7. Reflections on a Career in Pharmacy and Medicine with Dr. Steven Berk

🎙️ Prepare for an enlightening Episode 7 of The Physician Pharmacist Podcast Miniseries, where we sit down with Dr. Steven Berk, a seasoned Internal Medicine Physician with over 25 years of experience. Dr. Berk's remarkable career in healthcare has been greatly influenced by his strong pharmacy roots, and in this episode, we dive deep into the keys to finding fulfillment in both pharmacy and medicine.

📕 Join us for a thought-provoking conversation that explores various milestones along the pharmacy to physician journey:

1. The Life of a Pharmacy Graduate: Gain insights into the life of a pharmacy graduate as we discuss the challenges, opportunities, and valuable skills that emerge during this phase of one's career.

2. Lessons from Pharmacy Residency and Fellowship Training: Dr. Berk reflects on his pharmacy residency and fellowship experiences, sharing the pivotal moments that shaped his path and laid the foundation for his success as a healthcare professional.

3. A Glimpse into Pharmacy Academia: Discover the world of pharmacy academia and the contributions that pharmacists make to education and research. Dr. Berk sheds light on the rewards and responsibilities of this critical role.

4. Transitioning into Medicine: Explore the rationale behind transitioning from pharmacy to medicine, and understand the unique perspectives and insights that a pharmacy background can bring to the field of healthcare.

📕 Whether you're a pharmacy graduate contemplating a transition into medicine, a healthcare enthusiast looking for inspiration, or simply curious about the synergies between pharmacy and medicine, this podcast episode is a must-listen. Dr. Steven Berk's journey is a testament to the diverse paths one can take in the pursuit of a fulfilling career in healthcare. Join us as we uncover the valuable lessons learned along the pharmacy to physician journey and gain a deeper appreciation for the powerful combination of pharmacy and medicine. Don't miss this opportunity to be inspired and informed!

⚡️For more resources to get started, check out some of our other blog post content!

• The MCAT: Everything You Need To Know

• How Hard is Medical School

• Can you work while in Medical School? The Physician Pharmacist Do's and Don'ts

• 6 Most Common Questions About Transitioning From Pharmacy to Medicine

• The Art of Applying to Medical School (The Pharmacy Student Edition)!

🧠 Enjoying the podcast and want to listen to more? Visit The Physician Pharmacist Podcast for a list of episodes. Here's a featured episode below!

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🥼 Complete Transcript of "Reflections on a Career in Pharmacy and Medicine with Dr. Steven Berk"

Podcast Scripts - Steven Berk

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Nathan Gartland

Welcome to the physician pharmacist podcast, a show designed to shed some light on a very unusual pathway into medicine. I'm your host, Nathan Gartland, and I'm a licensed pharmacist and second year medical student. I'm also the author of farm D to MD and the owner of the physician pharmacist company. Most pharmacy students and professional graduates are aware of the possibility of going to medical school, but very few actually take the leap. We are here to unpack some of these details and open your eyes to the possibility of a career in both pharmacy and medicine. In today's show, we're going to cover many different milestones along the pharmacy to physician journey, we will wholesomely investigate the life of of a pharmacy graduate lessons from pharmacy residency, pharmacy, fellowships, and teaching and academia along with the decision to explore medicine later in one's career. We will discuss the outcomes of this transition and learn how to have a fulfilling career in healthcare. I'm very excited for our seventh and final episode of the physician pharmacist podcast mini series, where we will be interviewing Dr. Stephen Burke, a senior Internal Medicine attending with a substantial pharmacy history. Dr. Berg first began his journey in Pharmacy at the University of Buffalo where he graduated with his bachelor degree in pharmacy and underwent pharmacy residency training. Afterwards, he went back to school to continue his pharmacy Doctor education at the University of Chicago. And upon receiving his PharmD Dr. Burke, then continued his training in a pharmacy fellowship. He even spent some time in pharmacy academia teaching pharmacy students while balancing his clinical pharmacist responsibilities. After a few years, he was persuaded by a close mentor to continue his medical education at Stony Brook University in New York. He elected to complete a three year residency in Internal Medicine, and has been attending ever since. Despite all his accomplishments, Dr. Burke has a true passion for learning and recently completed his MBA from Cornell University in New York as well. Quite a long introduction, but I'm happy to welcome Dr. Burke to the show.

Steven Berk

Hi, Nathan. Thanks. Good to be here.

Nathan Gartland

Yeah, thank you so much for taking time out of your busy schedule. I know you just told me you had a pretty busy day. But um, I just want to say thanks again. And I think you're going to have a lot of great stuff to share with our guests. All righty. So just based on this introduction, I think we have quite a bit to unpack in today's episode. And our focus is to learn what it takes to have a fulfilling career in medicine, and how your pharmacy upbringing has made all the difference. While it's obvious you have strong roots in pharmacy, what caused you to pick the profession in the first place?

Steven Berk

Well, Nathan, I was an undergraduate student in college at the University of Buffalo, which is I guess where you're in medical school right now, isn't it? Yep, that's

Nathan Gartland

correct. Yeah, so

Steven Berk

I was just a typical college student, I wasn't sure what, what to study what I wanted to go into what I don't want to be when I grow up, etc. And I was my father was a accountant. And he kind of encouraged me to go into accounting and maybe go into practice with him. And so I took some business courses. And I was always interested in math and science and healthcare, I, you know, thought about, so I took math and science courses. And somewhere in my sophomore year, one of the people in the dorms I knew was a father was a pharmacist and buffalo had a really good pharmacy school and he was applying, and I thought I would just, you know, apply what the heck, I like math and science. I wasn't sure I wanted to work in the typical drugstore back at that time, but I thought it might be a good springboard and maybe go on to get a PhD in some in some sort of related field. So I applied to the pharmacy school and was accepted. And the next thing I knew I was a third year college student starting my first year of pharmacy school.

