With the 2023 Match day right around the corner, please enjoy this encore presentation of Drs. Sawhney and Khalif discussion about the challenges with the match program, and what can happen if things do not go the way you want them to.
Mohamed Khalif is the President of the American Society of Physicians and Chief Executive Officer of Bridging Care.
Henna Sawhney is one of the co-founders and executive board members of the American Society of Physicians (ASP), a non-profit organization committed to reversing the physician shortage and promoting patient well being.
The CME experience for this Podcast is powered by CMEfy – click here to reflect and unlock credits & more: https://earnc.me/1zeC1h
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MD Coaches, LLC provides leadership and executive coaching for physicians by physicians to overcome burnout, transition throughout your career, develop as a leader or meet your individual goals. Remember, you are not in this alone. Reach out to us today!
PHYSICIANS BY PHYSICIANS. It showcases unique physician talents, whether it be in the form of writing, painting, creating cookie masterpieces, or storming capital hill in the name of healthcare advocacy. Use promo code RxforSuccess to get three months free when selecting the monthly option. https://rxforsuccesspodcast.com/physicianoutlook
in 2019, Governor Jay Inslee appointed Mohamed Khalif to serve on the State Medical Graduate Workgroup. His organization successfully advocated for licensing reform every year since 2019 and helped pass three legislations during those times. The most recent legislation, HB1129, established a license for Unmatched doctors in Washington State. It was featured in several articles, including Federal Trade Commission Watch, Long Reads and Times Magazine. Dr. Khalif also speaks at educational seminars and webinars related to Brain Waste and workforce integration. His most recent presentations were at the World Education Services, and the Health Care Leadership Table. On his free time Mohamed loves playing basketball, and is diehard fan of the Phoenix Suns.
Henna Sawhney is a graduate of St. George’s University of London Medical Program and currently works a Public Health Advisor with the Centers for Disease Control and Prevention.
Henna is a California native and has a BA in Gender and Women Studies from UC Berkeley which influenced her passion to address disparities in health and medicine. While in medical school, she participated in free mobile clinics providing care to rural and underserved communities in Cyprus and continued these efforts as a volunteer with Remote Area Medical and migrant clinics. While she has not pursued Residency training, she has continued serving underserved communities and has gained licensure in 4 states while working throughout the COVID-19 pandemic.
Her background in policy and clinical research have afforded her diverse opportunities to identify, address, and provide solutions to disparities in healthcare and clinical practice.
She plans to continue advocating for the promotion of patient and physician well being through education and sustainable policy change.
Dr. Sawhney’s Prescription for Success:
Number 1: Be of service to others.
Number 2: Check in with yourself.
Number 3: Don’t be afraid to take risks.
Number 4: Define your own success.
Dr. Khalif’s Prescription for Success:
Number 1: Define your own Success.
Number 2: Put yourself into a growth mindset.
Number 3: Find others.
Connect with Drs. Sawhney and Khalif
Dr. Sawhney on Twitter: @hennaMD
Notable quotes from the interview:
For me, Medicine is about two things: serving others and the sciences.Henna Sawhney
It’s challenging regardless of where you graduate from medical school because of the overwhelming competition.Mohamed Khalif
Nothing succeeds like success – and success is how you define it.Henna Sawhney
Be of service to others and yourself.Henna Sawhney
Define your own success.Mohamed Khalif
Don’t be forced to live in society’s version of success.Mohamed Khalif
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Access the Show Transcript Here
[0:00] This year, what NRMP reports is that there was 11,600 something applicants that did not get into residency.
Paging Dr. Cook. Paging Dr. Cook. Dr. Cook, you’re wanted in the OR. Dr. Cook, you’re.
[0:25] Wanted in the OR.
[0:47] 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, CME credit is available when you listen with us.
Just look for CMFI in the show notes to learn how.
[1:26] Well I have a pair of guests on the podcast today. Both of them have had very personal experiences with that frequently excruciating experience of finding a residency in the U.S.
If you’ve been through it, you know how unnerving it can be.
It’s what we call very simply the match.
Dr. Mohammed Khalif and Dr. Henna Sawni joined me to share their personal experiences.
So let’s hear that conversation.
I’m really excited about today’s interview. I’m talking to a couple of really interesting people about what I think is probably the most significant issue facing all medical graduates who intend to practice in the U.S.
Question and the difficulties that we’ve had in getting that selection process, straightened out. So today we have Dr. Hina Sawni who’s coming to us from.
[2:41] I believe the San Francisco Bay Area, am I guessing correctly on that, Hannah?
Yes, yes you are. Man, how nice that I got it right. And Dr. Mohammed Khalif and the Seattle Tacoma area.
Did I get it right again?
Yep, yep, that’s right. Lucky me. All right.
And these two people, fortunately for all US medical graduates, have had the great wisdom to try to do something about the medical student residency matching program.
And we’re going to talk about that in some detail.
[3:24] But to begin with, Hannah and Mohammed, we like to learn a little bit about everybody’s, origin story. So, uh, Hannah, tell us at about what period in your life did you begin to think you might want a career in medicine?
So I would say quite young. I was about 10 years old. I was very interested in, you know, biological sciences. And I had this teacher in sixth grade, uh, that one of our like biology topics was like the signs of cancer. And that’s what really, I mean, it sounds morbid, but, I was just very interested in like the diagnosis of it. And the reason is because I’ve actually.
[4:12] Had a lot of people very close to me, including my grandmother and an aunt that had cancer and passed away from it. And for me, medicine wasn’t just about, you know, learning science and getting rich or having that respect for me, it was allowing me to bring two things that I love, is serving others and the sciences and putting it together and making a difference at the individual level.
