Episode Transcript
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Speaker 1 (00:01):
Hello and welcome to
another episode of the Med
School Minutes podcast, where wediscuss what it takes to attend
and successfully complete amedical program.
This show is brought to you bySt James School of Medicine.
Here is your host, kaushik Guha.
Speaker 2 (00:19):
Welcome to another
episode of Med School Minutes,
where we talk about everythingMD related, with a focus on
international students,specifically students from the
Caribbean.
Today we have a veryinteresting guest.
We're talking to Dr IvanEscudero.
Dr Escudero finished hisresidency in the United States
(00:40):
and then chose to start his ownclinic in Canada, so he has a
very unique perspective ofworking in both a privatized
health system in the UnitedStates as well as working in a
nationalized health system inCanada.
So, without further ado, let'swelcome Dr Escudero.
(01:02):
Thank you so much for makingthe time, dr Escudero.
I really appreciate it.
You know we were brieflytalking about how busy our
alumni get, and I know how busyyou guys are and we always
appreciate any time that yougive us.
But without further ado, Iwould really like you to
(01:23):
introduce yourself and tell us alittle bit about your
background, sure thank you somuch for having me.
Speaker 3 (01:29):
It's a pleasure.
You know anything for St James,such a great school, and I'm
happy to be here.
So, about me, you know I'm analumni from St James.
I went to Anguilla in 2014.
Loved every minute of it.
It was great.
Loved the atmosphere, thebeaches, the school.
(01:51):
It was a dream come true reallystudying in paradise and then
having the opportunity to doclinical rotations in the United
States.
That was great.
I I loved it.
Um, spent four years with saintsaint james and then I ended up
matching into residency infamily medicine residency uh,
(02:12):
beautiful, detroit, michigan.
Uh, very robust still, it wasamazing.
It was my number one choice.
Um, I was so blessed to havelearned from some amazing,
amazing attendings, so unique.
I count my lucky stars everyday that I met those people,
made some lifelong friends, didsome research as well.
I'm also Canadian, if I didn'tmention that, yeah, and did some
(02:38):
research, published a fewpapers, co-authored them, some
research abstract.
I worked in the United statesbriefly in a rural setting, and
then now I have my own clinic incanada.
Um, I'm working there.
I do some hospitals work, somesome er work from time to time,
(02:58):
uh, and it's great, it's, it'sawesome, and everything came
full circle.
And here I am awesome.
Speaker 2 (03:04):
So, uh, you mentioned
that obviously you're Canadian.
You're back in Canada now.
Did you find the residencymatch process particularly hard
for Canadian students?
Because we get that a lot fromour students.
Oh, canadians, it's just somuch harder, is it, or is it not
?
Or can you account for it orprepare for it so that it isn't
(03:25):
particularly hard?
Speaker 3 (03:27):
um, in canada, yeah,
it's, it is a little bit more
difficult.
I mean, there's not a lot ofresidency programs uh, there
there's, you can count them onyour fingertips.
Okay, um, there's a lot more inthe united states and you know
there's a lot more opportunityas well.
States and you know there's alot more opportunity as well.
It's.
(03:50):
I mean, you can also say thatit's a little bit more
competitive in Canada becausethere's so few residencies, but
you know it's not impossible.
But in order to stand out, youknow, having a great application
experience and so forth, it'llmake the process a little bit
more smooth and a little biteasier, especially you know,
with interviews and so forth.
Speaker 2 (04:08):
But canada is a
little bit more difficult but
what about, as a canadian,applying to the us?
Is that harder?
Is that?
You know?
I know it's.
It's got to be harder becausethe us uh programs are going to
make visa for you.
Speaker 3 (04:22):
Um, I mean, at least
for me, it was pretty
straightforward.
Um, I, I looked for programsthat offered the visa, the J one
visa, um, and I got a lot ofinterviews.
I mean they there was no issuewith me being Canadian and even
for some of my friends whoweren't Canadian or, you know,
(04:43):
american, they didn't haveissues as well.
If a residency really wants you, they'll invite you out.
They'll figure a way out tosponsor you.
One of my friends actually gotan interview at a hospital where
they don't offer any visas andthey made some exception.
Oh, wow, yeah, so coming fromCanada, not once was it ever
(05:04):
questioned at all.
It was very straightforward.
Speaker 2 (05:07):
I guess they're used
to it okay, yeah, yeah, you know
, uh, it's funny that you saythat actually, but two years ago
we actually had a student, acanadian student, who had
exactly the same experience, andthis was a big hospital system
like unc, unc.
It was a University of NorthCarolina hospital system.
And they've never accepted aninternational student before and
(05:29):
they liked her so much theywent ahead and did it.
In fact, the program directorand the CMO directly called her
up and said, hey, what do weneed to do to make sure that you
come to us?
