Network Director

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This episode was produced by Nikitha (Nikki) Sheth and Grace Kim, hosted by Nikitha (Nikki) Sheth, and graphic by Callista Wu.

00:00 Introduction

01:27 Dr. Srinivasan’s early life and immigrant childhood

04:23 Discovering identity and path to medicine

07:15 Journey into Asian health research

09:03 Common misconceptions: the model minority myth

13:41 Lifestyle choices for South Asian health

18:50 Pharmacogenomics and South Asian patients

24:17 Nutrition, diet myths, and healthy adjustments

37:17 Screening guidelines for South Asians

40:50 Building trust and rapport with South Asian patients

47:37 Opportunities to get involved with Stanford CARE

51:18 Advice for South Asian medical students

54:19 Finding supportive mentors

58:28 Audience question: relying on professors in residency

01:01:09 Closing

00:00 Introduction

Nikitha: Hi everyone, welcome to APAMSA White Coats and Rice’s new series South Asian Health in Lens, or SAHIL, where we delve into critical topics in South Asian health ranging from advocacy to cultural competency with distinguished health care leaders. My name is Nikitha Nikiseth, first-year medical student and third year in the University of Missouri Kansas City’s six-year BA/MD program, and the current vice president of UMKC APAMSA and member of the South Asian Committee here at National APAMSA. And I’ll be your host for our SAHIL series.

For today’s episode, we’ll be speaking with Dr. Malathi Srinivasan, who is a clinical professor of medicine at Stanford University and Associate Director at the Stanford Center for Asian Health Care Research and Education, also known as Stanford CARE. She also serves as Director for the Stanford CARE Scholars Program and Stanford Implementation Sciences Fellowship. Dr. Srinivasan is active in the Stanford Humanities and Arts Program and brings her skills as an educator, physician, health services researcher, and entrepreneur to shed light on crucial topics in Asian health. Let’s welcome Dr. Srinivasan. Dr. Srinivasan, thank you so much for joining APAMSA White Coats and Rice and for being our first guest on our South Asian Health in Lens series. Let’s start off with talking a little bit about yourself and your journey, and how it’s led you to become the Associate Director of Stanford CARE.

01:27 Dr. Srinivasan’s early life and immigrant childhood

Dr. Srinivasan: Niki, that’s such a pleasure to be with you here today. And thank you to you, your audience, and to APAMSA for inviting me. I’m so excited to share with you a little bit about things having to do with South Asian health today. And if you had asked me when I was a young girl growing up in the Chicago suburbs if one day I would be a clinical professor at Stanford working in South Asian health and in Asian health, I would have completely not believed you. Because my parents, like many other people in the United States who are Asian, had immigrated from India to Canada and then to the United States when I was a very young child. So I was actually born in Canada and I grew up in the Chicago suburbs. My brother was born when my dad was doing his postdoc at Notre Dame. And we had a very interesting immigrant childhood. In the sense that we had faced in this white collar, blue collar area that we grew up in a lot of overt discrimination when I was growing up. People didn’t really, hadn’t seen a lot of people who were South Asian and they didn’t really have a good cultural base. There’s a lot of prejudices that were held over about what it meant. To be not white in America. So when I was growing up, there was a lot of issues surrounding being bullied because of ethnicity, being called dothead, and other types of things in a questioning and Midwestern environment. But at the same time, that was counterbalanced by a very rich expat and immigrant culture. Of all of our friends and families with whom we would interact. So the home life was very rich with culture and great foods and science and music and art at a very elevated level. And then the outside culture was a Midwestern area where we were, you know, generally grossly misunderstood and in many cases actively discriminated against. You know, my parents had been PhDs in Canada. My mom was a nuclear physicist and my dad was a radiation chemist. So, you know, our friends and family were sort of along those lines. And when I had gone to high school, you know, my parents had dressed me up like a young South Asian girl, which meant like a pigtails with ribbons in my hair, which you can imagine didn’t go over particularly well when people were trying to be cool and trying to be styling. By the time I had gotten to college and was really finding my own voice at our state school, University of Illinois in Champaign-Urbana, I was really beginning to understand what it meant to have two identities. And being bicultural was a wonderful experience and also a scary experience because there was no navigation pathway. And there at the time there weren’t that many Asians and certainly South Asians in the United States, you 5.4 million people that we have right now.

04:23 Discovering identity and path to medicine

Dr. Srinivasan: So I went to medical school at Northwestern and then did most of my training in the Midwest, including after my medicine residency. I did a three year research fellowship that was focused on health services research as well as on medical education and had joined the faculty at UC Davis. And there I was doing a lot of work around education, asking questions about how do you train a great doctor? How do you build programs that are going to help physicians and allied health professionals all around the world train clinicians better and make them more compassionate, make them better decision makers. And so my early work at UC Davis was focused both on medical education as well as on health services research, which is how we deliver care. And I was teaching internationally a lot with one of my colleagues, Dr. Michael Wilkes, who he and I would go to different countries and we would teach about capacity building around education and educational leadership. And then through my work in Asia became much more interested, certainly in Asian health. And at the same time, as we were growing up, a lot of our family friends began having problems. They develop breast cancer more so than I would say in other groups. They develop cardiometabolic diseases, started having heart attacks. Early my grandfather died when he was around 60 of a heart attack, which given how active he was and the fact that he was eating a very good South Indian diet, which we thought was terrific for him, but was very surprising. And so when I had moved in 2018 from UC Davis to Stanford and joined the faculty, there were a couple of colleagues who have become fast friends who had started the Stanford Center for Asian Health Research and Education. And the goal of the center was to be able to improve the health of Asians everywhere. And you might say, well, that sounds pretty ambitious. And it is a very ambitious goal. And what we’re trying to do is take aggregated Asian data within the United States and then disaggregate it so that we can actually understand what’s happening with the health of Asians. Now, you might say that seems like pretty much of a no-brainer, right? Asians are 60% of the globe. There are 67% of the US population right now. But there are only 0.17% of NIH funding, and this is with prior NIH funding. We’re not quite sure what’s going to happen with funding given priority changes now federally. But it’s a very understudied group of individuals and we know that there’s differential health risks. So when I had joined Stanford and Dr. Latta Palaniippan and Dr. Bryant Lynn had started Stanford Care, I had joined to teach within a very small research program that they had started for undergraduates and we grew that program up into the current Care Scholars Program.

07:15 Journey into Asian health research

Dr. Srinivasan: Where we’re doing a lot of training around precision medicine for Asian health and training about 24 young people per year and also doing work with the team science fellowship that we built to support the Care Scholars Program. And so, you know, the pathway, and at the time when I was growing up, there was no such thing as Asian health research. In fact, there was a lot of work around African American health and Latino health and LGBTQ health, Native American health, and minoritized populations that didn’t really have a voice. But there wasn’t so much about South Asian health and or about other Asians comprising the big six, Chinese, South Asians, Filipinos, Koreans, Vietnamese, et cetera. So the opportunity to be able to do work in this area was not there. And as a health services researcher who had training on understanding how to think about vulnerable populations, it was something I never thought I would be able to do. And it was really an honor to be part of the center and now to be associate director, one of the associate directors of the center.

Nikitha: It’s truly inspiring to hear your story because I have a similar situation where I’m daughter to Indian immigrants. I grew up in the Chicago suburbs and to hear about the adversity that you faced while growing up in that situation and getting more involved in ways to bring more light to these issues and kind of the lack of awareness that Asian health trends are certainly prominent and should be addressed and cared for as many as the other minorities and other health trends. So I sincerely appreciate the work that you do. Just kind of.

09:03 Common misconceptions: the model minority myth

Nikitha: Leading into that, you recently led an insightful discussion on Asian health in America, and that delved into the model minority myth of Asians, as well as differences and causes of death across several groups of Asians, as well as mental health. So what have you found to be common misconceptions about the South Asian community and South Asian health?

Dr. Srinivasan: Well, I think we should start with what the model minority myth is and how it came to be. The model minority myth is this idea that one group of immigrants or a population is so much better than all the other groups. And in fact, that they’re a model because they’re so hardworking, they don’t speak up, they put their heads down and are successful. And what that does is several things. Now that sounds great, sure, you are the model minority, everybody wants to be like you, but that’s actually not true. But the model minority myth is used as a wedge to be able to set one group against the other. And by obscuring differences that are within a group, it actually leads to people ignoring important issues that happen for all of the people within the groups. For instance, the Asians generally, and Indians and Chinese people, Chinese groups in particular, are often held up as model minorities. If you are a South Asian, even though the South Asians generally may have a high overall income compared to other groups within the United States. There’s about 10% of people who are below the federal poverty limit. If you are South Asian, one in five people, 20% of individuals have mental health concerns like a depression or anxiety. And we don’t even know the rates of schizophrenia or some of the other important psychiatric disorders. It means that people then become, are not asked about issues around their health or mental health or problems that are very important to the community. And because of this, they also don’t seek help and they don’t end their stigma against being able to show your concerns. Right? So in many Asian cultures, you’re really taught that you have to present yourself in a certain way that is a very polished and together, but in essence, even if you are going through individual and personal struggles, because of the stigma associated with mental health disorders and with other health conditions, you may not actually seek help. And so that leads to things having to do with increased rates of depression, especially among older Asian adults who may have also language issues and with abuse and neglect or social isolation. There’s not a lot of pathways for things having to do with intergenerational conflict. South Asian youth who are suicidal might actually not present by saying, oh, I’m depressed. They might just have academic difficulties or have risky behaviors or just have a stomach ache or a headache. And so the issues around being a model minority where everyone expects you to be perfect show up in lots of ways that actually are detrimental to health and well-being of the entire group. So rather than personalized care and using a precision medicine approach, these stereotypes actually lead to these things that people may consider a positive stereotype actually lead to very negative consequences.

