HCDM 2 | Osteopathic Medicine

 

What is it with osteopathic medicine that attracts a relatively small, but increasing number of new medical professionals to its ranks? For Yolanda Tun-Chiong, DO, MBA, the allure had to do with her “whole picture” thinking, an attitude that she finds irreconcilable with the conventional, allopathic model. Joining Dr. Richard Marn as the show’s first guest, she recounts her journey in medicine, from pre-med to eventually building a thriving osteopathic practice in New York City. Throughout hers story, we hear of the reason why she chose the osteopathic route instead of the more traditional one, why she chose to practice family medicine and why she changed her path into direct primary care. Dr. Yolanda’s journey is marked by hard work, sacrifices and the dedication to stay true to her path – an indelible lesson that she took from her first mentor: her father. If you, like Dr. Yolanda, are someone who wants to explore the wider world beyond the restrictive confines of allopathic medicine, then this episode is a must-listen.

Listen to the podcast here:

Exploring The Wider World Of Osteopathic Medicine With Yolanda Tun-Chiong, DO, MBA

Welcome to the first-ever guest interview episode on this new podcast Health Careers with Dr. Marn. Thank you for joining us. Before we get going with this first episode, let me first send out my hopes and prayers to anyone who has been affected by the Coronavirus affecting our world. This moment in our lives is unlike anything any of us has likely ever experienced. At some point, most of us will be directly affected by this virus. I wish everyone to be safe and healthy. Getting back to our first episode, we will learn a few things. Number one, the difference between allopathic medicine versus osteopathic medicine and why our guest, Dr. Yolanda Tun-Chiong, chose the osteopathic route. Number two, how the second language helped her achieve a medical career. Number three, how having and listening to a mentor helps keep her focused.

This next guest is a wonderful person. I’m happy to have her on the show. Her name is Dr. Yolanda Tun-Chiong. She’s an osteopathic family practice physician. Originally from Burma, she moved to New York with her family when she was a young child. She grew up in New York City, primarily in Manhattan and Staten Island. She went to Stuyvesant High School then attended Boston University for college. She majored in Human Physiology and a minor in Art. She did a one-year post-baccalaureate degree in Biomedical Sciences at Philadelphia College of Osteopathic Medicine. She also completed an MBA at St. Joseph’s University in Philadelphia. She then went on to do a family medicine residency at Beth Israel Hospital in New York City when she won the Resident of the Year teaching award.

During that time, she worked at several different locations before she found Urban Medical Group, a private family medicine practice in Manhattan, where she primarily works. She is still in faculty as an associate attending at Mount Sinai Beth Israel Department of Family Medicine. Throughout her training and her career, she has participated in a number of community organizations and is board certified with the American Board of Family Medicine. She is fluent in a lot of languages, English, Spanish, Burmese, Mandarin, Cantonese and Hakka. I think you’re going to enjoy this conversation as I even learned a few things. If you want to find out more about Dr. Tun-Chiong, you can go to UrbanMedicalGroup.com. Let’s not wait any longer. I hope you enjoy this interview as much as I enjoyed hosting it. Here we go. Let’s get started.

Welcome to the show, Dr. Yolanda Tun-Chiong. How are you?

I’m good. How are you?

I’m doing fantastic. Thank you for joining us on our show. I’m so glad you’re here. To our readers, Yolanda is the type of person that is genuine and down to earth and fun. I’ve got to know that because I’m married to my wife who is your cousin. In the introduction, I go through your credentials and talked about your resume already. What I didn’t mention is how easy it is to talk to you. It’s very unassuming. I get the deep sense that you care. I think that’s what we want out of those who take care of us and who are taking care of us, especially in medicine. When you were younger, did you always want to go into medicine?

Hi, everybody, and thank you for having me, Richard. When I was younger, I think because my dad was a pediatrician, you only see what you’re exposed to. Dad would take me to the office, because he would work seven days a week as an immigrant. He used to work in the South Bronx, then he worked in the Lower East Side and Chinatown. Seven days a week, this is all I saw. To me, I was like, “This is what grownups do.” I think in my head, this is like, “He seems to have an easy life. I get to go to work with him. I get to spend time with my dad, so why not?” That changed quickly as you get older, and you realize how hard it is.

When you were young, you spent a lot of time with your dad when he was working?

Yeah. My mom would be his secretary on weekends. Monday to Friday, she used to work for Equifax, which is that credit card company near Wall Street. On Saturdays and Sundays, because he worked seven days, she would fill in, so there was no childcare. Me and my brother, we would go there and hang out all day in the office. I watched my mom check-in patients.

How old were you when this all started that you remember?

I must have been probably 3rd, 4th grade.

Stay on your path. Don’t waver. Click To Tweet

Even as you’re growing up through school, you spent a lot of time still going to your dad’s office?

On the weekends, Saturdays and Sundays, yeah, for a lot of my life. My mom was a secretary and will work Monday to Friday. On Saturday and Sunday, it’s always hard finding somebody to help and my mom would help with the billing because this is a private office. I did that and up to high school even, I started coming home early to help him out because sometimes he’d have a lot of patients and the secretary would leave and he would still be in the office. I took over like checking in patients or finding their charge. This is back in the days when there were paper charts. I used to file too.

Very early on, you were involved in medical and healthcare.

I was but I didn’t always live with my parents when I was younger. I lived with my grandmother when I was in pre-K, kindergarten. I lived with grandma most of the time from Monday to Friday because my dad was working, my mom was working. I also worked in my grandmother’s grocery stores. I wasn’t really working. I was weighing and measuring things so I was exposed to the business grocery aspect too.

When you were with your dad, does he let you into the office and see how he was interviewing patients and such or that was separate or you were outside?

I was mostly outside. As a kid, you had no interest to go to the exam rooms. You see needles, medication, smell of alcohol, and you’re like, “I don’t want any of this.” You see blood, it was a lot having patients check in, getting their charts, alphabetical order stuff that you do little, little tasks that were mundane at the time. Sometimes people will come and he saw walk-ins. He was like an urgent care before CDMT and people will come in with a laceration or kids will come in coughing and the parents would be like, “He’s open.” He had open hours. He didn’t have an appointment so people just walk in. You saw everything come in as you’re checking the patients in. Some of them are bleeding, some of them are fine, some of them are coughing. I did get a glimpse of that when he brought them in.

How did that affect your interest in medicine? Early on because of that, did you want to then say, “I want to be a doctor,” or it left you indifferent or turned you off? How was your mindset at that time when you were in school?

When I was younger, I didn’t think anything of it. It seemed natural. I took it for granted. I was like, “I see this. I go on the weekends with my parents,” and then do their things and I’d have to do my homework on the weekends in between all of that. I didn’t enjoy being in his office when I was little. I was like, “I’m going home,” because you get bored. It’s not like there’s playtime outdoors. You’re indoors. The one thing I tell people is my dad never made it seem like he hated his job or anything like that. He seemed to enjoy going work every day. He would wear his tie, do his thing. As I got older, he doesn’t make it look hard to me. He answered his own phone calls after hours. I don’t know if part of that is his own passion or he enjoyed being with kids. He enjoyed it. For me, it looked like, “That’s natural. That looks like a good job. Why not?” It’s like a lot of cops. They have families whose kids go into law enforcement. I feel like if that’s all you see and you’re exposed to, I think that’s where the influence partially comes from. No, he had nothing bad or no bad experience from it at all.

