Network Director

Listen here:

YouTube
Spotify
Apple Podcasts 

This episode was produced by Annie Nguyen and Ashley Tam, hosted by Amber Chan, and graphic by Callista Wu and Claire Sun.

Time Stamps: 

0:00 Introduction to White Coats & Rice: An APAMSA Podcast 

0:58 Introduction to Dr. Marcus Iwane 

1:48 Professional Background and Native Hawaiian Health

4:17 The Role of Cultural Identity in Career Choice 

10:50 Health Disparities in the Native Hawaiian & Pacific Islander Community 

18:01 Addressing Generational Trauma and Healthcare Mistrust 

23:21 Building Trust & Cultural Humility in Medicine 

29:58 Community-Based Healthcare Initiatives in Hawaii 

32:29 Climate Change

35:20 Healthcare Sustainability 

35:20 Work-Life Balance & Personal Life 

46:53 Closing Remarks 

48:00 AMA Outro 

Full Transcript:

0:00 Introduction to White Coats & Rice: An APAMSA Podcast 

Annie: Welcome everyone to the 8th episode of the Asian Pacific American Medical Student Association Podcast. From roundtable 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 Annie Nguyen, a postbac at Stanford University, and a member of the Leadership Committee at APAMSA. I’ll be your host for today! 

This is our Ask Me Anything Series! Each month, we spotlight an extraordinary physician who shares their insights on medicine, life, and everything in between. This is your chance to ask questions, hear their stories, and learn from their incredible experiences. Whether you’re curious about their journey, their day-to-day, or their views on the future of medicine, nothing is off the table. Let’s dive in! 

Today’s episode was moderated by Amber Chan, a medical student at the Hackensack Meridian School of Medicine and member of the 2024 Leadership Committee. 

0:58 Introduction to Dr. Marcus Iwane 

Amber: All right. Um, so just to give a brief intro before I hand it over. Um, this is Doctor Marcus Iwane. Um, he’s born and raised on Oahu, and he’s a board certified internal medicine physician. He earned his medical degree and completed residency at the University of Hawaii. And he’s currently the

chief of Kaiser Permanente West Oahu Medical Office, where he promotes Native Hawaiian health and healing. Um, so he also currently serves as clinical faculty and has been listed on 40 under 40’s Exceptional Leaders as well as best Doctors in America. Recently in 2023, he also completed the Climate and Health Equity Fellowship. So definitely be excited to hear about that. So, I’ll hand it over. Doctor Iwane, if you want to introduce yourself and tell us just a little bit to start off. 

1:48 Professional Background and Native Hawaiian Health

Dr. Marcus Iwane: Yeah. Hi. Good evening everybody. Uh, thank you for inviting me. You know, so I’d like to keep this very casual. So if anybody has any questions, you know, please feel free to ask me anything. So I’ll tell you first a little bit about myself. Born and raised in Hawaii on the island of Oahu, I did all my training here in Hawaii. Uh, that includes medical school, my residency training. I’m a internist by trade. And, yeah, after residency, I’ve been practicing with Hawaii Permanente Medical Group. Um, initially started off with a clinic in Nanakuli, which is a small little community on the west side of Oahu. We can maybe talk a little bit about that if you folks have questions about community health and what that means. And now we’re practicing in Kapolei, which is a little bigger clinic that I can share you a little bit about as well. But my passion is obviously Native Hawaiian health. So I don’t know if any of you on the call have roots here in Hawaii, or are part Native Hawaiian yourself, or have family who are Hawaiian or come from any indigenous background. But that is something that drives me to continue to do what I do, um, to serve our community and help to uplift our, our people so we can talk about Native Hawaiian health or indigenous health as well. That is another topic that if anybody has questions regarding, I can definitely share some viewpoints on. I currently serve as president for ‘Ahahui o nā Kauka, which is an association of Native Hawaiian physicians. I’ll drop in the chat our website. Um, you guys can go to kauka.org and we are a nonprofit, if you also want to learn a little bit more about ‘Ahahui o nā Kauka and what we do. Uh, go ahead and check it out. There’s a little video on the– on the website homepage as well. That kind of highlights a little bit about, you know, how we were formed, why we were formed. We established in 1998. And yeah, it’s a really it’s a really cool and very important organization to be a part of, to really focus on improving the health status of Native Hawaiians. And so yeah, we can definitely talk more about that as well. Um, but that’s a little bit intro to myself. 

4:17 The Role of Cultural Identity in Career Choice 

Amber: Definitely. From what you’ve introduced, you’ve spent most basically all of your medical training based in Hawaii still. Is there anything, I guess, growing up that kind of motivated you or inspired you to really be connected to your roots and really wanting to focus on giving back to the community instead of, you know, coming to like, the continental states or going elsewhere. 

Dr. Iwane: Yeah, that’s a great question. So I’ll share a little bit about my upbringing. Uh. First as a child. So I grew up in Oahu. I’m not sure if any of you have been here before, but, uh, Nanakuli is a– is a little town on the west side of Oahu, and my grandparents used to live there. So growing up as a child, I’m spending a lot of my weekends there. Their home was right across the beach, so that was also another good reason to go every single weekend. But my grandfather was a farmer and he has a child. He would always get me involved with getting my hands dirty in the garden with him, taking care of the– taking care of the grounds and the garden areas. And what really intrigued me growing up was hearing him speak Hawaiian language to his plants. And I was always kind of– always kind of thinking, what is he doing? You know, what is it? Why is my grandpa talking in Hawaiian language to plants? And so, you know, it was something that I really didn’t appreciate until I obviously got a little bit older. I started to learn a little bit more about my culture, including Hawaiian language and everything that comes with that. Yeah. And so, you know, I realized that at an early age, my grandfather was really teaching me the importance of connecting to land. Yeah, connecting to– connecting to the things that sustain us. Yeah. So our people, you know, being, you know, folks who have inhabited Hawaii for centuries. Yeah. You know, coming from a place that– an island that really didn’t have a lot of endless amount of resources, right? So everything was about resource management, protecting our precious water sources. You know, our– our land that sustains us, the fish that, you know, feed us from the ocean. And it was all about sustainability and really focusing on the understanding that, you know, once our precious resources are gone, there is no next state to drive through, right? There’s no next– next area to get more resources. Right. You know, so it was, it’s a very fine balance, right? That our people had a connection to land is so important. And you know that concept we refer to as something called “aloha ʻāina”. So aloha ʻāina. ‘Āina is a word that we refer to as land. And aloha obviously is love, you know, caring for. And so having this concept of aloha ʻāina ingrained in me from an early on, childhood, you know, really kind of helped me to understand the importance of making sure that you stay rooted. Yeah, you stay connected to your community. You stay connected to the land that sustains you. And that in addition to. Connecting to the importance of language. “Ōlelo Hawaiʻi” is what we refer to as Hawaiian language. And, you know, as I started to go through grade school and then eventually in college, I, you know, I took my language courses and, you know, that’s– that’s very important because in language, you that’s where you connect to cultural identity and, you know, through, through all of these things. Right? You know, you really focusing on what we refer to as cultural health. And so that, you know, really helped to lay a foundation for me as a, as a kanaka, as a, as a Hawaiian, as a Hawaiian person, as a Hawaiian, as a Hawaiian male, and, you know, carrying that through, you know, my training, um, really inspired me to figure out how to bring this into my medical practice. And so, you know, I decided to stay home for training throughout my, my college career, throughout medical school, even residency, specifically because of, you know, this connection that I have to to my in my land and being able to understand and care for our people, you know, we, we, we see this as more of what we call kuleana or responsibility that, that we have as, as, as native Hawaiians to really to really be able to take care of our own home. Yeah. And so, so that’s kind of what inspired me, um, to stay home and, you know, get even more deeply connected with community, which I feel has only helped me along once I started to establish my medical career, um, and really helped to build those connections with, uh, with folks. So, yeah, a little bit about why I chose to stay home. I’ve shared there– there’s obviously more, you know, maybe we can talk a little bit about what I do in my free time later. But yeah, I– I could not personally live away from the ocean. So that’s another reason. 

Amber: But honestly such an inspirational story. Just going from like your childhood, being with your grandfather and realizing later in life what you didn’t realize, like growing up that he was instilling in you all these traits that as a child you don’t really appreciate. But I definitely appreciate how you know you consciously are bringing that into how you practice medicine today, because I feel like it really brings a factor of humanism that I think many patients who, you know, may deal with America’s health care system today feel that we don’t really have that provider patient connection as much anymore, like the way things are driven, especially like larger hospitals or like metropolitan areas. It almost feels like patients see the doctor for two minutes and then they feel that, you know, yeah, you’re doing all this stuff for me in the background. You’re treating my physical health, but I don’t really know what emotionally is happening. So I think it’s definitely sounds great that, you know, you’ve been so conscious about that in your practice today. 

10:50 Health Disparities in the Native Hawaiian & Pacific Islander Community
Dr. Iwane: Yeah, I see something. So, Victoria, I see you put a question in the chat. Uh, Victoria,

where are you from? 

Victoria Shi: I am from new Jersey, but I’m currently doing my medical school in Kansas City. 

Dr. Iwane: Oh, fantastic. Awesome. 

Victoria Shi: Thank you so much for being here tonight. 

Dr. Iwane: Yeah. No. My pleasure, my pleasure. Uh, so I see your question. Yeah. What are some unique health challenges or needs of the Native Hawaiian Pacific Islander community that you feel are important for all clinicians to be aware of? So that’s an excellent question. You know, and so I kind of– I’ll kind of give a roundabout answer to that one, uh, by sharing another story. Um, because I like to share stories. So, you know, one of the very first patients that I began to care for right out of residency training was a young Native Hawaiian man who was diagnosed with really bad and uncontrolled diabetes. And, you know, I kept really trying to push medications. Yeah, trying to get his– his diabetes under better control, trying to stress the importance of that because, you know, his grandfather and his father, you know, both ended up having end stage renal disease on dialysis. And, you know, a lot of these bad complications and diabetes. And, you know, I felt like at his stage in his life, he, he, you know, he was at a point where he could make a difference. Yeah. And prevent, you know, his kidney function from declining and prevent his eyesight from getting affected and other things, you know, including decreasing his risk of strokes or heart attack. And so, you know, really, really pushing the medications, including lifestyle changes for him. And, you know, he really kind of seemed almost resistant to, you know, wanting to take medications. I didn’t know how engaged he was. And yeah, I couldn’t really understand why he wouldn’t want to get his diabetes under better control. And, you know, so it wasn’t until until while, you know, he he talked to me and he, you know, he said, “hey, you know, it’s not it’s not that I don’t want to take my diabetes, you know, or get my diabetes under better control by taking medications. You know, at the end of the day, I really gotta figure out, you know, how am I going to pay for these medications? Or how am I going to put food on the table to feed my family?” And so, you know, that kind of took me aback at– understanding that there’s so much, factors outside of just the medical care we deliver that influences health and wellness. And so, you know, Native Hawaiians, Pacific Islanders, especially here in Hawaii, you know, have the highest rates of chronic disease, diabetes, heart disease, obesity, hypertension. Um, we have the highest cancer incidence. Native Hawaiian females have the highest infant and maternal mortality across all ethnicities in our entire nation. And so how can this be, right? Why are people so sick? You know, I think there’s a lot of things that influence health and wellness outside of, you know, genetics, right? Outside of predisposition to getting certain certain conditions. You know, we’re talking about social cultural determinants of health. And so that’s something that’s very important for all of you to kind of understand is that, you know. Actually what we do within our four walls of the medical clinics, our hospital systems is just about 11% of a patient’s overall health pie. Yeah. The larger part of that is, you know, access to food, right? Uh, access to places where you can exercise safely, you know, so the list goes on and on. Education. And so there’s– there’s many things outside of just what we do in medicine that influences health and wellness. Yeah. So recognizing that I think is is important specifically for Native Hawaiians. Yeah. And this story is very similar for various indigenous peoples across our nation and including the world is, you know, we gotta factor in our historical determinants. 

So what are historical determinants, right? These are things that we refer to as non modifiable determinants to health. So um the impact of colonization marginalization of– of our people, you know, taking us away from ancestral and sacred lands. Yeah. And so through this you know transformation. Yeah. Through– through generations. Yeah. This generational trauma is what we refer to. It impacts health and wellness even hundreds of years down the road. And so, it’s so, you know, I think a lot of that is also a big factor, right. That we have to– we have to learn about, especially for our specific unique populations that we care for. Um, here in Hawaii, it’s obviously, you know, our Native Hawaiians and Pacific Islanders that we need to really kind of focus on so that we are approaching healthcare from an understanding and a place that, you know, we’re really a small part of the solution. So– so I think there’s a lot of things that– that, you know, we can learn. I can tell you, folks that Hawaii’s population of of Native Hawaiians is actually decreasing. More and more Native Hawaiians are now moving to various states around the continent because the cost of living is, you know, it’s hard to make it here in Hawaii. So we actually now have more Hawaiians living outside of Hawaii than we do actually here. So this is I’m I’m so happy that, you know, we’re having a conversation this evening with you folks because you folks are all going to be seeing Native Hawaiians one day. Yeah. In your– in your respective areas. And so, you know, the West Coast, uh, you know, Washington, Oregon, California, Las Vegas, right. Even Arizona, there’s– the population of Native Hawaiians and Pacific Islanders continues to grow. And so in order for us to really make a difference, and in order for us to be able to establish relationships with, with the people that we serve. Yeah, including Native Hawaiians and other indigenous populations, we gotta understand them. Yeah. We gotta understand where they came from. Uh, understand these historical contexts, all these factors outside of just their physical health. Yeah, that influences their well-being. So. So that’s just a brief, uh. Answer, I think to your question, Victoria, but yeah, it is– it is important to, to understand those things. 

18:01 Addressing Generational Trauma and Healthcare Mistrust 

Amber: I think you definitely highlighted some pretty important points there. You know like historical significance and how that impacts health down the road too and the generational trauma. So I guess that kind of made me wonder as well. Like as a native who’s practicing and working with this population, do you feel that you know, the native population and indigenous peoples have, like these communities have a mistrust of health care professionals and like the medical system because of how, you know, they’ve been treated over the years and just the effect of colonization and being marginalized in the past, having a trickle down effect now?

Dr. Iwane: Yeah, that– that is definitely alive and something that is a real challenge, you know. So what’s– what’s very important to note is that. You know, and we’re. We’re trained. Right. In a very Western way. You know, we’re trained to practice medicine, you know, by evidence, right? Um, by the book. And, you know, and so, you know, it’s very it’s very much, oh, you have this and, you know, you do this, this, and this, but a lot of a lot of indigenous cultures around the world, right? Not just Native Hawaiians have their own traditional healing methods. Yeah. That have been, that have been, have and continued to practice for centuries. Right. And so I think it’s important to note that or be aware that, you know, there are folks who– who do practice traditional healing methods. Yeah. And, you know, be open to hearing those. Uh, you know, one of the things that I love to do and where I go traveling and whatnot is always go check out some bookstores or different, different, different local areas that may sell, you know, books on on local plants that maybe are used traditionally for healing, you know, just to kind of read up because a lot of things are very similar across different cultures that you folks are starting to realize. 

Dr. Iwane: And so, so having an open mind and approaching– approaching your patients and community from– from a standpoint that– a standpoint of humility and curiosity, I think is something our great skills to have as a– as a clinician. I can tell you that that will only make you a better clinician because you’re able to build stronger relationships. Yeah. So, you know, the relationship between health care provider and the patient, I feel– and the patient’s family I feel is the strongest therapeutic force, even stronger than a medication we can provide for anybody. Right. Without that trust, without that foundational relationship its going to be very hard for you to, to, um, make change, right, to inform folks, to engage with them. And so and, you know, having a good relationship with, with your patients and their families, you know, is therapeutic not only for them it’s therapeutic for you, too, right? That’s what keeps us going, right? That’s what keeps us coming back every day for more. Right. Um, because medicine is really challenging. No matter what field you decide to go into, whether it’s surgical field, specialty, primary care, um, they’re all very challenging in its own ways. And so, you know, making sure that you have that foundation right to rely on it. That foundation is really, how do we build that trusting relationship. Yeah. So like you mentioned Amber, the generational trauma, the cultural trauma that our people have experienced, you know, even if it happened 100 years ago, for many it seems like it’s still happening. Yeah, there’s inherent racism and perceived discrimination is a real thing. Yeah. It impacts it’s a chronic stressor that increases– has been shown to increase risks for mental health disease. It increases risk for higher risk behaviors. Yeah. That impacts health and wellness. It also has been shown to affect cardiovascular reactivity and recovery increases the risk for diabetes. And so the list goes on and on. And so you know I think– I think it’s important right to talk about these things you know in forums. Yeah. Such as this. You know a lot of folks kind of like don’t feel comfortable talking about it. But it’s very important to talk about, you know, it’s not about pointing a finger or, you know, blaming this person or that person. Right? It’s about– it’s about the cultural humility. Yeah. And so wherever you folks go, wherever folks practice, you are going to have, you know, you’re going to be on indigenous rounds and in indigenous communities. And so learning in partnership with your folks and your population that you care for, I think is is extremely important. 