Nathan Gartland

That's incredible. And at that time period, the pharmacy curriculum was only five years. Right? So getting so from what I understand getting the pharmacy doctor wasn't obligatory at that time period. It wasn't a mandatory component to the education process. So I'm curious to know what why did you choose to continue with that? I know you had a residency afterwards. Was that a major influence as well?

Steven Berk

Well, yeah, Nathan. Like I said, I was interested in all kinds of to science and math and healthcare, and I thought I might go through pharmacy school and then go on to get a PhD in a related science. But while I was in pharmacy school, I saw farm DS, I met farm DS, who were teaching didactic classes. And in my clinical rotations, I was very impressed. These guys were rounding with doctors, and they seem to be very well respected. And I thought, hey, I think maybe that's what I want to do. And I was working, I got a job in a pharmacy satellite at Erie County Medical Center, I don't know if you're familiar with so County Health Center in Buffalo working in a pharmacy satellite, my last year of pharmacy school, up in the ICUs. And one of the so I was a pharmacy technician at the time, I wasn't a pharmacist yet. And one of the pharmacists that I worked with, was also Moonlighting, and he was a farm D student. And so like, kinds of questions, and he advised me to do a pharmacy residency program first before thinking about going on to farm the school at that time farm, the school was a two year program, rigorous two year program. So you would go to pharmacy school, we would do undergraduate prerequisites would take two years, and you would apply to pharmacy school, and then that would be another three years. So I was in my fifth year of college and you would graduate after five years with a bachelor's degree, it was the only degree I knew at the time that it would take a minimum of five years to earn a bachelor's degree. So in that, you know, I was talking with this farm D student and he was saying before you go to find the school, you might want to see if you like it, I would highly recommend doing a residency program in clinical pharmacy or half at the time it was hospital pharmacy. And I thought okay, that's a good idea. And I applied for different residency programs. And it runs just like the just like medical school residencies run now there was a matching program, and you would apply to different programs, and they would offer you interviews, and then you would later on you would rank the one you wanted to go to first, second, third, etc. And they would rank you and it all would go through the computer and you'd they you'd come up with a with a match, you'd get matched somewhere. And I matched to the same place that this farm farm D student who by the way, is now had a distinguished career at Buffalo. And I think now his is a distinguished professor. His name is Jean Morris, I think he's a Distinguished Professor of Pharmacy at the University of Buffalo. So if you ever run across them while you're there, please say hi for me. Absolutely. But he had done. Yeah, he did this residency program at a well known pharmacy program at the time in North Carolina, at Moses cone Hospital in Greensboro, North Carolina. He told me all about it, and I decided I would apply there and I applied to some other places as well and the mat. I was lucky enough to match there. So I packed up my things and drove down to North Carolina, Greensboro, North Carolina, and that's where I spent the next year. And yeah, so that I believe I remember the question you asked me, but that was so I guess, how did I get into pharmacy? And then how did I decide to go on? And so that was the first step was this residency in hospital pharmacy where I learned a lot, I saw a lot, did a lot of clinical things, did a research project and decided yeah, I want to go to pharmacy school. There was a one of my mentors there by the name of Peter gal, if I remember correctly, was also a PharmD graduate from Buffalo, and pharmaco kineticist. And he was really helpful. And, you know, helping me decide to go to pharmacy school and, and, and pulling off this research project I did. There was drug interaction study between mean a drug interaction between cytidine one a brand new drug at the time, h2 blocker, and light cane which at the time was given to all patients in coronary care unit to prevent the to prevent primary arrhythmias and primary ventricular fibrillation. So anyway did this to make long story short did this research project apply to find these school and was looking for a program. At that time, there were all the there were all these two year funded programs. And most of them you would do a year of didactic classwork and then a year of clinical rotations. Well, I came across the cross this program in Chicago. And by the way, it was it's the University of Illinois in Chicago, not the University of Chicago. So at the University of Illinois at Chicago had this unique PharmD program, where instead of doing a year of didactic and a year of clinical, you would do both right from the onset. So you would have clinical rotations in the morning, and then classes in the afternoon, and then back to your clinical rotations after classes, and then home to study at night. So I liked that idea, because I was already doing a lot of clinical stuff in my in my residency program in North Carolina. And so I thought this sounds like the program for me. And I applied and I was accepted. So the next thing I knew I was packing my beds and driving back north to Chicago.

Nathan Gartland

Wow. And I'm curious to know how many students in your graduating pharmacy class from from your bachelor's degree actually went on to continue their education? Because residencies in today's day and age seems to be relatively popular for a lot of pharmacy students? So I'm just curious, were you an exception was, were there a few other people who followed your pathway?

Steven Berk

Well, I don't remember how many it was. It was no more than a handful. There were actually the three two other residents that particularly year the two other there were four of the two. Two other people from my class and buffalo also went down to this hospital, Moses cone Hospital in Greensboro. So there were two of my classmates who actually joined me there. And then another person from West Virginia. And yeah, so I don't remember if there are any other people from my undergraduate pharmacy school class in Buffalo who went on to do residency programs. Don't remember.

Nathan Gartland

That's incredible. And so after you finished your your PharmD program, you entered clinical pharmacy, you got a job. Can you tell us a little bit more about, you know, the next steps in your career?

Steven Berk

I, the PharmD program was two rigorous years. And at that time, I was thinking about what I wanted to do after that, and one of the options was a fellowship. And while I was in pharmacy school, I got very interested in cardiology as a specialty. And that was also influenced by my mentor at the time, Jerry Bauman, who, who was a PharmD, who was a prolific researcher and amazing teacher. And because of him, I was really interested in cardiology, and he ran a cardiology fellowship at the time at the University of Illinois in Chicago. And I worked out a deal with him, so that I stayed on for another year after I got the PharmD to do a fellowship in cardiovascular pharmacotherapy. Wow.

