M.D.s and D.O.s Today

Cynthia Stotts, DO, interviewed by Dr. Michael Seffinger, DO

at the LA County USC Medical Center in Los Angeles California
March 29, 2007

Dr. Seffinger: Dr. Stotts, please introduce yourself and tell us how you became involved with the osteopathic profession.
Dr. Stotts: My name is Cynthia Stotts. I’m a very proud DO and I was born in Fort Leonard Wood, Missouri, into a military family who moved a lot. I went to five elementary schools, two junior highs and two high schools. My first experiences with a DO was as a patient. I’d say what brought me into the DO profession was my mother’s choice to seek out and choose DOs in Iowa and Missouri wherever we went. She liked the hands-on quality of the DOs, she liked the personal touch and the caring and she appreciated the competency. I grew up with the view of the doctor is always nice. They would give you medicines, they would examine you, they would do some type of OMT, which would relax you and you would scurry out the door, with or without a shot. That was my view of being a patient and being a physician. After graduating from high school and taking time to see parts of the United States and Central America I decided that having profession in the medical field was what I wanted to do and I was allowed the opportunity to go to COMP. I chose COMP over an MD program because it fit my model of what the type of physician that I wanted to be which is a single, sole practice, general practitioner up in the wilds of Idaho Snake River Valley. I looked forward to stabilizing patients and doing herniorrhaphies, and doing C-sections. And when I was an intern with you, Mickey, I would take all those things very seriously and would go to every surgery that I could when I was a DO intern at Pacific [Hospital in CA] and would do as much of the procedures as I could and including deliveries and the like. I certainly have great fondness for my mentors and the osteopathic training we got from Dr. Golanty at Pacific Hospital and Dr. Horowitz, our chief surgeon, and Dr. Chan our head OB. They allowed me to do many more procedures and be involved in providing care to the patient than when I was subsequently exposed to MD training. I was far ahead of other medical students and I really appreciated that.
Dr. Seffinger: When you were thinking about going to Medical school, this was in the 1980’s, early 80’s?
Dr. Stotts: Early 80’s.
Dr. Seffinger: And you went through UCLA and did your undergraduate there.
Dr. Stotts: Yes. Santa Monica College then transferred to UCLA.
Dr. Seffinger: You graduated from UCLA with a Bachelors degree.
Dr. Stotts: Yes. In Psychobiology.
Dr. Seffinger: Take us from that point until how you made your decision to go to Osteopathic medical training.
Dr. Stotts: In college, I was interested in the service in the healing arts and have long been a vegetarian and was very interested in leading a healthy life and advocating for health, so I got a master’s in nutrition but realized that as a dietician, I would make a recommendation, but the physician had to write the order. As I went through my training, I really came to own my desire and my interest in becoming a physician instead of being a dietician.
Dr. Seffinger: And then you had to decide what type of physician.
Dr. Stotts: Right. And so I applied to both DO and MD programs and struggled really at that time with what it meant to be a DO or an MD in California in the early 80’s because I was aware of the prejudice that existed. I knew that I had to go to a DO internship or I wouldn’t be licensed in all states in the United States. I was also 30 when I was approaching, entering medical school. I did not have a straightforward path to medical school, i.e., go to high school, go to college, go straight into a medical profession. I took a while to learn about life and about myself and to go though undergraduate and graduate school and although I was academically strong, I wasn’t your typical candidate. And even though I had the option of matriculating into either, I really felt like, in my heart, I would be a better DO than an MD per say because it would allow me the opportunity to do the OMT and to do the touch. I didn’t want to be a sub specialist MD. I wanted to be a single, solo practitioner who could deliver babies, do simple surgeries, identify people as high risk, try and get them helicoptered out if they needed somewhere else. I was going to be the doctor in the area and I wanted to be able to provide OMT service as well because I appreciated it so much, found it so helpful as a patient, that it seemed like the complete package to me. And so being a DO was the better offer to what I thought was a full doctor or complete doctor.
Dr. Seffinger: Can you give us your impressions when you first came to the College of Osteopathic Medicine Pacific in Pomona? What year was that? 19...
Dr. Stotts: ’84.
Dr. Seffinger: 1984. You were accepted there and you started there. What was your impression of that institution at that time?