23:21 Building Trust & Cultural Humility in Medicine
Amber: Yeah, definitely. Oh, yes, I see Reanna, you’re unmuted. Do you want to ask a question?

Reanna: Yes. Hi, Doctor Iwane. Thank you so much for being here today. My family is from Waianae, so I have roots there. And I’ll actually be out at the University of Hawaii soon for my OB-GYN rotation with maternal fetal medicine. So I think yeah, I’m– I’m so excited to, like, come and I go to school in the Bronx. So I have some experience with like underserved communities. But I was wondering if you have any advice for just medical students in general when they are even just on a clinical rotation, we don’t have very much time with our patients. So how– how do we incorporate cultural humility and build that relationship in a– in a short period of time? 

Dr. Iwane: Yeah, that’s a great question. You know, and I think, you know, part of that is. It comes with time. You know, I think the more, uh, the more folks you’re you take care of, the more people you talk to. You develop your own style of how you build that rapport. So, you know, I can tell you that mentorship is extremely important. Yeah. So I wouldn’t be in a position I am today without having awesome mentors. Yeah. And so, you know, you learn from your mentors, right? You can see how your mentors interact with patients and how they are able to build relationships. So, you know, one of my mentors, I don’t know if you folks have ever heard of him, Dr. Noa Emmett Aluli, um, so he is a family physician on the island of Molokaʻi. And, uh, you know, one of the things that really kind of stuck with me as I started to spend time with him in his clinic before, even before I went to medical school, uh, was his ability to– to make that instant connection. Yeah. With his patients. And, you know, for– for Uncle Emmett. Right? It wasn’t so much about them, about the medicine. Right? It was about that connection. And so, you know, when, when I would see him talking to his patients. Yeah. He will be talking about what’s your last name or who who your mom, who your dad or, wait, where are you from? You know, and so, you know, he’s trying to figure out he was always about that connection on a, on a humanistic level. Yeah. And so finding that commonality with, with your patients, I think is, is probably the first step, you know, that we all should be trying to aspire to reach. You know, I think the challenge that you mentioned is we have such a short time right, in primary care. You know, we’re on 20 minute visits, but after the patient gets worked out, right after the vitals and everything gets done, uh, I maybe have ten minutes in the room with the patient right before I gotta hop onto my next one. And so, uh, in the busyness of the day, you really you. It’s very easy to get caught up in addressing your needs as a physician rather than the patient’s needs. Right? And so it’s okay to take a pause. Right. It’s okay to slow down and just kind of like talk story. You know, most of the time I can tell you if it’s a brand new patient for me or even if it’s like a patient I’ve been taking care of for ten years, sometimes I hardly– we hardly even talked about medicine in the exam room. You know, we’re talking about fishing. We’re talking about where did they last go on their on their most recent vacation. Right. You’re talking about their grandkids. We’re talking about oh their son got married and you know so it’s it’s that type of connection that I feel like matter most to our patients. So yes we do have to address their medical needs. But unless you can figure out how to– how to build that relationship, right. And get to know people on a personal level, you know, it’s it’s going to be it’s going to be hard, right, to continue to engage with them. And so that’s kind of like something that that I would actually focus on. You know, when I go in to see, see my patients and I encourage, you know, you folks all to kind of also take cues from, from various mentors and see how– see how you know, your, your preceptors, you know, interact with their patients. Everybody has a different style, right? And so yeah, here, here in Hawaii, we’re all about the connection. Yeah. And so connection is not only personally but you know, connection is from a family. A family centered approach. Yeah. So so to me that to me that’s what matters. Right. And yeah you it’s fun because you find some really interesting things about people. You know, they, they do all kinds of really cool stuff in their life. And, you know, it’s just that’s what– that’s what excites me, you know, to, to learn more about them. You know, every time I see, see a patient. Yeah, I’m learning something new about them, which is super awesome. Yeah. And it’s these things that you remember. Yeah. But it helps you to also ground yourself as a physician, too. Yeah. So so awesome. No, I’m glad that you’re going to be coming out here. You know, you feel free to message me if you want to come out and check out, check out our clinic over here in Kapolei. 

Reanna: I would love to. I’m staying with my uncle. He lives in Makakilo. So it’s perfect. 

Dr. Iwane: Perfect. Yeah. Perfect. Yeah. Awesome. 

Reanna: Everything has changed there in West Oahu. So much the past. Well, the past 20 years, I feel like. 

Dr. Iwane: Yeah, yeah, yeah. So. Yeah. If yes, please send me a message. I’m not sure. Amber, does everybody have my email? 

Amber: I can send it out in the. 

Dr. Iwane: Actually, I’ll just type it in the chat right now. Yeah. So? So please feel free to email me anytime if you folks have questions. 

29:58 Community-Based Healthcare Initiatives in Hawaii
Dr. Iwane: You know, I guess I take a little bit to kind of talk about, you know, what we’re doing specifically over here in Hawaii within Kaiser Permanente. So maybe, maybe we’ll see you soon and you can come check it out over here. But, you know, we’re talking we you know, I talked a little bit about sociocultural determinants, right. And how that influences health and wellness. And if we– if we drill down health and wellness even to life expectancy per zip code. So if we’re looking at different zip codes or zip code where Reanna has roots, you know, if you come from this zip code, your life expectancy is actually 10 to 12 years less than if you if you reside just five, ten miles down the road. And there’s different pockets like that across all islands in Hawaii. Yeah. And typically these pockets are rural areas. These pockets are areas that have a very high concentration of Native Hawaiians. These are where what we call our homesteads are located. And so, you know, it’s it’s it’s really frustrating. Yeah. To to see this. Yeah. How can your life expectancy be determined by where you live? So that really kind of alludes to the fact that, you know, there are a lot of other things that are in the wellness. And so what we’ve done specifically in our– the clinic that we– I practice that here in Kapolei is really focusing on on that cultural health aspect. Right. And building programs and building community partnerships specifically to address these needs right, within our our vulnerable populations, our native Hawaiians or Pacific Islanders. Actually, our Filipinos have a very, uh, high rates of chronic disease as well. Um, so what we’ve done over here is we’ve we built this almost like center of, of excellence for Native Hawaiians. And so, you know, within our, our clinic grounds, we have a walking pathway that has garden beds and we have a traditional healing mala or garden, and we have taro patches, two that we actively farm on our clinic grounds. And so it’s a different way of approaching health and wellness. And so, uh, you know, you’re not just you’re not just a physician, right? That comes in practices within our four walls. But, you know, your reach goes far beyond that, right? Community partnerships. 

32:29 Climate Change 

Dr. Iwane: You know, I talked about the importance of mentorship. So we have high school students that come out, or medical students come out and work the land with us. Right. Going back to. The importance of aloha ‘aina. Yeah, that I talked about early on setting that foundation. Right. That understanding that, you know, our health is directly connected to the health of our land. And so being able to work the land, being able to harvest kalo, right, or taro and incorporate that into our diet is important culturally. Yeah. And so there’s a lot of other things that, that, that we do, um, to focus on that, uh, within our, within this specific clinic that, that we have built here in Kapolei. So, you know, the other thing that’s important, right? Aloha ‘aina is also it’s also a concept of being good stewards. Right? Environmental stewardship is a– is a big thing. And so, you know, putting in energy efficient features over here. Right. To reduce our carbon footprint and reduce our greenhouse gas emissions is also very important. So that’s another big passion of mine too is you kind of mentioned earlier about the climate. Yeah. Climate change and how climate change impacts on health and wellness of our communities. And so, you know, we constantly talking about these things, right. And trying to figure out how to be on the leading edge of, you know, being good stewards of what we do in in medicine. Right. You know, health care sector, you know, contributes 8.5% of greenhouse gas emissions in this country. That’s huge. That’s huge. 8.5%. This is you know, that comes from the health care sector. Yeah. A sector that should be taking care of people and taking care of our land. Right. How come we are destroying it by emitting 8.5% of greenhouse gas emissions? Well, you think about it, right? Everything we use. Yeah, all of our– our single use devices, you know, processing of labs, processing of, you know, all of these types of things. It takes energy. Yeah. It you know, this waste has to be disposed of. And so, you know, we’re having conversations about how can we be better stewards of all of this. Yeah. So so yeah, it’s very interesting. But yeah got lots to talk about. 

Amber: I think that’s really cool having, you know, having high school students even come in and work the land physically and really being able to connect. And it’s like being able to pass that on generationally and how, you know, like harvesting things brings it back into your diet. And it’s like this self rewarding cycle. I think that’s really cool. I wish I had something like this here that my school could do. 

35:20 Healthcare Sustainability 

Reanna: I had I have a question I’ve always sort of had the struggle of like with the health care sector. And like in my background, I studied like environmental engineering and sustainability in undergrad. And so it really like shook me when I, you know, started medical school and saw like all the single use items we have and like we– for sterility, we have to have a lot of these plastics and single use items. But I was wondering if there’s any suggestion you have or like if your medical practice has put into place some sort of effective like reduction of waste or recycling of items that you’ve found to be like really useful and like very satisfying to see that in practice. 

Dr. Iwane: Yeah. So I can tell you it’s really challenging to make such a big change happen. So across a large organization. Yeah. And so, you know, just bringing it back to understanding that, you know, change starts at home, right? It can start with you and, you know, making a conscious choice of, you know, how we how we support our environment, right, individually. So I can tell you agriculture, yeah, is a big contributor to greenhouse gas emissions. And so, you know a two pound, two pounds of beef, right to have two pounds of beef land on your plate. That’s actually equivalent to about 160 miles of greenhouse gas emissions driven by a car. So that’s just two pounds of beef, right? So, you know, figuring out how to– how to how to support local I think is also another big thing. So you know, for us over here in Hawaii, everything has to come to us by boat or plane. Right. And so that’s a huge amount of, of energy that needs to to make that happen. Yeah. You know, a lot of these things we have come to rely on in our everyday life. And so how can we be better stewards of supporting local, of supporting sustainable organizations? Yeah. Within your own communities and also being a little bit more mindful of, you know, the types of things that, you know, we’re eating. Uh, because I give you the example,  85% of food that we consume here in Hawaii is not from Hawaii, but yet traditionally, yeah, our lo’i kalo systems or our agriculture, traditional kalo system supported a population of upwards of a million people. And so I think about that. Right. We have come so far away from land stewardship, from resource management, right, to relying on something that is not even produced here in Hawaii. And so how do we get back to rebuilding that, that model of sustainability of land and resource management? Because food grown locally, wherever you are at right, the shorter distance of food has to travel from from the ground to your plate, the better it is for not only the environment, but it is for your health too. Less processing, right? The food is always fresher. It’s more beneficial to your health. So I always kind of encourage folks to think about how they eat, the types of foods that they eat, the type of things that they buy, you know, and so just making a little conscious effort starting at home. Yeah. And so that includes even, you know, lower carbon forms of transportation, right. Like electric vehicles, LED lights, all those types of things. So but yes, change is necessary. I think a lot of folks, you know, across the nation now, especially in the health care sector, is looking individually within their own organizations on how they can reduce their own greenhouse gas emissions and carbon footprint. So but but yeah, I think we have a long way to go, you know. But but we’re getting there. 

Dr. Iwane: Which is which is why, you know I think individuals like you folks. Right. If you are interested. Right. If, if, you know, environmental stewardship and environmental justice is a passion of yours, you guys should really harness that passion. Yeah. There’s so much environmental groups out there, right, that are doing fantastic work. So partner with them. Right. Get involved with these nonprofit organizations. One of the things that I completed in 2023 was what we call a Climate and Health Equity fellowship. So as a ten month fellowship based out of DC, to have physicians get trained in everything that we need to know about how climate impacts health. And so it’s a really cool fellowship because I got to meet so many folks across the nation. All physicians. Yeah, we’re passionate about this work. So the reason why there’s a big push to educate physicians about climate change is because there’s this critical intersection between how climate impacts health, but more importantly, it’s not universal across the board. Much like social and cultural determinants, the impact of climate on health is is more severe for specific vulnerable populations. And these are our indigenous communities, our brown and black communities, our redlined communities. Right. And these are the communities that folks that we’re going to take care of. And so the other important thing is to notice that there’s this thing called a trust veracity index. So it looks at all professions across the entire nation. And guess who are amongst the most trusted professionals amongst everybody? 

Reanna: Doctors. 

Dr. Iwane: Yes, it is physicians and nurses. And so we have to use this, right. We have this very unique position. Yeah, that you folks are going to be entering as a physician. Yeah. Your voice matters. Okay. Your voice matters in the exam room. Your voice matters outside of the exam room. And so we can all be leaders, right? In advocating for what’s right. Yeah. For our people and our communities. So, uh, so that is something, you know, that is, I think, going to be growing in popularity and importance over the next couple of years, especially as, you know, our our global warming continues.

Amber: Yeah, it’s definitely I feel like I would echo everything you’ve been repeating how the importance of just having these conversations and just starting that thought process, like plant a seed in all of our minds and, you know, as we’re going day to day working with our patients and encountering all these single use, you know, medical supplies, it’s I would definitely admit it’s definitely not in the forefront of my mind, but having these conversations always plants that idea were, you know, looking back, I would say today I probably threw out like 13 gallons because I have so many patients in contact rooms and. Then people are, you know, using the disposable stethoscopes and the amount of gloves and everything we’ve gone through. And it’s so difficult to try to balance, you know, how we can advocate as physicians and I guess lead by example and demonstrate it when at the same time, I feel like we’re bound by the other medical side of things when it comes to these things. But I did notice we’re coming to our last five minutes. I know, Doctor Iwane, you were, you know, excited to share a little bit about what you do in your free time outside of medicine as well. Um, so if you want to wrap it up and end by sharing a little bit of what your life is like enjoying the beaches and the culture and life there, we definitely love to hear it. 

35:20 Work-Life Balance & Personal Life 

Dr. Iwane: Yes. So. So yeah. So I am married. I have two children. Uh, so our son is 11 and our daughter is 6. And so, you know, it’s a lot of time outside of, you know, taking care of patients and the daily grind of being a physician is obviously spent with family. So family is a big, a big thing, you know, that is what grounds me. And, you know, I think that work life balance. Oh, look at that. Yeah. Yes. So that work life balance as a physician is extremely important. Yeah. You know, family is is really everything. Yeah. Family is who you can fall back on in your tough times, you know, and even celebrate with you and your good times. Yeah. And so, you know what? One of my, one of my best friends is, is also one of my colleagues. You know, he he always she always tells me, yeah, we’re all going to pass away one day. Right. And so what do you want. You know, people to write on your, on your, you know, your, your gravesite or your tombstone or whatever it may be. Right. Do they want– do you want people to know you, as you know, Dr. Iwane, he was a great physician. Dr. Iwane, you know, he is a great, you know, you know, clinician or whatever, you know, or would you want people to remember you as, you know, uh, Dr. Iwane, you know, he was a he was a great father, right? A great mentor. Right. You know, so, you know, it’s I think it’s important to really focus on what matters most to you. Um, and remember that through your medical training and even as you, as you start practicing because. You know, like I said, medical, the field of medicine is– it is a challenging profession. Yeah. But it is also, in my opinion, one of, if not one of the most rewarding. Yeah. When you can make the difference, right, when you can see that smile on your patient’s face, right? You know that that’s what keeps keeps me coming back. Right. And so, you know, besides family, you know, I love the outdoors. Fishing is like one of my my biggest, most favorite pastimes. And I love hiking. And I do a bit of hunting too. So just kind of being outdoors. And that allows me to also connect to our environment, connect to the land and that’s grounds me. And you know, just having that– that time right to, to rejuvenate. Yeah. To kind of re-energize and you know that that’s important. Yeah. So whatever it may be. Right. If you guys don’t have hobbies you know that is okay. You know. But I encourage you folks to explore your passions. Yeah. Whatever it might be. Because in the tough times. Yeah. That’s just going to keep you going, right. Or to your happy place and, you know, take care of yourself. Yeah. That’s important. 

