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):
Hello and welcome to
another episode of Med School
Minutes, where we talk abouteverything MD-related, with a
focus on international students,specifically students from the
Caribbean.
Today we have a veryinteresting guest and we have a
little bit of a surprise withour host as well, but today we
will be talking to Dr Pianis andDr Krewer, who are from Sutter
Health, from Modesto, california, here to talk about their
(00:41):
brand-new family medicine andinternal medicine residency
programs.
Every year we have studentcounselors who work at St James.
These are some of our beststudents who come in and, just
before residency, spend sometime with us, and every year we
have one of these studentcounselors host a show for us.
So today we have Dr SanketChaudhury hosting the podcast on
(01:04):
our behalf.
So, without further ado, let'swelcome Dr Payanis and Dr Kruer,
as well as Dr Choudhury.
Speaker 3 (01:12):
Thank you so much, Dr
Kruer and Dr Payanis for
joining us today.
This podcast is called MedSchool Minutes.
We're going to start off by abrief introduction about
yourself and about your program.
Speaker 4 (01:26):
Sure, thank you.
Thanks for having us.
I'm Raylee Payanes.
I'm a family medicine physicianin Modesto, california, and I'm
new to the role of programdirector, and we're building a
brand new family medicineprogram here at Sutter Memorial
Medical Center in Modesto whichis really aiming to meet the
(01:47):
growing needs of the Valley.
We need more primary carephysicians in the area, so that
is our mission and I'm superexcited to be a part of that.
Speaker 5 (01:57):
And my name is Dr
James Kroer.
I am the program director forinternal medicine and I'm also
at Southern Memorial MedicalCenter here in Modesto,
California, and we're building alarge primary care presence.
We're taking this we'll have 19categorical and seven pre-lent
spots for the coming year,starting in 2025.
(02:20):
We're a brand new residency.
Speaker 3 (02:22):
Okay, and how about
you, dr.
Dr Pan, how many spots do youhave for FM?
Speaker 4 (02:26):
We will have 13 per
year.
Speaker 3 (02:30):
Okay, and I know
about Dr Kure a little bit that
he had previous programs beforeright.
Speaker 5 (02:37):
I've built two other
programs before.
For some reason, I started outmy career in medical education
right after I finished residency.
I was a chief resident and I'vehad a lot of inaugurals in my
past.
I was an inaugural ambulatorychief resident and I was a
clinic director for many yearsand then I helped start or build
(02:57):
a program in Michigan and thenafter six years I started
another program in Georgia andnow, six years later, here I am
starting a program in Modesto.
Speaker 3 (03:09):
Thank you and you, Dr
.
Pinus.
Speaker 4 (03:11):
Yes.
So I graduated from residencyin 2015 here in Modesto and
right away I knew I wanted tocontinue teaching and wanted
that to be a part of my practice.
I knew I wanted to continueteaching and wanted that to be a
part of my practice.
So I worked closely withanother residency program here
(03:31):
in Modesto over the past nineyears and teaching both in the
inpatient and outpatient settingand predominantly with a focus
in the woman's health and laborand delivery, delivering babies
with residents and participatingwith maternal infant care and
developing curriculum there.
So I had a core faculty rolethere and I think it taught me a
(03:54):
lot about residency work andhow to develop curriculum and
how to be a better teacher andhow to be a better teacher.
And now I'm excited to be inthat role of program director
and develop, I think, a uniquetype of program that's really
focused on the needs of thecommunity.
So I think I'm looking forwardto that.
Speaker 3 (04:18):
Amazing, amazing,
Thank you.
So these two programs arestarting brand new.
Right Any other programs orprevious programs that are
already there at Sutter's Health?
Speaker 5 (04:31):
Not at our hospital.
Speaker 3 (04:33):
Or FM and IM are the
first ones.
Speaker 5 (04:35):
Yeah, we're the first
ones.
Speaker 3 (04:38):
Not at your hospital,
right Correct.
Speaker 5 (04:39):
This is actually not
uncommon, by the way.
If you look across the US,there's quite a few places doing
this.
As I mentioned, I was inGeorgia.
They had a big initiativeacross the whole state there
about eight years ago, and a lotof hospitals got involved with
starting new programs, and Iknow that this is happening in
South Carolina right now.
(04:59):
Texas has been busy building alot of new residencies, yeah,
and California is doing the same, so California has been
supporting this work since, like19 Saudi to actually, they have
some grant money thatencourages hospitals to start
training programs, and soCalifornia needs more doctors,
and so a lot of hospitals aredoing this, and Sutter Health is
(05:23):
the latest one that's planningto put residencies in all of our
hospitals.
So, Memorial and Modesto is thelatest place to go live.
Speaker 3 (05:34):
We have some students
that are wondering about
Modesto, Because when you thinkof California, you think about
it being very expensive.
So is Modesto.
Do we think it's more on theaffordable side?
Speaker 5 (05:48):
I think somebody's a
plant in your student group.
I was laughing and saying, drPianas, I'm going to start
branding myself as the mostaffordable option for residency
in California.
So the Valley, central Valley,is the agricultural heartbeat of
California.
So and a lot of folks from theBay Area and stuff are building
(06:09):
houses here in the CentralValley.
So there's a huge demand fordoctors, but they're all moving
here because the housing is moreaffordable.
So I'm not going to lie Ifyou're outside of California,
it's expensive to live inCalifornia.
California is expensive to livein California.
But from a cost of livingstandpoint, the Valley is way
more affordable than some of thebigger cities.
Speaker 4 (06:38):
I've lived in
California most of my life and
I've never lived in any of thebig cities where the cost of
living is much higher.
But throughout medical schooltraining I did live in several
different areas, live in severaldifferent areas and Modesto is
definitely much more affordable,especially for the size of city
that it is and the amount oflike entertainment and, you know
, good restaurants and lots ofdifferent businesses.
For what Modesto as a cityoffers it's a very affordable
(07:00):
place to live.
