0:01 — Natalie Bulger

Hey there everyone, welcome back to another episode of Motivation N'at where we take hot mess to high potential. My name is Natalie, I'm your host and I'm really excited today for a guest that I'm bringing on who is right here in my physical geographical area but is going to be able to talk to us about a topic that I think is one that maybe we don't understand all that much or maybe we're fascinated about learning how things have changed over time and how do we really know what makes up a clinician, a physician, how they get to where they are, and are we creating new spaces to craft those physicians moving forward? So I usually don't do a round of background on the guest, but Dr. Rose is someone that I have to call a few things out on. And then we will certainly have her touch on a few more things. But I was really enjoying reading about your background, Dr. Rose. So let me just share a little bit with everyone else here that's listening today.

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Dr. Miko Rose is the founding dean of the Indiana University of Pennsylvania's proposed College of Osteopathic Medicine. So if you hear us say IUP, it means Indiana University of Pennsylvania. That's something that always, I think, trips people up when they hear Indiana and Pennsylvania. Where exactly is this? But it's just outside of the Pittsburgh metro area, a little more rural than most people tend to think about being around Pittsburgh, but we'll get into that in a little bit.

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Dr. Rose has been named one of Pennsylvania's 50 over 50 by City and State Pennsylvania, meaning that she is one of the most influential leaders in government, business, and media, and those who are shaping the future of our state. Dr. Rose is a board-certified physician in psychiatry and neurology who is nationally known for wellness programming and began work as the founding dean of the IUP proposed College of Osteopathic Medicine in November of 2023. Prior to that, she worked as a program officer, fundraiser, and advocate for the underserved with a focus on overcoming domestic violence and trauma. With more than 25 years of experience and formal training and life coaching, she draws upon her experiences with underserved communities and creates and facilitates happiness training programs for medical providers and trainees across the country.

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And I can't say how much I think we probably need that, right? Bedside manner for a physician isn't just about how they interact with us, but how they are well themselves in so many ways. And what a stressful world to be in, especially right now. So thank you so much for taking a little bit of time out today for this kind of rapid fire. Let's learn about the college. Let's learn about you. Let's learn about rural medicine and who's going to be providing that care. But Dr. Rose, what else would you like listeners to know about you and where you come from and how you ended up here right in Indiana, PA?

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2:53 — Dr. Miko Rose

Well, you know, I love that tagline, Hot Mess to High Potential. That is just kind of brilliant. You know, I think one of the beautiful aspects of what you're doing in this podcast with your listeners today and for your other recordings is just this piece on high potential — and that for me, I'm a first generation physician. I was not a pre-medical student as an undergraduate in the college where I did my undergraduate studies. It wasn't even on my radar.

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And flash forward a few decades later, I've been blessed with this incredible role to now lead a charge to look at doing something in medical education, to build something that will support the infrastructure of this statewide Pennsylvania area network of government-based schools, both undergraduate and graduate programs, as well as this one school in that whole network of schools, Indiana University of Pennsylvania, as well as our surrounding communities to really set some models for rural health and rural healthcare to do things differently. It's kind of just been an amazing journey. I'm happy to pinpoint and highlight special points that might be helpful to some of our listeners, as well as just share some of the vision and pieces that we've been putting together. It's been not just me, but an incredible team of folks here at IUP and also in the Indiana surrounding community.

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4:23 — Natalie Bulger

Yeah, and when I was looking up a little background, you know, schools of medicine, whether they be for medical doctors or DOs — and we'll get into that difference in a minute — they don't just spring up everywhere. This isn't something that is just a, we're going to create this college to create physicians. It is really hard. In 10 years, I think I saw there were maybe 15 new schools between the two that have come up, which is slow in a world of higher education where you kind of see even the for-profit, not-for-profit, they're all diversifying and building — because there's so much that goes into it. It's not just a quick snap of the fingers, right? This is a work in progress. It's going to take a couple more years to fully flush out. But what has that initial piece been like? So why was it a vision in the first place? And what have you learned in the first half of this kind of development?