You can be interested in lab work, you can do the same thing in many different ways, But it was really the human aspect of medicine and its relation to the sciences that really drew me to it.
I can’t think of any better motivation than that.
[5:01] But the really interesting thing, and I think I’ve got this right, you actually grew up in this country, but you got your medical education in the UK, right?
How did that come about? So I’ve had an interest in global medicine. up here.
[5:20] I actually stayed in the Bay Area my entire life until medical school.
Grew up here in the East Bay as well as in San Francisco and then went to Berkeley for undergrad.
While I was at Berkeley, I decided to do something unconventional such as going into.
[5:42] A women’s studies major instead of doing my pre-medical majors like biological science or chemistry that most people do. That is unusual. Yeah and the reason was one of my high school teachers, she had gone to Berkeley and she said the best course she ever took was in women’s studies, and it was an easy way to clear off a general education course. So I took one and I loved it and I took another and another and it was all for gen ed and I realized I could make a major out of it. And it was it it was interesting to learn about privilege and how that relates to society and how political things can be personal and people make, personal things political. And it really drew me to it. And when I start I was always interested in studying abroad and I at the time I was in college you know, globalization was just starting and people were starting to think outside of just the United States and.
[6:50] So I thought it would be really interesting to learn about medicine outside because.
[6:56] The teaching is the same because you’re learning the same diagnostic.
[7:01] Criterias you’re learning how to treat patients, but the approach is very different The science is always the same.
And the approach to it. society is completely different.
[7:14] Exactly, exactly. And so I took a leap of faith and decided to go to the UK. And this particular program was an international program. So my classmates came from all over the world.
Asia, Europe, Australia, some were like, a few were even in Palestine and Syria and had like just narrowly escaped what was going on there.
And Canadian as well. And just hearing how medicine was practiced and the differences between their country and what we did in the US was very eye-opening.
And I think by far the best experience I ever had. Yeah, I thought it was.
That had to have been quite an experience.
[8:04] It was. And the UK, I think this also really showed me the flaws when I came back to the US and our system, especially in education and training and parts of practice.
I think because I had this exposure of how it’s different outside, I had more of a cultural shock coming back home and saying, well, why are we doing it this way when there is a better way that other countries are doing it.
[8:39] I think that really has pushed me in a lot of ways to find innovative processes and other options rather than sticking to what is the norm of society. So with residency, I pursued it actively for many years and I always got feedback that you’ll get in, you’ll make a great doctor, you have a sound education. And I like even working when I was in Missouri, which we can speak about later, being able to practice there, I got the same feedback. But the problem wasn’t, my capability as an individual physician. The problem was breaking through the system that we have established and being given a chance to do what I’ve been trained for.
I’m going to, I’m going to hold you right there.
Uh, and I’m going to see if I can bring you both to the same point, which I.
[9:40] Think is going to be pretty easy, but I’m going to go to you, Mohammed.
Now, uh, uh, Hannah actually, uh, had a somewhat different approach to medical, to medical education as compared to what we usually do in the U S.
But you certainly did and I think perhaps in a much more convoluted fashion as well.
So tell us about your decision to get into medicine and where you got your education.
And I was born in the 1990 right after the Civil War in Somalia.
Just immediately after the Civil War in Somalia and my parents, you know, flood the country because there was a huge conflict there.
[10:30] It was very brutal. And we had to flee to the neighboring Kenya for almost, let’s say, two years till 1992. We were fortunate enough to immigrate here to the United States. So I came to this country when I was two years old, started doing my earlier daycare, elementary school here, and And just kind of like coming to a new country, it was, I vividly remember like that transition, for my parents was very hard because of that trauma.
And some of the things, yeah, they had to go through there. Just hearing the stories sometimes, of all the bullets they missed and how fortunate they were to find safety was just a really remarkable story from them.
[11:22] So early in my childhood, I remember in elementary school, my teachers used to ask me here in Seattle, what do you want to be when you grow up? I always used to say I want to be a doctor.
I used to dress up as a doctor during Halloween.
Very early in your childhood. Very early in my childhood. It’s something that I just always wanted to do.
Well, now, did you get that from television doctors or your family doctor?
Where did that come from?
So I think that became, you know, when newly arrived immigrants come through, they go through a lot of medical screenings and they often, you know, plus I had some, you know, conditions as well.
I had, you know, tuberculosis and, you know, I had to go to the doctors most frequently.
And I think being around, you know, pediatricians and you know international medicine clinics just put that spark in me.
[12:20] And after that, my father started a business and, you know, he started the business because he realized that most of the immigrant community here in Seattle did not have some of the things that they used to have back home.
So whether it’s like clothing or decorations or other products that they used to enjoy, they couldn’t find it here anymore.
So he started the business with some other colleagues of his.
And after that, you know, we were just on the road.
I did ever from middle school all the way to medical school, I did it in other countries.
So I was in Amsterdam, I was in Pakistan, I was in China, I was in Dubai, I was in Kenya.
So I lived in five different countries and did school in all those different countries.
I did my high school and medical school in China because that’s where most of the manufacturing was happening and my dad was living the most at that time.
So you never really saw very much of the US educational system at any level.
Yes. Yes. Only elementary school. I did all the way to elementary school here, but from middle school to medical school, I was around the world.
[13:36] Okay. All right. We’ll pick up the story again. And after that, you know, I just, when I came back, you know, my dad lost his business, unfortunately, in 2008 because of the recession.
And you know, when we came back, when I came back here after medical school, you know, he drove a cab after he lost his business, tried to get me out of medical school in China. He was here.
