The Teacher: Zwade Marshall, MD, MBA

Transcript

[0:00] I don’t know that they’re targeting us, but they’re willfully blind to the fact that we are not what our FICO score predicts we would be.
And they don’t give us credit for the things that they know from the student loan example that they are all very familiar with to price their consumer loans accordingly.

[0:18] Music.

[0:24] Paging Dr. Cook. Dr. Cook, you’re wanted in the OR.

[0:30] Music.

[0:53] Welcome to the Prescription for Success podcast with your host, Dr. Randy Cook.
Hello everyone and welcome to Prescription for Success. I’m Dr. Randy Cook, your host for the podcast, which is a production of MD Coaches, providing leadership and executive coaching for physicians by physicians.
To overcome burnout, transition your career, develop as a leader or whatever your goal might be, visit MD Coaches on the web at mymdcoaches.com because you’re not in this alone.
And don’t forget that CME credit is available when you listen with us.
Just look for CMFI in the show notes to learn how.
My guest today is a board-certified anesthesiologist and interventional pain management specialist, but that doesn’t really come close to describing his complete list of interests and accomplishments.
I think the term Renaissance Man might be more accurate.
So.
Let’s hear my conversation with Dr. Zwade Marshall. And it’s a real pleasure for me today to be speaking with Dr. Zwade Marshall, who is over in the Atlanta area.
Zwade, thank you so much for being here and welcome to Prescription for Success.

[2:07] It is my pleasure to be here with you, Dr. Cook. I’m a fan of the podcast and certainly look forward to our conversation today.
Well, I am flattered to hear you say that because you are a man who is involved in a lot of things and to think that you have the time to listen to my podcast is quite flattering.
But let’s get down to your story. I’m presuming that you were born and did all of your growing up in Atlanta, is that correct?
No, it’s not. It’s, I took a very circuitous- I’ve uncovered a secret already.
You sure did. I took a very circuitous path to Atlanta.
So as this chat goes on, I think you’ll pick up the hint of a Caribbean accent.
Some of my enunciations and syllables are going to have a sing-song lilt to it.
And so I’m from British Guyana in South America. It’s now Guyana, it’s an independent nation.
Geographically in South America, but certainly culturally we’re Caribbean and I grew up speaking the Queen’s English. My last year of high school in New Jersey though, then got into Emory for college and that’s when I came to So that was in 2001.
Well, how about that?

[3:29] Consider it home. I’ve made a home out of the place and love it.
Well, that brings me to the next question. I had sort of assumed, obviously wrongly, that you had always been in Atlanta and maybe that’s why you picked Emory.
But if that’s not the case, why did you pick Emory? You know, that’s an interesting question. It’s quite funny.
Where I’m from, we have a very challenging tertiary educational system.
So, for grade school, for elementary and high school, it’s an exceptional system.

[3:57] We wear uniforms, it’s kind of like the British system. It’s a meritocracy.
If you test well and do well in school generally, you tend to advance you.
So it’s more of like a tracking system like they do in Asia.
So you get this very robust, early educational kind of resources.
And then the country doesn’t have the finances and the resources for a robust university system.
And so many of my peers, like I did, we leave for college And it meant that my mom moved my sister and me, my parents were divorced, and to the US to pursue my dream of going to college and becoming a doctor here.
Really? While we were in Guyana, yep, certainly. And while we were there, we identified a few schools that we loved.
And Emory was very high in that list. Georgetown was there, and Hopkins, and Morehouse.
And I visited Emory while in high school, and I received a scholarship from them, even though my green card process was still to be decided.
Like I’d gotten an approved application and was in the process of being a student.

[5:09] Did not yet have the green card in hand, and Emory gave me a scholarship contingent upon me of having my green card by the end of that first year. That became a story in and of itself because.

[5:21] While I was pending an approval that I would have received from the INS within the first three months of me starting college at Emory, 9-11 happened. And so when I watched those Twin Towers fall on TV at my first year freshman lit class, so were the hopes of my green card being approved within time from my scholarship eligibility. It was all put on pause. And that was a transformative moment for me in the sense of what happened next in terms of financing school and the process to manage what was an event that changed my eligibility for funding and navigating that process while managing a pre-medicine course load was a trialing time in my life that I’m proud to have come out of and had a lot of help from a lot of amazing people.
Yeah, I bet that was, to say the least, a little bit of a nail-biter for you.
It most certainly was.
I had the benefit of a non-profit Catholic legal charity based in New York that took.