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5:13 — Dr. Miko Rose

So the birth of this project as a concept and conceptualization was not started by me. I was actually hired much after the project was decided to be mid-webbed and started to be birthed. So Steve Wolf, who is president of the Indiana Regional Medical Center, as well as the Pennsylvania Mountain Healthcare Alliance of community hospitals that have in essence banded together and share resources — and I know you know that group quite well — along with President Driscoll, who is the president of Indiana University of Pennsylvania, got together with Steve Wolf and the two of them said, look, we have a healthcare crisis and a need for healthcare providers throughout rural Pennsylvania, particularly in the Indiana region. IUP and the region of Indiana had seen a great decline in enrollment, particularly undergraduate, but university enrollment across the board. And so they came together — it was kind of like the Reese's Pieces commercials from the 80s, you know, like, you got peanut butter, you got chocolate, let's bring it together. And it's like this delicious snack. And they really came together and said, you know, let's build a medical school.

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It was sort of an idea that initially, when they first started having discussions and looking into the feasibility, knowing some of the economic models — that if one could overcome a number of the great barriers to build, that these are sustainable for economic development and promotion of the wellbeing in the communities and neighboring towns, for infrastructure of a university, and for the healthcare entities throughout the region. And for us, because we now have clinical rotations throughout rural Pennsylvania and throughout the state — not just for Indiana and this region, but for rural regions across the state of Pennsylvania.

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So this is something that was dreamed up by two brilliant leaders who knew that if we're going to solve some of the problems that we've been having in Pennsylvania for frankly decades — that have not been getting any better. In fact, unfortunately, with another hospital closure of OB services, our services and access to healthcare here in rural regions is not getting better. In fact, the disparities in delivery of healthcare between urban versus rural areas only continues to grow wider. So they were really creative in thinking outside of the box, not just recruiting new physicians and healthcare providers who may come to regions and stay for a few years or leave — they really put their heads together and thought outside of the box around how to solve problems at a different level than which these problems have been created. And it's been an incredible ride to be a part of the leadership group pulling this off.

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7:48 — Natalie Bulger

Yeah, and you've touched on the rural crisis. And I think one of the questions is, why should we care about rural healthcare? It's that idea of, if it's a dispersed population, people choose to live rurally. One of the things you have to come to terms with is you don't have everything down the street. Ironically, it's much quicker for me to get to a Walmart here in Indiana than it was when I was in the downtown Pittsburgh area. So some things are easier to access, but I think our closest level one trauma center is probably right in downtown Pittsburgh, which is going to be an hour and a half away. Our cancer centers that are known — we have it here now in our Pennsylvania Mountain Health region, we have the ability to get that care — but those specialty clinics are a drive, especially for people that are fragile in many ways.

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And it's quite the shift from — you know, my grandfather was a village doctor. They had no stoplight in the town and they walked and they brought him baked goods and meat and milk and that's how they paid for their services. But we don't have that anymore. Everything's kind of been condensed. Why do we care about the rural healthcare access crisis? Why should people who aren't rural care about this topic?

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8:56 — Dr. Miko Rose

Well, at the end of the day, when you look at the demographics and statistics of population distribution — on most numbers, though we often talk about populations as rural, suburban, and urban, there are ultimately on a number of guidelines, the Center for Rural PA for example will say you've got urban and rural, and that's it. So regardless of the numbers and rankings, a majority of not only the statewide population here in Pennsylvania, but in the rest of the country — a majority of our population is rural. So we can't say, oh well, we don't care about a majority of the population within the United States because that is frankly most of us. It's not just you and I doing a podcast talking about rural health. That is a majority of the population — actually, in fact, most people do live rural when you look at maps of the United States. You look at a map of Pennsylvania, we've got Pittsburgh, we've got Philadelphia, and everywhere else is essentially rural to a large degree.

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And that's that piece that you're talking about where even if something technically has some suburban character, the access looks in some areas identical to the stark outright rural regions. So we're looking at aspects of access to care. And we're also looking at, as you've described, sort of this country doctor original model that has so dramatically changed — through this overhaul of our medical care system, like regardless of administration, this change has been coming for multiple federal administrations. Different people have different approaches, but the overhaul and change back to what things used to be decades ago — hey, let me check your blood pressure, give me some fresh eggs — just bartering and trading and getting back to the roots of communities. That's where it matters.

