speaker-1: Welcome back to Beyond the White Coat, the show where we explore lives, stories, and journeys of healthcare professionals beyond medicine. ⁓ in the past, we've discussed leadership, entrepreneurship, resilience, and the realities of building a meaningful life in medicine. And today's guest is someone whose story perfectly embodies all that this show is about. Dr. Wail Sasu came to the US from Beirut on an O1 visa, reserved For individuals with extraordinary ability ⁓ is the Luka Donczyk Visa. ⁓ Since then, he's been he's become an internationally respected physician scientist. He founded the division of research within the Department of Anesthesiology at Detroit Medical Center. He leads research efforts there today and serves on faculty at both Michigan State University and Wayne State University. But beyond all those accomplishments, Weill has been an integral part. of the Dr. Doc family since almost the very beginning. He was once a resident physician, struggling with the same financial pressures that thousands of doctors experience, that I experienced personally. He became a Dr. Doc borrower and today he's chair of our scientific research committee and serves on our advisory board. And he's now one of our physician investors. So that journey from borrower to advisor to owner is exactly the kind of community we're trying to build. So Weill, tell us a little bit about the origin story of the man that you are today. Tell us about growing up in Lebanon, what inspired medicine, and what life was like before coming here to fulfill your dreams.
speaker-0: Sure. First of all, Zodia, thank you for the invite. I appreciate being on the on the show. ⁓ it's it's been a long journey, so I'll keep it brief. I did my entire medical school training and residency training in anesthesia back home in Lebanon. And the choice of medicine was more of a choice by elimination. I couldn't find anything that featured all the things I wanted to do in life. ⁓ it it I was very optimistic about things I could do. I was very hopeful that I can get to to make an impact and and medicine seemed like a very natural ⁓ progression of of ⁓ of my training. I did a my bachelor's in chemistry. and then when I graduated anesthesia back home, ⁓ American University of Beirut, I started working at two different hospitals. One of them was my main job and the other one was back in my community just to kind of give back a little bit. And I had a pretty good life. and I I was fulfilling most of what I wanted. But then there was that point of What about more growth? What about more opportunities? ⁓ research, academics, ⁓ things of that nature. And I didn't have enough opportunities there. And that's why we decided, my wife and I at the time, to to make the move to the US. And in our minds, I'm an anesthesiologist. I'm going to probably have to redo residency. She's a critical care ⁓ certified nurse and she's been in the coronary care unit for years and and she's she's held really high positions. And we thought with the sh nursing shortage in the US this would be a breeze. She'll get a job. I live off of her salary until I manage to make it on my own. Sure. And we and we made the move. The move was I I I was ⁓ offered a research position at the Cleveland Clinic. ⁓ very strong research group. I was very proud to be there. ⁓ the salary was minimal, ⁓ much as a research fellow would get. ⁓ and but then when we made the move, she had no way of getting a job. The Despite the nursing shortage, ⁓ I came in on a jay on a on an H1 visa with the Cleveland Clinic. Her as a spouse, it was near impossible for anyone to sponsor her to convert to ⁓ an actual working visa. And we struggled with that for three years and nothing. ⁓ so eventually we were starting to s family planning and we decided to abort that mission. But in the meantime, we were living basically day to day on on minimal wages and we were living in apartments at the worst parts of town. ⁓ in Ohio and ⁓ and we had a lot of healthcare expenses and and a lot of things ⁓ popped up and that that we didn't account for. So the journey didn't the journey I call it the new start of the journey. It didn't look like it was supposed to. And ⁓ that's when I was actually exposed to Doctor Doc. At the time being an international graduate, I had no access to ⁓ to to any kind of funding except for the salary that I was getting. ⁓ from the fellowship. And I remember I had to go open a credit card and nobody would give me a credit card. They said, You have zero credit history. And I opened up a secure credit card for five hundred dollars at a bank. And I basically had to give them five hundred dollars to give me five a credit card to to draw against those five hundred. Yep. And with time, with proper financial hygiene, I think, ⁓ I managed to grow out of that into into a more decent ⁓ lineup of of of accounts and cards, but still with a limited income. So I still needed to get that extra push. And looking around, being an international graduate, not a citizen, on a visa, I had one option, and that was a very modest option where I could get maybe $10,000, $12,000 at a time. And I had to pay it back with a sizable interest. And ⁓ I was at the American Society of Anesthesiologists ⁓ meeting one of those years. And I just happened to see ⁓ a post by ⁓ one of my colleagues now that says ⁓ we're starting doctor doc and this is new and this is meant for doctors and this is ⁓ lending for people who need it and we understand the the the pathway. So I reached out and you were the one to pick up the call actually. I know Yeah and it's it's it's been years. ⁓ and the one thing that that struck me was okay this is exactly what I'm looking for. This is what I need. And these are people who don't treat me as ⁓ a financial risk from the get go because I don't yet have a good job. This is a group of people who knows what the pathway looks like and who are banking on what I'm going to do later, not what I'm doing now. And that was all the difference I needed. And that's that's basically what carried me through the entire fellowship and then residency afterwards. ⁓ I borrowed twice from Doctor Doc. And by the time I made it to I I matched in residency in Michigan in ⁓ in ⁓ twenty seventeen and then twenty twenty one was the time when I got my first job. We moved to the US in twenty fourteen. So fourteen to twenty one, that was the toughest period of me ⁓ for me financially. I remember my credit score was at its lowest, six hundredths. ⁓ but I still managed to be able to to borrow from Dr. Duck. So I I held that very special spot for it and and the the second I was able to I wanted to join the team and and just kind of help propel that idea. Because I I truly believe in it. ⁓
speaker-1: While before you go on, I think there are a couple of themes that I want to double click on because ⁓ your story's incredible. And I think for those that are like us, immigrants that moved here at with great sacrifice to pursue a better life, it a lot of what you said tracks parallel to what I experienced myself and what millions of others have within the US healthcare system because about a quarter of all of our doctors are being imported from somewhere else, right? Thinking about those seven years between 2014 and 2021, was there a time when you second guessed your decision to be here? You'd already accomplished the goal of becoming a physician. You already had the training and the expertise. And you took this jump, right, to go into a to move to a different country, tens of thousands of miles away from where home is, a different culture, different environment. You got young family thinking of having kids and You now hit this obstacle in terms of finances, but also redoing your career in the training. Right. What did you ever say, like, what did I do? And did you guys discuss at any point in time, maybe we should go back?