Where was the point then, if any, that you said, “This is why I want to go to healthcare or even medicine?” Was there a point or a moment?

Once you decide, “This is what I want to do,” because you think that’s a natural step to do, you go to high school. I try to look into dentistry as you know. Your wife and our other cousins, we have like 30 cousins.

There’s a lot of healthcare in your side of the family.

HCDM 2 | Osteopathic Medicine

Osteopathic Medicine: Finding a major was one of the hardest things. You would think it’s easy, but it wasn’t.

 

We have many dentists in my family but not one of my cousin was a physician. My dad and my uncle were the physicians, but I didn’t have a young cousin who went into. My cousins who went into dentistry, I started to work with them autoclaving too. One of my cousins who’s an orthodontist, he started his practice in my dad’s office. There were weekends where I would help autoclave because then as I got older, they’re like, “Come here. You’re not following your dad’s chart.” They were in the other room. I would help autoclave.

They were cross-training you.

I was doing free labor.

“She’s here today. Let’s see what we can have her do.”

To me, I was like, “There’s medicine. There’s dentistry.” I’ll tell you, I feel very lucky because not everyone has that experience. Did I miss out on playing outdoors? Of course, I did. Did I miss out on doing other things? I was indoors on the weekend. We talked about sacrifice and I didn’t see it as sacrifice then. I was hanging out with my family. I’m hanging out with my cousin. They buy me lunch. “I’ll autoclave your instruments for you. I’ll set up your chair. I’ll clean it down for you.” At that point, I was like, “Let me look into dentistry.” In high school, I looked into it and I was like, “This is not for me. Let me go back into medicine.” I did waver between the two because again, that was my influence. It wasn’t because dentistry is bad at all. I think that dentistry is good. I couldn’t focus on the mouth alone. I remember doing research at NYU for Westinghouse research in high school, and I was like, “This is just a specialty that I want to see the rest of the body.” I’m a big picture type of person. I think it was in high school when I realized medicine is the track for me.

With that in mind, you entered college. After high school, you went into college with that mindset that you were going to go into medicine?

Yeah. I went to Boston University. I was like, “I’m going to start the pre-med track.” My dad didn’t graduate from here. He’s a foreign medical graduate from Burma. They have a different track there. There, you go from high school straight to medical school and you get one test. The top percentage of people who do well on that test have the ability to choose their line of work. Here, you have to go to college. None of my cousins did it so I was like, “I have no one to talk to about this,” and I felt a little alone there. I had to learn about MCAT. My dad didn’t have that path. He didn’t have to do for your college. That’s where I was like, “I’ve got to do the pre-med right now in first year. I’m not going to mess around.”

Did you feel like you’re blazing your own way in some way because you weren’t following a path that anybody had exactly done before.

I felt like it, yes. My dad showed me this occupation that looks fun. He had kids, they were happy, you come in and out of the office, they cry, they come out and laugh and get a lollipop. I’m like, “I’m here, worked my way to get to college and now pre-med was hard.” I’m sure you know that too. If you don’t have somebody walking you through it, sometimes you’re like, “What classes should I take? These classes are hard. Am I going to take bio because everybody else is doing bio? Am I going to do organic chem?” Finding a major was one of the hardest things. You would think it’s easy, but it wasn’t.

How competitive did you feel it was to get into your career? Was it competitive when you’re in college, when you already had the idea that you’re going to healthcare?

I think college is hard. To me, high school was tough, but I know lots of people are taking SAT exams. When I took it, it must have been different back then. I went to Stuyvesant High School. I remember I was in middle school and I took the test and never thought twice about it. Then I get called on the loudspeaker of the principal’s office, like five kids to come down to the principal’s office midday afternoon. I remember this moment, and I thought I was in trouble. I was like, “My name is in the loudspeaker.” They called five people down to the principal’s office and you’re thinking, “The other names they called, are they in trouble too?” We sat there, and I remember my hands were sweating.

The body has the ability to heal itself. Only when it doesn’t heal itself should physicians intervene. Click To Tweet

They’re like, “Congratulations, you scored well to one of these specialized high school.” I remember being like, “No way.” To me, that path itself was hard but it wasn’t that hard. Going from high school to college, I thought it was tough. BU is a big school, and then you become a number in some of the big colleges. It’s not that it’s a bad school. It’s a great school. I felt like all of a sudden, I went from like 500 students, which again is also a big school in high school, to 20,000 students. I felt lost and not knowing about pre-med majors. You can only have the guidance counselor or who they assign you as your advisor to rely on and that advisor has thousands of other kids.

How did you work your way through that then? You’re here at a big university and you have an idea what you want to do. Where was your guidance from? Is it just a guidance counselor, fellow students, mentors that you sought out?

This is the point where I’ve started feeling like my dad was helpful in telling me, “Stay on your path. Keep to your goal. Don’t waver.” You have a whole bunch of friends now. I grew up in New York City. I went from like this big city to Boston, which is a smaller city, but I also felt like all my friends who came from smaller towns, Jersey, California, Puerto Rico, they were all partying because they haven’t had that kind of freedom. I also felt like, “I worked a little bit.” I did work in high school. I had a job. I worked as a security guard. I did my experience. By the time I went to college, I was like, “I don’t really want to party.” Everybody was trying to find freedom away from home.

I don’t know if Jess ever mentioned to you, I did live by myself in high school with my cousin Steve. We didn’t have a lot of, I don’t want to say because I had parental guidance, but the supervision was a little different than, less traditional. To me, I took that as a privilege when I went to college and I’m in a big school. I could choose my way partying and go out and all this other stuff. Not that I didn’t do it. I did go to parties, but I also had friends. They put you into pre-med floor? When you mark off, you want to be pre-med, they had two floors in the dorm. That’s where we started to talk. These are friends and people that you start studying with because they’re in the same class as you doing pre-med classes, and you’ll see them so that helped.

You were surrounded by other people, like-minded, wants to go into medicine, and then fed off each other.

A lot of them did drop out because some of them thought they were pre-med and decided that’s not the path they want to take or it was too hard or some people just was like this is not what they signed up for. I still have those friends. One of them is my best friend to this day, Kathy. We supported each other. When they say, “I’m taking this class and this class,” I remember being like, “I’ve got to take that too. I want to do that and learn about it.” A lot of them veered off that path too. That’s important for a lot of your listeners and viewers to understand. Have friends that will be like, “I want to be a psychologist instead. I want to do engineering. This is not from me.” You’re like, “Maybe I want to look into that too.” I remember my dad always saying like, “You don’t have to go into medicine because of me, but don’t veer off your path. Stick to it.” My parents are like, “You picked it, you stick to it. Don’t get distracted,” because college can be distracting.

It sounds like your dad was a strong and ever-present influence or presence as well.

He still is.

Were there any particular skills that you felt you had to develop in college or even high school with the intention that you’re going to go into medicine?