Nikitha: Yeah, absolutely. I think the model minority myth definitely needs to have more attention in how it can feed into negative thoughts and feelings and misconceptions around especially Asian subgroups where that may cause people to not feel like it’s worth bringing up very important health problems. Like you said, a lot of research still has to be done on a lot of different trends like psychiatric disorders and other treatments that should be worked on to bring more light into what Asians may go through and their health trends. And yeah, those misconceptions are definitely some things that we want to tackle in the South Asian health in land. I do appreciate the work you do with Stanford Care because I think it does help push us towards more knowledge and that knowledge is something that we can utilize to bring a lot of advocacy to these problems. And with the work that you do, you recently published an article on the association of sleep duration and cardiovascular disease among Asian Americans. And it highlights how suboptimal sleep duration had a higher relevance of cardiovascular disease.

13:41 Lifestyle choices for South Asian health

Nikitha: So in addition to sleep, what are some lifestyle choices South Asian Americans can consider to promote heart and metabolic health? Because like you mentioned, it’s pretty common in the family to hear of someone having either hypertension or diabetes. I know definitely people in my family suffer from it and I’m sure it’s a very common instance. So to bring more light to this type of lifestyle, what are some different choices that South Asian Americans could consider so that they’re able to promote those aspects of health?

Dr. Srinivasan: Yeah, so I want to spend a moment on sleep. You probably know that the American Heart Association has recently, about two years ago, has adopted sleep as the eighth healthy lifestyle step. Poor sleep and poor quality sleep is considered as a bad or risk factor as smoking. And the other thing of course is that sitting is the new smoking also because we know that exercise dramatically changes your cardio metabolic risks. South Asians have about twice the heart disease risk and about twice to two and a half times the diabetes risk as someone who is non-Hispanic white. If you can imagine India over, say, the last 10,000 years has gone through periods of feast and famine, of low water resource, of time where there was a lot of food scarcity. And the same way that in Africa, if you had specific mutations that made you less likely to die of malaria, namely having sickle cell disease, with oxidative stress, these cells become sickles, and then it’ll kill a parasite also. There was a survival advantage to being able to someone who stored fat and who was able to not and because fat is a food storage that lets you release sugar when there’s no food. Okay. So what has become a survival advantage in times of food scarcity is now a survival disadvantages when you come to longevity. So the that paradox is really important. And one of the things that you’ll notice is that there’s also something called the obesity paradox, where you have people who are actually normal weight. And if you look at them, they look just like a normal, healthy person. But in fact, they are metabolically unhealthy and they are metabolically obese. And because South Asians in particular store fat around their organs and it’s called visceral fat. And for the same body mass are going to have less muscle. We actually have much higher rates of heart disease and diabetes. And in fact, it’s a combination of cardiometabolic health where you have fat deposition in your liver, around your organs, you don’t build as much muscle, and muscle, believe it or not, is actually a major component of your metabolic health. And because South Asians don’t build as much muscle, and most Asians don’t in comparison to non-Hispanic white, and you build muscle really until your 30s and kind of your 40s, and then it’s harder to keep, and then you start to lose it after that. can actually, and having low muscle mass later on in life is one of the biggest predictors of whether or not you age healthily and whether or not you’re gonna die. Because people have falls, are unable to, they get hip fractures. So this combination and also fat, excuse me, muscle uses glucose independently of insulin. And so if you have someone who is unable to process and store sugar in the most healthy way, if you can actually reduce your blood sugar by having more muscle, you do better. Okay, so there was a study called Masala that was produced, that was published in 2010, which is the mediation of atherosclerosis in South Asians living in America that had really shown the higher incidences of cardiometabolic disease in Indians. And so in fact, it’s so bad that the World Health Organization and the Indian Ministry of Health have reclassified what it means to have a healthy weight for people who are Asian. And if you are Asian, whereas the body mass index, which is a measure of how tall you are compared to how much you weigh, if you take a look at that, the body mass index of 25 is considered the upper limits of normal for someone who’s Caucasian or Hispanic or African-American, but it’s actually 1.5 points lower for people who are South Asian and Asian. So at every point in time, whether you’re thinking of obesity at a BMI of 30 or morbid obesity at a BMI of 40, because of our differences in cardiometabolic health, the numbers are 1.5 less. So it’s really important for us to have an understanding of the foundations of this and also understand that there’s pharmacogenomic differences that are also driving how we treat these issues.

18:50 Pharmacogenomics and South Asian patients

Nikitha: Could you delve into the pharmacogenomics because I think that’s also a really critical topic to kind of delve into to provide more context on that foundation.

Dr. Srinivasan: Right. So in every country where people have grown, have lived for tens of thousands of years in a specific location, there will be variations from what’s studied. I want to make two points. The first one is that Asians in general and South Asians in particular do not participate in very many research trials. If you take a look at the number of people who are Asian in the world, it’s about 60%, the number of people who are participating in clinical trials is about 10%. So all of the decisions that are made about Asian health are for the most part done with non-Asian data. When it comes to genomics. So there was a study in 2016 that was a meta-analysis of about 2,500 studies that looked at genomic data for 35 million people, so including people from China. Only 19% of all of the genomic data is done on Asians. So what that means is that you have a mission aggregation, an extrapolation of data from other populations to the Asian population. And what does that mean for South Asians? Well, we know a lot of stuff, right? So already what we do know is that there’s, let’s just kind of stay on cardiovascular issues since we’ve been talking about that. If you take a look at things like metabolism of drugs for treating heart disease and heart attacks, or someone who’s had a stint, you might use a medication called Plavix, which is, you the generic is clopridogrel. And if you’re Asian, a South Asian you are more likely to bleed if you’re given Plavix. And why is that? It’s because you have something called a gain-of-function mutation. And what that means is that a particular enzyme, I, without getting too technical, the enzyme name for those of you, since there’s a pre-medical audience here who might care, is CYP2C19-star-17, okay? I know that’s a mouthful. But that gain-of-function mutation takes a protigrel, which is a prodrug, and translates it into its active form. And because that enzyme system in the liver is more active, you make more of it. So you’re going to be more likely to bleed because it’s an anticoagulant, right? So if you have a medication that we use for atrial fibrillation called warfarin, you actually need to have less of a dose because you’re going to be more likely to bleed because there’s an enzyme system called V-Core C1, which is different in Asian Americans and in South Asians. And you should be giving someone a different dose than you would because you’re going to be more likely to bleed. If you look at statins, which we use to be able to treat high cholesterol, then you also want to, it’s important to know that statins aren’t metabolized as well for people who are South Asian. And in fact, you need less of it because you might actually have more side effects. So for people who are South Asian, for all of you blood and cardiologists out there, if you have a South Asian patient, start at a lower dose and then ramp up slowly and monitor for side effects. And if you start getting side effects, back off on the dose and you can add second and third drugs like Zetia or the PSK9 inhibitors. But it’s important to kind of think about these differences. And that’s the first point. The second point is that in many cases, we actually don’t even know why we’re having differential outcomes. Breast cancer rates are increasing significantly in South Asian women. And when you do genomic profiling against the things that we know are hereditary breast cancers for people who are Caucasian, like the BCARA 1 and 2 genes, they may not have those. But when they do whole genome sequencing, we have things that are in that same area which people are calling variations of unknown significance, right? So there are variations that may be very common in South Asians, but we actually don’t know what they mean because they haven’t been studied. So it’s very important for people who are South Asian and people who are Asian in general to join clinical trials so that we contribute their genomic data so we can begin to understand what’s happening in our populations.

Nikitha: Yeah, definitely. And learning more about the foundation of why these trends are what they are, rather than just knowing that they exist, I think is crucial, especially for aspiring physicians, that they can gain more perspective and kind of awareness from that pharmacogenomics, just so that they have more understanding going into when they treat these patients. I think what you said about statins also resonated with me a lot because it’s such a common form of treatment but something as simple as a statin you have to consider the nuances when you have a South Asian patient because it may not present the exact same way they may have more side effects and so the dosage has to be adjusted accordingly so that is really important to know so I appreciate you mentioning that and.

24:17 Nutrition, diet myths, and healthy adjustments

Nikitha: With those lifestyle choices as well. So knowing that foundation is really helpful. So with the building muscle might also help. So I know oftentimes we just say that exercise is great because maybe with diabetes that tends to be the trend if they’re more obese. But when it comes to Asians and South Asians, that’s not always the case. They may be a smaller frame but still have diabetes just because of those environmental aspects and the genomics. And so things like maybe building muscle might be helpful to consider in addition to what they may consider as other exercise like walking and simpler exercises like that. So it’s good to know that maybe building muscle is another thing to keep in mind for those lifestyle choices.

Dr. Srinivasan: Nikitha, you’re so correct. And in fact, Dr. Palaniapin had done a study called Strong D. So it was a strength training versus cardiovascular training program. Take a look at what happened to people with diabetes. And in fact, strength training for South Asians was more important than cardiovascular exercise to address diabetes. And I think it’s in large part because of the visceral fat issue and then the building of muscle issues with sarcopenia that we talked about. There’s a lot of other things that people can do also to be able to improve their sleep. And some of it is the standard advice that you’re going to get. So, you know, make sure you’re paying attention to your sleep. You know, don’t smoke. Ideally, we used to think that some amount of alcohol was safe in terms of long-term health, but we know now that really, you know, all alcohol is bad alcohol for your health. And so if you’re going to drink, you know, just make sure that you’re being very moderate and use it as something that’s occasional, not every day. We could talk a lot more about diet and fats too. I know a lot of people are always asking me about what cooking oils to use and.