46:53 Closing Remarks 

Amber: Yeah. That’s definitely some great advice that I think as students we can all try to really take

away and actually explore. I know it’s so difficult for students. Once you start school, the hobbies, the priorities aren’t exactly up there to be pursuing them as much. But you’re definitely right. You know the things that will ground us at the end of the day, whether it is going outdoors or knitting, whatever the climbing the hobby is, is always going to be there for us at the end of the day and this exam will be over, you know, the next thing you know, but the things that really ground you are really still there. Great words to end on. Thank you, Doctor Iwane, for taking the time to speak with us today. 

Dr. Iwane: Yes, absolutely. And like I said, you folks have my contact information, my email. You can go ahead and share it. You know, even to the broader– who put in joining us today. If you folks have any other questions or want to reach out any time, okay? 

Amber: Thank you. Enjoy the rest of your night. 

48:00 AMA Outro
Annie: And that’s our latest installment in the Ask Me Anything series. If you have a specific physician or specialty that you’d love to hear from, let us know. You can reach us at professionaldev@apamsa.org. We hope you enjoyed today’s episode as much as we did, and don’t forget to tune in next time! Thanks everyone!

Listen here:

YouTube
Spotify
Apple Podcasts 

This episode was produced by James Chua and Ashley Tam, hosted by James Chua, and graphic by Callista Wu and Claire Sun.

Time Stamps:

00:00 Introduction to White Coats & Rice: An APAMSA Podcast

00:23 Introduction to Paul Tominez

02:06 Plant Parenting

06.28 Pharmaceutical Chemistry Major

10:10 Solo Traveling to 5 Countries in 1 Year

13:31 Military Match

16:46 Specialty Exploration and Why General Surgery

25:30 Challenges With Moving and Adjusting to New Places

29:43 Prioritizing Your Joy 

31:48 Hopes For Future Career

34:26 This Or That? Questions

37:42 Advice for Pre-Health and Medical Students

Full Transcript:

00:00 Introduction to White Coats & Rice: An APAMSA Podcast

James: Welcome everyone to the seventh episode of the APAMSA podcast. From roundtable 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 James Chua, second year medical student at Touro Nevada, and the current fundraising director at APAMSA. I’ll be your host for today.

00:23 Introduction to Paul Tominez

James: For today’s episode, we have Paul Tominez, a fourth year medical student at UCSF School of Medicine and a proud graduate of UC Davis where he received his degree in pharmaceutical chemistry. During his time in APAMSA, he has served as the Region 8 director and now serves as one of the Membership Vice Presidents on the executive board. Originally from the island of Guam, Paul is an Army Health Professions Scholarship Program recipient, and he has recently matched into, well stay tuned for the rest of the episode to find out where. But spoiler, it’s another island. Former collegiate rower and highschool athlete, Paul’s interests include staying on top of his fitness by running and working out. He’s also an avid solo traveler, having a total of five countries under his belt this year. Without further ado, join us as we explore Paul’s incredible journey in medicine, his insights on leadership, and the unique passions that shape his inspiring story. Paul, welcome to the show. How are you doing today?

Paul: I’m doing good James, thanks for having me.

James: Yeah, no, we want to get as many of the executive board members on this podcast just so we have a very, more clear insight on to who you guys are, because you guys are like the leaders, you guys are shaping basically the next generation of APAMSA.

Paul: Yeah, we’re kind of this weird enigma in APAMSA that we have all the directors reaching out to our local chapters that we kind of just work in the background and a lot of people don’t get to meet us in person.

James: Yeah, you guys are pulling all the strings. But before we get on to the interesting questions we have in store for you, I have a couple questions myself. Just so I and our viewers or listeners can get to know each other better.

Paul: Of course.

02:06 Plant Parenting

James: So first, you are a plant dad.

Paul: Yes, I am.

James: Tell me more about that.

Paul: Yeah so I guess I started my collection in medical school, I think it was during my second year. But growing up is actually where I started taking care of plants so growing up on an island. We had this big yard that like was basically ours to do whatever we wanted to. So, my dad would plant a lot of fruit and vegetables. My mom would plant all of her flowers and other more decorative plants. And from like the earliest age I can recall like helping them in the garden in the afternoon. And like I’d get off school, change and then we’d be outside playing with my dogs, planting things, getting things, like harvesting, whatever we had growing that summer. And then in high school, I kind of cleared out this plot of land and we actually like built like, where it was like a farm and we had like a bunch of eggplant, papaya, I think we had cucumbers and maybe like several like pineapple plants and dragon fruit. And my dad was in the army, so he deployed like, I think later that summer, so I was the one mainly taking care of it. And it was actually like pretty relaxing. And I kind of lost touch with that during undergrad. I didn’t have any plants in Davis, but then in medical school, I stopped by Home Depot one day and was kind of just strolling around as one does in Home Depot. And I picked up two plants and then now I have an entire collection sitting by my window. And I think I probably have an addiction but I need some control.

James: Wow. How many plants – what would you say your favorite plant is?

Paul: Oh, I think it was the first one I got. It’s called a Ficus Audrey, but the interesting story behind that is that… So back in Guam, the other name for Ficus Audrey is called the Tatamuna Tree. So Tatamuna are the spirits back home in Guam that kind of like watch over you and you don’t just respect them. So another word is that these are big Banyan trees, the massive ones you see in the movies with all the things hanging down the sides. So I didn’t know that at first, I didn’t know this was the same plant. So now I playfully think that I have a big banyan tree growing in my apartment with spirits that may or may not be there. And it’s been growing really, really well. It was a super easy plant to start off with. And spoiler, unfortunately I’ll have to get rid of all my plants at the end of the year, but shhh. We’ll get to that soon. 

James: Yeah, I’m sure they’ll go to a very good home. It’s also interesting though because, so you grew up to some degree like growing your own fruits and vegetables.

Paul: Yeah, we also had calamansi. My nino had like tangerines in his yard. I remember seeing bananas. Obviously an island we had a lot of coconuts and avocados, mangoes yeah a lot of like very tropical fruits which I took for granted and then coming out to California’s like oh shoot you’ll have the same kind of fruits that we have back home.

James: Yeah no it’s funny because I also so I’m in Vegas a very desert climate environment, um one of the first things that my dad gave to me as a gift was a potted calamansi tree and it was already fruiting right? But like, lo and behold, my roommate, so I kept it indoors. I was told you can keep it in its pot for 5 or so years, and I was like “Perfect, by the time I’m done with medical school, I’ll know where I am for residency,” and than I can put it like, in the ground. But then I kept it inside and then my roommate kinda got mad because he was like, “yo, I think these are kinda toxic to dogs and worried that my dog is going to eat them all.” And I was like, “Oh man.” So I had to move it outside and then within a week it just shriveled up. 

Paul: Oh no, I didn’t know they were toxic to dogs because we have plants back home and I guess I never saw my dogs eat it but.

06.28 Pharmaceutical Chemistry Major

James: I am not studying to be a veterinarian and I cannot speak on how strict of a dog father my roommate is. It’s whatever, but in any case enough about plants I want to talk a little bit more about your medical journey because I think that’s why we’re all here. We want to get to know you know what motivates you and what drove you to become a physician but even before that something when I was reading about your history something that I was really interested in is, you received your degree basically in pharm. How did that translate over to medical school? Were you considering becoming a pharmacist first or something like that?

Paul:  Yeah, so I think I decided my major back in high school. I really liked my chemistry teacher and the class. I took AP Chem and really, really enjoyed the topic. So I kind of knew I wanted to major in chemistry in college. Kind of jumping ahead. So for college at Davis, there’s a general chemistry major, which I applied into, but then I was kind of going through the requirements and it required linear algebra, a bunch more complicated math topics, which I had no interest in taking but they had pharmaceutical chemistry as an option and that aligned a lot better with the pre-med requirement so I went into medical– I went into undergrad knowing that I wanted to be a doctor already so, I switched majors because it was a little bit more easier to integrate the requirements for medical school while also avoiding the death of linear algebra, super extensive quantum physics. And I was able to switch pretty easily because I had a few friends taking those classes and I don’t think I would have survived taking those. 

James: Yeah. No, I can definitely relate. When I went to my undergraduate, the University of San Diego, I received my degree in biology, just general bio, no specific specialty within it. But I remember like, I was doing really well in my chemistry classes. So I thought I was like, “Oh, maybe I should major in like biochemistry instead”. And then, you know, I love chemistry I love organic chemistry too. But when they recommended you have to take inorganic chemistry or these really niche chemistries, I was like, this is… this is not for me. And I also, like on a similar note to your linear algebra, for us, one of the requirements is like AP Cal– or uh, Calculus 1. And so if you’re a Biochem major you have to take Calculus 2. And I was like, I didn’t even need to take AP Calculus– or like Calculus here because I took AP Calculus and that covered it, so I was like “I can’t do anymore man, like physics is gonna be the end of it”.

Paul: I know, because like I didn’t make that change until maybe three quarters of the way into my first year of college, so I was already taking the calculus for engineers and that definitely was like a rough time. I wish I’d made that decision a little bit earlier, but you know, hindsight is 20/20. And then, yeah, I’m glad I kind of switched out of it because I had to take one semester of physical chemistry and took it during the pandemic, and that was a rough time. I’m glad I avoided the subsequent classes that would have followed after that. 

James: Yeah, no, I can only imagine, I can only imagine how difficult that journey may have been, but hey, it got you to UCSF nevertheless, so.

Paul: It did, yes. 

10:10 Solo Traveling to 5 Countries in 1 Year

James: Yeah, but even though– before we talk more about your medical journey I want to talk about your traveling. So we have five countries this year, huh?

Paul: Mhmm, ya, five countries this year.

James: Have all of them been solo?

Paul: Yes, they have, or I guess, technically, they’ve all been solo. One of them, my friend joined along, but he could not continue on with the trip because of some other personal reasons. But for the most part, yeah, they’re all solo. This is my first time traveling solo internationally. And the other few times I’ve been internationals with my family. And it’s been something I’ve been thinking about doing for the longest time, but I was always scared to do it. One, because traveling internationally by yourself, you don’t know what to do if there’s something that goes wrong. How do you ask for help? I was also worried about the language barrier, navigating public transportation, but things actually worked out really really nicely. 

James: So which countries did you end up– places did you end up visiting? 

Paul: Yeah, so I took my first trip in September of this past year. So I went to London first and then I took the Eurostar to Brussels and Belgium and then I went down to Paris and I went up to Amsterdam. I spent about, I think I was gone for 10 days, 10-11 days, and then I recently got back from Montreal, I think I left the day after Thanksgiving. I spent like five or six days there.

James: Yeah. How did you find the time to do that being a third/fourth year in rotations?

Paul: Yeah, I guess one of the nice things about UCSF is that once you submit your ERAS application, your schedule lightens up very nicely. So over the span of September until now I’ve had a very light class schedule. I only had one rotation that I had to do. I’ll be going back to the hospital in a couple weeks. So I was doing quote unquote research during the time. So I was able to do that on the side while also getting to travel internationally. I saved up a lot of credit card points so they would pay for my hotels very nicely. And yeah it was a nice experience. I’m hoping to take a few more trips hopefully before graduation. 

James: Yeah no I really, so since I’m only a second year and I don’t know how truly rigorous rotations are, I’m always like I know Match for us normal folk for us civilians is in March right and so I’m just hoping that when March rolls around it’s like oh from March to May and May is our graduation it’s like alright everyone, let’s go on the vacation that we all talked about for four years. 

Paul: Yeah. Yeah. Even before that too, like if you’re able to get all your rotations done, like just advice for anybody who’s able to do this, if you’re able to pack everything earlier on, let’s say finish and like, I know a lot of my friends are finishing in like December, January. So between February until graduating, they’re traveling the world and staying at home doing whatever they want. So if you have– if your school has the capability to push things a little bit earlier on in your fourth year, definitely I would take that. 

13:31 Military Match

James: Yeah. Well, since we’re already on the topic of medical school and all of that. Let’s just start. What– so I kinda spoiled it just a little bit in the beginning but what field or specialty of medicine are you interested in and why?

Paul: Yeah, so I applied into general surgery this past summer, so once again I am one of the Army HPSP recipients. Our match process is a little bit earlier, we found out our results a couple weeks ago so I matched into general surgery at Tripler Army Medical Center in Honolulu, Hawaii.

James: The pink hospital correct?

Paul: Yes, the pink hospital. They currently have a big I guess Christmas tree outside you could see it from like off the cliff.

James: No, it’s funny, so I was actually very interested… So let’s dive more into this. So you mentioned that your dad is in the army, right? Yeah. So did that play a big role into you choosing the Army HPSP? Or did it play a role in you choosing gen surg?

Paul: Oh definitely. Yeah. I guess for the Army specifically, so my grandpa was also in the military. I think he served in the Korean War I want to say. Don’t quote me on that. And then my dad was, served in the Army for I think 33 years. And then a bunch of my cousins are also in the Army, not in the Army, but in the Air Force. And then I went to what’s called a DoDEA school, which is like a school for all military kids and federal workers to have their children go to the same campus. So I was surrounded by a lot of like department of defense people and children. So that was definitely a big influence. And then I guess for me, the financial aspect of it was a big part because being from Guam, you are not considered in-state for anywhere besides University of Hawaii. So the cost of medical school would have been egregiously expensive for me wherever I went. So it kind of helped take off that financial burden of being able to attend medical school. 

James: Gotcha. You know, something that I don’t share with a lot of people, but I now I guess I’m going to share with every person listening, is that so my dad was also in the Army. And so for a brief moment, I was really interested in doing HPSP. But, um, also on that note, since my dad when he was active duty, he was once stationed in Washington in Tacoma. And so that’s actually where I was born. I was born in Madigan. And so I was, yeah. So I always think to myself that even though I’m in M2 right now, that maybe one day like I could sort of circle back and end my story in like Seattle slash Washington, you know, like that’s where I was born and that’s where I want to end my career you know? But we’ll see, we’ll see. 

Paul: Ya, I actually did a rotation up there at Madigan 4 weeks this past summer. They have an excellent general surgery program and they have a couple civilian doctors who work at the hospital. If you’re interested in general surgery, you can definitely work up there. 

16:46 Specialty Exploration and Why General Surgery

James: I’m currently interested in psychiatry, but you know, you know, things, things really could change. And on that, oh yeah. Yeah. Yeah. Because when I was, again, doing my research about you, you know, two years ago on your APAMSA’s bio, it said that you were interested in emergency medicine. So why did you switch from emergency to gen surg?