My dad is like my mentor in life. He’s my guiding light. We’re close as a father-daughter, it’s like he’s my best friend. I tell him too much. I love my mother too. My mother and I, as you know, the women on our family are strong-minded. I remember in third grade, they offered three foreign languages to me. It was Spanish, Italian, and French. Back then, I was watching Muppets and Miss Piggy goes to Paris. She’s eating croissants and I want to learn French. I told my dad I want to choose French and you had to choose one. This is public school in Staten Island. I said, “I want to learn French.” My dad is like, “No.” “What? You’re saying no to me? I want to pick this language.” “You’re learning Spanish.” “No, I’m not. I want to do French.” He’s like, “No.”

I remember they gave us a test. They expose all of these third graders in my class to take the three languages. They’ll do a little bit of Spanish, Italian and French and then they tested you. They give you ten questions because I guess a lot of kids picked the language and they had to even it out. I took the test and I came out the highest scoring in Spanish and the lowest in French. It wasn’t by choice. I wanted to try hard in French. Even the teachers were like, “We think you should pick Spanish.” I told my dad. I remember I didn’t want to do it, but it became easier and easier. I don’t know if it’s because we were exposed when I used to live in Brooklyn. I have no idea. It’s not like we speak Spanish at home. It’s just maybe growing up in New York. I continued, I liked it at the end.

In high school, I continued to the point where I took Advanced Placement because I went to Spain that time. This is the one thing I thank my dad for. He made me do something because he never tells me I should do anything I don’t want to. He’s never been that dad. If I say, “I don’t want to do it,” he’s like, “Then don’t do it.” I remember strongly about the Spanish and the French and I’m mad at him in third grade. Until this day, after going to Spain, I’m fluent in Spanish. I have tons of Spanish patients. In high school, in college, I was translating. I forgot to tell you this, but I also worked at a telephone operator in high school, answering Spanish and Chinese calls to the point where my Spanish is better than my Chinese.

HCDM 2 | Osteopathic Medicine

Osteopathic Medicine: Osteopathic medicine studies the body not just based on symptoms, but based on the body as a whole.

 

That is my skill. The language skill, if you have a language, you have to play it, because it makes you a more marketable candidate. A straight-A, 4.0 student, no. I feel like sometimes my ability to understand and relate to people comes from learning the language as well and being open to it. Obviously, I became good enough to go to Spain, live there for two months, study more Spanish culture, come back to New York. When I want to have a lot of Spanish patients, they understand that. They like that even though they can speak English. We have that bond. I think that language ability which anybody can learn from.

Some better than others, but the trying part, this is the part. If you’re genuine about trying to hone in on things and say, “I’m willing to speak your language,” it got me into all these interviews, into the jobs. I must have been seventeen as a telephone operator. That helped, talking to people, being on the phone, checking patients in, saying hi, greeting. I know it sounds menial, but these were the things that helped me in my career.

Because you had developed another language and skill and you even took advantage of it by traveling and spending time there and utilizing it. You got to know and understand people better, especially in that culture.

People will tell you people in Spain are different from people in New York. Latinos in New York are different. I grew up in the neighborhood. It’s also a different type of Spanish but to me, I went to Spain to learn about a different country and was to practice more Spanish. It was part of my high school program. That gave me the confidence to speak even better, to learn it, to read it, to write it. I was writing literary essays in Spanish. I can’t do that now. I’ve lost a lot of that, but I’ve kept the conversational pieces and to talk to patients in that way. Seeing the world, travel is another thing that I think my parents early on tried to ingrain in us. Even though my dad works seven days a week, we took three weeks off, I remember in third grade into Southeast Asia. That was an amazing trip that I still remember to this day.

You applied and eventually went to medical school, but you went to an osteopathic medicine school. Can you tell me how that is different than the traditional medical school or allopathic schools? How is that different and what was your experience like when you’re there? You went to school in Philadelphia for that.

In high school, I went to pre-med and went to college. In college, I majored in a non-traditional major called Human Physiology because everyone was doing Bio and Chemistry. They thought they had to pick a science background. I did too. Sometimes that can work against you as well. I was like, “I still want to do this, but I want to look into human physiology. Boston University School of Allied Health Sciences had a Human Physiology major to smaller school within the big university. It was for healthcare professionals. You can be PTs. They graduated Master’s and PT, doctors, nurses. It’s called Allied Health Sciences. I decided to pick that part of the school and part of the large university and I said, “I’m going to human physiology.” The reason why I chose it was that you were exposed to the cadavers early on in your career. That, to me, was the turning point of me deciding to go to osteopathic medical school. We did dissections as a college student, which you know usually is reserved until you get to medical school.

I didn’t do my cadaver until I was in medical school for sure.

I was like, “This little program is the major.” I did the human physiology and then in there learned exercise physiology. They were more geared towards physical therapy. I almost wanted to become a physical therapist at that point, because I learned like every muscle in the body, every origin insertion, what every muscle did. We learned about exercise physiology. I even worked and volunteered at a gym for corporate companies and to teach people about exercise physiology. I did a lot of jobs. When I did that, I was like, “I love this. I want to be a physical therapist.” I told my dad, I was like, “I did all these pre-med. I think I want do physical therapy.” He goes, “You went to school for medicine.” I go, “I like the human body.” The human body is this amazing thing.

That’s where I learned about osteopathic medical school. Some of the people were there like, “If you like it so much and you still want to be a doctor, why don’t you become an osteopath?” I’m like. “What’s that?” and then I talked to my dad. I learned about it. Osteopathic medicine came out in the ‘60s like allopathic medicines, the MD world where most of the majority of medical schools are. In the 1800s, Dr. Andrew Taylor Still who was an MD, he was a physician. He had a lot of kids. I want to say 6 or 7 kids, and they were all devastated by meningitis. I think 5 or 4 of the kids all came down with meningitis and as a father, physician, he felt helpless. Modern-day medicine back in the 1800s could not save these kids, couldn’t help these kids. He dedicated to study the bones and how the human body in a physiological way interacted, bones, muscles. What else can we do? Medications at that time was not helpful for meningitis.

He started to look into this whole other world of biomechanics of the body, studying the body not just based on symptoms, but based on the body as a whole. Again, I told you I’m a big picture kind of person. He developed a curriculum for osteopaths and osteopathic medicine to say, “Do no harm as you know, but the body has the ability to heal itself. Only when it doesn’t heal itself should we as physicians intervene.” He developed medical schools. Osteopathic schools were one of the first ones to let women in. Treating the patient and not just a disease was his whole point. As an osteopath, when I started learning more about it, I get to learn about the human body more in detail. I learned about the physiology of how everything works in a small way, but how it works in a bigger way. Every cell has a function in our body. Not one cell is wasted in our body. It’s amazing. I told my dad, “I want to be a physical therapist.” He was like, “Look into osteopathic medicine. It’s this new thing.” I was like, “Is it?”

Your dad was encouraging you to look into it?

