6. Pharmacist to Infectious Disease Physician with Dr. Brandon J. Smith

🎙️ Join us for an inspiring and informative Episode 6 of The Physician Pharmacist Podcast, where we have the privilege of sitting down with Dr. Brandon J. Smith, a newly appointed Infectious Disease Attending Physician. In this episode, we delve into Dr. Smith's personal journey into the world of medicine, a journey that included pursuing fellowship training during the challenging COVID-19 Pandemic.

📕 Our conversation with Dr. Smith covers a wide array of topics that will resonate with aspiring medical professionals and pharmacy enthusiasts alike:

1. Applying to Medical School as a Pharmacy Applicant: Discover the unique considerations and challenges that pharmacy applicants face when making the transition to medical school. Dr. Smith shares his firsthand experience and valuable advice for prospective medical students.

2. Considerations for Pharmacy Residencies: Gain insights into the decision-making process behind pursuing pharmacy residencies. Dr. Smith discusses the role of residencies in shaping his career path and shares tips for success.

3. Life as a Medical Resident: Explore the demanding yet transformative life of a medical resident. Dr. Smith provides a glimpse into the rigorous training and the rewards that come with it.

4. Life as an Infectious Disease Fellow: Dive into the specialized world of infectious diseases as Dr. Smith reflects on his fellowship training. Learn about the unique challenges and opportunities in this critical field of medicine.

5. Living the Life as an Attending in the Era of COVID-19: Gain a firsthand perspective on the experiences of medical professionals during the COVID-19 pandemic. Dr. Smith shares the challenges and triumphs of being on the frontlines and adapting to the evolving landscape of healthcare.

📕 Whether you're considering a career in medicine, interested in the journey from pharmacy to infectious disease attending, or simply looking for inspiration from a dedicated healthcare professional, this podcast episode is a must-listen. Join us as we unravel the fascinating path that led Dr. Brandon J. Smith to become an Infectious Disease Attending Physician, and gain valuable insights into the ever-evolving world of healthcare. 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 "Pharmacist to Infectious Disease Physician with Dr. Brandon J. Smith"

Nathan Gartland

All right. 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. 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're 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 will briefly cover applying to medical school as a pharmacy applicant considerations for pharmacy residency, life as a medical resident life as an infectious disease fellow and living the life of an attending in the era of COVID-19. I'm very excited for our sixth episode of the physician pharmacist podcast mini series where we will be interviewing Dr. Brandon Smith, a newly graduated infectious disease attending. Dr. Smith first began his journey by attending pharmacy school at Duquesne University, where he completed his doctorate in 2012. Upon graduation, he elected to continue his healthcare training by receiving his medical education at Marshall University in West Virginia. He followed that up with three years of internal medicine training at a large hospital in Pennsylvania, and spent another two years in a grueling infectious disease fellowship at the renowned UPMC Presbyterian Hospital, all during a global pandemic. Despite all the terrible consequences of COVID-19 I can't think of a more exciting time to be in the profession of infectious disease. Welcome, Dr. Smith.

Brandon Smith

Thanks so much Dr. Golightly. Please feel free to call me Brandon. But thanks. I'm Brandon Smith. I am originally from Pittsburgh, Pennsylvania, which is where I currently reside. I'm currently a clinical assistant professor of medicine and the Department of Medicine, Division of infectious diseases here at University of Pittsburgh Medical Center in Pittsburgh, which is where I did my both internal medicine training, and then my infectious diseases fellowship.

Nathan Gartland

Wonderful. Well, thank you so much for being on the show today. And we're gonna have a lot of great things to talk about not I'm excited to have you here. And now that we've heard a little bit about your background, what got you started with pharmacy in the first place?

Brandon Smith

Oh, that's a great question. So it's interesting. Whenever I was in high school, about 16 years old, I remember talking to my parents, and they were saying, Well, if you want a car, you're going to be have to be able to put gas in it. And you're gonna have to start looking for a job. So during my sophomore year of high school, I was actually trying to figure out what kind of job I wanted. And I wanted to do something sciency and something I thought that I could learn from, and my mom suggested, well, why don't you apply down at Rite Aid in their pharmacy? That's actually not a bad idea. And I went down to the pharmacy, talk to the pharmacist, and he said, You know, I actually have an opening coming up starting this summer. Yeah, we could talk about hiring you. And I actually started working for Rite Aid as a pharmacy technician. The day after I finished sophomore year of high school, and worked throughout the summer and said, You know, I like this. I think I'm gonna go to pharmacy school now.

Nathan Gartland

Wow, that's it's definitely a unique way into the profession. A lot of people you know, give the classic Oh, I'm good at math and science. So I picked pharmacy but you had real life experience before you even like had the opportunity of choosing. So that's great. And you ended up at Duquesne. What was the reasoning for choosing Duquesne in the first place?

Brandon Smith

I did end up at Duquesne. So as I said, I'm born and raised in Pittsburgh. Other than the time I spent at medical school, I've lived in Pittsburgh my whole life. So when I was applying for colleges, I applied to Duquesne and I applied to the University of Pittsburgh, and Duquesne had a 06 Guaranteed program, as long as you maintain a certain GPA, there was no taking the PCAT, no reapplying. You had to take the PCAT. And you had to reapply after two years. I went with Duquesne.

Nathan Gartland

Good option. And so I'm curious, obviously, through, we know where you are at these points in times, but like what actually caused you to switch into medical school.

Brandon Smith

So around the same time that I was in pharmacy school and working in the pharmacy at Rite Aid, there was this TV show that I'm sure many of the listeners probably recall house that was quite popular. And as with most of us around that time, especially those that were interested in medicine, we watched household a lot. And I'll be honest, it was watching House and seeing the dynamics of diagnostic medicine, the interplays of the different specialties interacting together. And just the overall interesting cases that they saw. I said you know, I think I I really like pharmacy, but I think I want to go into medical school. And then I decided, well, yeah, I think I'm just gonna go to medical school.

Nathan Gartland

They said, Yeah, give it a try and take the MCAT and see where it goes. And it obviously worked out for you. Yes,

Brandon Smith

I'm very blessed that I'm able to say I saw something on TV said, I want to do that as my career. And I get to do that as my career. And I'm very, very blessed.

Nathan Gartland

And you learned a lot from house to I'm sure. Like, it's never lupus and all that.

Brandon Smith

I have never diagnosed lupus in my life.

Nathan Gartland

So if my memory serves me, too, I remember you mentioned that you applied to both, obviously medical school and pharmacy residencies. So what was your rationale for doing this? And did you ever participate in the match process.