[6:30] On my case because my mom, who’s very into like advocacy and has the agency to come up with ideas of finding someone who can be helpful in this nonprofit. I was doing well in school and I’d had a screen card application approved, but just didn’t have it in hand. And the clock was ticking and nothing was working. I had to get that green card by the end of, by May of 2022, or I was gonna lose scholarship and couldn’t return.
And they said, you know, write a Hail Mary letter to the congressman of New Jersey where you went to high school and then also to the congressman of Georgia where Emory is.
And I wrote this Hail Mary letter, handwritten.

[7:14] It was then, it was actually state senator, Johnny Isakson in Georgia.
And you’d never believe it, you know, a week later I got a call from his chief of staff.
Hey, Zwade, Zwade, I got your letter.
How can we help? You know, it’s fascinating how that can work. It’s fascinating.
I’m going to tell you a really quick anecdote, because this program is supposed to be about you.
But while I was a resident at Medical College of Georgia, there was a veteran in the VA hospital out there that I saw several times who took a liking in me.
And he told me he was going to help, arrangement for me to get a chief of staff position at the VA.
And I and all my resident colleagues got a big laugh out of that.
And about a year and a half later, the secretary for the chairman of the Department of Surgery called me up and said, Dr. Cook, you’re not going to believe this, but there’s a guy on the phone from Washington, he wants to talk to you about being a chief of staff.
So, you just never know. You never know. It’s the beautiful part of life. I know.
It makes you feel, you know, 10 feet tall and bulletproof, like your steps are ordered, you’re doing something right.
Well, I apologize for that diversion, but it suddenly occurred to me that we share something there. But let’s get back to your education. You graduated from Emory with a BA in economics, and I’m curious if you were even thinking about medical school when you embarked on.

[8:43] That course of study.
Yes, I was thinking about medical school. I just happened to enjoy economics a lot.
I enjoyed economic history and understanding the ebbs and flows of societies around economic theory. And it was the kind of thing where I was a pre-med student, and I did well in my science courses. But if you found me reading something that was not for leisure in the it was likely an economic journal. I enjoyed Business Week and The Economist, etc. And I got the great advice early in my college path that I should study something that I enjoy, that I’ll do well in, while completing the pre-medicine coursework, and.

[9:27] It actually made me somewhat of a unique applicant. I bet it did.
To medical school. It was a differentiator that certainly made my interview process, I think, interesting to many that were sitting across the table from me.
Yeah, I bet it did. And I’ve heard of people going to medical school with a degree in English or a degree in history and political science and things of that nature, but I can’t recall ever hearing an economics major getting in there, but medical school was the target.
He was always a target. Yes. And yes. And, and, you know, I was at, in that cluster of, you know, med school has always been very competitive and, and it’s certainly significantly more competitive now. I’ve done a couple of admissions committee positions recently.

[10:15] And I, I just, I’m astonished by the talent that we reject today. You know, it’s the cohort of of folks that get in are excited. Absolutely. But I remember that, um, when I was coming through with that econ, with the econ degree, and I was thinking about how do I frame my journey to someone listening? And the econ degree led me to also being a high school mathematics teacher, uh, for a short period before applying to medical school. And the two things together, I think, as I thought about what my elevator pitch would be about what my, how do I tell a story of what I want to do with my life in medicine and how I view the world through the healthcare lens.

[10:56] The economics degree was so critical to that narrative for me because I was able to kind of articulate that I cared about the individual doctor-patient interaction.
I also cared about the systems and the things that go into keeping the medical engine going and the flows of resources, because healthcare is a finite resource.
And if you give here, you take from somewhere else. And the kind of thoughtfulness that goes into determining where the winners are and where the losers are and seeing what’s inherently wrong about that process, but knowing that it’s a tension that we just need to solve and to do so as best as we can at any given point in time.
And the more I spoke, the people that was interviewing me, they appreciated the perspective because they were in seats that had to make those decisions on a daily basis.
And so it felt like a kinship to them, I think, the more I spoke.
And I got an MBA as well while I was in medical school, like Kenton, my co-founder did in your interview.
And I think that further kind of transformed my view of myself and of what I thought my strengths would be as a servant leader in medicine. and it certainly inspired many of the things that I do today.