Dr. Stotts: It was young and it was growing. Great classes the first two years in the classroom, the didactics were very strong. The more challenging part was the third and fourth years because you really had to be an active participant and you really had to aggressively create your own curriculum. It allowed me to see what doctors did on the job and it allowed me the opportunity to explore whether I would end up being a DO in Los Angeles or a DO solo practitioner in rural America which is which was my original goal. The two best decisions I made in my life were to leave Iowa and to marry my wonderful husband. My husband has a wonderful career in computer sciences at UCLA. He will remain there until he retires which made me reevaluate my goals as to how I was going to be a DO in Los Angeles. While I think primary care in an urban setting is essential and crucial and is absolutely needed, I think that the competition that exists in a large urban setting really makes you need to look at your training and your skill sets that you are going to bring to patients. I’ve actually ended up being a full time in-patient pediatric hospitalist where my job duties are taking care of patients in the ICU and on the wards which really does require pediatric specialty training. So being a DO has been important in doing that because it has allowed me the opportunity to have better physical exam skills than I believe that I would have if I hadn’t gone through all of the anatomy, and all of the OMT, and all of the DO training. Just the function in, if you want to call it, a straight allopathic model of medicine, I think DOs actually function better doing that and do a better job because we did get additional training. I remember one of the things I asked Dr. Rafi [Younoszai] in one of our anatomy classes at COMP, I said “Are we allowed to cheat?” And the whole class laughed and he said “what do you mean?” I said “What will you do if we find ourselves touching ourselves during the exam?” I said, “Because my body is the anatomy exam.” And he goes, “Hmm, I’ve never had that question asked. I don’t think we can keep you from touching yourself so I don’t think we’re going to call that cheating.” I said “Great, because I’ve got the answers right on me.” So that’s how I’ve always approached the additional extra training and it has allowed me to be a better diagnostician and a physical oriented physician. Certainly the nurses in my hospital know who the DOs and who the MD residents are because once they know that you are a DO, they will be backing themselves into you going “Dr. Stotts, my neck. Dr. Stotts, adjust my shoulder, just five minutes.” Because they see the value that placing your hands and touching an area that’s troublesome and allowing the energies that you can feel with the body mechanics and know what’s going on in that area that’s causing them discomfort and pain and disability is something that once taught, you don’t lose. You may not be as finessed in the skills as you were, but it is part of being a DO physician. Even though I’m in a very structured, hospitalist professional, I still do OMT to patients, I do OMT to nurses, and I just did OMT to one of our top administrators on Friday. I find that I really like the portability of having my OMT skills with me at all times. It’s very convenient and that it allows me to take somebody who may be in immediate pain and to alleviate some pain and suffering and maybe teach them some relaxation or some muscle energy techniques. That could really make a huge difference in the quality of their life. That has never left me and I like being able to provide that assessment, and that treatment, and that education, and those skills. It speaks to being a physician in me versus we’ve got a problem, where’s the script, I need a pen, let me write something, you know and go do it. Because, unfortunately, life’s ills and the slings and arrows are carried in our bodies. If we don’t address those, medications don’t resolve all of them. That’s part of the things that I’ve learned through being a DO, but it was always a thing that I knew being a patient of a DO as a child and that is satisfying to me now.
Dr. Seffinger: Do you want to tell us what it is that you’ve done with your career since you finished your internship at Pacific Hospital, Long Beach back in 1989? You went on to become involved with the LA County USC Hospital. Can you tell us about what you did there? I believe that will lead us into the role you have in the history of Osteopathy in California.
Dr. Stotts: Instead of completing the family practice program I changed into a Med/Peds program. It’s a dual program at LA County/USC. I rotated through the medical center both as a DO student and then as a DO intern at Pacific. And appreciated the patients, appreciated the role that I played and I really felt the ownership that I was the doctor of the patient as a resident. Which is very difficult and challenging because you need to be allowed enough latitude to feel the responsibility and still be shepherded and supervised. I felt that really a unique setting at the LA County USC medical center in that those elements were there in the right proportion for me. So I’ve always appreciated that sanctity of the person that admits you, who sees you, who takes your history, who writes the orders, there’s a special bond that occurs when you are the actual bedside doctor taking care of the patient. Even if you are in a hierarchy of a team, the patients identify you as the real doctor. Even if you have to respond to other people. So it’s one of the things that I have very much appreciated here in this institution and it’s one of the things that really drew me to the program. While I was here, I had the opportunity of being involved in spending a fairly large amount of money for our medical center. Because residents twenty years ago, gave up a ten percent salary raise in order to state and make decisions on what equipment should be