Speaker 5 (07:01):
I like to I like to
say we're kind of an island that
has everything here.
We've got all the chainrestaurants, all the shopping
places, we have the malls, wehave all that stuff.
But it's just so easy to getaround.
The whole area is flats.
There's not even any hills togo up and down.
But it's beautiful and warm andsunny night on the side of the
(07:24):
year.
So it's just amazingMediterranean climate.
They call it Nice.
Speaker 3 (07:28):
Amazing it's close to
San Francisco right, Like how
far is it Do residents go there?
Speaker 5 (07:37):
Yeah, it depends on
the time of the day.
So we just say it's about atwo-hour drive, but it's like 90
minutes if you go on a Saturdaymorning with no traffic.
It's like a two-and-a-half-hourdrive if you go on rush hour at
five and six in the morning.
So it's a very easy drive on aweekend.
Speaker 3 (07:57):
It's actually a
little tougher if you're
commuting for business reasonsso there, uh, I was looking you
guys up and uh, there was a newprogram.
Uh, their sister program, Ithink sutter uh, is roseville,
if I'm if I'm not mistaken right.
They started two years ago.
So some of those students werewondering, like in terms of
(08:21):
fellowships, like how can thenew pro, how would a new program
help them, you know, get intomaybe a competitive fellowship,
for example, like cardiology, ifthey want to do that?
So what are your thoughts onthat?
Or do you know any fellows fromor anyone interested in
fellowship on your sisterprogram Of?
Speaker 5 (08:38):
course.
So you know I've actually builtprograms that have started
fellowships and I've done thatbefore.
Roseville is about two and ahalf years ahead of us on the
trajectory.
Roseville is one of Sutter'slarger campuses and they are the
campus that's building probablythe most variety of residencies
(09:00):
.
And now they are on the journeyto build fellowships.
So they are building acardiology fellowship.
They, I'm sure, are going tobuild Palm Creek Care and some
other ones.
They just can't announce themyet until they're accredited.
But there will be morefellowships built there.
Not clear yet if we're buildingany fellowships in Modesto.
But to answer your question, howdo you get into a fellowship?
(09:23):
I think you can get into afellowship from any residency
you want to.
It's just a matter of buildingyour portfolio and work.
So you know you have to have awell-rounded portfolio of CV,
you have to do quality projects,you have to do research,
publish, you need to, you know,show that you've done some
volunteerism, and you can dothat from any residency.
(09:46):
It's probably easier actuallyfrom a new residency because you
get to basically be the firstperson on the ground and you can
pick what you want to work with.
You get to work at elbow withyour faculty.
Pretty easy to do that.
We have a lot of cardiologistshere so it would be quite easy
and feasible to get onto aproject and do that with your
(10:08):
mentor.
So quite easy.
But the challenge is that mostof the fellowships already have
people hanging around hoping toget into their fellowship, so
it's going to be much more facetime if you're trying to get to
know the fellowship director.
Um, it's a little easier ifyou're actually from that
(10:29):
residence.
Yeah, but totally, totally alot, of, a lot of fellowship
directors I've met.
They like to have a mixture ofboth people that train within as
well as people from outside,because they don't want to
become what's considered inbred.
So a lot of fellowships willpick from both in and outside of
a program.
Speaker 3 (10:51):
Would you like to say
anything, Dr Pinus, regarding
that?
Speaker 4 (10:57):
No, I think there's a
growing number of maternal,
infant care and maternity carefellowships, like in the in the
area and in California also.
So I have had several residentsand students you know
interested in some of thosefellowship opportunities.
Just like residencies,fellowships are increasing in
number, which is really greatfor residents to have the
(11:19):
opportunity to really focustheir practice and what they are
really passionate about.
So I think there's no shortageof opportunity for fellowships
for both family medicine andinternal medicine.
Speaker 3 (11:31):
Okay, and just on the
same track, we have like some
students that are interested inthe OB side of family medicine.
Does your program have like alot of OBs or a lot of
deliveries that they get to see?
Speaker 4 (11:48):
Yes.
So you know that's one of myareas of interest and so that's
something I'm, you know, verypassionate about, and it's such
a need across the nation, butespecially actually here in our
community.
We've had many OBGYNs leavingmedicine from retirement or
leaving the area.
We're in such a crisis in needof physicians providing prenatal
(12:12):
care and obstetric care, not tomention access to contraception
and reproductive health optionsfor patients.
So, um, it is such a huge needand it's, uh, definitely a need
that family medicine doctors canhelp meet, and so that's why I
am very passionate about fullscope family medicine and
(12:34):
training all family medicinephysicians.
Even if they may not want thelifestyle of of, um, delivering
and being on call and that typeof thing, still they can provide
prenatal care and be veryexperienced with women's health
and caring for newborns also,and postpartum care.
(12:57):
So I think that's an importantpart of the curriculum and we
have excellent support here fromour OBGYN colleagues and we are
actively recruiting familymedicine OB physicians.
The hospital and the medicalgroup are very supportive of
that mission to meet that need.
Speaker 3 (13:16):
Now we're going to
talk about some questions that
students had and try tounderstand, like program
director's point of view, sincethe application just opened up
last week, right.
So our students want tounderstand how, like, the whole
application review processworked.
For example, like do youdownload all applications on day
(13:39):
one or do you download them asyou go on?
Like is it first come, firstserve?
How does the review processwork?
Speaker 5 (13:49):
Well, they come in
continuously actually.
So if you have your applicationin advance you know Eris
actually the application reviewsoftware it holds your documents
for like five business daysbefore it releases it to the
program.
So one piece of advice I'd haveis start early and students can
enter as early as likeSeptember 9th, 4th I think this
(14:12):
year was the day.
So if you got it in early, whenit opened to us on the 25th, we
would see your wholeapplication.