Yeah, and I was like, wow, yeah.
So it sounds like you have avery similar experience, or like
have experienced the same thing.
The programs are more fixatedon the candidate than they are
(05:51):
about qualifications.
Speaker 3 (05:52):
Exactly.
I mean, even in your interviewprocess they'll ask you some
questions that are out of leftfield just to see you know who
you are as a person, right, butyou know everyone doesn are as a
person, right, but you knoweveryone doesn't matter where
you're from.
You know even St James like.
You're qualified and you havethe credentials to do residency
(06:13):
and succeed.
Speaker 2 (06:15):
Awesome.
So you said after you finishedyour residency, you went into a
rural setting.
Why was that?
Because you studied in or youdid your residence in Detroit,
which is obviously a big metroarea.
Why did you choose to go to arural setting?
Speaker 3 (06:32):
Well, I mean, I like
rural medicine.
It's something that always, youknow, interested me, you know,
serving people in theunderserved area and in a rural
setting.
A lot of patients, a lot ofpeople have multi-system
diseases.
They're, you know, they don'treally have a lot of resources
(06:53):
available in major metro citiesand I'd be able to use my skills
to, you know, help those people.
Most of the time I'd be actingas their specialist, because
there's no specialist available,there's no endocrinologist, so
I'd essentially be acting astheir endocrinologist or their
cardiologist to a certain extent, um and be that basically main
(07:16):
point of contact for their care.
And I was able to use also my,you know, procedural skills as
well in a rural setting.
Even now in Canada, when I workin some places up north, those
skills that I learned in myresidency and when I worked in a
rural area really helped me andit's great, it's something that
(07:36):
resonates with me.
My folks live in an underservedarea and since they don't have
any very little access to care,you know, I wanted to contribute
back.
I want people similar to myparents, to, you know, have that
position.
That's there, you know, andwith those skills as well.
Speaker 2 (07:57):
That's awesome.
So was it a big adjustmentgoing from Detroit, Michigan, to
a rural area, from lifestylelifestyle as well as
professionally, was it a bigdifference?
Speaker 3 (08:09):
Sort of.
I mean, I've lived everywhere.
I've lived in the Caribbean,I've lived in major metro city.
I actually came from a very,very small town it was.
It wasn't like a big cultureshock.
But you know, settling in, uh,you know it obviously takes some
time, but it wasn't somethinglike, yeah, um, totally out of
(08:31):
you know, out of context, it was, it was, it was good, it was
okay, it was all right yeah,because one thing I have noticed
, and you know we have a bigsystem in, uh, west virginia
that we work with, okay, whichis largely rural.
Speaker 2 (08:45):
But I visited west
virginia several times, I
visited kentucky, rural kentucky, um, and I've been to several
like even in south dakota andstuff like that.
But at least in the unitedstates the term rural is not the
same definition as what youwould say a rural, even in
countries like, say, australiaor um, I'm originally from india
(09:09):
.
Like in india, rural means nosanitation, no water, no
electricity.
Right in america, rural meansoh yeah, you have to drive 45
minutes in the closest walmartyeah.
Speaker 3 (09:32):
So, um, in your
experience, is canada rural and
america rural, equitable or ornot?
Um, actually, yeah.
So in terms of medical care,yeah, I mean canada, it's a lot
more pronounced.
There's many, many millions ofcanadians without a physician, a
family physician I think thelatest report was 2.5 million
Canadians without a familyphysician and and a lot of the
(09:54):
areas.
There's a lot of small townsand there's not a lot of major
metro cities in Canada and it'sso spaced out so it's it's
pretty emphasized.
I'd say it's you's a lot morepronounced in Canada than the
United States and similar issueswith distant facilities where
(10:21):
to get certain types ofprocedures done, certain testing
done.
I think it's kind of the samein the States and Canada.
Speaker 1 (10:30):
But it's way more
pronounced in.
Speaker 3 (10:31):
Canada, In my opinion
at least.
Speaker 2 (10:35):
So I mean you are
particularly unique because you
obviously studied and worked inthe US system, but then you
chose and now you have your ownpractice in Canada.
What was the process like?
And obviously you wereoriginally from Canada and it
seems like you wanted to getcloser back to home, closer to
your parents.
(10:55):
What were the other than these?
Were there any other majordriving forces?
Are pace scales the same in usaand canada?
What was the driving force foryou to actually move back to
canada?
Speaker 3 (11:10):
because we honestly,
we don't really see a lot of uh,
our alumni, canadian alumni, goback as soon as you did so I
mean, you know, I, I, I was deadset on the united states, you
know, and the united statesprovided me with that
opportunity to live the americandream um it's something that I
(11:32):
I I dreamt about ever since Iwas younger, you know, like
fulfilling that, that dream,getting the opportunity to to
work in the united states.
