AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, monkeypox, medical education, advocacy issues, burnout, vaccines and more.
In today’s AMA Update, we have a special "What I Wish I Knew In Medical School" segment discussing the rewards and challenges of becoming and being a DO with Ilse Levin, DO, an AMA Trustee and a board-certified internist and epidemiologist, as well as a hospital-based physician for the Mid-Atlantic Permanente Medical Group in Silver Spring, Maryland. AMA Chief Experience Officer Todd Unger hosts.
- Ilse Levin, DO, board-certified internist and epidemiologist; member of AMA Board of Trustees
Unger: Hello and welcome to the AMA Update video and podcast. Today we have another episode in our “What I Wish I Knew in Medical School” series featuring physician leaders and questions from medical students. Before we get started, if you're a medical student and you've got a question, use the link in the description of this episode to record it and send it to us, and we might just use it in a future "What I Wish I Knew in Medical School" episode. So get going.
But today, I'm joined by Dr. Ilse Levin, an AMA trustee and board-certified internist and epidemiologist, as well as a hospital-based physician for the mid-Atlantic Permanente Medical Group in Silver Spring, Maryland. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Levin, thanks so much for joining us today.
Dr. Levin: Oh, thank you for having me.
Unger: You've said that you've had a non-traditional journey into medicine. Why don't we just start by talking a little bit about what your road looked like?
Dr. Levin: Well, after I completed an undergrad degree in marine biology, I decided to up and move to Australia, where I studied public health and tropical medicine. And that is where I had a pivotal change in my life. I had this amazing opportunity to work with the World Health Organization, studying lymphatic filariasis in Myanmar. And up until that point, I'd never really had experience really working in an underserved country and looking at their healthcare system.
And it really changed my approach to medicine and where I want to put my focus, moving forward. And it also opened up so many doors for me, moving forward. It's amazing how you make one decision to go down one path and it can change your entire life. And Myanmar itself is incredibly underserved and poor, and lacking in resources.
And so when I was looking at how to treat this infectious disease, lymphatic filariasis, it was much more about looking at, how do we involve the community? How do we work without resources that I would normally have, including clean water and refrigerators and just being able to get medications to the places and educate the people in order to deliver those medications and even being able to test people and knowing how to test people and training the locals? It wasn't a place where the resources and the infrastructure were in place. And so I really had to learn to think differently than coming from the U.S. and Australia, where the resources and the infrastructure were so different.
Unger: It's funny because we talk a lot about obstacles to patient care, but I don't think most people have those particular things on their list. You recently gave a presentation to a group of students and you talked about what you thought you knew about becoming a doctor. I'm curious how that differed from the reality of it.
Dr. Levin: When I started down the road to medicine, I thought about it a lot as black and white. You learn, you study, you understand how to treat something and then you treat it. And what I found was the art of medicine is so much more involved than that.
So it's understanding the big picture and where you are in that big picture with that patient and how you apply the knowledge that you have to that patient's individual experience. So if you have someone—and I'm going to use extreme examples—if you have someone who's homeless and needs to be on insulin, how do you get insulin to that patient? And if you have someone—let's use COVID as another example.
In the beginning, we didn't have tests that would tell us that someone had COVID for about a week. And so we had to figure out, well, what are the patterns that we're looking at? What are the things that will tell us what's going on with this patient? And so it was much more the grays of medicine that I had to learn, but those are really the most important parts of actually practicing medicine.
Unger: Dr. Levin, you're a DO. And I'm curious, what made you make that initial decision to pursue a DO instead of an MD?
Dr. Levin: Well, when I first applied to medical school, I applied to both DO and MD programs. I was very drawn to the philosophy of how to practice medicine from the osteopathic side. And to be quite frank, I got into both osteopathic and allopathic medical schools. And for me, it was really following that philosophy which called to me.
But I often say to the students when I talk to them, we self-select, not just for allopathic or osteopathic, but for the individual medical schools as well. There are things about those places that call to us. And I think that's something that we should own and be proud of.
Unger: I'm curious—because I've also heard you say that there are some challenges that come along with being a DO in what you call an MD world. And were you prepared for those? Were they a surprise to you? What really stands out?
