Exploring the DO path with Dr. Ian Storch

And now, Stephanie, I don't even know if you know what a book is, right?

Pretty much, yeah.

Right. But, Sarah, you'll get this. It was called Baron's Guide to Medical and Dental Schools.

I think I had that book.

I'm sure you had that book. We all had that book. Stephanie did not have that book, but we had that book back in the day.

So.

Hi, everybody, and welcome to the podcast. This is Generations md. My name is Stephanie, and I'm joined here by my colleague, Dr. Sarah Davis. It was also my mother. And today we have a very special guest mom, if you want to give him an introduction.

Well, first, I want to give a shout out to one of our listeners. We got an email from a listener named Ian Cook, and he said that he had recently been accepted to do school. Congratulations, Ian. And he said that it really might be helpful for our listeners to know a little bit more about the DO path. And so he recommended that we listen to the do or Do not podcast by Dr. Ian Storch. So we did. We listened to it, and we reached out to him, and he was kind enough to agree to be on our podcast. So welcome, Dr. Storch.

Thank you so much. Pleasure to be here.

We just like to ask people to kind of give a background about their story, kind of starting, like, how you got into medicine and then how you ended up where you are today.

Sure, yeah. So I never wanted to be a doctor. Like, it wasn't really in the cards for me. So unlike you, Stephanie, I didn't have a great Maryland doctor role model, and I actually wanted to be an English teacher. So I. English professor. So I went to school for English. My parents hadn't gone to college and weren't really able to guide me. And college was great. I was sort of on my path, and I lived with another student who always wanted to be a doctor. He wanted to be ER doctor since he was a kid, and. And he was very into ambulance. You know, he had one of those. I recently asked someone if they still have it. He had, like, a green light that he put on his car when he, like, went to all these emergencies. It was really. He had oxygen in his trunk. He was, like, all into the ems. And we saw a really bad accident right before we started sophomore year of college, and we got out, and he wanted me to help him help this woman. And I really didn't obviously know what I was doing. And afterward, I really was very saddened by the whole thing, maybe a little depressed. And I just felt like if I was there by myself, I wouldn't have been able to help the woman. So I basically tried to figure out what I could do to help if I was in the situation again. I took an EMS class and I started riding with him with the ambulance. And I didn't have a green light on my car, but I really did enjoy it. And. And at some point I thought maybe I wanted to be in ems. And I did a little more research and I said, if I'm going to do this, I'm going to do it all the way. And I decided I want to go to medical school. Obviously, I'm here to talk about do school, which I'll come back to, but I went to medical school for years and I then fell in love with internal medicine. I think shout out to primary care. I think family practice and internal medicine are internists and family practice docs are the smartest people in the room. I loved it. Again, I decided on internal medicine. And during my internal medicine residency, I, you know, sort of had an inkling before that I may want to be a gastroenterologist based on a mentor that I had, which I'm happy to talk about a little bit later. And I did a GI fellowship at. I did a chief resident year, so I taught for a year. GI's pretty competitive. Doing an extra teaching year definitely helps you set yourself apart, you know, I was blessed to be asked to be chief. And then I went to University of Miami for GI again. Blessed. Really amazing GI program. I spent three years there. And then I decided that I wanted to stay in Miami. But unfortunately, or fortunately, I was married to a lovely woman whose mom still lived on Long Island. So she said to me that she wanted to come home. We came back to New York, I joined a private practice, which I'm still in now, and I practice general gastroenterology.

Great. Okay. Sorry, I have to know. Your friend, did he end up becoming like an emergency medicine physician or what happened to him?

He did. And that's a story. That's a story, yeah. So he actually went to osteopathic school also. I haven't spoken to him in a really long time, but he's in Florida practicing emergency medicine.

He has good. I mean, I'm glad things worked out for him because it would have been kind of unfortunate if you went to medical school and then he didn't.

And dream, correct? No, he's. He's doing great. He's in Florida. He's an ER doc. Again, I haven't spoken to him in a long time, but shout Out Gary.

Shout out Gary.

Love it.

So just kind of backtracking a little bit. And for some of our listeners who might not know, we have some listeners that are not in medicine and people kind of on the pre med path who maybe don't know the difference between MD and do. Can you kind of go into that a little bit?

Yeah. So that's a great question. So I'll just start with how I ended up in osteopathic medicine. I think maybe that'll answer your question. So, you know, I alluded to the fact that didn't have anybody in medicine, didn't have any real role models, but I did have a roommate. Not Gary, another roommate in my junior year when I was ready to apply to med school. His name is James Duel. He's an anesthesiologist now. He went to University of Rochester for M school. And James was kind of like my guide to applying to medical school. So I said, james, I want to apply to med school. You know, do you have any advice for me? And he gave me. He was so organized. He's like one of these OCD guys where everything's highlighted. He's a genius and he's very organized. So he said, I have a file cabinet. I think he was a year above me. He was a senior. I was a junior. He gave me his file cabinet full of med school stuff. And. And in. In that package was a book that was called and Now Stephanie, I don't even know if you know what a book is, right?