You always hear about theopportunity and everything, and
even with the pay right.
Um, there were some changes inin circumstance, that you know.
I can't really get into toomuch detail with, uh, you know,
(11:53):
my former employer, um, you know, contractual right, of course
issues.
And then, um, you know, comingbeing a Canadian citizen, that
that's where my home is, that'sthat's'm from, that's where I
was raised.
And you know, I said, well, I'mgonna be working in canada.
Um, I, I took the leap, wentback to canada and went through
(12:16):
the process of getting mylicensure, my certification and
then I said you know what?
I've always dreamt of having myown clinic one day, whether it's
in the united states or whetherit's in Canada.
And now that I'm back in Canada, I took that opportunity and
said let me, let me go aheadwith this.
And you know, I also maintainmy, my license as well in the
States.
But OK, yeah, it's kind of aunique feature.
(12:39):
Got to train in the UnitedStates, had that opportunity,
and now I'm back in Canada mywhole country.
Speaker 2 (12:46):
That's awesome.
So you said that you had to gothrough the paperwork.
Was the paperwork process easy?
Is there a lot of reciprocitywith Canada and USA?
Speaker 3 (12:55):
Canada has gone a lot
better in terms of having
physicians return back to Canadaif they trained in the United
States or if they trained abroad.
It's a better process now, um,it's, it takes a long time, um,
but the paperwork it's prettystraightforward and, depending
(13:16):
on which province you plan onworking in Canada, the colleges
are very, very friendly.
They're very nicer.
They can answer all yourquestions.
Very friendly, they're verynicer.
They can answer all yourquestions.
I've I've called the, theontario college, several times
to figure out everything elsethat I need to, and they're so
friendly.
They said, yeah, just do thisand this, okay, and it's very,
very straightforward okay, soit's not like a crazy
(13:38):
complicated process like I'veheard.
Speaker 2 (13:41):
Uh, especially in
countries like, say, for example
, india, nobody really knowswhat's happening.
There's no clear answer.
Speaker 3 (13:49):
Well, they use the
ECFMG to validate your
credentials and your residency.
So you know my residency isamazing and they communicated
that to the ECFMG and it wasvery straightforward.
I mean, my residency program,they're excellent.
Everyone there is on top oftheir game From other places, I
(14:09):
mean, I really don't know, somaybe kind of delayed.
You know, translated and soforth, so it really really
depends.
But for me at least it waspretty smooth and anyone else
who does a residency in theUnited States it should be
pretty straightforward.
Speaker 2 (14:27):
So you mentioned that
Canada is open to foreign
physicians who are trainedabroad not just the United
States and I know that Canadahas a massive dearth of
physicians across the board andCanada doesn't have the number
of applicants that say Americahas with its 350 million
(14:48):
population.
Can you tell me a little bitmore?
Do you think and I know thatyou don't have first-hand
experience of not being trainedin the US, but if somebody were
to train in somewhere like theCaribbean or Europe, what is the
process for them?
Is that?
Do you know if it's anydifferent, or is it easier, is
(15:08):
it harder?
Speaker 3 (15:10):
From what I know,
that Canada, you know, they
consider the training equivalentin certain countries, not all
countries.
Okay, it's the uk, um,australia, um, the united states
(15:30):
, I think singapore and I thinkhawk, I think, I believe, I'm
not too sure and obviously, ifyou train in canada, right, um,
but uh, they consider itequivalent.
I know that there's a fewphysicians from the uk who are
from the canada and it's it'sclear to quibble with the
training From other countries.
It doesn't mean that theycannot come back to Canada.
I think there's a separateroute that they have to do, like
a study, assessment orsomething.
(15:51):
I'm not familiar with that,since I didn't go naturally,
naturally.
Speaker 2 (15:56):
Naturally.
So now comes the mostinteresting question, to me at
least, and that is USA is acommercialized, privatized
health care system with it.
Canada is a nationalized healthcare system that kind of
follows the pathway of the ukwith the, with their national
health services, nhs and whatnot.
(16:17):
Really, you've worked in bothand not just work, you actually
own a business in canada, aclinic in canada.
Can you tell us from yourexperience, what do you think,
from personal experiences, whatsystems?
What were the pros of anamerican system and what were
(16:40):
the pros of the canadian system?
Let's start with pros and thenwe can get into cons.
Speaker 3 (16:44):
Right.
Right, I mean like my clinictechnically, you know I run it
and so forth, but you know Ihave one of my partners manages
everything, so it's technicallyunder their umbrella.
But yeah, in the United States,I mean, having your own clinic
is essentially like a thing ofthe past because it's really
(17:08):
dictated by insurance companiesand the reimbursement as a solo
practitioner is extremelydifficult now.
That's why it's a lot ofhospital systems.
Our physicians work under orwith a very big group of
physicians systems.
