Carl Nunziato, MD is an orthopaedic resident at the University of Texas at Austin Dell Medical School. A California native, Dr. Nunziato completed medical school at the University of Vermont and received an undergraduate degree from Yale. Dr. Nunziato is a Lieutenant in the United States Navy Reserves.

TOA asked Dr. Nunziato to testify before the Texas Legislature on three different items related to opioids during the 2019 Texas Legislature. Dr. Nunziato’s testimony played a major role in shaping the outcome of public policy related to opioids in the 2019 Texas Legislature.

The following is a conversation that TOA had with Dr. Nunziato had about his experience testifying before a legislative committee.

TOA: You testified on three different opioid issues at the Texas Capitol? Did the testimony go as you expected? 

Carl Nunziato: Prior to appearing before the Capitol I had never provided testimony on legislation. I think the process was made easier by the fact that I was confident in my testimony and had plenty of experience with opiates, surgical pain, and addiction as a medical student and resident.  I felt I had something to contribute and that it was well received by the legislators to whom I spoke. Given the attention the opioid crisis has commanded, I expected a large turnout, but I was still surprised by the number of people there to testify, observe, or report on the proceedings. Some of the personal stories I heard were tragic and served as a sobering reminder that, while I get to go home at the end of the day, many patients and families don’t ever get a reprieve from injury or addiction.

TOA: You have spent time in different states through the Navy, undergraduate, and medical school.  When compared to other states, is there different about the health care system in Texas? 

Carl Nunziato: Well I grew up in California and started my medical training on the East Coast (University of Vermont College of Medicine). While some things are definitely different, I think the actual medicine is largely the same. For me the most significant difference is the relative rarity of private practice surgeons on the East Coast compared to Austin. Most of my faculty in medical school were hospital employed, whereas in residency I spend a lot more time with private practice surgeons. I think getting to experience both styles has been a great benefit.

As for public policy I was happy to see there wasn’t nearly as much partisan bickering in the Texas  House, at least for relatively non-controversial opiate bills, as I would have expected. It seems the legislators on the Texas House Public Health Committee  are working to address some of the health problems facing the state. I would encourage the state legislature to revisit the big pot of federal money in the form of Medicaid expansion. I’m optimistic there is a solution out there either via expansion or 1115 waiver that would help mitigate our issues with opiate addiction, mental health, and maternal mortality that fits with the values and priorities of Texans.

TOA: What does your Navy commitment entail?

Carl Nunziato: I was commissioned on acceptance to medical school as an O-1 (Ensign) in the Navy through the Health Professions Scholarship Program (HPSP). In exchange for a four-year postgraduate commitment, my tuition and school expenses were covered and I was given a monthly stipend for living expenses. While the usual pathway for HPSP students involves an active duty residency at one of our major teaching hospitals, I was selected for “civilian deferment” for residency due to a higher need for orthopedic surgeons than can be met with the in-service training positions alone. Once I received my M.D. I was promoted to O-3 (Lieutenant).

TOA:  What has your experience been like at the University of Texas at Austin Dell Medical School? 

Carl Nunziato: So far, my experience at Dell has been great, and I’m thankful to my program leads and faculty for giving me the opportunity to train here. I’ve really enjoyed the ability to help shape the program alongside my co-residents as the inaugural class. The faculty have been more than generous in allowing me to pursue my extracurricular interests, such as involvement with the TOA or with some of the value-based care initiatives and research at the Musculoskeletal Institute. I would recommend the program to anyone.

TOA: What’s your plan after your residency?

Carl Nunziato: That sort of depends on Uncle Sam. While I’m currently interested in either a pediatrics or trauma fellowship I’m open to whatever the needs of the Navy will be once I’m done. Right now, just happy to keep focused on improving my surgical skills and ortho knowledge.