Nathan Gartland

That's incredible. Just more and more school, and then after the completion, I'm sure that was relatively rigorous as How would you compare your fellowship experience to your your residency, or excuse me, your pharmacy experience?

Steven Berk

Well, there were no classes. It was just and it was all cardiology. So all my rotations were in cardiology research projects, at least two or three more research projects, completed writing papers, submitting them for publication, working real hard, you know, I also was part of the general resident, post PharmD residency program there as well as I like to call I think it was every four nights or maybe every four or five nights we take call and stay in the emergency room overnight, performing or providing clinical pharmacy services. So I got a lot of good experience and cardio intensive experience and cardiology, and not only general cardiology, but I Jerry Bauman specialized in a rhythmic pharmacotherapy, so antiarrhythmics which at the time were used much more widely than they are now. So I a lot my research really involved antiarrhythmic pharma, pharmacology and pharmacotherapy, and yeah, so that I spent a rigorous year in that program. And then I decided to stay on at the University of Illinois College of Pharmacy as a junior faculty member, and my clinical site was the VA hospital right across the street from the medical campus at that time. At that time, it was called the West Side VA hospital. And my I was assigned to the ICU there. So I was the PharmD. For the it was a combined medical and cardiac, cardiac ICU, coronary care unit slash medical ICU became, yeah. I became the PharmD there. And I was part of the Department of Medicine at the West Side VA. I provide a clinical pharmacy services. I also was involved in teaching pharmacy students in the cardiovascular and the didactic pharma, clinical cardiovascular classes there. So I did a lot of teaching there. I think by that time, they were transitioning to an all farm D program. So it was I think I was one of the early teachers teaching. They had like a crossover program. So they had this program ran where a practicing pharmacist could come back and get their funding program. I forgot what it was called exactly continuation program of something. And then I think they were also the new class of all farm deeds. Were starting at that time. So I was involved in teaching, mostly cardiology courses and working at the VA hospital providing clinical pharmacy services and having residents on see residents with me there.

Nathan Gartland

And how many years were you doing this? Multifactor I guess different roles in pharmacy was a, you know, a couple years and then you decided to switch over into medicine. I'm interested to hear a little bit more about that.

Steven Berk

Yeah, I stayed at the University of Illinois for three years in that role. So I was there for a total of six years to as a pharmacy school, one for fellowship, and then three years on faculty as an assistant professor in the College of Pharmacy, and practitioner at the west side, VA. I stayed there for three years, and then wanted to move back to New York where my roots were. And all my family was. And I took a position at the College of Pharmacy at St. John's University here in New York. And my clinical site there was at the Long Island Jewish Hospital in the CCU there. So I was the PharmD in the CCU there, and did a lot and ran the cardiology section for pharmacy program at St. John's.

Nathan Gartland

And were you also involved in academia at St. John's? Or was Was that something that felt

Steven Berk

random? No, no, no, it actually increased. I actually ran the didactic section for pharmacy student I think St. John's was still I remember correctly, boy, you're really testing my memory here. But if I remember correctly, St. John's was still on the five year bachelor's of Pharmacy program. And they then and they had a PharmD program as well with a few with a handful of pharmacy students. So they were still they were, you know, university, Illinois was an early adapter to the all PharmD program at St. John's hadn't gone that way at that time. So I was teaching didactic class, I was the coordinator for the believe for the cardiology section for the pharmacy student for the undergraduate pharmacist students and the pharmacy students. So I did a lot of teaching and a lot of the didactic teaching at St. John's and also a lot of clinical teaching.

Nathan Gartland

Wow. And so then during all this exposure, obviously have quite a prolific career in pharmacy. What started to interest you in medicine and what what caused you to start looking into a different specialty considering you had such a robust career in pharmacy already?