If some of your pieces haven'tbeen in there yet, like the
letters or some other dean'sletters, et cetera, those will
trickle in as they get enteredand uploaded by your faculty and
so we will look at applicationsas soon as they come in on day
(14:35):
one.
If we have a large number, whichwe usually do in primary care,
it'll take us a while to workthrough those.
It'll take us a while to workthrough those, and so if we see
some of them are incomplete, wemight hold them and just come
back later and wait for the restof the documents to catch up.
Okay, yeah, so so we we startright away, but we are
(15:01):
constantly reviewing.
So if you look at my website,we actually post on there that
we'll be reviewing all the waythrough January, and so you know
there's still an opportunity.
We may invite some people whodidn't apply right at the
beginning but then decided tojoin later and apply in October,
november, december.
Dr Pounds.
Speaker 4 (15:20):
Yeah, basically we
apply, you know, kind of a
filtering strategy to try andprioritize specific qualities
and characteristics that we wantfor residents.
So we started that like righton the first day.
But, like Dr Kerr said, thoseapplications are still coming in
.
Some of the applications thatare actually in the system are
(15:41):
incomplete.
They're still waiting for someof the documents to come through
, or waiting for, um, the testresults or something like this.
So, uh, we do recognize thatand we know we have to keep
capturing that, that data, andkeep looking back at it.
So, um, it's kind of like on arolling basis and, um, honestly,
invitations for interviews now,pretty quickly on day one and
(16:05):
we've just been continuing to,you know, go through those
applications with our processand offer interviews.
We give applicants, you know, areasonable amount of time
because we know medical studentsare busy and on different
schedules and all you know,different time zones.
Give them a reasonable amountof time to respond to, either
(16:26):
decline or accept the interviewposition and then they get
scheduled.
And we've had a lot of successalready scheduling applicants.
And also, one thing that wasreally important to me was like
making that process verytransparent.
So on our website there's lotsof information about exactly how
we're doing interview season,what to expect, so that
(16:48):
applicants can kind of get anidea, if they haven't heard by a
certain amount of time, or whatour interview season looks like
, so that they can kind of knowwhether to keep holding out and
waiting and expecting to hearfrom us, or whether those
interview slots have alreadybeen filled.
Speaker 3 (17:04):
All right.
So would you advise someone toapply early but with an
incomplete application, or waita little bit and have a complete
application and then apply?
Speaker 4 (17:19):
I think the best
advice is to have your
application complete on day one.
I think that's the best bestoption.
And if you're not able to havethat application complete on day
one, I think that's like thebest, best option.
And if that is not, if you'renot able to have that for
different reasons sometimes it'sout of your control then I
still think that having yourapplication in the system as
early as possible is probablythe best way to go about it.
(17:41):
That would be my advice.
Speaker 5 (17:47):
My advice is the same
.
I think you should always lookto be there right at day one,
but I wouldn't despair if youhad to apply later.
Like she said, we're used toseeing some applications come
later, you know.
The other thing that's been inplace for a couple of years now
is signaling.
So if you really want to benoticed, you should spend one of
(18:10):
your signals.
You get like three gold tokensand I think it's 12 silver for
internal medicine.
So use one of your tokens ifyou want to get noticed, because
a lot of programs have come torely on that as a like raising
your hand to say I want to benoticed.
Speaker 3 (18:31):
That's a good point
you brought up.
So that brings me to like.
Our next discussion point isyou would probably get like a
lot of, like thousands ofapplications right.
You can't really offer all ofthem an interview.
So what would be your initialfilter?
If you had a filter, would itbe signals, or would it be their
(18:52):
status, maybe non-USIMG versusUSIMG or USMD, or their scores?
Speaker 4 (18:59):
So that's a hard
question.
It's a little more sophisticated.
The platform that we're using tofilter through applications is
quite sophisticated and we canreally identify like positive
factors and negative factors,and you can create filters that
have like multiple differentcharacteristics that can be
isolated certain parties who arereviewing applications from
(19:24):
things like the applicant'sphoto, the applicant's birthday
and age, gender, race, ethnicityso there's a lot of you can
blind to.
History of felonies andconvictions you can blind to.
So there's a ton of things thatcan be done and you know it's
it's a bit of a complicatedprocess, but the priority for me
was making sure that we'reminimizing bias as much as
(19:45):
possible and also identifyingapplicants who have a strong
passion for primary care andcommunity-oriented primary care
and also have what we're kind of.
We make some assumptions likethat people from the area might
(20:06):
be more interested in stayinghere and be more connected to
the community and desire to stayhere as a primary care
physician in the future, andthat is something that's a big
mission for the programs.
So so there's not one thingthat we filter for or filter out
.
I don't know if that reallyanswers your question, but it is
(20:27):
quite sophisticated that you'reable to create several layers
of a filtering system toidentify candidates.
Some of our filters areisolating 80 to 100 applicants
out of maybe 700 or 800, to givean example.
Speaker 5 (20:45):
I can maybe share a
little bit how things have
evolved.
So back when I was startingother residencies, we didn't
have the signaling.
So what would happen is youwould start with people like
from your state.
So you would assume, like maybestudents from your state
colleges, your state medicalschools, people who had a
hometown address in your stateyou would often filter had a
hometown address in your state.
(21:05):
You would often filter for thatbecause you kind of assumed
they were going to stay in yourstate and then you would maybe
work to some surrounding states.
So when I was in Michigan wewould go to Ohio, indiana,
illinois, and then we would sortof then go farther and farther
and I can remember looking forapplicants in the in the filters
, and I would get all thesepeople from California and I was
(21:28):
like wow, I don't know how todiscern like which of these
people from California areseriously willing to come to
Michigan and how many of themare actually just applying
broadly just because they wantto be be considered somewhere.
And so now that signaling is inplace it makes that a lot
easier.
So like if you're in New Yorkor you're in Florida or
(21:48):
somewhere and you want to moveback to California.