You can do your job well and make the money that you want to make, but at the end of the day, are you happy? Click To Tweet

Yeah, and he’s an MD. He was like, “Why don’t you look into something like this because I hear there’s something like this going on. Their doctors, they could prescribe medical, you could still see patients, but you get to learn about the body in a different way.” It is a different philosophy in treating the body. That’s when I started to gain interest in it and I shadow positions. I took a year off between college and medical school, because I was like, “Do I want to go the MD world or allopathic world?” which is what everybody is well-renowned and all these universities. The osteopathic route, the smaller school where nobody knows what a DO is. I didn’t know what it was until college. I was like, “What do I do?” My dad mentioned it and then at the human physiology, there were a couple of fellows there that mentioned it too. They were going to go to osteopathic school because they love the human body too.

I was like, “Let me look into this.” That’s what I did. I spent a year shadowing osteopaths. The curriculum is pretty much the same. It’s a parallel track with the MD, but we do have to take 400 and in some schools, that was when I was in medical school, I don’t know how that works now, but extra hours in manual therapy like using your hands to manipulate certain bones and muscles. If you come in with a headache, if you go to an MD, it’s like, “Take two Tylenols and call me in the morning.” Us it’s like, “Let’s look at your stressors.” We try to look into the emotional stressors. What’s going on at home? Are you on a computer too much? When we rule out all of those things, then we say, “I know cranial psychotherapy. Let me try that on you right now. Maybe it’s your neck muscles pulling on your head, causing your headache. Let me try and treat that with my hands.” That’s where the treatment plan differs than MD. My husband is an MD, you’re an MD. I’m able to offer manual therapy on top of that.

I didn’t even know this. It’s a much more emphasis or at least a broader at respect for the physiology of the human body. Does that sound about right?

Yeah, absolutely. That’s exactly what it is. You have DMDs and DDS or dentist. They’re still dentists. They still practice the same thing. You don’t even know when you go to a dentist, are they DMD or DDS. It is still the same, but the reason I mentioned the 1960s was a lot of people in the beginning were like osteopaths are quacks because they’re like, “What is this?” All the MDs are like, “You don’t know what you’re doing. You’re just studying bones and muscles. What do they have to do with it? What do you know?” It didn’t gain its popularity until 1960s where I believe the military started to accept it and open it up because they were looking for more medics and doctors. I think it’s starting to gain more popularity. There are a lot fewer osteopathic schools than allopathic schools, but it definitely is gaining popularity because we look at the patient a little bit more holistically. I’m not saying the MD world is bad because it’s not. I come from a whole family of MDs, my husband, my dad, you guys. It’s just a different way to look at the body.

When you were in medical school now, like Osteopathic Medicine school, you went to practice family medicine. Was that something that you want to do because your dad was a pediatrician. Were you thinking about doing pediatrics or what was your idea after you’ve gone to school, graduate school now to go into family practice?

To me, it was like, “It’s easy. My dad is a pediatrician. I work with him. We’re done.” That’s how it would be. Family medicine is more of a verbal thing. It’s not popular in big urban cities because you have many specialists. New York, LA, New Jersey, there are a lot of doctors in the city. It’s either pediatrician or internal medicine. Internal medicine are doctors who go and see people eighteen and over. From 0 to 18, you see a pediatrician. From eighteen years old, you got to switch to a new doctor, internal medicine. I started seeing that in medical school because I never knew that. I only saw kids come to my dad’s office day by day. I didn’t know what happened to them when they became twenty. That was not in my head.

I remember going back during medical school, visiting my dad on and then 25-year-olds would be like, “Dr. Tun, I need to see you. I have a cold.” He’s like, “You need to see an adult doctor. I’m a baby doctor.” They’re like, “I don’t like my adult doctor. I haven’t found one.” They were coming back from college and didn’t find any doctors. They didn’t have that time to shop around. I was looking at my dad and I’m like, “Why don’t you see them?” “I’m not trained in adult medicine.” “That’s silly. You know these kids since they were newborn. You delivered them. You were there.” He was like, “I know, but that’s how it is. That’s the law.” PCOM and osteopathic medicine has a lot of emphasis on primary care.

Most of the osteopathic medical schools are in more rural areas. They had a lot of family doctors because when you have a physician shortage in a rural area where there are not a lot of doctors, they see the whole gamut. Family in itself is a new concept in a lot of places. There you see from zero to death, we say 0 to 100. When I shadowed many of them, I was like, “This is great. You don’t let an age cutoff your doctor physician-patient relationship. You continue until you’re 30.” You see a kid, they go through life with them. They get married, have kids and a family and you see the family. That’s what I saw when I shadowed the doctors or in clinical rotations. I was like, “That’s cool. You know the entire family. Your family doctor.” That’s when I said to my dad, “I’m doing this.” He was like, “That’s a great idea.” In New York, there are few family doctors.

It is interesting that for family medicine, I think it would be harder to thrive in a city setting.

Nobody knows that it exists because it’s a fairly new resident, also specialty.

I remember when we got to know each other, I was like, “You’re going to try and make this work in family medicine in the city. That’s not going to be easy.” In New York, it’s a lot of emphasis on specialists. To thrive as a family practitioner, I remember talking to family practitioners in the city I grew up and I was like, “That’s not common.” It’s not a common thing. Most go to suburban or rural areas.

HCDM 2 | Osteopathic Medicine

Osteopathic Medicine: The stereotype against family medicine is that it is not such a hard specialty like neurosurgery.

 

Some of them do deliver babies and I’m trained in delivering babies. I don’t do C-sections. I don’t do it now but you get to see everything. In my residency, I had to deliver babies. I did obstetrics. We had to do surgery, because in some rural areas, you can do appendectomies. Family doctors can do that. I assisted in surgeries in Amish country. I was doing derm biopsies in Pennsylvania. This is in Bucks County. It’s not even that rural, it’s suburban. We did inpatient. In some hospitals, the inpatient doctors, the doctors who work inside the hospital, are also family doctors who have outpatient, offices outside. When you see that, you’re like, “That is the old school family doctor I want to be like. That’s what I strive to be. That’s what I want. I want to know my patient. I want to grow old with my patients.”

When I was in medical school, I followed a family practitioner but he was in a rural setting. He would see a patient on the beach. He did a clinical exam on the beach and I thought, “This is cool.” You did residency in family medicine and you finally decided that was done in Philadelphia too?

No. I usually do residency here in New York. I came back home. I did it at Beth Israel.

They had a family medicine program at Beth Israel. Is that still present? Do you know?

Yes. I still go in and give my yearly talks to residents there. It was established. It’s a young programming. I think it was established in the ‘80s. It was affiliated with Albert Einstein. Montefiore, and it was in the city. It was on 14th Street. When I came back home, I was like, “I’m going to look for family medicine.” There are only two in New York in Manhattan. That and Columbia. A lot of the connotations in family medicine is easy. It’s private care. Most of the time I think the stereotype is not such a hard specialty like neurosurgery, but in New York City, there are only two. There are others in Brooklyn and Queens. If you grew up and live in Manhattan, there were only Columbia and Beth Israel.

After you finished residency, you started working as a family medicine doctor. Was that easy to find work as a family medicine doctor? Did you have to join a pediatric practice or intermittent practice to utilize your skills in those separate areas?

No, it was easy. I worked seven days like my dad used to. I graduated and was like, “I’m ready for practice.” He was like, “No, you’re not. You need to work and get your experience. I’m not handing this practice over to you.” When I came out, I was like, “What? I’ve got to find a job.” I thought I was going to go to private practice and he said no. I also spent another year doing my MBA in Business Administration and I thought I would be marketable with that.