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[13:32] Hi, I’m Rhonda Crowe, founder and CEO for MDCoaches. Here on RX for Success, We interview a lot of great medical professionals on how they grew their careers, how they overcame challenges, and how they handle day-to-day work.
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Get the support you need today. Visit us at mymdcoaches.com to schedule your complimentary consultation.
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[14:34] We’ll get back to our interview in just a moment, but right now I want to tell you a little bit about Physician Outlook.
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[15:40] As you can imagine, I do a lot of snooping around in the lives with the people I’m going to interview. And I heard you on Brad Block’s really very informative podcast that he does.
Of the things that you said during that interview was that education that you got in economics changed the lens through which you saw the world. Can you talk about that a little bit? Indeed. I think I’m growing up, I’d always thought of my role as a doctor as being an individual contributor, someone who can see the single patient, have a create as as positive as an experience as possible, educate, do my best to heal and provide comfort and some amount of relief.
What business school did was it preserved that view of doctor, but it gave me the tools, to create the space in which I can truly provide that experience for a patient.

[16:40] While having a longevity of practice, knowing what the levers are, knowing exactly the inputs that go into making a practice successful. Understanding the interplay between empathy and having a high emotional quotient, knowing exactly what it is about me that I enjoy doing and the things that drag me down. There was a huge element of people management that I find to be be exhausting at times.
And what an MBA does is you.
This dedicated time to be self-reflective and to nurture the talents that you have and to mitigate your shortcomings, so knowing exactly where it is that you struggle. And for me, I began to see myself in the role of doctor as a leader of a high-performing team that I hadn’t envisioned directly before going to business school and understanding how to lead people that are smarter than me, that are older than me, that need to all feel nurtured, understood, heard.

[17:47] Being the glue to each of their vision to this common goal meant there was going to be some element of working with folks to understand what drives and motivates them while still remaining true to the common purpose of the group. And those were skills that I think I would not have been able to mature as quickly as I did if I hadn’t had the coaching in organizational management in business school, in the public speaking courses in business school, in the finance and the OR utilization studies that I did. It all.

[18:20] Kind of meshed well to get me to a place of understanding myself and how I viewed myself within a health practice.
While there is so much wisdom in that and for you to have been able to arrive at that level of realization at that point in your development just absolutely stuns me. I can assure you that during my time as a graduate student, I don’t think I was thinking anywhere near that. Clearly, I’m surprised I even graduated. But let’s talk a little bit about medical school. This was clearly something that you’d been planning for a long time and you’re getting into it rather simultaneously with, well maybe not an entirely different, but a somewhat different discipline. Did medical school turn out to be what you expected? Were there any disappointments. How did that experience work out for you?
I think it was overwhelmingly positive for me. Emory has a very nurturing environment.
And I had what I think was an especially positive experience there because I grew up at Emory.
You know, like they saw the mentors and professors and the folks that kind of nurtured me.

[19:35] Saw me from the confused kid who wasn’t quite sure exactly what I wanted to do and how to kind of make it all come together to become a professional later in life.
They saw me through those processes. And I interned in the admissions office at the medical school while I was in college. I worked in work study at one of the doctor’s labs.
So they viewed me as their child, so to speak.
And many of them took a special interest in me to ensure that I succeeded.
And because of that, I had this rich experience of being in a place where I felt supported when I had the most doubt in myself. when there was the imposter syndrome of feeling as, as though, you know, I don’t, do I deserve to be here amongst these brilliant people?
And having someone saying, yes, you do, here are the things that you do so well, Suad, and here’s why you’re here, was absolutely critical to my development.
Now, I’ll tell you though, the disappointing parts were never around patient care or experiences, because Emory has a diverse kind of clinical settings.
They have, you know, Grady Health System, which is a level one trauma center that where you treat a plethora of uninsured patients. You’ve got Emory Main Campus, that does a lot of high-end procedures and exotic surgeries.
And, you know, you’ve got the outpatient ambulatory centers as well.
And so I got the exposure to a number of different clinical settings.