It's going to help you a lotbecause now I can sort of take
all that external applicantsfrom other states and I can say,
okay, this one has definitelygot a reason, they're trying to
come to California.
So the signaling helps us a lotto pinpoint people who are
interested in being in your area.
(22:10):
And I think you know there issome assumptions that might be
made if you don't signal likemaybe we're not one of your top
15.
But on the other hand that'snot really true either.
So we look at all applications.
So it's not just aboutsignaling, but it's uh.
Speaker 4 (22:27):
but the signaling
does sort of particularly help
if you're coming from acrosscountry and trying to to get
noticed and actually I want tojust say one other thing,
because you mentioned umfiltering by like img or
american, an american graduateand I do just want to say that I
am an img myself, graduatedfrom ross university, and I know
(22:49):
that I had an excellenteducation there and I was a very
competitive applicant andhistorically there may have been
some different challenges thatprograms had to face with
licensing for uh imgs and a lotof that has been eliminated in
recent, you know, five to sevenyears.
And so I am.
You know I myself do not filterout by IMG versus American grad
(23:13):
at all and it's much more kindof based off of like
geographical preferences andjust like like I said commitment
to service, commitment tocommunity projects, and you know
all different things that weselect for.
And then I will also just saythat different programs will
have different priorities and,in addition to us wanting people
(23:36):
who want to stay here in thecommunity, we also are
prioritizing diversity for ourprogram.
That can be a challenge whenwe're blinding for things to try
and minimize bias.
That can be a challenge whenwe're blinding for things to try
and minimize bias.
But there are ways that we canI'll say, you know, select for
things like applicants who speakadditional languages or you
(23:58):
know different things that mightbe helpful to actually being a
primary care physician in ourcommunity here, where we have
50% of our patient populationhere is Spanish speaking.
So those are some examples ofthe things that we can look at
in the filtering process.
Speaker 5 (24:12):
Yeah, I think
patients like to sort of bond
with people that can speak theirown language.
Right Culturally, they're veryattuned to getting.
They don't necessarilyappreciate always having to have
an interpreter.
So I can remember when I'vehired, like, for example,
spanish speaking doctors in theresidence clinic.
The patients were loyal.
(24:32):
It's all craziness.
They were like, oh, if thedoctor wasn't in clinic, they'd
wait till the doctor came backjust to have a Spanish speaking
doctor, for example.
So I think that diversityreally matters here in the
central valley.
Uh, the logistics are quitediverse.
We've got a lot ofspanish-speaking patients, but
we've got probably eight, nine,ten percent of the patients are
(24:54):
from pacific, asian of alldifferent varieties, you know,
from chinese, yemenis and india,pakistani, and you just name it
.
There's a very diverse communityin California, so we're always
looking for everything but we'realways kind of thinking how's
that person going to be withpatients and are their
communication skills excellent?
(25:15):
Do they have empathy?
Are they very professional?
So there's a lot of differentthings we look for when we're
selecting people, but we'realways looking for people that
are kind of camera ready on dayone to do a great job with
patients.
All right, awesome.
Speaker 3 (25:34):
There is one other
thing I want to ask you about
was you know, a lot of studentsfind it very hard to write a
personal statement and they kindof struggle to keep it within
one page.
So what do you look at whenyou're reading a personal
statement and they try to, theykind of struggle to keep it
within one page.
So what, what do you look atwhen you're looking, when you're
reading a personal statement?
Like, what makes a goodpersonal statement?
Speaker 5 (25:52):
well, uh, I've done a
lot of work on coaching, uh,
students in this area, uh, so Ialways just remind people that
the name of the document shouldspeak speaks volumes.
It should be number onepersonal, and number two make a
statement.
And so if it's not doing eitherof those two things, it's
(26:12):
probably missing the mark.
And so I've read many apersonal statement that starts
with a quote from Osler orstarts with a quote from some
famous person, and I'm like I'mnot reading it to hear from a
famous person who's dead, I'mreading it to hear from you.
So I always appreciate personalstatements that are actually
about you and tell stories aboutyou and your past.
(26:33):
I think a good personalstatement should start with a
hook.
A lot of them start with a caseor an interesting patient that
maybe helped them decide thatthis is their specialty of
passion.
So what was that personal casethat made you decide family med
or internal med is your thing,that you want to do and make it
your life's career?
I also think that keeping itorganized is important.
(26:59):
So sometimes people just wantto write like what I call a
chronology, like, ok, I was bornon this year and then I went to
grade school and high schoolReally what we want to?
Speaker 4 (27:10):
really what we want
to hear?
Speaker 5 (27:11):
is like your
attributes, your you know your
qualities, maybe yourqualifications and experience
that is going to make you agreat internist or a great
family doc.
So so we don't want to knowyour whole life story, we want
to know the key stories that aresort of defined, defining
moments for you and how it'shelped you discern that you want
(27:34):
to be a great medical, medicineor family doc, for example.
Speaker 4 (27:39):
Yeah, I think I would
just echo some of those same,
some of those same things.
It definitely helps if it isauthentic and real sometimes
vulnerability.
It helps also if, when readingit, I can see that the person
who's written this has insightinto their own challenges or
(28:03):
their experiences where they'recoming from.
Also, if there are, you know,challenges that have been faced
you know in life or academics, Ithink you know it is a good
opportunity to talk about themand be open about them and take
accountability.
Or, you know, just share yourexperience with that.
(28:23):
And because we're looking forall medical students all medical
graduates are excellent, youknow, you know capable students
and we really are looking forpeople who have excellent
communication and you knowinterpersonal skills, able to
build relationships, and peoplewho are ready and open to have
feedback and want to grow.
And if you have a growthmindset, that's the most
important thing that and want togrow, and if you have a growth
(28:45):
mindset, that's the mostimportant thing that we need for
residents.
And if you can kind of sharesome of your experiences or
challenges, but then show whatyou know, that you've had
personal growth from it, you'velearned something about yourself
from it, that's that'sdefinitely better than hoping.