Steven Berk

Well, yeah, the seed was there, and I have to go back to University of Illinois in Chicago at the West Side VA hospital I was telling you about. I became the PharmD not only in the ICU, but also for the Department of Medicine there. And there was this gentleman, an internal internist by the name of Clifford pills PLC, may he rest in peace, and he was the chief of medicine at the West Side VA and he was an old school doctor. You know, he was the kind of guy you trembled in your boots when you present it in front of him. Yeah, he was. He was old school. And he took a liking to me, I worked really hard. He got me up. And, and I attended the morning report. Every morning, he ran a morning report for the medicine residents. And it was in a lecture hall. And he called people up to present cases and I was the PharmD. And he would call me anytime there would be a pharmacology question he'd asked me, and he would have these things called dingleberries, he would have these things where he would ask people, these esoteric questions. And of course, nobody knew the answer. And he would say, Well, tomorrow you'll know the answer. And you'd have to go home and study up on it and, and come up with an answer for the next day. So he would assign me all these dingleberries and I would come back the next day with the with the answers as best I could. He took a liking to me, I would go to after morning report, there would be another you would go back to his office, and there would be all these leather couches. And each team on the Medicine Service would meet with him one day a week. And so then we'd go into his office and there was a team there and there would be some nurses and other administrators. And he would you would go and I would go to that every day as well. And so, one day he was at, you know, he asked me to present grand rounds on two occasions, which was quite an honor for a pharmacist at that time to be asked to present at medical Grand Rounds. And I worked really hard on the presentation and I didn't think he anything it would be it was shared with a physician. And so, you know, the physician, I was always really well prepared and not not so I was probably more prepared than the physician who gave the Grand Rounds. And the next day at at medical Morning Report. Dr. Pills will you know, he gave me a standing ovation. For my performance and medical Grand Rounds. I remember the first one was on warfarin, Warfarin toxicity. And I titled the name of my talk, I still remember it was Warfarin toxicity sweet clover disease. So you can you can look that look that up sweet clover disease. And next one was on Neuroleptic Malignant syndrome. So anyway, he took a real lie, I did a good job, he took a liking to me, and he always asked me, So when are you going to medical schools? He and you know, he was the kind of guy who was interested in medical history. And so we learn all these esoteric things about famous physicians and medical history. And so he put the, you know, he there was a seed there, but he definitely watered the seed in me about going to medical school. And, you know, then I went I went back to when I moved back to New York. I was in the CCU at Long Island Jewish Medical Center in St. John's and pharmacy wasn't as advanced clinical pharmacy wasn't as progressive and advanced in New York as it was in Illinois at the time. So whereas at the University of Illinois, it was a very unique program. They had a farm D on an attendant farm D on every service in in the hospital, you name it. Pediatrics, ICU, cardiology, Gi, you name it, they were and they had a pharmacokinetics lab at the University. They had a major Drug Information Center at the University. It was it was quite a program at the University of Illinois. And so when I went to New York moved back to New York pharmacy was not a was recognized as much and I really had to kind of prove myself there and I did I got in with the with the cardiologists there did a paper did a research paper on other drug and interaction paper on Heparin night. True glycerin interaction. There was one of the cardiologists who asked me about it and thought it would be a good idea to do a study so I took the ball and ran with that. And it was was a it was a difficult study to do in a difficult setting. And but I was able to pull it off. And a paper published in the American Journal of Cardiology at the time. But it was, but also some of the, at least there was one pivotal resident, she was a rehabilitation medicine resident doing a rotation in the CCU. And she saw I was a little frustrated sometimes. And how it was difficult to break in with the cardiologists there. And she told me, you know, I have a friend who was a PharmD, just like you, and she got a little frustrated with it, and decided to go back to medical school, and she loved it, and you should really think about it. And I was like, really, you know, really? Wow, tell me more about it. And so I'm like, I, you know, I thought about it, but I don't, you know, I didn't even know what to do. And she was like, well, first thing you got to do is take the MCAT. So you know, and you and, you know, it had been quite a while since I took organic chemistry and even just, you know, freshman biology and I had never taken physics, I think you mentioned you didn't, I took one hat for pharmacy school, I think I only had to take a half a year of physics, I never took the second part of it. So I had to. So she said, Well, first thing you got to do is pass the you know, MCAT. And you should enroll in Stanley Kaplan. And so I enrolled in Stanley Kaplan, I spent the worst summer of my life in the bowels of the Stanley Kaplan Center. You know, at that time, it was all it was all tapes, it was all audio tapes and books. And so you would listen to these audio tapes, you would take the exam, you then you go back to the audio tapes and review all the answers you got wrong. So I did that for an entire summer. And then I took the MCAT. And I did reasonably well, I guess well enough to get into medical school. And so I got it, I was accepted to medical school and Stony Brook, which was near my home. And by that time I was married and didn't want to move. So I thought this is great. I'll just stay here. And I had to take the SAT and I was accepted contingent on passing the second half of physics, which I did at a local community college. And that was not a big deal. And next thing I know I was enrolled in medical school.

Nathan Gartland

Wow. And I'm glad you brought up the prerequisite with physics because that seems to be a big problem for a lot of pharmacy students that I work with just in today's current day and age. Exactly. So making sure that they have their entire application ready to go. But then oops, I forgot to take physics, you know. So that can be problematic for some. So I love that. But so that started your career into medicine, you had a lot of mentors, and the change in practice setting kind of gave you the spark to transition and try it out. So I'm curious to know, how was your experience in medical school? And how did it compare to your pharmacy training? Because you had already been a practicing pharmacist at operating at basically at the top of your license?

Steven Berk

Right? Well, medical school was obviously rigorous. I loved it, I you know, I devoured it. You know, when you know, when you kind of apply things that you're learning to past experiences, it makes the learning so much easier and more interesting. So having that experience was great. A lot of it was easier for me than my other my traditional medical school students, classmates. Because I was learning most of it or a lot of it for the second time. But you know, every time you learn something, you know, we all learn by repetition. And every time you repeat the learning, you take it to a new level. So I think when I was studying in medical school, it was easier for me. And I think some of my classmates were a little either jealous or intimidated. But, you know, I took it to a new level. Every time I read something I had already learned about and seen in practice. It just meant meant so much more to me and I was able to dig deeper into it. And, you know, there was certain courses that I never took which like anatomy, I mean, I just devoured anatomy, because I learned all about medicine in my pharmacy career but I never had an anatomy course I don't know if they have anatomy courses nowadays and in PharmD programs, but I think they did at the University of UCSF California. I think they had one of my one of them My colleagues at the time told me he had an anatomy class. But anyway, I devoured anatomy getting to see and learn the intricacies of human anatomy. It was just it was it was beyond belief. For me, it

Nathan Gartland

was great. One of my least favorite classes and one of my favorite classes. And you're right, not having that that background definitely was another challenge, compared to some of my other courses that I'm experiencing right now. And I know a lot of medical students or other PharmD, to medical school students that I've worked with also have like the same kind of complaint. So it's very interesting. And I'm curious to know, so obviously, as we progress through medical school, you enjoyed it, you enjoy how much time you were, you know, investing and studying and learning new material. How did you end up on internal medicine? And I'm curious to know, because you mentioned, cardiology was a big interest of yours. What what happened with that? And I guess, why did you settle for not necessarily settled, but why did you select internal medicine?