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Because it's not just that a majority of our populations are rural. It's that even if you live in an urban region, you have family members, people that you care about, and you yourself may end up living in rural regions. And it's not just about access to care — it's that at the end of the day, when we look at the cultural changes in medicine, these are trends where the rural versus urban areas are more vulnerable to the healthcare changes that we're now starting to see. Because we've got folks who are using emergency rooms as their primary care. We've seen similar models in urban centers, but that seems to be getting a little bit better with reform and some of the healthcare measures for payments for primary care. But we're starting to see rural getting more and more underserved. So this isn't just about a rural healthcare crisis. This is about a healthcare crisis across the board where rural is really just that canary in the coal mine waving the flag saying there's a big problem here because it's more pronounced. But these challenges are going to be a problem everywhere if we don't start to make some changes.

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12:01 — Natalie Bulger

Yeah, and you've mentioned the PCP component and the idea that a healthy community is a more productive community — so the ability to do more of those preventative wellness services upfront versus always just treating at that critical component, whether it's an urgent care or an ED. And I know that's some of the groundwork that's been laid here, which is with a really great residency program that's already kind of rotational for family medicine. My new PCP is in that program. He's fabulous. He high-fived me over a six-pound weight loss in three months and I was like, that's nothing. He was like, no, that's awesome. That's what we like to see. And I was like, okay, I'm ready. I'm going to keep up with things. So the ability to have those partnerships between the university, the local medical center, and have a little bit of this foundation of people that have been going through some of those rotations through the residency programs — what are some of the areas that you've had to focus on in building the actual college? And I also want to touch on the difference that this is an osteopathic college. So it is different initials after the name. And folks may not care about that, but there are some who do. They're like, a DO versus an MD? Why does that matter? So tell us a little bit about that formulation of the academic programming and the DO piece versus the MD piece.

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13:23 — Dr. Miko Rose

Sure. So in order to start a medical school, one of the most important things is creating the opportunities for clinical rotations. What's really interesting in getting accredited by the National Medical Accrediting Association for Osteopathic Medical Colleges is that you're not even really allowed to build out an extensive detailed curriculum for training until you demonstrate that you have clinical rotations. Now this is a paradox because in traditional medical school training, years one and two are what are called the preclinical years, where students typically sit in a classroom, look at lectures, and do case studies. Years three and four, after they have that baseline traditional classroom training, they go into clinical rotations and apply that training to patient care.

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Now, the irony of having to complete the requirements and have infrastructure set up for clinical rotations many years before building out the preclinical curriculum is a real one. But we've also seen that this is because for many medical schools nationally, there is a shortage of healthcare rotations for healthcare trainees across the nation. So it is not uncommon to have a healthcare training program where students do their classroom training at the school — whether a medical school, a PA school, or a nursing school — and then do their clinical training in another state or another geographic location.

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We have been very fortunate that here at IUP we have now achieved 247% of the minimum required rotations. And the minimum required rotations has some margin — you take the number of rotations needed and multiply by 1.2, so you have to have 120% of the required rotations set up. We now have 247% of required clinical rotations. We have additional clinics, facilities, and hospital networks still coming to us. That was a huge hurdle for us to pass, and we significantly surpassed it. And that's the one that has often set programs back in their progression towards accreditation.

The second area is fundraising, which I think every startup — whether it's an internet startup, starting a laundromat or a restaurant, or an educational program — needs minimum amounts of funding. Some of the funding is for the infrastructure, the programming, paying for faculty, paying for staff, paying for leadership, building buildings, paying for all of the expenses required, including application fees. They're incredibly expensive. These fees are high because the programming and everything we submit is very carefully vetted by national experts within the industry of medical education to very high and strict standards.