And when I came back, it was a total different story for me because then I had to go back to go through the challenges that I think we’ll talk about later of trying to get into residency and try to get into the match.
And it was a very different experience for me.
But in short, that was my experience on how I became a doctor and then let’s spark that interest.
[14:27] Anywhere along the way, did you think, well, gee, I’ve made a mistake or were you still pretty well motivated? No, I was very motivated.
I was very motivated. I had my eye on the target.
This is something that I always wanted to do. And this is something that I always spoke about as a child.
And, um, I had huge support from my family because of that, because they knew like, this is what I wanted to do.
Um, and, uh, they were supporting me throughout the time and, um, yeah, I never thought for a second that I wanted to change a career.
So we’ve gotten medical school done for the both of you and we got to talk about the really next big step and that is that both of you had to face the infamous matching program.
And Hannah, I’m going to go back to you.
Tell us about your experiences with that.
[15:27] I graduated in 2018 and I had just moved back home to the Bay Area from Chicago.
Finished, you know, the USMLEs was gearing up for residency match and I was working at UCSF at the time as a clinical research coordinator because the feedback I had gotten at that time was since even though I’m born and raised American, I mean, my parents are immigrants, So I faced the balancing of two cultures.
[15:59] My entire life has been in the US. And then coming from a foreign medical school, they said, even though you are American, you will have some setbacks as a foreign, with someone with a foreign degree.
And so I was doing research because they said that getting some publications and staying clinically involved to some degree would help get into residency.
And so I started the application process, had my LORs, everything ready to go.
And I didn’t get any interviews the first time.
The first two years I applied actually.
The feedback was maybe I wasn’t applying everywhere. You know, the number of programs I wasn’t applying wasn’t enough or it wasn’t focused.
Like I got a lot of feedback. And there was always something that I was told wasn’t enough from my end as an applicant.
And just to give you some numbers, I applied to over 400 programs across the country every year I’ve applied, except this last year.
Cost wise, that’s up to about $10,000 a year that I have saved.
I have the support of my parents and my family and I was able to stay at home and didn’t have to worry about.
[17:24] You know living costs because of them. So whatever money I had made, you know as a research coordinator coordinator went directly into the match process because that was my personal investment into my future.
[17:39] And the first two years, I always found a reason that I didn’t get in.
You know, my scores weren’t high enough.
I didn’t have enough research experience. I didn’t do enough clinical rotations.
But I mean, even though I went to a foreign medical school, my third and fourth year medical school rotations were actually here in Chicago.
[18:02] I had clinical rotations prior to that in Cyprus, where my first two years were located since we were in an international program.
But the core clinical rotations were all in the US. So there was no gap in terms of trying to understand how the medical system worked in the US.
And all my LOR writers, like all the doctors that wrote me a letter of recommendation were US doctors.
But I wasn’t getting through whatever filters there were for these programs the first two years.
[18:38] The third year I applied, I got one interview and it was in the middle of the pandemic, and it was sheer dumb luck to be honest.
I had gone on this rant on Twitter and that’s actually how Muhammad and I were connected to create our, found our nonprofit.
And this program director just happened to have been on Twitter and he reached out to me and he asked, why haven’t you matched?
And I started speaking to this program director and.
[19:09] Luckily, it was just prior, like it was just after match and prior to the new season and after reviewing my application and seeing how dedicated I was, they said they would, consider me for an interview for a residency and they did interview me.
It was the first time I got an interview for a residency and so I was very excited, but I also had gone through it twice knowing what can happen and how you can’t have your hopes too high because the fall is much worse. So the interview went well. I wasn’t expecting anything. I was hopeful more than previous years, but I was just trying to be realistic as well. And so I didn’t match. And that year, my mom was the most devastated. She has been my support and rock through all of this. She’s told me many times, is it worth the emotional and mental distress you’ve put yourself through all these years? And I keep saying, yes, it is.
[20:18] She says, okay, then I will support you. And so seeing how it affected her after match that I didn’t get it really brought it to perspective to me, is this worth doing it anymore? And it’s not about is it worth to practice medicine, but is the process we have created in this country, worth the struggle to be able to practice medicine? And so after that year, I got feedback from the program director. He said, funnily enough, that the other faculty had said that I had too much research on my application and it was too much research focused. And so at that moment, I kind of shifted my perspective on residency. I was like, this is not the end all be all that I’ve been putting it for for the past couple of years. I moved out to Missouri to practice medicine with the license that they give, the assistant physician license. I also got a job as.
[21:25] I work with the CDC and have been working on their COVID teams at the San Francisco quarantine station, and I kind of left research because although it was interesting and I liked it, it wasn’t what I was pursuing as a career. It was and it was always going to be a stepping stone. No, not at all. The The experience is great and I’ve utilized it and I will continue to utilize it and possibly see another career option, but it wasn’t what I wanted to do.
And so last year was the last time I applied for residency. And I remember.
[22:03] The application had just opened and we had to pay the fee for it and the registration fee.
And the day I applied for that and paid it, after that for almost like three weeks, I just laid in bed.
I, other than going to the urgent care clinic or the volunteer things I was doing, I was just in bed because I was just so distraught from the process.
Was actually having a traumatic response to it. And so I was like, this is the last time. I’ll put all my effort into this. And then after that, if I get into residency, that’s great. But if I don’t, it’s just not worth the, struggle anymore for me. I was fortunate enough for my friends to advocate for me in the last cycle, so I got two interviews. But unfortunately, it was the same thing, I just didn’t match and for whatever reason. And it’s just, it’s a numbers game. And.