speaker-0: Let me rephrase the question for you. How many hundred times did I did that come up? ⁓ yes, absolutely. It's ⁓ it's one of those times when and I've it's one of those times when you look at your decisions and you think, I know I did this for a good reason, but it's not worth it. You know, and it's you start thinking about all the struggles and all the all the the suffering you have to go through to get to a to a target, to a goal that's years ahead. And I always say in medicine we're we're the we're the kings and queens of of delayed gratification because we we work so hard we we use a lot of years and a lot of time, a lot of effort for things that we don't get right away. It's things that we're gonna get later. And you see your friends from college already owning businesses or working or doing whatever. And you're just basically stuck and studying from for med school. ⁓ so yeah, that did come up quite a bit. I think what helped was the vision. We had a my wife and I had a very good vision for what we wanted to achieve and accomplish. what kind of helped was that I was moving away from a situation back home that I didn't deem appropriate for me to raise my family, political instabilities and ⁓ lack of opportunity and some things that were happening around what I wanted to do, that I just couldn't find a way to do it there. And looking to hear it seemed like the the opportunities would be more available. And then my wife used to live here as a as a child and and she missed the the life and the and the and then how they were here. So it that helps us kind of stay grounded and and stay focused on it's okay, we're gonna go through this and then eventually it'll be fine.
speaker-1: What was the ⁓ part of American medicine that most surprised you, that was most different from what you expected once you once you started training here? Like when I came, I remember I'd romanticized the idea of being in America and studying, right? And ⁓ and and I think in large part it exceeded my expectations. ⁓ I don't know if that has to s more to say about where I was coming from or if it says more about the healthcare system here, but ⁓ the biggest difference That I like recognized early is a large part of how things are done where I'm from, it's who are your parents? Who are your grandparents? We know who you are. Right. And so there's this kind of like historical kind of village mentality, but it becomes something more insidious that you can only become as good as your parents or your grandparents were. Whereas in the when I got to the US and it felt like everyone wanted to have an underdog story. And it was better to say it was bet even the folks that had that were on third base were claiming to be on first. And so there's this celebration of coming from nothing and and there was a lot of doors that I think ⁓ were opened because I had a thirst, a hunger, a resilience to kind of get to the thing. But people celebrated that and like they wanted to to be able to help someone who was who had the the the the deck stacked against them. What surprised you most?
speaker-0: I'll tell you the medicine part itself did not surprise me at all. Well the place I trained is an American university. We had roughly the same systems. We even had extra influence from European medicine. So one of the things that surprised me actually in medical practice was that I was doing things back home five and ten years ago that are just coming to market here. Sure. So when they did come into market, I was already very familiar with them. So I was very comfortable using them. working on them, researching them and and talking about them. So that was a distinct advantage. The other thing was, similar to what you described, ⁓ back home, it seemed like there was a ceiling on what I could achieve. Sure. Unless I pled fealty to somebody or to something or to an idea or to a political party. That concept was was was very, very it didn't sit with me well. So I come here and Of course there's some of that everywhere. It's it's not no place is perfect. But I found that if you if you persevere and if you're persistent enough and if you have a good vision and if you're adaptable, you can find many more ways to to go through, to progress, to grow. I wouldn't have dreamed of of achieving what I achieved ⁓ in the time period that I did back home because here it was purely skill based. Over there would have been I need somebody to sponsor me. To able to get a position, you know? That's exactly right. That's it's it's tough. And ⁓ with the with the mentality that we come in as immigrants, as people who have been used to the struggle and the strife, and the you have to be the absolute best before you can take one more step forward. And we come here and it just explodes. One thing I would I always caution people against is you come here, fine, you make it, and you get to a point where you're comfortable and you're at a position that you like. But you forget to change your your mentality. You forget to say that, okay, I've been pushing so hard and now I got where I wanted to get. And now I can relax a little bit. I think a lot of people struggle with this concept of ⁓ taking a breath and and and catching up and and ⁓ not until very recently did I did I stop feeling like I had to keep continuously proving myself and then it looks great on paper because now you're publishing and you're doing and you're you're you're getting promoted. But you're just exhausting yourself the whole time. So
speaker-1: Suffering mental health, your psyche, it's real because of that. A lot of pressure.
speaker-0: It is a lot of pressure and and I have a lot of faith in people who who go through the struggle that they're going to make it. And I think the one area that we haven't looked at enough yet is what happens after you make it. How do you how do you handle it? How what do you do with it?
speaker-1: Yeah. And I think a part of what we think about a doctor doc is how do you handle the money when you start to make that money that you had. So you go from a poverty mindset to one of ⁓ I wouldn't call it abundance because we're still, you know, there's still some challenges in how we're we're compensated, but ⁓ but it's it's a difficult transition. Now, most of us, myself included, we just struggle to survive residency. But somehow you became head of research. What what spark you you've got all this stuff going on with immigration and and family building and all the things that you described and you were able to kind of rise to as a cream of the crop. What is there what sparked your research interest and where did that come from?