Pretty much, yeah.

Right. But, Sarah, you'll get this. It was called Baron's Guide to Medical and Dental Schools.

I think I had that book.

I'm sure you had that book. We all had that book. Stephanie did not have that book, but we had that book back in the day. So it was like basically like 100 pages of med schools with addresses and kind of like the highlights on the school. And then there are a couple of pages on dental school, maybe 10 schools on dental school. And on page 145, and I still have. The page that I tore out of the book was one page front and back on osteopathic schools with a little description. And I read it and it was basically talking about holistic medicine and. And manipulation and the osteopathic philosophy. And I believe there were 14 schools at the time. And I tore it out of the book and I wrote away again, you guys don't do this anymore because you got the Internet, which is great. But I wrote away for paraphernalia from each of the schools. And then again, I'm a little OCD myself. I went to the library, I took out all the books I could find on osteopathic medicine, and I just fell in love. I was like, this. This is what I want to do. And I went back to James Duel, and I said, what do you think of this? And he said, I've never heard of that in my life. You know, so. Which was, you know, funny. But he said, I don't know, it sounds cool. Like, you know, do a little more research. I went home and I had a physical. I went to my primary care doc, my family practice doc. I was wrestling at the time, and I needed a sports physical. And I asked him, his name is Stuart Horowitz. I said, Dr. Horowitz, do you. Do you know what this is? And I pulled out my page that I had torn out of this. This Barron's book, and. And he said, yeah, of course I went to Des Moines. I'm a do. So. Yeah. I said, I didn't even know you were with. I didn't know you were do. How come I didn't know it? And it doesn't say do on the door. And it said Dr. Stuart Horowitz. And he said, listen, when I first got out of school, I put it on my door, but then I was, like, explaining it all the time. It was really annoying. So I just put Dr. Stuart Horowitz. And I was asking him all these questions, and he said that he loved it. I asked him why he didn't do any manual medicine. He told me that he wasn't good at it in school. And even though he thought it was really a great modality, it just wasn't something that he was great at. He didn't want to hurt anybody. So, you know, if he. If he thought somebody needed it, he referred it out. And he said, yeah, I think you should go to osteopathic school. I love that. So I applied to the 14 schools, or a few of them, and I ended up getting into Kirksville, which is in Missouri. That's the Founder School. Because if I'm going to, you know, go big or go home, right? I'm like, let me go to the Founder School. So I went there, I interviewed, I got in, and I also got into the New York school. I got into a few other schools as well, but I got into the New York school. And I had a girlfriend at the time who is not my wife. We were together for about a year into medical school, but she was like, you know, if you want to stay together, we have to be in New York. I'm not going to Missouri, so I ended up going to the New York College of Osteopathic Medicine. I'm going to come back and answer your questions. So I loved osteopathic school. I'll talk to you a little bit about why I started the podcast. I'll come full circle to that as well. But, you know, the, the philosophy of osteopathic medicine, as I mentioned, is very holistic, which means that we. And it's used very loosely and it's hard to really comprehend and not to. You know, I have obviously tons of friends that are MDs, and you know, sometimes we'll have this type of conversation, but the philosophy is mind, body, spirit, and looking at the patient as a whole. And, and it's really ingrained into. So as an md, you know, sometimes people would be like, yeah, but we do that too. Like, you know, and I get it. I have great MD colleagues and friends, great friends, besties that definitely are in internal medicine, family practice and looking at the patient as a whole. But I think in osteopathic school, it's just part of the DNA of the school that you approach things that way. And I'm not sure that all MDs have that. Not all MD schools give that. Again, not saying that. Some don't. And the manual medicine is manipulative medicine for people that want it explained. It's a little bit difficult, but some of the. There's a group of techniques, none of which I practice, by the way. So I'm a. I'm a regular gastroenterologist. You know, I do endoscopies and colonoscopies and all these kind of fun procedures. I don't do manipulation, but there are some soft tissue techniques which are similar to massage. There are some things called muscle energy techniques that are similar to techniques that a physical therapist would use. And then there are some techniques that are called high velocity, low amplitude thrusting techniques that are similar to what a chiropractor would use. The difference between those other practitioners and a do that's practicing those modalities is that a do is a complete physician, obviously. And again, I'm sorry if I didn't talk about that for your listeners at the beginning. A do practice do in the United States, and it's different in other countries, but in the US is a complete physician. Right. We practice full spectrum of medicine and surgery. We can go into any specialty, but we get this extra training time in manual medicine. Many dos like myself don't do this on a regular basis. And I've been asked on podcasts, do I think that it's do, do schools need to have manipulation in their schools? Like, does this need to be taught if most dos going out into practice don't use the technique? And the answer is 100% yes. And why? Because again, that's part of our DNA. That's part of who we are. And I think that there is value, whether you practice it or not. But learning complimentary therapies, which I'm sure both of you know from your experience in practice, that people want these things and we don't always have the answer. You know, evidence, evidence, evidence. I'm an allopathic or MD trained gastroenterologist. Again, I trained at University of Miami, a big MD program. But I think that, again, when you talk about evidence, we want evidence on everything. We don't have evidence on most things that we do. And there are many complementary therapies that have value. And I think one OMM does have value. Osteopathic manipulative therapy does have value. But I think just learning a complementary therapy and learning something a little outside the box gives you a different perspective and more of an open mind toward other complementary therapies.