Nikitha: How to think about their food choices. Yes, that would be a great thing to touch upon because it is something that’s quite common with cooking. At least from my perspective, I would hear from family members or family friends that the amount of cooking oil is playing a big role, but they don’t really know how to adjust things. They’ve just kind of heard a lot of bits and pieces here and there, but don’t know what to do with it to help improve their health. So definitely talking about that would be wonderful.

Dr. Srinivasan: Indians and Asians love to eat. And in fact, I don’t know about you, Nikitha, but my fondest memories are of our family gatherings and everyone, you know, cooking together and eating together. And in fact, much of our conversation would usually center on what we had eaten, what we were eating and what we were going to eat. And the deliciousness of the foods is unsurpassed, I think, amongst all of the Asian groups. And of course, I’m very biased. But if I could have my mom’s gulab jamun every day, I’d be very, very happy. So what does that mean for our health, though? So knowing what we know about cardiometabolic health in South Asians, the things that we have to know about are sugars and fats, right? So we have our energy comes from either carbohydrates, which can be simple, complex or fibers, proteins, and then also from fats. And so I’m going to touch briefly on all three of these. So let’s kind of talk about the protein issue. So for people who are vegetarian, which many South Asians are, finding adequate protein is a little challenging. And you have to be pretty meticulous about making sure that you’re having balanced protein so that the essential amino acids that you need come from both legumes as well as from grains. And when you’re choosing grains, you want to choose more complex carbohydrates, which take a little bit longer for your body to digest and metabolize into sugar. For proteins, the general recommendation is that you want between 0.8 to say maybe two grams of protein per kilogram. It depends on how much you weigh. And I would encourage all of the APAMSA students who are listening to this podcast to really go out and take a look at food labels because I think that getting familiar with food labels is very important. So every plant or food group has all of the essential amino acids. It’s just the proportions of them and having them available to you in a way that’s useful, that’s important. And so if you’re a vegetarian and you have either eggs or milk products, it becomes much easier because there’s both protein supplements that you can take as well as, you know, dolls and excuse me, as well as eggs and milk that are available to you that have complete proteins. But if you’re vegan, then you have to be a lot more careful with your protein intake. So, you know, just please become a little bit more educated about that and then read your food labels and think about how you can get the right amount of protein. And it should be about 30 grams per meal. You know, usually less than about 20 grams per meal. The protein is not necessarily going into building muscle. It’s often just used and or stored as fat. So we don’t have a form of protein storage. We only have a form of carbohydrate storage and carbohydrates, of course, are stored as fat. And so all the excess protein that you eat, if you eat a lot in a meal, is just going to get converted to fat if you’re not going to be using it right away. The carbohydrates, as I’d mentioned, come as simple, which are just things like sugar, like glucose, fructose, and other simple sugars, or things that are more complex carbohydrates that are longer chain sugars, and then things that are fibers, which are really fairly either soluble or insoluble. the insoluble fibers are the ones that are used by bacteria to be able to support your metabolism in your GI tract. What’s important about carbohydrates is carbohydrates are metabolized, are digested by your stomach and by some of the enzymes in your intestine, and then they’re absorbed. And when you think about people who have diabetes, the rate at which those sugars are absorbed into your blood system in the intestines and the baseline amount of blood sugar, of sugar that you’re making from your liver are the two things that determine your blood sugar level. So when you’re eating, what you want to do is try to reduce the spike by slowing down digestion. And that can be done by several things, by having fats and complex carbohydrates, like salads and things, at the beginning of your meal. So salad with a really good salad dressing, having vinegar, which will slow down about two tablespoons or so, which will slow down your gastric emptying. So again, going back to that really great salad at the beginning of the meal, and then having more complex carbohydrates, which your body has to work harder to digest. And so a carrot that is baked has a different glycemic index, which is kind of a rate of if you have 100 grams of carbohydrates, how fast does your blood sugar rise? The, you know, an hour or so, the type of food and the food composition becomes very important and the order in which you eat also becomes important. So understanding that about carbohydrates that you can actually choose things that are lower glycemic index, meaning how fast the sugar is absorbed and how much your blood sugar spikes when you have that type of food, right? So a glycemic index of 100 is if you have like 100 grams or so of glucose and what happens to your blood sugar. But a baked potato has a glycemic index of 110, whereas a broccoli is gonna have a glycemic index of maybe 20. So in general, we wanna try to keep most of our foods having a glycemic index of less than 55. And then when it comes to things having to do with fats, there’s a lot of misconceptions about dietary fats. In our blood, the good cholesterol is called HDL and the bad cholesterol is called LDL. South Asians also have a higher incidence of a very bad type of lipoprotein called lipoprotein A. And if you don’t know if you or your family have it, you should get checked out. And the things that drive up the bad cholesterol, the LDL, are saturated fats and trans-saturated fats. Things like the seed oils are actually not that bad for you. And there’s a lot of villainization of individual food groups that comes from a lot of food misinformation. And the seed oils in general are just fine, even if they are refined at a slightly higher temperature. When you cook, you’re also cooking at a slightly higher temperature. The so things that we love that make our food really, really tasty, like ghee and clarified butter or a coconut oil are actually really bad for your health. They will drive up the bad cholesterol and make you more prone to having heart disease. And the good fats are things that are liquid at room temperature, which are the omega-3 and omega-6 fatty acids. The omega-3s are anti-inflammatory, and they’re found in things like nuts, avocados, fish, and also canola oil and a lot of the seed oils. So there’s things like omega-3s are really important for you in terms of your brain health as well as your cardiovascular health. And so paying attention to the types of fat is really important, less so than the amount of fat, although we tend to, because our food is so delicious, eat a lot of it. And so I would just say that, you know, the amount of total fats that we eat, especially saturated fats, should be reduced. There’s a couple other food groups that you should be careful about, particularly in South Asian food. One of them is milk products. We use a lot of yogurt and cheese, particularly in the northern part of India. And cheese. And milk products are very inflammatory, and they contain some sugars and things like that that are just not great for your gut health. In general, I don’t really recommend milk products, although if you can take it, it’s just fine. We use a lot of rice, as you know, and white rice has a very high glycemic index. So if you can, try to have more either brown rice or you can have white rice, but eat a lot of protein and vegetables and fat with your white rice to try to slow down the absorption of the sugars into your bloodstream. The other thing is that we love potatoes and we love a lot of root vegetables that tend to have higher glycemic index and can cause that sugar spike. So, you know, don’t eat those things in isolation. I wouldn’t eat a huge pile of potatoes, but if you’re eating a small amount of potatoes, eat some vegetables and eat some protein, like chickpeas and other things, along with it so that you don’t get that sugar spike. And then try to have more salads and leafy greens and things like that as well as fruits and vegetables in your diet. So in general, I think that the rules of thumb are eat in the right order. So that means vegetables, protein, and then carbohydrates last. That will help you with a glycemic load, not just with the glycemic index of a particular food group. Two, reduce the amount of saturated fats that you eat and increase the amount of healthy fats that you eat, especially things like the nuts and the avocados. Three, don’t eat so much rice. Four, try to incorporate some kind of strength training exercise in your life, even if it’s just walking a lot with, you know, a very light weight, but it’s important for you to get out there and get some exercise.

37:17 Screening guidelines for South Asians

Nikitha: Yeah, definitely. I think the diet misconceptions, I think that’s a big thing because people have just heard what they should do, but they don’t really know why they’re doing it. Like you mentioned with the rice, people know that white rice isn’t that great, but they don’t really know that they should eat something alongside it to help with that absorption, like you mentioned. And just understanding that foundation, I think is really helpful. You also mentioned, since a lot of the South Asian population are not studied in clinical trials, what are some recommendations for routine screenings for South Asians, especially when we talk about things like breast cancer, heart disease, and those cardiometabolic issues? What are some things that people should keep in mind in terms of screenings?

Dr. Srinivasan: Right. So in general, I think you should still follow the standard guidelines. So for cholesterol, for diabetes, for hypertension, all of those things you should follow the standard guidelines. So your family doctor is going to start checking you for some of these things around age 40 or so. Now, if you are a South Asian American, you might want to start thinking about it earlier in your 30s. And especially if you’re a male, you might want to consider doing a calcium score, a coronary calcium score, which is a scan of your arteries to see if there’s any plaque deposition, just as a way of being able to get a baseline on where you’re at and whether or not you might want to consider going on a statin earlier than you would otherwise. The other thing is that, you know, there’s no official recommendation, but I would highly recommend for South Asians to get their lipoprotein A measured. Now, this is not a routine lab that your doctor will be ordering for you, but it’s an important risk factor that’s been implicated. And so I would ask your physician to order it just for your own purposes, right? It’s not part of the standard lipid panel. So when you get your cholesterol panel, you’re going to get an LDL and HDL and a triglycerides and a total cholesterol, but you’re not going to get the lipoprotein A. In terms of breast cancer, there’s still a lot of debate on how often you should be getting a mammogram, whether it should be yearly or every two years, and what age to start. But in general, I would say to you that the best rule of thumb is a woman should probably get her first mammogram by age 40 and then do it yearly after that. And if you have a family history, you might want to start in your 30s. And that’s something you should probably talk with your doctor about. But the earlier the better in terms of diagnosing breast cancer, particularly because rates are increasing in South Asians, as well as in other women in the United States. In terms of mental health, it’s very important to ask your doctor if you’re having any issues with mental health. If you feel down or blue or if you’re having a lot of anxiety and you’re not able to sleep, it’s really important for you to be able to talk about those things. You know, we don’t really have a cultural base that makes it easy to talk about some of our mental health issues, but it’s important to be able to talk about it with a professional. So I would just say that for all of our listeners and all of you, particularly young people who may be listening to this podcast, if you’re having those issues, please go and seek help. A physician, your physician, is your ally in this case.