Steven Berk

Well, you know, I just loved everything. I loved surg one, my best rotation in medical school was surgery, I just couldn't believe it was so I was just awed by by surgery, and really, you know, took to it. And I, my teachers, and the surgery residents and people I work with, you know, saw my interest in it, and, you know, like they do with everybody in medical school, they try and get you to go into their, their, their specialty, and they were like, You should go into surgery. You know, surgeons are the best doctors, and I believed it. And I really wanted to go into surgery. But at the time, I was already older. And you know, I had a family my, actually, my, my first daughter was born in my fourth year of medical school. So I, you know, yeah, you have to balance your home life with your career. And at that time, I thought, you know, and of course, internal medicine was my love to begin with. So, I always had every intention of going into internal medicine. So that was it. I thought actually thought I was going to go into cardiology, at the time I applied for residency, you know, you need to do internal medicine before you do cardiology. So I went into internal medicine with the, with the idea of I probably would go into cardiology afterward.

Nathan Gartland

Yeah, interesting. And yeah, and make sense life kind of takes over and you have to find that work life balance of, do I really want to spend another 10 years in the O R, versus, you know, being done that being an attending after three years of residency training, and still getting to enjoy your life outside of medicine. So I think that's also an important consideration. So now that obviously you've been attending for and correct me if I'm wrong, this is your approach in your 28 years as a practicing physician.

Steven Berk

I've been here and my current job, it'll be 24 years in July, and then three years of residency. Yes. So I've been a doctor for been a physician for 27 years.

Nathan Gartland

27. And I guess my question for you is does anything surprise you anymore?

Steven Berk

Yeah, I'm not sure. I mean, yeah. Nothing really surprises me. Oh, that can really surprises me. I mean, I guess you could say the COVID epidemic, or pandemic, you know, it was a surprise. I never thought I'd see anything like that before. So I guess the pandemic was probably the, and it's so recent to that's, that was surprising to be the extent of the pandemic, and the amount of changes in the world of medicine was just mind boggling. Yeah. Yeah.

Nathan Gartland

And I guess would you be able to reflect that on how much healthcare has changed as a whole since the start of your training? I think it's just fascinating to see how like technology and research has brought so much forward with medical care. Can you think of like a particular innovation that really changed medical practice forever?

Steven Berk

I mean, there are so many seen so much come and go I mean, all the all the meds we use now most of them weren't around when I when I started out in pharmacy school. All these classes I think I mentioned sometta D And you know, back then that was a breakthrough medicine. They histamine two blockers were breakthrough back then. It was in I remember working in that satellite, I was telling you about an Erie County Medical Center. All we had were liquid and acids. I remember like packing, you know, patients who were in the ICU where they were prophylaxis was stressful. arose and it was a nurse would have to give up. toasts of Maalox or my lanta like via NG tube every two hours. I remember like, they call those an acid. Cops wouldn't fit in the the patient drug bots. So that was like huge. I mean, that was like the breakthrough. Histamine blockers a pill that you can take that actually you know treated peptic ulcer disease, all of the blood pressure medicines that we use now, call the class that I remember verapamil, one of the studies I did as a PharmD student was in Verapamil with a Verapamil a suddenly will form a Verapamil with Jerry Bauman. And that was interesting I got to learn I collaborated with pharmaceutic pharmaceutics professor, developing the sublingual Verapamil to be used to treat acute acute episodes of supraventricular paroxysmal supraventricular tachycardia. And so, Verapamil was a new drug at the time, I remember when it was like a number. I was reading research papers, and it was this new class of calcium channel blockers, which was just a number so that the ACE inhibitors didn't even exist at the time I was a pharmacy student. I remember going to this gala affair put out by the pharmaceutical company in Chicago when this breakthrough new class of drug called ACE inhibitors, and Captopril was the first of the kind and, you know, that was that was a breakthrough, much less angiotensin blockers and all the new categories of antihypertensive so, so that was new. And then the thing, another thing would be like the anti rhythms I spent a year of my life studying anti arrhythmia pharmacology, am spent time researching, I spent time looking over files in the basement of the medical school in Chicago, dusting cobwebs off of these old files of studies of electrophysiologic studies that were done to evaluate a new drug called amiodarone at the time, and then, so I became this expert in antiarrhythmics. And that at the time, pacemakers were becoming high tech. And then defibrillators were coming into use, and we're evolving. At the time I remember the first defibrillator I saw a patient had was a was a box it was it was like a clock that was a picture like a round clock, about six inches in diameter. And it was that was the battery and it was placed in the abdomen, abdominal cavity. That was the first automatic defibrillator now they put them into into the heart into the chamber of the heart. But yeah, so because so learning, being an expert on a rhythm of pharmacology became like obsolete, because like a lot of these drugs, well, first of all, new studies were coming out to show that these drugs actually shorten lives, people were dying suddenly, from taking these medications, when, when there wasn't a when they didn't really need them. They thought they needed them at the time to suppress atopy to suppress PVCs if you had a PVC, it sounded bad, and a drug that could suppress it found. That sounds like a great thing to do. But it was actually people were actually dying sooner because of these drugs. And then these defibrillators came out. And they replaced the need for a lot of the antiarrhythmics. So that was a huge change. And it was one of the things where I decided I wanted to go into general medicine because you never know what's going to be obsolete, you know, 10 years from now, as medicine and technology advances to other things like the HIV HIV epidemic, pandemic, I guess it was, and is, you know, came into, came into light just at the time I was doing my first residency program in farm pharmacy in 1983. And, you know, at that time, there was no cure, people were dying from it. It was a death sentence. It was it was like metastatic cancer, you're gonna die from it. And then you know, the technology has come so far since then, and we first started you know, for was the first anti retrovirals. Try AZT came out. And that was a breakthrough, but it's still people was still dying. And you know, to make a long story short, short now people are, you know, I saw people having to take multiple pills, buckets of pills several times a day, but at least they were like surviving. And now it's like one pill a day. And people live a normal, normal lifespan. It's like having diabetes, you know, take a medicine, and you'll live a normal lifespan. So I mean, these are just just a handful of things that I can think of. To answer your question,