[21:04] That enriched my medical training and experience.
The parts that were disappointing though, I’d say that many medical schools have the leadership, they have a very narrow perspective on what, Being doctor means out of their program. And so oftentimes Saying that you’re gonna do a business degree.

[21:26] To them feels like you’re getting off the path of being a servant that you’re, Too interested in what?
Some can perceive as being antithetical Yeah to the the helper aspect of medicine and so I can believe that, How can you be a true scientist if you’re over here doing balance sheets, right?
Exactly right. And I found myself having to defend my decision to get an MBA to many of my professors.
And I wouldn’t say that it was a supportive environment for that path.
It was a lot more support to getting an MPH, because that fit into the mold of what they viewed as being a doctor, right?
So if I were asking for grant funding to go abroad to Haiti or somewhere else to do some medical mission work as a part of understanding global health, that made sense.
But doing an internship with McKinsey did not so much.

[22:25] And so that part of it felt disappointing at times, but then there was this small cadre of doctors or graduates that had done it before that were very fiercely passionate about ensuring that I stuck to it, I did it too.
And so they helped to order my steps as well. And some of those folks, Dr. Arun Mohan, I’ll say my name.
He graduated from the Emory MD MBA program four years before I did.
And was someone that I reached out to back then. And he’s now one of the earliest investors in knock-to-knock lending, you know, a decade later.
But you find the folks that believe and see the world the way you do, that can help to order your steps, while also speaking and polishing your belief by interacting with the folks that don’t get it as well and understanding what it is about their perspective.

[23:19] That informs how they feel about your path. And I think it all comes together to create some validation for you as you think through where you want to be.
Well, you know, for me, and looking at your CV and the things that you’ve done, it seems so patently obvious to me that this is one thing that we are desperately in need of in medicine because it is so unbelievably expensive.

[23:47] And if we’re going to get the care to everybody that needs it, we better understand how it’s going to get paid for, right?
Absolutely. And it’s very complicated. Right. And the pendulum has now swung. There is certainly a resurgence now of medical schools offering some kind of a business curriculum for interested students. And I think the Affordable Care Act changed the way many of us view healthcare and economics and healthcare, where you saw the sausage-making happening right before our eyes, and the ups and downs of it, you.

[24:27] Know, the pros and the cons.
And so I think reasonable doctors can appreciate that there’s certainly a wisdom to understanding business.
And there are a number of schools now that offer a formal program, an MD-MBA program.
Kent and I were together at Dartmouth earlier this year in January speaking to the MD-MBA that I’m from Tuck Business School over there at Dartmouth.
And the kids are brilliant.
They’re so full of promise. And you can see that the gears are all kind of moving in ways in which I can’t comprehend and what they’ll do in future because of how rapidly the world is changing with the advent of machine learning and artificial intelligence that impacts exactly how we deliver care, personalized care.
And so it all requires a skill set that goes beyond the traditional pedagogical method from medical schools of old.

[25:25] Well, you have given me a good reason to be optimistic, and I appreciate that.
Let’s move you along a little bit.
So you decided to do your post-grad work at Brigham and Women’s, and it was going to be anesthesia. Is that?

[25:42] The choice of the specialty, was that something that you had settled on for years or did it come to you late in the process? How did you arrive at that?
It came to me late in the process. I had thought I was going to do a surgical subspecialty to be honest and I spent a large part of my medical education, medical school, aspiring to be a surgeon and then I did my surgical rotation and it’s, you know, for any of your listeners.
Go ahead, it won’t hurt my feelings. For any of your listeners who struggle with, you know, like, how much credence do you give to a bad experience compared to making a life-altering decision because of it?
And I had a miserable rotation. I had a miserable intern who was directly supervising me as a medical student, who was led by a miserable resident, who was led by an attending that was draconian.
And the rounding, you know, I was pre-rounding before pre-round, so then round.

[26:43] And I was miserable. And I wanted to be in the perioperative environment.
So I still loved the OR environment. I loved the fix-it nature of surgery and getting an illness kind of treated to completion.
Something about that is gratifying to me. Anesthesia allowed me to be a part of the environment.
It allowed me to be a part of that perioperative process. And when I did the rotation, I found myself being drawn to elements of doctor that I envisioned in myself when I was a kid.
I thought I was gonna be an internist when I was growing up, you know?
And I liked the people part.