40:50 Building trust and rapport with South Asian patients

Nikitha: Building trust and rapport with South Asian patients. That is something that, like you said, can be very difficult at times, just due to the cultural nuances and some of those stigmas that we mentioned that may be prevalent. So how do you approach building trust and rapport with your patients, especially when you encounter some of those topics that may be deemed sensitive?

Dr. Srinivasan: Well, I think the first thing that a physician, a health care provider, can do is to just ask a patient what’s important to them. So, you know, when you go into a room, if I ask a patient, you know, what’s a family life like? What do you do for fun? How do you have fun? What are your hobbies? What are you interested in? And I try to learn about the people who are in my waiting room. I try to, you know, greet them in a way that, you know, I show them that I’m interested in their culture, you know, maybe ask them, you know, what’s your family background? And when they tell me, I’ll say, oh, you know, what’s your language? And I’ll try to find some words in their language and try to do that. And you can just see patients light up when you’re interested in them as a person and not just as a medical problem. So I think that that’s the most important thing to do. You know, for many South Asians, we’ve come from countries and we’ve been, you know, in the diaspora for a number of years where we’ve also had different types of health systems. Some of them are not as patient-centered and you’re not used to a doctor asking you, you know, what’s wrong with you? Or, you know, how are you feeling? It’s more of a very professional and formal relationship. And so I think that for many people who come from that environment, it’s a little bit jarring to hear someone ask about your personal life. But in general, I think the vast majority of our patients really appreciate that. And it’s important for them to know that you are a partner in their health. You know, there’s a lot of issues that we see in our health system in the United States, but one of the beauties of our health system is that patients are supposed to be partners in their care and their doctor is supposed to be an advocate for them. And that’s something that may be a little bit different from where people have come from and their personal upbringing. In terms of culture, I think that, you know, it’s just really important to kind of be sensitive, know that, you know, we, you know, that patients may not want to talk about their mental health issues in front of their family. If you are seeing someone who is, say, a young woman, and she comes to the office with her parents, and you want to be able to ask her about, say, reproductive health issues or about her mental health, you might just ask the patient to step outside for a moment and just ask her questions in a private way. And, you know, that might be seen as a little bit of a cultural taboo, but I think that it’s important to kind of find a way to navigate these types of issues and just do so with a lot of grace and dignity. And know that it’s okay to ask patients about some of these things. And then if they don’t want to talk about it, then you can just step back and say, okay, well, if you change your mind, I’m here for you and I would be happy to discuss some of these things with you. And I think that that shows a patient that you’re an advocate for them and that you’re an ally for them. And that you’re also respecting them and their privacy and their personal issues. But I think it’s important for us to kind of remember that as doctors, our duty is not just to our patients, but it’s to the health of the entire community and that we’re supposed to be asking people about things that we know are important to their health and well-being. And just being able to find a way to introduce it so that it’s not a taboo subject. I mean, it’s not normal in our culture. You know, we don’t just sit down with a family and say, oh, you know, how are you feeling? And you know, what’s going on? And, you know, are you having problems in school? And, you know, you can do that in a kind of a friendly way, but a lot of these things are considered private subjects, especially around things like fertility issues and mental health issues. But a doctor’s job is to just ask about them. And sometimes just asking about it gives a patient license to talk about something that they might have on their mind that they don’t know who to talk about. And you’re giving them an opportunity and an opening to be able to talk about it. And so I would say just, you know, lean into it. Don’t be afraid.

Nikitha: I think that’s such a great approach because I think it can be so difficult when you’re in a situation as a physician and you have a patient that may have family members that accompany them. And you’re in that situation where you’re not sure how to have that conversation where you might be asking about more private issues. But what you said about asking the patient to step outside for a moment, I think that is a wonderful approach because it shows that you’re being accommodating and you’re providing the best care possible that may be needed for that situation. So I appreciate you mentioning that.

47:37 Opportunities to get involved with Stanford CARE

Nikitha: Just kind of going into our next question, since you are also a professor, I think it’s important for a lot of our listeners who may be undergraduate students to hear about opportunities that they may have with you at Stanford Care. I know you mentioned the scholars program, but what are some other ways that students can get involved with you?

Dr. Srinivasan: Well, I think that, you know, we always are looking for research projects. If you have, if you are a young person who is listening to this, and you have ideas for research, we have a number of different faculty that are interested in projects ranging from the arts and humanities to health services research, to data science and to the hard sciences. So we have a lot of interest. The best thing to do is to just email one of us and ask us about opportunities to participate in our research. Now, that being said, we get a lot of emails. So I would say that it’s important for you to be pretty specific about what you’re interested in. You know, it’s not helpful to say, you know, I’m interested in working with you on anything. You should probably say, you know, I’m very interested in working on a project having to do with say, South Asian health or maybe with breast cancer or with diabetes, whatever your particular interest might be. And that would be helpful. The other thing is that we have a program called the Care Scholars Program. We’re going to be having our fifth class next summer. It is an intense summer program that you can get a research project, a mentor, get a lot of professional development, and also get some stipend support as well as a journal club. And a lot of other activities. So that’s another way that you can, you know, apply for that particular program.

Nikitha: Perfect. So I do appreciate you mentioning that because it’s always great to have more opportunities to get involved. So I appreciate you mentioning that.

Dr. Srinivasan: You know, for many of your listeners who are pre-med, I think that what you can do is start getting involved in research projects at your home institution. Now, I will say that a lot of people think that, you know, the most important thing is to do a research project with someone who has a big name at a big name school. And I would say that that’s not always the case. If you have a professor who’s an educator or a health services researcher at your home institution, and they’re really, you know, well funded and they have some project that’s kind of big, that can be a really great way to get involved in research and show some publications that you might have. You know, some of the projects are a little bit smaller at smaller institutions, but they can be a wonderful learning opportunity.

Nikitha: And just kind of getting the ball rolling with that. I think that’s a very valuable advice because like you said, you don’t always have to go to a prestigious institution to get that kind of experience. You can get that at your home institution, and sometimes the professors at your home institution are a little bit more accessible, and you’re able to connect with them better to build a stronger relationship and a stronger mentorship.

51:18 Advice for South Asian medical students

Nikitha: And you also, since you are a clinical professor and you also have a lot of experience with students, what would be your advice for South Asian medical students, especially those who may be interested in a career in academia, like yours?

Dr. Srinivasan: I think it’s always great to find a mentor. And a mentor doesn’t always have to be your professor. A mentor can be someone that you, you know, that you admire in terms of their career pathway or their personal life. I have been very fortunate in my career to be able to find a lot of mentors who’ve been so supportive to me and who’ve been, you know, really great to ask questions to. And I don’t really know that a career in academia is for everyone. In terms of a career in academia, I think that a lot of it is just luck. It’s about being in the right place at the right time. But I think you make your own luck, especially if you, you know, continue to do hard work. A lot of the academic medical centers that are out there, like Stanford, like you know, Northwestern and UC Davis and things like that, you know, are very supportive of students of all backgrounds and all ethnicities and all genders. And I think that if you are a student and you’re looking for, say, a particular medical school or a particular residency program, you should look for places that support diversity, equity and inclusion because they will also support you as a person and as a medical student. So if you’re looking at a residency program or a medical school, I would say look for those things. Look for people who have been, you know, in that institution, whether they’ve been there for a year, two years, or three years, and find out what their experience has been like, because you can be, you know, you can say, oh, you know, this institution is so supportive, and then you get there and you find out that, you know, there’s not a lot of, you know, people who are of your background, or there’s not a lot of support for people from different backgrounds. And so it’s always good to be able to find, you know, someone who can advise you in those spaces.

Nikitha: I would agree. So I think mentorship is crucial in a lot of different aspects of our career, so I appreciate you mentioning that. I’m going into medical school myself, and so I definitely appreciate that advice in terms of what I should look for in my mentors.

54:19 Finding supportive mentors

Dr. Srinivasan: Well, one of the things about mentorship that is always surprising is that you can have multiple mentors, right? So you might have a mentor who’s at your home institution, and then you might have a different type of mentor that you have at your academic center. That can be more of a personal mentor. And sometimes you may need a mentor that can provide more career-oriented advice that may not be available within your institution, that may be more of a personal mentor that may be a family friend that you can reach out to, or that’s maybe more of a personal friend that you have as a mentor. I think a lot of people think that, you know, they need to have one mentor who can serve as an advisor, as a friend, as a guide, and as a research mentor, and that’s not necessarily true.

Nikitha: Right. And you may have different people who may serve different purposes and may serve to guide you in different ways. And I think that’s why it’s so important to build a strong professional network so that you can have different people you can reach out to for different aspects of your life.

Dr. Srinivasan: And as I said, you know, you are a professional, but you’re a person first. And so it’s important to find people who can support you both professionally as well as personally. And so, you know, you might be a medical student or a pre-med student at your university and find, say, a professor who’s interested in your career goals, but then you may also have, say, a close friend or a family friend who’s already gone through that process that can kind of help you with some of the personal issues that come up with being a medical student.

Nikitha: That is a wonderful point. And I think that brings up the idea of a sponsor, which is someone who goes out of their way to advocate for you.

Dr. Srinivasan: Right. And sponsorship is something that is, you know, it’s very important. And in fact, I would say to you that, you know, for people, especially from minority communities that, you know, it’s really important for you to be able to find someone that can sponsor you and go out on a limb for you.

Nikitha: I appreciate you touching on that because I think that’s a very important aspect of networking and building professional relationships. In addition to that, what would be your advice on finding a supportive mentor? So how can students kind of approach that?