Brandon Smith

During my final year of pharmacy school, I when I was applying to medical school, so I went straight from pharmacy to medicine, I didn't have a gap year or any time in between. So I was applying while I was on clinical rotations, my six year total of pharmacy school. And I had some delays in getting my application out. I hit it taken a calculus class whenever I was in high school that got me credit through one of the local colleges here in Pittsburgh. And there were actually delays getting my transcripts from them because shocking, Brandon Smith is a apparently a common name. And they were having a hard time finding the right transcripts. So my application didn't get out for quite a while. And it was sometime I think in like October, I think before my final application went out. I started getting very, very nervous knowing how late in the application cycle it was becoming. And I said, If I don't go to medical school, I think I really would like a clinical pharmacy position. So I might as well apply for pharmacy residency, not really necessarily as a backup plan, but sort of as a backup plan of if medical school wasn't going to work out. And regarding the match, I did interview for pharmacy residency, and I made it very clear up front that I was applying to medical school. And if I did, if I got into medical school and accepted a position I was going to drop out before the match took place. If I did not pursue medical school participated in the match and match somewhere. Even if I got a late acceptance to medical school, I was going to take the pharmacy residency spot I wasn't going to drop out after the fact. So I was actually accepted to Marshall, believe it was March 1. And the match was about a week later. And I accepted the position at March Oh, and I emailed the programs I interviewed at for pharmacy residency said thank you so much for interviewing me, I am accepting a medical school position I am dropping out of the match. I did not participate in the match.

Nathan Gartland

Wow, it's crazy to think back and wonder what your life could have been if it was just one week later.

Brandon Smith

It was yeah, it was a very, very close call for what decision I would have made, had it come down to submitting to the match without nailing if I wasn't accepted anywhere for medical school.

Nathan Gartland

Yeah, and that's a big thing, too. I talked to a lot of other pharmacy professionals who are interested in making the switches to be wary of rolling admissions and applying as early as possible. Otherwise, you know, you could be stuck waiting and possibly miss out on opportunities. So it's a big thing.

Brandon Smith

It is and it's something I've always really also tried to help emphasize to any of the pharmacy students or pharmacists that are applying. My application was done in July and ready to go. And it was just email after email back and forth with the logo institution that was holding up the transcripts. And it just ended up being. Again, common name things happen. So do everything you can to get those applications in early,

Nathan Gartland

pesky calculus. All right, so let's take a few minutes and cover your medical school experience. So what was it like transitioning into medical school from pharmacy school? This is one of the most popular questions I get.

Brandon Smith

So the initial transition was a huge whirlwind. I mean, if you graduate pharmacy school, I graduated in May of 2012. And four months later, I'm starting in medical school. So in that period of time, I've gone through all of the emotions and excitement of graduating. All of my friends are getting ready to start jobs and I'm like, Oh, I've got another nine to 10 years plus of training to go. The apprehensions of starting medical school. Moving in most cases for me I had to move that was the first time I ever lived away from home Also getting licensure in originally Pennsylvania took me a year to get my West Virginia license, just due to timing, I sat for my eight Plex, and my PA boards, or my eight Plex, the week before I moved to Marshall, and my PA boards the week after classes started, and just trying to enjoy summer break it, it's a lot of emotions and different experiences. That all come at you at once, and then you started medical school. But it was, it was a good transition. I enjoyed the first year, but the first year is a little bit different. And I'm sure the folks that have read your book or have learned a little bit about first year medical school, it's going back to didactics. And after doing a year of clinical rotations, it's a little challenging. It really is because you've been working directly with patients and other health care providers for a year. And then you go back to basically sitting in a classroom for the entire year to like what we were talking about it early pharmacy school, back to the basics of biology, chemistry, anatomy, physiology, and it's a lot less clinically oriented. So it is a lot of what's the right word for it emote different different emotions and different experiences.

Nathan Gartland

Absolutely, yeah, I agree with that entirely just with, with going back to after being so clinically oriented with everything seeing patients, like you said, being experts at all these drugs, took the nap Plex crushed it and you know, operating at the peak of my license at that time, and then I go back to medical school, and it's Wow, I'm getting hit in the face with anatomy textbooks. And I have no I've never even seen this material before. And it's just, it was a tough transition, at least for the first semester for sure. So I agree with you. And so did you find your pharmacy background helped you a lot during your medical school experiences? Was it more or less helpful than you were expecting?

Brandon Smith

I would say it was, I expected it to be helpful. But I think it was even more helpful in ways that I didn't realize. So one of the things I love about medical school is the diversity of backgrounds of everybody in your class. For the most part with pharmacy school, everybody is coming out of high school, they kind of all have I mean, yes, we all have different experiences in high school. But you're all kind of starting at the same playing field, you're roughly the same age. Now it's a little different in some of the programs, where people come in with a full a true undergraduate degree. And they're just doing the professional phase of pharmacy, it's a little bit different there. But in medical school, there was a girl in my class that turned 21 in medical school, and there was a guy in my class who was 37, when we started had two kids who had had a full career before this and decided, you know, I want to have a career change. Much much different than then a pharmacy school class looks like. So everybody comes in with their own unique experiences, their background, and my pharmacy background definitely set me apart, definitely set me up for success, and gave me a unique perspective to medicine. But the good thing is everybody comes in with those perspectives from what their backgrounds are. And I think you need to recognize what your other classmates backgrounds are and their experiences and learn from them. There were people in my class that had been professors of anatomy, prior to med school, or whatever it might be, and you can learn so much from them because they just had these differing experiences.

Nathan Gartland

Yeah, absolutely. I love that. And I think another point too, with with having the pharmacy background is just the added like professionalism, when it came to working some of like some of the applicants that some of the more traditional traditional applicants had never even seen some of the volume of medical school. So having those expectations from pharmacy school, I think helped them a lot to just not getting hit in the face or knowing that you have to study way harder, upfront, and I guess it was less of an adjustment period when it came to the volume of the material, at least. Yeah.

Brandon Smith

And once you start getting into some of the clinical stages of medical school, as a pharmacy student and pharmacist, you are already so familiar with interacting with a patient, your comfort level and your interaction skills are just leaps and bounds beyond many of your colleagues and no fault of their own other than just they haven't necessarily had the same experiences you have.

Nathan Gartland

Exactly. And I that was actually leading into my next question too. And I was curious to know how did your pharmacy education help you with clinical rotations because I'm actually starting my clinical rotations in a couple months. So I'm curious personally and I'm curious to know just generally speaking, how useful was it?