Dr. Levin: They were a surprise, really. I don't think you're prepared for that, necessarily, when you apply to medical school. In the beginning, I thought everyone would be treated equal. But the reality is there is stigma out there. So I could do rotations at just about any place I want to do them. But if I wanted to go to certain residencies, I knew certain residencies had never been given a DO a spot and weren't going to.
There are also other subtle differences, where I think previously—and less so now—there was this view that going to osteopathic school was the backup, which is absolutely not true. Many people who choose osteopathic medical schools have gotten into both osteopathic and allopathic medical schools and made a choice. Like I said before, it's self-selection. We have the same books, often, and the same courses—aside from, we have osteopathic manipulative medicine. But it's getting past that stigma and that idea that because it was different, somehow, it wasn't as good.
Unger: When you talk to DO, students do you have a specific piece of advice you really like to give them?
Dr. Levin: I do. I tell them, don't let anyone define you. And don't let anyone minimize who you are. I still get told sometimes to just pretend that I'm an MD. I will never do that. I will always be proud of my training. I thought my training was excellent and I was very well prepared for working in very tough situations. So I tell them, own who you are. Educate people about who you are.
And the other thing that I'd like to share with people is when someone tells you that, "Oh, it doesn't matter, you don't need to talk about being a DO anymore. No one really cares." Well, the DOs care. And it minimizes the fact that there is still stigma. And we do have to deal with it, and we do have to educate people about it.
And so I think having that confidence to speak up for who we are is really important and not allowing someone to define us and put us into a role that they think that we feel.
Unger: Now, you also have another piece of advice that's for all medical students. And that is that it's important to know who to listen to. What do you mean by that, specifically?
Dr. Levin: So, first of all, I would say never assume that you know more than anyone else in the room just because you're a physician. That nurse who's been working 20 years in the ICU probably knows more than you as a resident or student—and maybe even you as a doctor—on plenty of things. So never assume you know more.
Listening to family and friends when they tell you something about a patient—they're going to know the patient better than you will. And they may see those subtle differences. And then most importantly, listening to your own instincts—to me, that has really been vital in learning how to be a good physician. Because sometimes, you will subconsciously see things and note things that you're not really aware of. But they will lead you down the correct path, so always listening to your own instincts about something.
Unger: Now, one other very particular part of your journey, of course, is being a physician leader and being an advocate, which you really speak about how important that is to do, really advocating for your patients in and outside of the exam room. Why is that so important and where should medical students begin?
Dr. Levin: We have a frontline voice, and we have a frontline voice at different points in our careers. And that's really vital and that's why the medical students' voices are so vital. Because when you get out of medical school and you've been away for 20 years, you may not see the same things or remember things in the same way. The business side of medicine may become more important to you.
And this is the beauty of the AMA, is having representatives throughout the course of the medical career, all the way from medical school through retirement, because that perspective changes over time. But each of those perspectives are really vital to how we keep health care functioning and moving forward and evolving. And that student voice can really be key in creating new policy and advocating for things that, perhaps, we didn't even think were possible before.
I saw it firsthand as a medical student. And I've seen it since that time with other medical students coming up with amazing policies that have changed our course of health care.
Unger: Now, when we talk to medical students out there, they may or may not know about the AMA at this point in their journey. And we talk about how important the AMA is and supporting them as medical students, but also protecting their future as physicians. Any final thoughts on why you encourage somebody to become part of the AMA?
Dr. Levin: I think every student, every physician should be a member of the AMA because the AMA represents all of us. That being said—and I will always say this to DOs—they need to stay members of the AOA as well. So members of the AMA, absolutely. We need a voice. We need to be heard. And that's for all physicians, all students—and for DOs, the AOA along with the AMA.
Unger: Dr. Levin, thank you so much. I know medical students when they see and they get a chance to listen to you, I can just see the wheels turning in their minds. They love so much hearing from you. It's really important that all physician leaders out there provide that kind of encouragement. So thanks again.
And medical students, don't forget to use the link in the description of this episode. We want to hear your questions. Send them to us and we will answer them. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today and please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.