Dr. Srinivasan: So I think, you know, first of all, you know, start, as I’d said, at your home institution, and don’t be afraid to go up to a professor and just kind of express your interest. And as I’d said, you know, in this conversation already, you want to be specific about what your interest is, right? You don’t want to just go up to them and say, you know, oh, you know, I’m really interested in your career, which is also fine, but, you know, I would just kind of say that, you know, you should have, you know, something a little bit more specific in mind so that you have some sort of an opening that you can engage with the professor about. And as I said, you know, a lot of the faculty are very open to these discussions, right? And I think that, you know, a lot of people are also shy. And if you don’t know someone who’s a physician or a professor, it may be a little bit intimidating to go up to someone and ask about these things. But in general, I think that most people will take the time to answer a well-formulated question or a kind of a direct question, you know, to give a lot of good advice. So, you know, and I would also say that, you know, just as you’re in life, you want to try to be as supportive and nurturing to others as others have been to you.

58:28 Audience question: relying on professors in residency

Nikitha: Awesome. So we have one audience question. So this is more tailored to medical students who are in their fourth year, going into residency. So the question asks about how much you can rely on the professors in your residency. So Dr. Srinivasan, you have so much experience. What would be your opinion on this?

Dr. Srinivasan: Well, as I said, a lot of it is about finding a mentor, finding a professor in your residency that is going to, you know, have some interests that are similar to yours. So if you’re interested in research, if you’re interested in patient care, if you’re interested in education, you know, go up to a professor and just say that you’re interested and ask them what the opportunities are at their home institution for that. You know, I don’t really know that there’s a good way of being able to say that, you know, this program has this amount of support. You kind of have to do your own research by asking students who are in the programs already about what their experience has been like and how much the faculty are available to them.

Nikitha: I would agree. So I think it’s important to not just look at the program on paper, but also look at the faculty as well as the students who are currently in the program to get a better feel of the culture of the program. And I think it’s also important to not just rely on one person, but rely on different people as mentors. And finding a mentor outside of the institution can be a good resource that can be more tailored to what you want to discuss or talk about, whether it’s something that’s more applicable to the institution’s program versus something that’s more personal and career oriented. So I definitely agree about that.

01:01:09 Closing

Nikitha: All right. So thank you so much, Dr. Srinivasan. That was everything that we wanted to cover. And so thank you so much for taking the time to discuss so many critical topics. I think it’s so important for people of any background to learn more about South Asian health and how nuanced it can be when it comes to the different health trends we see, but I really appreciate how you touched upon the why behind some of them and like how our culture and our environment, both in the Indian subcontinent and South Asia in general, to being immigrants, how different things can kind of factor in to what we see on paper and how some things we’ve yet to discover and different trends that we’re still working towards. Why the research is so important. So thank you so much for taking the time today. I really appreciate it.

Dr. Srinivasan: Thank you, Nikitha. And thank you to APAMSA and to your audience for letting me share some of these ideas. It’s really been an honor to be with you.

Nikitha: To our listeners, we hope you enjoyed today’s episode and learn more about the beauty and nuance that is South Asian health in America. Don’t forget to tune into the rest of our series and until next time, take care. Thank you.

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This episode was produced by Eujung Park and Kevin Gaw, hosted by Eujung Park, and graphic by Callista Wu.

00:00 Introduction

01:09 About Dr. Monica Soni

02:54 Meet the patient

06:29 Navigating the patient interaction

08:26 Intersectionality of identity 

11:24 Medical school experience

13:56 Covered California

15:50 Working with the community

18:30 Barrier to accessing communities

20:10 Balancing physicianship with other responsibilities 

22:07 How can we integrate into the community

25:18 Scarcity mindset

26:58 Optimism

30:09 Beyond Covered

34:02 Expanding outside of California

36:15 Advice to younger POC women

37:57 What keeps you grounded?

38:59 Mentorship (Creating a healthy mentee-mentor role or relationship)

43:55 Closing remarks

46:35 How to connect

47:27 Closing

00:00 Introduction

Eujung Park: Welcome everyone to our APAMSA Podcast. From round table discussions of current health topics to recaps of our panels with distinguished leaders in the healthcare field to even meeting current student leaders within the organization. This is White Coats and Rice.

My name is Eujung Park, third-year medical student at University of Arizona College of Medicine – Phoenix, and the current Women in Medicine Director here at APAMSA and I will be your host today.

Hi, welcome to another episode of White Coats and Rice. My name is Eujung Park. I’m the Women in Medicine Director for the National Board of APAMSA. And today we have a very special guest, Dr. Monica Soni. I’ll now ask Dr. Soni to introduce herself and tell us a little bit about herself as well.

Dr. Monica Soni: Wonderful. Thank you so much for having me. I’m Monica Soni. I am a practicing internal medicine physician and also chief medical officer at Covered California, which is California’s state-based marketplace or California’s Obamacare, depending on what term you’re most familiar with. I’m really happy to be with you today.

01:09 About Dr. Monica Soni

Eujung Park: That’s amazing. Thank you so much. And so just kind of before we get into your work, we’d love to know more about you. Could you tell us kind of a little bit about your journey and what initially first sparked your interest in medicine and how did that path kind of lead you to where you are today?

Dr. Monica Soni: Of course. You know, I’ll have to confess that my dad was extremely encouraging of a path in medicine, as I’m sure many folks’ parents are. But I’ll say even as early as being in high school and volunteering in the emergency rooms, I started to get curious about some of the differences I was seeing for folks’ care experience. In particular, I remember I grew up in Los Angeles and so I was working in an emergency room in Los Angeles and, you know, there were folks trying to get by with broken Spanish to, you know, folks they were caring or not using interpreter services. And you can immediately just see the difference in outcomes, experience, and treatment planning when there are these barriers based on context, culture, background. And that piqued my interest.

And so when I went to undergrad, I studied cultural anthropology or medical anthropology, which again is sort of this broader lens of how’s the world we grow up in, the context we’re immersed in affect our perspectives and our life trajectories. So those were very informative experiences for me and I think have continued to build on some of those early exposures in terms of how my career has unfolded and what continues to drive me.

Eujung Park: That is really cool. I know a lot of people going into medicine don’t have that extensive background, especially knowing that cultural roots and anthropological roots of like what’s going on in society. So that’s really excellent and cool to hear.

02:54 Meet the patient

Eujung Park: Just talking a little bit more about your own personal journey, I know that you are both Black as well as Asian, which is a very powerful as well as underrepresented identity in medicine. How do you feel that intersection shaped your experience in the healthcare system, both as a provider and a leader?

Dr. Monica Soni: I think it’s been extremely influential in terms of, I’ll start with being a provider or a practitioner. I think I’m extremely sensitive to what it is like to navigate our health systems as an immigrant. I’m really sensitive to what it’s like to try to navigate if English is not your language, your dominant language. I think my mom is very into alternative non-Western health traditions. I was telling some folks a story of how actually the summer before I was going to medical school, I was trying to get all my paperwork in and my vaccine titers. And so I asked her, like, hey, where’s my documentation? She said, I’m not sure where it is. So I went to get titers to make sure that I had everything fully vaccinated. I found out she had not fully vaccinated me, actually. And so I was in my 20s getting my full series of polio and measles and mumps and rubella again. And that is not that she’s an anti-vaccine. It’s just I really hadn’t needed antibiotics until I was 30. I hadn’t been engaged in more traditional Western care. And so I think I bring a lot of that into primary care. I’m very kind of open to whatever care model folks are interested in.

And then I also think I’m hopefully empathetic to folks that are skeptical of a health system that maybe hasn’t treated them with respect or dignity or kindness. And then conversely, those that maybe are overly trusting of the system and where they might need to be advocating for themselves more or pushing a little bit harder, frankly, against sometimes their health care practitioners. So I hope that’s what I brought from my lived experience into the exam room or bedside. Even when you’ve got folks that might be angry in crisis, aggressive, I try to always bring that lens of, you know what, folks have a lot that’s going on. I’m here to be of service in any way that I can. And then I think as a leader, similarly, that curiosity has been a guiding principle in terms of not assuming I understand the answer to a particular challenge. I think a lot of folks have made assumptions about who I am and what my background is. And  really asking folks first and trusting that people know their own selves, bodies, and communities, and that that in and of itself is a valuable data source with as much validity as a peer-reviewed journal article. And so trying to really ground myself in that first-person experience and narrative, even as a leader.

Eujung Park: That’s so amazing to hear. I hear a lot of the things that you talked about are very much reflected in APAMSA’s own kind of initiatives, saying that we want to make sure we’re respecting a lot of people come from different cultural backgrounds, have different approaches to medicine, both like maybe more traditional versus more modern, all that different intersections of treatment. And I’m just curious, it sounds like you’re doing such an amazing job of meeting the patients where they want to be treated. How do you start that dialogue and I guess how does that play out in like a patient interaction for you?

06:29 Navigating the patient interaction

Dr. Monica Soni: Yeah, some of it is very, it’s almost so simple it sounds ridiculous. You know, I’m sure you and your listeners know this, but there’s been all these studies about how we, particularly physicians, don’t even let patients or family members speak uninterrupted for a few minutes before we jump kind of in front of them. We stand instead of sitting down to be at eye level. We are looking at the computer instead of at least first engaging. And so some of it is that very simple nonverbal. I always walk in and introduce myself to everybody in the room and ask what’s the relationship between everybody in the room so that they have the opportunity to tell me themselves. I make sure that anyone in the room that the person I’m treating wants those folks to be in the room. So a lot of permission. I always sit down. If there’s not a chair, I squat, frankly, because I think it’s better than standing even in the hospital. And I will say that I’m someone who believes in the physical touch. So I shake hands. I’m making eye contact, all of that. And so immediately within seconds, you’re creating an environment that is intimate. It’s personal. It’s clear that it’s safe. And then I have found so far in my career that that allows the dialogue to be much more bi-directional and feel trusting and open. And I chart and I type and I do all those things, too, because you got to get through your day. But I try to angle the screen and my chair so that they can see what I’m doing and there’s no secrets. And if they ask me a question, I let them look at their labs themselves so that the computer is a part of the experience versus something that’s pulling me away from the interaction.