Paul: So I think during my third year I had so many life crisis of what I wanted to do in medicine. So I came into medical school thinking I wanted to do emergency medicine. That was the only thing I wanted to do. That’s mainly because I did research in emergency medicine during undergrad and during my gap year. I really liked the big, I guess, catchment of patients that you get to see. So it’s a very wide patient population. Everyone ends up being in the emergency room at some point unfortunately, in their life, so you get to see a wide array of presentations. Your ability to come up with different differentials very quickly to provide critical care and a very like adoptions to do that in a very resource limited setting was something that was very attractive to me and also kind of working as like the quarterback to coordinate care for all these patients who are coming into the hospital. So whether they can go home safely whether they need you know be admitted or they need to stay in the emergency room for a couple more hours, maybe a day or so. That was what really drove me to the field, and also the flexibility. So I heard that you can pile your shifts earlier on in the month and then take the last half of the month for you, whether that be traveling, teaching, doing research and so on. But then during my third year, I got more exposed to the different specialties. So I kind of got more interested in internal medicine because I really liked the depth of knowledge that they had for all the different specialties and being able to coordinate care more long term for these patients. And oftentimes when you care for patients in the hospital, like the relationship with them is very intense. So you’re caring for them for a span of 2-3 days to upwards of several weeks. And you get to see them every single day. You get to see them progressing, changing– their clinical status changing, which you don’t necessarily see in emergency medicine, because oftentimes you give them to a consultant or admit them to the hospital for medicine, or they get discharged. You do get to see some repeat patients who come in frequently, but you don’t really get that long-term care that a hospitalist will get. So I kind of got interested in being more like in the hospital, like on the wards through internal medicine. But I still liked the idea of critical care. So I thought of, okay, let’s do a critical care elective or pulmonology elective because I really like– unfortunately really like very sick patients. I like the complexity that they have behind them. And then I finally had my general surgery rotation. It was– I personally, I always felt like surgery could be an option for me. But I had never gotten any exposure to that. So I’m the first one to go to medical school in my family and have any exposure to surgery beforehand. But when I got to the OR I was… “wow, kike this is an incredible environment.” My first exposure was through a pediatric urology elective where, on my very first day being in the OR, the fellow handed me the scalpel, held the skin taut, and allowed me to do the first incision. I was like, this is insane. Like I’ve never held a scalpel before, never had cut anyone before and he was allowing me to do something. So that kind of like stuck with me and throughout the the two weeks of that elective they continued to allow me to do different things they taught me how to suture things closed they taught me how to tie things. One day it was just me and the attending so I was basically just opening for the case with just attending again with limited experience as a medical student, which was a very like incredible like memory that I’ll continue to take with me going forward. And then I had my actual general surgery rotation the week after for two months. So I did four weeks of vascular surgery and then four weeks of acute care surgery. For my time in vascular surgery, I liked it because again, the patients are very critically ill. So a lot of the vascular patients have multiple comorbidities, the cases are very long and complex. I think the longest case I was in was maybe I want to say six or seven hours. And I think that was only planned for like a 45 to hour and a half case. So it ended up just being at one point it was just me and the fellow trying to figure out like what to do. And I was like assisting the fellow in like kind of getting hemostasis and like holding things with like the forceps and cutting things, which was a very good experience. And then a lot of the patients end up going into the ICU. So I kind of got to see that, you get to do surgery but you also still get the care for these critically ill patients as like the primary team. So it kind of combined two interests that I had. And then the following month, so I did acute care surgery, which is basically the consulting service for general surgery. So what that means is that whenever I guess the hospital service needs like a consult from surgery, you’ll call the acute care service. So would that be for like a bowel obstruction or let’s say in the emergency room, they’re admitted for appendicitis or cholecystitis, you call that service in the hospital. And I really liked that service because there’s a lot of running around. So I think at one point, our list ballooned up to like 30 some to 40 some patients. So our patient list was too thick that we couldn’t staple it together. And I really liked the one– again running around. So running between the OR and the floor to check on non-patients. We just had a bunch of cases going on it throughout the day. I felt like the residents allowed me to do a lot. So one, care for the patient and write notes of course, and then also in the OR getting to close, drive the camera for a lot of laparoscopic cases, and then closing of course honestly with just the attending sometimes, which kind of stuck with me as well. And then the very last case of my rotation was an ex-lap and that was the first ex-lap that I had ever seen. And when we’d gone to open the body cavity, the blood was just gushing out of the patient, unfortunately. But that really stuck with me because I got to see how quickly these general surgeons had to think to figure out what’s going on. And while also, again, using their hands to see where the source of bleeding is. And I really liked how quick on their feet they were thinking. Also being able to make a difference in the moment at that time that you don’t necessarily get to see in other specialties. And this emphasis of using your hands thinking critically. Very sick patients continue to stick with me through all of my um through like all the other general surgery rotation that I did. Even in my GYN surgery rotations where they allowed– again allowed me to do a lot of things in the OR continue to stick with me. And ultimately, like it was the teacher I had in the OR that drove me more and more towards that general surgery path. 

James: I can see why you have felt like so inspired to pursue this specific route. I think in my own experiences. So even before, so I mentioned I was interested in psychiatry, but prior to this, I was interested in infectious diseases. And I think that was from all of my mentors throughout my undergraduate and post-grad time. Like they were the ones who like wrote off however many hours I shadowed them in the hospital for applications but when I went with them and learning from them and getting inspired by them, I think that’s what really propels us forward. Especially in our medical journey you know?

Paul: But it truly is. Ultimately, your clerkship year is decided by who you’re working with. You can have a tremendous attending who gets you involved with the cases and teaches you a lot and allows you to do a lot of things. Or you can have the opposite of where you’re basically just shadowing as a medical student, which may not be the most exciting thing in the world. So your teachers, your mentors, your attendings, even your residents will make or break your clinical rotation. 

25:30 Challenges With Moving and Adjusting to New Places

James: Absolutely. But I think medical school has its ups and downs, and so we talked a lot about all of the ups right now and how great your rotations have been. I’m sort of curious about the antithesis of that, like what has been the more challenging part of your medical journey, you know? Like was it in med school? Was it in undergrad?

Paul: Yeah. I think I mean, I’ve struggled a lot throughout my life. I think– so I moved away from Guam at the ripe age of 18. I think I was only 18 for like two weeks before starting undergrad. So I think that was a pretty big struggle trying to figure out how to be an adult, how to manage being a college student, making new friends, building a new support system in a place that was completely unfamiliar without any existing family in like a several hundred mile radius was challenging. So, that first couple of like quarters in undergrad, it was like hard. I wanted to go home almost every single day, I was trying to call my parents every single day. The time difference alone made it hard to be able to make that connection, right? I think towards like halfway through, I was like, “Oh, like this is too much. I’m going to transfer back home and kind of just go back, go to school back in Guam.” But I stuck through it. I was able to find community through my club rowing team. Built a lot of, built a lot of lifelong friends that kind of gave me more balance for, for school. So we had the school side and then I would be working out with my teammates. So that kind of helped keep me cemented at UC Davis and then as the years went on, continued to feel more and more comfortable with being in Davis, you know, buying my own groceries, doing laundry, cleaning and whatever, and then also managing, being a pre-med. And then kind of experience the same, I guess, adjustment in medical school. It wasn’t a big move, so Davis is only what, like an hour and a half from SF, if there’s no traffic. But again, San Francisco is a very different place than Davis. I always joke around that Davis was a nice stepping stone for me, going from an island in the Pacific to California to a small college town, now being in a city of 900,000 people. So I kind of had that same similar adjustment, trying to find like, okay, who do I connect with? How do I manage my medical school? How do I navigate being in a new city? Manage being able to drive in a city, I just got in my car a year ago, so figuring out how to drive in this very cramped city. But I continue to adjust. I think the hardest parts for medical school is that you’re surrounded by such tremendous people, people who’ve done incredible work, both your colleagues, your classmates, the residents, the attendings. Oftentimes you can feel like wow, am I good enough? Am I good enough for this? Am I putting in enough work? But being able to acknowledge that you’ve done the work, you’re here, you made it, like, you’re going to be a doctor at the end of the day. And to remind yourself that constantly really does help to kind of manage your expectations. I think being able build like good work-life balance is something that I’m continuing to work on. I think I built it pretty nicely during my first year and a half, but during clerkships, it kind of took the backseat because of how much you’re trying to learn, how long your hours end up being, kind of, I personally tried to prioritize as much learning as I could for clerkships while at the expense of like, you know, like, my personal wellbeing. So now that I’m in my fourth year, I’m trying to rebuild all the hobbies I lost over the last year: solo traveling, taking care of my plans. And hopefully build that, like, routine for residency coming up in the next six months or so.

29:43 Prioritizing Your Joy 

James: I can definitely speak as well on how important it is to maintain, you know, these hobbies that you have, that keep you grounded during medical school. I remember like prior to medical school, I used to go to the gym very regularly, but then when MS1 started I was just like no time for studying– or no time for working out, all time for studying. And I think that was just me being like… I was just not prioritizing what needed to truly be prioritized and that’s, you know, your physical and mental health first. And so now that we’re in our second year, I’m– it’s kind of people say it’s pretty wild. But for me, my personal schedule is that I wake up at 3am to go to the gym but mind you that means I go to bed at like 9 to10. I’m still getting about 6 hours of sleep. But I just like starting off my day with that one thing that like is so routine, you know, because things are so rapidly changing and it’s hard to stay grounded. So yeah, yeah. 

Paul: Yeah. I mean, kind of speaking to that. Yeah. I mean, I used to go to the gym a lot, especially during undergrad and honestly during my first year and a half of medical school, but during clerkships, your schedule is not really your own. So being able to fit in like what brings you joy during that time, like it’s a struggle because you can always study more. You can always try to get more sleep, but you really have to make time for the things that bring you joy, whether that be your hobbies, whether that be working out, whether that’d be like working on your mental health, or even meeting up with your friends because for clerkships everyone’s spread across the city or the Bay Area or wherever you’re going to medical school and it’s hard to talk to people at times. It can feel very isolating especially if you’re the only medical student on your team. So making sure you also maintain the connections you make during the first year and a half. Having people you can rely on to kind of like decompress, talk about what you’ve been experiencing like during your clinical day, can really like change your experience overall. 

31:48 Hopes For Future Career

James: Yeah, absolutely. So now we’ve taken the time to talk about all the highs and your incredible rotations and surgery and how that inspired you. And we talked about the lows and all of the challenges that shaped you into the medical student you are today. I’m now curious what we can expect for the future. So in other words, if we had a crystal ball for you and we were trying to predict your future medical career, what is the one thing you are looking most forward to now that you’re going to be what, an 01? An 01– is that not the term? Like for officers?

Paul: Yea, so I’ll actually be a captain which is an 03. 

James: Oh my god, so you’re skipping a little bit.

Paul: Yeah, so I’m skipping a few!

James: So skipping first and second lieutenant.

Paul: I’m actually a second Lieutenant right now. 

James: Oh, okay. Yeah. For medical school year, you commission as an 01and then once you graduate, you become an 03.

James: Got you. Okay, thank you for the clarification. Well, in any case, what do you look forward to in your future medical career or even military career?

Paul: Yeah. So I kind of touched on this before, but it was all again, my decision to go into surgery was based off the residents and the attending that I had. So I’m really, really looking forward to being able to teach as, as a physician over the past couple of months or even over the past year, I’ve been leading a lot of like, suturing workshops, knot tying. And I’ve also been tutoring for the school of medicine and I’ve really enjoyed my time being able to teach younger medical students like all the knowledge that I’ve gathered over the past several years. So I think at least at Tripler they do an excellent job of trying to emphasize teaching for medical students so I’m looking forward to being in that resident position and being able to have like all these chalk talks and teaching medical students how to like suture and knot tie and all like the different surgical pearls. And then ultimately I would love to continue mentoring like medical students and pre meds and others like people in general who are interested in medicine, because I feel like a lot of wisdom can be passed down through the experience that you live. But everyone’s journey is gonna be different but being able to hear what other people’s journeys were like and what the life lessons they took away from that can really help someone navigate this foggy field of medicine that often for people who don’t have family in medicine itself can be kind of difficult to navigate at times. 

34:26 This Or That? Questions

James: Yeah, absolutely, that intergenerational connection between generations and generations of physicians, it really carries on. And I look forward to the day when you know you’re an attending and APAMSA can call back to you so that you can mentor another bright-eyed future captain. But yeah, in any case, thank you for sharing so much about your medical journey. We’ve really learned so much about your professional side and the academic side, but I wanted to end the podcast more on a lighter note. And I’ve been asking every single person we do this 1-on-1 series with a bunch of this-or-that questions just so we end on a goofier note. It’s just gonna be A or B just choose one, you can give an explanation, but it can be pretty rapid fire. I have actually found that every single person I’ve interviewed has to always pause and then expand upon. So, feel free to do that as well.

Paul: Alright I’ll try to be as rapid fire as possible.

James: I’ll just give it to you then. First, city or beach

Paul: Beach

James: Cats or dogs? 

Paul: Dogs. 

James: Text or call?

Paul: What was that? Sorry, one more time. 

James: Text or call? 

Paul: Text. 

James: Black or white? 

Paul: Black. 

James: Morning or night? 

Paul: Morning.

James: Summer or winter?

Paul: Summer

James: Breakfast or dinner?

Paul: Breakfast

James: Would you rather have the power to be invisible or the power to read minds?

Paul: Be invisible.

James: You know, you’re actually the first person to answer that. 

Paul: Oh, really? I think my anxiety would go off the rails if I could read people minds. 

James: Would you rather have 100,000 to spend on yourself or a million you could only spend on others? 

Paul: A million to spend on others. 

James: We have such kind hearted guests, everyone always says that. And then finally, for our final this or that question, would you rather retake step one or retake?

Paul: I think I’d rather retake the MCAT unfortunately. 

James: Okay, so I’m gonna ask you why. 

Paul: I think I’m the first one who probably said that right? 

James: Yes, that is correct.

Paul: I don’t know, I really like basic sciences. I mean I was a chemistry major so like that wasn’t like an issue for me. Really love biology so biology and biochem. So that was like, fine. The only issue with the CARS section, which I think I could do better if I actually practice CARS. And then the psych-sociology is like, yeah, you just do the flashcards. So yeah. STEP1 was rough for me. 

James: Yeah, I really thought we were gonna have like a 100% unanimous step one answer. Way to break the mold. So that’s wild. Alright, well that brings us to the end of our This or That segment. Thank you for your honesty. 

37:42 Advice for Pre-Health and Medical Students

James: As we wrap up this episode of White Coats and Rice we love to close out our 1-on-1 series seeking advice from our guests. So, Paul, what is one piece of advice you’d like to share with someone navigating the journey of medicine/medical school?

Paul: Yeah, I think making it your own journey is a big one. I think there are so many different ways to be successful in this field and ultimately it will be your own experience in the end. So take all the advice that you get, take all the experiences that you see with a grain of salt. Integrate into your decisions but ultimately make the decision because you want to do it. No one else can make the decision for you or people will try to make the decision for you, but ultimately again, like it’s your career, your life. So building that confidence to be able to navigate this incredible field of medicine with confidence is… It can be challenging at times, but once you start to build the repetition of doing that, life gets a lot easier.

James: Thank you Paul for sharing so much about you. It has really been such an honor to have you on the podcast. Thank you for sharing your incredible journey from the beginnings on the island of Guam to where you’re headed next, to the island of Hawaii. It has been so inspiring. If our listeners want to contact you his current email is membership@apamsa.org feel free to shoot him a question if there’s something you want to learn more about, whether it’s maybe a military health scholarship or anything like that I’m sure he’s an open book. To everyone tuning in we hope you found this conversation as meaningful as we did. Be sure to join us next time for more stories that uplift and connect – we hope to see you all at the National Conference at Duke University this upcoming Mar 7 – 9, 2025. Thank you Paul!

Paul: Thank you for having me!

Listen here:

YouTube
Spotify
Apple Podcasts 

This episode was produced by Annie Nguyen, Reanna Dona-Termine, and Ashley Tam, hosted by Annie Nguyen, and graphic by Callista Wu and Claire Sun.

Time Stamps: 

0:00 Introduction to White Coats & Rice: An APAMSA Podcast

0:57 Speaker and Event Introduction

2:40 Dr. Grace Kajita: Support, Simplicity, and Presence

8:39 Dr. Indu Partha: Attitude, Business, and People

14:25 Dr. Nolan Kagetsu: Policies, Time Off, and Work-Life Balance

18:42 Dr. Caroline Park: Balance, Teamwork, and Growth

25:56 Q&A From Audience

27:00 Navigating Conflict in Residency: Strategies for Professional Growth

32:33 Common Pitfalls and How to Avoid Them

36:38 Endurance in Medicine: Sustaining Passion and Well-Being

41:00 Finding Our Voice: Asian Identity in Medicine

50:48 Closing

Full Transcript 

0:00 Introduction to White Coats & Rice: An APAMSA Podcast

Annie: Welcome everyone to the 6th episode of the Asian Pacific American Medical Student Association Podcast. From roundtable 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 Annie Nguyen, a postbac at Stanford University, and a member of the Leadership Committee at APAMSA. I’ll be your host for today! 

This is our Preparing for PGY-1 Event, where doctors Grace Kajita, Indu Partha, Nolan Kagetsu, and Caroline Park share insights on navigating the transition to residency. These four program directors provide concrete advice on making a great impression, choosing the right program, and managing the challenges of intern year. Whether you’re preparing for PGY-1 yourself, or simply looking for professional development tips, this event is for you! Let’s dive in!