Our physicians work under orwith a very big group of
(17:29):
physicians.
Um, a lot of docs are at themercy of, you know, the
insurance companies, so forth,and it's it can be very tired,
it can be very cumbersome withthe paperwork and the history of
tasks as well.
Um, you know you can get burntpretty quickly, but it it's,
it's good lif.
Well, depending on where youwork and the model that you work
at.
In Canada, a lot of thephysicians there it's through
(17:54):
the government and thegovernment is the one that deals
with the payment and so forthand reimburses the physicians or
organizations.
It is totally different and thepay scale as well varies.
You can get paid very, verylittle or a lot, and it's
socialized as well and it'sdictated by the government, but
(18:16):
there's not that much red tapeas opposed to the United States.
Yeah, in terms of billing andso so forth, right, and
especially with diagnoses.
I know that in my residencytraining, like my residency
training, like I, I have nothingbut high regard for my training
and I learned about billing andthis was in the United States
(18:38):
and having certain diagnoseswere very important.
Like you want to say hey, likeuh, for example, like acute on
chronic kidney disease secondaryto uncontrolled diabetes
mellitus, dk.
In canada it's not reallyemphasized, but when diagnoses,
so it can be a little bitdifferent, but you know the the
(19:02):
underserved population is iskind of the same in both
settings.
Hopefully that answers thatquestion.
Speaker 2 (19:10):
No, I think it does.
I think this was a real eyeopener, because you said that
the US system has a lot more redtape.
Usually, that is something thatpeople do not associate with
the privatized system, right formore of like the insurance
companies in irrespective.
Speaker 3 (19:25):
Yeah, like I I, for
example, I have.
I prescribed insulin.
It was simple insulin, nph forone of my patients and I needed
to do a prior and that was amind blow for me.
That patient needs that andit's like what's the purpose of
this, you know, whereas inCanada that's not really, there
(19:49):
are some things with insurancecompanies, but not as emphasized
as it is in the United States.
Speaker 2 (19:56):
Okay, interesting,
because one of the biggest
arguments that a lot of you knowthis is a political debate as a
nationalized health care systemversus privatized.
In the united states at least,they keep talking about how uh
are are because of theprivatization there's price
gouging, all these negativethings that happen, and but one
(20:18):
of the big things that peopleactually mention about the
benefits of privatizedhealthcare is that it is
efficient and there's no redtape.
But here, as a practitioner,you're saying it's actually the
opposite.
Because of all these oligarchyplayers that are controlling the
system, you end up doing morered tape, though it's not
(20:40):
necessarily mandated by thegovernment.
Speaker 3 (20:42):
Exactly.
I mean, and the thing is it'ssomething a lot of people don't
realize that you know, insurancecompanies really dictate how
physicians should practice,which that should never be the
case.
That you know.
I can prescribe you amedication.
That is perfectly what youlearn in medical school, what
you learn in residency.
Insurance company says, no,we're not going to cover that at
(21:04):
all.
And then you have a patient whocannot afford anything else and
it's like this is I'm now myhands are tied, essentially
right, and with thatprivatization, many, many
patients are able to, you know,see specialists or see other
physicians or nursepractitioners or PA, and they
have the freedom to do so.
Right, whereas in Canada, youknow, in order to see a
(21:29):
specialist, you have to see yourfamily physician first.
And you know, if I prescribe amedication, the government I
mean some medications arecovered, but it's not like they
say, hey, this is rejected, youneed to do a prior off, unless
it's like private insurance.
Speaker 2 (21:46):
But, um, yeah, it's
kind of like those, those little
nuances, those, wow yeah, andand from from a time standpoint
for a physician, by yourestimate how much, beyond hiring
like if you're a small clinicthat you own in the United
States beyond hiring aspecialist who's going to code
(22:07):
all of these things for you howmuch time do you think that this
takes up for the physician inthe United States?
Speaker 3 (22:14):
I think you know, if
it's an independent physician,
it forever.
And that's why you know havinga clinic of your own is almost a
thing of the past.
That's why a lot of employersnow would have billers, coders,
so they take care of all thatand kind of alleviate a lot of
that administrative burden onthe physician.
(22:36):
Um, you know, but you'reessentially at the mercy of
their policies, want, um, but Imean it, it varies.
It varies depending if you workfor.
You know certain, you know fqhc, for example, another big
hospital system.
It it kind of varies okay so.
Speaker 2 (22:57):
But does that mean
that in canada you can go ahead
and say you have two, twodoctors, two physicians, very
good physicians, they can starta clinic.
Speaker 3 (23:05):
But it sounds like in
the USA that can't be, that two
physicians just cannot start aclinic months and even the
reimbursement is very, um, okay,so a lot of physicians, there's
no financial incentive to do so.
(23:26):
Okay, that's pretty limited,whereas the, whereas canada
doesn't have that.