I agree with that. And I also like to retain my patients whenever possible for things. So, you know, sometimes if you, if they're interested in a lot of these alternative medicine techniques or whatever they are, if they leave me and they go somewhere else for some of those things, sometimes they get some other stuff that I don't really want them doing. Or sometimes they get prescribed a lot of different herbal remedies, which sometimes are just fine, but sometimes can be harmful depending on the patient. So I agree with. It's nice to be able to offer your patients some more of those things if that's what they're looking for, and be able to retain them in your practice to do those rather than referring them out for, for that. But I do want to back up. And so we've kind of talked a little bit about the differences between MD and do, but really, I mean, most of it is very, very similar. I mean, if there's, if there's pre meds listening right now and they are applying to both MD and D.O. schools, I guess I want to talk a little bit about maybe the application process, which obviously you're not doing, you haven't done in a while, but kind of talk about how while there are these differences in some of wants, really most of it is very, very much the Same. So I guess I just wanted to kind of go over that about, you know, when you're applying to do school versus MD school and when premeds are looking at this, what. What kind of advice do you give them?

Yeah. So I would a couple of things. So, first of all, I'm not in medical education. I do not speak for the American Osteopathic Association. This is all my personal opinion. So, you know, a little. Little caveat, but I think. Let me talk about the podcast again. I never answer questions directly. I apologize for that. But the reason that I started the podcast is because I sat down five years ago and I thought to myself, and I do this every once in a while. I take a deep breath and say, is there anything that I should be doing with my life that I'm not? And I do a lot. Like, I'm a little bit nut. My poor family has to deal with me. I'm always doing like 800 things at the same time. I sat down and I said, I think the one thing I don't do is anything osteopathic. That was kind. And again, I have these philosophies. I believe in osteopathic medicine, but I wasn't really doing anything osteopathic. And at the time, I was listening to a podcast called How I Built this, which is. Yeah, you know that one?

It's great. Yeah.

Guy Raz. Love Guy Raz. Love anyone that knows Guy Raz. I appreciate that. Yeah. So Guy Raz is great. And he interviews entrepreneurs. And I really thought to myself, if I was interested in going to osteopathic school today.

What?

Or if somebody came to me and asked me exactly the question that you just asked. What would I advise if somebody was interested in going to osteopathic school? I would tell them to talk to 100 deals. I would tell them to talk to 200 deals. Like, just get a feeling for what they are and what they do. And you can't do that, obviously. Or maybe some people can, but most people can't do that. And I have so many friends that are great deals that I would say, look, talk to this person. Talk to this person. Talk to this person. And again, I was thinking, like, Guy Raz kind of does that for entrepreneurs. I think we could do that for dos. And just at that time, this is right before the pandemic, a medical student at NYT came to me for a research project. I give one lecture. I have a associate professorship at an MD school and at a DO school. I give lectures at both he remembered one of my lectures. He decided he wanted to go into gastroenterology. And he called me to see if I had research for him. And I told him, listen, I have a great idea for a research project, but I have an even better idea for a podcast. And what's funny is he was like, why do you want to do a DO podcast? Like, you have this great pedigree or gastroenterologist, I don't understand. And I told him I think that the value in doing the podcast and being able to allow students to hear the DO journey to help decide if that's for them is more important than cutting up rats or giving people probiotics or whatever. So he agreed to do it. He's actually. I think he's like two weeks away from his. His GI match, which, you know, I'm pretty hopeful he'll get. Yeah, he's great. But the first thing I would say is decide if osteopathic medicine is for you. And obviously, like, I'm promoting the podcast. If you want to talk to some D Os, we have 150 episodes of DOS that you can listen to their story and see if any of those fit with your. Your philosophy. That's number one. Number two, I think you have to seriously think about primary care. So obviously, I'm a specialist. You know, we interview neurosurgeons, we interview, you know, as a DO you can do anything. And we'll talk a little bit about the combined match and how that's changed over the years. But, you know, the main philosophy, the main mission statement of Most of the D.O. schools is to. Is to train primary care docs. So, you know, I think if. If you're totally against primary care, if holistic medicine is not for you, if you think manipulation is silly, then. Then maybe that's not what you want to do. You know, I think, you know, I interview for New York Institute of Technology. I interview students. And I think ultimately, as you said, we're. We're Both, you know, NDs and DOs are complete physicians. You know, most. Most of the schooling is the same. Most of the practice is the same. They're sort of parallel professions. So I think if you want to be a doctor, that's great, and DO school should be in the running. But to answer your question, I think that a student should think about all those things, think about if that's something that they're interested in and try to find some dos to talk to and see what their experience was like.

