Interview with Dr. Jeffrey Gazzara

In today's episode,  John learns how a visually impaired physician overcame challenges during his training and career. Dr. Jeffrey Gazzara describes the difficulties he encountered and what he did to surmount them.

For the past five and a half years, Dr. Gazzara has been a general practitioner working in telemedicine. During this period, he has advanced to several managerial positions, such as Medical Director and Supervising Physician Leader.

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How This Physician Overcame Challenges

At the age of 12, Dr. Gazzara was diagnosed with retinitis pigmentosa, which ultimately resulted in the loss of his vision. His initial career plan was to specialize in neuromusculoskeletal medicine. However, during his residency, he faced several obstacles that made it impossible to continue, and was forced to leave the program.

However, Dr. Gazzara eventually found his way into telemedicine, which enabled him to apply his medical expertise.

Advice from Dr. Jeffrey Gazzara

When faced with a significant physical impairment such as his, he recommends that such physicians consider this advice:

  1. Be honest with yourself;
  2. Surround yourself with support;
  3. Find a medical school and a residency who are on your side, and
  4. Don't forget about nonclinical jobs.

Summary and Next Steps

Dr. Gazzara is focusing on exploring remote opportunities in the Pharma industry and other nonclinical positions that leverage his medical background. Many remote jobs already leverage technology and are potential options for visually impaired physicians such as him.

NOTE: Look below for a transcript of today's episode. 

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Transcription PNC Podcast Episode 298

How This Visually Impaired Physician Overcame Challenges to Achieve Success

- Interview with Dr. Jeffrey Gazzara

John: I was recently introduced to today's guest by a colleague, and I thought his story would be instructive. He's faced some unique challenges in his education and his career, and I think we can learn from them. So welcome to the show, Dr. Jeffrey Gazzara.

Dr. Jeffrey Gazzara: Thank you very much for having me, John. I'm excited.

John: Good. I'm glad you're here and we can connect today. I guess the easiest thing is to just get right into your story. So tell us about your medical education and your clinical work that you've done to this point and we'll just take it from there.

Dr. Jeffrey Gazzara: Yeah. I attended the Philadelphia College of Osteopathic Medicine in obviously Philadelphia, Pennsylvania. Graduated in 2016. After that I went to Michigan Mercy Health Muskegon in Michigan. It's part of the Michigan State University College of Osteopathic Medicine. I completed my internship there. Now the goal was to complete a residency in neuro musculoskeletal medicine. I am visually impaired. So, I did not complete my residency.

I came home to South Jersey in 2017 and found work in telemedicine. I've been working in telemedicine as a general practitioner for five and a half years. I offer acute services, urgent care services, mental health, prescription refills, some primary care services.

I've also been promoted to a number of administrative roles. So, currently I serve as the medical director for Axiva Infusion Centers in Philadelphia. I was also the medical director for a nationwide telemedicine company, and I've also been promoted to supervising physician leader for a nationwide telemedicine company.

John: Okay, very good. I'm hearing some success there. A lot of success in terms of working and taking care of patients and managing some things and being a medical director. But you mentioned that you didn't complete the residency. So, apparently there was a glitch there which I guess the question we would all have is, "Okay, you went into that and they knew who you were and what was going on. So what happened? Why did that not get completed?"

Dr. Jeffrey Gazzara: Yeah. And you mentioned earlier that I have a unique story and this is where it kind of comes into place. Again, I am visually impaired. I was diagnosed with retinitis pigmentosa at the age of 12. My biggest difficulties, I have lost a lot of my acuity, a lot of my peripheral vision. I just don't see images very well.

My plan was to go into neuromusculoskeletal medicine. It is the residency for osteopathic manipulative therapy. What we do in osteopathic manipulative therapy is we use our hands to diagnose musculoskeletal dysfunctions, to diagnose back pain, neck pain, chronic pain, and then you use your hands to treat those conditions. I thought that this was perfect for me.

When you're in residency, certain residencies require a rotating internship. I was still being asked to go through OB-GYN, surgery, emergency medicine, and obviously there's just things that I was not able to do as a visually impaired person. The program flagged it and said "We're not so sure you can continue." I immediately fought back. I reached out to a number of blind or visually impaired doctors around the country and it just seemed like they did not face what I faced. It seems like their programs worked with them. They knew their end goal was to be a psychiatrist, for example. That's just an example. And they were willing to help them to get to their end goal. For some reason, that was not the case with me. They let me finish my internship, but I did not continue the residency.

John: Got it. So did you then immediately proceed looking for work? Is that what happened after that?

Dr. Jeffrey Gazzara: Correct, yes. When I came home from Michigan, again, back in South Jersey, I completed my internship, which means I could get licenses, state licenses. Unfortunately, when you don't complete a residency, you can't become board certified. So yes, I came home, started looking at, "Okay, what can I do?" And that is how I found work in telemedicine.

John: Okay. Tell us a little bit more about the telemedicine work that you've done. It sounds like it'd be pretty straightforward, but apparently, you experienced some challenges along the way in that as well. So, let's hear more about that.

