Audio Upload | Nov 25, 2023 3:04 PM
Nov 25, 2023 • 2:08 PM - 3:05 PM • Denise Billen-Mejia • Audio Upload
Speaker 0
00:08
Hi. Welcome again to Myth, Magic, Medicine with me, Denise Billen-Mejia and my guest today is Srikanth Mahankali, who is from India
and is a radiologist. So welcome, Sri. Thank you so much for joining us.
Speaker 1
00:22
Hi, Denise. Thank you so much for having me on your podcast. And it's great to be here. And I love the fact that you got my first and
last name right. The first.
Speaker 0
00:37
So let's let's start very briefly. You were born and raised in Hydrabad and you went to school there too. You went to medical school
there.
Speaker 1
00:51
Correct.
Speaker 0
00:51
Okay. And since obviously we've talked before, I know that you were a fully trained radiologist and practicing radiologist in India before
you came to the US. But you didn't expect to stay in the US? What did you originally expect to be doing when you came here and what
you did initially when you came here?
Speaker 1
01:12
So after I finished radiology, I was with a franchisee of a tertiary care hospital and had been there for some time, almost like a year,
when I began to hear that this tertiary care institute, the parent one, was looking to expand their neuroradiology division. I was also
someone who was always interested in neuroradiology and particularly neuro at the intersection of MR. While I trained at one of the
top-notch institutions at that time, there were limits to how much I could learn on the neuro-MR front. So when I became aware that
there was an opportunity to get some additional training and this tertiary care institute was also, it was a corporate hospital was also
looking. Some trained people to expand their neuroradiology division. I decided to come to the US to get some additional training.
Speaker 0
02:18
Was that your first choice? She says, as an English woman,
Speaker 1
02:19
My first choice was initially to go to UK, to be honest, because the tertiary care institute where I did my radiology training was one of
the overseas training centers for the Fellowship of the Royal College of Radiologists. So the original plan always was to go to UK, do
the FRCR, as it is called, and then come back to India. Because I'm the eldest son in my family, we are twins, but I'm older by about 13
minutes. And culturally, the eldest son in our Hindu culture typically is the one who's responsible for parents at the old age. And then
the fact that I was a physician and also the fact that my wife is a physician and is also the eldest in her family, kind of the plan was for
us to come back and basically take care of our parents and practice in India.
Speaker 0
03:19
But, but things were not to be. You chose instead to come to the US.
Speaker 1
03:25
Correct.
Speaker 0
03:27
So you came on a J-1 visa. So you were expecting just to be here, get some training and then go home. Where did you land?
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Speaker 1
03:36
So I first came to the Health Science Center in San Antonio. At that time, the Neuro Radiology Fellowship program there was under the
ambit of a world famous Spine radiologist. So I came there initially to get one year's worth of training in Neuroradiology and then
fundamentally head back home. That was the original plan. Part of the plan was also for my wife and son to be (my three year old son
at that time), to be in India while I finished this one year training, because I was going to be going back to India at the end of that one
year training. That was a plan. But three months after I got here, my wife and three year old son showed up.
Speaker 1
04:24
And that basically kind of fundamentally altered the plan because my wife is also a physician who had just finished medical school at
that time and had taken care of my son for those first couple of years. And so she had career aspirations as well, and she showed up
in San Antonio and then one thing led to another, and here we are.
Speaker 0
04:48
So how much training did you yourself do while you were there? Because I assume she was also on a J-1.
Speaker 1
04:56
Well, when we first got here, I had already done my medical school and radiology training in India, so I was coming here to do some
subspeciality training in neuroimaging, whereas she had finished her medical school and then upon the birth of her child, had taken a
couple of years off. And then, came here to the US.
Speaker 0
05:19
She was tagged onto your visa.
Speaker 1
05:22
Correct.
Speaker 0
05:24
Did that give her permission to work?
Speaker 1
05:26
The original portion of it was I was on J-1, and she came in on what is called as the J-2. But within the J-2, or what's called the
dependent visa, which she and my son were on, there's an opportunity to do something called an EAD, an Employment Authorization
Document. And basically, what the employment authorization document does, especially if one is a skilled professional like my wife
was, is give them the opportunity to work in the US. And one of the tacks that's usually taken, especially if the dependent also happens
to be a skilled professional, is that one income is not enough for a growing family of three, number one and number two. As a skilled
professional, I would also like to use the opportunity for my being here in the US. To develop my skill sets, contribute to the family
income, and therefore, with that increase income, it would provide us the opportunity to explore the social and cultural milieu of the
US.
Speaker 0
06:38
That's good. It gave you a little wiggle room. And in addition, she was probably an intern, and that didn't give her a lot of time for sleep
and all the other things. But you do get some vacations, so hopefully you got some travel in there. And then you spent how long in San
Antonio?