speaker-0: ⁓ I did have my interest in research back home when I was in res in my first residency. And when I moved here, I moved on the basis of becoming a researcher before redoing residency. So it it got ingrained in me that research is something I enjoy doing and I I had exposure to a lot of things, including a lot of industry sponsored studies where I started working with pharmaceuticals, device ⁓ manufacturers, I started looking at the technology of things and that's always been ⁓ a topic that I l I enjoyed. And now I found a way to combine my my love for technology and advancement and and ⁓ all that progress with my my enjoyment of of medicine. And research was the was the very perfect way to to combine all those two. So when I went to my residency, my second residency, I kept contact and I kept doing research. And I got to a point where midway through residency, somebody came and approached me to ⁓ take a job at the at the institution where I was training. And Where I am now, it's is staffed by ⁓ by an anesthesia staffing company. It's a for profit organization, it's not an academic institution, they don't have ⁓ research infrastructure, most of their sites are non-academic. There's only two residency programs. ⁓ it was just the one at the time and then they added another one. So I refused the job offer saying that this I I can't just do bread and butter stuff and and and sit still. I need to be working, I need to be ⁓ ⁓ working on research, creating something. And so the the person trying to hire me was the regional medical director. He said, Okay, I hear you. Why don't we make it? Why don't we create it together? I said, What do you mean create it together? He said, We don't have a research arm. We're interested. It seems like a good thing to do. So let's create a research arm for the entire organization, the national organization, and then you can just handle it. And it was more of a I challenge you, I dare you, I don't know what to call it. But ⁓ I said yes. ⁓ and so I graduated residency from the get go being a director of research for a large national organization. And by default I became the director of research at my site because they didn't have a former structure either. And that's that was day one. not even day minus a year. ⁓ so that's that's how that came up and and it's been growing ever since. And within two years we created a research fellowship. Now I have I have people who were in my shoes who are remote. who are outside the country, who wanna get in and who want to get academically more ⁓ involved and they they want to enhance their CVs. Now they're coming to me so that we can I can help them with the research and they can now then apply to ⁓ to residencies, much like I did. Sure. ⁓ and that program grew from two people to about twenty seven people in just a couple of years. So it's th the need is there and and I probably only recognize it because I I suffered through the the the steps of it. And and tell where the pain points are.
speaker-1: When our audience hears research, I think many will think, that's not me. Tell us why every physician should care about research.
speaker-0: Absolutely. When you talk about research, ⁓ it's not just Ivory Tower institutions. A lot of really good research comes from there. But a lot of a lot of real world research comes from elsewhere. And that hasn't been looked at appropriately yet. And and just a month or two ago we were talking to the in a in a in a big ⁓ collaboration on ⁓ enhancing patient outcomes and how we do this in this institution at that institution. My talk there was how do we get the perspective of the non-academic sites, which comprise two thirds of all the anesthetics that we do around the country. So it's a really big chunk of of ⁓ of of patients who go through non-academic sites to get their surgeries done and they get anesthetics. And there's a lot of quality improvement that we can do there. There's a lot of ⁓ patient outcomes, patient centered outcomes. There's a lot of personal and professional targets that we can hit there. For the organization, for the patients, for us as individuals who are trying to build something or are trying to progress in our career, we're trying to climb the ladder, we're trying to become known for something, ⁓ have our own subspecialty. so research doesn't have to be RCTs all the time and several thousand patients. It can be a lot of things. It can be a simple quality improvement project that you do on twenty patients or on a in a month, or there's a lot you can do from very small to very large. And I think we've been able to prove that you don't necessarily have to be in one of the large organizations to be able to do research. The type of research differs obviously, but there's a lot that we can do and the impact is absolutely there. One of the studies that we did was a hundred and twenty seven thousand patients and it was purely non academic. It was all from from private centers, aca ⁓ ambulatory surgery centers and the like. Sure. So you your impact can be really big.
speaker-1: One of the things that I'm personally most proud of as ⁓ co-founder and CEO of Doctor Doc is the Scientific Research Committee. And when we first discussed it, your immediate response wasn't what does it pay? It was, how do we help our peers? Why is that important to you?
speaker-0: Because I've I've been burned with it by this whole process. And I know I know that it's important. I know that it's ⁓ I know a lot of people have the drive to do all of this work because it impacts them professionally, it impacts their institutions where they work, and it impacts their patients, which should be our priority. and I know a lot of people don't do it because they're they're hyper focused on everything else, not the least of which is the finances, that they feel like they're too overburdened. to think about things that they deem optional. So when when when we had that discussion back then, it seemed to me like Dr. Doc is building something that is novel, that is needed, and that targets a very specific set of of people who absolutely need these services. And those are basically the same people who would be most driven to to do quality work and who are zealous to to to kind of, you know, make an impact and prove themselves and show that that they bring something to the table. So it it seemed like a very natural idea to to make work and and it was a nice challenge to have.
speaker-1: I think, you know, a a large part of when people think about research, I think about being in a lab in a microscope and doing benchwork. And I think your explanation of of how quality improvement projects, small sample size, ⁓ just hypothesis testing leads to kind of meaningful data. And I I think for me with Doc to Doc and when we had the conversation, I thought that research in this realm can also lead to influence policy around physician. costs within the medical education journey, right? Like the cost of medical education is so prohibitive that it it it's this kind of gorilla sitting in the room that that influences and clouds all future decisions that we make. You know, a lot of us are thinking about the the specialty because we got to pay back these loans. You're thinking about the first job offer because we got to pay back these loans. And and so if we were able to kind of shed light on How harmful that financial burden is while you're training and then when you're early in your career and the kind of debt that we have to take on, ⁓ commercial, consumer, educational debt that creates this drag on our financial lives, the more we discuss it, the more we publish it, the more we kind of shed light, the more we can possibly influence policy. But the more we also kind of create this camaraderie where we're not suffering in silence anymore. Because as you describe your story, it resonates deeply with me and what mine was. And I know that Kenton's was similar and we we've now had twenty thousand health professionals apply to our platform with similar experiences around trying to finance their way through this medical journey.
