'd be like, I'd be running as soon as they said constantly, Hey, little, I was like,

I'll figure out what room it's in.

I'll go down and ask because I just didn't, I wanted to be there.

And even now, amidst everything that's going on in our specialty, like we practice awesome

medicine.

You know, if you're wondering, like, why is emergency medicine for me, I still remember

my personal statement where I talked about how I wanted to take care of people regardless

of their ability to pay.

I really wanted to be the physician for everybody.

Yeah.

And if you think about that, we're the only physicians that the gate was open.

It's always open 24 seven, regardless of ability to pay.

Like that's just who we are.

We're the physicians.

Everybody went to medical school to be, I don't think many people went to medical school

to say, I only want to take care of people if I take their insurance or if they can afford

the $300 for their procedure.

Like that's not, that's just not honestly who anybody that wants to go to med school

is.

Now we slowly become those people because we want better schedules or, you know, we

get fascinated with procedures, but we all went to medical school to be emergency doctors.

The question is if you got shook from that throughout through med school or not.

So I like the way you put that.

Yeah.

Yeah.

The only reason I brought up a guy, believe it or not, that was the boat I was in.

Yeah.

And my wife was the one that shied me away from it.

Not because, you know, of anything else, but just the fact that she really just knew her

being in med school with me.

She knew I wanted to do ER.

She knew that, you know, she knew me better than I knew myself.

And jokes aside, my, my, you know, we had that conversation and you know, weeks later

somebody asked and she may, even now when people ask like, oh, did he always want to

be a doctor?

She's like, yeah, he had this idea that he wanted to be an OB for about a month, but

I just knew my husband and I knew that he always wanted to do emergency medicine and

I was just on board.

Exactly.

And that was something about being with the right person that knows you and is willing

to help you make the right decision.

That's exactly right.

I hope she's listening.

This isn't marriage advice, by the way, it is marriage advice, but for those that aren't

married.

Exactly.

Yeah.

So just a little bit more about just your time as a rotating student or even during

your residency, what was your experience like?

Did you see that you were having a harder time than your MD counterparts, both with

material as well as with the way you were treated?

I will tell you that I never saw any like gross negligence of being a DO.

I think the benefit there is having gone to OU, which again, like I mentioned, Ohio has

been a well-established osteopathic state for a long time.

Oh, you had a very, very robust clinical experience, which I know is not the case for all people

to go to DO school.

That's actually one of the reasons why I chose to go there on top of other ones.

Shout out to John Schneider, the admissions office and Jill, Jill Herman.

Now they're never going to listen to this, but if for some reason, you know, then tell

them Dr. Little.

We'll send it to them.

But I have to admit that when I was on my way rotations, it was interesting to me to

see how some of the programs I interviewed at were newer programs or programs that, you

know, were in states where, you know, probably more of their faculty were MDs than DOs, where

there was kind of like, Oh, you're, you're a DO student.

And I was like, yeah, yeah.

And they're like, Oh, well, let's see if you're any good.

You know, the kind of that mentality, but never, never any gross, never any gross negligence.

And then it was interesting training in a city, you know, in Columbus, where there are

two training programs.

There's a three year university program, and then there was our four year community program.

And we did a ton of cross training with them, both at our children's hospital and our trauma

center.

And it was, it was reassuring to see the glitz of training at a university hospital wore

off very quickly when a critical patient came into where we were equals.

And I would say that, you know, my training in some aspects were superior because I trained

in a community program where most of osteopathic training programs were based where I was good

at seeing all comers.

You know, we saw kids at our hospital, the university folks didn't, so I wasn't as scared

to see kids.

And so to me, I never truly saw that DO versus MD, I guess, abuse that I know some people

have.

I think part, I was insulated for that being in Ohio and even here in Florida, I mean,

the biggest hassle of being a DO at the time, now it's of course resolved because of the

unification was getting a Florida license and having to verify that I did an osteopathic

internship, which was making sure a piece of paper was filled out correctly.

But no, I've never had that DO MD stigma.

I will tell you that when I applied for jobs at a residency and then initially when I was

looking at, at leaving before I came here to Evan health, there were a couple of places

where just the little comments of like, well, you know, you'd be our first DO or you'd be

our first person that's AOBEM certified, you know, so a couple of those phrases where it

was just like, if said around the wrong person could trigger somebody else for me were some

of that's an expectation, right?

Because if you are going to a place where the first one, that's going to get said, don't

like it, like it, it's going to get said.

So I kind of knew going in that somebody was going to make a comment as such, or my credentials

were going to be called into question because I went to a smaller university, which osteopathic

schools prefer.

Exactly.

Or not prefer, but like there's a higher number of people that go to these small colleges

that go to osteopathic medical school.

And then going to a DO school that doesn't have the prominent name of, despite being

a state school, but not having the prominence, you know, the school of Ohio State or University

of Cincinnati.

So, but yeah, it's, it's just be expected.

And that's unless if you're going to train at a place with a ton of DOs and work at a

shop with a ton of DOs or go, you know, somebody's going to be the first and be ready for that.

Cause it's just, it's just human nature.

Yeah.

Yeah.

Don't get it.

Don't get mad about it.

I think we have to really think as an osteopath or a future osteopath myself in nine months.

Yes.

Hopefully I really, I really have to thank you and all of the other osteopaths that have

really kicked down doors for us because you know, that implementation of the single GME

accreditation has really helped.

And I believe you can speak on your experience as a residency director, associate residency

director.

Yeah.

Associate.

Sorry.

Associate residency director.

I believe that it's made our lives much easier applying to a programs a hundred percent.

It's required people to recognize the other group exists.

I will tell you one thing that was always at times off putting, again, I trained prior

to the certification.

I graduated.

I mean, I graduated.