[27:22] I liked the teaching part. And you get this snippet in those, I would say 12 to 15 minutes prior to surgery of meeting a patient and their family members who are oftentimes terrified.
You bet. And they’re so hopeful for a positive outcome. And they’ll look at you and you can see the hope and the fear in their faces.
And I’ve got a few minutes to inspire confidence, to educate, to help them trust me and the process and the system.
And there’s a gravity to that I embraced as I was trained, and I quite frankly loved it.
And so I was drawn to that. I love the immediacy also of being in the OR and having someone’s blood pressure go up and being able to give them a medication and it goes down immediately.
I don’t have to wait three months and see them back for a fall, but I hope that they comply.

[28:17] There’s an instant gratification piece of they’re bleeding and hypotensive and you transfuse with packed cells right there in the OR and they get better.
So that excitement, that part of it, the team-based approach to medicine also kind of fulfilled all the other elements that I was nurturing in myself around leading high-performing and being a part of that kind of environment was helpful for me.

[28:42] And then anesthesia is one of those unique specialties that has a very diverse subspecialty range where you can choose the kind of life you wanna live and the kind of practice you wanna have based upon your subspecialty.
So if you love shift-based work in a perioperative environment, you can do critical care and take care of the sickest of the sick who are relying upon the best of your skills to survive the most traumatic period in their existence while they’re alive.
They’re at death’s door when you’re caring for them.
Or you can take care of kids.

[29:20] And pediatric anesthesia is an incredibly rewarding field, but you’re treating parents and kids.
You know, I can remember taking care of kids where by the time you put the kid down to sleep, there’s no dry eye in the room because the parents are crying, you’re crying, the surgeon’s crying.
Because seeing a child’s body go limp from anesthesia, you just never get used to it.
You know, it just doesn’t seem natural. And so you feel this emotional like pulling, you feel like your work is so meaningful every day you do it.
And then there’s interventional pain, which is what I did. That allows me to feel some iota of what it’s like to be a surgeon where I own an ambulatory surgery center today.
I come to work and patients come to see me.
I am the one doing the procedures, whether they’re epidural injections or nerve blocks or spinal cord simulator implants.
I am the proceduralist and I also get to run a business. And I have 27 employees.
I have nurses that work with me. I have nurse anesthetists that work with me.
And so.

[30:31] Allows me to utilize all facets of my brain and my personality that I was nurturing in medical school, in business school, being a high school math teacher, and getting a real sense of that human experience of what it’s like to work with folks that are really struggling economically, financially, and having the empathy quotient to understand what it’s like to not be able to afford the medications, or not be able to afford transportation to come see me.
You know, there are all these factors that impact how care is delivered.
And if you’re a provider that’s experienced different settings, either personally or you’ve been a part of it in your training or you’ve lived it.

[31:14] It certainly informs the level of care that you provide, but it also informs your level of satisfaction with the care that you provide. And so, it all kind of came back full circle for me mean that way.
Dr. Darrell Bock Sounds like you landed in exactly the right spot and you’re obviously very enthusiastic about it and I think that’s a great thing.
Clearly you love what you do.
I want to shift the gears just a moment so that we can get into one of the many interests that you have and tell us about meeting Kenton Allen and how Dr. Doc Lending came about.
Dr. John Sanford Sure. So your regular listeners already had the pleasure of meeting my co-founder and partner.
He’s got the perfect kind of radio podcast voice.
But from the cadence with which he speaks, you can tell that he’s a steady hand.
He’s the anesthesiologist that you want to have in the operating room with you when it’s chaos.

[32:14] He’s very ordered in his thinking and is just a brilliant, brilliant guy.
So we met at residency.
He was an MD, MBA, and so am I. And we’d always kind of thought about ways in which we would get together at some point in time in our lives. And we hadn’t quite figured it out until we began to talk about our own financial journeys. And we were completely different in background. Kenton, you know, grew up in that New England area and certainly not a wealthy guy by any means, but, you know, had a wife and three kids while in training. And that was his kind of pressure point for needing finances. Mine was different. Mine was single parent household, immigrant family, matched into Harvard from Emory. So going from a low cost of living city in Atlanta to a significantly higher cost of living city in Boston, having north of $200,000 in student loan debt. Income in residency was going to be $54,000 a year. And my FICO score was considered to be subprime, not because of bad behavior.