0:57  Speaker and Event Introduction

Annie: So thank you everyone for coming today. we’re very excited for this event, brought to you by our Leadership Committee. We hope that we can provide some meaningful insights on how to best prepare for PGY-1, or just in general, how to navigate your journey in medicine, since everyone here might be at a different stage. Um, to do this, we’ve gathered the most incredible panel, Um, to help share their tips with you. And just as a brief overview of the events, we want to start with a presentation where each of our panelists will share their insights, and then we’ll open up to all of you for a Q&A. Um, this event is definitely for you guys, so don’t hesitate to ask questions. You can drop them in the chat. You can also just raise your hand or unmute. Um, we just want to make sure that you get all your questions answered. So without further ado, I wanted to introduce our panelists. We’re going to start with doctor Grace Kajita. She’s an internal medicine program director at the Albert Einstein College of Medicine. We have Doctor Indu Partha an internal medicine associate program director at the University of Arizona, Tucson. Um, we have Doctor Nolan Kagetsu, a former radiology program director at Mount Sinai. And last but not least, Doctor Caroline Park, the trauma medical director and former fellowship program director at UT southwestern. So, big round of applause for everyone. And just before we get started, as Doctor Partha mentioned, if any of you are comfortable turning on your cameras, we would love to see your faces. It’s nice to talk to other faces. Um, okay. So I’ll go ahead and share my screen.

2:40 Dr. Grace Kajita: Support, Simplicity, and Presence

Annie: We’ll start with the presentation, and we’re going to hear first from Doctor Kajita.

Dr. Kajita: Thank you so much for that great introduction, Annie, and it’s really a pleasure to be with all of you again. I think this is my second APAMSA event and I’m really excited for all of you. I don’t know where everyone is at this point in the process, but I’m going to address a common concern that lots of people have coming into residency. One thing I do want to do before I start is just sort of say a little bit about myself. I’m a general internist. I currently work at the Montefiore Medical Center in the Bronx, at one of the smaller internal medicine residency programs, we’re primarily international medical grads. But I used to work at NYU. Everyone always has the same questions, so please feel free to stop me if you can’t hear anything or also to ask questions afterwards. Now, yes, that’s me on my– on this slide. It’s not a great photo. This is one of the reasons why we don’t turn on our cameras when we do these things right. But I’m going to make a point about this at the end of my sort of three major bullet points. And what you’re going to see on the slide is that I’m not talking about stuff you should read or learn or skills necessarily to get better that going into residency. And while, that’s really important. And I understand you’re worried about this, I’m going to talk about some of the peripheral things about your life outside of the hospital, because that really needs to be worked on or cared for just as much as preparing for the academic stuff. So when people ask me, should I review EKGs or chest X-rays? These are sort of the questions I ask them. So for starters, and by the way, you will get some amazing pointers from the other slides that are to come. I’ve seen the slide show, so I’m excited for that as well. So medical school is really different from residency because it’s still at school. And remember that when you go into residency, the expectations are more along the lines of a job. So your work day is different, your downtime is different. Your ability to connect and just hang with people is completely different. One thing throughout everything is that we know you’re outstanding academic achievers, but you also in this space, need to make time to connect. Refresh. Stay close to the people who’ve supported you throughout this journey. So my first point is please establish your support network before you start your residency. And what does that mean? Who are your people? Who are the people who keep you supported that you could call, you know, anytime something is going on? Sometimes it’s a mix of family and friends and mentors. Identify those people. Then make a clear cut plan on how you’re going to stay in touch with them, meaning maybe you want to call them once a week, but if you’re working nights, you’re not going to be able to call them at the same time. So adjust that plan, but don’t let it go, because the more you lose contact with those people, the more isolated you’re going to feel. And residency is a really hard time to feel isolated. So think about your people. Secondly, and I think you guys are of a generation where you do this really well. Simplify your life, okay. Take out the extra stuff and the things that are a hassle, even if they seem cool. Just to make it easier again. You’re kind of. You kind of have a working life now, right? So your time is going to be really, really busy. You come home from the day, you’re going to be tired. So if you, for example, I’m in New York, you think I’m going to be working in the Bronx, but it’ll be really cool to live in Brooklyn. I tell all the interns, please don’t do that. You wouldn’t be miserable with that commute. You’re going to fall asleep if you’re driving. Think about keeping it simple, at least for your first year. Now, I know some of you really have a preference because you want to stay close to family. That’s okay. Or for other reasons. But try to allow yourself plenty of time to do things outside the hospital and outside of work. And by that, I need you also want to make everything as automatic as possible. Your bank payments, your student loan payments, everything. When you prepare a meal, make extra, bundle it so you have leftovers to take for lunch the next day or to have for dinner the next day. Keep it simple if it means a food delivery service. That’s okay too. But set that all up before you start residency, because if you can-, or work on it along the way, it just makes it easier when you have fewer things to worry about. Finally, under this point, remember that you’re just going to be sort of a little bit out of water at the beginning, even if it’s your medical school or a program affiliated with your current medical school. Assume that everything’s going to take longer than it needs to take, right? So just schedule it for double the time. Don’t overbook because that leads to a lot of disappointment. Yes. You think you can go hang out with your friends at a bar after a long call, but you’re also going to do your laundry beforehand? Keep it real. Okay. Finally, and this relates to that point I mentioned earlier about turning on the cameras or seeing each other. Be kind and be present to yourself, your patience to everyone you work with, and show kindness to the first person you see. It’s the person who is assisting patients at the door, the greeter, security guard, whoever it is. Eye contact is amazing. It makes such a difference. Especially since we’re Zooming so many things. Even turning on the camera during the Zoom will make you feel a little more connected to your teachers, your colleagues. And all of that will definitely, although it might feel like a hassle at a time or you’re having a bad hair day, really, people don’t care. Just be there for everyone else. And that’s basically what I have to say. And so I’ll pass it on to my colleague if that’s okay. 

8:39 Dr. Indu Partha: Attitude, Business, and People

Dr. Partha: Wonderful! Thanks so much, um, Annie, for the invitation and Grace. It is a pleasure to hear your tips. I, um, cannot agree with them more. Um, so helpful and really so relevant. I am Indu Partha and I am also a general internist. I am a primary care physician by training and passion. And I am one of the associate program directors with the University of Arizona College of Medicine in Tucson, and heading up the ambulatory education side of things for our internal medicine residents. And I really do need to echo what Doctor Kajita said is, you know, we aren’t really here to tell you about what books you should be reading and what you know, learning you need to do to be a successful resident. Because truthfully, that’s what residency is there for. We’re there to educate you. We’re there to train you. We can teach you how to be smarter, but we cannot, um, in– teach you how to have more integrity, more humility, more compassion and more enthusiasm. And those are the qualities that I would love to see you all bring to your respective residencies when you get there. Um, I’ve kind of broken it down to what I thought might be helpful tips for you all as you prepare for residency. And honestly, if you’re earlier in clerkships, I think these are helpful tips as well. Um, and I’ve broken it down into kind of the approach to your attitude to the business and to the people. So in terms of the attitude, this kind of speaks to Doctor Kajita’s. Um, advice to be connected to um. Be integrated with the people around you. Um, and what are your bring– what you’re bringing to the table each and every day. Cannot highlight enough the need for you all to ask for help and feedback and learn how to do so early. Um, think about what you’re bringing to your team, to your junior residents, to your faculty. That energy is very contagious, and what you bring spreads like wildfire and a great attitude. You know, you’ll be working hard regardless, but having a positive, um, not unrealistic attitude, but just a positive ‘we can do it. Let’s work together’ attitude can really go a long way to, um, making residency a lot more fun, a lot more enjoyable, and I might say easier. Um, one of my favorite sayings is water your flowers, not your weeds. Um, this is sort of, put your attention into the places that are giving you back what you need, but also learn how to focus on the things you do well, not always focusing on the things that you do poorly. Um, and really highlight those and spend time growing those passions, um, both clinically and personally. Don’t speculate. Ask and clarify. You know, don’t think ‘I think this is the diagnosis for this patient’, um, yeah. ‘I think they are taking their medications all the time. I think this is what my program director means when they are telling me we have to do x, Y, and Z’. Just ask. Clarify. Don’t write your own narrative and story about what’s going on. Check in with others. If you’re having a rough day, hard time, chances are very, very likely that others are as well. This is how you guys all will work together. Um, and kind of hold each other’s hands through a tiring and rough time of life as being there for one another and check in. Hey. How are you doing? Can I help you? I need help. Can you help me? Um. Be a hand raiser. Again, this goes along with. Turn your camera on. Volunteer to do things. Be available. Be enthusiastic. Um. Any and all faculty are overjoyed when residents show up with enthusiasm and interest. Um, in the midst of their busy days, it’s speaking to the business of things as well. There is business to be done. Please get your paperwork done on time. Believe it or not, this is what program directors and APD’s discuss about their residents. Make sure you set aside time to study. Answer the emails that you get. Please don’t ignore those. It’s part of being a responsible adult resident, which you guys all will be. So please make sure you’re, um, being responsible and replying. And then first and foremost, you need to show up. Show up to conference. Show up for other people. You’re there to learn. And those conferences are important and have been prepared for you to learn. And lastly, don’t forget about the people. Build relationships with your peers. Uh, with your attendings. Learn about your patients beyond their illness. Find the senior residents you admire and emulate how they behave. Ask them, how do you do what you do? How did you learn what you learned? Um. Your chief residents are going to be working really hard on your behalf. Please treat them with thoughtfulness and respect. It’s not an easy job. Um. So do trust them. And lastly, assume positive intent first. It’s really easy when you’re tired and overworked to think, oh my gosh, everyone is kind of out to get me. But if you take a step back, assume a positive intent. Take away what you can from it and then put the rest aside. Um, I think it’ll do a lot towards keeping you happy and healthy as you get through your residency. Um. That is what I’ve got for you. Thanks for your time. 

14:25 Dr. Nolan Kagetsu: Policies, Time Off, and Work-Life Balance

Dr. Kagetsu: All right. Thank you. Thank you everyone. Um, it’s great advice from my– my colleagues. Um, I’ll summarize some things. Um, just a reminder. You’re an employee, not a student. I think I forgot that one of my first days, because when I was sick, I didn’t just. I just didn’t show up. And then somebody said, you know, you’re not a student anymore, so, um. Yeah, I and so it seems obvious and stupid now, but whatever. Just saying that, putting it up there. Um, so sometimes different programs have different policies. So you just have to, um, clarify what the policy is at your place. When I was a program director, if a resident said, ‘oh, I have to have a dentist appointment’, I said, ‘okay, fine, that’s like a sick half day or a sick hour or something’. But some programs are more hardcore, if you will. And they say, oh, you get wellness days. So that way you can go to the doctor once a year. And it’s like, I’m thinking, that’s not very generous, but it is pretty common. So, um, I think certainly when you’re an attending, if you have a doctor’s appointment, colleagues will cover you and you’re not you don’t have to take vacation time to, to, um, have medical care. So anyways, I think the key thing is, um, figure out the expectations, the policies, so that you, um, whatever, um, don’t break break rules or or don’t mess up, whatever the culture is. Another thing that is interesting, some people, even for attendings, they you have to kind of get a sense of what personal days are. So personal days. Some people would say, oh, that’s only if I have a personal emergency, and if I want to take a personal day to go shopping, then that’s an abuse of the system. Um, I would say in some ways, personal days are like extra vacation days, and but you have to make sure that’s the culture of your organization. Like the way I used to run it is personal day is essentially like a vacation day. And, you know, if you had a genuine emergency, then you would essentially take an emergency vacation day. And if you had run out of vacation days and have an emergency, well, then maybe you can pay it back next year or something like that. But I think I, even some faculty I remember would essentially not use their personal days when– and for them it was not fair that people would use them. So I think it’s just a better place to be with, if you– if the PD says you know what your personal days are like PTO and use them or or lose them, frankly. And then for some of them I call– I had one resident that, um, you know, there was a scheduled exam that was going to be on Lunar New Year. And for her, that was a– one of the most important days of the year where she had to, I don’t know, you know, always saw her family. And so if there’s 1 or 2 days that are really important for you, I think the program director should try to accommodate, those 1 or 2 days. Um, and, uh, you know, maybe if 15 out of 20 are asking for Lunar New Year off, then obviously that’s going to be an issue. But or perhaps have some sort of lottery system, but I think it’s okay to ask for, um, perhaps 2– 2 holidays should, uh, not break the bank, if you will. I had one resident who for him, his most important day to have a personal day or vacation day was Halloween. And so, you know, for him, that would have been terrible if you did not have Halloween off. So we brought Halloween, and that’s it for me. Happy to take questions at the end.

18:42 Dr. Caroline Park: Balance, Teamwork, and Growth

Dr. Park: Um, I just want to say thanks to Doctor Kagetsu actually, because he reached out to me, uh, on Twitter and, uh, told me about this opportunity. So I think, number one, just, um, looking out for each other. I think that’s the really incredible thing about not only just, you know, us humans, but, um, you know, being in medicine, which is actually a pretty small world and kind of leaving all the other, you know, bits of advice that everyone has given you. If you think about it, you know, we’re going to be working 80 hours a week. You’ll be working 80 hours a week, which is really like that’s double the standard workweek, right? Like that’s crazy. Some people think about that and be like, that’s insane. That’s two jobs. And that’s the reason why I think it’s so important that you spend quality time. It’s not going to be a lot of time. It’s not as much as you used to have, but it’s really high quality and you’re very deliberate about the time that you choose to, you know, meet certain people or whether it’s for yourself or for other people. So, um, that’s just my little segway for my introduction. So, um, first of all, I’m really glad for Annie, uh, for, for pulling this together and all the other, uh, leaders in APAMSA. I’ve actually never been to an APAMSA event, so I’m super excited to be a part of this. I’ve actually been thinking that I have not been very good about being in, like, our own society of Asian-American surgeons, and like, that has been like my priority this year to be, like, more, uh, present, uh, because I really do think that it’s important that, you know, you guys look around your generation, you see mentors that look like you, right? Um, and so then you can kind of see, like what? What are their paths? How are they able to get there? Right? Like, I feel like that’s how people are more comfortable, um, sort of choosing those careers, right? Like. I was kind of intimidated about being a surgeon because I looked around and it was a bunch of white males, and I was like, how do I really fit in here? Right? And I think the more that I went through my clerkships and obviously residency, it changed. And so it’s, it’s become a lot more diverse and in fact, more women than men are. So background for me. I’m an acute care trauma surgeon, so I do both emergency general surgery and trauma. Um, I am now in Dallas. Um, so I trained in Boston and I’m actually from New York, so I’m jealous of all the people that get to enjoy New York bagels, because the bagels in Texas are terrible. Um, and then I train in Los Angeles for fellowships, so now I’m all over the country. I used to be the associate program director for the fellowship, and I am very good friends with a lot of the associate program directors for the residency as well. Um, so number one, uh, I’d say that, you know, when you are first exploring this new city because oftentimes you guys are moving towards totally different cities, different states, right? Like, explore that place before you have to hit there, like day one, right? Like, where is the hospital? How am I going to commute to get there? Like practice the commute, right. Whether it’s biking, walking, subway, car or whatever. Um, because you might find like, for example, in the snowstorm, when you’re parking on that street, you got to dig your car out of the snow, right? And that’s an extra 20 minutes. 30 minutes you have to factor in to your commute. Um, I personally, I was like, I pay more money just to get covered parking if I were in a snowy city. Um, so just get the lay of the land, you know, talk to the other, you know, people that live there now, whether they’re medical students or interns and be like, where do you live? Why do you like being there? Right. Like, just figure out that place. Um, and for anyone in residency, you’re going to be in a new rotation every month, every 30 days, 31 days. You’re going to be thrown into a completely different world. Pediatrics. Gastroenterology. Cardiology. Like, I think honestly, that’s one of the best things about medicine. You get to just experience. I think it’s almost like a new country. It’s a new language. You’re looking at different body systems. You’re learning the lingo of certain things, right. Vascular surgery, it’s all about pulse exams, circulation, inflow and outflow. And I think it’s really cool. I think that if you look into each rotation as being an expert in that field, like this month, I’m going to be a pediatrician next month. You know, I’m gonna be a gastroenterologist and really, like, immerse yourself in that. I feel like you can get your best shot of, like, thinking, is this the kind of life I want? Right? Um, some of you guys already know what you want to do, and that’s great. But I know a lot of people that change your mind as they’re going into medicine, so keep an open mind. Um. The other big thing that I learned was reaching out to the interns that are already on service and kind of like figuring out their hacks, right? Like, what’s the fastest way that you get information? Um, how do you print out lists? Like, how do you like, what’s the way that you build your electronic medical records, sign out sheets, right. Like everyone’s got a different way of doing things. And those little hacks that the interns give you are going to be gold. Um, and then the big thing, and I’m sure you guys have figured out as medical students and, you know, the staff figure this out to the attendings. We know when, um, you know, when people are working really well together as a team. And we can also feel at least like when there’s, like one person that just wants it all and doesn’t want to share with anyone else. And that’s just not helpful. Um, and because at the end of the day, it’s all about the patient, right? And I think that being a part of the team and not just being it’s me because you’re past already. You got through the gates. You’re now a doctor. Okay. Now you just focus on taking care of the patient. It’s not about winning anymore. Okay. Um, so the next thing I already kind of talked about, but just kind of like immersing yourself, you know? And if you’re like, I really want to be, you know, an interventional radiologist. Well, you know, go do that rotation. Ask them what their lifestyle is like. Like, I’ve had plenty of medical students ask me, like, I really love surgery, but gosh, like, these calls are so hard. And I tell them, like, that’s not my whole life. I don’t do this all the time. Um, that’s only half of my month. And the other half don’t even see me because I’m in my office. I’m like, running around the lake, like I’m doing other things. So our lifestyle is very different from what you see as a student, from what you see as a resident, from what you see a fellow, it is so a different hour that you have to wake up at the time that you go to bed and the kind of responsibilities you have. So don’t think that your experience as a med student is like, that’s what my life’s going to be, it will change. The last thing, I am very, very active. Um, I have a lot of hobbies, but I realized that when I became an intern that my 20 hobbies came down to, like, three hobbies. Right? So it was like I had some very, very, very selective about things that I really love to do. I love to bike. I love to run, and that was pretty much it. So I knew that it was are the only two things. If I had an hour on the weekend, I was going to do those two things. So be very, very selective about your hobbies and just pick the ones that like really, really mean a lot to you. Um, the other thing I was just going to say, just like, listen to your body. Like, you know, when you’re really tired and you just have to, like, say, okay, enough is enough. Those clinic notes, I’ll get to them, right? Like, I actually need to sleep. And I think the people who are, like, chugging the Red Bulls and the Celsius drink and all that stuff just to stay awake like it’s temporary, but you’re going to crash at some point. So, um, you’ll get a sense of like when you’re pushing yourself a little too hard and you’ll get a sense– you get a better sense of that. I think you kind of know, like when to kind of back off a little bit. But listen to your barometer. Um. That’s all I got. 