Eujung Park: Yeah, that sounds like really helpful and practical advice, just how to orient yourself in the room. And I love what you talked about, like physically getting on the patient’s kind of eye level and making sure that we’re not as physicians. There’s kind of that complex that can come above that. We’re like going to be taking care of someone, but really it’s a two way conversation. So that’s really awesome to hear.

08:26 Intersectionality of identity

Eujung Park: So just kind of going back a little bit on your personal journey as well, we kind of touched about like how your background played into why you have such good two way conversations with all of your patients. Do you feel as though that at any point your identity posed additional barriers that other people may have not ever seen or experienced? And how did you navigate that?

Dr. Monica Soni: Certainly, you know, I think you alluded to this, but we all have intersectional identities, right? I identify as a woman. I’m of color. I have an ethnic last name. Earlier in my career, I was young appearing, less young appearing as the years have gone on. And I’m also, frankly, like pretty outgoing. And so I’m not always that like serious in an exam room or, you know, at the board table or whatever you might call it. And so there’s a lot of perceptions that people have based off of any of those identities, let alone all of them, you know, compounded. And then I think, you know, to your point about potential barrier that folks might not have seen, you know, I think socioeconomic barriers are really substantial. The journey from, you know, high school to college to medical school to residency and potentially beyond in training is an expensive one. And even if you come originally from means, that has strain on life. And so I do think that plays out in some complicated ways that don’t always get acknowledged or sort of honored as the socioeconomic barriers along the way. So yeah, so I think all of those things together and you never know which of your identities folks have a positive reaction to or potentially a less positive reaction to. And so frankly, that has, I don’t do the brain calculations anymore of those things. I try to be myself in whatever space that I have access to. I do think about who the audience is, of course, because we’re all multifaceted and you don’t talk to your siblings the same way you talk to your grandma, but that’s still you. Both of those identities are still you. It’s still showing up as yourself. And so of course, there are different components of myself that might show up in different environments.

Eujung Park: Yeah, that is very powerful. I think, again, we all are facing different points of intersectionality. And so I really like that last point where you mentioned just because we approach different conversations a little differently doesn’t mean they’re any less genuine. And so being able to navigate how people want to recognize you and where you are is really important there. Thank you.

11:24 Medical School Experience 

Eujung Park: And so is there anything else about your journey that you’d like to share? 

Dr. Monica Soni: You know, I felt once I got to medical school, I thought medical school was so hard. I mean, the first two years maybe in particular, I mean, the clinical years are hard in a whole different way. But when I finally got to the clinical years, I was like, OK, at least this is what I thought I was going to be doing and what I, you know, at least you get to be with patients and be by the bedside. I don’t think I could have done anything in medicine. I really think I was made for primary care. I’ve, of course, worked in the hospital as a hospitalist and non-teaching service for most of my career as well. But my identity is really as a primary care doc.

And it was hard in medical school. At the time, I was a Harvard med undergrad, excuse me, Harvard med student. There was not a focus on primary care. It’s different now. But at the time, I was told and I quote, “Oh, you’re too smart to go do primary care. Like you should really do a specialty,” very undermining to that experience. There was not even a family medicine rotation that we all were required to go through. So really, there wasn’t an institutional commitment to primary care. And so I found a, you know, a mentor who worked at a community clinic. I had to take two trains and a bus to get there to be able to spend time there. But so formative. And it showed me like, yes, there is a space for me in medicine that I think I can have a career in.

And when I went to UC San Francisco, San Francisco General Hospital for my primary care residency in internal medicine, I was like, ah, I found my people. Like they think holistically, that’s kind of an anthropological undercurrent of the way that environment and politics and all the things shape us. Like that was very present and acknowledged and researched in an academic way too. And so I just, I started to, over time, find that what I wanted to do for my career, that there was a space for it.

Eujung Park: Wow, that is really interesting. I had no clue that it’s been such more of a recent development in the primary care field. Just like I know many med schools nowadays are trying to make sure that people get appropriate exposure because it is so fundamental. It’s normally people’s first exposure or interaction with the healthcare system. So that’s amazing that you were able to kind of find your own path and your own mentorship into this career.

13:56 Covered California 

Eujung Park: And so kind of jumping off that point a little bit, I’d love to talk about Covered California, if you wouldn’t mind telling us a little bit about it, how did you get into it? Kind of just the basics.

Dr. Monica Soni: Yes, Covered California is an amazing institution. I’m very grateful to be where I am today. So as I shared in my opening, Covered California is California’s state-based marketplace. It’s the only place where folks can go to get financial assistance to purchase their own health coverage. And that really came out of the Affordable Care Act. So there, of course, was Medicaid expansion and then the creation of the marketplaces. California, maybe unsurprisingly, was eager as soon as, before even the law was passed to be able to offer this to Californians. And again, it’s folks that are, because of where they, their employer doesn’t offer them coverage or maybe they’re not low income enough to qualify for Medicaid, we are there to be intermediary, bridge coverage, whatever folks might need.

And we had an amazing year. I always like to celebrate the things that we can celebrate. You know, for 2025, yes, we hit record levels of enrollment. We hit nearly 2 million folks on Covered California’s exchange with expansions in every community that you can think of. So a lot to celebrate there. And I will say we’re a very interesting marketplace. So we are what we call active purchasers. So we negotiate with our health plans on price. We make sure that our health plans are delivering access, quality, equity. We can really hold their feet to the fire to make sure that they’re achieving those outcomes. And I really just love how diverse and interesting my role is and what my day-to-day is. It’s extremely different depending on which day you catch me on. So yeah, that’s sort of my role. And I do think about everything from affordability to access to equitable outcomes.

15:50 Working with the community 

Eujung Park: Well, first of all, congratulations on such a successful past year. That is so amazing to hear just the reach that this program has and how many people that you’ve been able to help with your program. I guess for you, because you’ve been able to reach so many different communities like you’ve mentioned, what partnerships or innovations do you feel like have been the most effective in addressing the different social determinants of health and how have you been able to expand your reach so far?

Dr. Monica Soni: Yes, I would say equity has been in our DNA from the beginning. So our mission statement from over a decade ago included to reduce disparities. And that shows up in every department. So from our communications team to marketing to how we standardize benefits for folks, appreciating that health literacy can be very challenging in what is a very complicated healthcare sector. It’s really in everything that we do. And I would say the community partnerships are really an integral part of that. We have had such phenomenal community consumer advocate groups who from jump, from the beginning, we’re like, look, this is how it needs to show up. We want to look at your materials. What’s the script going to say? And that is not just co-creation. It’s true power sharing. We take the lead of the folks that are representing the communities that we want to serve. And just some specific examples:

• I’ve gone to Black communities on Sundays and the churches.
• I’ve gone to the health fairs.
• We do all sorts of cultural celebrations.
• Most recently, the Asian Pacific Community Fund and also Asian Inc. were partners in thinking about how do we package information in an accessible way to, again, continue to disseminate to the folks that we want to serve.

So this is like, it’s probably the most important thing that we do is really that listening, power sharing, co-creation, and the cyclical nature of it. You’re never one and done. You’re always bringing it back to folks to get input and to iterate.

Eujung Park: Wow, that’s really great. I mean, honestly, just again, I feel like it’s this dialogue of making sure you’re empowering the people that you’re working with. And so also you guys seem like just from the root upwards, like you are diverse in like who you guys are, and then you’re able to capitalize on that and expand to all your individual communities and have like true connections with each of them. So that is just honestly so wonderful to hear.

18:30 Barrier to accessing communities 

Eujung Park: And kind of playing on that role a little bit, do you feel like there have been any barriers, I guess, in connecting with certain communities or I guess like any systemic barriers with reaching out to communities?

Dr. Monica Soni: Of course. I think we’re a government agency still. And so there is, you know, uncertainties, skepticism that of course I think is getting worse under the current circumstances. There’s a lot of questions about what our intentions are and if our intentions are good or otherwise. So I think we know that we continue to have gaps in coverage. We know that there are communities mostly of color who could qualify for help and services who choose not to avail themselves of them. Some of that is because healthcare is still expensive and we continue to try to tackle that. But I do think some of it is also that truly we have not connected with folks in the ways that we need to be connecting with them. And so we continue to be boots on the ground and try to again, listen and see if there’s anything that we can do that might help convince folks that we actually are some organization that’s here to open doors and achieve health and wellness. And like you said, we learn, we pivot, we grow. And if we didn’t get it right the first time, we come back again and try again.

Eujung Park: Yeah I mean, I love that as well. You know, you’re just always making sure you’re listening to the people and their obstacles, and I can’t imagine all the difficulties under the current circumstances that you guys might be facing, but we’re rooting for you on this side as well. 

Dr. Monica Soni: Thank you.

20:10 Balancing physicianship with other responsibilities

Eujung Park: Sorry, not going to pivot too much into that, but I guess also just in your own life, I know that you’re still a practicing physician and you’re still doing a lot of work. How are you able to balance your physicianship as well as your high-impact administrative roles, and do you feel like these roles conflict or complement each other, or I guess where does that balance kind of lie for you?

Dr. Monica Soni: For me personally, it is extremely complementary. I love patient care. It is what I thought I would be doing for my entire career, and even though I’ve moved into these other roles and opportunities, I feel completely dysregulated if I’m not seeing patients. It grounds me. It makes me better and smarter. It puts things into scale and perspective. Pretty much my whole career, I was about, you know, probably 40% direct patient care and then other responsibilities. This is the least I’ve ever done. I’m just in clinic on Fridays, and that feels too little to me, frankly, just because it’s so critical, I think, certainly from a skills perspective, but even from a listening growth perspective to be there and see the implications of policy or see what folks are really worried about as you are solutioning in a different space. You can’t always fuse the voices together, although you wish that you could. So I find it extremely complementary. I love it. I think it’s – I encourage it for all people, right? I think if you’re not interested in being a full-time practitioner, I would still say to have a lion’s share of your week or a meaningful portion of your week still be in deliberative care is – it’s the way. I think it makes both the administrative and the direct patient care side. You’re better at both of them for being informed about the whole ecosystem.