purchased for their ability of care for patients. And that lineage and that ownership of the patient including giving up ten percent of your salary is really a philosophy that’s imbedded at LA County/USC Medical Center. And to this day, the Patient Care fund, the residents get together and collectively decide how they’re going to spend 1.2 million dollars worth of equipment. And who is going to use it and how it will be used. As I was representing the Pediatric department of the Joint Council of Interns and Residents (JCIR), the second oldest union of physicians of interns and residents in the United States, I had the opportunity as I went up through the leadership to advocate for better patient care and better resident education. I would come as the JCIR President to the CMO (Chief Medical Officer), to the CEO (Chief Executive Officer), to the COO (Chief Operating Officer), to the CFO (Chief financial Officer), in meetings with them and state, “This is what we want in order to take care of patients better and in order to have better resident education.” We were phenomenally and profoundly supported by our administration because our missions were aligned. In the process we made significant improvements that you could see year after year. “I bought that pulse ox”; “I bought that echo machine”; “I bought that portable chest x-ray”; “we bought an anesthesia machine”; “we bought the things that we thought we needed for the institution in order to make our lives and the patients lives better.” You felt an ownership in being able to improve a system. If you can improve a system, you become part of the system and it allows you to own it and it allows you to push through those wedges for changes that are so necessary in order to make things happen differently. This institution has long been a resident run, attending supported institution that really allowed residents to play an active role in the delivery of care and their education. I was very honored and privileged to be the president of JCIR during that period of time. There was our hospital (USC) which had about a thousand residents. Then there was a collective that included Harbor General and Martin Luther King; we had together our three hospitals which were banded together as a union. I actually became president of the Interns and Residents at all three of the hospitals.
Dr. Seffinger: So how many residents were you representing?
Dr. Stotts: Probably about 18 hundred residents at that period of time. We had a 2 million dollar budget for the patient care fund. 1.2 million was at County, three hundred thousand was at King, and about five hundred thousand was at Harbor based on the number of residents. Remember the residents before us had given up 10 percent of their salary in order to purchase this equipment. I held the president of our institution at the medical center for three years and two years as the JCIR president of all three organizations. That was 1995 through 1997 right? I really cared about the quality and the commitment to our residents. While going through the process of advocacy. Because that’s really what the position of the president and the union allowed was a platform, an obligation, and a possibility to advocate for patients and residents while you were a resident. That was the power in a collective voice, standing together, making a decision about what was in the best interest for them. As long as you’re aligned and your missions are aligned with your administration, you can get a lot done and that was the tenor that I perceived during that period of time. I believe it was that ability to advocate for the residents and the patients that the medical staff recognized and I was asked to become Chief of Staff-elect of the organized independent medical staff of the Medical Center. The Chief of Staff is the leader of the physicians, the attending physicians, the medical physicians in a facility to perform certain duties. They have to credential and privilege, they have to be responsible for the delivery of care and the quality of care; they have to be responsible for producing medical records, for utilization management and review, for tissue and basic procedures. There’s a number of things in California code of regulations, Title 22, that the physicians of a hospital are responsible for because the physicians are really the ones providing the care. So there was a fundamental change that no longer a voluntary attending would be the chief of staff but we were going to go to a full time attending who worked in the hospital full-time and I was the chief of staff elect position. I then went through the process of becoming the first female, DO, chief of staff in the 158 year history of the LA County USC Medical Center.
Dr. Seffinger: So you were the first female ever in this position.
Dr. Stotts: Correct.
Dr. Seffinger: And you also were the first DO in this position.