Nathan Gartland

yeah, that I mean, it's absolutely, absolutely incredible just to look back and see how much change has occurred over that time period. You know, just in my recent practice, I remember some of my professors talking about using, you know, ACE inhibitors and ARBs together. And, you know, now, medical practice would obviously dissuade you from doing so that's almost borderline malpractice. So it's just kind of interesting to see like, how these interventions have changed dramatically over time, based off a lot of trial and error. But I also understand you have to work with what you have at the time period, but it's just very cool. Cool, especially like you mentioned, technology has gone so far. Right? I can imagine, you know, like you mentioned that everything was paper copies, everything was in books and textbooks, and very few things were, you know, electronic. And now we have such robust medical systems EMRs and everything. I'm just curious to know, how does that compare? Is it better? Is it worse?

Steven Berk

Oh, my gosh, Nathan is so much better. I can't tell you. I mean, a lot of the doctors moaned and groaned about the electronic medical record, but I was an advocate, right from the beginning. It made my life easier, and it made patient care so much better. And there's still a lot of room for improvement. But it's really, I mean, I think it's it's just great, great technology, and even just medical information, like I think you started to say, Me Back in the day, we I would go to the library to look up information on subjects that I was researching, I would go to the library and look in the stacks of what's called Index Medicus. Do you even know what Index Medicus is Nathan? I'm ashamed to say no. Index Medicus was a, it was an encyclopedia bigger than an encyclopedia of books that had references in it. So you would look up a topic, and you would then see papers that were published references or papers that were published on that topic. And then you would have to go with a pad and a pen and write down all the different references from Index Medicus of articles that seem like they would be relevant. And then so you would go from that stack, and then go back into the deeper part of the library where you would go into the stacks, where they had all the journals, bound and big, fat heavy books. And then so you would go with your list of articles that you wanted to pull, and you would pull out these heavy books of journals. And then bring them to your desk and then look over the articles and see what you thought you needed. And then you'd have to take the big heavy book over to a photocopy machine and photocopy the papers. So you know, and now, what do you do you get on your computer, or even your phone and you go to PubMed, and you pull up the list of references, and half the time you can or more than half the time, you can actually get the full PDF of the article, I was just just before you call, I was doing that pulling up in an article on using aspirin to prevent migraines. And it wasn't I was just thought back of what I would have had to do back in the day where I'd have to go to the library and pull out Index Medicus get the references and then go to the stacks to pull the article and photocopy it. So yeah, I mean, things have changed me dramatically.

Nathan Gartland

I'd say a different time. It's funny, I get frustrated when I type a search query into Google and it's not on the first page so so I guess that's my tolerance for for that. But um, alright, let's talk a little bit about your average day as an attending. You've been doing this for some time now and I can imagine you're pretty efficient at it and you have a very good system for working through patients. What does your average day look like? And how frequently do you end up taking work home with you?

Steven Berk

I make it my business to rarely take work home with me but what I work long hours I probably averaged 10 or more hours a day here We're in the office. I see patients all morning. And then I'm usually my, um, you usually eating my lunch while I'm answering messages and writing prescription refills. And then I go back to see the afternoon patients. And then I come back to my office again to finish up on all the messages that have accumulated throughout the day. I also teach a couple of about a month or so in the hospital, I got back to the hospital for a month or so. And I am a ward attending on one of the medicine services. And then there I will go and make morning rounds. The team, see all the new patients see the old patients at the bedside, then usually come back to my office in the afternoon and see my own patients. And, you know, the residents would call me keep me updated on things. You know, back when I started this job, I would admit my own patients to the hospital, like the first 16 years when I was here, patient any of my patients would get admitted to the hospital I would be the the admitting physician so I would be admitting them would be called from the emergency room so and so was here and it needs to be admitted or I would send patients from my office to the emergency room for admission. And so I would make making rounds either in early in the morning or after my day in the office. I would go see my patients and in the hospital. And then slowly but surely the hospital hired more and more hospitalists and the whole hospital movement. hospitalist movement took over and I no longer admit my patients to the hospital which has made my life a lot easier or at least less hectic. But I miss it I miss seeing my patients in the hospital and my my patients for sure would rather me be taking care of them in the hospital than a strange hospitalists. So that's pretty much my day. I do have first year medical students here for intro to clinical medicine. Monday afternoons I have a first year medical student. I also teach in the there's a MD Ph. D program here at Einstein Montefiore and MD PhD students after they do their first two years of medical school, then they go into the lab for five years. And so to get their feet wet before they go back for their last two clinical years of medicine, they have this clinic that they run at Jacobi Medical Center, which is part of this whole Einstein metaplot. I just came out of your campus. And so I precept there on Thursday evenings trying to get these MD Ph. D students back up to speed to go back onto their clinical clerkships.

Nathan Gartland

So it seems like that was actually going to be my next question was, are you still planning on doing your teaching and in staying in academics? And it sounds like you're doing your part? Have you ever considered going back to teaching full time at any point? Or do you just love the clinical side of medicine so much?

Steven Berk

Well, I do a lot of teaching. I mean to do the month of wards I do my do some first year medical student teaching and the MD PhDs teaching I also do some noon conferences on certain topics for the house for the medical students and house staff. And I just start I just actually this year, took on a new role teaching a course in basic and clinical pharmacology, to a brand new physician assistant program here at the through Yeshiva University, which is affiliated with Einstein or has always been affiliated with Einstein medical school. And so yeah, I'm the founding lecturer and basic clinical pharmacology to this PA program. Actually, tomorrow's their final exam for the year. I developed and implemented a whole course in clinical pharmacology 24 lectures, each lectures two and a half hours and exams and it was a lot of fun. I went back I had to reread Goodman and Gilman to they still have Goodman and Gilman and pharmacy school. I hope so.