[23:05] A lot of our colleagues, they’ve applied four or five times and some of them have gotten consistent, interviews every year. And the year they match, they happen to have gotten maybe only one interview, or it was with the program they didn’t even think they had a chance with. So there’s no consistent, there’s no real checklist you can fill to say this is the type of applicant that we’ll get in.
[23:32] Especially for people with foreign degrees, whether you’re US born or like with Muhammad have traveled the world and had different experiences or if you’re an immigrant into the country. So.
[23:47] For me now, residency is not something I’m pursuing and it’s not because I’ve given up on being a physician.
It’s because the process of becoming a physician is too toxic at this point.
My recollection is, I think they actually officially put the MATCH system into place in the early 50s, like 1952, and they’ve tweaked it every single year since that time, but clearly there are some additional problems.
And so Mohammed, I’m going to go back to you.
Tell us about your experience with the match, just to show us how many ways it could go better.
[24:24] So I graduated in medical school in the end of 2014. I came back here into the United States.
You know, by that time, you know, my family was in a very difficult spot financially.
[24:41] Because, you know, my dad was driving cab to try to get me out of medical school after he lost the business. There was a lot of financial problems. My mom was sick as well.
[24:52] And I just really had to not only finish the prerequisites that are required to enter the match, which is the USMLE exam, I had to study for those kids. During in China, when I did my medical school there, I had to prepare their boards and I didn’t have the time to prepare the USMLE to get the process faster. First of all, I had to find the job because I didn’t have no money to pay $1,000 for the test because that’s how much that would cost me to do the test, for each test. So I needed some money. So I was looking for jobs. So that was the first thing that I did and I applied everywhere. I applied to every clinic, every hospital, and even the regular jobs was very difficult for me because everybody was like, hey, you’re a doctor and you’re open qualified.
You know, we’re not going to give you this job.
[25:53] And it was really difficult. And somebody else just, you know, recommended, hey, just remove the doctor degree from your resume. I mean, I think that will make it difficult for you to get a job.
And once I removed that, everybody was like, well, you don’t have no education.
Oh, no. So it was a catch-22, a really difficult process for me.
And so I had to, you know, eventually to make ends meet, I had to work in a lot of odd jobs.
So I worked as a security guard. I worked at a pie factory, you know, cooking pie.
[26:29] I did a lot of things just so I could make some money to prepare and take the tests.
You know, eventually I was able to save up some money, take my tests, pass my tests. And I was ready to apply for the residency match in 2017.
And after that, I didn’t have enough money because everybody tells, especially if you’re graduated from an international school, you have to apply really, really broadly, because it’s very difficult. So I had to sell a lot of things, I had to borrow.
So I invested $10,000 in the first year and try to apply it as wide as well.
I always wanted to, for me, I always wanted to be a primary care physician.
I wanted to be a family doc. So that’s where I applied.
Nothing, no other specialties. And this applied very broadly the first year.
And I got zero interviews. It was a very devastating experience for me, putting all that money and energy and time and the tests and everything.
It was very difficult. So what I did was I tried again the next year.
And the next year I applied to multiple different specialties because I thought maybe, you know.
[27:54] Because I applied to one specialty, maybe that was the problem I didn’t get in.
And I went on LinkedIn. I made some connections, you know, with local hospitals here.
I spoke with some program directors. And the next year I was fortunate enough to get one interview, from the University of Washington UW Family Medicine here in Seattle. And I was really excited and stoked because that was the first interview that I got to the residency process. But that was just one interview out of 500 I applied to. And I knew that my odds were very less, but I was still very hopeful because I thought, you know what, if I, you know, this was the hospital, that system that I came to in this country when I was an immigrant, you know, child and, you know, the doctors here were the doctors who inspired me to become a physician. I have history here. You know, I didn’t know the community really well and I thought that I would be very competitive.
But, you know, unfortunately, one night they came, I did not get in and I asked, you know, feedback for the program.
And the program’s response was that, you know, we just had so many applicants and it was very difficult for us to make a decision. I think they got like these days each family medicine program gets like.
[29:23] So, 3,000 applications for eight spots because of the way the applications in the medical schools are rising compared to the applicants.
I didn’t realize it was that competitive. Yeah. Right now, it is very competitive.
Each program director that I spoke with and saying, hey, I have people.
One program director I spoke with told me, hey, I have people who are doing rotations here.
I have people who are coming from away rotations. have thousands and it’s we don’t even review every application right we have a filtering process, you know if you’re if you’re under 250 or 240 you know we’re not going to get the, chance to even review your application so i’m really happy right now they made step one pass fail because i think if that was in place you know when i was applying maybe that maybe i would have more better chances because I think that puts a lot of stress on a lot of people and that probably will force a lot of programs to review more applications and do a more holistic review as well so a lot of people don’t get filtered out. But I think the biggest problem that I faced is.
[30:37] Nine times out of 10, if I reached out to somebody, if I were able to speak with the program director and I was able to tell them about my story like you know, Hannah described and I did.
I mean, those times if you get lucky that way, it’s easier to get an interview but just yeah.
But applying, you know, it’s really hard and there’s so many program directors that you can get a hold of. So, that was my challenge in the match. Marshall We’ll get back to our interview in just a moment, but right now I want to tell you about a new sponsor for us. Growing Innovation Health Solutions is a comprehensive medical billing service that allows you to shift the burden of, collections off your shoulders so you can focus on patient care. GI Health Solutions has the, experience and the expertise to help you manage all your billing-related chores efficiently and, professionally. Their expert team will handle all your coding, claim follow-up, and billing issues to be certain you receive your payments on time. They can, streamline your building process and increase your revenue by up to 30 percent.