22:07 How can we integrate into the community

Eujung Park: Yeah, and that makes total sense. Do you have – I know many of our listeners are kind of in that pre-physician era, you know, med students, pre-med students. And I guess as we go through our journey, we’re just trying to make sure how our careers are going to develop. Do you have any advice for people who not necessarily are in administrative roles but how to get involved in helping the community? Do you have any advice on that point?

Dr. Monica Soni: Yes. Well, I feel like all of you all are – you all are our future. I have a lot of hope. I have a lot of hope that you all are going to help us course correct. And I would say a big portion of that is following your passions, right? If your passion is in communication, if your passion is in research, if your passion is in advocacy, all of those things can live in a healthcare framework. I think they’re all complementary. Healthcare is a gigantic beast of an industry, and so all of those skill sets are super important. You are busy, and self-care is incredibly important. So I think thinking about what’s something I can take on that has a clearly defined scope, that I know that I have time in my week or my month to be able to dedicate maximally to it, and just take that on. And then lean into the opportunities that present themselves there.

I remember when I was in med school, we were doing case-based learning, and I feel like my med school is really going to drag me after I do this podcast. They’re going to be like, stop talking about us. But nonetheless, it was case-based learning, and you’d read a case, and it’d be pretty reductive or a little bit overly indexing on some stereotypes, right? It was always a diarrheal illness for a developing country, and it was always the veteran that had alcohol disorder, and it was that kind of stuff, or it was violent. And so me and a couple other classmates were like, gosh, it would be great to just modernize this a little bit and add some more nuance. And so we channeled our energy, and we went to the faculty and we said, could we help you? Could we create a group of students to help rewrite some of the cases? Not less the clinical pieces, although, of course, that was really interesting to go to learn and read about why was it structured this way? What’s the prevalence? What’s the incidence of some of these diagnoses? But especially through the cultural lens, and I’m grateful that we had faculty that said yes to that, and so we rewrote the cases so that we felt like they were much more sensitive and, like I said, modernized. So that was like an early example of it was self-contained. It wasn’t a huge thing. We weren’t foiling the ocean, but it helped us feel empowered from a very early stage in our journey, we’re change agents, which is what I know a lot of folks want to be.

Eujung Park: That’s really inspiring. And don’t worry, I feel like med schools always get a little bit of shade from their alumni because it’s always a very tough time. But that’s a really inspiring story, though, just like even at any stage of your training, you’re able to kind of just connect with your community and really try to bring about any change about what you’re passionate about.

25:18 Scarcity Mindset

Eujung Park: I know for our listeners of this podcast is a lot to do with our identity and making sure that we’re not misrepresented or trying to combat stereotypes, which is very important. And so kind of with your work with the administrative sides and just all of your work that you’ve done in your career, what are some misconceptions that people have about health care reform or equity work that you’ve noticed?

Dr. Monica Soni: Fantastic question. You know, I think I would say the scarcity mindset, right, that we believe that you have to take something away from one group or one part of the pie to give it to somebody else. There are always tough decisions to be made. I’m not arguing that we have limitless resources. I already said health care is extremely affordable. It’s impacting folks’ lives and a lot of times in negative ways when there’s financial pressures. But I do think an acknowledgement that we already have a system of haves and have-nots and that is how the American health care system is structured. And I would argue that health care reform and frankly even equity is about instead of sort of letting the chips fall where they’re falling or having them fall on racial or ethnic lines or socioeconomic lines, could we not have a rational, you know, values-driven, holistic care framework that’s really about the right care at the right time and the right place? And that is really what we’re all striving for. If we could think on that, then I actually think there’ll be less of this idea of infighting or that we’re taking something away from somebody.

26:58 Optimism

Eujung Park: And in your current work, do you see any shifts towards that more value-based health care system or is that something we’ll be looking forward to more in the future?

Dr. Monica Soni: What a good question. Well, I think from a financial perspective, sort of, you know, I think there’s an idea that from a true financing, potentially moving away from fee-for-service to more sophisticated models. But I think from a values, you know, driven, no, I don’t think so. I don’t think that we’re actually thinking about what does the American population care about and making sure that we are delivering on that. That does not feel like the direction we’re currently heading.

Eujung Park: And in your own Covered California, do you think that you’re able to initiate that at all or is it kind of one of those obstacles that are just going to constantly be overcoming for a little bit?

Dr. Monica Soni: Oh, I feel empowered. I’m an optimist. I’m an optimist and I’m a hopeful person. And, you know, I’ll name one of the biggest challenges, of course, that we’re newly facing is the, you know, the reconciliation bill, which just was signed, you know, over the last couple days. And we know for us, the numbers are very stark. We, you know, I’ll just give you some specifics. There’s probably 112,000 Californians who, you know, are lawfully present immigrants that would have their tax credits and their cost sharing stripped away. 112,000, like almost immediately. It’s a lot of folks. We’ve already needed to start the retraction of services and support for deferred action for childhood arrivals or DACA recipients. We were just given authority to do that last year, and now it was taken away. You know, these are critical policy pieces that have allowed us to, again, focus on access, focus on quality. Think about affordability, right? We don’t always connect those two things, but frankly, to have a large, stable risk pool of folks that you are insuring drives costs down. It does. And when you do anything that destabilizes, that introduces uncertainty, costs go up. And I think we’re already seeing that that’s starting to happen. So I think it’s a mix, right? We are always going to do everything that we can do at Covered California to maintain the progress that we have made, to remain true to our mission and our vision, which is to improve the health of all Californians. That is our vision. But there are some serious headwinds that I think we are vocal about. We’re researching, we’re writing about, we’re advocating in the ways that we can so that folks know, right, what are the implications of policy decisions that are being made.

Eujung Park: And I think, again, like you guys are doing fantastic work. I guess just a little bit more of an optimistic note, and you guys are really sticking to your initiatives.

30:09 Beyond Covered

Eujung Park: And do you guys have any, I guess, plans or next steps that we should be looking forward to in the coming years or anything? 

Dr. Monica Soni: I’ll share a little bit about what I would consider an innovative and exciting program that’s both been implemented and we’re continuing to grow. We’re calling it Beyond Covered by Covered California. And like I said, we’re an active purchaser. So we can really hold our plans to very high standards for quality and hold them accountable for achieving them. So we’re in our second year of a program called the Quality Transformation Initiative. It’s big money on the line for our health plans if they don’t hit nearly just a few quality measures:

1. Diabetes control.
2. Blood pressure control.
3. Colorectal cancer screening.
4. Childhood immunization.

And we had some plans that were unsuccessful. And so we had about $15 million to decide how do we actually improve the health and wellness of our population. It was very exciting to be able to spend $15 million. And we took it to our enrollees. We asked them. We cold-called them. We sent surveys out to thousands of folks who responded and said, what would make a difference in your life? And we heard about the real financial pressures that folks are experiencing, that almost half of folks that we support said they didn’t feel like they had enough money to make ends meet. And they were worried about the next 12 months. That’s pretty staggering.

Folks told us that they were making tradeoffs between picking up a medication and food, between child care and transportation. These are impossible decisions for households to make. So when we heard that that was kind of front of mind for folks and they were unable to manage their chronic conditions because of that, we decided to take some of that $15 million and put it back in the pockets of our enrollees. So we have given folks reloadable cards to buy groceries and food for folks that have chronic conditions and are food insecure. We are funding for all of our babies, two and under, child savings accounts. Again, really talking about that there really is no health if you can’t think about wealth acquisition too, particularly for low income folks. So really out of the box ways to get dollars back into the pockets of our enrollees. So that’s been enormously successful. Our folks who have been receiving those grocery support cards have already spent over a million dollars on groceries, which is awesome. And we’re, you know, it’s 10,000 plus people who are getting some new support for some of these programs. So we’re continuing to grow that, study that, learn from it, thinking about how you disseminate that and scale. So yeah, that’s a bit of a silver lining, I think, amongst other challenges that we’re facing.

Eujung Park: Yeah, I mean, that sounds like an incredible initiative and it sounds like it’s been super successful with being able to reach out and actually help individuals, not as patients, but as a person, which is very, very impressive. And I guess, just in your terms, I know it’s kind of a newer program, have you seen any differences that Beyond Covered has been able to have on how people are adherent to, I guess, their health care or is, or I guess, like, are they more open to getting health care? Have you guys seen a change in mindset at all with the program?

Dr. Monica Soni: We will learn more. We were really, you know, I guess, scientists at our core. So we embedded within the program some randomizations. We have sort of a comparison arm, not a placebo, but a comparison arm. And we have baseline surveys, midpoint surveys, and final surveys, as well as we’ve got claims to do quantitative analysis too. So I think in a few more months, we’ll have some early indications of How do behaviors change? Did it reduce stress and allow more space for health-seeking behaviors? So much, much more to come. We only launched actually in the beginning of this year. So just early signs that things are going well, but we’re hoping for a more rigorous evaluation in a few more months.

34:02 Expanding outside of California

Eujung Park: Yeah. I mean, super early program and we’re really excited to hear about the results as well. So hopefully that all goes well. And I guess because you’ve been able to set up this really successful program and all these initiatives within California, what recommendations would you have for someone trying to set up a similar program in other states or other regions?