Speaker 1
06:57
I was there in San Antonio for four years while we were trying to resolve my immigration status. The J-1 is typically offered for seven
years. At that time, it used to be offered all at one shot for seven years. And as long as it's contingent on finding an employer who will
sponsor the J-1. But part of the deal with the J-1 is that it offers a lot of control to your employer to decide your next professional, or
for that matter, even a person.
Speaker 0
07:35
So does the H-1 has, be honest, there's a lot of control too. Okay, so you got your training that you wanted. Your wife completed her
residency there also.
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Speaker 1
07:48
No. While we were in San Antonio, my wife was basically in a more supportive role. While I was trying to straighten out our affairs, she
began working on the Employment Authorization Document as a J-2. She had the opportunity to get her own J-1. But the legal advice
at that point was not to open a second flank, because once you get on the J-1 track, then you'll have to get what is called as a J-1
waiver before you can move forward. And so we tried to keep it within one J-1, but then had J-2, which was my wife, with her own
employment authorization document that allowed her to work and improve upon her skill sets. So that was the first four years in San
Antonio.
Speaker 1
08:36
At the end of those four years, I had an opportunity to join MD Anderson as a faculty instructor but this time I went in there on an O-1
visa. In fact, by the end of my four years in San Antonio, I had moved from J-1 to O-1, which... gave we have missed out one very
important thing.
Speaker 0
09:01
Let's be honest and transparent about this. I managed to tape an entire hour without hitting record. So I know a lot of the story already
and the listeners are now going to benefit from that knowledge. You must talk about Harvard.
Speaker 1
09:17
Before you move on, because you are so part of my work in San Antonio, and training involved a lot of research, it was all
neuroscience-focused, by choice. And also, there was a heavy emphasis on MRI, particularly functional MRI. So I had the opportunity
to work with some of the leading people in those fields at that time. And functional MRI was a technique that had just kind of become,
what to say? Mainstream in 1991 So I was well within the seven- or eight-year time frame when I learned about the functional MRI
technique and both its clinical and research applications. And so in 2000, Beth Israel Deaconess Medical Center at Harvard started a
3T MRI program with people who were at the intersection of neuro and, especially, advanced MR
Speaker 1
10:21
So I was fortunate enough to be an attractive candidate to an entity like Beth Israel Deaconess Medical Center, and they had this six
year combo program where two years were part of a National Cancer Institute Cancer Radiology Fellowship. Which was followed by a
four year residency in radiology. And they had several graduates who had made that transition and done successfully and done well.
And therefore, when I applied, I was offered this position, but my handicap was that I didn't have the green card.
Speaker 0
11:00
It required citizenship or permanent residency.
Speaker 1
11:02
So you weren't able to NCI cancer radiology fellowship. The way it was funded was, you had to have either of those to receive your
stipend, even though it was a training grant. And without the green card, I couldn't begin that position.
Speaker 0
11:20
So tell us the sad story, because this hurts me, too. Although I don't particularly like the weather in Massachusetts. It's a lovely state,
and it's got a lot of fine institutions up there. So tell me the sad story.
Speaker 1
11:36
The reality of it was that this position was a two yearly intake of two fellows. So when it was first offered the position in 2000, I didn't
have the green card or the permanent residency, as it's called. So Harvard basically said, no problem. Our next intake is in July 2002,
and we are still interested in you. And so they wrote a letter to the INS on my behalf. Basically, the vice chair of the department and my
would-be mentor wrote letters to the INS saying that my work in the US. Up to that point and my future work, should I join that six-year
program, was critical to the healthcare, economy, and welfare of the people of the United States.
Speaker 1
12:26
It was a special category called the National Interest Waiver. Only the top 1% of applicants receive approval for that national interest
waiver, and I was one of the fortunate people to receive that approval. The only problem is that the last step in the green card process
is an FBI background check. And I was within about six months of having all of that and my green card in place when September 11
happened. Um, and the second intake after my first one, which I couldn't make, was in July 2002. And at that time, the FBI obviously
had matters of grave import, including national security. And so even when Harvard came back in July 2002, I did not have green card,
and I, unfortunately couldn't join that.
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Speaker 0
13:24
But that designation, the O-1 was still available to you, did you? Yes.
Speaker 1
13:31
So I was already on O-1 when I was at the Health Science Center in the last stages. And so I was basically able to transition that O-1
and transfer it to the MD Anderson Cancer Center and begin a faculty appointment in the Division of Diagnostic Imaging in March
2001. Ah. The one rookie mistake that I mentioned previously to you was that I told the folks at MD Anderson that I had this Harvard
position that I couldn't join in 2000, that I couldn't also join in 2002, and potentially there's an option to join it in 2004. And so therefore,
that was on the back burner. And so what could easily have been an assistant professor position to start with at MD Anderson instead
wound up as a faculty instructor position.