It's, everyone is coveredregardless.
Speaker 2 (23:35):
Um, and they were
depending on the, on the code
that use a billing code, you getreimbursed out of money okay,
yeah, wow, yeah, um, in the usis there, would there be a
situation where a patientessentially gets a treatment
(23:58):
because, say, for an emergencysituation, the insurance doesn't
really cover it and then thepatient can't really pay, but
then at that point the clinic orthe hospital system or the
physician ends up putting thebill.
Is that a likely scenario inthe united states?
Speaker 3 (24:16):
sometimes it does
happen, it does okay, um, you
know it it's.
It happens more often than youthink okay so, yeah, that's,
that's not something totallyforeign, but yeah, yeah, it does
happen.
Okay, and there's sometimes Imean, for example, this is a
classic example of medicare um,like a decubitus ulcer that it
(24:38):
may happen that occurs while thepatient is admitted in a
hospital.
Medicare will not pay for thatpatient's visit.
Wow, it will cost the hospitala lot of money.
Speaker 2 (24:51):
Wow.
So are these scenarios likelyin Canada at all, where the
hospital system or the clinic orthe physician they're out of
pocket, trying to care for apatient essentially?
Speaker 3 (25:04):
Yeah, there are a lot
of social issues in Canada as
well.
You know, it's not a one sizefits all.
It really depends, you know.
I know that Canada is trying toimprove on that and
implementing a lot of socialservices, but sometimes there's
not a lot of resources,especially in the rural areas,
(25:27):
so it's kind of a shame.
But yeah, sometimes hospitalshave to eat the cost for a lot
of things.
It's not available.
Speaker 2 (25:34):
Right.
So one great thing anytime thisdebate comes up about which
healthcare system is betterCanada or USA, or privatized
versus nationalized and one ofthe examples that they keep
saying is that, oh, there are nopractitioners to really do
(25:54):
processes that are notnecessarily required.
And now, by the Canadian healthsystem standards, a required
process may it's not justplastic surgery or to make
yourself look good, somethingthat doesn't necessarily kill
you.
So, for example, you know, Iknow a particular person who's
(26:23):
had a very open hernia andapparently in Canada this would
be considered to be an electiveprocedure because they can
survive by having somebody comeand change the dressing twice a
day through a third-partynursing practice or whatever.
(26:45):
But the quality of life wassuch a dramatic change when you
have to change your dressingtwice a day from a professional
versus if the wound iscompletely healed and cured and
whatnot, and it's done throughsurgery.
So I was told that in Canada aprocedure like that would not
even pass muster and would not.
(27:06):
You would be on a wait list andthis could be years before
anything gets taken care of,Whereas in the United States, as
long as you had insurance, youjust shopped around for a
surgeon within about a week,week and a half, everything was
taken care of.
Is this a real scenario?
I mean, I've I've heard this inpolitical debates, talked about
(27:28):
this a lot.
I've you know, and thisparticular incident was a real
situation that I experienced.
Or like a foreign year and dearone.
Speaker 3 (27:38):
Um, is this a likely
scenario, or from your
experience, or um, honestly, ithasn't been too too long since
I've been practicing back incanada for me to say, god, like
100, without a doubt.
But.
But I've seen instances thatwere kind of like very important
.
Okay, um, you know, need andsometimes, um, some specialists
(28:06):
depending who can flat outreject the referral, um, so,
yeah, it's possible.
Um, but you know, I I think thecanadian system is phenomenal,
it amazing.
It not only gave me anopportunity, but there may be
some flaws, yes, but I thinkCanada is striving to improve
(28:28):
that every single day and everysingle physician that works
there does everything possiblefor their patient and is fully
capable of helping them.
But, yeah, I think some ofthose scenarios with that, if
it's surgical, that's more oflike the surgery realm to deal
with, but yeah, sometimes in thefamily medicine clinic, it's
(28:49):
kind of like all right, let'stake this approach, let's go
down this avenue to find what wecan do, okay, yeah, that's very
interesting.
Speaker 2 (28:59):
So there is some
truth to this thing that because
you know, recently I visitedthe United Kingdom and met a
friend of mine and he was sayinghe and his wife haven't been.
They've been on a wait list tosee a general practitioner for
their annual checkups.
They're healthy, young,relatively young, healthy people
and they said that they haven'tbeen able to see a general
practitioner in three years.
(29:20):
Um, in the uk this is um, and Iwas like, yeah, that's never
going to happen in the us,because us it's the other way
around, where the generalpractitioners are.
Literally the systems aresending you messages, emails,
text messages like that anywhich way you can to come in for
your annual checkup, and I, andI really appreciate that, to be
(29:42):
honest, yeah, um, and whereasmy buddy in the uk was saying
that that's not, that's not howand he lives in a more rural
area.