25:56 Q&A From Audience

Annie: Okay. Thank you so much for each of those insights. I hope that someone on this call was able to take something with them. Um, I know that I personally am pretty far away from this step, but I think that in general, there are some very useful tips here on how to navigate medicine and how to take care of yourself while doing that. Um, so before we jump into questions, I just wanted to see if, um, anyone is if anyone is uncomfortable with us recording the Q&A part of this. Otherwise, good to go. Okay, perfect. So now we’re going to open up the floor for questions. Feel free to drop them in the chat. Or you can, like our panelists said, be brave. Um, unmute turn on your camera and ask anything you’d like.

27:00 Navigating Conflict in Residency: Strategies for Professional Growth

Donna: Uh, hi, I’m Donna Tran. I’m a fourth year. I’m going to psychiatry. Uh. Super excited. I had a general question. Um, can you give your tips on, like, when you don’t get along with your co-residents, either in your cohort or outside of your cohort? Um, and attendings, like, how do you handle those kinds of conflict? Especially now that I’ll be PGI one at the bottom of the totem pole. Again, not like med students, but you catch my drift. 

Dr. Kajita: Um, I’m happy to start. Uh, because I’m feeling talkative tonight. That is a great question. Right? Like, who do you go to? Like, you don’t want to be the person who’s, quote, high maintenance or ratting people out. You also, um, don’t want to have that kind of conflict, right? And can I just say something, even though you’re quote at the bottom of the totem pole or the– we don’t say that anymore, but if you’re at the bottom of the ladder, you know, you’re really you’re just as important. In fact, you’re one of the hardest working members of the team. So please don’t diminish your role as a PGY-1. Um, my suggestion would be that, um, usually, um, feel out when you start a program, your chief residents. They are a great place to start because usually they’re doing extra work to support all of you guys. Feel them out and check in with them. The other thing is, if it’s an attending conflict, you can sort of ask your colleagues, I’m not sure. And sometimes I’ll tell you now that’s the way the attending always is, right? But don’t bottle it up. Right. Think about it. Take it home. Think. Sometimes people are having a bad day. You can sit with your discomfort for a little bit, but if you know it’s impacting your work, please, um, reach out to someone. And there’s so much more I can say about this, but I want to leave it for other people to talk. 

Dr. Kagetsu: I’ll just make a comment. Uh, hopefully your hospital has an ombuds office, so depending on the issue, uh, reach out to the ombuds office and they can deal with– help you deal with issues, uh, confidentially and impartially and all that sort of thing. Um, but, yeah, it’s a good question. 

Dr. Partha: I would just add, I, I totally agree. Donna, I think unfortunately, this is a reality. You know, we don’t get along with everybody. Um, and if it is causing issues with patient care in your day to day well-being, you know, first and foremost, you might want to see if there’s an ability for you to just sit down and chat with the person, like, um, we all have different communication styles. It might just be a matter of saying, hey, just want to let you know a little bit of something about me. You know, you might think I’m kind of slow or you seem to be– I know I might be a little slower, but I work. I need to process things. I appreciate that we’re, we have a time constraint, and I can see that you would like me to be faster. So, um, you know, can we work on something? Because this is the way I work? And and just kind of putting it straight out there, if it’s sort of obvious why you both are clashing is just to say, you know, we’re going to be working together. I really want this to be a positive working relationship. This is how I work. How do you work? Can we figure out a way to, um, work together? And because inevitably, you guys will be back in contact again in a residency program. Um, but as others were saying, there should be a process if it’s actually really, um. An unhealthy situation. Chief residents. Associate program directors, program directors, etc. should be able to help. 

Dr. Kajita: To be clear, the other thing I wanted to point out is that conflict is part of working with other people. But let’s be clear if it’s harassment, please report it. Period. 

Dr. Park: Yeah. The only thing else I would add is that, like, you know, if it’s related to a patient, like, you know, obviously like take care of the patient first, unless it’s something that’s completely egregious, like, you feel like the patient’s life is in danger. Um, and I think there are some things that we have, you know, discussed as a high reliability organization. Those are things that you make here. But, you know, asking things like, hey, can I ask a clarifying question, you know, did you mean to do this? Or like, I just want to understand, like you want to do this, you want to administer this medication for this thing, you know, and just repeating it and, you know, maybe that will maybe that person would be like, oh, no, that’s definitely not what I meant. Um, and so it’s just kind of allowing the opportunity for them to maybe, you know, rethink what they said. Um, what I’ve heard some other people say, it’s like if someone says something like, really insulting, uh, I know other people have said, can you please repeat that again? And they usually don’t, because they realized that it was something that was just not appropriate at all. Um, and that’s, I think, some way of kind of asking people politely, um, to kind of address the question if it has to be in a public place without like, you know, having it escalated to something else.

Donna: Thank you. 

32:33 Common Pitfalls and How to Avoid Them

Annie: Those were some wonderful responses. Thank you guys. Um, we did have some questions submitted to our RSVP. So the first was what are some common pitfalls in intern year and how can I best prevent them? We did touch on some of these earlier, but if you guys have anything to add. 

Dr. Kagetsu: Oh, I’m just thinking one of my residents asked me you were a program director for 15 years. What advice do you have? So I said, you know, every day is a job interview. And, like, I don’t know if that’s what they wanted to hear, but it’s kind of true that, you know, um, and in fact, these days and that given given the toughness of the job market, some of the residents that, um, end up working at the place where they did residency, I recommend they do a fellowship elsewhere. But then you come back with this kind of secret knowledge and can be an attending. So we have had former chief residents end up working with us. And I would say, you know, um, consider a, um, a leadership position, like a chief resident. 

Dr. Partha: I would say one of the biggest pitfalls that I’ve seen, again, speaking in internal medicine is time management. You just do not have the time that you did as a student. Um, so figuring out that nice balance between I want to spend time with my patients, get to know them, but I do not have the, um, time that I had as a student so quickly realizing that you want to get your time management skills under control sooner rather than later, rather than waiting too long when you’re kind of struggling because you’re too embarrassed to say, I need some help here. So probably pitfall number one is not knowing how to ask for help soon enough. 

Dr. Park: One of the more memorable things that I had as an intern, I was talking for a friend at a hospital I had never been to for a week, and I, um, was late to sign out in the afternoon, and I just didn’t have all the numbers because I’d been running around all day. And the chief resident just, like, humiliated me in front of everybody. And I still remember that day. And you know, the lesson I took away from that was could I have been more efficient? Absolutely. Um, but as a chief resident, did I do that to somebody? Absolutely not. And I think you just learn, you know, there are just certain things you just won’t be able to do. And just don’t lie about it. Just you didn’t get it done. And you think about it when you go home and you’re like, how could I have done to make that better? Right. Observe other people. Right. How are they doing it? Like some people might, you know, make their lists a certain way. They might do checkboxes. They do, you know, whatever it is, it’s like– kind of gauge, like what’s going to work for you, right? Like, you might have a system as a for the medical student. Um, so I think for the med student, fourth year is a great year to start refining those things. Like what technique works for me? Do I like the multi-tip pens with all the colors and the color system works for me by whatever. Like if you figure out a system that works. Well, I think the biggest thing is that you will make a mistake at some point. Okay. And it’s just going to happen, right? Something’s got to happen at some point during your intern year. And I guarantee you every single year that you are a physician and it happens to everybody. Okay. The question is, is what do you do about it? And do you have a safe place to talk about that? Right. So don’t like bury it inside of you and say, I’m a terrible person and I’m not good for this job. There’s a reason why I’m sitting in this conference right now is the reason why I care about it, is to do that like you got here for a reason. So don’t forget that. 

Dr. Kajita: I think that’s we’re all great. And right now I don’t have anything else to add. 

36:38 Endurance in Medicine: Sustaining Passion and Well-Being

Annie: Okay. I’m going to ask a second question and then we’re going to open it back up. But the second was how can you stay the course throughout the length and the rigor of training mentally, mentally, physically, etc.? 

Dr. Kajita?: Um, if I may, I think this goes back to something that Dr. Park said it’s just kind of checking in with yourself, right? And I think that as part of checking in with yourself, don’t compare yourself to other people. Right? Be honest with yourself and remember that you’re doing this for your patient and yourself, and you just can’t do it well unless you leave something in the tank for yourself. So if that means that you have to tap out, that’s okay. If it means that, um, you need professional help. That’s okay. Um, but definitely, um, don’t ignore the signals that your, your emotions and your body are sending you. 

Dr. Partha: Um, I would add, uh, I forgot to mention I listened to a really great podcasts. If any of you listened to Hidden Brain, it’s wonderful. And there was an episode from September 2023 called Being Kind to Yourself that I highly recommend. So I think you can be, um, sustained in your career if you learn how to be kind to yourself, uh, to again, kind of tap on to what Dr. Park had mentioned, do things you love, take care of your body and your mind, and surround yourself with the people and the things that you love. Um, you know, nobody can do this by themselves. So rely on your friends, your family, your loved ones, whatever brings value and meaning to your life, whether it’s arts, religion, music, exercise, um, and choose a path that you can do on your worst day, is the best advice I could give you when you’re choosing what you’re going to choose for your lifetime. Um, and ask the people who have been doing it as Dr. Park mentioned, don’t imagine, oh, this is what it must be like. So I’m not going to do it or am going to do it. Ask the people who are doing it so you make a good choice. Um, because the road is long, the career is long. It’s a great thing. But also know that you can change your path a little bit as well. So you’ve got flexibility in this job. Um, so don’t feel like you’re going to be stuck. Um, but make– make as good a choice as you can when you start. 

Dr. Kagetsu: It’s my turn. I have nothing to add. Good advice. Or although I could kind of joke and say choose a specialty like radiology and it’s not so stressful. But that’s what propagates a stereotype. But it’s kind of we kind of deserve it. 

Dr. Park: Um, it’s not really advice. I just find it ironic that we have, like, been basically engineered to become perfectionists. And, you know, you kind of have to unlearn a lot of those, I don’t want to say bad habits, but I mean, to some degree they are because like you have, you know, been this way and been successful and that’s what made you so successful. But it can be also very destructive. And I think at some point you kind of have to know, like, okay, pushing myself too hard here, like I don’t have to be perfect for this one, right? Like I just have to do my best. So they’re very different things. 

Dr. Kajita: Yeah. And along those lines, I think we tend to think of big ones as success and fulfilling. But sometimes it’s finding the joy in the small moments, like you’re having a really lousy day and this happens everywhere, right? You’re having a terrible day. But then there’s that one thing where you connect with someone. You realize that you change something just a little bit, and if you can find a little bit of joy in that, that will keep you going. And as Dr. Partha was saying, um, choose something that can give you those moments, moments of joy. Maybe it’s radiology. So. Find joy. 

41:13 Finding Our Voice: Asian Identity in Medicine

Dr. Partha: Can I ask a question, Annie? I guess I’d be curious either for, um, the other panelists or some of the students. Uh, because this obviously is sponsored by a APAMSA and similar to Dr. Park, I hadn’t really been, you know, involved, um, the whole kind of Asian identity, South Asian identity as an Indian, I can say, can be a little confusing or mixing. Um, until I had done an event with Dr. Kajita and really enjoyed it. But I’d be curious how you all might feel that your Asian identity has impacted or not your medical path, or what do you think might be, uniquely a an experience that you all have had in as a person in medicine. Um, that someone who does not come from an Asian background may not be able to share.

Donna: Um, I just want to give a quick introduction, so. I’m sorry. That’s my dog. Uh, I’m Donna Tran. I’m the immediate past national president or her president is Joyce. She’s amazing. Um, but to answer one part of that question, we are working on expanding our alumni network and doing an outreach to see if we could kind of create a space for pan-Asian, um, physicians, because there isn’t really one, like there’s a national medical association, there’s a Hispanic association, but there actually really isn’t one on that scale for all Asian Americans. And so that’s something that we’re working on. And we actually have Dr. Kagetsu who’s one of our senior, uh, alumni advisory board members and also leads our faculty as well, uh, for APAMSA. So I would actually kind of put him on the spotlight. Sorry about that. I know you like it, though. Um, and for him to kind of answer that question since he, you know, obviously, you know, went to residency and did stuff before APAMSA, so, you know, came out. 

Dr. Kagetsu: Thank you Donna. Um, you know, I, I actually kind of have, um, imposter syndrome for being called an APAMSA alum because it didn’t exist, and I wish it did, but I think there are like, you know, we perhaps some of us on the call have experienced this. You know, somebody would always mistake me for the other Asian, uh, student and, and that sort of thing. So, um, yeah, I don’t know, sometimes maybe we feel we’re invisible, I suppose. And, um, I think the founders comment that there’s kind of a stereotype that the students are just quiet and, and, uh, and perhaps that was a survival skill for some of us. And, uh, I think we we do have to, um, almost prove that, um, we’re not that quiet stereotype and and, uh, speak out when the, when the time is right and that sort of thing. So I think it is, um, in my part of the stereotype, maybe positive that, you know, we’re smart, smarter than the average student or something, but I don’t, I don’t– It would be interesting to hear, hear my colleague’s thoughts. 