Speaker 0
14:28
Pro tip. Don't tip your hand. Tell keep things back.
Speaker 1
14:33
So I learned the hard way that there was a price to pay for honesty. But I have no regrets because I felt that that was the right thing to
do. And so that's what I did.
Speaker 0
14:45
Yeah. So where was the next move for you? What did you start doing after that?
Speaker 1
14:53
I loved MDAnderson, it was a great and enriching experience, and I was doing all the wonderful things that I ever wanted to do in
academics, particularly at the intersection of the neurosciences and all of these advanced MR techniques. My basic interest has
always been in cognitive neuroscience. And then when I went to MD. Anderson I was fortunate to be able to add a neuro-oncology
aspect to it, which I found fascinating. I had a grandmother who died of cervical cancer several years ago before I came to the US. So
cancer was something that I was always very familiar with and interested in. And so I was fortunate to find this intersection of the
neurosciences with oncology and so, therefore, be involved with neuro-oncology on one side, and then to be able to apply some of the
Mr techniques, and especially the functional MRI techniques at MD Anderson was a very rewarding and enriching experience.
Speaker 1
15:54
And so a lot of the clinical work that I did in MD Anderson, especially using the functional MRI technique, was basically to provide
neurosurgeons a roadmap of where the motor and sensory centers were when they went in to do surgery on patients with either
primary or secondary brain tumors. And basically, what this technique would do would allow them to know where the speech centers
are and the motor centers are, and therefore plan their surgery, their access, and also be potentially in a position to avoid
postoperative morbidity and mortality. So it was a very satisfying and very, what to say, state of the art work. And I also was fortunate
that my mentor, the late Dr. Edward Jackson, was one of the top notch authorities in the field of MR. Very affable, very humble, highly
skilled and highly learned person, who, tragically, a couple of years ago, actually passed with a brain tumor. A Glioblastoma areas of
work that we had been doing while we were together at MDS.
Speaker 1
17:14
Yeah. So life was good. My son progressed through high school. My wife had finished her residency. Everything was good. Life was
going on. Son got admitted to UT Austin and started doing a double major, initially in electrical engineering and then also in a liberal
arts honors program called Plan2 a very prestigious program done at the time.
Speaker 1
17:41
The global intake in that program was 65 people. That's it. And the acceptance rate was very low, and everything was good. And he
had plans to go into IP law and do have nothing to do with medicine, but he came down with a health issue, a back issue that required
a lot of focus from my wife and me and required a lot of, what to say, physical therapy, rehab, multiple surgeries. So while we were in
Houston, we had to make a choice between one of us being available to him full-time. So I decided that I had done a fair amount of
work, and I'd reached a certain point in my life where I could be the one who could take that time off to tend to our son and still be
potentially in a position to come back once this problem was resolved.
Speaker 0
18:42
Sure. You had a track record to lean on, so. So you took sort of mini sabbatical?
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Speaker 1
18:52
Well, the original plan was for it to be a mini sabbatical because we didn't anticipate how long it would take my son to kind of recover
and be on his way. It took a while. It took much longer than what we initially anticipated. In the interim, what happened was he had to
be in and out of school a number of times. So what was originally going to be a five year graduation plan eventually turned out to be
much beyond the five years. He also had to let go of his electrical engineering and plan to honors eventually graduated with a major in
government and a minor in East Asian studies. So his career and life from a professional standpoint took a pivot. In the meanwhile, my
wife made good progress in the VA system that she was a part of.
Speaker 1
19:51
And she had to move a couple of times. Once to Indianapolis and once to Muskogee. And here I was within all of that, trying to sort out
my professional affairs. But what it also did was give me the opportunity then to reimagine my life and my career in a different sort of
way and look for roles that were traditional. Well, I was never direct patient care because of my radiology background. I had never
really given serious thought to doing things that were fundamentally of a very non-clinical nature. But then the opportunity to be with
my son and take care.
Speaker 1
20:36
And then also have some time to myself, allowed me to make some very important pivots that currently were actually proving to be
very valuable and super interesting, too. So the first thing I did was I did something called the Credential of Readiness from Harvard
Business School, which was basically their in-house MBA pre-MBA program, because when they put their MBA class together, what
they realized is that they had people at various levels of training and expertise when they joined the MBA. And so there was some need
for a boot camp of sorts to bring everybody up to a certain level to the same platform before they joined the MBA class. So they had
this pre-MBA coursework, which eventually they transitioned and monetized into a program called the Credential of Readiness, or
CORe, and basically that involved financial accounting, business analytics, and economics for managers. So I first took that program
as a way to test the waters and kind of learn something new. And then from there, I transitioned into another program, which was
basically a global health radiology program with an entity based in Maryland called Rad Aid International, a nonprofit that was doing a
lot of global health radiology work, who had released a report in 2015 which said that two-thirds of the world didn't have access even
basic imaging resource. Like a chest X-ray or an ultrasound, things that we all take for granted in developed countries like the US.