He doesn't live in london.
Yeah, um, he lives in a morerural, uh village near
portsmouth and he's like it'sbeen three years.
There's just no physicianphysician comes.
They have a clinic here andthat clinic has not had, uh, an
(30:03):
actual permanent physician for avery, very long time.
Speaker 3 (30:06):
Yeah, I mean, um, my,
my office manager would, uh,
would tell me, hey, this uhpatient here has been looking
for a family doc for five, wow,and I would have patients who
would come in and say thank God,you are here, do not leave.
I've been looking for three,four years or my only family
(30:31):
physician either passed away orretired and we have no doctor
whatsoever.
Okay, and and yeah, like many,many patients are very grateful
for that, and you know that.
That that's why I got intomedicine, you know like like
it's.
It's not about the money.
For me it is not.
And you know, one could arguethat you get, you get paid like
(30:54):
very well in the united states,right, but for me it's about
delivering care to patients.
I love my patients.
I have this very good patientphysician relationship with
every single one of my patientsand they matter a lot to me and
I take that time and effort.
That's why I got into familymedicine, because because these
people need care, they need theydo not have anything.
(31:19):
Some of them don't even havevoices and for, like,
figuratively speaking, and now Ican act as an extension of
their family, to be a voice forthem when they don't have a
voice, and when I do, uh, somelocum up north, like it's my
opportunity to give back to them, to help them out.
That's why I got into medicineand it it's, it's something I
(31:43):
cherish every single day.
So when I hear patients sayplease don't leave, like that
resonates with me.
Oh, like, like it means a lot,like thank god it's been five
years, yep, don't worry, you'rein good hands, I'm gonna take
good care of you.
Speaker 2 (31:57):
That's awesome.
Um you mentioned that uhphysicians in in uh us don't
make as much money as physiciansin canada no, no, sorry, I
meant to say in the us, they,they would make, they would make
a lot oh, okay, okay, like,right like a significant, much
more.
Speaker 3 (32:17):
But you know, in
Canada it depends on the model
in which physicians, you know,work For me because I'm a solo
practitioner and so forth.
Coming back, you know, I'mfocused more on delivering high
quality care and whatnot and I'mnot after the money, Right.
(32:38):
And I love teaching as well,Right.
So you know, teaching medicalstudents and having them with me
and all that that means a lotmore to me.
Awesome, yeah.
Speaker 2 (32:53):
So one thing is so.
I mentioned right in thebeginning of the podcast we
haven't had that many studentsfrom Canada who finished their
residencies in the United Stateslike yourself, right.
Very few of them have gone backand every time I've spoken to
them they've always mentionedthat the salaries just in Canada
(33:14):
don't equate to salaries in theUS.
So the very fact that you wentback clearly shows your passion
for the subject.
Speaker 3 (33:28):
Yeah, I mean, it fits
my personality so well.
Yeah, and the states like Imean, with the privatization you
can make a lot, a lot of money,and that's a family physician.
You can right make more thansome specialists.
Speaker 2 (33:43):
Yes, in canada, no
not even close, but kudos to you
.
For me, you know, I meanliterally doing what doctors
were meant to do, yeah, helpingpeople.
That is really amazing,absolutely.
And I know you mentioned thatyou like training, teaching
(34:08):
students.
I know you are going back to StVincent later this year, in a
couple of months, a couple ofweeks actually, yeah, and we're
hoping that you get to interactwith some of the students and
inspire them with this amazingstory.
But why don't you tell us alittle bit about your time in St
(34:29):
Vincent?
You're from Anguilla, you aboutyour time in St Vincent.
You're from Anguilla, youweren't actually in St Vincent,
but what it means, like goingback to St James and to see the
development of St James in adifferent island.
I know we're a 25-year-oldschool and you're a part of our
rich history.
Speaker 3 (34:50):
Yeah, I mean, going
in Anguilla was wonderful, it
was incredible.
I miss it every single day,just being in shorts and
flip-flops going to lectures andjust that one-on-one with the
professors.
I wouldn't change it.
For the rest, if I could do itall over again, I definitely
would do it.
Speaker 2 (35:09):
St Vincent, I'm
looking forward to it and, yeah,
I'm looking forward to seeingstudents and, you know,
hopefully, you know, encouragethem to really follow their
dream, you know, and perhapsmaybe they get into family
medicine as well, and you know,and you know, and we need
practitioners like you who truly, you know, are passionate about
(35:33):
the subject, to talk to thesestudents, because one thing that
I've noticed with a lot of thenewer classes, that we've seen a
lot of the older classes theygenuinely get in because they're
passionate about the subject.
Passionate about the subjectbecause I'm going to be very
honest, there's no otherprofession in this planet where
(35:55):
you have to work or study ashard not study as hard as you
have to do in medicine.