My program became ACGME certified within weeks of my graduation, but it was always interesting

being like, Oh, you're at that osteopathic program in Columbus.

I mean, we've been around, I mean, we've technically been around longer than the university program.

Like some of these osteopathic programs have been, you know, we talk about first programs

in the country.

They talk about UC.

They talk about university of Louisville.

They talk about UT, our unit, uh, St. Vincent's in Toledo.

And then you got to talk about Sparrow in Michigan.

It started the same year.

Some of those did, you know, like osteopathic emergency medicine is not new.

Um, and osteopathic training centers are not new.

And I think unification is forced to the issue of recognizing that, you know, when EM joined

in 2020, there was this, you know, some people who were naive or didn't know like, man, why

do we have 55 more programs?

And it's like, well, we've always had 55 more programs.

You just acted as if they don't exist.

And so these 55 programs that were trained, the transitioned were always there, always

providing great education and sending people into the community and providing stellar opportunities

for, for osteopaths for years.

Absolutely.

Just speaking of osteopathic manipulation and medicine and all that, being an emergency

medicine physician, how do you try to incorporate the philosophy or the principles into your

practice?

Yeah.

So I think it's like, like any other tool, osteopathy is that for us.

And so there are specific patient complaints where an osteopathic examination is a part

of my exam and where an osteopathic treatment is a first line treatment while I'm doing

their exam.

Um, usually most of us go to complaints.

Usually I found most people do really well, especially with shoulder complaints and upper

and lower back complaints, people that come in with low back pain.

You know, it's the, you do the, you rotate them and you flex them and extend them.

And while I'm diagnosing a lesion, I'm also finding their end points and that documents

well if they can twist and move.

And then while I'm there, if I find something that's angry, I treat it and say, we all see

the stretch together.

And I kind of explained them that we're going to do a little bit of manipulation and they

always ask what that is.

And it's, it's, it's a modified stretch.

I'm a big fan of FPR and muscle energy.

So nothing that's really high impact.

Um, you know, I'm not a cruncher, mostly because I don't think that's widely accepting among

the general population.

It's hard to get somebody to be like, Hey, you're here.

Let me crack your back.

Some people ask for it, um, but because it's rapid treatment, you don't see the, the benefits

of that.

We're doing some of the other ones.

FPR and muscle energy are great.

And so for musculoskeletal complaints, it's part of my physical exam.

And then it's a first line treatment that I offer in as well as, Hey, we just did this

stretch.

I'm going to give you some medicine to help calm down the inflammation and everything

else.

That's the part of what I do.

Yeah.

And me doing it that way has made it easier than trying to make it a separate visit or

a separate, you know, cause I do know EM physicians who do their physical exam, order some medicine,

then go back and do OMM.

And that's just a workflow.

It's never worked for me.

Um, so for me, it's part of my physical exam and then I initially treat while I'm in the

room.

So yeah.

And it's not for everybody.

Cause as much as I would like to think everybody wants to get a hug from Dr. Little, uh, it

doesn't work out for everybody because, cause that's the other issue is OMM is, is a very

intimate treatment.

Yeah, it is.

And so a lot of people, you know, and I'll, and I'll kind of gauge that as I'm doing my

physical exam, my shoulders are the best example, cause I'm a huge fan of the Spencer's technique.

And as you're doing a shoulder exam, you can do a modified Spencer's while you're doing

it.

And you kind of get a patient's like, why is your hand in my armpit?

Like you kind of, like you get physical cues or they'll just be like, Hey, this is, and

I'm like, okay, we don't have to do this.

Give me some medicine.

And, uh, but, but it's, it's one where like, I wish I can incorporate it more, but it's

what I've found works is just with musculoskeletal complaints.

Awesome.

Dr. Little did mention FPR, FPR facilitated possession release just for the pre-meds out

there.

Look up these techniques.

These are awesome.

And it'll have your mind a little bit more open to applying to DO school and everything

and kind of show you the difference between MD and DOs just to kind of wrap this up.

Just a quick question.

Yeah.

What was the best piece of advice?

If you had any throughout your career or education, or if you had a piece of advice that you would

want to give your pre-med self or medical student self, what would you pass along early

on in your training?

Make a decision of who you are.

Um, this is a piece of advice I got really early on after some failures, cause that will

help you define how your life goes.

Are you going to be a reactive kind of person?

Are you going to be selfish?

Like you just got to make some decisions and you want to do it early.

Cause you're going to have a ton of opportunities to where decisions are going to be laid in

front of you.

Results are going to be laid in front of you.

And you want to be a person that's known to be levelheaded, methodical, not quick to

react.

Um, and this is coming from somebody who, by the way, was a lot of those things, but

got some good advice along the way.

And then, and probably the second piece of advice, if I could give a second one is look

up the idea of a personal board of directors.

We ask so much of you as a pre-med and as a medical student, you're going to make some

wrong decisions if it's just you.

You're going to make some wrong decisions if it's just you and your parents.

So look up the idea.

It's Harvard Business Review, Forbes.

They've all got articles about it and build one because that will help you make educated

decisions that are best for you now and best for your future.

So those are it.

Yeah.

Solid piece of advice.

I really wish I had someone to guide me through the stages that you guys are all going through.

And here you are.

That's why we have this podcast.

So feel free, please, if you haven't already, just follow us on Instagram at the deal or

do a podcast.

We have a Twitter, lots of memes, you know, to make you giggle and laugh.

And also please give Dr. Little a follow on his podcast, EM Over Easy.

EM Over Easy podcast at EM Over Easy on Twitter and Instagram, and then we are on Facebook.

So I appreciate that.

Awesome.

This concludes our episode of do or do not send all inquiries, comments, suggestions,

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We have plenty 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.