Dr. Jeffrey Gazzara: Sure. When you're not board certified, it is very hard to get jobs as a doctor. Plain and simple. I can't work for a hospital. I can't work for a large private practice. And it was news to me that even some of these large telemedicine companies, Teladoc, Doctor on Demand, Roman, Hims; they will not hire me. They don't even look at me.

Over the past five and a half years, the jobs that I have gotten are with startup companies. I've worked with a lot of clients. Again, I've had a lot of success. I received a lot of promotions with these companies, and in four separate cases really felt like, okay, this is my full-time job. This is going well. I want to be here for years. And in those four separate cases, they all collapsed. They all went under, and I was left pretty much unemployed. I always have little stipends here and there, little supervising jobs. And it got to the point, the last one that happened was earlier this year, 2023, and I just said, "You know what? I need more stability. I can't keep going through this vicious cycle."

John: Yeah, it sounds pretty frustrating. We were talking in preparation for this, and I've heard and didn't really understand that it's kind of hard to know with some of the telemed companies how stable they are. And lo and behold, either they stop paying you or they're no longer in business because there are just so many different startups. So it sounds like you have experienced that firsthand.

Dr. Jeffrey Gazzara: And the other thing is, yes, what you just said is correct. They're just professional like marketers and advertisers. I can't tell you how many times I'll get emails saying, "A high volume client, this is expected to be high volume, thousands of patients." And it just doesn't happen. This is like hundreds of times to the point where I'm just numb to it. It's like you don't believe it. Like I said, four times in the past five and a half years where I really started to pick up work with a very good client, but I've worked with over 26 clients in this time that just didn't pan out, never got going, collapsed. It's very frustrating.

John: Now, one of the things we were going to talk about today is sort of looking back and like you said, I think you've talked to other visually impaired physicians and so forth. Based on what you've gone through so far, do you have advice for, let's say, the pre-med student or even people in medical school in terms of what to expect, what to watch out for, how to be a little judicious maybe in selecting a field to pursue?

Dr. Jeffrey Gazzara: Yes. I thought about this a lot and a lot of it is really internal reflection. What could I have done differently? How could I have made this work a little bit better? I think there are four things that I want to highlight, and I could honestly talk about this all day and really have discussions with somebody. But the first thing was to be honest with yourself.

When we use the word visually impaired, that can be anything from blind to simply having poor acuity or poor peripheral vision. So, you have to be very honest with yourself in what can you do, what can't you do? And choose a medical specialty or profession based on that. And again, I really think I did that, but may have been a little stubborn in not just simply going into psychiatry because I wanted to pursue musculoskeletal medicine and I wanted to be kind of cavalier about it.

The second thing is to really surround yourself with support. And when I say support, I mean emotional support, but also support in people who are going to help you get accommodations and help you set up accommodations. So that's very important.

Third, now this is hard because again, I tried to do this and I thought the residency was on my side, but third would be to really find a medical school and a residency that are on your side. They know about your condition, they understand your end goals, and they're your advocate. They're your partner in this, they're going to help you get through this. Again, that's kind of easier said than done, but I think that is huge and it appears to me that that's how other blind and visually impaired doctors have navigated this.

And then last but not least, don't forget about nonclinical jobs. I have and still am considering a master's in public health. There's a lot of really cool stuff you can do with that. A lot of things that are very amenable to a blind or visually impaired person. There are jobs with pharmaceutical industry teaching roles. You can get into medical legal work, quality improvement, medical writing. So, definitely don't be afraid to consider those things as well.

John: Good points actually. Yeah. Because the important thing, at least the way we look at it on the podcast, the way I look at it, is you've gone through all that training and whether you're leaving because of circumstances like you or just fed up or burned out, whatever it might be, it's really helpful if you can just leverage your medical background. And there are different situations where you can do that and you're likely to get paid more that way. And you feel some satisfaction that you're still building a business or a career based on your training.

I'm going to go back to some of the four things that you mentioned. Just some things that occurred to me. I always think about the ADA and there are people that think, "Well man, that puts a lot of pressure on the employer", but it's led to a lot of more opportunity, obviously. And so, do you feel like the school or the residency was really complying with what the ADA required? I know I've heard recently that maybe there's limits on what it requires, of course, it's overly tough, but what do you think?

Dr. Jeffrey Gazzara: That's really interesting that you bring this up. Literally, yesterday, as I make my transition from clinical work, I was at a meeting yesterday, just networking and it was a group of blind and visually impaired people. And this was very, very helpful to me to have that camaraderie and to talk to other people who get it. And the idea of the ADA came up.

So what it gets down to is "reasonable" accommodations. When I was in med school, when I was in residency, I can honestly say they gave me accommodations. They did, but there's only so much you can do when somebody just can't see something, they can't see something. And so, that's where the reasonable comes in. And to get a little deeper into it, I reached out to attorneys. I wanted to fight for my career. And I never got the feel that these attorneys were like, "Oh, this is a slam dunk." Because it's so blurred. It's so he said, she said.