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And then the third area that is very important is staffing. We have to hire the right people to succeed. I actually made a slide from that movie with Matt Damon — We Bought a Zoo — and I replaced it with We Built a Med School. Like, my gosh, we had no idea what we were taking on. And finding the right people who have both the expertise to build the needed infrastructure in a very fast timeframe, as well as the enthusiasm and inspiration to do this work — that's a unique group. And we have been very fortunate that people have been coming forward to help be a part of this team.

We also have an advisory board with the president that is just a phenomenal group — presidents, chief medical officers, high-ranking executives in healthcare systems, hospital networks, and clinic collaborations — that meet with the president and me quarterly to talk about the direction of the college. We also have a steering committee, which is a monthly boots-on-the-ground group that volunteers and talks about all different aspects of building the layers of a medical school. So really having the right people, the clinical infrastructure, and community supports — we have had so many incredible supports to pull this off the ground. There isn't even enough air time to go through how many layers of support we've had on personal, professional, and community wide levels. And so those are the three main pillars of building the infrastructure for a college of medicine.

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19:38 — Natalie Bulger

So you mentioned healthcare shortage in general, and I do want to tease apart a little bit — we're sitting at a cliff, right? And not just for physicians, but also for nurses. And then we're also seeing this spike in nurse practitioners and physician assistants. So there's like this new competition for the people that want to get into medicine. What are they going to do? Will they get into nursing and then go forward with CRNAs and nurse anesthetists? Are they going to jump straight into medical school? So tease apart a little bit of who makes a good doctor of osteopathic medicine. What's the special component about that? And as one yourself, I'm sure you have very personal beliefs, but talk about it.

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20:14 — Dr. Miko Rose

Yeah, absolutely. And I think all of these positions — being PAs or NPs and these other roles — those are for certain personality types and what people are drawn to, and they provide invaluable care. And typically on large care teams, a physician will be supervising and signing off on many of these other providers' provision of care. So all teams need all players to work together and work well.

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The piece that has appealed to me in medicine — and I think for the right people that are drawn to this profession, particularly not just healthcare and communities but to be physicians and healthcare leaders in their communities — whether or not they signed up for it, just like your resident physician, right? He or she may not have signed up to be a community leader, but just by being one of the few primary care physicians in the Indiana community area, they've become leaders and people look to them in the community.

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Similarly, there is an element of leadership and service that are crucial and essential to being a physician. At the end of the day, we are the last stop. We take an oath to protect life, to do no harm, and to preserve and maintain the health of others with the greatest of intentions. And that is a very high oath that many of us have made extensive sacrifices to deliver.

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There are jokes in the American Medical Association around what's called "pajama time" — that time after you as the mother or father have tucked your kids in, read them stories, and they've gone to bed, but you're still finishing your charts, finishing your tasks, reviewing all the pieces that you need to practice today as a physician in order to ensure patient care safety. That takes a unique person — someone who's going to tuck their kids into bed and if the work's not done, go back in their pajamas and log onto a computer system to ensure that all of their patient care is addressed and will be delivered safely.

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There's also the layer of independence. MDs and DOs are the final signatory, the final approval. NPs in certain practices do have independent practice and ability to prescribe, but ultimately there are things like controlled substances, higher levels of care, even surgeries that can only be completed by an MD or a DO. There aren't NPs who are doing C-sections. There are still certain aspects that, even though some of these specialties can cover an incredible and valuable amount of care, they can't cover all services. And we know from emergency services that the more one individual is able to do in meeting the rural healthcare needs crisis, the better off they're going to be in their ability to help the communities.

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So it's a fundamental difference in becoming a physician. And what I have seen time and time again is that those who value autonomy and independence, who like to have this intricate balance between being a member of a team but also having their own autonomy, tend to do really well as physicians — because they end up often being the leaders of healthcare teams. They're always leading the care of their patients, even with specialty practice. Your primary care physicians are going to be directing and managing that care. And so it's really an independent and autonomous person who also works concurrently well with teams that is going to be uniquely well poised to be a physician.

