Episode 33: Laura Boylan, MD

The following interview was conducted during the Spring 2024 session of Hidden Figures: Brain Science through Diversity, taught by Dr. Adema Ribic at the University of Virginia. Student interviewers were Alexa Gromada, Laine Ingham, Esha Fateh, Veronica Pitts, Helena Cullen, Sydney Jones, Emily Epstein, Hadya Faqirzai, William Trukenbrod, Savita Singleton, Eli Frazier, Subhi Saibaba, Nicholas Morris and Emma Schoor, who also drafted Dr. Boylan’s biography. The final editing was by Dr. Adema Ribic.

Laura S. Boylan, MD is a distinguished physician in neurology at New York University where she also conducts research in behavioral neuroscience and healthcare ethics. Dr Boylan received her bachelors from Barnard College and her medical degree from Columbia University College of Physicians & Surgeons. She trained as an intern at St Vincent’s Hospital in New York City and as a resident at The Neurological Institute, Columbia-Presbyterian Medical Center. Post residency, Boylan conducted a post-doctoral research fellowship at Columbia-Presbyterian Hospital and New York State Psychiatric Institute. She has received various fellowships and grants for her research. Dr Boylan has conducted research in various subjects, including epilepsy, parkinsons, movement and affective disorders, and patient care ethics.

Could you please describe your upbringing and how that influenced your journey toward becoming a neuroscience researcher?

I grew up in New York City. My journey leading to neuroscience is complicated, but the shortest answer would be I wanted to cure my family disease.

What roadblocks did you encounter during your journey to obtain your MD, during your residency and fellowship training, and in securing your position at NYU Grossman School of Medicine? 

Training for medicine was extremely hard, particularly as I had a child. It costs pounds of metaphorical flesh. Going into medicine was probably one of the best decisions I’ve made. However, at many times in my training it was an exercise in delayed gratification. I was ‘looking forward to looking back’. I got the position at NYU/Bellevue through “old boys’ network” from Columbia. I was stunned to be hired over the phone without an interview through a chain of guys who told me “Call so and so and tell them I told you to call them.” 

Did you have any specific mentors that were significantly influential in your topics of interest?

I was introduced to academic medicine when, living in Washington Heights in NY and working in the arts, I took a “day job” at the HIV Center for Clinical and Behavioral Research at the New York State Psychiatric Institute. I was research assistant to Zena A. Stein, MD. She was a force of nature: brilliant and rigorous scientist, promoter of social justice first in South Africa and ultimately globally as well as the matriarch of a large family. I do not think I would have pursued a medical career without her example and support. 

I have profound personal regard for the wisdom, smarts and moral authority of Bud and Esther Rowland. Esther, who was my premedical advisor, told me that, yes, despite being a young mother with a work history in film and a major in Political Science and no science classes towards pre-medical requirements, I could and should go into medicine and set my sights high. She also told me I couldn't afford Columbia’s pre-med program but should instead go to the City College of New York. The elegant prose of her Dean's Letter on my behalf, written for me as a Barnard student though I attended CCNY for pre-medical studies brought tears to my eyes and I have tried to emulate her support of women in medicine.

A key mentor of mine, Lewis “Bud” Rowland, a Giant of Neurology, was visibly disappointed in my ultimate choice to specialize in the border zone between psychiatry and neurology. I distinctly remember the moment I told him my plans, we were in his office. He advised that I should stick to psychiatric manifestation of neurologic disease rather than vice versa. I did. Since then, my thinking has evolved, and I find this an historic rather than biological distinction.

I have benefited enormously from these privileged connections, and I try to never forget that despite all my grouching.

Have you experienced the disparity and devaluation of women in STEM and academia? How have you confronted this?  

My junior faculty plate was piled high with leadership honorifics and service obligations. I was given responsibility without commensurate authority. At the same time, I came to learn that research, teaching, and education were not three legs of a stool but a hierarchical structure in which, like many women, I was assigned tasks in the latter two and judged on the basis of my accomplishments in the first. Further my research accomplishments were presumed, without scrutiny, to be of no account.

Nonetheless, I did learn a lot about organizational structure, how committees work or don’t, as well as different leadership styles. I learned about what I refer to as the “psychopathology of organizations”. I am referring to dysfunctional behavioral patterns which arise as an emergent property of organizations of all sizes and types without either malicious intention or insight.