Brandon Smith

My advice to you and to the listeners are one, once you go into clinical rotations and they find out you're a pharmacist, be prepared to be treated as the drug expert in every specialty you round on with every disease that you encounter, and with every drug on the market. I started off my clinical rotations on OBGYN as a third year medical student. I've known for years I've wanted to do ID coming into med school I knew I wanted to do ID at no point in time, but I have ever considered myself any sort of expert in OB GYN pharmacology. Yet on my OB GYN farm rotation, anything that came up with question about a drug, I became the drug expert on the team. So you do get looked at as not only the medical student, but they look at you as a pharmacist, they turn to you they want your opinion. Whenever I was a third year on my pediatric clerkship, I was in a room with an attending. And she turned to me and asked me my opinion on antibiotics for a patient. And then she turned back to the patient's mother and said, Oh, I forgot to mention not only is he my medical student, he's also a pharmacist. That's why I'm asking my student antibiotic questions.

Nathan Gartland

Oh, my gosh,

Brandon Smith

you do get looked at as a drug expert, even from very early on, which is a big responsibility. But again, we've trained for this. That's what that what makes having the pharmacy background so special, if you do decide to go on to medical school, and it gives you not only appreciation, one for, again, the pharmacy knowledge, but just the interplay. And what happens on the other side of prescribing, I don't think is many, very few of my medicine colleagues that haven't ever worked in a pharmacy, understand what happens once they hit sign on an electronic prescription or they physically sign a paper prescription, whether it's in a hospital pharmacy, or a retail pharmacy. It just it's a whole nother world that they've never had the experience of of working.

Nathan Gartland

Yeah, I think that's an interesting point because I worked in a hospital pharmacy. So it was a big hospital pharmacy. And we have these medicine carousels and we're doing compounding in the back rooms and sterile preparation and all this crazy stuff. But it's all the behind the scenes legwork that a lot of physicians, I feel like it even like some of the nurses on the floors. Never see that, that behind the scenes. I guess experience that a lot of pharmacy students end up having. And I think it'd be kind of an interesting project to see if we could get physicians to maybe like do like a one day workshop just to see what the life of a pharmacist is like. And now they'll have an appreciation of every time they hit a senator put an order in that this is what's actually happening.

Brandon Smith

I'm very biased because of having a multidisciplinary background. And also, while I was doing my six year clinical rotations as a pharmacy student, I had a lot of opportunity to work with other healthcare professionals, a lot of work with nurses, as well. I have been saying for all of my medical training as part of medical school clerkships. I really think that medical students should have a month of training, where you spend basically, what each one of four different weeks with a different healthcare professional, that is not a physician, spend a week with pharmacy, spend a week with nursing, spend a week with physical therapy or occupational therapy or speech therapy, spend time with our colleagues that we don't necessarily have the best insight of their jobs, because we've never done them. So learn from them. I think it would add so much to our training as physicians if we would do that.

Nathan Gartland

I love that. And it's a great way to like build rapport with the rest of the hospital staff. You've lived in a day in their shoes, you understand the challenges they face, and I think it can lead to a lot better cohesiveness and obviously better patient outcomes.

Brandon Smith

Absolutely. All righty. So

Nathan Gartland

this is the last question for this section. But I was curious, you kind of alluded to it already. But what got you interested in infectious disease? And I guess at what point did you realize that this is the career that you wanted to follow?

Brandon Smith

There's an episode of House where I believe it's the episode where he is treating the bends on a plane or they're on a plane and a patient develops the bends. And I pretty sure that's the episode where he first stated that he was board certified in infectious diseases. And I knew that when I went on to medical if I got to go on to medical school, I wanted to go would be Dr. House minus the limp and the drug addiction. So I think that was the kind of the aha moment of I think I want to do infectious diseases. And then it was further solidify just as we're going through our pharmacy training. And we had our microbiology class, which was really one of the first times I think, in pharmacy school, where I got to see some of what I was doing in the pharmacy translate to what I was learning in school. And it was some of the first time it was really clinically relevant, and just kind of fell in love with a microbiology and antibiotics and then was what I was watching on house and decided I wanted to do infectious diseases. So if I went to medical school, I wanted to go to medical school to become an infectious disease doctor, if I would have gone the clinical pharmacy route, I would have gone and eventually looked to do a PGY, two and infectious diseases and been an IB clinical pharmacist.

Nathan Gartland

And they never looked back. Now. Alrighty, so let's take a few minutes and talk about your post medical school training. I understand that you elected to complete three years of Internal Medicine to ultimately get you to that infectious disease attending role. So what was the most challenging part of residency? And how difficult was it to adjust to the newfound responsibilities?

Brandon Smith

By far the most challenging part is night float. I'm not sure if you have had the opportunity yet. And if you once you have the opportunity, I think you'll probably realize it is incredibly difficult to flip your whole life schedule around for nightclub. I mean, if anybody listening has a midnight type job or has ever worked that type of schedule, at least from me, flipping the schedule and working 7pm to 7am was incredibly challenging. Particularly during my intern year, it got a little easier as I became more comfortable with it and had started doing it more often. But I don't think I ever really liked night float the schedule of night float all that much. Because it's just it's tough to flip your whole schedule, or your like wake sleep schedule. But career wise, residency is tough. Don't get me wrong, but it's a great experience. It really is when you're going to learn some of the greatest amount of knowledge and medicine of your entire career.

Nathan Gartland

Absolutely little bit of trial and fire never hurt anyone. So I'm curious to know, how frequently were you on no float? Is that like residency specific? Or is that just internal medicine specific? Or is that something that every resident experiences at some point or another?

Brandon Smith

I would say most residents will probably do night float at some point. Now with medicine. We were on night float I believe we did four weeks a year, would you have the option of either doing two two weeks stretches or a one lot one month long stretch. And then whenever we were in the ICU, we would do anywhere from four to six days of night float at one point during like the ICU month and we did two months of ICU per year. So that works out to be one about six weeks out of the year of knife load at UPMC mercy where I did my medicine training everywhere is a little bit different. Everyone is going to have a slightly different nightclub schedule. There are some caps on how many weeks you can do total. But different programs are going to be different and different specialties. If you're in surgery, you're probably going to be doing a lot of 24 hour shifts or deferring night shift schedules. I can't really speak to the specifics of those but with medicine, I think it's pretty standard about six weeks a year.