Speaker 1
22:21
And several other parts of the world. So that got me thinking, and I realized there was an opportunity now, as a radiology, to take that
to the next level and get involved with Global Health Radiology soon I became aware of global health as a whole. So I began an
affiliation with an entity, the largest global health consortium on the planet, based in Washington, DC. With whom I still have an
ongoing affiliation from 2019. I serve on several committees and subcommittees with them in roles that involve advocacy, service,
educational competencies, and research. I also have some abstract advising and mentor roles, some of which I have ongoing currently
at this point as we speak.
Speaker 1
23:15
And I also became aware that contrary to my earlier impression of what Global Health involved and my very preliminary knowledge
about global health, there's a lot to it.
Speaker 0
23:27
If you haven't got a house, it's really hard to think about all the other things. Everything is medicine.
Speaker 1
23:35
Everything from urban planning, water, sanitation, forestation, climate change, big data, AI, refugees, social justice, you name it. It's not
a global era.
Speaker 0
23:49
Medicine, the everything specialty. So are you still in that sort of lots of different pivots? Is that your focus? Do you have your own
LLC? I think you have your own consulting service.
Speaker 1
24:07
Yeah. So at this point, I have my own LLC. It's called Sri Advisory and Consulting in which is basically a vehicle for me to use all my
experiences in various domains, starting with AI and Digital and Connected Health, also Medical Imaging, Global Health, Global Health
Radiology. In 2021, I was fortunate to be a semifinalist alternate for something called the triple AS, the American Association for the
Advancement of Science, Science and Technology Policy Fellowship, based in Washington, DC. I was a semifinalist alternate and
couldn't make it past that.
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Speaker 1
24:51
But it was a great learning experience because around that time, and I still do, I'm involved with an entity called the National Science
Policy Network, which is fundamentally people in their early stages of career, but they also have an allied membership option where
people who are a little more seasoned, been there, done that in different fields, can get involved. And so I had the opportunity to be
involved with it. And have always had an interest in the science and technology policy domain. Also did some formal coursework in the
science and technology policy domain. So I have an understanding of the American government, the federal budget, how the
appropriations are done, how Congress decides on who gets what dollars. So it's very fascinating. And so of it, because it came
through the global health domain allows me to understand how the NIH receives its funds, the CDC, the Fogarty International Center.
Speaker 1
25:53
So it's at a macro level that all of these things are happening. And here, as a clinician here, I was just doing my thing in a small cubby
hole. So I've always wanted to be someone involved in that macro space and get an understanding of how all of this plays.
Speaker 0
26:11
If you had stayed in India. Had you stayed in India, would you have had any of those opportunities? Obviously, they would be Indian
versions of the same thing, or maybe World Health Organization, but would any of those things been possible?
Speaker 1
26:27
I don't know what the current state of the art in India is, but certainly at the time that I was in India, in the Indian system, first thing is
there's there was an aspect of the mindset involved at all, first thing. And that is that traditionally, if you had clinical training, clinical
stuff, even indirect patient care like radiology, that is all you did. There was no vision of what else you could do with that training.
Because one of the things that I like to highlight whenever I speak to physicians, especially, is the fact that your clinical training is just
one component of you. Your clinical training brings with it several other skills, both tangible and intangible, that allows you to
incorporate those in other domains, in all other life domains. And some of these skills that I'd like to highlight are the fact that you can
analyze vast streams of data. You have strong decision making skills, you have the ability to lead, you have vision and then if you are
one of those people who are slightly younger than I am, you also have qualitative and quantitative skills, especially if you are part of
the system here in the US.
Speaker 1
27:51
That allows you to translate those skills into several other domains. Interpersonal skills, communication skills, collaborative skills,
analyting skills, advising skills all of those that you could potentially take it to any other field that you want while there will be a
learning experience as you're trying to learn about that field. In terms of the skill sets, I believe that every clinician, even someone in an
indirect patient care domain like Radiology, for example, has the ability to take all of these and. Translate it elsewhere. That kind of
mindset was lacking when I was in India at that time. My understanding is that things are much better now, but I wouldn't still think
they would be at the level that it's possible to do here in the US. No question about that.
Speaker 1
28:46
And that's one of the things I like about the US. The fact that you could train and have all of these degrees and all of that in some other
totally different domain and still be in venture capital, finance, technology, things that I love and I'm interested in. Nowhere else, I think,
would I have been able to do some of the things that I have done and plan to do. No question about that.