Hoping some of those challengesyou know, don't get noticed or
brought up.
Speaker 5 (29:04):
Hoping- hoping some
of those challenges, you know,
don't get noticed or brought upRight.
That's actually a pet peeve forme.
Actually, I, if I see a failedexam and then I don't see
anything about it in thepersonal statement, I'm just
like, I think I'm done, like,wait, if we're not even going to
talk about that, like we'rejust pretending nobody's going
to notice that on the transcript, it's, it's just not the growth
mindset I'm looking for.
(29:25):
So I'd much rather see somebodysay you know, I had a challenge
, and this is my analysis of whyI think I failed that exam.
And then here's what I did tochange my study habits.
Here's how I changed my, youknow, got through the personal
challenge I was having, and thenyou know, show me how you
succeeded.
So for me it's a real turnoffwhen people ignore it and just
(29:47):
like don't even bother tomention it.
So I think you know if you'vehad a hiccup in your training.
Uh, everybody has hiccups.
Uh, no, he's perfect and we'renot expecting perfection.
So I think if you're trying tobuild an application and and say
, hey, I'm the perfect person,that also comes across as fake.
So I I think, uh, like directorpiano said, authentic and
(30:10):
genuine is way better if you can, if you can manage to pull that
off.
I know that everybody's a greatwriter.
In fact, most people going intointernal medicine are
science-minded people and theythey're better at math and
science experiments, probably.
But if you can be articulateenough to put into writing, you
(30:32):
know what you learn from some ofthose hiccups.
It's way more interesting forus.
Speaker 3 (30:38):
So how long do you
think would be a good, you know,
personal statement, like onepage should be within one page,
or if it goes over one page it'sokay.
Speaker 4 (30:48):
To me it doesn't
matter much.
I think it can be a littledaunting because of just the
sheer amount of information wehave for each applicant.
It's a lot to go through.
But I mean, to me I don't thinkit matters so much.
You definitely don't want it tobe.
You know, I think if it goes onto a second page, I think
that's still probably reasonable.
(31:08):
If it's more than that, uh,going on to a third page or
something, that might be like alittle excessive I tend I I
actually am a writer on my youknow, not in my non-medicine
life and I I really enjoywriting and I tend to just be
very brief with my writing.
It likes to sync, but uh, youknow, I think, I think it's just
depends on the style and whatwe're learning about the
(31:31):
applicant, what reading it, andit doesn't if it's a great
personal statement, it doesn'tbother me if it goes to a, to a
second page.
Speaker 5 (31:37):
I'll echo that.
I think um.
I think one page is a perfectone.
If you go a paragraph or twoover not a big deal, I think.
If you're on three pages, we'regoing to probably shut down.
When I coach, when I coachpeople, when I coach people to
write these, by the way, Isuggest that you start with five
paragraphs an introduction anda summary paragraph and then
(31:58):
pick three things you want tosay about yourself and put three
paragraphs and sandwich it inbetween the opening and closing
paragraphs.
So if you can get it into fiveparagraphs, it'll be pretty
normal and average, I think.
And the challenge is pickingwhat do you want to emphasize
about yourself.
So, like you know, some peopleusually start with like, oh,
(32:21):
this is who I am, my character.
With like, oh, this is who I am,my character, this you know,
I'm from an immigrant family, orI'm from a poor family, or I
grew up in a challenging part ofthe world.
For me, it was growing up on afarm.
So I usually start withsomething that sort of
identifies who's your identityand then I'd say you know,
somewhere in there you got totalk about your love and passion
(32:42):
for patient care, and I thinksomewhere in there you should
talk about highlights ofsuccesses.
Maybe that's in research or inteaching or something that's
really you want to point out onyour CV, and definitely do not
repeat your entire CV becauseit's already in there.
So do not waste any ink ortyping in your personal
(33:02):
statement about the CV, otherthan if you want to call
attention to something and say,as you can see from my CV, I did
research at this place, youknow.
So definitely don't waste anyextra words in the CV if it's
already in the personalstatement, if it's already on
the CV.
Speaker 3 (33:20):
All right.
So the next thing is thestudents that applied this year,
when would be like a good timeto write like a letter of
intention, if they haven'treceived any interviews, for
example, and they're interestedin your program?
Do you look at LOIs as anegative, positive or what time
(33:42):
frame should they look intosending one?
Speaker 5 (33:46):
That's a really
interesting question, because I
don't think it's harmful towrite, but I'd probably write to
the.
There's usually on your website, typically a residency email
and I think that if you're notusing that email of preference,
that comes across badly.
So if you're not using thatemail of preference, that that
comes across badly.
So so if you're like you'rewriting directly, you've managed
(34:09):
to get the direct email to thecoordinator, the direct email to
the program director.
I think that's a little bitannoying.
It looks like you're trying togo around the normal route of
communication.
So I would start by writing tothe actual website and email for
the actual residency.
And the reason for that is manyprograms are big and they have
(34:30):
multiple coordinators and sothey're constantly looking at
those.
Uh, you know, today might besomebody's day off and they're
actually that in that email isgetting covered by someone else.
So so use the preferred emailfor the residency.
You'll probably get a quickerresponse than if you, for
example, email my othercoordinator who's off.
(34:51):
She has to come back and catchup on email and there's all
these extra emails that somebodycould have taken care of while
she was away.
So I would just say it'sprobably not a bad thing to
write, but it's become moretransparent now.
So, like the family met umdirectors and the intro med
directors have all sort of saidyou know, this is kind of coming
(35:13):
from the double amc that youshould make it very clear on
your website when invites go out, and so, like some programs are
down to the specifics, like wesend it out on friday at three
o'clock or you know.
So pay attention to the websitefirst before you go ahead and
write to them, uh, and then alsoyou'll see like, uh, we may be
sending out every month untilthe month of january.
(35:35):
So so you probably shouldn'tworry about like writing that
right now.