Dr. Stotts: Correct. The history is that there was a unit one which is the big, beautiful general hospital that we see on the soap opera. We call her the stone mother. She is a magnificent art deco edifice with a phenomenal entryway that marvels the finest museums and then there are separate facilities referred to as unit two and those were DO run programs at hospitals. And you and I, Mickey, are currently sitting in what is now known as Women’s and Children’s hospital. It was dedicated in 1956 as the Los Angeles County Osteopathic Hospital. And I understand that it’s the first and the only county osteopathic hospital in the nation. And it was a full fledged hospital, run by DOs, with a full OR, and full delivery and internal medicine and pediatrics and all the subspecialties as a separate DO hospital unit two. Each of the two hospitals coexisted on the medical campus here and until all of the history that really prompted you to write the book, changed the way that we- we meaning DOs, functioned within the structure at LA County/USC Medical Center. I can honestly say that although I expect people occasionally to say, “Oh, you’re a DO? I thought you were an MD.” And I’ll say, “No. I’m a DO.” And they might ask. This may be another physician. It may be a nurse. It may be somebody who goes, “god but you’re like really good. I thought you were a doctor.” And it’s like “Yes. Thank you and I am.” And that happens very, very rarely but for the most part there really, I don’t feel the pressures of having a distinct degree that I know that exist in other hospitals systems to this day in California. My skills and my enthusiasm have actually been embraced and have been mentored and groomed in my facility which has about 40 thousand inpatient admissions a year and about a million outpatient visits because it’s General Hospital, Women’s and Children’s Hospital. It is our Rand Schrader clinic areas. We have three comprehensive health clinics that are embedded in Los Angeles with El Monte Health Clinic. We have Hudson Health Clinic and we have Roybal Health Clinics that are full standing health clinics. We have a number of large programs that are free standing programs. We have a violence intervention program which is nationwide, known and innovative in that it was one of the first geriatric programs. It’s amalgamated with the juvenile court health systems and we provide care to our incarcerated youths. We have a very large maternal-child AIDS program. The first Joint Commission certified disease management program in the United States in the Asthma Breath-mobile program that is really establishing the way that asthma should be managed in a case management, disease management fashion. And the Joint Commission recognized it and gave it the first disease management certification in the United States which is an extreme honor. I got to be involved in the inception of that because I did a chief residency in pediatrics after finishing my internal medicine/pediatric combined residency program and was also in an allergy/immunology fellowship and, as part of my fellowship, I got to be involved in the beginnings of the asthma breathmobile program. This program entails a fleet of vans that go to the schools and take care of children in the schools because we’ve got the tools to take care of asthma but what we don’t have is the access to the children. So, under superb leadership of the administration and medical leaders here we were able to go to the children and have the parents come to the school and it allowed a much higher accessibility and much better control if we go to where the kids are. And so, besides state of the art informatics and tracking and having systems that will allow patients to complete a survey while they are waiting for their clinic and will give a disease activity and when they walk in to see their practitioner, their resident, there is an assessment on their disease activity identifying whether they are in control, out of control, what type of asthmatic they are, and asthma treatment suggestions, and recommendations for follow up based on their ability to control that’s handed to them when they walk in and see the provider. So it’s a very powerful tools and we take those tools to the patient. It’s very exciting to be in a medical center that allows physicians to provide the best patient care and the best resident education possible. It has been a great honor and opportunity to continue this advocacy as an attending that I learned as a resident.
Dr. Seffinger: How many people are you overseeing or supervising as a chief of staff here? How many staff members are you representing?
Dr. Stotts: There are about two thousand providers and there are just about nine hundred house staff, interns and residents, and then there are another two to four hundred medical students, nursing students, respiratory students, physical therapy students and the like, and all of their care, whether it is part of their training program or not, if it’s care that the patient receives, the organized medical staff is responsible for it.
Dr. Seffinger: So this is one of the largest county hospitals in the world is it not?
Dr. Stotts: Yes.
Dr. Seffinger: If not the most.
Dr. Stotts: Yeah. By the changing in the dynamics it’s certainly one of the largest. And I’ve had the opportunity and the challenges of moving into a smaller but state of the art replacement facility and I was requested and very honored to serve as a second term chief of staff with the idea that all the skills that I had learned during residency and being a full time attending here at the medical center and being a chief of staff would really be helpful in trying to help fit our current facility into a smaller facility albeit a more efficient one. That’s been a mixed blessing in doing that because trying to down size while trying to gear up and being more efficient is a phenomenal wedge for change and that’s what the last couple of years have been focusing on, getting ready for us to move into the new facility.
Dr. Seffinger: So your leadership position as first of all chief elect and then chief of staff each position is two years?