Was that the reason you did it?

I did it because I had no business sense. People say follow your passion so I did the thing that my dad did. I remember in third grade, my dad goes, “You’re doing Spanish,” and it keeps going back to my head. I was like, “I don’t want to know because I don’t like it.” Now I love it, but I did it. It’s the same thing with the MBA. I was like, “I have no business sense, but my dad has this natural knack for entrepreneurship and his pocket is like a cat.” I feel like I made it, but I don’t. I hate managing money. It’s not my thing, but I told my dad I think I should do it because I have no businesses. I don’t know how to read a financial statement. I don’t even know how to do income taxes. I don’t do any of this. He was like, “Do it. If you want to do, take an extra year. It’s part of your medical curriculum,” because they incorporate it as a dual degree. You could get your osteopathic license and the medical degree with the MBA at a nearby school. I said, “I’m going to do it,” and I’m glad I did. Am I an expert? No, but now I have financial sense, which I don’t think I would have had if I didn’t do it. I don’t think everybody needs an MBA. It puts you to debt, but more school puts you into debt.

You’re at a point where you’re in a profession. You are a professional. How does someone get there? You’ve had different experiences, but they all added up to you becoming who you are right now. The MBA was you trying to plan to become better at your profession. My question was about what it was like to start working as a family practitioner when you got out. You brought up your MBA, which we didn’t cover yet, but you felt that it was important to mention because it was part of your decision-making process.

Like I said, you do what you know. I tell people that it’s an advantage and a disadvantage in many ways. Some people only see bad things happen in their family so that’s what they grew up with. My dad worked seven days, I came out on my hour seven days too because that’s what he did. What I did was I stayed on as faculty to precept, meaning to oversee and supervise residence at my residency because they needed somebody to help. I wasn’t super busy. My dad is like, “You’re not practicing right now full-time in my office.” I was like, “I need to get a job.” I also remember a sports medicine doctor. He worked at Chelsea Piers at the time. He had asked me to write a chapter in a textbook for osteopathic medical students. I said, “Okay.” I took that job on too. I was writing and precepting. I did those two, and I had a lot of free time. I had to make money. You can’t just make money supervising residents once a week.

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This is after your training on residency. You’re looking for a job and trying to find different ways to work.

I needed to make money. It’s not like my dad is going to hand over his practice to me. He is smart. There’s a lesson to be learned here. There was a community health center nearby where I lived, and I remember one of the doctors was leaving and they had a federally qualified health program. It’s more popular in rural areas where they need a doctor, so they’ll pay your medical school loans back for you. If you spent a year there, they’ll pay for a year’s worth of loans. If you spent two years there, it’s two years’ worth of school loans. Medical school is not cheap. There was a clinic right down the corner from me. This is the advantage of growing in the Lower East Side sometimes. It’s not the richest neighborhood, so they have all these opportunities for other things.

They had a clinic there, and it was qualified as a loan repayment. I said, “One of the doctor is leaving. He just finished his loan payment. I just heard this.” I went up there and I asked him, “Are you looking for anybody?” and they said no. I did my little resume, one page. I didn’t have much to put on it because I just graduated residency. There’s no real experience other than like all the little jobs I had, security guard, this and that, telephone operator, translator at the hospital, volunteer stuff that I’m sure every other medical student will be doing. I did my little resume and I handed it to HR there like, “If you’ve changed your mind, I’m here.” They were like, “We don’t need anybody,” and I kept writing to them every week.

Finally, they called me back. I don’t know if it was my language thing. I’m going back to language skills. They didn’t ask me for my grades. They didn’t ask me for anything. It was a clinic. These are underserved clinics. They need help too. They finally emailed me back about two weeks later, and they said, “Why don’t you come in for an interview?” I was like, “Okay, great.” It’s down the block. I can come home for lunch. It all made sense and then they hired me. I did that. I worked in the sports medicine practice in Chelsea Piers. It was two different things, talk about two different worlds. One was like, there were celebrities there in Chelsea Piers. We have famous people there. We would take care of the Chelsea Piers community members.

This is early 2000s now, right?

Early 2000s when it was first built, yeah. Here we are in the Lower East Side in a clinic, and I’m dealing with kids with scalpel wounds, and I’m putting in stitches, dealing with HIV, hepatitis C and people in my community, Chinese, Spanish, Latino, African-American, a much more diverse community. I’m co-writing a chapter, and once a week I would go in and work with my dad. It’s like a social thing, but I would work with him and see patients there. I precepted, so there’s my seven days.

You kept busy. It sounds like even when you were younger, you always want to keep busy and you were surrounded by this work ethic of being busy. It’s not just clock in, clock out, five days a week. Now you’re working, but you eventually are in your own practice. How did you go from that transition? You’re working for a different bunch of different practices, and then you’re transitioning to your own practice. That’s scary too.

It’s scary. I work seven days, and I had to put on four different hats. There was a lot of tears to get me to private practice. The chapter I was working on, I got barely any credit for most of the work I did. I get upset. I’m like, “I had to put that behind me. I’m not going to think about this.” That got to me. It was a defining point, because a year after residency, I was like, “Is this what I want to do, work seven days?” I started to look at my dad and I was like, “I thought it was cool working seven days, but I want a family.” Maybe it’s because I’m female, and I taught myself this. I go back to him like, “I love you for working hard and doing everything you did, but I did not want to work that hard. I don’t like it.” He goes, “I don’t want you to work as hard as I did. I had to.”

That’s when it became a defining moment. A year after working at the health center, I cried a lot. I thought I was a perfect fit. I spoke Spanish and Chinese. I would see 20, 30 patients. I felt like I was doing family medicine. Having an MBA background, I felt like it wasn’t well run. They had grants and stuff like that, and I was frustrated. I was a doctor there, but I had no input as to how they can improve their business. I had a little bit of business background. It started making me think like, “There’s a lot of money being wasted here in these things.” Precepting, I loved to teach residents and do things, I was like, “If I keep doing this, where am I going ahead with my life and my goals?” I want a family. I want to be a mom, I wanted to do all this stuff, but I’m not going to be able to do this seven days a week. I’m spread too thin.

In Chelsea Piers, while the population is different, I didn’t like it. I didn’t see that many patients. I didn’t feel like I was being a doctor there either. I would work on weekends there and make appointments and people would not show up because they were hungover or partying and missed the appointment. I’m like, “I’m here for you.” I started to see the world in a different way after a year working outside. I said, “I need to call my own shots, I’m being pulled.” This is part of me looking at the big picture again and say, “I want to family, I want to do things, and I want to get somewhere in my life. I need to pay my bills back. I need to pay my debt. I need to think of a plan.” I quit my job peacefully with all of that. I said, “I’m going to work on my own.” That’s when I talked to my dad and I said, “I’m going to do this.”

He had another office. He had opened his third office and he doesn’t have the time to go to office. I was like, “Let me take over that office for you right now.” One or two patients will come a week because he’s always busy in the other two. He had three offices by this time, and he was already on the 1 and 2 and is running back and forth. I looked at my dad. I was like, “He’s getting older. I want him to retire. He’s worked hard for me. Let me take over the rent and everything in this third office, and you don’t have to go there. I’ll be there and cover your patients.” Slowly, that’s how I start to build my practice. I got to call the shots. I hired my own staff. It started with one who happened to be a patient who’s eighteen. She’s still with me to this day.