speaker-0: You wouldn't think it. When when you're going through it, you wouldn't know. And the one thing that I think was heartening, even from the very first project that we did together as a as a research committee, was that how people recover their FICO scores after they've they've they're done with this gauntlet of of of medical school and residency and all that. And people do recover, but you don't see it. You don't expect it to happen and you're just sitting in this constant fear of my finances are going to be the worst thing in my life. And they probably are for a brief period of time. But then you get to where you want to get and then that doesn't become the issue anymore. That that becomes something that you can take care of. And then I think people should feel a lot of hope from from some of this work.
speaker-1: Tell us about the Kaper study that you just recently completed for us.
speaker-0: We so one of the things I I I got to do was to start a business and ⁓ to ⁓ create something in healthcare that I felt was needed. And b given my research background, I co created this ⁓ platform that surveys ⁓ populations and we called it CAPER the clinician and ⁓ patient experience registry. My aim for this was to ask the questions of of these populations, any country we can think of, basically. what they thought about healthcare, things in healthcare, processes, ⁓ experiences, things you can't find in an electronic health record. So one of the studies that we collaborated together on was to ask medical students and trainees and dentistry students how they felt about their finances, how much they knew, how much they felt comfortable handling their finances, ⁓ what they how much were their finances influencing their their career choice, their their their choice to say within healthcare or not. And There was a lot that we found there and we're still bossing through the data, but then you can see the the the immense impact of finances on even career choices. So if you think about it this way, talking about policy, people who who go through this prohibitive process of of medicine and healthcare in general, how much it costs, are more likely to drop out or to not even consider it. Think of this ten and twenty years down the line, now we have less healthcare providers and then the entire industry and the entire healthcare system collapses. from from that sense because we don't have people who are interested and now you have to settle for for less qualifications and you have to settle for less certifications and everybody suffers from that. So it's it's we're about to actually we're writing three different manuscripts from this and we we should be ready with those soon and I'm happy to share them once they are. ⁓ but there's so many insights that we couldn't find previously that now we have access to. And this seems to be the perfect place to do it.
speaker-1: Love it, man. Looking forward to seeing all the manuscript as they come out. ⁓ I've got a brief rapid fire section now. Answers should be as first thing that comes to mind within ten or fifteen seconds. Okay. Favorite paper you ever published?
speaker-0: Oof. The collaboration with ⁓ all the non academic sites on interoperative hypertension.
speaker-1: What happened? Say more about it.
speaker-0: We in in in traditional research, we know that about thirty percent of our patients get hypotensive in ⁓ under anesthesia. If you take the the definition of hypertension that's most widely adopted by the by the CMS and by everybody. ⁓ we looked at non academic sites, ambulatory surgery centers, where we thought that these are healthier patients, these are smaller procedures, there's no way we can have that much hypotension. Exactly thirty percent. So a third of all our patients, no matter what surgery they're having, no matter what comorbidities they have, no matter who's giving them the anesthetic They're one in three are getting hypotensive to a degree that might be impacting their health and their recovery. Sure.
speaker-1: Coffee or tea?
speaker-0: Oof. Used to be tea until I got married. And then my wife loves coffee, so now it's coffee.
speaker-1: Favorite city outside the US.
speaker-0: I wanna say Beirut. It's such a fun city when when it's quiet and calm.
speaker-1: One book every physician should read.
speaker-0: ⁓ any book you can lay hands on. I'm I'm I'm a very ⁓ I'm very I'm very supportive of reading outside of myself.
speaker-1: paper like open ⁓ hold the book or do you not care? It's gonna be an audio book or
speaker-0: It can be an audiobook. It's I I drive forty five minutes to work each day, ⁓ each way. So I I listen to a lot of audiobooks. I I'm trying to build my own library of books here. ⁓ I'm looking at all the history of anesthesia books and things that people should should hold on to.
speaker-1: Awesome. What is the biggest misconception about physician scientists?
speaker-0: ⁓ Especially the ones that that have relations with industry, that they're rich and they don't do anything.
speaker-1: I thought you were gonna say they're nerds.
speaker-0: ⁓ well they they have to be nerds. Proud of that.
speaker-1: What's one thing you wish that every resident knew?
speaker-0: ⁓ how to take care of themselves?
speaker-1: Say more.
speaker-0: A lot of the the burnout and the moral injury and all the things that that people are suffering from now come from a lot of external factors, but also from internal factors. It's like ⁓ when we talk about this mindset of I need to prove myself, I need to work more, I need to produce more, you get to a point where you're giving, giving, giving, and then you forget to take care of yourself along the way. And that's why when you get to a point where you're supposed to be comfortable, now you're just dealing with the repercussions of of that journey. ⁓ and if you take a little bit of time and effort to take care of yourself along the way, make sure you're in a good headspace, make sure that you're ⁓ you're giving enough time and attention to your family, your loved ones, to hobbies. ⁓ unless you do that, you're you're not going to end up in a good space. I let go of a lot of hobbies. I used to be in martial arts and basketball and soccer and all of those things. I've dropped everything. I dropped video gaming for for medicine, you know? So that's that's that's not something you should do. But it's not something that should occupy you too much either. So you have to find a good balance as you go.