Dr. Stotts: Right.
Dr. Seffinger: And then you were past chief, right and now you are chief again?
Dr. Stotts: Correct.
Dr. Seffinger: So it’s been a good seven years so far that you’ve been in a leadership position at this hospital facility?
Dr. Seffinger: Okay, and at this point in time looking forward, where do you see yourself going, it sounds like you have a vision of where you want to be during the remainder of your career, and also with this institution after you finish your tenure as chief of staff, where do you see yourself?
Dr. Stotts: Well, I see us firmly in the new building and trying to get through the challenges of ordering a new custom hospital home and getting into that home and making sure that care is delivered in the proper fashion while learning new ways in doing things is obviously going to be very challenging for the next few years. After that period of time, I have spent a lot of time in administration duties and full-time in-patient hospitalization duties and resident education, and look forward to spending more time in being involved in more formal academic pursuits and aligning patient care and resident education, but that area of my life that I was very active in as a resident and a junior attending has really fallen away while I’ve been on call for the in-patient services in the ICU over the past ten years ranging from every other night to every fourth night, just recently just every fourth night. The service duties have been real and full time, a couple full-time jobs just there alone. So I look forward to advancing my education and getting even a masters of health administration or a masters of medical education in academics as well for the future ten years.
Dr. Seffinger: Who are some of the main mentors and supporters on the one hand, and who did you mentor as well through the last couple of decades?
Dr. Stotts: My mentors have been numerous, starting just from back at COMP, which I always called College of Osteopathic Medicine of the Pomona, because it always felt like the Pacific was thirty miles thata way. That’s what it was to me. I lived in West L.A. and drove East a long way to get to the “Pacific.” But there were a number of just really outstanding instructors who made lasting impressions, from our anatomy professor, Dr. Rafi, I have to get out a book, because I don’t want to leave out anybody. Everybody was so helpful during that period of time, because everybody at COMP was so hands-on, from the administration, to our admissions offices, to our instructors, just really, really hands-on.
Dr. Seffinger: Who taught you clinical medicine?
Dr. Stotts: Clinical medicine, I had a great mentor in Dr. Stan Golanty, at the Pacific Hospital during my DO internship, and I was very fortunate to be assigned to his clinic, to his office as my clinic. And I learned the value of being thoughtful, being thorough, and looking at every laboratory value and not dismissing values because they didn’t fit conveniently with your thought of what you thought was going on with the patient, and Dr. Horowitz, surgeon, Dr. Chan, OB/GYN at Pacific were all very instrumental in allowing me to be as strong an intern and letting me do as much as I was capable of and they were there every single second. When I came and did rotations in OB at LA County USC it was during the hayday. Those were the days when there were about eighteen thousand deliveries a year at this institution. I was a rotating family practice intern from a DO program and there were no medical students around so I was the ‘scut puppy’. And I delivered 20 plus children every day plus two or three placentas and did a c-section in twenty-four minutes while the senior residents assisted me because of the training I received from Dr. Chan as being his first assistant in OB/GYN. At that point I was still very much going to go out into the rural setting and do this on my own and I took this as a serious challenge that I needed to capitalize every single opportunity before I was going to be the attending and there was going to be no Dr. Chan standing at my shoulder. I had just some great mentorship with people allowing me to do as much as I could as a resident. When I came to LA County USC, probably the finest pediatrician in the form of Dr. Larry Opaz, the finest critical care physician, Dr. Jeff Johnson have been part of the fabric that allowed me to really thrive as a resident and to continue to grow as an attending staff and it’s with their mentorship and their collaboration and their support that I feel like I’ve been able to make as much of an impact as I feel like I’ve been allowed to do so.
Dr. Seffinger: Then on into your fellowship and thereafter you probably had other mentors as well.