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And now let’s get back to our interview.
[32:24] It comes as no surprise to me that things have changed. I entered the match back in the days when the earth was starting to cool.
And it was my understanding that there were quite a number of residency slots that went unfilled in those days.
And it was actually my impression that there are still unfilled residency spots even today.
But it sounds as if the spots that are not available are those in primary care.
And I’ll put that question out for the two of you.
What do you guys think about that? Yeah. So basically, there’s two processes.
And I’ve seen this conversation for a while, and then I can jump in.
Basically there’s two processes.
There’s the soap system, right? And there’s the scramble system after the soap.
But a lot of people don’t understand that the applicants who end up applying for those scramble and soap system after the match, those quote unquote leftover spots, are still very minimal compared to the thousands of people that are competing for a, left-off spot. So, and Hannah, maybe you can add to that.
[33:37] Yeah, so I, having come for doing research for three years, I’ve approached this issue with data because I think that’s the best way to really open people’s eyes about this. So just going back into the little bit of history of this. So, Dr. Cook, when you were applying for residency, there were ample spots there for everyone.
It was just a matter of finding it. Whether you were a medical student here in the US, an immigrant into the US, or someone that had never set foot in the US and was trying to come in and practice here. But in 92, I believe it was 92 or 96.
I think it’s 96 actually.
[34:31] Oh, it’s 97. Thank you, Mohammed. So 1997, a cap was put on the number of residency spots, because of this fear that there would be too many doctors.
Oh, you can’t be serious. And what that has done… Sorry?
To coin a phrase from… I can’t even remember which comedian said it all the time, but what I said was, you can’t be serious. Oh, yes.
That was the perception that we would be having too many physicians in the workforce and not enough people to treat and not enough jobs for those physicians.
And so that’s why that cap was made by the Balanced Budget Act.
And since then, it has been an uphill battle.
[35:19] Now it makes sense. Yes. Yes. It’s a federal.
Since then there’s been an uphill battle to increase or lift this cap, especially now that we have a physician shortage. And so what has been happening for and I think has been heightened, maybe in the last five to ten years is that our residency system is built a little differently than other countries. We are an open market in terms of who can apply. If you go to Canada, they have a tiered system where they give preference to Canadian medical graduates and, then Canadian citizens and then whatever is left over after goes to anyone. In the UK, So with me as someone who holds a UK degree.
[36:12] I could have gone to the UK and practice. Unfortunately, my situation was a little different because the year I graduated was Brexit and at that time they were not giving any visas.
So they were only, you had to have a UK degree but you also had to either be a EU citizen, a citizen of the Commonwealth or citizen of the UK to be able to get into their training programs.
So for me, my option was to come back And when I came here, I realized that, you know, we don’t just have US medical graduates applying for this.
So we have the fourth year medical students in the US that are applying.
[36:55] Then we have graduates that might have taken a research year or didn’t match the previous year that are applying.
Then you have immigrants. These are people that have completed their degree, maybe even training in a foreign country and have immigrated into the country and either on green card or even citizens that are applying.
Then you have people like me that are born and bred in the US and decided to go abroad for an education and coming back.
And then there’s another group of people that have never even maybe set foot in the US that, are applying for visas to come into our residency training.
[37:36] And so what ends up happening is you have this huge pool of applicants, but not enough spots for all of those people.
And there’s no tiered system either like Canada or other countries where there’s a preference.
There’s a, you know, unspoken rule that US medical graduates, US, so people that have attended US medical schools get preference.
And that’s true because 98 to 99% of those students will match unless they have something, like there’s something really bad on their application.
But nowadays you even see that it’s not even because they have red flags or weren’t doing well in medical school.
You’re getting highly qualified applicants even from US medical schools that aren’t getting into residency.
Utah. So he graduated from Utah Medical School and he’s working with Dr. Mary Tipton Henna. So he’s, he’s doing associate.
[38:36] Position because then he had like 240 250 scores, but he said basically, he was applying to Utah and he wanted to get into the West Coast area. So and it was very difficult for him to even get a get a get an interview in that process. So, yeah, it’s challenging regardless of you know, where you graduate from medical school because of the overwhelming competition.
[39:01] Numbers wise, so I think a colleague of mine, Farina Khan, so she’s also a co-founder of our nonprofit and matched into residency in the previous cycle and just started her PGY2, in family medicine, but we were looking into the numbers again.
And this year, what NRMP reports is that there was 11,600 something applicants that did not get into residency. So out of 46,000 applicants, and so that’s about 25% of applicants don’t get into residency. However, that’s actually an understatement of the actual number because, the way they calculated is number of positions available and the number of active applicants.
And the way they say active applicant is someone that has submitted a rank list or ranked as at least one program on their rank list for residency.
So this astonished me because someone like me, my first two years I applied for residency when I didn’t get any interviews and had no rank list, I wasn’t considered in that unmatched pool, because according to NRMP, I wasn’t an active applicant.
[40:20] No, same with Mohammed and several of our other colleagues and a lot of other people I met.
So when we did the calculation and brought in the numbers of all applicants, including those that did not have a rank list, it actually comes out to about 13,600 something.
[40:41] Applicants that did not get into residency in this last cycle, so the 2021 to 2022 cycle.
[40:49] Out of 46 and then there’s a lot of people that you know may have withdrawn their application but had submitted it or they ended up being ineligible for residency for some reason for this cycle.
[41:07] But the unmatched rate is 25% consistently and if you do the 13,000 number it’s actually 29%.
So it’s actually almost a third of applicants will not get into residency.
Those are really some demoralizing numbers.