Speaker 0
29:12
So you don't regret not going back to India?
Speaker 1
29:16
The only regret if I had would have been the fact that originally and from a cultural standpoint, I would have been the one, and
particularly as a physician, to take care of my parents in their old age. My mom passed away in 2022 October. Suddenly she just went
to bed. Yeah, she just went to bed and never woke up. And my dad currently is about 89 going on 90. So from that standpoint, I always
think that I was a failure because I was not there when they reached advanced age and they fundamentally had to be by themselves,
because we are sibling group of four, three of whom are here. Ah.
Speaker 1
30:05
Me and my brother, we are twins, and my two younger sisters are here in California. So either my brother or me would have been the
one to take care of them. And it turns out that my brother was in a different state. He since moved, ironically, ten days before my
mother passed away, he moved to the same place that my parents were in, to Hyderabad. So my dad now lives with him. But for a
majority of their retirement age, my dad's retirement age, they've had to fend for themselves so that regret will always be there with
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me.
Speaker 0
30:42
I think that's true for most immigrants, that you can't be in two places at once.
Speaker 1
30:47
Yeah, absolutely. You're right. So a portion of you is always there, notwithstanding the time zone difference. But purely from a
professional standpoint, no regrets. In fact, I believe that whatever I've been able to do and whatever I potentially I'm going to be able
to do in the next, hopefully, 10-20 years.
Speaker 0
31:09
Do you think there are aspects of Indian culture that you wish were somewhat more evident here in the US.
Speaker 1
31:17
Yeah, one of the things, again, in the Indian culture. So whether it's job or marriage or career or any of these domains, important life
domains, was usually always focused on longevity, stability and longevity. That's how it was, at least when I was growing up. Things
have changed with the influx of culture was from all over the world to India at this point, and multinational companies and people
freely moving in and out of India, travel and immigration. But when I was growing up, the main focus was on two things, longevity and
stability. You were in with anything personal or professional, always for the long haul.
Speaker 0
32:04
Right but now the problem with that is perhaps that you are going to ignore other innovative things that may come along.
Speaker 1
32:11
Exactly. It came at a price, while there definitely was stability, and stability brings with it its own rewards. But they were also, on the flip
side of it, unwillingness, so to speak, to take up other interesting opportunities that came, for example, taking a very conservative
approach and a risk free approach to anything like investing, travel, going overseas, all of those things. That was basically the mindset
at that time. Since then, I've noticed, especially now when I look at the children of my peers, for example, they have traveled the globe.
They've done far more interesting things than what I would have done when I was their age. In fact, there is an emphasis on trying to
be multicultural and be a global citizen.
Speaker 0
33:15
Do you think some of that is just because communications are so much more open?So they see so much more now?
Speaker 1
33:17
Absolutely hundred percent the fact that Internet became available, TV became available. Um, initially, for example, being able to view
some of the channels from here, TV there, all of that. And then India itself had a major milestone in 1991 when the economy was
opened up. It was called the liberalization of the economy. So there was an influx of capital, influx of personnel, influx of talent from
overseas, and influx also of a lot of expats who are working for multinational companies in India. All of that. The commingling of the
cultures allowed people, for example, from a Western culture, to realize that there were things socially and culturally different that they
could do.
Speaker 1
34:09
And from the Indian standpoint, exposure to all of this talent, the technology and people and resources, food, name it, allowed them to
think that there was another way of life, too, where you could take risk, where you could be an entrepreneur, where you could not
necessarily have to have a conservative and very stable and longevity focused approach. Yeah. All of that changed. Definitely. Yeah.
And it was very helpful because the India that you see now is a much more confident, vibrant, multicultural, and global India from
whatever I can see. No question about that.
Speaker 0
34:52
How often do you get to go back?
Speaker 1
34:54
It in the early years, because of the immigration handicaps, I couldn't travel as much as I would have liked.
Speaker 0
35:01
Right.
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Speaker 1
35:02
And then, as we were all in different career stages and when we had the son, I couldn't travel that much. But now I go back as much as
my situation permits. I can't say I go annually. A lot of my colleagues here in India, from India actually do for various reasons. We are
not someone who make that annual pilgrimage.
Speaker 0
35:28
All the Indians I know, it's usually connected to somebody's wedding. Very often the reason that people go, I mean that's likely with a
large family that there will be a wedding quite frequently. So they go at a time that works for lots of different reasons. But obviously to
see family is the main reason.
Speaker 1
35:48
Correct? Yeah. I mean, one of the things that's happened for us is three of us siblings are here, and my twin brother is the only one
who's home in India. He, in fact, had two offices here in the US. One in California and one in New Jersey because he had a company
that did a lot of its work globally, including in the Middle East and South Africa. And so he used to come frequently to the US. And then
for a portion of time, both my parents held green cards, too.