Nathan Gartland

Wow. And so with the the night float you mentioned that's like 12 hours. I've heard some stories just online through other people that they have done like the 24 hour call and then they have another basically they have sign out in the morning. So it turns out to be like a 2728 hour shift. Have you ever had to experience anything like that?

Brandon Smith

Thankfully, no. The medicine program I trained at we did not have a 24 hour shift anywhere in our schedule. At any point in time. The longest shift that we had was a 16 hour shift. Oh, that doesn't remind me we would do 116 hour shift a month whenever we were on floor service. And it was a 7pm Saturday Night Shift to 11am Sunday morning. And essentially we were the night float team for Saturday night. We would round on our service Sunday morning with the attending and then the gone by 11am and I think the long I guess I was ever there was maybe 12, or one, if we had, if we had like somebody's condition very late, I have a code very late in the in the morning, that was one of our patients that we knew. But that one would have been quite rare. So we did not have 24 hour shifts at my institution. Other places, I know other programs, even within UPMC, some of them did have 24 hour shifts, but the only two times I ever had a 24 hour shift were as a med student, and that was one once on surgery once on pediatrics, and it was just a 24 hour I didn't didn't get stuck there later.

Nathan Gartland

Wow. I can't wait. But um, so obviously, the the general consensus is that residency training is long, it's tiring, it's mentally demanding. But, you know, while it's expected that residents work these long hours and get very little sleep, how did you make time for your life outside of the hospital?

Brandon Smith

My opinion, you just have to prioritize your own life as well recognize that when you leave the hospital, there are times where you may have to do some work at home. But you also have to make time for yourself. If you don't, you're not going to have a good emotional state, you're not going to have a good work life balance. And I actually think you do a huge disservice to your patients, if you're not in the best mental state to provide care. And if you're not enjoying your life outside of the hospital, it's very tough to put yourself in that right mental state to take care of patients. So you just have to really work on trying to prioritize it. And my recommendation for those applying to residency is look for programs where the residents are smiling, look for programs where the residents are happy, you can usually get a good sense of the work life balance of the residents when you go on your interviews. And you may ask this later on about kind of looking at the residences and fellowships, but do as much investigation of the programs as you possibly can to try to figure out is that somewhere that prioritizes, a work life balance. And I can say my experience at UPMC mercy, my experience at UPMC Presby for fellowship, work life balance was incredibly prioritized. And that really helps programs that emphasize that will make you better physicians, because to be a good physician, you have to be a good physician in the hospital, and mentally happy outside of the hospital.

Nathan Gartland

Absolutely, especially with burnout being such a major topic and healthcare. I think that's just great advice to follow through with. And also just kind of switching it up slightly in your experience. As a resident. I'm sure you worked with plenty of pharmacists during that time period on the medical team. And I'm curious to know, how important was it to have them on the team, especially since you were a pharmacist yourself? Were you? Did you see yourself taking recommendations from them as well? Or were they helping clean up your mess?

Brandon Smith

Well, I mean, I'm biased, I will occasionally describe myself as I'm actually just a pharmacy spy in the medical world. I want to have pharmacists around me as much as possible, I turn to them constantly, I really have the belief that there should be a clinical pharmacist on every rounding service in every unit, they are an essential component to the health care system. Right now I'm rounding on our endovascular infection service. And I get to round with one of our brilliant pharmacists, Dr. Bonnie Fousey own. And I sometimes feel bad for my fellow and nurse practitioner that are on the service with me, because Dr. Foul Ciona and I will just sit there and we will start nerding out on PK PD, and pharmacology about all of our patients. And to me, I think it really is enhancing the patient care having the different perspectives of how we're using the antibiotics that we're using for each and every patient. So yes, I really do believe that we should have pharmacists on pretty much every service that you can possibly have them round on and have them in every unit of the hospital.

Nathan Gartland

Absolutely. And especially with how advanced like post op pharmacy residency training has become I've even heard rumors that they're starting to do third, third year PGY threes residency programs. So the the pharmacists are just getting better and better. But

Brandon Smith

there, there are so many opportunities and I know we're kind of focusing on the going to med squad a pharmacy, career opportunity, which I don't think gets talked about nearly enough. But there are so many different opportunities out of pharmacy that don't get talked about. And now granted it's been In 10 years since I've graduated, but I remember that it was basically you went into retail, you went into hospital or clinical pharmacy. And that was it. That was really the only thing that mentioned and talked about. And there are just so many job opportunities out there, that even if somebody decides they don't want to go to medical school, they don't want to be a retail pharmacist and they don't want to do clinical. There's other things to do too. So it's a growing specialty.

Nathan Gartland

Absolutely. There's so many new avenues, especially like nuclear pharmacy, and there's just obviously, like long term care, pharmacy, and just a lot of different unique things that don't fit the traditional infrastructure of, you know, going to community pharmacy or hospital. So I love that. And so let's also talk a little bit real quick about your your fellowship training, how difficult was it applying to fellowships, it seems like these applications are like never ending, you apply for medical school, then you apply for rotations, and you apply for residency, then you apply for fellowship, and then you have to apply for an attending positions. It's never ending. So I'm curious to know a little bit more about that.

Brandon Smith

I think by the time you get to fellowship applications, you're just kind of used to the process of that point. So you've already applied to medical school, you've applied to internal medicine. And once you've done internal medicine, and you've gone through the match, the fellowship application is a reiteration of an internal medicine application. But now it's within the specialty that you really want to pursue. I mean, obviously, you want to pursue what you do residency in, but if you want to sub specialize, you get to really finally hone in on like that particular part of medicine that you like. It's a bit of a reiteration. But it's also the opportunity to really look more specifically into what your interests are applying to internal medicine, you're going to have programs where that you get to interact with all of the specialties, and get some experience with research. Maybe if you really want to just do internal medicine, there might be a particular research opportunity or a subspecialty that you want exposure to that goes with the medicine program. But with fellowship, particularly with infectious diseases, you have to start to think about, is there something within it I really am interested in? For me, it's kind of microbial stewardship. So I was looking for programs that had an emphasis, or a very standard very strong stewardship programs. Some people like transplant infectious diseases, or HIV or tropical medicine. And I tell all of our fellowship applicants here at UPMC. If you want to do tropical medicine, we may not be the optimal place for you. It's Pittsburgh, we see some tropical medicine, I actually had a case of leishmaniasis last Friday. Beyond that, it's not, we're not seeing these cases, walk in the door, all day long, you've got to go somewhere on a coast. But if you want to come to a great stewardship program, or a great Transplant Program, come to us, we're the place you want to come to, to train for that. And now, I think makes fellowship application really, really exciting because you really get to focus in on what you want to do, and find the places that are setting the standards for doing that training. And for doing that type of research, medicine training. On the other hand, you're looking for programs that they're going to give you a lot of support, great work life balance, and you're going to have solid training across multiple specialties. Doesn't have to be the best training for your particular specialty. Because you want a good background in all of Internal Medicine.