speaker-1: I hear you, man. Well, while your story is extraordinary, ⁓ and it's not just because of your accomplishments, but because you've never forgotten where you started. ⁓ to me, you represent exactly what Doc to Doc stands for. ⁓ and we just don't want to make loans. We want to create lifelong relationships. And those are relationships where every where today's borrower becomes tomorrow's researcher, advisor, investor, and leader. So that's how lasting communities are built. And we thank you for your friendship. For your leadership and for everything you're doing to advance medicine.
speaker-0: It's a pleasure. I'm I'm very happy to have met this group and it's ⁓ I I stay on board because I love it, not because it it not because of what you offered. It's because it's just it's easy. I don't know
speaker-1: I don't offer enough for what you're making. So like clearly clearly you're you're here for other reasons beyond Yeah. Well thank you so much, man.
speaker-0: Faction is built in. Thank you.
speaker-0: Sure. First of all, Zodia, thank you for the invite. I appreciate being on the on the show. ⁓ it's it's been a long journey, so I'll keep it brief. I did my entire medical school training and residency training in anesthesia back home in Lebanon. And the choice of medicine was more of a choice by elimination. I couldn't find anything that featured all the things I wanted to do in life. ⁓ it it I was very optimistic about things I could do. I was very hopeful that I can get to to make an impact and and medicine seemed like a very natural ⁓ progression of of ⁓ of my training. I did a my bachelor's in chemistry. and then when I graduated anesthesia back home, ⁓ American University of Beirut, I started working at two different hospitals. One of them was my main job and the other one was back in my community just to kind of give back a little bit. And I had a pretty good life. and I I was fulfilling most of what I wanted. But then there was that point of What about more growth? What about more opportunities? ⁓ research, academics, ⁓ things of that nature. And I didn't have enough opportunities there. And that's why we decided, my wife and I at the time, to to make the move to the US. And in our minds, I'm an anesthesiologist. I'm going to probably have to redo residency. She's a critical care ⁓ certified nurse and she's been in the coronary care unit for years and and she's she's held really high positions. And we thought with the sh nursing shortage in the US this would be a breeze. She'll get a job. I live off of her salary until I manage to make it on my own. Sure. And we and we made the move. The move was I I I was ⁓ offered a research position at the Cleveland Clinic. ⁓ very strong research group. I was very proud to be there. ⁓ the salary was minimal, ⁓ much as a research fellow would get. ⁓ and but then when we made the move, she had no way of getting a job. The Despite the nursing shortage, ⁓ I came in on a jay on a on an H1 visa with the Cleveland Clinic. Her as a spouse, it was near impossible for anyone to sponsor her to convert to ⁓ an actual working visa. And we struggled with that for three years and nothing. ⁓ so eventually we were starting to s family planning and we decided to abort that mission. But in the meantime, we were living basically day to day on on minimal wages and we were living in apartments at the worst parts of town. ⁓ in Ohio and ⁓ and we had a lot of healthcare expenses and and a lot of things ⁓ popped up and that that we didn't account for. So the journey didn't the journey I call it the new start of the journey. It didn't look like it was supposed to. And ⁓ that's when I was actually exposed to Doctor Doc. At the time being an international graduate, I had no access to ⁓ to to any kind of funding except for the salary that I was getting. ⁓ from the fellowship. And I remember I had to go open a credit card and nobody would give me a credit card. They said, You have zero credit history. And I opened up a secure credit card for five hundred dollars at a bank. And I basically had to give them five hundred dollars to give me five a credit card to to draw against those five hundred. Yep. And with time, with proper financial hygiene, I think, ⁓ I managed to grow out of that into into a more decent ⁓ lineup of of of accounts and cards, but still with a limited income. So I still needed to get that extra push. And looking around, being an international graduate, not a citizen, on a visa, I had one option, and that was a very modest option where I could get maybe $10,000, $12,000 at a time. And I had to pay it back with a sizable interest. And ⁓ I was at the American Society of Anesthesiologists ⁓ meeting one of those years. And I just happened to see ⁓ a post by ⁓ one of my colleagues now that says ⁓ we're starting doctor doc and this is new and this is meant for doctors and this is ⁓ lending for people who need it and we understand the the the pathway. So I reached out and you were the one to pick up the call actually. I know Yeah and it's it's it's been years. ⁓ and the one thing that that struck me was okay this is exactly what I'm looking for. This is what I need. And these are people who don't treat me as ⁓ a financial risk from the get go because I don't yet have a good job. This is a group of people who knows what the pathway looks like and who are banking on what I'm going to do later, not what I'm doing now. And that was all the difference I needed. And that's that's basically what carried me through the entire fellowship and then residency afterwards. ⁓ I borrowed twice from Doctor Doc. And by the time I made it to I I matched in residency in Michigan in ⁓ in ⁓ twenty seventeen and then twenty twenty one was the time when I got my first job. We moved to the US in twenty fourteen. So fourteen to twenty one, that was the toughest period of me ⁓ for me financially. I remember my credit score was at its lowest, six hundredths. ⁓ but I still managed to be able to to borrow from Dr. Duck. So I I held that very special spot for it and and the the second I was able to I wanted to join the team and and just kind of help propel that idea. Because I I truly believe in it. ⁓
speaker-1: While before you go on, I think there are a couple of themes that I want to double click on because ⁓ your story's incredible. And I think for those that are like us, immigrants that moved here at with great sacrifice to pursue a better life, it a lot of what you said tracks parallel to what I experienced myself and what millions of others have within the US healthcare system because about a quarter of all of our doctors are being imported from somewhere else, right? Thinking about those seven years between 2014 and 2021, was there a time when you second guessed your decision to be here? You'd already accomplished the goal of becoming a physician. You already had the training and the expertise. And you took this jump, right, to go into a to move to a different country, tens of thousands of miles away from where home is, a different culture, different environment. You got young family thinking of having kids and You now hit this obstacle in terms of finances, but also redoing your career in the training. Right. What did you ever say, like, what did I do? And did you guys discuss at any point in time, maybe we should go back?