Uh, because we're still in veryearly in the season and still
in a busy reading mode.
So so right now, um, like Ithink, on our website it said we
were going to start sending outoctober one uh, so that would
probably be too early to startwriting at this minute, because
(35:56):
we're still uh formulating, allright exactly yeah, the the
letter of intent is a new,something new to me that I've
learned about now in this roleas program director.
Speaker 4 (36:12):
So I would just say
it's probably it's not.
If I receive those it's notnegative, but it's not changing
my filters or my characteristicsthat I'm looking for when I am
deciding on who I want tointerview.
That's already beenpredetermined and it's a
(36:34):
standardized process and we'retrying to keep it as
standardized as possible tominimize bias.
Do receive those letters ofintent or those emails with a
lot of the personal information,personal documents kind of
(36:56):
attached like a CV or USLErecords.
I just say thank you, we'll bereviewing applications through
ERAS and that's kind of just theend of it.
So it doesn't really impact onmy end who we're interviewing.
But it's not like a negativething.
I don't see it as a yeah, okay.
Speaker 3 (37:11):
Well, not necessarily
a positive thing either, right?
Based on that?
Right, they're not going tohave more chances just because
they sent you an LOI?
It?
Speaker 4 (37:19):
doesn't influence the
decision for me specifically,
and I don't know how otherprograms handle that.
And similarly, you know, thankyou notes after interviews.
Yeah, those are a nice touchand especially if you had felt
like a personal, you knowconnection with someone, I think
it's fine to send like a thankyou card or a note.
But I think all of those thingsyou know, we have to really try
(37:41):
and be careful that, becausewe're trying to minimize bias,
we have to put up kind of somesome guardrails for those things
and we don't want those thingsinfluencing our decisions, right
.
So I mean it is a good, it isnice and thoughtful to receive a
thank you gift or thank you Imean a thank you card or
something but it doesn'tinfluence our decisions either
(38:02):
way.
Speaker 5 (38:02):
Yeah, and they've.
They've gotten more clear fromAAMC and ARIS that we shouldn't
really expect those.
So we don't really expect them.
They are nice if you really dohave that extra.
You want to give that wowfactor, but it's not required
and so similarly so, sending aletter of intent beforehand
(38:24):
isn't going to get you noticedany better.
You're still in that pool ofnames that we're working through
, so I would say it's not goingto help you.
It's probably a waste of yourtime if you're just hoping that
it maybe gets you some extralooks.
I suppose from a marketingstandpoint it probably does get
you some extra looks somehow.
(38:46):
But I don't think.
Like she said, I'm not going toopen the attachments number one
and number two.
My hospital's gotten so tightwith the external email.
It's flagging it already likedon't open this, and you know
it's external.
So I almost think that you'rebetter off to just go through
(39:06):
ARIS if you want to send acommunication, because at least
then the coordinator is going toread it right, because at least
then the coordinator is goingto read it right.
So you may not even get read ifyou send it through regular
email because the hospitals areso worried about malware and
viruses now.
So I honestly think you'rebetter just to be very
thoughtful about who you send itand when you send it, and just
(39:29):
send it through ARIS to thecoordinator, if you're going to
ask about where we are.
Speaker 3 (39:35):
Thank you.
So next thing I wanted to talkabout like a lot of, I've
noticed a lot of people or a lotof programs are starting
in-person interviews.
Is Sutter Health going to dothat this year or maybe next
year, or is it all virtual thisyear?
Speaker 4 (39:52):
It will be all
virtual this year which is in
alignment with therecommendations from all the
major organizations within boththe family medicine and internal
medicine specialties.
And again, that is a reallyimportant thing in order to make
sure we're minimizing bias andalso making sure it's
(40:13):
financially equitable for allapplicants who are interested to
be able to have the sameopportunity to interview, and I
think that that's reallyimportant.
So I personally don't know thatit will change for our programs
, but certainly we're going totry and stay in alignment with
(40:33):
what the recommendations are ofthose organizations that say
like this is the best, the bestprocess.
I don't know what you think, drKerr.
Speaker 5 (40:43):
Yeah, I'll give you,
I'll give you some behind the
curtains.
Look, since this is an audienceof students and applicants, I
think, I think I think, as faras predicting the future I never
try and do that, doctors areterrible at predicting the
future I think what I would sayis, historically, I think
(41:04):
historically, after the pandemic, there's a strong push,
particularly in the primary carespecialties, to stay on Zoom
and to stay virtual, and thereason is that people realized
it was so cost ineffective to dothe inside interviewing.
So in actually a lot of placesthe budgets dried up.
So there used to be big budgetsfor, like, having people to
(41:28):
have banquets and dinners and goout to eat and things, and all
those budgets dried up and theynever came back after the
pandemic and so, uh.
So from an equity standpoint, Ithink there's a big pressure to
to stay on zoom and stayvirtual because, uh, it's it's
more cost conscious for theprogram, it's more cost
conscious for the applicant and,and it's just, it makes the
(41:51):
playing field a lot more level.
So, uh, but uh, what I will sayat the national level, at the
program director meetings a lotof community hospitals want to
have on site options becausethey feel like their little
small town is so cute and theywant people to experience that,
and so there's this, there'sthis blended version that's in
(42:11):
play right now, where people aredoing virtual with an on-site
visit usually at the end of theseason, around January February
again tomitigate the bias and the
feeling that if I go and spendthat extra money to travel there
, that they're going to rank mehigher.
(42:36):
Are doing on-site visits becausethey still want the students or
applicants to know this is agreat place to live and that's
hard to get a feel for over theinternet.
So I think you're seeing moreand more places try to do
blended, but I'm only speakingfrom primary care.
I also see other specialtieslike surgical specialties and
stuff.
They don't really care, they'regoing to go all back to
(42:56):
in-person.