Nathan Gartland

Interesting. Yeah, that's something like I wasn't really familiar with. And I love how you broke that down. So for spell fellowships, essentially, it's finding that little niche that you're super passionate about, and then just going for it and the programs will match you into that field because of your passion. It's not so much based off of objective metrics, like it is for residency positions these days.

Brandon Smith

Right. And I think some of the best advice I can give for looking at both internal medicine residency is or really any residency coming out of medical school and fellowships. If there's somewhere you're really interested in or a couple places you're really interested in, try to do away rotations there. Try to get to know those folks, even if you have to just go shadow on your own time, or get in contact with them. It will make life much easier and at least in my opinion, gives you a step up on your application programs, so many applications anymore, because again, it's getting so competitive out there. that folks are applying to more and more and more programs. Well, what can set you apart, obviously, different components of your application, your grades, your board scores, but really having that one on one interaction with different providers at an institution, you're interested in training that will go such a long way, because they've already seen you. They've already worked with you, they know what your skills are, they know how you're going to interact with their team. And that I think, will go a very, very long way. It definitely goes a long way, in my evaluations of potential applicants, and may even be able to overcome if you do have a deficiency, or maybe you're not as strong in one particular area, I would personally would rather bring in a new candidate that I've worked with that I know performs very well clinically, that may not have a stellar board score, because at the end of the day, clinical skills and board scores don't always correlate one to one.

Nathan Gartland

Yeah, that's great advice. And it definitely helps putting a face to the numbers and having that connection, like you mentioned, kind of like tailing off of what you were saying, I'm curious to know, how important is doing like a chief residency position? Does that help significantly when it comes to matching into a fellowship? Or is that just like I said, or like you mentioned that it's more so finding someone who's going to fit the role that you're trying to find and not necessarily off of objective or positions.

Brandon Smith

I think chief residency positions are very unique opportunities that are tough to generalize. Now, I came from a medicine program where our chief residents, or our third year residents, so they were not doing an extra year of training, it was just part of their last year of training. We had 21 residents per class three were chosen to be chief residents. And they handle the administrative duties where the UPMC hospital I'm at for practice. Now. They do have a dedicated fourth year chief residency and they have they have five chief residents, I believe, per year. I think it depends on if you know exactly what you want to do, what your confidence level is of applying at a particular time, do you think you need to have more time to get some additional research experience? If you're in a relationship, maybe you're waiting on a significant other to finish a year of training, so then you could potentially move somewhere together. There's a lot of different personal factors that go into whether or not to do a chief resident year. And I think that's something that if somebody's considering it, talk to their colleagues that maybe have done it the year before them, or a couple years before them, talk to your advisors and your mentors, and see if it's the right fit for you isn't needed to match into competitive fellowships. I was not a chief resident and matched into a competitive fellowship here at UPMC. But it definitely doesn't I don't think hurt anybody's application to be a chief resident, whether it's a third year chief resident or a fourth year chief resident, but you have to see if it's the right fit for you and what you're looking for with your fellowship.

Nathan Gartland

Yeah, that's great advice. Thanks for for clarifying some of that for me. And additionally, so while you're in fellowship, you are obviously at the frontlines of COVID 19 pandemic and I'm curious to hear a little bit more about like the adaptability of the healthcare team. Everyone was obviously battling short staffing issues, extended service hours, lack of PPE, equipment, hospitals over capacity, and you're also battling an unknown illness, what kept you going and how did you tackle that with as a team in the healthcare setting?

Brandon Smith

I had the pleasure and great opportunity that in January of 2020, I was at the infection prevention meeting, whenever they were doing the very first discussion of SARS cov. Two at that time, Wuhan Coronavirus, it was so brand new, had been identified maybe two, three weeks beforehand. And I even remember sending out emails to some of my colleagues of the information I learned at that meeting. And they got to see the planning that was going on at that point in time. So beginning to middle ish of January 2020. We were already planning for what happens when this comes here because we know that it's inevitable. We know what's going to be here. What happens when it gets here. How are we going to handle our supply chain? How are we going to manage moving patients around? Again, very blessed to be in an institution that was thinking about this. We six months before the lockdown before everything became chaotic. And one of the things that we did once it did become chaotic, and when things did lock down the institution very quickly one moved students off site for their protection and to minimize potential exposures. We also moved a lot of residents and fellows off site, I actually spent all of pretty much April and May of 2020. Working from home, I was not in the hospital at all, our division made a concerted effort to say, you know, what, we don't know how quickly this might spread. What we're going to do is we're going to minimize the number of providers we have in the hospital, we're still going to have you working together and doing remote medicine. And we had a lot of capabilities to scale up our remote map and telemedicine, but we're going to minimize how many providers are there. So if somebody does get sick, we are not losing our entire staff all at once. And thankfully, one, everybody was able to stay safe. We never had PPE shortages, because we weren't rounding with six people on a team, we were minimizing how many people were using PPE at any given time. And we were really protecting our workforce. And I think in some parts of the country that didn't happen. And those areas, their workforce got decimated. And in some areas, part of it was luck that you didn't get hit nearly as hard at any one point in time. And you had some institutions that just really did a great job of protecting employees to the best of their ability. So thankfully, we never had PPE shortages, we had PPE where it was, we're going to hyper conserve what we have. So we don't hit those critical shortage levels. But we never ran out of anything, which was essential.

Nathan Gartland

Absolutely. And I can imagine it was just a very stressful time just to be in the fellow like being a Fellow in infectious disease, because all eyes in the hospital were turned on you and your team at that time to manage this this deadly virus. So I'm just curious to hear a little bit more about like, how was the residency training different? Like you already mentioned that you were off site for a little bit? How did that progress for the next couple years of your training?