Yeah, and it’s just getting worse.
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[42:32] Dr. Darrell Bock 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. If you haven’t discovered this remarkable magazine, please do so very soon. It was created by physicians, for physicians, to showcase the intersection between clinical and non-clinical interests. Whether it’s writing, painting, cooking, politics, and dozens of other topics, Physician Outlook gives a physician perspective. It’s available online and in print. It’s really unique among Physician Lifestyle magazines. And like the Prescription for Success podcast, Physician Outlook amplifies the voice, of any physician who has something to say. It also engages patients who still believe in physician-led, team-based care. And Prescription for Success listeners can get three months free when you enter our promo code, RxForSuccess, and select the monthly option at checkout. That’s a really great deal on this stunning publication.
And now let’s get back to today’s interview.
[43:43] Go ahead and tell us a little bit about the ASP and what their goals really are.
Dr. David P. Rodriguez So when I was, you know, just.
[43:50] Going off the last conversation, you know, after being unsuccessful at UW and not getting into residency, you know, with that one interview I had, you know, I went out to different, you know, nonprofits and I spoke with different nonprofits in the community and I talked to them about this issue that, hey, like, hey, I’m a physician and I can’t get into residency for some reason.
I just asked them for their advice. Back then, I don’t know why I even went to them. I just wanted to get some more information and have people to talk to. And they found this interesting and they told me about, hey, do you have any data on how many people in Washington state have this similar issue. So, you know, I started a social media page on Facebook and I started a WhatsApp group, and I just posted some posts about is there anybody in the same situation that I am and I spoke with different people and I told, hey, if you ever see like a physician that’s not able to get into residency here, definitely have them reach out to me. And it was really astonishing because the first day we had like, I think so one person joined the group.
[45:05] And then the next week we had two people. And then the third week we had like 40 people.
And then it just went up and up and up. And then, you know, by the end of the year, that year in 2019, we got to almost 600 people on that Facebook group, and WhatsApp group living in Washington state that were having the same similar issue.
And you know, I went back to the nonprofit and they asked me as a follow-up, hey, so did you get anybody? And I said, yes, I found 600 people.
And they were really shocked. They were like, 600 people, 600 physicians that have finished all the tests and everything and not able to get into the residency.
[45:50] I’m like, yes, they’re all here. And you know, so they didn’t believe me.
So we did a meeting at a hall that our local library kind of rents out.
So we did that and we got all 600 people in that meeting.
And it was mind-blowing. We even had the local senator and representative come to the meeting and we talked about the issue.
We saw the problem and that’s how I got into lobbying and legislative work.
And soon after that, we created a nonprofit called the Washington Academy for International Medical Graduates, which back then I thought the only problem that this problem only affected international medical graduates living in Washington state for some reason, but why was I wrong?
Because a lot of those people that I figured out later were actually US medical graduates from local schools, and people who graduated from other states having similar issues.
[46:48] And then we started doing a lot of legislative work. We worked with our state to create a program that would create a path to residency process, which is a license where people could practice for four years until they get a residency.
Right now, we found almost, I think so almost 20 people are working with the test, working with this license. And the reason it’s so low is because.
[47:16] We’re having a lot of back and forths with insurance companies and reimbursement and billings. But, this year, we’re able to have a lot of success on that. So we’re able to get a lot of people into to this program right now.
And during this time about understanding this issue and understanding people involved, I just went on Twitter and I saw a lot of posts, I think so, 20 posts from this girl named Hannah.
[47:52] She must have been fairly popular. Yeah.
[47:56] Oh, I was really upset. I think that’s what it was. So I just emailed, hey, I just messaged her on Twitter.
Hey, I said, you want to get together? Because I have this group in Washington, and I’m trying to, you know, bring in a larger national group to create a national nonprofit that could work on these issues.
And she was very excited. And that’s how I met Hannah. and we reached out to a lot of other medical graduates, and soon we found like, I think for the first cohort at ASB was, was it eight people?
Nine of us, nine of us, yes.
[48:35] Nine of us and then that’s how ASB was born and we then basically got into a lot of movements.
We got into the freedom care movement. We got together with a lot of other physicians different states. We worked with the NAP community in Missouri and we just basically grew from there and I think Hannah can add more of her new, perspective on those things. Yeah and I think so the reason I was on Twitter is I actually my supervisor at the time at UCSF where I was doing research had, mentioned that if you… Twitter’s a really good place to engage with other physicians and kind of brand yourself as a physician. And so they said that if you make a professional Twitter account, we’ll tag you in our projects or when we go to conferences.
[49:32] Or other things like that, like our publications, and then you can connect with other doctors and hopefully that’ll get you into the networking through social media for residency. I was not active on Twitter prior to that so I just gave it a shot and then I didn’t match into residency and went on this rant about my frustrations. It was, cathartic and it was it was nice to see that there was a lot of support and then But the most surprising thing wasn’t just the support from other physicians was actually all these other people saying.
[50:06] I’m in the same boat as you.
[50:10] And then that’s how muhammad and our other colleagues and I we met virtually through that and created asp.
[50:18] As I started looking more into it and All of us started trying to understand what is the problem?
We realized this is not just a problem of the bottleneck of residency, but there are problems for pre meds and medical students and then those in residency have issues. And then when we started talking to practicing physicians and they’re like, it doesn’t end once you get residency, like that these problems, it’s a systemic problem that starts from trying to get into the medical system as a pre-medical student all the way through practicing medicine. So we started off, advocating for those that were unmatched, like Muhammad said, these licenses that are in certain states like the one Muhammad has and his group has promoted and implemented in Washington, a summer license in Arizona and Missouri and Utah. And we found out there’s been a license similar to this in Florida since the 80s. So we, this license to, to license unmatched medical graduates, so those that haven’t completed residency so they can practice under supervision.