Dr. Monica Soni: Great question. You know, Covered California, we know we’re not the biggest fish in the pond. And so a lot of what we try to do is just that: innovate, study, write it up, disseminate it, help others scale. So there’s a few pieces that I think are worth exploring and that others could carry forward:

1. This idea of using your role as a purchaser to have more accountability for health plans. I think if health plans are an important part of our healthcare ecosystem, they are not just doing payment of claims. In a lot of states, a lot of places, they’re capitated. They get a large amount of money to be able to help manage a population. Well, are we getting the outcomes that we want? So that’s one piece is really high accountability for health plans for a broader set of responsibilities.
2. The other part that I think should and could be scaled is, you know, healthcare is also hyperlocal. So like listening to your own folks, listening to what folks are telling you they need, and then thinking about how do you deliver on those needs creatively.

I have to say, I kept our legal team extremely busy with all of the exploration that we did because it was the first time. We had never done anything like this. No other purchasers we know, certainly not at Marketplace, had ever done anything like this. You know, that takes a little bit of boldness, but also just, you know, a willingness to be creative and think a little bit outside of the box. So that maybe that’s the third piece is maybe not taking, it’s less not taking no for an answer, but finding a creative path to yes.

Eujung Park: Yes, I love that. So the accountability, making sure you’re integrating with your local community and just creativity. That’s like some great takeaways, I think, in any career, but particularly in this very dynamic region of like healthcare as well. Okay, thank you.

36:15 Advice to younger women POC

Eujung Park: And so I guess this is just kind of bouncing back for more advice, just because you’re such a well-rounded person. You’ve done so much. What advice would you give to young women of color entering the medical field today?

Dr. Monica Soni: I hope folks are not discouraged. I love my career. I love being a physician. It is extremely rewarding. It is extremely flexible. I’ve done a lot of different things at different stages of my life, and my advice would be go for it. Really, like you are the change agent. You are the future. You don’t need to feel imposter syndrome. Nobody is smarter or better than you. It’s you. It’s you. And I think when you can internalize that, you open up a lot of mental capacity and emotional capacity to do the interesting, hard, innovative thing versus holding a lot of space and energy for second guessing. Nobody needs that. Leave that alone and just lean all the way in. That would be my advice. People sometimes laugh, and I’m like, I just feel so confident. It’s like, yeah, why not? Why not? I guess is sort of what I would say to folks. It’s only you.

Eujung Park: Yes, that’s true. I totally agree. Confidence is definitely a mindset, and it’s encouraging to hear that it doesn’t necessarily have to stem from accomplishments or anything, but it just can start with just a change in your own belief in yourself. So that’s really, really encouraging to hear from someone like yourself.

37:57 What keeps you grounded?

Eujung Park: And then what is something that keeps you grounded or motivated even when the work feels overwhelming?

Dr. Monica Soni: Well, patient care is one component, but I think I would be remiss if I didn’t just talk about my family and my friends who, you know, sometimes there are days that are just hard clinically and non-clinically. And to know that you always have someone to pick up the phones, send a text to. My kids are hilarious. They really make me laugh. My daughter leaves little love notes all over my office, which is like, really, like, will get you through a tough day. And so whatever your community and people look like, chosen or not, you know, not chosen, that I think is what continues to get me going and keep me, get me out of the bed every day and putting my boots on and strapping my boots on and going on to the next challenge.

Eujung Park: Yeah, that’s very encouraging. I know we all need our own support systems as well as this very rigorous type of career in healthcare.

38:59 Mentorship (Creating a healthy mentee-mentor role or relationship)

Eujung Park: And then one of the last things I just kind of want to touch on, I know you mentioned this way back earlier in the interview, and I wanted to circle back, was that you were able to find a really good mentor for yourself during med school. Could you talk a little bit about why you believe that was a successful mentorship and any advice in creating a healthy mentee-mentor role or relationship. 

Dr. Monica Soni: I have had some phenomenal mentors and still do throughout my career. My first recommendation would be there’s no single mentor who will fit all of your needs or asks. So at any point in time, and this has been studied, the more mentors you have, actually the more successful folks tend to be from an upward mobility perspective because everyone has a different perspective and you might need Mentor A for this particular issue, but Mentor C for some other challenge. Just like nobody in your personal life can meet all of your needs, nobody in your professional life can meet all of your needs either. So that is what I would say is, collect a lot of mentors and just know you’re using them for a very specific ask or curiosity that you may have.

The second part would be I would be formal about it. I would say I am very impressed by X, Y, or Z. Here’s the skills or the way you’re showing up that is inspiring to me. Would you be willing to be my mentor? Most folks are very flattered by it. They like to be asked, especially if you’re pairing it with a here’s what I’ve witnessed in you and why I’m curious about learning more from you. Then people are like, you know what, this is a good investment of my time. This person has already identified something tactical that they’re looking to accomplish. So first is proliferation/diversity of mentors and two is the like being very formal about it.

And then the last one is just what I said is you don’t age out of having mentors. You know, you can be a mentor and still be a mentee. And I have just had some out of this world folks in my life who I can talk to about anything from family dynamics to complicated interpersonal work situations to policy questions. And again, that like picking up the phone, the ability to pick up the phone has made me a better leader as well as, you know, doctor, frankly.

Eujung Park: That’s amazing. That’s really very practical advice, especially for a lot of med students and pre-med students who are trying to figure out how can they get like practical advice from someone who might offer them some life experience, careers, and everything. I know that that’s really helpful. And I guess kind of branching off that point when you say you’re looking for a diverse round of mentors, where do you tend to look for mentors? And I guess how did you initially reach out?

Dr. Monica Soni: Hmm, see. I will say some are just people I admired, you know, and it’s hard because at first in medical school, you sort of see the same people and so everyone wants the same people. But as you get into the clinical world, sometimes it’s a resident, you know, or it’s a nurse leader or it’s that physical therapist who’s just really lovely by the bedside. And so I would say keep your kind of keep your eyes out for somebody that you just you have almost an emotional reaction to like, wow, like that’s pretty impressive. I like what I saw there. How do I get more of that? And then follow through, right? So don’t be discouraged. People are busy too. So like maybe the one inbound you didn’t quite get the, you know, they weren’t jumping for joy, but I would follow up again and say, you know, again, if you have bandwidth, if you have, I would do an email, you know, probably is the medium that I would prefer because then you can organize your thoughts and communicate in a way that you really want to communicate. You know, here are the reasons why I was really interested in connecting with you. I’m very impressed by X, Y, or Z. Flattery gets you everywhere. And then, you know, would you be willing to sort of be a mentor for me? So yeah, I think that that was it. It was just I saw something in someone. It inspired me. I had an emotional reaction to how they were showing up and that was it. And that’s kind of how I’ve collected my mentors.

Eujung Park: Yeah, that’s awesome. Really great advice. I know one thing as like the women in medicine director were to try to make sure that we’re able to connect people who want to be mentored with maybe people who are willing to mentor. And so just kind of knowing where to look and just having, again, what we kind of talked about, the confidence to reach out and just ask and obviously in a very respectful and flattering way to people branching out is really important. 

43:55 Closing remarks

Eujung Park: And so I know we’re kind of closing on to the end bit of here. Is there anything, I guess, that weI haven’t touched on that you would like to talk about?

Dr. Monica Soni: We’ve covered a very broad range of topics, right, from navigating the academic pathway to the importance of mentorship to policy to what you do in the face of adversity to how important and empowering our intersectional identities can be. So we covered quite a lot. I would say maybe my last piece I would communicate is, you know, I am hopeful. I am optimistic and I have a lot of joy in my life. And that doesn’t diminish the challenges that are out there or how hard the path is or how hard the work is. And so I hope that all of the listeners and you all are also finding the joy. You know, what’s the point? If there isn’t going to be joy and laughter and fun, I’m not sure that there really is a point. And some of the toxicity, I believe, I think the studies will show in years that it erodes you inside. It actually makes you sicker. And so I would encourage folks to be joy-seeking as seriously as you are studying and as seriously as you are trying to be clinically excellent. Also be joy-seeking. And if you want your career to feel that way, and it may not, the first thing you land in may not be the right thing, that’s okay. The beauty of a career in healthcare, you can pivot, you can change, you can go do something else, you can titrate hours up or down in your schedule. We’re so lucky that way. So, you know, find the path that is going to bring you both peace and joy.

Eujung Park: Yeah, that’s a completely inspirational last message is just that joy-seeking mindset. Again, right now, like everyone knows in healthcare, it’s very difficult to navigate both personally and career-wise. So just to hear that, you know, there’s never going to be a dead end, but we can always kind of figure out what we want to do with our careers. Really encouraging. So I just want to thank you on behalf of myself and everyone at APAMSA for coming and speaking with us today. It was so great to hear all of your wisdom and all of your experience in your life. And we are so, so grateful that you’re able to join us today.

Dr. Monica Soni: Thank you for having me. I’m grateful to you all. Your careers are going to be rich and full and wonderful. And we’re counting on you. Thank you.

46:35 How to connect

Eujung Park: And then just for our listeners, I know we have a lot of people in California who are interested. Is there any good way that if people who are listening are interested in reaching out and connecting or helping out? Any contacts that you would recommend or anything?

Dr. Monica Soni: Yes, of course. So many folks have poured into me. I’m always happy to be a resource. So LinkedIn is a great place to find me, S. Monica Soni. You can look me up. I think I’ve come up immediately under that. Feel free to connect with me on LinkedIn. And then if you’ve got some specific questions, I’m happy to try to connect you to some specific resources and not just specifics to Californians. If there are other folks that could be of use, just feel free to reach out.

Eujung Park: All right. Thank you so, so much again. And then I think that concludes the session. Thank you everyone for listening in and have a wonderful rest of your day.

47:27 Closing

Eujung Park: And of course to our listeners, we hope you enjoyed today’s episode as much as we did. Don’t forget to tune in next time and until then, take care and keep striving. Catch y’all soon and thank you.