So there are some specialties Iknow that are pushing and
they're itching to go back toin-person and so I would say
it's going to depend reallyheavily on the specialty and
it's going to really depend onhow bad they feel that in-person
is needed to get a feeling offit with the program and I can
(43:17):
imagine, if you're going to beoperating in an operating room
with somebody a lot, whysomebody in surgery might want
to have an in-person interviewfor sure, but I think the
evolution is going to go back tosomewhere in the middle.
Speaker 3 (43:33):
But I think primary
care specialties right now are
pretty satisfied with beingvirtual um so so you mentioned,
like you know, site wizardsright, like is it usually done
after you finish ranking, or umis it most places?
Yes, but.
Speaker 5 (43:50):
I think there are
some that'll do it a little
earlier, maybe before they'redone with the rank list, but
typically what they're going todo is you're not going to meet
the PD, You're going to go to asite visit.
They're going to have a bigconference room, they're going
to give you some orientationtalk and they may have residents
or chief residents take youaround and show you the place.
There's probably going to besome faculty or maybe associate
(44:14):
program director to take youaround.
But I think you're going to seeeither it happens after the
rank lists are done or you'regoing to see they're going to
have it on site but you're notgoing to have a chance to meet
the PD because they don't wantthe rank list to be biased or
even perceived as being biased.
So you'll see, I think those twotypes of options most likely.
Speaker 4 (44:38):
Yeah, I think those
site visits really are there for
the applicant.
They're for the applicant tocome and see the community, see
the facilities and get a feel orsense of how the people
interact and how with theculture, the faculty or the
residents.
And when there was residentsthere already, I think that is
(44:59):
really important.
And I as an applicant you knowlong ago, I remember you know a
lot of my decisions at that timewere based off of just how
people interacted, how peoplewelcomed me, made me feel
comfortable or not, how theyspoke about and interacted with,
how the residents interactedwith their faculty and how they
spoke about their faculty.
So I think you know there'svalue in that.
(45:20):
Definitely it's fun, it's like afun social activity to have you
know social events happeningduring interview season.
I remember that only as aresident too, but I think its
purpose is really to help theapplicant kind of get a feel for
the community and the programand the people and make their
decisions.
(45:40):
And so you know, not for us asa program to get more
information or to influence ourdecisions about ranking in any
way right, because ultimatelyprograms should be selecting
applicants based off of their,their qualities and, um, the,
the characteristics they need tobe able to be a physician.
(46:01):
Um, and so for that reason, youknow, we we are choosing to uh
for family medicine.
Um have the site visit uh orthe socials, only after the rate
border list is finalized.
Also, that means I can come andhang out with people and
socialize.
Speaker 3 (46:22):
Oh, excellent.
Coming from a student point ofview, one of the biggest fear we
have is, if we don't go visit,do a second visit.
We're not going to match there.
It's good that you cleared allthese you know misconceptions.
Last two questions.
I just had two more questions.
One was regarding J1.
(46:42):
Do you think for, like you know, like Canadian IMGs or someone
from international non-US IMGsare you planning on doing J1 in
the future for future applicants?
Speaker 5 (46:56):
That's a really
interesting question.
So I've done a lot of work inthe past with, like the ECFMG
and I've been a big advocate forwhy we need to have J1s in the
program.
I personally think residenciesare much more culturally rich
and diverse when there's J-1s inthe mix.
So I'm very much not opposed tohaving J-1s and J-1s don't
(47:22):
really cost the program thatmuch.
That's why you'll see a lot ofplaces say like H visas need not
apply, but J visas welcome.
So I think there are a lot ofresidencies that welcome J visa
holders because the ECFMG is thesponsor of the visa and so it
doesn't really cost theresidency that much to do that.
So I think that's why you see,j1s are generally more welcome
(47:46):
than H visas in many places.
I think they add a lot ofdiversity.
I think they add a lot ofoptions to bring in a variety of
people.
So I'm not opposed to them.
But I am going to say, goingback to, one of the very first
questions was how do we filter?
(48:07):
Most places do what they callholistic review now and they're
going to write a mission aboutwhat they're trying to do, and
so you really do want to payattention to the mission of the
program.
So and you should think abouthow does my experience as an
international grad or somebodywho's on a J visa, how will that
help that that program that I'mapplying to?
(48:29):
Because, for example, if I sayI'm looking to hire a lot of
Spanish speakers for the CentralValley because 52% of my
patients speak Spanish andyou're on a J visa and you speak
Spanish, you should use that asa way to introduce yourself as
to why you think you would be agreat applicant for my program.
(48:50):
Similarly, if you look atprograms that maybe serve like
an African-American communityand you're coming on a J visa,
say from Nigeria or someplace inAfrica, you should emphasize
that you could bring diversityfor your patients in that
residency.
So I don't know, I kind of havethis sort of thing about when
(49:11):
people love things together.
It just sort of rubs me alittle bit on the edge, like
it's not about the visa at all,it's actually the visa itself.
Doesn't cost me that much moneyto have have a j visa resident.
Uh, so I'm I'm really, I'mreally.
It's not about the visa, it'sabout, uh, what do you bring
into the program from a holisticstandpoint, and I think the
(49:35):
problem is folks frominternational think there's like
it's what.
It is definitely harder to getnoticed and get in, but it's not
impossible.
You just have to do a littlemore research to find the
programs that accept J visas.
So for both of my priorprograms, we accept J visas and
you have a lot of greatdiversity.
We had folks from the MiddleEast, folks from India, pakistan
(49:59):
, asia.
We had folks from South andCentral America, africa.
So I think you know, look atthe programs website, look at
who are the people that arealready there as residents, and
definitely you know, look andsee, you know what are they
selecting for?
You know, uh, like I, in myprograms we tried to do
(50:21):
diversity across the continents,so so like we would try to make
sure we were.
If we were going to invite jvisa holders, we were usually
trying to make sure we weredistributing across the
continents and being not youknow instead of just going into
one country or one school or onetype of applicant.