Nathan Gartland

Yeah, I think so. It sounds familiar, but it slipped my memory at the time.

Steven Berk

Yeah, it was it was the but back when I was a pharmacy student In Buffalo, I mean it was the Bible for men and Gomez pharmacological basis of therapeutics. And so I use that as one of the two textbooks in this pharmacology course. And I had to go back and reread it for probably more more than probably the second or third time now. And of course, like I said, before, every time you learn something, again, you take it to a new and deeper level. So when I'm reading, Goodman, and Gilman now preparing for these lectures, I have like 20, many decades worth of clinical experience to relate it to. And I try to teach that in in the class to try and make the class a little less boring for these students. You know, it's a two and a half hour lecture. I try and incorporate a lot of my clinical experience when talking about the drugs and pharmacology that we're talking about. I I tell them stories about how this applies to patient I have or I've seen?

Nathan Gartland

Yeah, I'm sure they love that to keep it keeps them awake and reminds them of you know, this is why, right particular information is important. And this is how it relates to clinical practice and changing patient lives. So I love that. And I also noticed, and like I mentioned, that started the show, you obtained your MBA recently. And I'm curious to know, what was your rationale for for further adding to your long list of credentials? And I'm especially curious, just because I'm considering getting my MBA at some point as well. Down the line?

Steven Berk

Yeah. Well, for me, it was in sanity, no, I'm just kidding. It was great. It was a great, it was a great, great two year rigorous program, I would highly recommend that if you have the grit, you know, which I know you do, Nathan, because I see the incredible efforts, you're making not only going to medical school working part time as a pharmacist and doing this whole venture into the pharmacy medicine interface. So I applaud you for that. And yeah, the, why did I go into AI, I was kind of just sucked up into it, I was wanting to get more involved in, in more administrative things, you know, I practice on a micro level now. And I was thinking about using my, you know, decades of experience in healthcare, on a more macro level. And I was exploring ways in which I could do that. And I thought, you know, an MBA, you know, my, my, my younger daughter was a business student at the time, and a business major in college. And she would ask me to help her on some of her papers and projects. And I was, and I would read some of the papers and helped her on it. And I was like, wow, this is interesting, this business school stuff. And I thought, you know, it would really be useful to apply to my medical career. So I started just looking into programs, you know, not even serious, about a half serious about it. And I came across this program, this brand new program through Cornell, which was a combined MBA and Masters of Science in healthcare leadership. And the MBA was geared towards health care. And all the students are, you know, half of half of them were physicians, and the other half were either allied health care providers or in some management or business or industrial and business of healthcare. And so I was intrigued by the program, and I just wrote away for more information. And before I knew it, I was filling out applications. And before I knew it again, I was accepted to the program. And I still didn't, couldn't believe I was actually going to do it. And it was a really hard decision to make. But it was just sort of the momentum was there. And I got excited about it. And before I knew it, I was enrolled in this program. And like I said, it was it was hard work. I was, you know, I can I kept my day job. I kept my full time medical practice. And the classes were all on weekends and studying in the evenings. But I met a bunch of great, you know, interesting people, both classmates and faculty professors. And it was just an incredible experience, but it took a lot out of me and let me tell you why. But I got through it. And then of course, as I finished the pandemic started, just as I was getting ready to finish the program. And so I went from that to the, to the pandemic. And, you know, I never looked back. Oh,

Nathan Gartland

well, I'm convinced.

Steven Berk

Yeah, let me you know, talk to me off offline. And I can tell you more about can tell you more about it, or whenever you're ready. Yeah.

Nathan Gartland

All righty. So we are coming to the final few minutes of our show today. And I just want to ask you a few closing questions. And we'll start out with to all of our listeners, how do you plan on helping promote pharmacies role in healthcare and or in the community in your current practice of medicine?