 When I told colleagues I was going to do locum tenens work I was looked at as if I had an eggplant growing out of my ear. However, with that move, I was empowered to buy back own intellectual and scholarly freedom and dignity. “La Vida Locums” entailed higher and less gender discrepant pay. It also entailed serving neurologically underserved populations who, in contrast to their physicians, were predominantly white and rural. The shedding of independent research and the world of grants was not overly painful. The switch from a more traditional career path to neurological nomadism was a move to an environment where the climate suited my clothes.

Before I left NYU I did some 'consciousness raising' amongst women in my department by circulating salary information from the AAMC compensation surveys which were oddly missing in the library stacks. Other women faculty members and I shared information on salaries between ourselves and male faculty as we could obtain them. The constant argument was that salary discrepancies were due to "apples and oranges" comparisons. I drew up charts of gender discrepancies in assignments to committee and service obligations.  

You had a unique opportunity with your academic position at Addis Ababa University in Ethiopia, could you elaborate on your experience? 

I wanted to visit Ethiopia. For pleasure. I was not on a “medical mission”. It’s always good to have a “local contact”. I had read there were only 7 neurologists in Ethiopia. I thought, surely, someone would like to have a coffee at least. I reached out to neurologist Dr. Guta Zenebe in a "cold email" having gotten his email address from a paper he wrote. He introduced me around and ultimately I ended up teaching both in formal didactics and in clinical rounding on hospital wards in Addis Ababa and Gondar in Ethiopia. It was exhilarating. My Ethiopian colleagues were extraordinarily generous in honoring me with an academic title. I considered that title overly generous. However, I try not to leave credit on the table.

You have taught many different training courses, classes, and lectures across different universities, medical centers, clinics, and conferences. What has been your favorite thing to teach and why?

I most enjoy clinical teaching rather than didactics. It keeps me on my toes. What I love about research now is how you can reach out to other researchers and ask anything, and people are almost always so happy to find others interested in their areas of passion.

When considering the diagnostic aspect of your field, do you think increased medicalization due to widespread access to online medical information is more helpful or harmful for individuals seeking treatment?

The model of medicine has changed to a more horizontal rather than vertical arrangement between doctors and patients. I support this. It doesn’t matter what I think about patients getting information on the interne - it will happen. I look all sorts of things up myself constantly – for myself, friends and for patients. I tell patients and teach residents to disbelieve information on any site which has a shopping cart attached. The tidal wave of medical information has promoted hyper specialization of doctors, which has an overall negative effect on public health, in my view.

Given your research on emotional dimensions of the physician-patient relationship, how might physicians cultivate or model high multicultural competence with patients?

I try to be mindful of cultural factors and maintain an attitude of both curiosity and humility – to model this in patient care. The economic and health care system issues are so ubiquitous I try to note them as they come up – the issues of money, power, race, and culture are intertwined. I try to be mindful of my own biases.

The research on physician-patient relations was led my psychologist colleague Jairo Fuertes. More central to what I consider a very solid competence with Latin American culture is that I have lived as an embed, practiced medicine heavily in Spanish and am mistaken as Latina when I speak Spanish.

You've been practicing neurology for over 20 years. How have you seen the field evolve during your career?

I am dismayed at sub-specialization, at a hyper-focus of resources on rare diseases and diseases primarily of the elderly. I was and remain very interested in neuromodulation/neuroplasticity. I chose my fellowship in significant part because one of two transcranial magnetic stimulators in NYC was located in the building next to the neuro institute at Columbia. Neuromodulation was not a term at that time.

My self-identification as a neurologist is on the level of an "order of being", a way of looking at the world and myself. In my time in neurology, I see great scientific progress and some progress in improved access to healthcare, transparency in pay. There has been a positive culture change in medicine, in neurology and, in my own department at NYU.

What things do you like to do outside of your professional work?

Spending time with family, friends, and dog. I write poetry, create digital art. I love to read. Increasingly, and in a focused way I am trying to enjoy receiving from the world without constantly feeling the need to “impact”. It’s an aging thing. I love to ride trains. I’m involved as a caregiver for my elderly in-laws. I’d like to go somewhere deeply isolated and wild in nature, with all the creature comforts and free delivery of fabulous food. No driving. No long hikes or carrying stuff. Last year I got wallpaper with birds on it. A start at least to a more realistic version of this fantasy.

What is your main source of motivation to be a part of this field?

Off the cuff, the mystery of the soul, if there is one.