Well, I love that, and I appreciate you just Kind of explaining all of this and looking at it as, like, yes, D O and M D, they're both complete physicians. But it's different philosophies and it is different schooling. Yes, a lot of it is the same, but I really like looking at it in that way of, okay, is this something that I'm interested in? Is this something that I want to do? I didn't really know about the do track until probably my sophomore year of college when I was, like, starting to think about applying to medical school and different admissions committees would, like, come and talk to us. And I heard the philosophy of the DO school, and I was like, okay, like, this seems kind of cool. I like the idea of the holistic approach to things. And when I started kind of bringing that up to people, I automatically kind of got a little bit. Bit stigmatized already. Can you talk a little bit about, like, a stigma associated with do school and, like, why you think that that is a thing?

So I guess if you want me to, I can speak about my own. It's hard for me to talk in as. As a generality. Okay. So I guess I can only talk from my own experience, which I'm happy to share to you with you. So, for example, and I talk to people about this. Nobody asks their doctor where they went to undergraduate. Most people don't ask where they went to medical school. Again, I'm telling you, I'm bragging a little bit, but just about my program. University of Miami, in my opinion, is the best place that you could train for gastroenterology for a number of reasons, which is not anything that you'd be interested in. But I got such spectacular training at University of Miami. My teachers are spectacular, but nobody comes into my office and knows where I did my fellowship. They have no idea when I'm doing the colonoscopy. I think I'm a great gastroenterologist and a great proceduralist, but they're getting propofol and sleeping, so they don't even know how good I am at the procedures. So, you know, I think at the end of the day, when you're practicing, it doesn't matter. I think looking for jobs, it doesn't matter. I don't think anybody's looking at two applications. You know, I would say, sarah, if you were going to hire an associate, if it was a D or an MD you probably wouldn't care when patients come in. Have I ever had somebody come in and say, I don't want to see you because you're a do? It's actually never happened, to be honest. Sometimes people come in and tell me they came to see me because I'm a D.O. gastroenterologist, which is totally ludicrous. And, you know, again, the only thing I offer, the things that I just mentioned to you, that I have a little bit more of an open mind, but I'm a regular gastroenterologist. All of that having been said when I applied for GI fellowship. Let's talk about that. So, again, stigma is a little tough. But again, my personal experience. So I went to New York College of Osteopathic Medicine. I had no idea that there could be a stigma or that there could be a prejudice or that there could be an issue. I didn't know anything. I didn't know any doctors. I just knew this sounded cool. I went to medical school. I did well in school. I applied for internal medicine. I actually met a gastroenterologist when I was a medical student. You know, I didn't tell you this part of the story who was just awesome. He was just, like, so nice to me. And mentorship, you know, that's the other piece of do or do not. That's the other piece of advice that I would give any medical students. And, you know, obviously you have your mom as a mentor, right? Whether you appreciated her growing up or not, you know, she influenced you. But, you know, I think the. The importance of mentorship is huge. So I had an MD Gastroenterologist who is sort of my mentor, who's super nice to me. And people say, why'd you do gi? And there are a lot. I like procedures. I like internal medicine. I can give you a hundred reasons, but the main reason is because of a doctor that I met who is awesome. And I said, I want to be like him. And I think that's most people's stories. So I went to. I got offered. At the time that I was applying, it was an interesting time. And we can talk about this. But there were DO residencies and MD residencies. If you're a do, you can go into the DO match and apply for DO residencies, or you can go into MD residencies. And also at that time, there was this crazy thing where you could. You were sort of a free agent as a do, so you could sign outside the match. So if somebody could, like, tap you on the shoulder and offer you a position. So I was blessed again. My whole career, I've been blessed. But I was blessed that some big institutions like Mayo Clinic offered me spot outside the match. And ultimately the hospital that I Ended up going to offered me a spot outside the match, and it was great. So I didn't have to compete. I didn't have to have the stress of, what do you have? Match day, all this crazy stuff, Everybody's nervous. I knew where I was going to go. It was really nice. Again, you could argue that's not really fair to other people, but that's the way it was at the time. And the chief of GI at the time, I went to him before I accepted my internal medicine position. I said, listen, I'm really interested in gi. I think this is what I want to do for my career. And if I come here, what do you think? Do you think there's a chance I would get a spot? And he said, he's a great guy. I'm still friends with him. He's still practicing. And he said, stuart, if you're half as good a resident as you are as a medical student, and you know, I'd done a lot of rotations there, he's like 100%, I'm going to give you a fellowship and you're going to train with me. So no brainer, right? So I stayed there and unfortunately he left and went into this big private practice, maybe my first or second year residency. So he left and there was a new chief that came in and I applied for GI my second year. Super competitive. I applied for GI my second year of residency and I didn't get a spot. There were a lot of good. There were a lot of good people. There are a lot of people applying in my program. Around the time my program director called me. And in internal medicine, there's. I may have mentioned this, but this thing called chief resident, for those that don't know, chief resident in internal medicine is an extra year. So you do three years of internal medicine, and then if you're selected, you could spend a year as chief resident. And there were three chiefs in my program each year. And basically you teach, you do some administration, and really the other reason that you do it, you don't get paid very well, but you're paid like a resident. But the reason that you do it is because it makes you more competitive for selective. For very competitive subspecialties. So I was flattered that they offered it to me. Of course I'm going to do it, and it's going to help me get gi and usually the unwritten rule is that the chief resident of the program gets the fellowship in their program, right? So I went into the chief of GI and who. This new chief and And I sat with it and I said, look, I accepted chief resident. And, you know, I really, you know, I want to. I want to stay here for gi. You know. And he said something like, you'll have a really good chance as chief resident of getting the spot. Something like that. It was not what I really thought. He should have said, so I'm like a no B.S. kind of guy. I closed the door, I said, listen, if you're not going to give me the spot, the door is closed. Tell me I'm not going to give you. You're not going to give me the spot? He said, I'm not going to give you the spot. Yeah. And I said, can you tell me why you're not going to give me the spot? And he said, I'm not going to take a deal in my program. Like, I'm trying to increase the status. Yeah, that's. Yikes. Right? Right. Whoa. That's my story. So I was crushed, right? I walked out and I was crushed. And he said, I'll never say anything in public, but. And, and, And I believe in my family, my wife and my kids don't believe in karma. I'm not going to tell you his karma story, but what goes around comes around. But anyway, so. But I left the office. I was crushed. And. And I said to myself, you know, I'm. I'm not going to get a gi. You know, what am I going to do? I'm not going to get a GI position. You know, I'm going to be chief resident. I'm not going to get a GI position. And, and, you know, I was. I. I took a couple of days, I thought about it, and I said, you know what? Like, this is just one person, right? And we talk about, you know, we could talk about people that are. Have a bias or a prejudice against any type of person, right? And like, whether you're. Again, fill in the blank, right? We can. We can talk about a hundred different types of prejudice, and it's always terrible. So it doesn't matter why, but this was one person that wasn't gonna. That just had a bias toward me. Cause I was a do. So I thought about going to law school. I really did. I studied for the bar, for the. For the bar, for the LSAT for a little while. I had all these crazy thoughts, you know, and ultimately I would have been so happy being an internal medicine doctor. But you know how it is when you're an overachiever and somebody tells you no, like, it's just terrible. And this was kind of my dream. So I said to myself, what I need to do is, is I need everybody. Every GI program is taking in house. I can't get a spot in house. I need to become in house somewhere else. That was my. And again, I'm not on the DO topic. I apologize, but I think it's important. So I thought to myself, where would I want to go? What would my top choice of GI program be? And I sat and I thought about that for a while, and I decided University of Miami. I had interviewed there. I loved it. It's a great program. Went to my program director. He knew the story. I told him what happened. He said, there's nothing he could do. So I said, okay, you need to let me take a month of my vacation and rotate at University of Miami and insure me. And he agreed to do it. I called the chief at the University of Miami. I said, I want to come down and use a month of my vacation and prove to you that I deserve a spot. And the chief said, listen, last year we took five gi. We have five GI spots. We ranked you six, and we got our top five. So you missed the spot by one. And this year, you're chief resident, your program, you have a better shot at getting the spot. And if you come here, you could screw the whole thing up. So, yeah, so I said, look, I'm willing to bet a month of my vacation that if you let me come down, like, you'll give me the spot at the end of the month. And I went down, and at the end of the month, he gave me the spot. So, you know. Yeah, I mean, and that's just like, again, that's just a short story, but, you know, so I don't know if that answers your question to bias, but there's going to be bias against any demographic that you can think of, whether you're in the select or the minority. And there. There are biases toward dos, but, you know, again, I think it's more on an individual basis than as an overall issue.