speaker-0: Let me rephrase the question for you. How many hundred times did I did that come up? ⁓ yes, absolutely. It's ⁓ it's one of those times when and I've it's one of those times when you look at your decisions and you think, I know I did this for a good reason, but it's not worth it. You know, and it's you start thinking about all the struggles and all the all the the suffering you have to go through to get to a to a target, to a goal that's years ahead. And I always say in medicine we're we're the we're the kings and queens of of delayed gratification because we we work so hard we we use a lot of years and a lot of time, a lot of effort for things that we don't get right away. It's things that we're gonna get later. And you see your friends from college already owning businesses or working or doing whatever. And you're just basically stuck and studying from for med school. ⁓ so yeah, that did come up quite a bit. I think what helped was the vision. We had a my wife and I had a very good vision for what we wanted to achieve and accomplish. what kind of helped was that I was moving away from a situation back home that I didn't deem appropriate for me to raise my family, political instabilities and ⁓ lack of opportunity and some things that were happening around what I wanted to do, that I just couldn't find a way to do it there. And looking to hear it seemed like the the opportunities would be more available. And then my wife used to live here as a as a child and and she missed the the life and the and the and then how they were here. So it that helps us kind of stay grounded and and stay focused on it's okay, we're gonna go through this and then eventually it'll be fine.
speaker-1: What was the ⁓ part of American medicine that most surprised you, that was most different from what you expected once you once you started training here? Like when I came, I remember I'd romanticized the idea of being in America and studying, right? And ⁓ and and I think in large part it exceeded my expectations. ⁓ I don't know if that has to s more to say about where I was coming from or if it says more about the healthcare system here, but ⁓ the biggest difference That I like recognized early is a large part of how things are done where I'm from, it's who are your parents? Who are your grandparents? We know who you are. Right. And so there's this kind of like historical kind of village mentality, but it becomes something more insidious that you can only become as good as your parents or your grandparents were. Whereas in the when I got to the US and it felt like everyone wanted to have an underdog story. And it was better to say it was bet even the folks that had that were on third base were claiming to be on first. And so there's this celebration of coming from nothing and and there was a lot of doors that I think ⁓ were opened because I had a thirst, a hunger, a resilience to kind of get to the thing. But people celebrated that and like they wanted to to be able to help someone who was who had the the the the deck stacked against them. What surprised you most?
speaker-0: I'll tell you the medicine part itself did not surprise me at all. Well the place I trained is an American university. We had roughly the same systems. We even had extra influence from European medicine. So one of the things that surprised me actually in medical practice was that I was doing things back home five and ten years ago that are just coming to market here. Sure. So when they did come into market, I was already very familiar with them. So I was very comfortable using them. working on them, researching them and and talking about them. So that was a distinct advantage. The other thing was, similar to what you described, ⁓ back home, it seemed like there was a ceiling on what I could achieve. Sure. Unless I pled fealty to somebody or to something or to an idea or to a political party. That concept was was was very, very it didn't sit with me well. So I come here and Of course there's some of that everywhere. It's it's not no place is perfect. But I found that if you if you persevere and if you're persistent enough and if you have a good vision and if you're adaptable, you can find many more ways to to go through, to progress, to grow. I wouldn't have dreamed of of achieving what I achieved ⁓ in the time period that I did back home because here it was purely skill based. Over there would have been I need somebody to sponsor me. To able to get a position, you know? That's exactly right. That's it's it's tough. And ⁓ with the with the mentality that we come in as immigrants, as people who have been used to the struggle and the strife, and the you have to be the absolute best before you can take one more step forward. And we come here and it just explodes. One thing I would I always caution people against is you come here, fine, you make it, and you get to a point where you're comfortable and you're at a position that you like. But you forget to change your your mentality. You forget to say that, okay, I've been pushing so hard and now I got where I wanted to get. And now I can relax a little bit. I think a lot of people struggle with this concept of ⁓ taking a breath and and and catching up and and ⁓ not until very recently did I did I stop feeling like I had to keep continuously proving myself and then it looks great on paper because now you're publishing and you're doing and you're you're you're getting promoted. But you're just exhausting yourself the whole time. So
speaker-1: Suffering mental health, your psyche, it's real because of that. A lot of pressure.
speaker-0: It is a lot of pressure and and I have a lot of faith in people who who go through the struggle that they're going to make it. And I think the one area that we haven't looked at enough yet is what happens after you make it. How do you how do you handle it? How what do you do with it?
speaker-1: Yeah. And I think a part of what we think about a doctor doc is how do you handle the money when you start to make that money that you had. So you go from a poverty mindset to one of ⁓ I wouldn't call it abundance because we're still, you know, there's still some challenges in how we're we're compensated, but ⁓ but it's it's a difficult transition. Now, most of us, myself included, we just struggle to survive residency. But somehow you became head of research. What what spark you you've got all this stuff going on with immigration and and family building and all the things that you described and you were able to kind of rise to as a cream of the crop. What is there what sparked your research interest and where did that come from?