(50:41):
We would try and make sure wepicked invites for a variety of
different parts of the world,but I think your chances are
better if you can align.
You know, maybe you're fromIndia but you speak Spanish, and
that would be a good attributeto sell to me as a person in a
residency in the Central Valley.
There's a lot of diversity inpeople, and helping me see
(51:05):
what's that diversity that youcan bring to the table is where
I'm.
That's what I'm looking for ina JVS holder.
Speaker 4 (51:12):
Ultimately, you know,
we can advocate for the things
that we think are important forthe programs, like as program
directors, but that decision ofwhether to accept or sponsor
these is ultimately it is adecision made by, you know, the
sponsoring institution or theorganization as a whole.
So just to keep that in mind,you know it's not just a
decision that us programdirectors are making.
Speaker 3 (51:35):
Yeah, okay, fair
enough.
Last question that I had beforeI let you guys go was do PD
talk amongst each other?
So if a student applied to bothIM and FM at your program,
would you guys know, and is thatsomething you'd be like?
No, they're not interested ineither and met your program, uh,
(51:55):
would you guys know, and isthat like something you'll be
like?
Speaker 4 (51:58):
no, you know they're
not interested in either or or?
Would that be a negative?
I don't think it's a negative.
Um, it hasn't.
Uh, of course we talk and youknow dr guru's like a mentor for
me, so he's um helping me inthis new role, so I get a lot of
advice from him.
Um, so he's helping me in thisnew role, so I get a lot of
(52:18):
advice from him.
But I think I wouldn't besurprised if there were
applicants who were veryinterested in this program here
in Modesto.
Could they could have that,that career in primary care, you
know, through both internalmedicine or family medicine.
(52:38):
That wouldn't be surprising tome.
It's not necessarily like anegative thing.
I don't think Sometimes it.
Sometimes I think what I see ismore applicants who maybe are
really interested in that OBGYNresidency and that they're using
like family medicine with someOB care maybe as like a.
Maybe they feel a lesscompetitive easier to get into
(52:59):
option.
I think that is.
You know, it's.
It's a little different thansomeone who's just wanting
primary care and wanting aspecific geographical region.
I understand that because as anapplicant I had family already
and, um, you know, sometimesit's not, uh, it's not, it's not
a it's not option, like, it'snot an optimal option to have to
(53:21):
move your, your family, likeacross the country or you know,
to another state.
So I think it's multifactorial.
Why?
Why people are deciding whichprograms are choosing.
And to me, if somebody ispassionate about primary care
and they think they can do itboth with internal medicine or
family medicine and they justwant to be here in their
community, and to me thatdoesn't, that's not a negative
(53:43):
thing, but it we have separatesign ins and separate a separate
process, and so we're notreally discussing or looking for
those applicants in any way.
But we do have a lot ofstudents who've come through who
maybe have expressed interestin both programs.
So I think it wouldn't besurprising to see some overlap.
Speaker 5 (54:03):
Yeah.
I'll echo that I think.
I think you shouldn't assumethat it's completely separated.
So and I am probably not like,I think, people who've done a
sub-I here we're going to lookup and see if you applied, and
if you didn't, then did youapply to the other program.
But honestly, I thinkcoordinators talk more than the
(54:25):
PDs do.
So I think, I think coordinatorsoften you know they often sit
together, they often sittogether and they share duties
and errors.
So I think it's much morelikely the coordinator is going
to notice that you applied toboth places than it is the PDs,
and I think it doesn'tnecessarily come across as a
(54:45):
negative.
I think you do have to sort ofshow your love, for you know,
and like Dr Pena said, modestois kind of out here in the
middle of Central Valley,there's only one other residency
sort of in town, and sobasically you don't have very
many options.
So if you want to stay inModesto and do primary care, you
got limited options.
(55:07):
So it wouldn't surprise us atall if you're applying to both
FM and IM.
Not a surprise whatsoever.
And I do think that you have tobe able to explain it though.
So, like, if you're interestedin OB, obviously, why are you
applying to internal medicine?
So if you don't get FM with OB,how are you going to be happy?
(55:30):
Like you're not going to seeany kids, you're not going to
see any women with babies, Imean, it's uh.
So you have to get you have tokind of know who you are and you
have to be able to explain youknow who you are, who you want
to become so for me I did medpeds, by the way oh, I think
that concludes.
Speaker 3 (55:51):
Yeah, I was just.
Oh, was it really okay?
Speaker 5 (55:57):
that concludes yeah,
I was just.
Oh, was it really okay?
Yeah, I was med peed, so Iactually couldn't I couldn't
decide either, so I I applied tomed peed so I could be both and
uh and ultimately I ended updoing internal medicine after
the long run.
Speaker 3 (56:05):
So oh nice, thank you
so much once again.
Uh, for you know, come onjoining us today for this
podcast.
Really appreciate it.
Doctor, we really appreciateyour point of view, what you do
when all the applications comein, what you look for, all your
advice that you gave today.
Speaker 2 (56:25):
Thank you so much, dr
Pianist and Dr Kroer, for
giving us insight into what goesinto running a medical program
and why you started yourinternal and family medicine
programs.
And thank you so much, sanket,for asking the really burning
questions.
We always thought it was agreat idea to have somebody who
is in the shoes of a potentialresident to host this show, just
so that we could get therelevant questions out there.
(56:48):
But again, as always, if youliked our show and if you liked
our content, please downloadmore at any of your favorite
podcast providers and give us afollow and give us a like.
It goes a long way for us.
A lot of work goes into puttingthis together, and always
remember there is no shortcut tobecoming an MD.
(57:09):
Also, if you have any specifictips and tricks that you think
would be helpful for our futureresidents for the upcoming math
season, don't forget to put itin the comments.
And also, if you think Sanketwas a better host than me, don't
hesitate to comment on that aswell.
Speaker 1 (57:30):
Thank you so much for
tuning into our show.
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