HCDM 2 | Osteopathic Medicine

Osteopathic Medicine: We already had a messed up healthcare system even before COVID. All the money’s going to administrations, insurance companies and pharmaceutical companies. The doctor gets pennies compared to what everybody else gets.

 

The one thing I learned is that you do all of this to get to where you are. You make all these sacrifices. You party to do the stuff. My brother was making more money than I was, and I was like, “I’m still in debt. I had to grow up. It’s time to grow up.” That’s when I was like, “I’ve got to do this.” To become a private practice, I started to use the skills I learned from all the places I worked at, the billing, how to bring in patients, which I had to do in the beginning. I was working for myself. I brought in my own patient, answered my own calls, picked up my phone, everything myself. I was a one-woman show. Later on, I started to grow. Word of mouth started happening in the community, and then my dad was starting to retire. His patient started to come to me and I think it started to grow that way.

I went to the traditional route of medicine. A year later, this past year in 2019, I decided I wanted to take another path. I was like, “I can’t do this medicine the way I’ve been doing for fifteen years of using insurances.” In 2019, I was like, “That’s it. I’m going to do something new.” I always feel like I need to reinvent myself not for anybody else, but for my own wellbeing. I was at the height of my career. I felt like I was doing well financially, paying my debt on everything, but the traditional way to practice medicine, I was burnt out. I don’t know if you’re burnt out, but I was burnt out. I had a PA and we were doing good, and I was like, “I can’t do this anymore. I need more time. Why did I go into medicine?” The point of going to private practice was to be with my family. I transitioned to direct primary care, which is what I’m in now.

What is that? I know we’ve talked about that before. I will tell you, I’m not in primary care. As a family practitioner, you’re now in Direct Primary Care, DPC. What is that and how is that different than the other model where you go to the doctor and you give your insurance card, pay a copay and maybe a coinsurance? How is that different? How was that transition to even move into that area?

It stemmed from me being burnt out. I tell people you could do your job well and you could make the money that you wanted to make. You could be satisfied with that, but at the end of the day, are you happy? I was charting and typing notes for insurance companies until 1:00, 2:00 in the morning. I would work from 8:30 to 8:00 PM doing paperwork. Half that time wasn’t even seeing patients. It was because of the more patients you saw, the more you build the insurance, and the more you build the insurance, you have to charge for the insurance. I felt like maybe 70% of my time was spent on trying to write notes, and it didn’t make sense. I was like, “I want to be a doctor and I’m not being a doctor right now.” Being a doctor is supposed to make me happy. I saw my dad being happy and like, “This is what I want and I’m not getting it. I don’t know how to get there.”

If you talk to a lot of physicians in primary care, or specialists, they’re burnt out because they have to do the same thing. It’s not just in primary care we have to document chart. It’s every specialty if you build an insurance. I didn’t want to be concierge. Concierge is you charge a patient a lot of money, like $10,000 a year and you are at that beck and call of that patient and that’s okay. That’s like the celebrity move like with Michael Jackson like, “I need you to come to my house and give me an infusion of propofol or something.” That blurs that line a little bit sometimes, and I’m not taking away from it. They also build the insurance so you’re double-dipping. You charge the patient a couple thousand a year to have that personal care and to be able to contact you, but you also say for all your services, “I’m going to add an extra fee on top of that, and I’m going to bill your insurance.” I’m not helping healthcare. That’s more money. Our healthcare system is messed up as it is.

Pre-COVID is already messed up. You have burnt out doctors who don’t get paid. All the money is going to the administration’s, insurance companies, and pharmaceutical companies. The doctor gets pennies compared to what everybody else gets. It doesn’t look like it but it is pennies. There’s a lot of money in helping them. It doesn’t go to the healthcare provider. That’s why I was like, “This is wrong. I can’t sit by and do this anymore.” I talked to my friend. He’s a family doctor, he does internal medicine and he said, “I’m doing this model because I’m burnt out.” He’s at NYU, and I was like, “Tell me about it,” and he said it’s a membership-based model. You pay an affordable membership, that’s it. A monthly membership like a gym, but you’re going to be with that patient like full access. They can call you, email you, and you’re the doctor.

You want to care for the patient. You don’t care if the patient comes in if they don’t have to. The traditional model is the doctor only gets paid when the patient physically comes into the office. That’s the time you bill. You bill for surgeries, for the patient is face-to-face. In the direct primary care model, the patient calls the shots. The patient is paying you so you don’t take any money from insurance company, nothing. I have no insurance companies under my belt and the patient pays me monthly. It’s an ongoing relationship. If a patient happens to be in California with a urinary tract infection that can easily be called in with an antibiotic, first of all, you get to answer the call because you’re their doctor because you want to. Number two, why get them to go to urgent care and pay $250 to a doctor they don’t know. They’re going to call you first. You’re like, “Let me call an antibiotic for you, because you’re just there for vacation and not disrupt your vacation.”

Now the patient has the convenience of being like, “I’ve got to speak to my doctor. My doctor knows me, I’ve had this before. They know what allergies to medications I have and called in a prescription.” It became this personalized attention and each patient had their own personal doctor. That’s what direct primary care is about, that relationship, like we will not let insurance interfere with our bond. It’s this monthly membership. Since insurance companies aren’t calling in me paying for us, it’s the patient that calls the shots. If the patient says, “I need to come in. I don’t feel good,” a lot of primary care doctors will say, “Meet me at the office.”

That’s what I do now. If I don’t have patients scheduled for today, but if a patient calls me like, “I cut my finger. Can you come and look at it?” I’ll say, “I’ll meet you at the office,” because I’m working for the patient. I found that model to be awesome. This is what I went to medicine for. I get that old school doctor who knows the patient, their family, that continuity. That’s all it is. It’s a monthly membership. If the patient decides they don’t want to be part of our membership anymore, they say, “We’re done. We’re terminating, and I’m no longer your doctor.” It’s a clear contract. So far, we’ve been doing good.

When you said you were in a traditional model where insurance was involved, 70% of you felt your time was like administrative and paperwork. Has that gone down?

Yes. I’m documenting for me now. The insurance companies aren’t asking for charts for medications. I’m not billing. I don’t send a bill out. I don’t need a biller.

You don’t have to have high IQ in medicine. You just have to surround yourself with good people. Click To Tweet

There’s always some administrative work. How much time do you take for that now?

There is. You still have to document notes for the lawyers. You have to put the vitals in and all that. My administrative work has probably gone down I would say 50%. It’s bad habits. I love to write every little detail. I don’t have a perfect template for every patient because as a family doctor, I’ll see a kid, a GYN visit, a woman who had diagnosed pregnancy, a woman diagnosed with cancer, a guy who has a tumor. I don’t have a template that’s easy. Every patient is different so it does take time to document that but it’s what I want to put in there. I’m not putting things to like code right.