That’s the license I was speaking of that’s called an assistant physician license in.
[51:44] In Missouri and associate physician license in Utah and I think Arkansas as well.
A famous doctor once said that first it’s trying to get into the medical system and then it’s trying to survive in it. Yes, yes and that’s what we’ve noticed and the problems are getting worse every year. I’ve connected with some medical students and I was blinded to this because I went to a UK medical school, but they’re also focused on their scores for the USMLEs.
They don’t think about learning medicine and the art of medicine and the practice of medicine.
They’re learning it so they can get the highest score in the test.
[52:31] When I saw that, I was really, really disappointed because you lose out on so much of that learning, you’re just focusing on how to get that number and not really learning about what’s the best practice for the patient to streamline things for you as a physician so you can spend the most time with your patient and really develop that relationship and provide them the best care. So we our mission is to create a coalition of not just medical students and physicians, but healthcare workers and professionals as well as a community who want to make the medical system better. Our goal is to make it ethically and morally just as well as providing opportunities that are equal to all. Because a lot of like one issue I’ve noticed, which I myself went through was, and one of our colleagues, well, Leah Ajicef, she’s been trying to figure out how to quantify this in data, is there is a discrepancy in who gets into medical school in this country.
[53:50] Versus who doesn’t. And there are certain demographics that are privy to getting in or there’s a lot of discrimination in certain ways.
Like, and then there’s the issue of gender. Like I faced that when I was in clinical rotations, not just abroad, but here in the US where no one really took me seriously because I was a woman of color.
[54:13] And so there are so many issues that we are just like kind of making this list of, and really thinking about what is the best way to approach these issues.
One thing that has been really disappointing to me is that, coming from, I’ve worked both in research, public health and clinical medicine, innovation is applauded in research and even public health.
But when it comes to the practice of clinical medicine, they want to stay with the old ways.
They are not as readily or eager to change. That is fascinating, isn’t it?
Yes, so for us, it’s about this change, but the change for the better.
And if we don’t get the opportunity to try and take these risks, we probably won’t ever find out if there is a better way to practice medicine, to train residents, and even to teach our medical students.
[55:19] And Mohammed and his group, like WAIMG, They’ve done a great job of showing how you can take those risks and implement sustainable and very, you know, advantageous bills within the state that have helped bridge the gap and not just the number of physicians working and practicing, but also in the gap in care in these really underserved and rural communities that need that type of care.
So it’s very hard right now to simply state what we’re doing with ASP.
And it’s really a part of our growing pain as a new nonprofit.
But our main goal is this coalition that allows everyone the opportunity to practice medicine, and to get the quality education and training required for it and to provide a service to these communities that are so desperately needed.
I’m going to have to say that I think that, uh, you are two of the.
[56:28] Why is this the young people that i have run across in a long time and it certainly sounds to me is if you have your eyes on exactly the right target or targets and it really gives me.
A really good feeling to know that there are young people like you who have A, that kind of wisdom and B, the motivation and the intensity of motivation to go ahead and get the job done.
So I’m really looking forward to seeing what you guys are going to do and I’ll have to tell you that we have, we’re about to give birth to a companion program for prescription for success.
It’s called What Have We Learned Today, where we like to expand on the topics that we’ve talked about here.
And I hope that you’ll plan to be with us on that because this is a huge subject and it needs a great deal more time than we’ve given it today. And we’d love to be able to give you a platform.
But at this point, I am going to give you a little more time.
And we’re at the part of the program that I like the best. And that’s when I close my mic and get out of the way and let you people speak on your own.
So we’ll begin with Dr. Hinnah Sawney.
I’m going to be quiet while you give us your prescriptions for success.
[57:57] All right. So my prescription for success.
[58:03] I think one of the biggest things that has shaped myself and that I think really is.
[58:11] What is profound and special just to us as human beings is being able to help others.
There’s this ideology in India called Seva and it’s about being of service to others.
But it’s an altruistic, like you’re not doing it for anything in return, it’s just from the good of your heart. And that’s something I’ve taken to, that’s kind of been my motto in life is to be, to do seva for others. And I think that is something that really is important, especially nowadays. Doing what’s good for not just you, but the community around you, making that change around you. I was fortunate enough that in high school I had a little stronger foundation, you could say, than my peers in high school for my education prior.
[59:16] My high school was very low income. I felt like I wasn’t challenged enough. I would, kind of complain, you know, it’s a 14 to 15 year old saying I’m bored in school to my professor or sorry, my the principal and say I want to be challenged more. And while they did provide a lot of like resources for me, one thing he said was that instead of just thinking about lifting yourself, think about lifting those around you. And that’s really what SEVA is encompass encompasses as well, is providing service and doing service for yourself and those around you and building up together. And that’s what I feel is really important about medicine, especially right now. It’s not about competing with your colleagues.
It’s not about being the best doctor just for yourself. It’s about this higher calling. I mean, I mean, we take the Hippocratic oath about…
[1:00:19] Being doing the best for the patient and doing the best for those around you and I think that’s very important. But even though you are of service to others to make sure that you’re checking in with yourself. That’s something I neglected a lot of time and I feel I should have listened to a lot of my especially my medical school professors and the attending saying that this is the time to rest. Make sure you’re taking care of yourself. Just like they say on an airplane, put the mask on yourself before you help others in an emergency. And that’s very true. The last thing I would say is.