Speaker 1
36:24
They were sponsored by my sister who came to the US a little earlier than me and came wouldn't she got her citizenship much earlier
than me, and so she was in a position to sponsor them. So they used to spend six months plus of their time here and six months back
home in India. So that was also one of the reasons why I didn't have to go back, because they would be here. Three of us were here.
They would rotate among the three of us. So I didn't have to do that annual pilgrimage that a lot of my peers here do.
Speaker 0
37:04
All right, so what else would you like to tell people? I want to know more about your LLC, your consulting work.
Speaker 1
37:11
So the advisory and consulting thing I put together because I often had people both personal at a personal level and at a professional
reach out to me over the years for various things. And this is something I didn't realize myself. And I'm sure my wife may not
completely agree with it, but everybody tends to see me as someone that they could reach out to for advice. So whether it's their
career or anything of a personal nature, one is there's a confidence that they can confide in me without that going viral in some way,
number one. And number two, because I also like to think that I provide honest feedback. I'm not someone who likes a lot of fluff, so I
say it as it is. But even within that, I try to be gentle and accommodating of what people's needs are.
Speaker 1
38:14
And I do my best in terms of giving them whatever advice it is, whether it's career or at a personal level, I don't know. There's probably
a misconception that I know a lot, which I don't, because of what I realize is that there's so much of knowledge out there in so many
domains, and every day you learn something new. So that's part of one of the things I like about the advising and consulting part.
Because if I have to advise or consult or give someone some feedback, then I better know what it is that I'm talking about. So I like that
part of it because it's a daily learning process. And then for a number of years I've done this. I've done this for children of my peers
back home in India whenever how to navigate the system here.
Speaker 1
39:03
Exactly. And I have several here who reach out to me on WhatsApp sometimes call especially when they're going through the
immigration process. Because my immigration story is familiar to a lot of people. And so while they're not all necessarily in healthcare,
they're in different industries. The fundamental immigration process in some ways is the same, give or take a little bit, in case there's
any people who are not familiar with the system.
Speaker 0
39:33
A lot of Americans truly believe that it's just a question of filling out a form and handing it in with the fee. And then they give you back
the visa. There are so many hoops that you have to jump through for so many different reasons and so many setbacks, and they can
be really minor. Like, the last time I had to renew my green card, I was flying back from the UK. You have to hand in your old one. If
you're going to leave the country, you must have a visa stamped in your passport. So I had asked them, Please, and the woman was
sort of annoyed that I was asking for this.
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Speaker 0
40:07
And I didn't check, just it's an old fashioned stamp, and they fill in the blanks by hand. Very old fashioned. I was bemused by the fact
that was flying back from the UK, and I was landing in Toronto in order to be cleared for American airspace. And was there a war? I
didn't hear about what happened. I'm in Toronto. So I was used by that.
Speaker 0
40:31
And the guy said, no, this is out of date. And I said, it can't possibly be. I only got it, like, two months ago. She'd written January instead
of June. And so it was two days out of date. Thankfully, they have computers, so he was nice enough to look it up on the computer.
But had he been in a bad mood himself, I could conceivably have been stuck in Toronto for quite a while.
Speaker 0
40:54
It's a very strange and imperfect system.
Speaker 1
40:59
We love you, we're really happy we're here, but it can be very stressful the first few years, especially when you're dealing with the
immigration thing, and potentially because of which you have let go some opportunities like I had too. It's a lot more taxing for you to
be 100% at your place of work or present personally at all these social gatherings and be in a very what to say? Be in a very good spirit,
so to speak, to be very honest. Because what happens is and I have my own Toronto story too, by the way, I'll share with you. Well, I
was in MD Anderson, and I think this was 2004. I was involved with the Society of Neuro-Oncology, and I had been invited for the first
time to be a part of their Education Day committee, which was very prestigious for a young and upcoming faculty like me. And then I
was also part of the Scientific Program advisory committee.o
Speaker 1
42:01
So basically someone involved in putting the scientific program together, especially in terms of choosing abstracts and scientific
proposals that had a radiology or an imaging background. So it was very prestigious. I'm ready to go to Toronto for the meeting. I go to
the airport in Houston, the Bush Airport in Houston, and then I'm about to catch the flight and then realize that there's something in my
passport that's missing. Some stamp of some sort. I don't remember what the stamp was. Maybe parole, if I'm not mistaken.
Speaker 0
42:43
If you were still in process because you were processing a new visa.
Speaker 1
42:47
Yeah, correct. I don't remember because it was almost like 19-20 years ago. But I'm there. And so the person at the airline, employee at
the desk scan hands my passport like you do the credit card because there's some digital thing in the passport. And then she tells me,
you don't have it. So I said, I don't have what? And then she gave me details.