Brandon Smith

I at that point. So the ID fellowship is two here is generally two years unless you're a part of the research track. And our first year is all clinical rotations. And our second year is really elective time and time that you get to kind of pick and choose what you're doing. So all of our required rotations are in the first year. And the pandemic happened the second half of my first year. So I already had really about the first nine months of my training in person, for the most part fairly normal. But then I had two months of that remote training. And I will say it taught me so much about remembering and understanding what is important about the patient interactions. And what we do just because it's what we do. You don't necessarily need to listen, listen to every patient's heart and lungs, we all kind of do it because that's the way that we're trained, but taught me to understand when I'm only reviewing a patient based off of their chart, what are the little points of the exam, or of the history Do I not have in the chart that would be useful for taking care of this patient. And now I had my attending that was in the hospital. And I would say, okay, when you examine them, these are the two three or four physical exam findings that I'm most interested in. And then they could report them back. I mean, at that point of my training, I had to do a physical exam. So the actual repetition of doing the exam wasn't, is important, but learning what parts of the physical exam really were changing my management, and what we're being done just because it's what we do, I thought was really interesting and helpful for my training. And it taught me I think, to be better at biasing the chart, pulling out the information I needed. And I think now when I go see patients, I feel like I try not to re ask the same questions that have been asked over and over and over again, just to ask the same questions. It's really picking out the parts of their history or looking for things on exam that aren't found anywhere else on the chart. So it taught me skills that I don't know that I would have mastered in the same way. If I would have just kept learning the exact same way it forced me to learn from a different perspective.

Nathan Gartland

Interesting. I love that. And I know we're getting towards the end of our episode already. So let's take a few minutes and you find only finished with your training. So I want to talk a little bit about your life as an attending physician. What does that been like? And how are the responsibilities different from obviously being a Fellow?

Brandon Smith

It's a relief and stressful all at the same time. The buck now stops with me, the liability now rests on me. But having a very supportive division, very supportive colleagues, knowing that if I get stuck, if I have a question, if I have a concern, I have dozens of people I can turn to. I have amazing pharmacists that I can I call up daily and ask questions to. And knowing that I'm never alone in this is very, very helpful. But at the end of the day, I really do get to make the final decision for my patients. And that's what I've been training for for 15 years. And it is very, very exciting.

Nathan Gartland

Absolutely. And I'm curious to know with as some attendings, their work life balance actually shifts, some gets a little bit better others, it actually gets worse than some of the residents. So I'm curious, are you working more or less than you were as a fellow or resident?

Brandon Smith

I think both. It depends on the rotations that I'm on. I, I do a lot of rounding in person, I do some telemedicine and I also have some research time. And because this is my first year, and I'm trying to also grow my research career, I do oftentimes feel like I'm working as much as when I did as a fellow or sometimes more than when I was a fellow. But it's for different reasons. I'm trying to do a lot of different things all at once. I don't feel like I'm spending the same amount of time doing the same tasks. It's more just also, I don't say no to anything. So I'm constantly going in multiple directions and doing different projects. But it is it's very enjoyable. So even if I am working a little bit more, I'm still happy with it. And I'm definitely not burned out yet and hopefully don't get burnt out. But

Nathan Gartland

it's great to hear. Yeah, yeah. And I'm curious kind of following up with that question. What is your average day look like? Can you walk us through like your 7am to 7pm day or however many hours you're working? What can you let's like follow your your daily routine, I suppose.

Brandon Smith

I will tell you my day almost never starts at 7am. I am not a morning person. And that might be the greatest part about being an attending is by day is trying to stroll into the office by 9am. But I'm also happy being here later in the day, and I'm usually at the hospital 9am, maybe 7pm busier services, sometimes eight 910, if I'm also trying to do a bunch of projects as well, but I'm okay with that I would rather be able to sleep in a little bit more. So my day really, again, starts around nine, it's reviewing patients in the morning, depending on the service, if I'm on if I've got learners or fellows, we'll be meeting up with them. It can can be anywhere from nine to 10. And doing cable rounds. And then we'll go see patients, these tend to be broken up with a lot of meetings, depending on which day of the week it is, and rounding in between the different meetings. And then in the evening, again, finishing up notes catching up on any product projects or on any emails. I like that my days are almost never the same, partially because of the meetings breaking up the days. But just depending on what service I'm on who I'm rounding with, my days are quite varied. And I like that some people love their schedule of seven to 530. Everything is like they have like their whole day planned out by the by the minute and they know what they're doing. That's great. As an attending, you can do that if you want. As an attending if you want to be more, come in a little later work a little later, mix your day up a little bit, you can do that. So that's probably one of the other things I really like about a technique life.

Nathan Gartland

Yeah, it's much more customizable, and no one's going to tell you no. So how often are you on calls and attending to I'm just curious, is that problematic? Or is that obviously it's gonna be institution specific, but

Brandon Smith

Right. My weekend call is about 878 weekends per year, which I don't think is bad. That's about the average most ID positions. You're on call one out of every four weeks or so sometimes a little bit less. Sometimes if it's a smaller private practice a little bit more. And then the overnight call is not usually too bad. It's only kind of rough. If I'm on our teaching service that handles all of the just the general Id call calls, then it's a few phone calls a night. Otherwise, I was on call this whole past week for our endovascular service. And I don't think I got paged after five or 6pm. Once the entire week, it would be rare, I would get more than like one late page in a week on that particular service. So it depends on the service that I'm on. Sometimes it's a little bit more, a little bit less, but it's not overwhelming, except the a couple of weeks a year on on that fellow teaching service.

Nathan Gartland

Awesome. That's good to know. And let's take a few more minutes. I know we're getting toward towards the end right now. But let's talk a little bit about pharmacy. And, you know, obviously, you're super passionate about the profession. And I'm curious to know what you think, are there ways that pharmacists can expand their clinical scope or roles on the medical team? And if so, how can they? How can anyone listening to this helped further advance the profession of pharmacy?

Brandon Smith

I think an important opportunity is to really get involved in some of the pharmacy degree pharmacy organizations out there. I'm a member of SI EDP Society of infectious disease pharmacists. And they're constantly working to grow, grow the role of infectious disease pharmacists, across inpatient, outpatient outreach with government organizations. I suspect that there are probably different advocacy groups and clinical groups like that for different specialties within pharmacy for cardiology, oncology, whatever, specialty you really enjoy. And I would get involved in those because they really do help to make a difference. And at a local level, learn learn who the key players are. Go introduce yourself, make your presence known. Handshake, we use the term and met and stewardship handshake stewardship, go learn who the providers are, once they know you, they will be much more likely to call you to involve you. They will say, Oh, I met that person. I like them, I want to I would like them to come back on rounds with us. So get to know those key stakeholders.