You’re not trying to meet someone else’s parameter. You alluded to it with different patients. What is your typical day like as a family practitioner in this type of direct primary care model? It’s still healthcare, it’s just a different way of the time and administration aspect of it. As a family practitioner, what do you do and what kind of patients do you see? What is your day-to-day work like?

My day-to-day work is I set my own hours. I have fewer patients. I’m the first female doctor in New York City to bring this model to New York. This is more of a rural model Midwest. This goes back to my whole family medicine model. I needed to spend time with my patients. I spent 30, 40 minutes already with a patient and I was losing money when I was doing the insurance model. I wasn’t billing enough. I was like, “I don’t want to give up my patient bond,” because some patients need an hour. Some patients who are going through death need a lot of time and you can’t rush through them with a code. I’m not a trailblazer though. I felt like I needed to do this. Being the first female family doctor who does this for from 0 to 100, I had to set my own goals. I didn’t even know if I was going to get any patients to join me in this model.

It’s risky, trying to do something new.

That’s what it is. I’m a risk-taker. I’m not a trailblazer, just a risk-taker. From a traditional model, you’re making all the time money and you think it could pay all your bills and you feel good going to vacations and you do things. You’re like, “I’m going to take a huge pay cut and I’m going to do something untried in New York City.” Just like family medicine was like, “There’s only two residencies. Are you going to put your eggs in this basket?” “Yeah, I’m going to do it.” Maybe part of it is you have to. My typical day is still the same as it was before, but it’s a lot less right. Not all my patients transitioned with me to this new model. I still get to see kids for shots. I went in for a patient who had chest pains. I wasn’t working because COVID times are a little different. We do a lot of telemedicine call. I got a call with a woman that had chest pain.

I know her. She’s been my patient for ten years. She hasn’t been out but she had chest pains. “Meet me at the office. I don’t want to go to the ER right now. All the ERs are dealing with COVID, tough cases.” She came into the office, I met her. I’ll see that I swabbed her nose. She’s COVID positive. I’ll see a woman who had unintended pregnancy who may want termination or doesn’t know what to do and is scared. That’s also part of my typical day. A guy with a scrotal tumor, anything because family medicine is everything. I might not be able to do surgery. I did a telemedicine call between seeing patients, and the guy cut his finger up with a glass. I was like, “You can go to urgent care,” but he was scared because there are a lot of COVID people out there. I said, “Go to CVS, get some wound closure tape sterile strips,” and he was able to find it and we telemedicined it together, like how to put it on. We were able to avoid that trip, saved him in urgent care money and a visit, and expose himself to COVID. He has a family. That’s my typical day. We see everything. I do Pap smears. I don’t know what I’ll get in a day.

Are you still working seven days a week? I’m talking about pre-COVID, before the whole Coronavirus.

No. When I started having kids and my first daughter, I remember, Tim, my husband was like, “What are you doing? You can’t work seven days. You’re eight months pregnant. You need to cut one day off.” I started taking Sundays off and then when my daughter was young, she didn’t know the difference if I work 6 days or 5 days or 4 days, so I did go to work. I had help. I had my mom and my family. As my daughter got older, and I remember in pre-K, she goes, “Mom, why do you not spend weekends with us?” That hurt. Somebody had to tell me that and that’s the problem. Sometimes we get wrapped in our daily work routine. When she said that, she must have been probably four. I was like, “You noticed I’m not here.” That’s when I was like, “I need to stop this.” I started taking weekends off. I had a PA who would work there and then that was an old model. Then I transitioned to DPC, you can make your hours in private practice. You can make your hours instead of taking these two weeks off for school. In my private care, that’s even way more flexible.

You mentioned you had some debt, I was just wondering, that’s a sacrifice you had to take on or an obligation to take on to get to where you are. What sacrifice or obligations did you take besides that, if any, so you get to achieve your achiever goal and has it been worth it?

It has definitely been worth it. My dad didn’t pay for any of my schooling at all. He didn’t try to make things hard for me, but it feels better when you achieve your own goals yourself. I got debt in college, you go through it. I applied for loans, Stafford loans, subsidized, unsubsidized. In New York, there’s a Pell Grant. I got Dean scholarship in college. You got to work hard, so that’s the whole point. I would tell people, “If you work hard, you get a grant, money and a scholarship.” For those of us who can’t get that, and not all of us can qualify, but the one thing that helped being amongst my peers in college was that they were also in the same position. They were applying for all sorts of things. They were applying for female scholarships. There are scholarships for everything.

HCDM 2 | Osteopathic Medicine

Osteopathic Medicine: Self-care is the one thing that none of us, healthcare personnel, do well. We should, but we don’t.

 

There’s a scholarship literally for almost everything, whether it’s like you’re missing a pinky or because you have this ethnic background. You need to look for it. My friends were good at that, because not all of them had money either. I was like, “Let me look into this.” There are many opportunities for a lot of minorities and females that I didn’t qualify for. I remember applying for George Soros. I applied for everything. I did all of that. At the end of the day, it was funded by scholarships, loans, but at the time and I think it’s also a good time right now because the loan is such a low-interest rate. When I was going to school then, I remember signing the loans and they’re saying, “if you consolidate your debt, we will bring it down another 1%.” It was already a 3% loan, and I brought it down to 2% by consolidating all my loans in one to one holder, and then they said, “If you do direct debit, we’ll bring down another percentage.” It was cheaper.

At the end of the day, it was like 2% I paid on my loan money. It’s basically free, not free, but you think about it over the span of 10, 15, 20 years, that money has helped because I use the money instead of paying back my loan. I’m not suggesting people do this, but if it’s such a low rate, you can also use your money to live and do other things. You can’t spend lavishly. I did not own my first car until we had kids. It’s not like I went out and bought all these things. You have to live within your means too. I didn’t travel lavishly. I did what I could. I didn’t buy nice clothes or watches. I don’t even buy watch. That’s the part of my debt management. I think a lot of that has to come with your family, what you grew up with, and how the spending habits are. It’s important. I see this a lot with doctors.

They get money and they spend it all and then they’re in debt, but they’re in debt because they caused it, not because of the education. That’s why I said my regret is not that how I lived was lavish. If everything went to schooling, and I’m using that money. I still carry a debt. It’s not because that’s what got my MBA. That’s another year to extend my debt and pay but I’m paying it off and you have to be smart about it. You have to think about where consolidating it next, associating with the lender, if they have good things, you constantly have to be on the lookout for those things.

If you could go back and you could do anything different on your career path, would you do anything different?

If I could do anything differently, I would travel more. I wish I traveled more and I stress a little less. Part of it is like the risk-taking behavior that we talked about. I always felt like I needed to do something and prove myself to someone. Maybe it was my dad, and he never asked me to. I always felt like I needed him to think I could handle this. I was busy trying to like, “I’m going to do this and do it right. I would be successful at this. I’m going to try and be successful at that.” I went to family medicine. He’s a teacher to do something different. Now I’m going to go into working with these seven different practices and see how I could do it and I’m going to do good on that. Maybe I didn’t need to work seven days a week, I don’t know. Maybe I took a little time off myself. Self-care as a medical person, or healthcare personnel is the one thing that none of us do well. We should, but we don’t.