Some of the other aspects are just the sheer volume of work. I have been described time and time again as an enthusiastic, energetic person, and I am sure that is a huge part of the reason that I've been successful in getting into medical school, graduating, and being board certified in my specialty of choosing. It was a lot of work. It's a huge lift. Even being the founding dean of a medical school — this is not for the faint of heart. It takes very unique personalities who just kind of lean into stress to say, yeah, okay, I don't know if I can do this, but I'm not running away. I'm going to lean in, feel that edge, and just try. For better or for worse, the medical care training system does have some ways of trying to weed out those that are not as enthusiastic or do not have quite as much ability to really push through long, huge projects. But it is a part of the training to have that utmost autonomy after years and years.

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25:17 — Natalie Bulger

So you've touched on the personality component a little bit. And I've got it, it's just so front and center because the new episodes of The Pitt have just dropped. You know, based right here in Pittsburgh. I think it brings — I've heard a lot of people in medicine say it's probably the most accurate depiction that they've seen on television of some of this outside of any reality shows that might be out there. But the component of it shows the different tiers, right? That medical student, the resident, the fellow — but it also has such a layer of empathy and self-care component, whether it's lacking or it's there. And I gotta pick your brain on it. What is the piece — how do physicians take care of themselves when they are the ones that seem to be on the hook so often for saving everyone around them and being that decision maker at the end of the day?

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26:25 — Dr. Miko Rose

I've watched portions of some of those episodes, actually, while in a gym on a treadmill. And so without going into any spoiler alerts, there's this one series of scenes where a physician — a female physician — we're following her through what is essentially managing a miscarriage and not ending her shift. Because it's clear that there isn't enough coverage, or she's making that choice to stay on shift while also actively having a miscarriage. And there are elements of that that unfortunately are entirely true.

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And there are moments that this profession is very much likened to other types of service and leadership where wellness is an important part while also managing what we call professionalism. In military service, if you are leading troops ahead and you have an injury on your foot — if you can still walk and lead, many will push through if they're able. And so this mentality of being a physician — not ignoring one's wellness, but being able to maintain professionalism and leadership perspective — doesn't mean I recommend that if someone's having a miscarriage they get back on shift. But we can see so deeply the psyche of that physician and what she was going through and trying to prove herself and maintain leadership, and just these intricate balances of managing self and other.

Because so much of our identities as physicians are tied into doing good work, saving patients' lives, doing beautiful things that change the trajectory of a patient's life so dramatically. Especially in psychiatry, we can see that impact within hours, days, weeks, or months. And to be able to make those sacrifices, there is this intricate balance that when we identify something as deeply important to us — these roles as physicians — it's identity. It's not just for physicians. Military, police force — we make many physical, mental, and social sacrifices to do the roles that we've chosen to do. And that's because it's a deep life calling. When you feel the call, nothing can get in your way. And that's one of the beautiful, ironic, and sometimes tragic aspects of what being a physician means — that we are choosing, for many of us, a life that has a calling to it, that leads us to naturally make decisions that in other professions you're just not asked to decide.

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29:46 — Natalie Bulger

Well, and it brings about, you know, an idea — as you mentioned, being so sure of who you are, it's also the idea that you're not a doctor to be liked by everyone. You're not going to be liked. You have to deliver some of the most complicated news. And so not everyone is going to like you. I always laugh with the five-star ratings on things because some of the best doctors have been the ones that have told me that I'm a horrible patient. And you know what? They were awesome because I needed to hear that. I needed the riot act read to me a little bit. But if they were just there to say, Natalie, how can we make you feel better? No, it was: you did not follow your care plan. What do you want me to do about it?

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So when we think of who should think about going into this type of career, applying to a school like IUP will have — it sounds like something that doesn't have to start with, I got my undergrad, I was pre-med, I'm going right in. There can be a gap there. It may be a little trickier life-wise, but it doesn't rule out that this could still be that calling and you're just realizing it now, right?