Dr. Stotts: Phenomenal. Craig Jones is the fellowship director whose brilliance to go to where the patients were instead of forcing them to miss appointments and miss school and come to us and his advocacy for taking state of the art medical informatics and providing it in a setting that really makes a usable difference and a measurable difference to the quality of care that the patient receives and to be able to track the outcomes of the disease state has been an incredible experience and he’s really leading the way that the disease management, obesity, hypertension, asthma, and diabetes are all models that are now being expanded upon. The tools that he developed with our asthma program are being replicated throughout the United States. Phenomenal mentors. The facility itself knows when to get out of the way and allow people who are gifted and competent and passionate to move forward. It’s extremely luxurious to be in a medical center that will allow people who see a better way of delivering care to work outside of the usual constraints and to bring resources together. For example, Dr. Jones brought the Asthma and Allergy Foundation of America who had funds and resources and wanted to help. The LA Unified School District, with the bureaucracy that you can imagine, and trying to work with such a system, and our medical center, and all of the bureaucracies of the day, the LA Department of Health Services, and was able to bring all those organizations together to provide a new pilot organization. The administration here was very supportive of that and it really takes a lot to do things differently. It’s one of the things that makes showing up to work feel like a good thing because not only do you feel like you can do the things that you are supposed to do but that you are allowed the opportunity to do things in a better way. With effort, but still allowed that same opportunity. It makes you want to do things better.
Dr. Seffinger: Who did you feel you mentored and had an impact on their career?
Dr. Stotts: I never had biologic children, but I say that I have a lot of children and my pediatric and Med-Peds residents are my children and I take that seriously as any mother would and expect your children expect the best from your children and want the best for your children and will interact with my adult learners on different ways to get the best from them. I feel like my obligation to pediatrics is to not see individual patients the number of patients that I see in the wards of the ICU but it is to train all of the residents who come through this program and to touch the pediatrics and to touch the lives of the patients that they are going to take care of. So I feel like I’ve been blessed with the opportunity of mentoring hundreds of residents.
Dr. Seffinger: What advice do you have for future Osteopathic physicians in training?
Dr. Stotts: Just go for it. Decide if you want to be a physician. If you don’t want to be a physician, do something else. But if you really want to take care of patients and your passion is patient care then you must commit to the things you need to do in order to do that which is just to go for it which is to read and read and read and read some more. And to be there with the patient and to not pre-judge the patient to be open to what history or physical exam or labs are presenting to you and to use all the value of your reading to try to figure out what is going on inside the body because it is not about being right, it is not about you, it’s about what’s going on inside their body and it’s a very daunting and challenging thing and occasionally there is a right answer but usually you’re left with degrees of probability. Outcomes speak for themselves. Just take the job seriously. Be with the patient and be there with the patient. If you can’t do that, you shouldn’t be in the profession. You should be doing something else.
Dr. Seffinger: What advice do you have for future allopathic physicians in training?
Dr. Stotts: I don’t know that there would be any difference in the distinction between allopathic and osteopathic to me is ... the only thing that allopathic students miss out is the extra training which I think was so helpful to me because we are talking about a body going wrong and there are signs and symptoms in the body when something is not working correctly. To be open to capturing all of that information with your eyes and with your hands and with your ears. A very good colleague of mine, Dr. Uzumian walk down to the emergency room together and we are constantly having a race to see who can identify the patient with DKA (diabetic ketoacidosis) fastest in the hallway prior to walking into the room. Because you can smell the ketosis [ketones]. Ten percent of people can’t smell it, though, they just don’t have the gene, but the other ninety percent, you use your nose, you use all of your faculties to diagnose what you think is going on in the patient. It’s not about you, it’s about being as close to understanding the true derangements and trying to head those off and change the natural course of an event if it’s changeable and recognizing when you can’t and being able to provide comfort and care. Other than DOs having a focus on the patient that I think that their MD counterparts are starting to get because of focus on primary care is being embraced by the allopathic world, not I believe to the same degree that it has been embraced by the osteopathic world. But the importance of the patient as a whole, the patient as a unit, the patient in society. And how all those components fit together is really the bread and butter of the DO profession and the MD profession is catching on.
Dr. Seffinger: What about the relations between the two professions? How should a student in either of the schools view their colleagues in the other profession in terms of how should they think about relating when they get out in clinical practice?