[33:21] But simply because of the toll that the sojourn through medicine takes on your overall credit profile. I was surprised to realize that the banks viewed me as a high-risk borrower.
I was stunned to hear that from Kenton. And do go ahead, I apologize for the interruption.
No, it’s quite okay. And I think most people in finance don’t understand this. We’re not this a sympathetic bunch. No one thinks of us as having this frailty. We’re supposed to be superhuman. We’re the folks that serve people and do it with poison. They think of us as being wealthy in the top one percentile of income earners in the US. But I think what’s often forgotten is the sojourn to get there. And we don’t all end up earning a whole lot of money, and there’s certainly this huge financial toll.
So what we decided to do together with Doc2Doc is rethink risk and underwriting.

[34:22] For physicians and dentists, where we give you credit for being a physician and knowing what your career arc looks like and the variability in career arc, depending upon specialty, the variability depending upon where you practice as a proxy for insurance rates and Medicare reimbursement rates, variability based upon your free cash flow, if you’re a fourth year student that’s just graduating and starting internship, compared to if you’re a late year resident that’s moonlighting, compared to a fellow on their path to signing up their first job contract, to being an early stage doctor who’s going to be partner in an orthopedic surgery practice in the course of the next 15 months.
Each of those kind of time points on a doctor’s career arc, they’re unique financial products that we need to consume, that folks within finance and the capital markets world don’t understand the nuance of what our needs are, when we need it, why we need it.
And because we have that intelligence internally, we’re able to provide the product at the right time for the right use case.
And we’re certainly going to be building out a suite of products over the course of the next.

[35:41] 12 to 15 months, but certainly our initial products have been very successful in the marketplace because of that understanding between product market fit.
I’m gonna have to ask you about what may or may not be the elephant in the room but it’s something that I’m really curious about you say that these big lenders don’t really understand The level of risk that newly trained physicians are having to deal with is that true?
Do they really not understand or they just taking advantage of the fact that they can charge these, Unnecessarily high interest rates in spite of the fact that their risk is low. Am I too cynical?
It’s a great point Randy. No, I don’t think you are cynical at all Lenders have been giving doctor student loans for a very long time and they have the data in in the student loan world, at least, on default rates, right?

[36:35] Doctors is a category default at less than 1% on student loans compared to any other professional group that are multiples higher in default risk.
And so they know this. I think it’s convenient that during training, the way the credit system is set up.

[36:54] That we’re oftentimes near prime or subprime borrowers, FICO scores in between 600 and 650, which if you use a FICO driven algorithm to make lending and risk pricing decisions, we’ll fall on the low end of the curve. And so it’s not that they, I don’t know that they’re targeting us, but they’re willfully blind to the fact that we are not what our FICO score predicts we would be. And they don’t give us credit for the things that they know from the student loan example that they’re all very familiar with to price their consumer loans accordingly.

[37:30] Well, that’s certainly the way that it appears to me that they are taking advantage of the fact that you just don’t have anywhere else to go, at least up until Dr. Doc Lending showed up.
And thank goodness that you did because you are providing very necessary and highly valuable service to people who are— Thank you.
Trying to deal with a lot of educational debt, and we did go into this in some detail as well with Ken, which I hope if our audience hasn’t heard that interview, I hope they will.
And I just want to go ahead and continue to advance along in your path.
Once you got trained, once you finished your training in Boston, you made the decision to come back to Atlanta.
Clearly, it was a place that you really loved.
So I wanted to be a part of not only the medical scene, but the civic scene as well.
You’re a part of, and actually, I think this might’ve happened before you even finished medical school. You can.
You can get my timeline correct, but you were responsible for the development of a thing called.