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31:07 — Dr. Miko Rose

Yes. And one of the things that I often don't talk about — I don't know if I've ever shared this publicly — but when I worked at a number of the places where I was supervising residents and medical students, I would often just screen and ask who had been in food service. Because what I found personally is that some of the best training I had in being a doctor was working the graveyard shift at Denny's. Working in these dive diners where at 2 a.m. some guy is yelling, smoking in the smoking section, and these french fries need to be reheated — and these are some very interesting, challenging individuals to work with. And yet we still have a role to serve them, to get folks in and out as quickly as we can, to try to make and earn a living through tips, getting as close to what the customers want so that they can enjoy their meals. I can't tell you how many times I've seen that folks who are really good waitresses or baristas just kind of knew how to work some of the situations that were incredibly challenging in patient care. There are a lot of similarities in knowing how to approach different personalities in stressful times.

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One of the big indicators is not so much the scores and grades. Above a minimum standard of scores and grades and scholarly activity, what I have seen time and time again is that the key indicating factors come down to growth mindset. I've seen students that looked amazing on paper — their scores, their grades, their letters of rec. I was blown away. And then those that did not have a growth mindset, who were just used to being number one in their class and doing well in everything they touched, all of a sudden had challenges. Because this is a whole other level of volumes of information that one needs to know, memorize, integrate, and apply. Those that couldn't pivot and shift to learn new tools, develop new skills — they often had some of the greatest challenges. Maybe they would barely pass or become more mediocre, but psychologically they really suffered.

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Versus some of our students that kind of barely got into medical school — their grades were okay, their scores were good enough — but if they had a growth mindset, they were so able to quickly pivot that by the time they hit clinical rotations, they absolutely excelled. So one of the factors that is not about numbers, scores, and grades — and interestingly going back to the restaurant and server example — is having a growth mindset and ability to adapt, shift, and change with an openness. Not about getting it perfect from day one, but an openness of, okay, let's see what shows up. How am I going to pivot to make this situation work? So that doing well isn't necessarily about the end point and outcome, but about the process towards success. The more students who have a natural growth mindset or can learn a growth-oriented mindset, those tend to excel. If we can just get them into the medical training that they choose, we can often help them excel if they have that mindset. I've seen that in sports, with medical students, with physicians in practice, and in leadership trainings. The growth mindset seems to be one of the very most important aspects.

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35:17 — Natalie Bulger

So what are some of the suggestions or ways that you or the admissions group have worked with students who could be the very best candidates out there, but just don't have the opportunities or the funds to do this with ease — because we know there are loans and things like that, it's still a lot of pressure in today's world.

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36:01 — Dr. Miko Rose

Yeah. So there are a lot of opportunities. The easiest — which I did not follow — is to get your pre-medical classes through your undergraduate degree as you're pursuing it. And we have so many students now who graduate with so many college credits that even if you're not a pre-medical or sciences major, you can get those pre-medical classes in, especially if you have additional credit. So that's certainly the easiest track because it's a part of what you're already doing.

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For me, I had absolutely no idea that I was going to be pre-medical when I was studying psychology as an undergraduate. So I went back and I took night classes. It was a heavy lift to have both a career and take classes at night. I also invested in some property and was able to refinance that property to help pay for it. I've worked with many students who do the same — they work and any extra money they have, they put it into taking night classes slowly over years. I did that for a couple of years and then was able to refinance a home I had invested in in my 20s, went back to school full time, studied full time for the MCATs, and folded that funding back into investing in myself.

The other opportunities for students who are working are graduate degrees — like a master's in biomedical sciences. IUP currently does not have one but we have been talking about the possibility. Almost every medical school has a master's in biomedical sciences, which is a way to get all of your pre-medical requirements into one master's degree — anywhere from a 10 to 18-month program. And the additional opportunity in that is that by enrolling in full-time classes, you would then have opportunities for financial aid.

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This piece on debt is a big question that we are discussing with several legislators, funders, and folks across the state. If we want to solve the rural healthcare crisis, we are going to have to look at affordability and cost. Leadership at IUP is deeply devoted to making medical education affordable within the state of Pennsylvania and accessible to our Pennsylvania statewide constituents. We are very devoted to that. IUP is a statewide system as an extension of the Commonwealth. Our motivation is to be financially healthy, but it's not to make as much money as possible to fold into itself — we really have a mission of serving workforce fulfillment.