Nathan Gartland

That's great advice. And that can be applied for pretty much anything, you know, just being personable is just such a huge thing, especially in healthcare. And I think that's a great way to to get pharmacists more involved. And obviously, another avenue for pharmacists to get involved is antimicrobial stewardship. And I know this is your, your favorite topic. So I guess how can we further advance this mission to appropriately utilize antibiotics and obviously, minimize resistance from a pharmacy perspective and from just a national health care perspective.

Brandon Smith

From a pharmacy perspective, we've been really working on this hard the last 10 years or so, I mean, in some places have been working on it even longer than that our stewardship program here at Pres. B, dates back to the early 2000s. We just celebrated I believe it was our 20th anniversary. And it's getting the education out there. Meeting with the providers, showing them what you have to offer and reassuring them that you're not trying to one necessarily do their job, or to kind of step on their toes, you're trying to help them help their patients. And that's really what clinical pharmacy is all about is it's trying to work together to improve patient care at the end of the day. I think the one gap that we have in stewardship outreach right now, everybody wants to look at inpatient. A lot of people really want to look at outpatient and like skilled nursing facilities. I don't think we do enough teaching in schools at young ages to really start kind of helping to mold society's understanding of stewardship early on the just in the general public. The idea of, oh, I have a cold, I need to go get an antibiotic. It's 2022. That shouldn't me be the prevalent mind set of many Americans, we should really be doing a better job educating early on of, hey, this is what an allergy actually is. It's not having nausea. After you take a medicine, it's you have a rash your throat swells up. We have 10% of the population reporting a penicillin allergy, but only 10% of those allergies are actually true. You myself, I grew up quote unquote, having an augmented allergy because they gave me banana flavored augmentin when I was a child, and I hate the banana flavor, and so I wouldn't let them give me augment again until I was in pharmacy school and said, this makes zero sense. And I did my own direct oral challenge with a dose of augment and I'm still here. My gosh, we need to educate the public, I think is the next great step to advance stewardship.

Nathan Gartland

Yeah, that's a super interesting take on that as well. And that's, that's such a common thing I always get, like question is like, Oh, I have this cold and you know I'm sniffling, and it's only been three days, like, Should I go get an antibiotic? I'm like, no, no, no, please, please don't, you know, but I think that's just something that can be reinforced. And it's something a super easy intervention, that can happen too. So it's not like there's shouldn't be too much red tape with that. So I like that idea. And we're talking about like stewardship. Obviously, the concern is for growing resistance, and I'm sure you've seen some pretty scary resistant pathogens. What's the scariest bug you've come in contact with or just have seen in your tenure?

Brandon Smith

Serious bug is whatever the next bug that I have to treat is, but my my interest really is in multidrug resistant bacteria because that's, that's the one of the great challenges as an ID. Just based off of pure resistance. I've treated a New Delhi Metalla beta lactamase Klebsiella pneumonia, which has very, very limited treatment options. And that was before we had reliable access to the Ceph Hasidim, IV back cam or meropenem Vabre backhand plus as tre Anam combinations that we're now using for some of those. multidrug resistant Pseudomonas seems to be the plague that never ends and the MDR gram negative world. It keeps on common no matter what we try to do every time we get a new drug for monitor resistant pseudomonas, it's, it's popping its head back up and developing more resistance. And then on the gram positive side VRT vancomycin resistant Enterococcus i, we see a lot of it. And as we start working our way down treatment options, it's not so much that we have limited treatment options. But we have limited treatment options because of collectability, because of cost, because of the sight of the bug that there may be they're not efficacious there. There's a bunch of different ones that we see that all deserve attention and, and new drugs. And that's really what we need to focus on, I think in the ideal world is getting new drugs for these bad bugs.

Nathan Gartland

Yeah, lastly, my question was actually what, um, are there any new like promising clinical trials that you're seeing for new drugs on the market that that are showing really good data for some of these nastier pathogens.

Brandon Smith

Back in January, I had the privilege of virtually attending a antimicrobial resistance conference put on by, I apologize, I should know the exact name of the group. But it's an antimicrobial resistance society out of Texas, I believe they're based out of a bunch of the institutions in Houston. And they had several speakers that were talking about some of the new beta lactams that are coming to market and really some of the new beta lactamase inhibitors. And I don't know that there's any one particular antibiotic that is promising. It's just the novel way we are approaching grim gram negative resistance. Typically, we'll bring out a new antibiotic in combination with a new beta lactam in combination with the beta lactamase inhibitor. And there are some standalone beta lactamase inhibitors that are in the pipeline, that you'll be able to do a little bit more mixing and matching. So pick your beta lactam of choice, pick your beta lactamase inhibitor of choice, and put them together. So I think, in the next couple of years, as more of these products at the market, we're going to see more tailored precision type medicine rather than just the days of Oh, put them on vancomycin in comparison with Taser backhand, and you're going to cover everything. I think it's going to become a lot more nuanced and targeted therapy in the future, which is great for the pharmacy profession. Because it's definitely going to give pharmacists even more things to intervene upon. And it's great from an infectious disease perspective, because one, it's some job security and to it's just downright fun to try to mix and match these combinations and figure out the right drug for the right, Buck.

Nathan Gartland

Wonderful. Yeah, that's a super interesting. I think that's a great perspective and pharmacists are going to be just very happy to hear that when this when this actually goes live. And so we're coming to the final few minutes of our show today. And I just want to ask you a few closing questions. How do you plan to stay involved in the pharmacy world you've kind of alluded to it a little bit, but

Brandon Smith

I mentioned I'm an active member of society of infectious disease pharmacists, si DP. I really try to continue to work closely with our pharmacy colleagues here at UPMC. I love having pharmacy students on rotation with me. And it's really trying to help educate the next generation and I say that as if I'm old, but I'm not again, not that far removed, have won the opportunities in medicine and also the opportunities in pharmacy. It's, I don't think I don't ever feel like I've left pharmacy world I mentioned a little earlier. I'm kind of like a pharmacy spy, living the doctor life.

Nathan Gartland

I think that's a funny, funny way to put it. But I love that. I guess I'm going to be a spy when I started rotations.

Brandon Smith

I'll teach you the secret hanging handshake as soon as you graduate.

Nathan Gartland

I can't wait. So additionally, you mentioned that you're precepting pharmacy students. I remember back when I was in school, there were you were trying to set up a rotation, clinical epi rotation for pharmacy students, is that something that you were hoping to revisit in the future? To make it more of an official process?