Steven Berk

You know, that's a great question. I one of the other things I do here is I sit on the pharmacy and therapeutics committee, the PMT committee. I've been at Montefiore Einstein and I've been doing it for a long time, probably 10 or 15 years. And so it's run by pharmacists. And I'm extremely impressed by the way they run it. And the things they do, there's a there's a big pharmacy residency program here. And the pharmacy, big, big contribution and involvement in the PMT committee. So I'm keeping keeping my hands in the in the world of pharmacy through that, and my wife is a pharmacist, by the way. And I I think that it how to keep how to promote pharmacy as a profession and to utilize the education and training, I think that's going to come with the electronic medical record, you know, further further promoting and utilization of electronic medical record. But what I think needs to happen is I think, then it needs to be unique, it needs to be a universal, a universal medical record. In order for, you know, let's say from a pharmacist who works in a retail chain pharmacy, in order for them to really utilize their education, training and clinical expertise, you need to you need the patient's medical records, you need the history, you need the and so I think that the, that's and it will probably happen, you know, it's already happening to a great extent, like, here, we use the EMR, epic. And so, other hospitals, other medical centers, like New York Presbyterian and NYU and Mount Sinai here are all on Epic. So when my patients go to see, go to the hospital or to other providers at one of those institutions, and they come to see me, I can, there's a thing and epic called care everywhere, where I could look up, everything that's been done for them at these other institutions, and the patients love it, they love it. And it makes my life so much more easier. It's so much easier, I don't have to get faxes and letters from other doctors, but it's but it's not universal at this point. So there are other big medical centers who are not on epic, and you know, it's the same old story, I don't have access to the medical record. And the pharmacy, you know, and I don't think that the pharmacists and working in the community pharmacies have access to patient's medical records. So it's, it's real hard to be to be clinical, when you don't have the whole story. And, you know, I mean, it's, it's an economic thing, you know, it's a time thing. It's a it's a, it's a time of volume, versus value. Question, you know, the, you know, the, the bottom line is always the bottom line, and, you know, so I think, I think places like CVS might be on the right track with their minute clinics, you know, bringing health care out into the community and primary care out into the community, you know, with right into the neighborhood, but I don't see how they could do a really, you know, valuable job without, you know, having access to the medical record, and then when they come back to see me and they were my patients were at the Minute Clinic, I don't have you know, total access to what they're doing. And, and then the, the whole, you know, the electronic medical record and the electronic prescriptions are, were a major boon to to medical care and to my life, you know, when I stopped having to write handwritten prescriptions, and I was able, that's just when I was able to start just printing them out. You know, out and handing up to my patient, that was a huge boon and major convenience for me. But then when I was able to actually send the prescription directly to the pharmacy, you know, that was really good. But the problem is, is that, you know, I don't have access to the pharmacies, electronic medical record, so I can't see what refills my patients have picked up on what they haven't picked up and what they're taking and what they're not taking and what other doctors may from outside institutions may be prescribing. So once we, once we got the medical record universal, and and it's a two way street, you know, the farmer pharmacist can send the prescription renewal request directly to the provider through the electronic medical records. That would be that would be great. And the other thing I want to say, I know we're running out of time, one last thing I think that pharmacists can do to really create value for health care is to get somehow get involved in med rec, medication, reconciliate, Medic medication, regimen, reconciliation, you know, that's a huge thing now, with in most medical centers is med rec. It's one of these things press is one of these things that it's on the Press Ganey. Press Ganey review patients are asked, you know, when patients say, Oh, you just went to Dr. Jones, and how did he do? And we did? Was the staff helpful? And And did they ask you about your medications, you know, and so that's like one of the one of the boxes that medical administrators have to check off, you know, and the patient, they ask you about your medications. So now what they do is they have all the providers everywhere, making sure that they ask the patients about the medication. But of course, providers are so busy and you know, in in the electronical medical record, it's easy to just click a box and say, Yeah, I reviewed the patient's medications, you know, but and I that's like what I spent a huge amount of time doing. And it's not an easy job. And a lot of times it's regular around relegated to people who don't have the education and training to really do a good job of it. Low level, you know, med techs and things like that. And so if I would love to have a pharmacist be able to review, do my med Rex from a before or, you know, while I'm seeing my patients, that would be a huge, it would be huge, it would be a great thing for patient care, it will get pharmacist doing the things that they're trained to do. And, you know, so I'll leave it with that somehow, people from your generation need to figure out or pharmacists from your generation need to figure out how they can get involved in medication reconciliation. So it would be it would be it would be major.

Nathan Gartland

Yeah, in the era of polypharmacy, and obviously multiple the growth of multiple sub specialties in medicine, there's there's sometimes too many cooks in the kitchen, and a lot of information is lost in translation, which I definitely can appreciate. But I love that. So great points. And looking back, this is our final question before we start to wrap things up. Looking back, do you have any final tips for pharmacy students interested in making the switch into medicine?

Steven Berk

Wow. Final tips. I mean, you got to it's, you got to have it in your heart. You know, it's got to be in your heart. You got to really want it, though. Because, you know, you could have a great career in pharmacy as well. You know, I think if I would have stayed in pharmacy, I would have had a great career, a productive successful career. But I think for me, you know, not for everyone, but for me there was there would have been something missing, I would have always thought you know, what if I would have went down that route, and I think I probably would have always like thought, you know, what, what if I would have been a, you know, provider, a physician, you know, who could prescribe the medications and you know, really have the, the full the the whole thing, the whole bag of tricks and medical education, so you gotta want it gotta love it. And you gotta if you do GG I'd say go for it.

Nathan Gartland

Absolutely. And it's funny. I love that you brought that up because when I was actually in the process of applying to medical school, myself and to others were actually other pharmacy students that I had been working with were also interested in going to medical school. And myself and one of them ended up going through with it. But the other individual took the MCAT and did well on it and decided at last minute that they wanted to have a life in pharmacy. And it took a lot of, you know, it was a lot of respect to study for the MCAT do all this work for two years, or for an entire two years and then decide last minute, you know, I'm, I'm contented with where I'm at, I want to work and I don't want to go to more school, add more debt and so on. So, you know, and to him, he had, he had proven to himself that okay, I do well, on the MCAT, like I had this life, I could have had this life, but I'm going to be happy with where I'm at. So and I think a lot of students, you know, experienced that same kind of mentality.

Steven Berk

Yeah, right. And it's never too late, you can always change.

Nathan Gartland

Exactly, exactly. Alrighty, so we have come to the end of our interview, and I'd like to thank our listeners for their support today. If you have additional questions about the medical school journey, check out my website at WWW dot physician pharmacist.com. Before we let you go, Dr. Burke, how can our listeners get in touch with you?

Steven Berk

The best way would be through LinkedIn, easily found on LinkedIn and the spelling of my last name is B E R K. My first name is Steven with a V and search me on LinkedIn and send me know we'd be happy to hear from you.

Nathan Gartland

Wonderful. Alrighty. So thank you so much for being on the show today. Dr. Burke, I realize you're a super busy individual. So I don't want to take up too much more your time but I can't thank you enough for for your participation in this project that we're doing.

Steven Berk

Thank you, Nathan. I enjoyed it a lot.

Nathan Gartland

All righty. Well, take care and have a wonderful week. You

Steven Berk

do the same bye

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