Well, and I think what I hear you saying is that you just. You have to make your own path, and there are many obstacles that come along your way that you don't have any control over. And so if you continue to do what you love, you can find a very successful path. And sometimes it's not. It's maybe a little circuitous or it wasn't quite exactly what you had in mind, especially when you were going to that particular program and thought you would just stay there. But of course, it all Worked out great.

Exactly. And, you know, I think sometimes, you know, again, dos are the. The philosophy. The mission statement is towards primary care. You know, sometimes I hear. Do students say, you know, I couldn't get dermatology. I couldn't get orthopedics. I couldn't get neurosurgery. But, you know, when it comes down to it, you know, I have MD residents, surgical residents come to my office and rotate with me. So I like. We call it kibitzing in New York. So we have these little side talks about different things. And I talk to Maryland surgical residents from very prestigious programs and about people that went to derm from their med school. And a lot of times they tell me the students are taking a gap year in the middle of med school to do derm research in order to get it. So it's always interesting to me when people say, oh, there's a bias against me. I didn't get derm. Well, it's like, first of all, everybody wants Derm. Second of all, did you do a gap year? Did you do research? Did you get 99th percentile on your USMLE or your Comlex? And if you didn't, like, is that really a bias, or. It's just he didn't deserve the spot. So, you know, I think sometimes you need to tease that out a little bit, too.

Yeah. There's plenty of MCD students that don't get derm as well, so. Or neurosurgery or any of those.