Brandon Smith

It is, I probably would have done something like that for this current academic year. However, with the COVID pandemic, and the limitations, I wasn't, I wasn't really sure what we were going to do with allowing students back into the hospitals. When I started as an attending last July, it was still very limited as to what students were allowed in what roles could be with the pandemic, I probably will give it one more year. And also as everything is kind of settling down with my career. But yes, I do plan to try to offer some more opportunities in the future. And that rotation was really going to be geared towards pharmacy students who were interested in going to medical school, and trying to give them a almost medical student like rotation experience. So while I don't necessarily expect a pharmacy student to completely understand all of the physical exam, or understand if I pull out a chest X ray or a CT scan, and being able to read it, looking at it from those perspectives, and focusing on more than just the drugs, but actually the interpretation of an exam, the interpretation of imaging, the interpretation of the EKG, things that the pharmacists, even our clinical pharmacist, don't always participate in, they might care what the results are, but they're not actually pulling up the images maybe as much as a medical student would and putting a separate spin on the role to the pharmacy students. Yeah, 15

Nathan Gartland

years. Yeah, that's a great recommendation. And I think it's interesting, like, just in my experience with the medical school is, and what I've seen in pharmacy school is obviously the education in pharmacy is focused on optimizing the care of the patient, all of our test prompts are given we're given the disease, and we have to figure out what's the best third fourth line medication, and how do we manage these symptoms. And this is obviously like a bird's eye view of the topic. And then with medical school, it's very different. They give you all these symptoms, and they don't really there, at least in my experience thus far, they're not looking so much to figure out how to optimize the care there, the thinking of what's the first line antibiotic, alright, you're good next, someone else will take care of it. I'm sure that'll change my experience as I move into more clinical roles. But that's something that like, never dawned on me, especially as like a new foreign pharmacy student turned medical student. So I think that rotation would have been very helpful for me.

Brandon Smith

I apologize. There were some limitations at administrative levels that were above my head that prevented that from getting off the ground initially. That being said, I was trying to do that as a resident, so maybe it was a little bit

Nathan Gartland

aggressive. No, no worries. And I'm sure a lot of people are going to benefit from from doing that in the future. So I'm excited. And so I'm curious to as an attending this is obviously it's focused more on clinical parts of medicine. But are there Do you have any financial recommendations, especially for students with like massive loan burdens? This is something like I have a ton of loan burden as well. And I always get questions from people, how do you justify going to medical school and spending all this extra money? So I'm curious to hear from the other side of the now that you're finished?

Brandon Smith

I would love to have some magical answer to this. As somebody that has over $600,000 of student loan debt. I don't know that I'm the one that should be giving financial advice to anybody. My advice on the financial side is map out what your what your tuition is going to be, what your loans are going to be. If you know what specialty you want to go in, what is the average salary in that specialty, and really look to see what is the opportunity cost of going to medical school. You can graduate pharmacy school and make well over $100,000 a year at the age of 2425. And then it's going to be potentially another 10 years before you would graduate your residency or fellowship training if you go on so 10 years of last salaries, that's a lot of money that you have to account for in addition to the tuition. I understand what that situation is going to be like for yourself and ask yourself, Is this something I will be happy doing? If that enjoyment from going to medical school and sub specializing and name your specialty for me infectious diseases, is what you want, then then go for it. And that's what I did, I knew it was going to be a financial burden. That being said, I'm very blessed. I'm not living out of a cardboard box, I do make a great salary. And I'm able to put food on the table and bones in my dog's mouth. It's, it's just something you have to recognize very, very early on.

Nathan Gartland

Absolutely. And I always joke, a joke about it as well. It's like, well, I'll just go to law school after this so that I can stay in deferment and not have to pay my loans. I considered

Brandon Smith

law school. And I sat down with an attorney actually right before I considered medical school and talk to them. And they basically said, we don't think law school is for you. Maybe consider medical school. And sometimes I look back and wonder if that also played a little bit of a triggering role in addition to house it thinking about medical school. But yes, at this point in time, my wife will not let me go on for any more degrees or training, and his total cut off. I'm cut off, I cannot go to law school, which I have joked about doing, but I'm not allowed.

Nathan Gartland

We're just serial academics, that's all. But anyway, so let's end on a fun question. And what is your favorite bacteria and why? Funny,

Brandon Smith

I research multidrug resistant gram negatives, I trained at an academic institution that is known for multidrug resistant gram negatives. I also kind of sub specialize in treating Lyme infections. But my favorite bacteria is rickettsia rickettsia, which causes Rocky Mountain Spotted Fever. That's a step question. It isn't that question. I never actually treated Rocky Mountain Spotted Fever I've treated its cousin rickettsia Park Harry I, as a pharmacy student. And that's like I still to this day is like my diagnostic claim to fame occurred on my final rotation as a pharmacy student of diagnosing rickettsia parkeri I. But I've always loved Rocky Mountain Spotted Fever. And I think it goes back to my first year of pharmacy school, and like general biology, and learning about the bacteria, and the interplays of the bacteria and the antibiotics. And it was one of the first times and I didn't even know I wanted to do it at this point. One of the times I really felt like what I was learning in school, was connecting to some of the things I saw in the pharmacy. And it kind of goes along to how I saw that, again, a little bit later on in microbiology. But yes, I've always loved Rocky Mountain Spotted Fever.

Nathan Gartland

And the drug of choice is Doxy. And is that correct?

Brandon Smith

That is correct. And that also happens to be my favorite antibiotic. That by the way, I receive no commercial funding from any manufacturers of doxycycline. But I prescribe it more than any other antibiotic.

Nathan Gartland

Oh my gosh, I love that. Alrighty, so we've come to the end of our interview. And I'd like to thank all of our listeners for the support. 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. Smith, how can our listeners get in touch with you?

Brandon Smith

So they can email me at my UPMC email which is Smith BJ five Smith B as in Bravo, J as in Juliet, the number five@upmc.edu? Or you could I suppose if you are really a glutton for punishment, follow me on Twitter. No more than I actually thought you're putting me on the spot here. I have to actually look at my Twitter handle, which I should probably know, at MD PharmD. MVP.

Nathan Gartland

There we go. Well, thank you so much for being on the show today in the podcast, I realize you're very busy individuals, so I can't thank you enough. And I also recognize you can't say no. So taking advantage of you. But um, no thanks again for taking time and it's a great episode.

Brandon Smith

Absolutely. And again, I would encourage anybody if you've got questions about the journey going to pharmacy school or from pharmacy school to medical school, please again, feel free, you can always reach out to me. I'm pretty easygoing. I will respond. It might take me a little bit of time, but I will respond. So good luck.

Nathan Gartland

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

Brandon Smith

You too. Thank you, sir.

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