[38:36] The Pipeline Program. I’m very interested in hearing about that.
Yeah, thanks for asking. Yeah, no, I am. I’m proud of it. I had a partner in crime in that one as well, Dr. Sam Funt, who’s currently an oncologist at Columbia Presbyterian in New York now. But we were students at Emory. I had just left being a teacher, a high school math teacher.
And again, I taught high school at what’s called a Title I school in a place called Decatur, Georgia, where greater than 90% of those students were on free lunch because they were food insecure at home. They just couldn’t afford to provide meals. If there was a holiday or a break away from school, there was a good chance they’re going to be hungry at home. So there was that kind of school. And you and you can imagine with the challenges of that kind of economic uncertainty.

[39:30] It created an exceptional environment to be a young male teacher, where classroom control was tough, but I had to kind of work overtime to earn their trust.
And- I bet you did. It felt to me like, by the time I got good at being a teacher, by the time I got good at creating lesson plans that were engaging to hold their attention, because I was young and I was closer to their generation than most, I can draw the parallels between pop culture and what I was doing in the classroom.
And right before I left to go to medical school, I felt this sense of guilt, Randy, that I was just beginning to write down.
The recommendation letters for kids that are going to apply to college in a school in which only 62% of the kids went off to college. And they were coming to my classroom to confide in me and ask for advice and help to navigate life. And I really felt like I was making an impact. When I decided to go to medical school, and that was always the plan to go to medical school, as I said before, it felt like I was leaving them behind. And the way I chose to bridge what I felt inside at kind of making it so that I believed, as Sam did, we can transform lives of students if they were exposed to environments different from where they live.

[40:51] The way they can see Mr. Marshall become Dr. Marshall out of Decatur into Emory, bring them onto the campus where they can see the entire educational pipeline.
And so we created a program in which it was longitudinal. So we had sophomore high school kids, mentored by sophomore college students, mentored by second year medical students, who were given didactics by residents.
And so in any given instructional room for the pipeline program, you had multiple layers of the educational journey from high school to resident and attending physician and we got.

[41:32] A little bit lucky in that the first graduating cohort from the Pipeline program that had been with us for two years through their senior year of high school, we had three of those kids, two of them, sorry, win Gates Millennium Scholarships out of a school that hadn’t had Gates Scholarship recipients.
And when the kids were interviewed by the Atlanta Journal-Constitution, and they were talking about like, you know, like, what did it take for you to get here, they gave credit to us at Pipeline.
And all of a sudden, we’re getting a lot of attention. We got an NIH grant that allowed the program to really become sustainable.
We had a lot of foundation donors that gave money to Emory to keep the program going.

[42:13] And I’m proud to tell you that it’s the Pipeline program that was started back in 2006, is still in existence today at Emory.
And I spoke at one of the graduation ceremonies about three years ago, as the old man founder back on campus.
And it certainly is one of the things that I’m most proud to have been associated with.
And I’ve interacted with students.
One of my high school students is now a nurse in my practice, a nurse practitioner.
I met her at Towers High School in Decatur.
And Robin is now here with me. I didn’t mentor her through the entire time.
She reached out to me to apply for a job when she finished nursing school and said, Dr.
Marshall, I was one of your kids at Towers High School. And it gives me goosebumps to even talk about it now, but it’s certainly – I’m so proud of that program and the time I spent in that school, in that high school.

[43:09] Dr. Marshall I bet you are proud and rightfully so. And I’m going to also mention because I’m sure you’re too humble to admit it yourself, you were named humanitarian of the year some years ago on the strength of your work with the pipeline program and I can’t think of a more.
Deserving recipient. Thank you. So, Zwade, I’ve really enjoyed our conversation and I can’t even begin to explain to the audience how much more there is to tell about you, but in the interest of time, I guess we’re going to have to close this out. And I’m going to give you some time to speak on your own and let’s hear what you’ve got on your mind. So, audience, here is Dr. Zwade Marshall and his personal prescriptions for success.
Thank you. Thank you, Randy. As I kind of thought about what I would want to say to others in terms of what do I ascribe to the modicum of success that I’ve achieved and the satisfaction I have with my career and personally at this point, if I were to look back at myself.