Exactly.

I love that story, though. And I love just the idea of, like, getting out there and, you know, actually, like, going and grabbing what you want, like, actually being like, okay, I want this program. I'm gonna go do it. This is what I'm gonna do. And, like, actually, like, having control over your path, because I think so much what I feel like a lot just going down this long path towards medicine. I feel kind of like a lack of control of, like, okay, I'm gonna go to this school, and then I'm gonna do this. But that's really inspiring that you were like, I want this thing, and I'm gonna go get it. So thank you for sharing that.

Yeah. On the other side, I'm nuts. Like, I already told you that. Right? Like, I don't. Yeah, I'm just a little crazy. And, you know, it's interesting. Sometimes I have students come to me, and they say, listen, I really want to. Like, I had a woman come to me once, and she's actually a gastroenterologist now, but she said, I want to be a gastroenterologist and I want to have a work life balance. Certainly again it is possible and people do it. But I think like if you have to look at your whole life, you know. And again, this is a tangent, but I think when you're choosing a specialty, you have to not, don't just pick the specialty that's like you see as the most prestigious or you go on medscape and makes the most money. You have to find the specialty that speaks to you. You have to find what makes you happy and fits into the lifestyle that you want. And you know, that might not be neurosurgery, even though you think you want to do that time.

Yeah, I, I listened to your podcast episode recently with the white code investor guy, Jim Dolly. Yeah, he's great. But I, I, I thought he made a really excellent point talking about how, and when people are talking about how much money you can make in different specialties, that there's actually a huge margin of, you know, intra within a given specialty, how, how much difference income can be. We always look at these things of like from specialty to specialty, what the different incomes are. And yet if you look like even within this specialty, within neurosurgery or orthopedics or family medicine or internal medicine, there's a huge bell shaped curve as far as like you know, what the, what the income is. And so I, I thought that was an excellent point. I think when people, and obviously it's, you certainly have to look at what, what your income is going to be, especially when you have big loans. It's not, you can't ignore that. But I also think if you're trying to have this great work life balance. Well, I want to go in this specialty because I want to make lots of money, but I also don't want to work too hard. Well, even in that specialty, you're probably not going to make that great income if you're not going to be out there hustling.

Absolutely, absolutely. And just circling back to some of the other questions, you know, kind of going back to the direct answer to the question. And from my experience, so when I applied, as I said there were, there were separate batches. There's now one unified match. The DO programs were merged about six or seven years ago. I don't know the exact year. There's now a combined match. So whether you go to do school or MD school, osteopathic or allopathic, you enter the same match process again. DoS can be licensed in all 50 states. There are Separate boards. And that's something that you'll see on Reddit and people talking about. We try to address that on the podcast as well. So the DOs have boards that are called the Comlex and obviously the MDs have the USMLE. DOs are required to take the Comlex, but they also can take the usmle. So I think if you have questions or if somebody's listening and they have questions about the Comlex or about our boards, the DO boards. We have interviewed the president of the mbo, me and some key osteopathic figures on why the MBOME and the COMLEX is needed, how it developed. It is the boards for the dos. However, some competitive specialties like surgery, some programs, you may be more competitive with the USMLE. And again, some DOs do take the USMLE as well. I took only the Comlex for, again, I applied for internal medicine. At the time, it was nothing different. At the time that I applied, it was still, there were people that felt that you needed to take both boards. My feeling at the time was that if they don't want to take me with my DO boards, I don't want to go there. But that's me personal.

Yeah, that sounds like a lot to take two boards.

A lot. It's a lot, yeah. Again, that's one of some D.O. students do complain about that. But again, for a deep dive into why the boards are necessary and what the differences are, I would just direct people to. His name is Dr. Gimple. He's the president of the MBO. He's very intelligent, very nice guy, and we have a few episodes where we speak to him about why it's needed.

What. And I don't know if you even have this information, but is there any difference in the cost of D.O. schools versus M.D.

Schools? Yeah. So, yeah, I think that on average, first of all, I would say that I. And again, I don't have this information at my fingertips, but I think that only a few of the D.O. schools are state schools. So, you know, even in our discussion with Jim Dolly, you know, I was talking to him about cost of medical school and things like this, but, you know, I think state schools are obviously less expensive than private. So if you're looking at an average, I would say the average D.O. school is definitely going to be more expensive. As far as private school to private school, they're all so expensive now. Right? Like all of, I mean, even, even state, state funded schools are expensive. My son wants to go to medical school. He's going to be start. He's a junior in high school. So we're going to start looking at colleges. I mean, college is crazy expensive. Med school's crazy expensive. On average, I believe osteopathic medical school is more expensive.

Yeah, that was kind of my impression, but I didn't know if that was really.

I think that's true.

How are some ways that you use. You talk about the philosophy of do school and the holistic approach. How are some, like, applicable ways you use that in your practice now?