Speaker 1
43:16
Of what? I didn't have. And then she very also generously said, well, I can't put you on the flight. I said, why not? And when she said,
this is what you're missing, I asked her, what happens if I take the flight and go to Toronto? Let's say I don't listen to you because
you're not an immigration official. And I go.
Speaker 1
43:39
She said, Then you will not be able to re enter, back to the US. For me, at that time, was a fantastic and potentially a life changing
opportunity because it was a meeting in Toronto, and so all of the heavyweights in Neuroncology from both the US and Canada would
definitely be there, and so would many people from all over the world.
Speaker 0
44:03
UK, certainly.
Speaker 1
44:05
Yeah, definitely UK. In fact, there was a person from UK also that I was going to meet, a person who was a specialist in dynamic
susceptibility contrast MRI that I was looking forward to. I couldn't go. I couldn't go. I mean, I could take a chance and go and not be
able to re-enter, but I couldn't go. And so there was a litany of missed opportunities like that that I couldn't take because of the
immigration requirement. But over the years, I learned that when life closes one door on you, someone opens, it may not be the door
that you are looking for.
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Speaker 1
44:48
It, but the Universe, Destiny, and, if you believe in GOD, there's a plan and there's a method to this that we don't understand at that time.
Speaker 0
44:57
Exactly. You just have to figure out what that pivot is.
Speaker 1
45:00
Exactly. And a lot of times, that pivot is made for you, even though you have the illusion that you're the one who's actually engineering
the pivot. I've realized that, when I was younger, I didn't have that that wisdom. But now, since I've reached a certain stage, I know that
there's a path for you.
Speaker 0
45:21
You have to find it, and you have to be open to taking it when it presents itself.
Speaker 1
45:26
These are all paths to go back to one of your earlier questions. These are all paths that I wouldn't necessarily have taken had I been in
India, because I remember in India, I had a very mindset, very derisk strategy, not willing to try anything new. So if there's one thing that
I have to hands down hand over to my experience here in the US. It's the fact that now I'm ready to take. With all kinds of risks, whether
it's advising or consulting or legal risks, rather. So the advising and consulting is one thing that I kind of have been wanting to do
formally for a long time.
Speaker 1
46:09
And now that I have a critical mass of I hate to use the word expert because I don't think in my view that anybody is really an expert at
anything.
Speaker 0
46:22
Because the amount you can have expertise in things. You're an expert amongst the general population. You may not be an expert's
expert, but you can be expert in some areas. You always help somebody else.
Speaker 1
46:37
Yeah, I always feel like that. The word expert is used very loosely, in my view. For example, an expert would be somebody like Einstein.
It. But because we have spent a significant portion of time in one domain and have some accumulated experiences, it does definitely
give you the opportunity to pass on whatever you have accumulated to others, especially if that's an important moment. In their life or
a decision making moment, and you're able to pass on what you've learned to somebody else and help them along with their journey.
Speaker 0
47:16
It's something that I really enjoyed on the topic of being an expert, I was an expert witness for child abuse cases for many years and it
always felt really strange to be called an expert witness. But all it means is I knew more about that subject than the trier-of-fact, as
they called it. Usually the judge. Yeah.
Speaker 1
47:37
Check.
Speaker 0
47:38
I wouldn't have gone to a meeting of experts in the field and suggested I was any more expert than anybody else. But I did know more
than the judge about it. So what else would you like to tell anybody? We've talked for a long time, even more because of my faux par
earlier with the recording.
Speaker 1
47:58
Depending on who the audience of your podcast is and my understanding, a majority would be physicians and I'm assuming that
there'll be a lot of young and upcoming physicians too. So one of the things that I would like to a couple of things that I'd like to say as
take home messages first thing is realize that as a physician, your clinical training is only one aspect of you as a physician. And what it
does is it's a very structured curriculum and a very structured experience. But through that structured experience, what you do is, learn
how to analyze things, learn how to what I'd say is prioritize things, learn how to explore other facets of healthcare. So whether that's
policy, whether that's entrepreneurship, whether that's as a startup advisor, whether that's as a mentor, one thing that I'd like to
emphasize is think about those things right at the start. The second thing is medicine is fundamentally a business.
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Speaker 1
49:15
Even though you have this idealistic view of what medicine is, when you begin your baby steps in the field, realize that medicine is a
business and so therefore confine some of your learning in terms of formal coursework or even informal experiences to getting some
idea about business and business foundations. Make a conscious effort to understand the whole ecosystem outside of your clinical
practice in healthcare into who the various stakeholders are and how this whole thing. Works. Whether that's on the patient side of
things, on the payer side of things, whether it's insurance, the regulatory aspects of business and all of that pharma, biotech, medtech,
diagnostics try to understand the whole ecosystem. What that does will allow you to broaden your horizons and think of. In terms of
being a holistic player in this ecosystem and not just as a clinician. A lot of clinicians get that wisdom.