speaker-0: ⁓ I did have my interest in research back home when I was in res in my first residency. And when I moved here, I moved on the basis of becoming a researcher before redoing residency. So it it got ingrained in me that research is something I enjoy doing and I I had exposure to a lot of things, including a lot of industry sponsored studies where I started working with pharmaceuticals, device ⁓ manufacturers, I started looking at the technology of things and that's always been ⁓ a topic that I l I enjoyed. And now I found a way to combine my my love for technology and advancement and and ⁓ all that progress with my my enjoyment of of medicine. And research was the was the very perfect way to to combine all those two. So when I went to my residency, my second residency, I kept contact and I kept doing research. And I got to a point where midway through residency, somebody came and approached me to ⁓ take a job at the at the institution where I was training. And Where I am now, it's is staffed by ⁓ by an anesthesia staffing company. It's a for profit organization, it's not an academic institution, they don't have ⁓ research infrastructure, most of their sites are non-academic. There's only two residency programs. ⁓ it was just the one at the time and then they added another one. So I refused the job offer saying that this I I can't just do bread and butter stuff and and and sit still. I need to be working, I need to be ⁓ ⁓ working on research, creating something. And so the the person trying to hire me was the regional medical director. He said, Okay, I hear you. Why don't we make it? Why don't we create it together? I said, What do you mean create it together? He said, We don't have a research arm. We're interested. It seems like a good thing to do. So let's create a research arm for the entire organization, the national organization, and then you can just handle it. And it was more of a I challenge you, I dare you, I don't know what to call it. But ⁓ I said yes. ⁓ and so I graduated residency from the get go being a director of research for a large national organization. And by default I became the director of research at my site because they didn't have a former structure either. And that's that was day one. not even day minus a year. ⁓ so that's that's how that came up and and it's been growing ever since. And within two years we created a research fellowship. Now I have I have people who were in my shoes who are remote. who are outside the country, who wanna get in and who want to get academically more ⁓ involved and they they want to enhance their CVs. Now they're coming to me so that we can I can help them with the research and they can now then apply to ⁓ to residencies, much like I did. Sure. ⁓ and that program grew from two people to about twenty seven people in just a couple of years. So it's th the need is there and and I probably only recognize it because I I suffered through the the the steps of it. And and tell where the pain points are.
speaker-1: When our audience hears research, I think many will think, that's not me. Tell us why every physician should care about research.
speaker-0: Absolutely. When you talk about research, ⁓ it's not just Ivory Tower institutions. A lot of really good research comes from there. But a lot of a lot of real world research comes from elsewhere. And that hasn't been looked at appropriately yet. And and just a month or two ago we were talking to the in a in a in a big ⁓ collaboration on ⁓ enhancing patient outcomes and how we do this in this institution at that institution. My talk there was how do we get the perspective of the non-academic sites, which comprise two thirds of all the anesthetics that we do around the country. So it's a really big chunk of of ⁓ of of patients who go through non-academic sites to get their surgeries done and they get anesthetics. And there's a lot of quality improvement that we can do there. There's a lot of ⁓ patient outcomes, patient centered outcomes. There's a lot of personal and professional targets that we can hit there. For the organization, for the patients, for us as individuals who are trying to build something or are trying to progress in our career, we're trying to climb the ladder, we're trying to become known for something, ⁓ have our own subspecialty. so research doesn't have to be RCTs all the time and several thousand patients. It can be a lot of things. It can be a simple quality improvement project that you do on twenty patients or on a in a month, or there's a lot you can do from very small to very large. And I think we've been able to prove that you don't necessarily have to be in one of the large organizations to be able to do research. The type of research differs obviously, but there's a lot that we can do and the impact is absolutely there. One of the studies that we did was a hundred and twenty seven thousand patients and it was purely non academic. It was all from from private centers, aca ⁓ ambulatory surgery centers and the like. Sure. So you your impact can be really big.
speaker-1: One of the things that I'm personally most proud of as ⁓ co-founder and CEO of Doctor Doc is the Scientific Research Committee. And when we first discussed it, your immediate response wasn't what does it pay? It was, how do we help our peers? Why is that important to you?
speaker-0: Because I've I've been burned with it by this whole process. And I know I know that it's important. I know that it's ⁓ I know a lot of people have the drive to do all of this work because it impacts them professionally, it impacts their institutions where they work, and it impacts their patients, which should be our priority. and I know a lot of people don't do it because they're they're hyper focused on everything else, not the least of which is the finances, that they feel like they're too overburdened. to think about things that they deem optional. So when when when we had that discussion back then, it seemed to me like Dr. Doc is building something that is novel, that is needed, and that targets a very specific set of of people who absolutely need these services. And those are basically the same people who would be most driven to to do quality work and who are zealous to to to kind of, you know, make an impact and prove themselves and show that that they bring something to the table. So it it seemed like a very natural idea to to make work and and it was a nice challenge to have.
speaker-1: I think, you know, a a large part of when people think about research, I think about being in a lab in a microscope and doing benchwork. And I think your explanation of of how quality improvement projects, small sample size, ⁓ just hypothesis testing leads to kind of meaningful data. And I I think for me with Doc to Doc and when we had the conversation, I thought that research in this realm can also lead to influence policy around physician. costs within the medical education journey, right? Like the cost of medical education is so prohibitive that it it it's this kind of gorilla sitting in the room that that influences and clouds all future decisions that we make. You know, a lot of us are thinking about the the specialty because we got to pay back these loans. You're thinking about the first job offer because we got to pay back these loans. And and so if we were able to kind of shed light on How harmful that financial burden is while you're training and then when you're early in your career and the kind of debt that we have to take on, ⁓ commercial, consumer, educational debt that creates this drag on our financial lives, the more we discuss it, the more we publish it, the more we kind of shed light, the more we can possibly influence policy. But the more we also kind of create this camaraderie where we're not suffering in silence anymore. Because as you describe your story, it resonates deeply with me and what mine was. And I know that Kenton's was similar and we we've now had twenty thousand health professionals apply to our platform with similar experiences around trying to finance their way through this medical journey.
speaker-0: You wouldn't think it. When when you're going through it, you wouldn't know. And the one thing that I think was heartening, even from the very first project that we did together as a as a research committee, was that how people recover their FICO scores after they've they've they're done with this gauntlet of of of medical school and residency and all that. And people do recover, but you don't see it. You don't expect it to happen and you're just sitting in this constant fear of my finances are going to be the worst thing in my life. And they probably are for a brief period of time. But then you get to where you want to get and then that doesn't become the issue anymore. That that becomes something that you can take care of. And then I think people should feel a lot of hope from from some of this work.