Dr. Park: Uh, I did, I mean, I, I went to high school– elementary school. There weren’t a whole lot of people. I actually grew up in the Bronx. Um, and, uh, it didn’t have outside of, like, Korean school on Saturdays, I didn’t actually really have much interaction with, uh, Asian Americans, specifically Koreans. Uh, and so I think just like a lot of people, um, in my group, it’s like you tend to gravitate back towards that and you want to learn, relearn your language and all these things. And, you know, in your second, third, fourth decade of life, um, I find that I kind of do live to the stereotype in some ways. I am a little– I am actually a very big introvert. And, uh, I actually did not get the best scores in my surgery rotation because I was so quiet. Um, people kind of misinterpreted that as being disinterested, which is too bad. And so I kind of struggled with, like, how do I show my interest without, like, being the loudest person? And I still struggle with that. And I think it helps when you are an environment where people notice your hard work. Not everyone is like that. Not everyone has bosses that kick off for people who are like just going through the ride, doing a good job and doing the right thing. Um, and we can easily get lost in that so easily. So there’s a reason why there are not that many Asian-American surgeons in leadership roles. I think there’s a lot of reasons why we get passed up on the things. We either don’t seek them, we get passed up on things or whatever it is. Um, so I– for me, anyway, I think it’s the first personality thing, I think it’s a cultural thing and it’s something I’m still working on. Um, but, you know, I think unless we talk about it and we kind of approach other people like this, it just will continue to perpetuate. 

Dr. Kajita: So I think I would echo what, um, the other panels said and Dr. Parker just put a comment in the chat box about the bamboo ceiling. Uh, there are many ceilings. And I think, um, you know, there’s an assumption, obviously, that certain obviously just stereotypes that go with race, ethnicity, uh, identity groups and you’re sort of saddled with those and you also have to acknowledge that some of those values are not necessarily bad things if you’re a little quiet. Right. And the other thing is that, you know, don’t always assume that I’m good at math. I was terrible at math. It brought death. Really. So. So it’s tricky, right? Because I think we struggle. Then also, what does it mean to be, um, uh, sort of, not your your voice not being heard or feeling underrepresented because I think sometimes Asians are not considered the classic model of underrepresented minorities, for example. So I think hearing from people I work with now, residents and so forth, I’m happy to see that a lot of that has changed. Um, but I still think that it is something that it is, um, something that I find hard when I see an evaluation. It’s like the too quiet thing. They’re thinking, okay with that, right? Um, and that part of it has not changed entirely, I think, to some degree. And that’s my two cents. 

Donna: Yes, you’re all goals, I think everyone here can agree on that. You’re all goals for us. And if you would like to still stay involved just with, you know, at a med student level or even interested and, you know, seeing what, you know, a pan-Asian physician organization kind of looks like, please, um, just let Annie know and then she can, you know, give your emails to our appropriate, like, APAMSA student directors. Um, just because. Yeah, just because, you know, it wasn’t around when you weren’t in med school or you didn’t have a chapter. Uh, I think the goal for us is that, you know, advocating for health is, you know, a lot better in bigger numbers, right? And there’s just so much untapped potential in the, you know, power of numbers. And so just giving everyone on the same page, I think on the backdrop of COVID and anti-Asian racism has really brought everyone together. And so hopefully moving forward in the next few years, we’re going to be building that up. So yeah, please let her know if you’re interested in keeping in the loop for that. Even if you’re, you know, from different backgrounds, like even on national board APAMSA, we have a South Asian and Southeast Asian, LGBTQIA, women in medicine directors. Like we try to hit every target I can to be as inclusive as possible. 

Dr. Partha: No. That’s wonderful, I guess. Um, it this the South Asian term, and this is how old I am, is kind of a new term. I was never South Asian, and growing up I was just Indian. Um, and so when I went to went to undergrad at Stanford many years ago, I was like, oh, there’s an Asian American student group. Of course I belong there. And I’d go and show up. And I was literally like, the only Indian there. I was like, oh, am I not Asian? Um, and there was not an Indian student group at that time, which sounds unbelievable in the Bay Area to say that now. But we started an undergrad Indian student group because there was a graduate student one, but those were mostly students who were international students. So it’s very interesting. And I find it– I think there’s a lot of commonalities between Asians of many backgrounds in terms of culturally and, um, how we’re brought up the whole ‘we’re great hard workers, and there’s many of us, but fewer of us’. My husband and I always laugh like we’re always the Indians and not the chief kind of thing. So, um, I think there’s a lot of great work, um, that can be done. And I’m excited that there’s all these really passionate students who are being motivated to do this. And it begs the question of just the science as well, like studying Asian American health and moving that forward. So kudos to all you guys for really, you know, not just talking about the change but making it so it is a privilege to be with you guys. 

50:48 Closing

Annie: And that’s our latest installment from the Leadership Committee. If you have a specific topic or specialty you’d love to hear more about, please let us know. You can reach us at professionaldev@apamsa.org. We hope you enjoyed today’s episode as much as we did, and don’t forget to tune in next time! Thanks everyone! 

Listen here:

YouTube
Spotify
Apple Podcasts 

This episode was produced by James Chua and Ashley Tam, hosted by James Chua, and graphic by Callista Wu and Claire Sun.

Time Stamps: 

00:00 Introduction to White Coats & Rice: An APAMSA Podcast

00:52 Introduction to Dr. Neel Singhal

01:24 Day in the Life of a Neurocritical Care Physician Scientist

03:57 Why Neurocritical Care?

05:16 Evolution of the Practice of Neurocritical Care

06:48 Neurocritical Care at UCSF 

07:51 The Various Roles of a Modern Physician

09:44 -Omics Research in Medicine

12:11 Recommended Experiences to Pursue Neurocritical Care

13:22 How to Find Mentors  

14:33 How to Stay Grounded

16:09 Having a Partner in Medicine

18:03 Maintaining Relationships and Friendships While in Medicine

19:37 The Role of Research in Work-Life Balance

20:45  How to Be Present for Your Family

23:39 Taking Care of Yourself

25:44 Intramural Sports and Friends Outside of Medicine

26:43 Taking Vacation Time and Traveling

29:20 What Would You Have Done Differently?

31:02 Taking Advantage of Free Time Before Residency

32:45 Closing: What is One Thing that Brought You Joy Today?

Full Transcript 

0:00 Introduction to White Coats & Rice: An APAMSA Podcast

Annie: Welcome everyone to the 5th episode of the Asian Pacific American Medical Student Association Podcast. From roundtable 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 Annie Nguyen, a postbac at Stanford University, and a member of the Leadership Committee at APAMSA. I’ll be your host for today! 

This is our Ask Me Anything Series! Each month, we spotlight an extraordinary physician who shares their insights on medicine, life, and everything in between. This is your chance to ask questions, hear their stories, and learn more from their incredible experiences. Whether you’re curious about their journey, their day-to-day, or their views on the future of medicine, nothing is off the table. Let’s dive in!

00:52 Introduction to Dr. Neel Singhal

Annie:  Today, we’re speaking with Dr. Neel Singhal, a physician scientist at UCSF specializing in neuro critical care. Dr. Singhal earned his medical degree and doctoral degree in neuroscience from the Perelman School of Medicine. He then completed a residency in neurology and a fellowship in neurocritical care at UCSF. He is a member of the Neurocritical Care Society and American Heart Association, and his research focuses on improving the diagnosis and treatment of neurological emergencies, including stroke and traumatic brain injury.

01:24 Day in the Life of a Neurocritical Care Physician Scientist

Annie: Dr. Singhal, we’re very excited to have you here today. Thank you for being here. if you could start with just a brief introduction about what a day in your life looks like. 

Dr. Singhal: Thanks so much for having me and happy to be here and impart any wisdom or lack thereof that I’ve learned over the last many, many years in academia. At this point, although I don’t feel that old when I look back at the calendar and see how long I’ve been in medicine. It’s it’s been most of my life at this point, um, or more so than when I was a kid. A little bit about my day looks like I would say, I finished my training, my fellowship in 2015. So I’ve been out of training, just for about ten years, and I would say year-to-year of what I do in a day or what I do over a calendar has changed somewhat. I would say right now I’m reached somewhat of an optimal state for at least you know, what I want to do. About two thirds of my time is protected for research, and then about one third of my time is clinical work. On an average week I’ll see patients half a day a week, and then the rest of the have reserved for research and administrative activities. One week out of every two months or so, I’ll spend the entire week in the hospital. You know, in terms of rounding on patients and the neuro critical care unit or neurology services. On a day to day running a lab for those of you that have worked in labs, I do a lot of the things that you’ve seen your PIs do. I would say I spend a two days, writing, whether it’s papers or grants. Writing is a never ending thing that you continually evolve with how good you are at it and how quickly you can do it. I spent a lot of time analyzing data. I still have a very small research group. you know, two and a half full time personnel and three students, and while they’re busy generating a lot of data, I end up doing a lot of the analysis. I do a lot of mentoring of the people I have, helping them write their grants, helping them write their papers. I do some experiments every now and then, especially if I’m onboard new undergraduates. And a lot of meetings, like to facilitate collaborations, to facilitate clinical care of the clinical programs I’m involved in, some meetings for fun, like academic talks and, clinical talks and things like I’ve come to the point where I feel like I have a pretty good balance of the things that I enjoy.

3:57 Why Neurocritical Care?

Annie: So this balance and having your hands in a bunch of different places sounds really exciting because you get some of the clinical input as well as some of the maybe less exciting administrative stuff, and then you have all your scientific endeavors. Was this structure something that attracted you to this specific line of work, or what was it that attracted you to neuro critical care? 

Dr. Singhal: I would say that, really for me, and it might be different for different people that you ask. But for me, I was really driven by the content more than anything else. I didn’t think so much about what my life would be like, and if I had thought more about what my life would be like, I think I would have been wrong, because I wouldn’t have exactly known how either clinical care would evolve or labs would evolve as well, or differently as they have. But I was really just content driven, you know, for better or for worse. I just really enjoyed working in the intense environment of the ICU. I really like thinking about the brain. I mean, ever since I was a kid and my mom was in college while I was a kid, bringing home psychology textbooks, like the stuff about the brain just always kind of fascinated me, and I’ve just always been drawn to it. And in college, that was cultivated in med it was just the, the content, the teamwork, talking with patients, helping patients deal with devastating brain injuries, helping families come to terms.

5:16 Evolution of the Practice of Neurocritical Care

Annie: How do you feel like the field of neuro critical care has changed the course of your practice? Where do you see it going?

Dr. Singhal: Neurocritical care in particular, is an example of a field that’s pretty young compared to other, more established fields. And because it’s so young, it’s practiced differently at different places. And in terms of practice, I don’t mean the actual content, I just mean kind of like what the structure of your day is. For some neuro critical care it’s very embedded within neurosurgery. And, you know, you’re really, really hand in hand with the neurosurgeons a lot. And in some programs, it’s a little bit more like you’re practicing neurology in the ICU– how we practice it here’s a little bit of we do some stroke work and some neurosurgical work and some more straight up neurology, sort of a good mix. You know, when I was inspired to go into neuro critical care is when I was in medical school at Penn. But the way that the unit is set up there is kind of very different from the way that it’s set up here. One thing that’s evolved in ICUs, not just neuro ICU, but other ICUs the strong contributions NPs and PAs to the critical care practice, so it really allow for these larger– for you to practice in larger units, taking care of more patients with more staff, but still sort of being able to do a good job because you have really well physician extenders to some, to some degree. So I think the practice has changed in many ways. And it’s different in many ways because of just depending on what institution you’re at.

6:48 Neurocritical Care at UCSF 

Annie: Are there certain things about the division at UCSF that really drew you in, aside from being able to do research? 

Dr. Singhal: I think being able to do the research is a big part of it. At a lot of places around the country, when you’re practicing something technically intense as, like, surgical specialties or practically intensive, as many medical specialties are, the program really benefits from having clinicians that are really focused on the clinical. But at places like UCSF or academically focused places, we just have an abundance of intensivist and neuro intensivists. Look at the whole state California or look at all the non big cities in California, and maybe there’s like one or 2 or 3 neuro intensivist in those cities, Fresno or, Reno or upstate California, there’s very few, but then you look at the big cities, the big academic centers we have like a dozen, just here at UCSF and, if you include the whole Bay Area we have so many, so it really gives us the time that we need to, know, devote to clinical care, but then also to extend the capabilities of clinical care with research. 

7:51 The Various Roles of a Modern Physician

Annie: For those who are interested in neuro critical care, do you believe that research is an experience that is essential for their training? Or are there other skills and experiences that would be very helpful?

Dr. Singhal: Nowadays, in most fields of medicine, I don’t know if research is essential anymore because there’s so many roles for physicians, so many useful roles physicians can play, and research is just one of them. Even at places like UCSF, research is not, necessarily required for some specific job descriptions. Historically, places like UCSF and academic centers really benefit from having researchers around, and a lot of patients come to places like UCSF because of the research capabilities and the history of that. There’s just sort of no end to the, to the need that physicians could fill. There are so many skills that amazing administrators and leaders, clinical leaders have that researchers just don’t have the training and maybe don’t want to cultivate the skills necessary to do that. And having specialized administrators that can really put together excellent clinical programs is a skill unto itself. Education is another forefront where academic centers don’t necessarily need you to focus on research and over the last five years, there’s a late but growing recognition that just because you’re a physician doesn’t mean you’re a teacher. Places like UCSF and probably others have really invested a lot of time and money into teaching educations, teaching physicians how to be educators as opposed to just sort of handing them students and saying, you know, somebody taught you, so now you can teach they’re actually giving people training in how to be a good teacher. And then even within research, right, it’s not just basic science or clinical research, but is epidemiology, public health. There’s almost different niches to fill if you’re a physician.

9:44 -Omics Research in Medicine

Annie: So on the note of research, there was a question in the chat from Reanna about transcriptomics and genomics research in the neuro critical care setting. So any thoughts on that? 

Dr. Singhal: One of the best examples the medicine field has for precision medicine is oncology. Oncology really had amazing progress in treating so many different types of cancers over the last 15 years and brought new things, new therapies to market for very specific cancers and have the promise to do so more. And not maybe not every field is going to benefit as much precision knowledge about the disease, but it can’t hurt. And I think we’re just at the surface of understanding the contributions of -omics like genomics or transcriptomics or proteomics other new -omics that people keep coming up with, and other omics that are that we don’t even know about, you know. And how that’s related to a specific patient’s disease. A lot of people say that progress in clinical research is slow because it takes evidence so long to accumulate about a treatment for example, in the in the world of stroke, one of the newest treatments since 2015 is something called embolectomy, where you can actually go in with a catheter and remove the blood clot if a patient has a specific kind of a stroke. And it makes such intuitive sense that this procedure would work because you’re taking out the blood clot and now they have restored blood flow. But there’s actually a kind of a long history of this procedure actually causing more harm than good when the devices were early and, even when the devices were, it wasn’t clear which patients would benefit from it, but then the science of radiology using specific radiology scans, you could define which population would benefit more from the procedure versus less. And it had to do with how much viable brain tissue they had. So that type of precision radiology really helped stroke advance. And similarly I think that type of precision-omics can help a lot of different fields advance, including neuro critical care. There’s so many controversies in neuro critical care that haven’t necessarily been answered by what people thought would be, definitive clinical trials. And the opportunity to have additional biomarkers from -omics that might really help specify the patient populations that benefit from a treatment or don’t benefit from a treatment. 

12:11 Recommended Experiences to Pursue Neurocritical Care

Annie: So the generation of all these I agree, is very interesting. Sifting through all that data and finding these biomarkers is the next frontier, but there’s definitely a lot to sort. Are there specific skills or experiences that you would recommend for those who are interested in neuro critical care to pursue? 

Dr. Singhal: Most places now have a neuro critical care rotation. Certainly having that rotation under your belt helps a lot. If you want to go into any critical care field, the rotation that actually helped me the most as a med student was anesthesia. Spending a month in anesthesia was the most helpful thing I can think of in medical school. Maybe just for one reason, it just really made you comfortable with more critical situations. If you ask the most intensivists what the scariest things are for them, by far and away airway issues and spending a month on anesthesia is by no means enough time to become an expert on airway, but at least it gives you some knowledge of like what you would need to know to help take care of patients airways when those crises come up. So anesthesia was a super helpful rotation for many reasons. The background that you get from neurology is obviously helpful. But then, you know, more specifically, putting that together in the critical care.

13:22 How to Find Mentors  

Annie: You mentioned earlier that there are undergrads that you’ve mentored before, and it does sound like mentorship is very important to you. Do you have any advice on how to approach mentors in neuro critical care or the best way to find mentors? 