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39:32 — Natalie Bulger

And there are lots of resources too if folks are interested and don't know where to start — actually reach out to the schools and ask those questions. That's what the counselors and admissions people are there for. So definitely a shout out to that. But one more context-based question before we talk about how people can reach out to you.

You know, back to the very start of the conversation, you mentioned the socioeconomic differences, we talked about access to healthcare — how are we going to create the next generation of physicians that are good at looking at that bigger population health picture? So not just what's my specialty area, but the fact that this isn't just OB-GYN. This is OB-GYN to someone who's going home to limited food in the refrigerator, or they have no backup care in the home to help them out and they've had a C-section — all of those different pieces that are that whole health model. Academically, how are we looking at building that out further? And what do those supports look like as they're going through rotations, or building those expectations that this is part of the gig now — it's not just that person, it's that person within their system?

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40:48 — Dr. Miko Rose

Yes, so one of the pieces we're working on in the background, especially in terms of our anticipated future recruitment of potential medical students here at IUP, is looking at the infrastructure — not just IUP, but the entire healthcare system, of who we recruit, what we attract, and what that requires. So intrinsic versus extrinsic values. Extrinsic values are things like great amounts of fortune, fame, public recognition, acquisition of items and things. And then the opposite end of that model is intrinsic values — connection, relationships, inner happiness, joy.

You look at people oriented towards intrinsic values versus extrinsic values, and we can recruit with those values in mind. Because we have a system right now that paradoxically — even though it's a healthcare system — financially only survives by keeping people in a diseased state. It financially only survives by billing, by keeping people in a diseased state. And then even more paradoxically, we pay for health insurance that we often have to fight. And sometimes the providers, we as physicians and the people writing the prescriptions, are often fighting the hardest to get that insurance coverage to manage the disease state.

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Whereas if we have an intrinsically-based system with a new stream of future learners and generations — just like that resident physician who gave you a high five, right? They're not there to collect cars and have their faces in the paper. They're there for that moment when they gave you the high five. Because one of the greatest deficiencies that I have seen in healthcare, particularly as a psychiatrist, is the deficiency of connection. And once we lose connection, that begins to deteriorate our connection to all of humanity. It's a deficiency of hope. And those that are intrinsically motivated are naturally drawn to that.

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So we flip the system rather than pre-gaming it towards what tends to attract extrinsically motivated individuals. Because those individuals often go through this huge crunch of, my gosh, I was attracted to this to do good but also for these other reasons — and with all the debt and the loans, these things aren't happening. Then you get widespread physician burnout. And I've worked with countless physicians and clinicians, especially in rural areas, that are actually more on that intrinsic end. Go through IRMC or Punxsutawney Hospital and find me one physician that doesn't have a preponderance of intrinsic motivations — they'll stop you in the hospital, hey, how are you doing? So we just need to take the model that already predominantly exists in rural areas and replicate that intentionally. We're creating an intentional workforce stream of more doctors like the ones we already see in the rural regions where we live and visit.

 

45:17 — Natalie Bulger

And I am a firm believer that the more physicians we create like that, the more that outside pressure on the system itself — which I fully believe is very broken — will force change. We already see it with the concierge medicine model kicking up. We already see some of those pieces that this isn't sustainable long-term. We have to make change, and good people doing good work is who's going to lead a lot of that change.

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As we get towards the end here, I have to ask — I saw in one of the write-ups that you are a reality TV person.

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45:50 — Dr. Miko Rose

I'm a big reality TV fan. It's because I'm a psychiatrist, right? I love watching humans being human.

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46:00 — Natalie Bulger

So I gotta ask, what's your watch of the moment right now? With all this extra time you have.