[1:01:05] Don’t be afraid to take risks. There is nothing in this world that really is set in stone.
Everything can be changed for the better. And usually your gut feeling is right compared to others.
[1:01:22] I’ve never been someone that’s fit into boxes or what typically people see.
I’ve always found another way to reach my goal, whether whatever obstacles are in there.
And I think this really stems from my parents because they came here as immigrants with almost nothing to their name and they’ve built a life for my sister and I.
And one of the things I was really struggling with when I didn’t get into residency was that I was failing all their hard work.
And so being able to…
[1:01:59] Find another route where I can be happy and.
[1:02:05] Succeed on my own terms is what my mom always says is that nothing succeeds like success and, Success is how you define it. So.
[1:02:16] Overall just My prescriptions for success is be of service to others and yourself take care of yourself.
[1:02:25] Don’t be afraid to take risks and and define your success yourself.
Don’t let others define it for you.
[1:02:35] Well, thank you, Hannah. A lot of wisdom packed into all that, and we appreciate you sharing with us. And I’m gonna move on to Dr. Mohammed Khalif and your prescriptions for success.
Yeah, well, I think my prescription for success is gonna be very similar to Hannah’s prescription.
And I’ve struggled with one thing ever since I got into this whirlwind of different issues and problems.
Because success for me was always about becoming a licensed physician and getting into that room with the patients that you want to serve.
And changing people’s lives, sitting down with family, and helping people become more healthy.
[1:03:23] Being a community leader.
And the only way I saw that to get to that point was this residency system and the problems that I went through.
And I struggled with this word for a long time, success, is it that?
And once I took a different route and said like, hey, I want to take a different route other than the match.
And now I want to become a non-profit leader and I want to become an advocate for this.
I realized in that moment that I defined my own success. And, you know, the biggest, my biggest prescription is that define your own success.
[1:04:05] You know, don’t be forced to live in society’s version of success. And a lot of times, you know, that’s the case. And that was the case for me as well. I always lived in a society’s version of success. I never had a definition of what success looked like for me. And everybody needs to prescribe their own success. And sometimes that involves risk, as Hannah said.
[1:04:30] And risk can be scary, it can be uncomfortable. And it can be something that we do not run to all the time. But I think we need to experience fear. I think we need to experience uncertainty.
[1:04:45] And we need to put ourselves in situations that are uncomfortable to be successful, because that’s what it takes to be successful.
I mean, if somebody doesn’t like, if you don’t like your job, I think you should take that risk.
If you don’t like your employer or administrator breathing down your neck, if you want to open up your own practice, you might not open it up today, but you can make the building blocks.
You can start one day at a time, right? You can transition to a part-time job and try to run your practice on the side.
And I love this book. My next prescription for success would be this book by Carol Dweck called Mindset.
And she talks about the concept of growth mindset, which is really, I love that book.
That book changed my life. And I would recommend that book to anybody listening because it is so valuable.
Know, valuable, some of the things that she talks about on mindset and growth.
And my last prescription for success is…
[1:05:50] Find others, right? And whether it’s just reaching out on social media and today, we’re very fortunate because we’re all so connected through social media and other platforms.
And it’s very easy to find people in the same boat. Like, you know, I found Hannah, I was very fortunate enough to find an amazing friend like her and a co-founder that has helped us reach the potentials that we might have not reached and other co-founders of ASB as well.
[1:06:20] And there’s this famous saying in Africa which is, you go fast, go alone, go far, go together.
And if you want to go far, you’ll find other people and like-minded so you can reach that point.
So to summarize, my prescriptions for success is one, define your own success. Two is be uncomfortable. Three is read that book, The Growth Mindset by Carol Dweck. And the fourth is find others. So those are my prescription processes.
[1:06:55] Well, Dr. Mohammed Khalif and Dr. Henna Sani, I thank you so much for sharing your wisdom with us today. And you are both very wise, particularly for your years, and we are honored, to have had you. Before we go, I want to give both of you an opportunity to let people know where you can be found and how they can follow you in whatever way you wish to be followed.
So we’ll start again with Hannah. Thank you. I first want to thank you for giving us this opportunity to speak about this issue and really appreciate what you’re doing with prescription for success.
And we are very excited to collaborate with you and anyone else.
So you can find our organization, American Society Physicians, at asphysicians.org.
[1:07:54] We have a Twitter as well. and it is ASP underscore underscore ORG. We have about 1800 followers, which we’re very excited and hoping to collaborate and expand our platform with them. You can find myself at at henna, H-E-N-N-M-D on Twitter. You’re also welcome to add us on LinkedIn as well. We have a page for for American society physicians as well as our own.
[1:08:28] And to learn more about our organization, definitely see the website since we have a lot of information on the events we’ve done, other co-founders in the work they’ve done, and our collaborators.
And we will also be attending the FridaCare, Muhammad and I will be attending the FridaCare conference in Austin from September 15th to 17th.
So if anyone is there and either would like to attend or would like to meet us there, please reach out, and we look forward to that.
Outstanding and Mohammed, anything to add? Yes, so you can find my Twitter handle.
My Twitter handle is at Prez and W-A-I-M-G. So Prez is P as in pencil, R-E-Z, Prez, W-A-I-M-G.
And you can find us on our website, and I’ll also be at the conference with Hannah and excited to meet anybody there.
So that’s all I would add.
Thank you so much again for inviting us to this podcast. We’re very honored to share our story and have your listeners listen as well.
Thank you so much.
Well, Dr. Hannah Sane and Dr. Mohammed Khalif, thank you once again for being with us on Prescription for Success.
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And remember, be sure to fill your prescription for success with my next episode.