No, I think that's a good question. So I, I would say, and it's interesting, again, we can talk about how philosophies come together. We. We have a great episode with a doctor named Norman Gevitz. So there's, there's a book called the dos. And, and this is Sarah, to one of the points that you made about, like, what are. You know, that we're talking about the differences, but there's so many more similarities. So Norman Gevitz wrote a book, which I read. I told you, I went to the library to go look for DO books when I was in college. So one of the books I read was the Do's by Norman Gevitz. And I got to interview him like, 20 years later for our podcast. So. Cool.

That's awesome.

Yeah. So, you know, he really talks about, you know, the fact that we really need to, as osteopathic physicians, to be proud and to highlight our differences because they're all great and the MDs are picking up a lot of them. So you may not. It's like, kind of fading a bit. Right. That, you know, the MDs are, are picking up the DO philosophies. But, you know, the interesting thing to me as I talk to you about having an open mind, you know, again, we're talking about my practice, and I'll tell you something silly in a second, too, but have having an open mind to complementary therapies. So. And in gi, you know, I would use. The microbiome is like a huge one. So. Right. So if you went to an MD gastroenterologist, and I'm totally stereotyping and overgeneralizing. But if you went to an MD gastroenterologist 10 years ago and said, what do you think of probiotics? You know, most people would be like, that's garbage. Like, don't bother with probiotics. Right. That's silly. And, and the catchphrase now in gastroenterology is microbiome. Like, everybody's looking at microbiome, you know, Patients come to me and ask me about microbiome. And the problem is we don't know what to do with it yet. But I don't think any gastroenterologist, academic or not, that's. That's reading journals and keeping up to date would tell you anything. But the future is looking into microbiome. Like, that's what we're doing. And it goes beyond. You know, at one point, maybe five or 10 years ago, we were looking at, you know, fecal transplants for C. Diff, which is kind of gross, but, you know, like, you know, changing the microbiome of the GI tract to treat diseases that we're having problems with with classic conventional therapy, antibiotics, you know, and fecal transplant really became a thing. But now we're looking again at microbiome, and I think I've always had an open mind to those things. Again, I'm overgeneralizing. Does every. Do gastroenterologist have an open mind to complementary therapy? Maybe not, but I think that's part of our education as far as patients, you know, I see. I'm an internist, right? Like, Sarah, your family practice. So, like, I am. I always say I'm an internist, internist, internist, and then a gastroenterologist. I don't treat general medical problems, but if somebody comes in to see me and they haven't seen a doctor, well, I'll still check their cholesterol. Sometimes I'll send them for a mammogram. You know, I do, like, wacky things, but I'm like, I'm a. I'm a real doctor. I got to take care of people in the same way. You know, that's sort of the holistic, you know, and you could say that's because I was a chief resident or because I'm an internist, or you can say it's for 100 reasons. But I think that's part of my DNA, from my training, that you have to look at the patient as a whole. And if the patient's coming in for blood in their stool, you know, that, you know, even as a specialist, I take a few minutes to make sure that the healthcare maintenance is up to date. I make sure that they're seeing their primary care doctor. And again, if I can't get them to see their primary care doctor, I always say, like, I'll pretend I'm a real doctor. Right, Obviously a real doctor. But, like, you know, and I tell them, like, look, if your cholesterol comes back high, you still need to see your family practice. Doc. Or I'm going to send you to see. I'm going to send you to see somebody that I trust, but I'll send it. You know, So I think that's important. I think as far as having an appreciation, you know, I have patients sometimes that say they have a headache and they've been on medications and they're doing, you know, biologic therapies for this or that, and it's not working. And I have a lot of friends that are. That do only manipulation. And I do think that there's value for back pain, for headaches, for. For multiple problems. And if other things aren't working or they're not getting 100% of the way, I will refer to a practitioner that. That. That's all they do. And. And the silly. My last answer is, I already told you my son. And I want to get back to my son in a second, too, because I think it's an important point. My son is a rock star student. Like, he wants to be a doctor despite the fact that he grew up with me and I'm crazy. But he wants to go to med school, which, you know, and I think Sarah and Stephanie, it's really nice that, you know, you both are supporting a medical career, obviously, going forward, because you hear a lot of docs say, like, I would never let my kids go into medicine. I just think that's so sad.

They tried to get me to not do it, but, you know, here I am.

Yeah, sorry. I'm sorry. But that's sad. That's sad. Be a doctor. Like, if you love it. If you love it, there is nothing better, right? If you don't love it, there's nothing worse. But if you love it, there's nothing better. So my son wants to be a doctor. He's very studious. He's in 11th grade, and he is the heaviest backpack I've ever seen. Right? So he has this backpack with. And I bought him one with, like, clips in the front because I think it might, like, help his posture. But he's always complaining that his back hurts and at some point and he has, like, you know, he has, like, an iPad in there. He has a MacBook in there. He's got a Chromebook in there and, like, three textbooks in there. Like, you can imagine with this. And he's like a little skinny kid, and you can imagine what this backpack looks like. And he comes home and he's like, my back is killing me. I need to go see the doctor. I think I need a brace or an operation. And I'm like, I think you need to lighten up your backpack. You know, like, I think you just need to lighten up the backpack. But, like, at some point he was really upset about it and he was, he said, like, like, you're a do. Isn't there something you could do for my back? And I said, I have a table in the garage. We could dust it off and I could do some manipulation on your back. So it's a couple of years ago, and I would say most days when I get home, like, I'm. I'm talking to you guys, I'm going to get home in a little bit and he's probably going to ask me to take out the table and do some manipulation on his back. So. So I do. That's the limitation of what I do with manipulation. But I think my son would say it's important.