For people who are reading, they want to get a wide range of perspectives to make an educated decision about their career choice. What resources do you recommend that some students look into, listen to or read about, organizations to belong to, or even venues to attend with regard to someone interested in something you’re doing, family medicine and private practice?

If we’re talking about med students, you could do the American Academy of Family Physicians. That’s a nice big organization. I did things like Medical Explorers. I worked with Boy Scouts. We opened up our medical school to Boy Scouts, but this is open to boys and girls to come and visit the osteopathic school, the Philadelphia College of Osteopathic Medicine. We took them to look at the sheep’s brain, the neuro lab, the cadaver just to expose them. They weren’t dissecting. It was a one-day little seminar. There are these opportunities out there. Don’t knock the Boy Scouts. There’s always all these opportunities and if you don’t have those opportunities to create them. We didn’t have that. We had a lot of hearsay and word of mouth and friends. I think the one thing I can say is that in medicine, you don’t have to have high IQ. You don’t have to be smart, but you have to surround yourself with good people.

This is in life, you have to surround yourself with people who are like-minded, who aren’t going to distract you into doing things, people who are going to open you up to things, but you also have to be able to set boundaries. There’s plenty of conferences, looking at scholarships, I’m sure you can google all of them. I think the AFP for family medicine is good. That’s where I learned about direct primary care. I got to meet other people who are interested. There were residents there. There were 80-year-old doctors there. I’m like, “What are you doing? You should be retired.” I was surprised. They put you in these little workshops. Talk to your doctor or talk to a nurse. Find something in your community that does it and that’s where it starts. That’s where it started for me. It started with family, or just your connections. If somebody speaks to you, ask them what they did. That’s all about mentorship.

Even though they’re not necessarily in that career choice that you’re interested in.

They may know somebody else. I get this from patients all the time. “I’m interested,” and I go, “Go volunteer at a hospital if you like that. Let me hook you up with a doctor. Maybe you can email that person or a nurse.”

You’ve also alluded to it before, but change is constant and you keep changing with the times and modifying it. Strong factors like climate change, technology, social media, the pandemic have changed how we do our jobs. What changes do you think or challenges in your career do you foresee happening in your career, family medicine, for example? What kind of changes do you expect in the next 1, 3, 5, 10 years from now?

Technology may change medicine in a lot of ways, but the one thing it can’t replicate is the human bond between doctor and patient. Click To Tweet

My brother asked me this, he’s not in medicine. He goes, “Are you worried about artificial intelligence taking over your job?” I thought about it and I said no. He’s like, “Why?” I said, “Because the one thing that an artificial intelligence I don’t think can replicate is the doctor-patient relationship. That bond is a human bond that can’t be taught. It has to be earned.” Maybe I’m wrong. I don’t know much about artificial intelligence enough, but anybody could take your temperature. There’s a pulse ox you could buy on Amazon and somebody could take their pulse ox pump, which I think is great. This is different than as a geologist. Your pulse ox is important. I remember pre-COVID, it was on Amazon for $20. I was buying it for family members. I was like, “Here, take one. Have it at home. It doesn’t cost much. They work just as well as my medical grade one.

Post-COVID, I looked online and it’s $50, $60, $80. I’m like, “This is ridiculous.” People need to be aware there are a lot of wearable devices out there. Some of them are good and legit, some of them are not. I do think that a lot of patients are going to try to doctor themselves. A lot of patients are going to be googling their own symptoms and using a lot of technology to help that, which is great. It’s also accuracy. As pandemic goes, there’s a lot of testing out there. There’s a lot of money to be made in healthcare. Healthcare is a huge business. I’m talking take doctors out of the equation, it still costs a lot of money. Doctors are a small portion of that, and our fees. People need to understand that. A lot of these wearable technologies cost a lot, but sometimes they don’t cost a lot. It could be $20.

I think what’s going to change and what I see changing is that a lot of patients are going to want this telemedicine now. I don’t go to the doctor, again, the direct primary care model is perfect for that, which is what we were doing before. You didn’t have to call me, just telemedicine me from California and we could talk about your urinary tract infection. You go to a lab and send them there and I can view the results. I like that part of medicine because I’m still your doctor. If you’re in Asia, Africa, or California, I’m still your doctor and we could still see if you have a pulse ox, check your pulse ox at home. That technology is nice. I want to make sure it’s as good as our medical-grade quality ones and I want to make sure the testing is a lot more standard. The one thing you can’t take away is that patient who calls me is not going to have the same bond with an urgent care doctor.

That can’t be replicated. Medicine is here to stay. The art of medicine is still as much as we talk about randomized control studies and trials and we try the sites, make it such a science and replicate thing. The one thing you can’t replicate is that human bond. I’m not saying every patient loves me. Obviously, there are patients that you don’t bond with, but the human bond is what I think everyone is craving as we move towards technology. That is the one thing that I don’t think anybody can give up. It’s that trust I feel safe.

You are perfecting science and medicine and you enjoy it and you have a patient base that keeps coming to you. That speaks volumes.

I’ve been lucky.

Yolanda, do you have any parting thoughts for anybody interested in your career?

The one thing I see a lot with our staff who go into pre-med and a lot of students is that distraction. If you want to be a doctor in your heart, and not just in medicine but whatever path you choose, stick to it. Just remember, if you’re going into it for the right reasons, if you feel like this is the right thing to do, and it makes you happy, then you stick to it. Don’t be a doctor for financial reasons. Because that reason, forget it. If being a doctor makes you little money but you want to be a doctor, what you can do is make it work for you. That passion is going to live with you. I know that sounds cliché, but you can reinvent yourself or do something different, and take that risk and try to make money in a different way.

When I did direct primary care, I can’t tell you how many people in our family, cousins that said, “You’re doing way better than I am.” It said to me, “You are brave to be doing this.” I have people laugh at me. My own dad was like, “You’re on your own.” He looked at me like, “You are giving that up? You worked hard. You’re on your own.” That hurt a little bit and I was like, “I don’t know if he believes in me.” I had doubts and even so, I tell people I knew that the old model is not working for me and I was not happy I couldn’t spend time with my family or my patients. Is that worth it? Now I get to practice medicine under my terms, go in because I like to, not because I have to, and make time for my kids. Am I good about doing that perfectly? No. Balancing? No.

My parting thought is, if it’s your passion, follow it. The money will come. I feel that’s how it is. If you love what you do, you’ll find a new way to make money. That’s why don’t get bogged down by the debt. Some people are bogged down and held in chains by certain negative thoughts that I feel like if you don’t let that bog you down, just find a different twist. Find a way out of that negativity, then you’ll get where you are. I’m still working on it, but I feel like I feel safe right now. Hopefully, that means something.

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About Dr. Yolanda Tun-Chiong

HCDM 2 | Osteopathic MedicineBoard Certified Family Physician

Medical School

Philadelphia College of Osteopathic Medicine D.O./M.B.A 2003

Residency

Albert Einstein Beth Israel Residency

Family Medicine 2006

Hospital Affiliation

Mount Sinai Beth Israel Medical Center

Languages

Burmese, Chinese (Cantonese, Mandarin, Hakka), Spanish, English

Dr. Tun-Chiong utilizes an OSTEOPATHIC approach and perspective to all her patient care.  She practices family medicine under the Direct Primary Care Model.