Absolutely, um, and the amountof time, commitment and effort
that goes into becoming aphysician, at least in the
united states, it's unparalleledthere.
There's no other country in theworld or no other profession in
the world where you'd have toput that kind of time commitment
in order to do this Is it.
(36:17):
However, what we're beginning tosee is that and I think that
this is kind of an offshoot, Imean we're going on a little bit
of a tangent here, but.
I have to rant a little bit, andI think social media has a huge
role to play, because peoplestarted talking about their
salaries and income, and whenyou take a physician who's been
(36:38):
practicing for 10 years, theincome that they're going to
make it's unparalleled that inalmost any other profession
they're not making that kind ofmoney.
Now, the issue is that, no, thesocial media conveniently cuts
out the fact that this personprobably spent anywhere between
10 to 16 years.
Uh, just being able to lay thegroundwork.
(37:00):
To have to start from groundzero, yep, and then they work
for 10 years.
So those are some of the thingsthat are omitted.
So what we're beginning to seeis a lot of students coming in
that are entirely focused on thepaycheck and having a
personality like you, who istruly in it for the passion.
I mean, we have a ton of alumniwho are very similar to you,
(37:26):
but you being able to addressthe students would make a world
of difference to them.
Yeah, that you know, becauseyou had all these choices, but
despite that, you chose toliterally give back to community
.
Mm-hmm.
Speaker 3 (37:40):
It's yeah, it's
honestly it sounds cliche, but
you know I love being part ofthe community.
That's how I was raised, youknow, very family oriented, very
, very tight knit, and I grew upin a small community and you
know that's my personality andyou know, telling any student
(38:01):
chasing after the money, you'llnever be happy, because it can
go like that in a heartbeat.
And I've seen people where ithappened, you know, and even in
my residency training, rightLike the, my associate program
director, my program director.
They were so inspirational,they were incredible.
(38:21):
The faculty and theirdedication to the underserved
area was unparalleled.
It was amazing.
So I was able to see thatfirsthand and I'm like you know
what, thank God I'm in thisprogram.
Amazing, so I was able to seethat firsthand.
And I'm like you know what,thank god I'm in this program,
thank god that I got to see thisfirsthand right?
Um, you know, at the end of theday you'll be getting a good
salary in the united states, forsure, but if you chase after
(38:44):
money, you won't be happy.
You won't be happy and it'lljust be a rabbit hole that
you're gonna go into.
And you know, once that's allgone, you should have something
that'll make you feel fulfilled.
That's why I love teaching,that's why I love giving back to
the community, because thatthat gives me it's, it's like my
(39:05):
vice.
It really is right, right sowell, I trust me.
Speaker 2 (39:09):
If I had vices that
are that good, I mean, my wife
would be very proud of me.
Speaker 3 (39:15):
I can tell you that
yeah but it's funny you
mentioned like social media doeshave an influence.
Like, oh, a day in the life,like a dermatologist, like that,
like that's cool, that'sawesome.
For me, with family medicine, Idon't know what I'd see next,
and that's why I like variety aswell.
And yeah, no matter where youwork in the States, like
(39:37):
employers will give you a verygood contract, right.
So it varies, but you know, thewhole point of studying
medicine is to help people.
Speaker 2 (39:47):
Yeah, yeah.
I would even argue thatsomebody who is not passionate
about the subject, which is whatwe're seeing more and more of
people, would be like oh, I sawthis tv show and this looked
great and I want to join it, butwhat you see in a tv show is
number one, an embellishment,any, every tv show yeah yep, yep
(40:10):
, um.
But number two is that whatyou're seeing on the tv show is
probably after 10 to 16 years ofwork that an individual
physician would have to put into, even be yes, recording at that
level.
Yes, you know absolutely, andthese are things that that, like
Grey's Anatomy, doesn't talkabout this that, oh, hey, yeah,
by the way, this person wentthrough three board exams and
(40:34):
how many state board licensingtests and how many failures and
how many broken relationshipsand how many all-nighters.
Nobody talks about all that,right, exactly.
And that's when you have theseyoungsters come in, because even
med school is not easy.
Um, especially in a programlike, uh, st james, it's an
(40:55):
accelerated program, it'stougher, it's harder, um, these
are all things that studentscompletely tend to ignore.
And then when the going getstough, you know the people who
aren't cut out for it are justdropping off like flies of that
pond.
They were like whoa, this isnot what I signed up for.
(41:15):
This did not nothing like whatI saw on tv, or this is not
nothing like what I saw ontiktok exactly, and like
residency too.
Speaker 3 (41:23):
like you know,
residency is hard, it is
extremely hard.
So I think you know expectingeverything to be, you know, on a
silver platter no, that doesn'thappen.
