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

00:00 Introduction

01:09 About Dr. Monica Soni

02:54 Meet the patient

06:29 Navigating the patient interaction

08:26 Intersectionality of identity 

11:24 Medical school experience

13:56 Covered California

15:50 Working with the community

18:30 Barrier to accessing communities

20:10 Balancing physicianship with other responsibilities 

22:07 How can we integrate into the community

25:18 Scarcity mindset

26:58 Optimism

30:09 Beyond Covered

34:02 Expanding outside of California

36:15 Advice to younger POC women

37:57 What keeps you grounded?

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

43:55 Closing remarks

46:35 How to connect

47:27 Closing

 

00:00 Introduction

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

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

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

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

 

01:09 About Dr. Monica Soni

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

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

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

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

 

02:54 Meet the patient

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

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

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

 

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

 

06:29 Navigating the patient interaction

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

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

 

08:26 Intersectionality of identity

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

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

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

 

11:24 Medical School Experience 

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

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

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

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

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

 

13:56 Covered California 

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

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

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

 

15:50 Working with the community 

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

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

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

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

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

 

18:30 Barrier to accessing communities 

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

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

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

Dr. Monica Soni: Thank you.

 

20:10 Balancing physicianship with other responsibilities

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

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

 

22:07 How can we integrate into the community

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

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

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

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

 

25:18 Scarcity Mindset

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

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

 

26:58 Optimism

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

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

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

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

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

 

30:09 Beyond Covered

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

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

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

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

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

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

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

 

34:02 Expanding outside of California

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

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

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

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

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

 

36:15 Advice to younger women POC

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

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

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

 

37:57 What keeps you grounded?

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

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

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

 

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

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

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

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

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

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

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

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

 

43:55 Closing remarks

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

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

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

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

 

46:35 How to connect

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

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

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

 

47:27 Closing

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