Speaker 1
50:23
I'm seeing post pandemic especially and are now looking for roles in utilization review, utilization management and trying to do thing,
at this point, I'm not suggesting that it cannot be done, but it's little bit of a steep learning curve. So one thing that you probably want to
do while you're doing all of your clinical work is to devote a portion of your time, energy and effort to getting up to speed on
coursework or formal coursework or informal experiences where you learn all these other aspects. Could be venture capital. It could
be any of these other things that I mentioned writing, for example. So build some time for that portion of your professional
development into your schedule right from the start. It could be policy.
Speaker 1
51:14
So spend some time writing, spend some time learning about policy and get out there. Other part of it is when you are a little late to the
game, what happens is you have this impostor syndrome because you've never done any of these things.
Speaker 0
51:32
Good old impostor syndrome.
Speaker 1
51:34
Exactly.
Speaker 0
51:34
The only time you were an imposter was when that step from being a student to being a doctor. And then once you've seen a patient
as a doctor, you're a doctor. It's an ongoing education.
Speaker 1
51:49
We can always learn more and then embrace all these modern technologies that are coming. Make them rather than you being
subservient to these technologies, make these technologies a part of your work, your training, so you know how to use them and get
there. Recently, I had what to say, the good fortune to listen to a podcast on which one of the top 50 healthcare executives was
speaking and he was speaking with I forget the name of this individual, someone who's written a book called Beyond the Walls.
Basically, the whole premise of this beyond the Walls is that partnerships, collaboration, and the ability to look beyond your immediate.
Is what we need to all learn.
Speaker 0
52:48
As you said before, it's integrative. No one thing is the answer. It has to work together.
Speaker 1
52:56
Exactly. And as clinicians, including me, at one point, when I was younger and naive, I had the feeling that I was the main player in the
system. I have subsequently realized that we are one of many in the system. So while you can do your part understanding who the
other players are and your willingness to work with all of these other players to provide a more holistic approach for the future of
healthcare is very important. A future of healthcare is going to involve the home, for example. Is going to involve a lot of digital
technologies and the hospital of the future is one that's going to be where the hospital will be coming to you, wherever your location is.
So plan for all of those things.
Speaker 1
53:43
Be open to new challenges, open to new technologies, open to other stakeholders in this pie. And that's going to stand you in good
stead whatever it is that you do in the future. So those are some of my take home messages. Fundamentally, all I'm saying, extend
yourself on a daily basis every day. Don't be content with what you're just doing and what is right in front of you.
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Speaker 0
54:10
Pointing out, though, was one of my pet things is self care, too. Don't overextend yourself.
Speaker 1
54:15
Take some time, do some meditation, take some time for what you need, but don't pigeonhole yourself totally 100% and try to find, and
it is feasible to find some work life balance within all of this too, and be involved in various interesting, stimulating things with a lot of
engaging people. But you're absolutely right is that take care of yourself before you can take care of others.
Speaker 0
54:48
Yeah, but be ready to take a new path if it's offered to you because you don't know where to lead.
Speaker 1
54:55
Exactly. Yeah, and I'm always fond of this other line, too. If there's no path there, then you be the one to make it. You be the one to
make.
Speaker 0
55:05
This is great. Thank you so much for joining me. I'm going to make you come back in another season and talk about all the advances
that have happened in radiology because it's been such an explosion in the last 30 years. I mean, it probably was before, but the one
I've seen has been in the last 30 years.
Speaker 1
55:23
Absolutely. Denise, it was my honor and privilege to be a guest on your show. It was wonderful chatting with you both online and
offline. And if there's anything that any of your listeners want, I believe I have provided some contact information.
Speaker 0
55:39
Their contact information for both of us for both me and my guests is always on the show notes. Yes.
Speaker 1
55:46
They're welcome to reach out to me at any time. As I mentioned, I am not an expert in anything because my yard stick for someone
being called an expert is Einstein.
Speaker 0
55:59
But whatever little I know, but you may have seen it before, you'd be happy to talk to them about it.
Speaker 1
56:07
Absolutely.
Speaker 0
56:08
That's great. Thank you so much.
Speaker 1
56:10
Thank you, Dennis. Much appreciated.
Speaker 0
56:16
Thank you for joining us at Myth, Magic,Medicine. If you have found this episode useful, you can apply for free CME credit through the
link provided in the transcript. If you're not a medical professional, please remember while we're physicians, we're not your physicians,
so please consult with your own healthcare professional if you think something you have heard might apply to you or a loved one. Until
next time, bye.
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