There are countless nightswhere I didn't get sleep and
whatnot, but you know, I washungry for it, I was passionate
(41:47):
about it, right, and I wantedthat me and my friends, my
colleagues but I was able tode-stress as well.
But there's a lot that you haveto go through in order to reach
that level, right, right?
Speaker 2 (42:01):
right?
Well, I mean Dr Escudero.
Thank you so much for your time, but before we leave I do have
one final question for you.
Sure, so for students who arealready in our program, say
hypothetically, when you go in acouple of weeks you're going to
meet a couple of them andusually when I ask, hey, what do
you want to be, it's usuallyalways something ultra sexy,
(42:21):
like the most common answer iscardiothoracic surgery.
Because I don't know, maybe itjust rolls off the tongue better
I who knows what it is.
But incoming class md1, wealways ask, okay, what, what
would you want to be?
And the hands go up and it'salways cardiothoracic surgeon.
I don't know why, but these areobviously students who are
(42:44):
thinking about the end resultand not all the work that has to
go in.
What advice would you have forthe students coming in to an MD1
program now?
Speaker 3 (42:57):
I'd say take it step
by step.
I mean, every single physician,whether it's a cardiothoracic
surgeon to pediatrician,cardiothoracic surgeon to
pediatrician, have has to learnthis um, but don't go chasing
after the final result.
Take everything step by step,day by day.
(43:19):
Absorb this information, learn,ask questions, ask why, and
then, when you do your rotations, you'll be be able to, you know
, get a better glimpse of that.
But going in an MD one, take itday by day, one day at a time.
You know, give it your allevery single day and everything.
(43:41):
There's light at the end of thetunnel.
Every day it's a new chapter,it's a new blessing.
You know.
So, learn about, you knowastrology, learn about the
biochemistry, and thateventually, time's going to pass
by and you're going to startlearning about the pharmacology
and you're going to startlearning about the physical
examination.
Everything's going to come intoplace right.
And then now you'll startsaying, maybe I start want to do
(44:03):
this.
If you don't want to do that,take it every single day, one
step at a time, and don't lookat the end, because you'll miss
the enjoyment, literally.
You'll enjoy it too.
Go to the beach, go enjoy,sometimes, relax, spend time
with friends.
But just take every single day,step by step, and get tons of
(44:24):
sleep as much as you can,because once you start residency
, you won't get sleep.
Oh wow does.
Speaker 2 (44:30):
Does that ever get
any better?
Because I heard for surgeonsthey're like yeah, we're
lifelong residents yeah, yeah,for I mean does that get better
for like you?
Speaker 3 (44:38):
guys.
Eventually attending life isvery, very, um.
Okay, you know you can set yourschedule to a certain extent,
but, um yeah, family medicine,I'd say, has a lot more
work-life balance and you can,you can do everything.
But you know, for thoseincoming md1 students, take it
day by day awesome well.
Speaker 2 (45:00):
Thank you so much for
your time, dr.
We're so excited to have you onthe island and I know, uh,
we're actually creating somebuzz around you and you your
visit, so it's some of ourstudents, so you will have one
full day if you want.
That is, to address thestudents and talk to them and
meet them.
Yeah, we're also organizing ahealth fair when you're going to
be there, so you might have, uh, exposure to the local
(45:23):
population.
I know you've done this inanguilla when you were there,
yes, so now you're going to dothis in St Vincent and I think
you're going to be meeting a lotof our board members and stuff
like that.
Speaker 1 (45:33):
Absolutely.
Speaker 2 (45:34):
But thank you so much
for your time.
Thank you as always.
We really appreciate it.
I know you've helped us so muchin the past with open houses
and student referrals and thingslike that.
Speaker 3 (45:44):
We really appreciate
it a lot, absolutely.
Thank you for having me, andyou know St James, you know, has
always been there helpingachieve my dream, so it's the
least I can do.
Speaker 2 (46:08):
Thank you so much, dr
Escudero.
It really was eye opening tolearn about the differences in a
privatized and a nationalizedhealth system and how you,
operating in both those systems,really worked for you.
But thank you so much forgiving us those insights.
We really appreciate it.
And thank you so much for yourpassion and all that you're
doing for the Canadian communityat large.
But again, if you like thecontents of this podcast, please
follow us on any of theplatforms where you prefer to
(46:30):
get your podcast from, be itspotify, google, apple, you name
it.
And don't forget to like andfollow and download as many
episodes as you like.
But but one thing alwaysremember there is no shortcut to
(46:52):
becoming an MD.
Speaker 1 (46:54):
Thank you so much for
tuning into our show.
We hope you enjoyed anotherepisode of Med School Minutes.
If you like our content, pleasefollow us and receive
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This podcast is brought to youby St James School of Medicine
posted.
This podcast is brought to youby St James School of Medicine.
For a video version of thispodcast, please check us out on
(47:15):
sjsmorg slash video.