speaker-1: Tell us about the Kaper study that you just recently completed for us.
speaker-0: We so one of the things I I I got to do was to start a business and ⁓ to ⁓ create something in healthcare that I felt was needed. And b given my research background, I co created this ⁓ platform that surveys ⁓ populations and we called it CAPER the clinician and ⁓ patient experience registry. My aim for this was to ask the questions of of these populations, any country we can think of, basically. what they thought about healthcare, things in healthcare, processes, ⁓ experiences, things you can't find in an electronic health record. So one of the studies that we collaborated together on was to ask medical students and trainees and dentistry students how they felt about their finances, how much they knew, how much they felt comfortable handling their finances, ⁓ what they how much were their finances influencing their their career choice, their their their choice to say within healthcare or not. And There was a lot that we found there and we're still bossing through the data, but then you can see the the the immense impact of finances on even career choices. So if you think about it this way, talking about policy, people who who go through this prohibitive process of of medicine and healthcare in general, how much it costs, are more likely to drop out or to not even consider it. Think of this ten and twenty years down the line, now we have less healthcare providers and then the entire industry and the entire healthcare system collapses. from from that sense because we don't have people who are interested and now you have to settle for for less qualifications and you have to settle for less certifications and everybody suffers from that. So it's it's we're about to actually we're writing three different manuscripts from this and we we should be ready with those soon and I'm happy to share them once they are. ⁓ but there's so many insights that we couldn't find previously that now we have access to. And this seems to be the perfect place to do it.
speaker-1: Love it, man. Looking forward to seeing all the manuscript as they come out. ⁓ I've got a brief rapid fire section now. Answers should be as first thing that comes to mind within ten or fifteen seconds. Okay. Favorite paper you ever published?
speaker-0: Oof. The collaboration with ⁓ all the non academic sites on interoperative hypertension.
speaker-1: What happened? Say more about it.
speaker-0: We in in in traditional research, we know that about thirty percent of our patients get hypotensive in ⁓ under anesthesia. If you take the the definition of hypertension that's most widely adopted by the by the CMS and by everybody. ⁓ we looked at non academic sites, ambulatory surgery centers, where we thought that these are healthier patients, these are smaller procedures, there's no way we can have that much hypotension. Exactly thirty percent. So a third of all our patients, no matter what surgery they're having, no matter what comorbidities they have, no matter who's giving them the anesthetic They're one in three are getting hypotensive to a degree that might be impacting their health and their recovery. Sure.
speaker-1: Coffee or tea?
speaker-0: Oof. Used to be tea until I got married. And then my wife loves coffee, so now it's coffee.
speaker-1: Favorite city outside the US.
speaker-0: I wanna say Beirut. It's such a fun city when when it's quiet and calm.
speaker-1: One book every physician should read.
speaker-0: ⁓ any book you can lay hands on. I'm I'm I'm a very ⁓ I'm very I'm very supportive of reading outside of myself.
speaker-1: paper like open ⁓ hold the book or do you not care? It's gonna be an audio book or
speaker-0: It can be an audiobook. It's I I drive forty five minutes to work each day, ⁓ each way. So I I listen to a lot of audiobooks. I I'm trying to build my own library of books here. ⁓ I'm looking at all the history of anesthesia books and things that people should should hold on to.
speaker-1: Awesome. What is the biggest misconception about physician scientists?
speaker-0: ⁓ Especially the ones that that have relations with industry, that they're rich and they don't do anything.
speaker-1: I thought you were gonna say they're nerds.
speaker-0: ⁓ well they they have to be nerds. Proud of that.
speaker-1: What's one thing you wish that every resident knew?
speaker-0: ⁓ how to take care of themselves?
speaker-1: Say more.
speaker-0: A lot of the the burnout and the moral injury and all the things that that people are suffering from now come from a lot of external factors, but also from internal factors. It's like ⁓ when we talk about this mindset of I need to prove myself, I need to work more, I need to produce more, you get to a point where you're giving, giving, giving, and then you forget to take care of yourself along the way. And that's why when you get to a point where you're supposed to be comfortable, now you're just dealing with the repercussions of of that journey. ⁓ and if you take a little bit of time and effort to take care of yourself along the way, make sure you're in a good headspace, make sure that you're ⁓ you're giving enough time and attention to your family, your loved ones, to hobbies. ⁓ unless you do that, you're you're not going to end up in a good space. I let go of a lot of hobbies. I used to be in martial arts and basketball and soccer and all of those things. I've dropped everything. I dropped video gaming for for medicine, you know? So that's that's that's not something you should do. But it's not something that should occupy you too much either. So you have to find a good balance as you go.
speaker-1: I hear you, man. Well, while your story is extraordinary, ⁓ and it's not just because of your accomplishments, but because you've never forgotten where you started. ⁓ to me, you represent exactly what Doc to Doc stands for. ⁓ and we just don't want to make loans. We want to create lifelong relationships. And those are relationships where every where today's borrower becomes tomorrow's researcher, advisor, investor, and leader. So that's how lasting communities are built. And we thank you for your friendship. For your leadership and for everything you're doing to advance medicine.
speaker-0: It's a pleasure. I'm I'm very happy to have met this group and it's ⁓ I I stay on board because I love it, not because it it not because of what you offered. It's because it's just it's easy. I don't know
speaker-1: I don't offer enough for what you're making. So like clearly clearly you're you're here for other reasons beyond Yeah. Well thank you so much, man.
speaker-0: Faction is built in. Thank you.