Dr. Singhal: Yeah, that’s a hard question. sometimes you find a kind of by accident. You know, you just, come across someone in a clinical setting or a non-clinical setting and, you know, sort of clicks that, they’ve gone down the path that you want to go down and you want to learn from them, and they seem to be open to it. And that’s always those organic types cultivated relationships are sometimes always the most rewarding. But sometimes you’re not going to run across that by accident, and you have to kind of go out searching for it. You know, the power of a cold email when they’re not ignoring that tells you something about, someone’s openness to mentoring because a cold email might be the best way to put you in touch with someone who you truly feel like you could learn from. I would suggest that that email talk about what your interests are moving and just see if you can set up an initial meeting and talk more. What really comes through in the students that we take on often, are less the experiences they’ve had and more, you know, what they can commit.

14:33 How to Stay Grounded

Annie: You mentioned that this is a very intense, uh, specialty to pursue. Are there certain things that you did during your training to really maintain, like a strong sense of grounding, or what were the things that you relied on to kind of get you through it? 

Dr. Singhal: Oh, that’s a sort of a multiple fold question. I was the type of person and maybe still and just kind of put my head down and do the work as efficiently as possible, and then, you know, go live my life. So on one it’s nice to silo the work and the non-work. There’s nothing that’s going to recharge you as much as leaving your place of work. But on the other hand while you’re in training, you’re working so many and there’s always pressure to work more hours, it’s difficult to, like, totally silo it, and it’s difficult to step away from it. It’s difficult to know when to say “no” to those things. It is important to, set up some sort of boundaries, although it doesn’t have to be perfect silos. It’s important to also, while you’re going through to not forget what motivated you in the first place. I interview a lot of students as they’re applying for medical school and I’m always so impressed with everything they’ve accomplished and everything they want to accomplish. And then I work with a lot of students on the wards, and sometimes you can tell the students on the wards are beat down and have forgotten the things that motivated them to go into medicine in the first place. So not forgetting the things you’re motivated and knowing when to say no or when to go home and then knowing what recharges you, is important. The things that might recharge you that’s different for and that’s changed for me from time to time as well. 

16:09 Having a Partner in Medicine

Annie: So having a support system definitely sounds very critical for you. You had mentioned that you or we know that you have a partner in medicine. Can you tell us a little bit more about how this played out for you, or what kind of support this provided you? 

Dr. Singhal: Yeah, yeah. I mean, we, we’re like the super dorky couple we met at a neuroscience conference. We met at– my wife and I met at Society for Neuroscience in 2006 and, uh, she was already matched to come out to San Francisco. We started dating when we were both in Philadelphia and training, and then she was already matched to come out here in 2009. And then I remember meeting with one of my mentors, uh, Steven Galetta, who’s at NYU and was at Penn before, and he has this thick New York accent that I’m not going to try to imitate. But he said, “you know, if you’re serious about the girl, go to San Francisco”. So I, I came out and did in a way, sub-I in San Francisco. Um, and, and loved it out here. Um, so it was, you know, sort of amazing and also serendipitous that we were able to go through residency, kind of at the same, go through fellowship at the same time, faculty at the same time, and although we’re both in neurology, my wife does pediatrics and she does epilepsy and she does education. Our department is 300 people. So it’s not it’s not like we really overlap in space or subject matter, but there’s sort of enough overlap in our universe that, it’s great. It’s great to have a partner in that. It can also, at some points in time, be too much to have a partner that’s in the exact same, you know, field as you. I think from the beginning of our relationship that we’ve always really not talked about medicine that much. Like, I think we both have this unspoken rule of, you know, there’s other things going on. and that’s naturally happened as we’ve had kids, you know, we have an 11 year old, a 9 year old, and a 4 year old where, like most parents, 80% of what we talk about is the kids at this point. 

18:03 Maintaining Relationships and Friendships While in Medicine

Annie: What advice would you give to other physicians who are trying to manage their careers alongside supporting their spouse, who is also in medicine? 

Dr. Singhal: Maybe even though I have a lot more years on you guys, um, you know, maintaining any kind of relationship, whether it’s a marriage or a friendship or whatever it might be, it’s like a lot of work, right? You know, being a– being a son or daughter, you always have to put in work into maintaining that relationship. And, and there are times when you’re just going to have to apologize because you are going to have a lot of other demands on you. And sometimes you just have no choice, you chose this path where I’m going to be a resident and working eighty hours a week for four years. And, uh, it it just happens to be that in, you know, March, I have to work, you know, 80 plus hours a week, and I just don’t have time to hang out with my brother or hang out, go see my parents or, you know, hang out with my spouse as much. And, and the people in your life, in some ways have to accept that you have to apologize for it and offer, you know, support in times that you can or make small, uh, bits for bits of support in the ways that you can when you don’t have time. Um, Yeah, for better or for worse, going down the path of residency will sacrifice the time that you have for other things, and the people that are going to be closest to you are going to understand that. But some people may not. 

19:37 The Role of Research in Work-Life Balance

Annie: So setting realistic expectations, knowing what to expect and taking accountability. Those are definitely very helpful pieces of advice. Oh, we have a question on the same note from Reanna. Do you want to unmute? 

Reanna: How do you manage kids during your training and or career? And how do you ensure your present for your family? And then finally, do you feel like the aspect of research helps your work life balance? 

Dr. Singhal: I think research definitely helps. I’ll go with the last one first. I feel like research definitely helps the work life balance. That, you know, the thing about having kids is that it’s unpredictable when they’re going to need extra help or, you know, parents around or not. And, um, especially when they’re young, it’s just a lot of, like, brute force parenting where you have to be there for them, like when they’re infants and they’re sick and they can’t go to school. And, so it’s so unpredictable to have a little kid and research is predictable in that it’s never an emergency. So it’s the more time you have carved out for research or flexible time. That’s not patient care, the easier it is to manage your work life balance. 

20:45  How to Be Present for Your Family

Dr. Singhal: Um, Um, how can you be present for your family? Yeah, I, I think for me, that’s evolved over time. Like being an intensivist is both good and bad for the family. It’s good because, uh, what’s considered an academic workload for an intensivist or even a full time intensivist is not actually working every single week of the year. You know, like most hospitalist jobs are like 22 weeks out of the year, 20 weeks out of the year. Um, so you’re actually fairly available, right? As long as it’s not one of those 20 weeks out of the year, you’re pretty available the rest of the time to have flexible work life balance. But then you have to have arrangements on those weeks where you’re not present at all or like you may be totally ransacked even when you are home because of phone calls or having to look at images on the– on your EMR because people are sick and need your help. So how can you ensure that your present for your family, um, that evolves over time. Uh, when your kids are young, uh, when your kids are young, they’re going to need you more, and you may have to cut down your clinical workload. Um, or you may have to change your job a bit. I mean, one thing, I actually transitioned my job in 2022 to be less at the county hospital and more at the VA hospital, uh, because at that point, we had a third kid and I was going to have more responsibility at home. So kind of signed up for a five year, you know, period of time to be more at the VA and less at the county. Um, so that’s, that’s been great. You know, instead of working like 8 to 12 weekends a year, I’m only working like, you know, 3 or 4 weekends a year. So, you know, that’s a huge difference when it comes to like going to soccer games and being with your family. So, so even within one institution, you can cultivate your job, uh, such that, you know, I was at UCSF this whole time, but I just kind of focused more on one hospital, less on the other. Um, know, hopefully if you’re in a good spot, hopefully this flexibility in how you can structure your job. And then managing kids during training, I think that’s the hardest, actually, because you really don’t have much flexible time in training. Um, I don’t know how my co-residents, we had our kids at the end of our training, uh, so it didn’t impact us. But my co-residents who had kids, like, I just don’t know how they did it. It’s ,it’s really hard. Like, you– need you need help. You can’t do it on your own. Uh, whether that help is family or somehow paid or a combination. Um, I would say it would be expecting too much. I think having a kid in training, it’s definitely possible, people do it. Um, I don’t think people can get it done without help, though. 

23:39 Taking Care of Yourself

Annie: Fantastic insights. Thank you so much. So far we’ve covered balancing clinical care and research. Now we’ve talked about being a spouse and also being a parent. Um, the last thing is how you’ve managed to take care of yourself in all of this. Um, because you definitely can’t take care of others if you’re not sustaining, you know, your own well-being and everything. So are there certain things that have, you know, kind of helped keep you sane or are the things that you rely on? 

Dr. Singhal: As a kid and in college, um, I never really thought about, like, health or wellness that much. And that’s because I was already doing it without knowing it, probably like I was already super, you know, I was super into sports. I was always, like, playing a sport. Always. Um. You know, we’ve kind of signing up for different teams and staying super active, uh, you know, socially with friend circles and things. And then as you get deeper into your career or professional life, you kind of forget how important those things are to you. Or maybe you never realized how important those things are to you. And it’s like, well, well, I’m just, you know, I’m not going to really have time to play in that soccer league this year or I’m not going to worry about going for a run, you know, today. But, um, when those things are missing from my life, um, because life gets busy, uh, definitely, you know, realize that those are the things that recharge me, you know, like staying active. Um, not forgetting about social engagements with friends and, you know, you know, hosting dinner parties or going out with friends. And, and then it’s like, yeah, as things have evolved, it’s, you know, more like hanging out with my kids, taking them to the beach, uh, watching their basketball games, things like that. Um, those those so, yeah, in some ways, you got to kind of think about, okay, what are the things that really made me happy when I was younger? Am I still doing those things, or did they drop out of my life for some reason, and should I go back to them or not? So yeah, for me. You know, playing sports. Watching sports. Definitely. 

25:44 Intramural Sports and Friends Outside of Medicine

Annie: Can you tell us a little bit more about how you found little pockets or people or groups for these sports when you were transitioning from different areas? 

Dr. Singhal: Yeah, yeah, yeah, definitely. In my um, most cities have, you know, have different ways to like, meet up for, for leagues or gyms, I would say like joining gyms and joining, you know, joining sports leagues that you find online. You know, those are ways that my friend circle grew, I think, during training, um, serendipitously came across a lot of friends that weren’t in medicine. And that was also really, uh, an important part of staying grounded is having a lot of friends and outside of medicine as well. Kind of forgot about that when I said that earlier. Yeah. I had I had roommates who weren’t in medicine and that, um, expanded my friend circle to a much larger friend circle outside of medicine. And that kind of helps remind you of what life is like outside of medicine. 

26:43 Taking Vacation Time and Traveling

Annie: Always good to have those reminders for sure. Uh, one thing that you had mentioned, um, when we talked previously was traveling. So that was something that you have tried to make time for. Are there specific destinations that are your favorites, or how has travel changed now with your kids? 

Dr. Singhal: Yeah, yeah. I think, um, traveling is actually, you know, for friends I have outside of medicine, it can be hard to find time to travel because there’s there’s always, like, something going on in high pressure fields. And the good thing about medicine is that often, you know, you can, because because the culture has evolved, you can take two weeks off. Or if you don’t take that two weeks off, people are like, you know, why aren’t you using your time? And especially now a lot of places, you know, you can’t just keep accumulating vacation. You have to use it. Um, you know, UCSF we get four weeks off. So we’re pretty good about using that whole four weeks. Um, yeah, when you don’t have kids, that’s great because you can just travel off season and go to amazing places. And that’s what I highly recommend. During residency, traveling was great because it was just me and my wife, and we could go off season and, you know, take advantage of cheap flights. Um, so we had amazing trips before we had kids. As we had kids, we had less amazing but also fun, but also fun trips that were more local. Although this summer we did our first, um, trip to Spain with three kids. So we’re still trying to we’re still we still have the travel bug and trying to pass it on to them. Um, so totally possible to travel with kids. Um, you just got to work your way there and your parenting patience and skills. 

Annie: Do you have any tips for that? Specifically traveling with kids, especially when quite young.

Dr. Singhal: Yeah, yeah. Hard to give a blanket tip because every kid is different. But I will say that when the kid when kids are from like eight months to two, it’s just so hard to travel with kids, even though it’s free for this, even though it’s free for them to travel. It’s like, oh my gosh, short plane flight, much better than a long plane flight. And yeah, I saw someone put in the chat– to bring an extra person. Yeah, I think it’s all hands on deck sometimes. But once they get to iPad age, then, uh, they are happy to, they’re happy to watch the iPad for three hours when you usually, when I usually limit their screen time to much, much less than that. Mhm. Okay. Pro parenting tip right there. Yeah. 

29:20 What Would You Have Done Differently?

Annie: Um, as we come to a close, we just have some general questions to end with.  Um, are there any things that you would have done differently in your medical journey if you could go back in time? 

Dr. Singhal: I probably didn’t, um, really confront my weaknesses as much, and I might still not, um, you know, I know that one of my main weaknesses is not asking for help when I need it. Um, not asking for mentorship when I need it. Not. Uh, getting the collaborations. Not spending the time on cultivating collaboration, and instead just putting my head down and doing the work. I think I know those are my weaknesses. And, um, if I maybe really appreciated it, um, some of those things earlier. I think, you know, especially in the research world, I would have, you know, I could have maybe set myself up for better success or better collaborations. Uh, earlier. The general piece of advice surrounding that is, yeah, I think, you know, reflect hard about, you know, what your weaknesses might be, what your blind spots might be. And, you know, really, really try to face it head on. Like and critically. It’s hard. And I still don’t know if I do it correctly, but that would be one piece of advice. And then yeah, things that I would– 

Annie: I think you were saying that there’s always so many opportunities that you can pursue, and, uh, saying no can also be really hard. Um, have there been certain things that you’ve tried that have made saying no a little bit easier?

Dr. Singhal: No, I still struggle with saying no. 

Annie: Totally real life journey then. Okay. 

31:02 Taking Advantage of Free Time Before Residency

Dr. Singhal: But yeah, yeah. You know how to say no. Um, know, you want to say no as positively as possible when you do have to say no. Um, and then you just also have to realise that some things you can’t say no to. There’s a lot of unwritten curriculum in moving up the ladder in a hierarchical place like academia. And sometimes if you say no to the wrong thing, you know, they may not ask you again. Um, so, yeah, there is yeah, that’s talked about a lot now, but it wasn’t before. But yeah, there’s a lot of unwritten curricula in academia. Most important advice is, um, yeah, really enjoy that free time that you have before internship. It’s not the last free time you’ll ever have because residency is more humane now, but also has vacation. But it’s still a really, just nice part time in your life to really, like, just sit. Kind of sit back on your laurels a little bit and enjoy everything you’ve accomplished. Um, without much responsibility. In my fourth year, I got so much out of going abroad in the Spring, um, had an opportunity to to practice medicine in Botswana and South Africa and like, learned so much independence from that, that carried over to internship. Like, I think I was a mediocre MS3 and I was like a decent MS4. But then I became like a really good intern. And I think a lot of it was because I spent like two months abroad at the end of my fourth year, which was like super fun, but also like, just really increased my confidence clinically. 

32:45 Closing: What is One Thing that Brought You Joy Today?

Annie:  That’s an incredible experience. Wish we could learn more about that! Um, but the one thing we always love to end on with each of our speakers in this series, um, has been focusing on one good thing that happened today, kind of what you were saying. It’s really important to step back to enjoy this whole process, um, and to really be grateful for each day. So is there one thing that has happened today that you’ve been very excited about, or one thing that brought you a lot of joy? 

Dr. Singhal: Today was an interesting day of reflection for me because of this phone call, but also because I had, um, a meeting with another mentee. Um, so, yeah, it was kind of like a good chance to step back and, you know, think about, uh, and also I had a conversation with the premed person as well. So I had, like, uh, a lot of self-reflection about, uh, how far I’ve come the last few years so that, you know, that’s kind of, you know, a similar point where many fourth year med students are as well. 

Annie: I think it’s encouraging to hear that this self-reflection is something that has to happen at every stage. It never stops. You’re always learning, always growing. Perfect. Any last thoughts that you would want to share? That’s all that we have for today. 

Dr. Singhal: No. Yeah. Thanks for all the great questions.

Annie: And that’s our latest installment in the Ask Me Anything Series! If you have a specific physician or speciality you’d love to hear from, let us know! You can reach us at professionaldev@apamsa.org. We hope you enjoyed today’s episode as much as we did and don’t forget to tune in next time. Thanks everyone!