I hope that answers your question. It's very tough. The ADA stuff is very tough because of that "What is reasonable? How far do you help somebody like me in my situation when there's just things that they're not going to be able to do?" To be honest, I think that "human thing" to have done was, Jeff wants to go into neuromuscular skeletal medicine. He's not performing surgery, he's not delivering babies, he's not putting anybody at risk by using his hands and treating somebody. But that's just not what was done for me.

John: Yeah. Like you said, the ADA it's talking about maybe some concrete things that can be done within a reasonable price. To me, I might think, yeah, well, the accommodation might also be in the curriculum. That's not really physically trying to overcome some kind of impairment, but to change the curriculum sufficiently or to make some kind of accommodation in the curriculum, be knowing that like you said down the line you're not going to be doing that, you're not going to be applying for residency and neurosurgery or something.

Dr. Jeffrey Gazzara: Yeah. And what you just said, you hit the nail in the head. Because that's it, it was the curriculum and in each clinical rotation, there's a checklist of things. But then you're really getting into the AMA or the AOA and kind of adjusting it on their behalf. But I agree with you. That would've solved a lot of issues.

John: There's another thing that brings to my mind, which we've seen a lot of recently. And as far as I know, these positions that I'm going to reference weren't created because of necessarily physical ability or disability. We know we have hospitals and training centers, training institutions that have chief equity officers, and those are mostly out of race and gender and whatever to try and make sure that everybody has a chance.

But to me that would be conceptually the next step beyond sort of something like the ADA. It's like making these opportunities available to perhaps in the past, people that wouldn't have access. Now I know they're focused primarily on patient care, but I believe those chief equity officers and some of whom are physicians actually have to also consider the employees and make sure the employment is equitable and whatever that means. I just wonder if over the next five to 10 years as they start actually putting professionals in these positions of ensuring equity, if that might be something that someone with an impairment of their vision or other situations could benefit.

Dr. Jeffrey Gazzara: One thing I say, and when I was going through this whole process, I spoke to another man who's visually impaired. He's kind of said this as well. We're not back in the early 1900s where one doctor is serving a rural community and delivering babies, treating your sinus infection, removing your gallbladder. It's not like that anymore. Now, I'm not ignorant. There are still rural doctors, rural medicine doctors. But largely, they're not practicing everything. We now have specialists, and if you were to talk to your heart surgeon, I guarantee you they wouldn't remember the guidelines on pap smears and screenings and all that stuff. I argue that it's just kind of antiquated to discriminate against somebody because they can't do everything. I kind of look at it as absurd. Maybe in the next five to 10 years that will come to light. So we'll see.

John: All right. Getting back to you and what you kind of been focusing on, have you come to a point where you feel like you mentioned the MPH, do you have this thing narrowed down? You're still doing a lot of investigating or exploring in terms of what might be possible with the nonclinical side?

Dr. Jeffrey Gazzara: It's coming along. Still kind of looking at everything. Looking at pharmaceutical companies, and that has really opened my eyes to the different positions that are available. I'm still very interested in the master's in public health. But of course that will come with education costs. I've also, again, from networking with this blind and visually impaired group, there's a lot of opportunity in technology that's very doable for a visually impaired person. Unfortunately, it wouldn't be very related to medicine. And I'd hate to just put my medical degree aside, but it kind of gives me a sense of stability and gives me that peace of mind. So, I'm also considering that as well.

John: Okay. Well, it's definitely going to be a challenge, but of course, many of us have made that shift from clinical to nonclinical and found the right sort of niche that fit best with our skills, our abilities, and our interests. So, definitely we wish you the best of luck and in the next few years, we will be interesting maybe to follow along and get back together and talk about what you've accomplished in two or three years down the road.

Dr. Jeffrey Gazzara: Well, I appreciate that, and I would be happy to check back in and hopefully things are a little more stable and I'm working towards another goal.

John: Well, one thing that myself and the other basically career coaches that help physicians and mentors and even faculty at courses and so forth, what we all agree is that a medical degree is extremely valuable. So, there's got to be a way to really leverage that over time, because you just have certain knowledge and skills that those without that degree just don't have. So, if you can just find the right fit for you, I think you'll be very successful.

Dr. Jeffrey Gazzara: I'm learning that. You've told me that before. I've read some books. Just as an example, looking at these jobs within pharmaceutical companies, I don't have the correct, relevant experience. Maybe relevant, but not direct experience. However the organizational skills, the ability to triage, the knowledge of science, and pharmacology, the ability to just take on a lot of work. Those are things that I am going to leverage when I apply for these.

John: Excellent. Any last comments or just advice for just anyone who's starting their medical career that might have this or similar challenges?

Dr. Jeffrey Gazzara: No. Actually, I think I was able to get my thoughts out there. And again, I thank you for this opportunity because I'm always happy to talk about it and express my feelings and advocate for people. So thank you very much.

John: No, thank you. It's been a wonderful conversation. I appreciate the time that you took today to share this with us.

Dr. Jeffrey Gazzara: Thank you. Have a nice day.

John: Bye-Bye.


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