Yeah, that's awesome. And I, I do agree with your point that the MD schools are kind of shifting through towards this idea of, like, looking at the patient as a whole and like holistic medicine in that way. So I do agree with that point on things. But, yeah, I, I like your philosophy on everything. And that's fun with your son. He probably likes that. That's cute. I always like to ask this to our guests that come on. And I'm in my first semester of my first year of medical school, and it's about to be a long journey ahead. Do you have any advice for people like me who are at the beginning of this journey, just as we kind of continue on?

Yeah. So the. My. My son comes to me and says, and this is great. Right. So I didn't have any doctors advising me, but my son has, again, for better or worse, as me, and he says, dad, am I going to do school or am I going to MD school? Ooh, right. That's a tough one. And, you know, I tell him, like, look, you're gonna make your own decision. Like, I loved my education. I love being a do. I am the host of the do or do not podcast. Right. Like, card carrying member of the American Osteopathic association, even though, you know, again, all my postgrad is is md. But he's going to have to make his own decision the same way that your listeners will have to make their own decision on what they want to do. But advice for you. Yeah, so advice for you. So I'm going to give you the same advice I give to my son. And again, obviously, Stephanie, I don't know you that well outside of the past. Hour. But you seem like a heart. You're doing this podcast. You're going to. You're in your med school. You're doing all this stuff like you're a rock star. You're going to be fine, all right? So just chill out, right? So my son, Saturday and Sunday is in the library. You know, he's like, yeah, he's in. In high school and he has friends. He goes out on the weekend when he gets home. But he works so hard, like, do the best he can. I tell my son all the time, do the best he can. I would tell you to do the best you can. You're going to be fine. It's done. Especially for you. You're in med school already. You're done. Everything's going to be fine. And once you get in, you're a doctor, right? So you're going to be fine. I've never seen somebody that puts in 110% fail. So just always put in 110%. Never give up. Don't let anybody get you down, and figure out what makes you happy again. I think the important part of the journeys is, number one, enjoying it, which is hard when you're going through it, but you'll look back. I love medical school. Like, medical school's awesome. Like, you have four years. You know, the first two years, like, kind of stink because you're just studying. Like, my son just took a test on the Krebs cycle, and he is like, what do you think of this? I'm like, that stinks, right? The Krebs cycle is not fun. But there's so many things. There's so much knowledge. It's like, you know, the, the. The term that people use, like drinking from a. From a fire hydrant, right? They're just like, giving all this knowledge to you, and you've wanted this your whole life. So just, like, take a deep breath, don't stress. You're going to be fine. You're going to learn the material, you're going to do great, right? And then just don't get sidetracked by these medscape things. Or, like, again, I get so annoyed, you know, I'm sorry, I shouldn't even say this, but, like, when. When first year med students say they want to be a dermatologist, and I have friends at dermatologists. I love them, but that's not the end all be all. You need to find out what you like, what you love. How is that going to happen? You're going to find a mentor, just like I did. You're going to find somebody that you know and maybe it's your mom or maybe it's not. Maybe it's an ob GYN who knows who that is. But you're going to find somebody that you just click with, that you love, that you're going to say, I want to be like this person and that's what you're going to do. That's how it happens most of the time. Again, we We've interviewed 150 doctors. I'd say almost all of them met a mentor who set them on their path. And, and I think that's how it goes. So take a deep breath. You'll find your mentor, you'll figure out what you want to do and I guarantee you're going to do great.

Thank you so much. I really appreciate that. I appreciate this conversation. This has been really fun and I learned a lot about DO programs and everything. So thank you so much for being on this podcast. Do you want to plug your own podcast or any socials or anything else that you have before we wrap up?

Yeah, sure. So our podcast is Do Not, do not or do or Do Not. Some people call it do or do not. We have 150 episodes posted. We interview mostly osteopathic physicians. Sometimes we'll have guests that are sort of osteopathically affiliated, like Jim Dolly who talks about finances. Specifically we talk to him about osteopathic school. It is again, if there are premeds or medical school students listening, I think it's a great resource. We have a team of about 30 medical students that do our social media that host that are very involved with me as a mentor. So we're always looking for great pre medical students or medical students that want to be involved with us on the podcast. And if there is any one that you think we should be interviewing or anything, any topic that you'd like us to discuss, do or do not podcast.com you could send us an email. We're happy to look into doing that for you.

Awesome. And you guys know where to find us @Generations MD on Instagram, Generations MD on TikTok. And if you have any questions or interested in being a guest on the podcast, you can email us at Ask Generations mdmail. We will talk to you next week.

Thanks. Bye guys.