[44:15] 10 years ago and what would I say to say that that’s what a back then and the first thing I would say is to be patient, to be patient with yourself.
I’ve always felt like I needed to get there quickly, that metaphorical there that was motivated partly by just an overwhelming sense of gratitude for my family’s sacrifice to be where I am.
I needed to feel like I’m living up to expectations placed on me to get that imposter syndrome feeling out of me, like I didn’t belong at Emory or Harvard or wherever I was.
And once I began to enjoy the journey itself to do the self-work to realize that I have unique talents that inspired a confidence to achieve.
And so it stopped being about the destination and more about the journey.
And I think most of your listeners may have heard something similar to that at some point in time.
But if you place that kind of framing to your own life, it often illuminates the things that you should not be doing.
So instead of being miserable, toiling in something that you’re hoping will get better later, or I just have to endure this until this thing happens, maybe you shouldn’t be doing that thing because life is short.

[45:35] And those of us that find great pleasure out of the journey to get to that destination, where the journey is the destination. So that’s the first thing I’d say.
The second is, there’s a power in positive visualization and self-affirmation.

[45:52] And it may sound a bit absurd, but I can remember when I was interviewing for residency, I’d been at Emory for a very long time. It’s a place that I knew and loved. I’d gone there for college, med school, and business school, like we just discussed. And I had these deep, meaningful relationships with faculty there. And I thought I was going to stay there for residency until I interviewed at Harvard and fell in love with the Brigham. And as I awaited the match day results. I did something that I realized I do often is that I began to dream awake about the outcome that I wanted. So I imagined myself opening that match letter and seeing it said Harvard.

[46:30] I could see my wife smile next to me and my mom cry. I envisioned that greeter at the hospital door that I met when I interviewed, that they would see me in my first day of internship and say, welcome Dr. Marshall.
And it felt like deja vu when it really did happen in reality.
I’ve had that feeling so many times because of that visualization.
It meant that I was ordering my energy, my prayers, my work ethic to seeing that dream come true and it’s all connected.
And then the last thing I’d say is it’s more important to make a decision than to make the quote unquote right decision.
I found that times when I was dithering with indecision, that it kills momentum, it kills creativity, it kills deals.
And there’s so much to learn.
Any decision that you take, if you have an intuitive sense about course-correcting.

[47:25] As you learn the elements of that, call it a bad decision, that you need to know that it’s okay to make mistakes in your thoughts. And so this only works if the aforementioned exists when you have established a true north already and you can identify when you’re drifting away from goals.
So, instead of agonizing over the right decision, decide that you’re gonna do whatever it is and be ready to course correct as you need to.
Those are my prescriptions for success. That’s some very powerful thinking there and I can’t say I’m at all surprised.
So, have patience, have a positive vision for the future and have the courage to decide.
It’s good advice. And I thank you for sharing with us, Zwade.
Before we go, I want to give you an opportunity to tell our audience where they can find you and publicize whatever you like, email addresses, websites, public appearances, books.
What have you got to share with us? Absolutely. Well, thank you so much for having me.
This was a pleasure, Randy. You’re very easy to speak with, and it felt like we were in a living room just having fun. I appreciate that.
I am Zwade, Z-W-A-D-E, at doc2doclending.com. that’s Doc, number two, Doc.

[48:43] And our website is Dock2DockLending.com and on our site I think we do a pretty good job of telling the story of who we are and we’re happy to speak with anyone and I’m personally happy to do so.
Know that our team of physicians, we still call every approved borrower to welcome them to our family.
So there’s this physician to physician interaction and it’s part of the D’s in Dock2Dock.
Our investor base is, you know, over 95% physicians as well.
And so the money that we use to fund our loans, the equity capital comes from doctors.
And so we’re really proud of the community that we’ve created and would be happy to chat with anyone that’s contemplating needing to access capital for whatever reason.
It may not be with us, but we can help you think through how the financing process works.
Dr. Zawadeh Marshall, it has been a pleasure. Thank you so much for being with us on Prescription for Success.
Thank you so much, Randy.

[49:45] Thank you so much for listening with us today. If you enjoyed the show, you can help us reach more listeners by leaving a rating and a review, especially on Spotify or Apple Podcasts.
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Special thanks to our producer, Craig Clausen, our promotions manager, Mariana Rotabaugh, and to Ryan Jones, who created and performs our theme music.
And finally, please remember to fill your prescription for success with my next episode.

[50:34] Music.