Dr. Stotts: I think DOs should be very proud of being DOs. If you want to take this as an example you have UMDNJ (University of Medicine and Dentistry, New Jersey, School of Osteopathic Medicine), where the medical (MD) and osteopathic medical (DO) students take classes all together and then the DO students stay after and do their OMT or do their extra training. So, I think you should be very proud of the focus and the heritage that has been instilled on us as the patient, and on the body and it’s extra training. I am very proud to be a DO and anytime anybody inadvertently writes ‘MD’ in my minutes or notes, or on my nametag or whatever, I take it as a point of pride to say, “I’m a DO”. Nurses know it and recognize it and are very happy that there are DO residents because their needs get tended to differently than their MD residents. I would say, to the DO students, “be very proud.” To the MD students if your back is out or your neck is hurting, get a good friend who’s a DO and start a lifelong friendship and it will behoove you, and your spine and your spouse and your whole family if you are not as much in discomfort. Both groups just need to be very proud.
Dr. Seffinger: You have about how many DOs here at the LA County Hospital and how many MDs that work together here?
Dr. Stotts: There are probably 40 DOs on staff. I can run the numbers for the residents. In our residency program alone there are probably always ten percent of the program are DOs.
Dr. Seffinger: Is there a quota for ten percent?
Dr. Stotts: No. No. There is no quota at all. You can’t be faint of heart and train at LA County USC. A breed gets selected because people who don’t want to work go somewhere else. But there is no quota, I think that’s just the actual numbers and I really don’t feel any discrimination here. Sometimes, as I said before, I’ll see bewilderment. It’s like, “What do you mean you’re a DO?” you know, “I thought you were a doctor.” But it’s more bewilderment, it’s not discrimination and if it is here, no one shows it to me. The medical staff leadership, the department chairs, the CEO, everyone has gone out of their way to do nothing but to make my position as powerful and as helpful and as a tool for change as helps the institution. I haven’t seen discrimination. It may be here, I just haven’t seen it.
Dr. Seffinger: Are there any documents that you know about or have that we should look up as a reference to corroborate the facts you mentioned in your interview?
Dr. Stotts: Well I got this CD, I got a couple of fun LA Times articles that I can show you. I gave you the history of the medical center and the timeline and the speech that I gave at one of our annual attending staff meetings which we had chief Bratton at the meeting and supervisor Molina. Senator Boxer gave a videotaped greeting at our annual dinner as well.
Dr. Seffinger: And what do you plan to do with the plaque designating this building as Los Angeles Osteopathic Hospital as well as the time capsule that is in that cornerstone there?
Dr. Stotts: Well, when this building is evacuated and razed, this campus gets transformed into a biotech park, we certainly would have a very formal and very inclusive ceremony to commemorate the time capsule. It certainly will be one of my responsibilities as a DO chief of staff to make certain that is shepherded and that we give this building the respect that it deserves and the time capsule and the plaque that it deserves.
Dr. Seffinger: Is there anybody else that you think we should contact that you felt was instrumental in the historical development of Osteopathy in California? Other than those that we’ve already discussed?
Dr. Stotts: I’d say Dr. Michael Seffinger.
Dr. Seffinger: I’ve already been interviewed. Is there anything you would like to talk about that we haven’t touched upon or discussed in relation to Osteopathy in California?
Dr. Stotts: I guess the other part of the five year plan or ten year plan would be able to move in my career to be able to give back to the profession and be able to give back to the teaching part of the profession and COMP. Right now between hospitalist and chief of staff and I’m actually in charge of planning the patient move of three buildings, fifty wards, twenty outpatient clinics, including seven ERs with eight different ambulance entrance areas and we are going to be moving patients through three different buildings. It’s the best crossword puzzle in town. But it’s taking a lot of time to plan it out. So no good deed goes unpunished and administration asked me if I would lead and be responsible for planning the patient move. Even more challenging is, I’ve been asked to advocate for all of the medical staff in identifying the offices for all physicians and support staff on the entire medical campus master plan. Now besides parking, offices are right up there with being an important item in a professional career separate from remuneration. I’m chair of the health records committee, I’m chair of the cancer committee, I’m active in the credentials committee, I’m active part of every committee in Pediatrics and the Pediatric ICU committee and as chief of staff, I oversee twenty-one clinical departments and twenty standing committees of the medical center. In the future, I would like to get back to that program that actually gave me the opportunity to do this. In due time.
Dr. Seffinger: It has been a great honor to have spent this time with you and to hear of your great accomplishments and your tremendous responsibilities and your leadership roles that you’re playing now. It’s a very exciting time for you and I think that you would be an excellent role model for the students to come in the future. So I thank you very much.
Dr. Stotts: Thanks for being an intern with me.