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46:02 — Dr. Miko Rose

I will also mention I'm a big avid puzzler. I just picked up a really nice Ravensburger that I've been working on for the last few nights. I've had a lot of stints in reality TV and kind of gone on some dives of a couple of different shows — I've seen them all, well, a lot of them. I think right now my favorite is Bravo and the Real Housewives of Salt Lake City. In the spirit of full confessional, I was a Vanderpump Rules fan and then they changed everyone, and I was used to watching the old guard. So now I've become a big Salt Lake City fan. There's just something about watching all these individuals with a lot of resources trying to self-regulate in their homes as they travel in their careers that's kind of amazing. Psychiatry never leaves me. The profession shows me and I just never left.

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47:04 — Natalie Bulger

Well, and I saw someone saying that that specific location has this extra layer of the impact of fundamental religion on some of those characters. So even that — like, it spices it up just an extra level. We're like, okay, what traumas does this tie back to?

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47:15 — Dr. Miko Rose

Yes, like cultural and political differences and how do people still find the common themes? I mean, I feel like we here in Indiana and throughout rural Pennsylvania — it's the constant conversations of people coming together with different views, different politics, different backgrounds, different cultural beliefs, and finding that common ground so that we can be together in communities and have those difficult conversations. I personally think — with a whole lot of bias having been here for just over two years — that's something we do here in Indiana really, really well.

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47:50 — Natalie Bulger

And it is. You can walk down the street and you kind of just feel slight changes in where people have even nested right in this borough itself. And having the university here, I think, mixes things up very interestingly compared to a very similar town like Indiana that doesn't have a university situated in the middle of it. Just fantastic sociodynamics of everything.

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We're getting to the end here. I want to make sure that people know how to find out more information about the IUP College of Osteopathic Medicine and everything we're working towards. So we'll make sure it's all linked, but tell us a little bit about where they can go to find out what's happening, the timelines around this and everything like that.

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48:29 — Dr. Miko Rose

Yes, so we are in the next couple of months going to be shifting over the web pages to be independently housed under our own college. Right now it's under the president's web page at IUP. And we are looking to matriculate students in 2027, which means we could be able to start recruiting as early as May or June of this year. So in just four to five short months, we will potentially be opening our doors and starting to accept applications.

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48:58 — Natalie Bulger

Incredible. And I think too, if people are out there that want to be part of something very inaugural, I'm sure that'll be super interesting. I can't say enough — the people in this area, to treat them, it's really interesting. You don't have to be in an inner-city, high academic medical center to see really unique individuals. All kinds of different things. The diseases exist everywhere. The personalities exist everywhere. So you get the same kind of mix of patients that you see anywhere. But I am just really thankful and grateful to have been at the Rural Health Symposium, heard about all of these things coming forward, and that you jumped on the opportunity to come in here and chat a little bit about this. And hopefully we'll be in a year from now doing a follow-up going, alright, how are things going? How are we getting into everything?

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But Dr. Rose, thank you so much. Is there anything you'd like to leave everyone with as kind of a closing note, closing message that you hope they take away from our chat today?

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50:08 — Dr. Miko Rose

You know, I think we talked a lot about being DOs in osteopathic medicine, following the needs of the community, rural health, and all these elements. I think at the end of the day, the big picture is to find something that inspires you, even if it doesn't make sense, and do more of that. Because for me, it ended up being medicine. And this is a second career. That was a great surprise to me. I just followed my passions and the things that gave me joy. Many of those things were surprising. I followed that road and it's been incredible. And the types of students that we will be looking for when we recruit are those who are passionate and inspired.

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But even for your listeners who have absolutely no interest in pursuing medicine or becoming a physician — that is also amazing. And I think we have been just so incredibly lucky to have so much support. I want to thank all the listeners and those who already know about the college and have supported us in so many ways. This has just been an amazing project, and for folks who are interested, we'll send you some links to make sure that you get updated materials on our websites and ways to reach out and help.

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51:24 — Natalie Bulger

Yeah, and it really does fall into that — hey, you never know what hot mess will end up as a high potential. Podcasting wasn't on my radar. This is just my little hobby on the side, but I love it. And getting back to knowing what fills your cup — it'll make sense as you get into it. So Dr. Rose, thank you so much for joining me. We will talk again soon.

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51:40 — Dr. Miko Rose

Thank you. Thanks for having me.