I also wanted to include some of my remarks to place the attached timeline in context. Here's some excerpts from my address to the medical staff in 2004.

"In preparing for the Chief of Staff's report I had the pleasure of reading Dr. Helen Eastman Martin's remarkable history of the County Hospital. I devoured the 500-page tome looking for the answers to problems we face today. As I read, I suddenly understood the real meaning of the "Back to the Future" movies.

California had been declared a free state only 8 years before the Sisters of Charity and physicians started seeing both paying patients and charity patients in rented adobes.

It is fitting that Chief Bratton is with us tonight, because there has been a long and important association with the medical and police community. A physician was the first mayor of LA and obviously health issues were at the forefront of politics. Some things remain the same.

The Council on Police was very specific in their expectations of the police. They assigned the police "To attend to everything touching the health and adornment of the City." This was with a census of 1600 and a county that consisted of LA, SB, OC and Kern and there were about one murder per day usually followed by as many hangings. Chief Bratton, you think that you have it tough now.

And the expectations of the state were equally as clear. Initially, California set up state hospitals, but abandoned this concept when the first state hospital in San Francisco failed to provide care deemed adequate to 400 patients in a 137 square foot facility. Dr. Newton, that makes C Booth look spacious.

And so the state declared that the counties would now be encouraged to take care of their own sick. They even sent money: San Francisco received $927, Sacramento $599, San Diego $17.75 and Los Angeles being an inconsequential county received nothing. Dr. Garthwaite, you think that you have it tough now.

I direct your attention to the inside of your program where you will find a few of the highlights of County Hospital.

The LA County Infirmary run by the Sisters of Charity were paid initially 1 dollar a day per patient. This was thought to be too extravagant and was reduced to 75 cents. When the County could no longer afford the 75 cents per patient day they built the first dedicated building on Mission Road, the LA County Hospital and Farm. Inmates, I mean patients, who were well enough would work on the farm. This was a resounding success as the cost dropped to 36 cents per inmate per day. They did note that they did not believe that it was possible to go below these figures and do justice to the patients. Dave Runke you think that you have it tough now.

USC established the College of Medicine in 1885 and the collaboration improved the quality of care just at a time when the railroads reached LA. Physicians noted that "Happily, our county is blessed with an intelligent and progressive Board of Supervisors who realize that if the public wants good doctors, it must aid to make them. The population boomed and the community demanded a new facility. In fact it took only 9 years for General Hospital to be realized. Ron Kaufman, David Altman and Pete Delgado, sound familiar?

The new facility was state of the art but major concerns were raised after the building was completed. An additional appropriation of $29,500 was needed for screens for the 1,859 windows in the new hospital. It had been thought that flies would not reach some of the upper stories of the hospital. One of the biggest complaints by the physicians was the lack of planned office and conference rooms for teaching. Now things are definitely back to the future.

WWII decimated the physician population and the County couldn't provide adequate physician services, so in 1939 USC became responsible for the attending staff. Private and public patients were admitted and Faculty paid $10 a month for the privilege.

The first USC LA County contract in which actual dollars for physicians occurred in the same year that Watson and Crick discovered DNA. With it came the final import of this report.

Namely that of accountability and documentation. Thank God for Lazlo Biro invented the ballpoint pen in 1938. Without the mightly pen we wouldn't have survived. We have long struggled with documenting the things that are actually being done. What was important when I was an intern was to make certain that the patient was cared for, that I drew the labs, that I filled out the lab slips, that I carried the labs to the 2nd floor window, that I had recorded the results in the lab summary sheet. And that was just a blood test, getting a CXR was another obstacle course in and of itself. Times have changed for the better, we have more phlebotomy, improved access to labs and xrays, but we still live and die by the almighty ballpoint pen. Our accountability and documentation is tied to our ability to reduce unnecessary ancillary work and utilize the electronic era. And so with the pains of fitting into a smaller facility, the efficiencies we will realize, I predict will result in more patients being care for.

I would like to thank all of the full-time, part-time and especially the more than 800 voluntary attendings who continue the tradition of giving their services with the same charge as has been the noble tradition for almost 150 years, for free. It takes a special breed of physician to come to The County. You can't be swayed by modern niceties, rather you walk head on into the epicenter of care for the uninsured and underinsured.

I am so proud of this group and of this institution. It has been an honor to represent you, to advocate for you and to serve as the elected Chief of Staff. I look forward with delight to the future with Peter Gruen and Ron Ben-Ari at the helm."

Those were the concluding comments of my first tenure as Chief of Staff.

Cynthia Stotts, DO MS FAAP FAAAAI
Chief of Staff
LAC+USC Healthcare Network
VM (323) 226-5608
FX (323) 226-5590
PG (213) 704-3672
Text message: 2137043672@ArchWireLess.net

Cynthia Stotts, D.O. Interview March 29, 2007 PAGE 22 1858 1878 1923-1932 1968 1977-20077 LA County LA County LA County LAC+USC New Infirmary Hospital General Hospital Medical Center Facility Hospital & Farm 1859 1885 1939 19533 Darwin College of USC School First USC Origin of Species Medicine responsible for LA County USC Attending Staff Contract 1857 1877 1922 1953 19555 Virchow Pasteur Fleming Watson & Salk Polio Cell Theory Germ Theory Penicillin Crick DNA Vaccine 1844 1876 1879 1903 1938 19677 Morse Bell Edison Wright Biro CAT Scan Telegraph Telephone Light Bulb Airplane Ball Point Pen 1861 –18 65 1876-1885 1903 – 1914 1939-1945 19944 Civil War Railroads in LA Panama Canal WWII Northridge Quake