"The Doctor's Art" is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.
While this podcast has largely featured clinicians sharing the joy they have found in medicine, in this episode -- breaking with tradition -- we speak with a physician left disenchanted by her experiences working in medicine. Our guest is Arghavan Salles, MD, PhD, a minimally invasive and bariatric surgeon who conducts research on gender equity and implicit bias in medicine. At Stanford Hospital, she advises initiatives to promote physician well-being and diversity. During the COVID-19 pandemic, her frontline experiences were featured in outlets including Newsweek, NBC, CBS, and others.
Over the course of her conversation with Henry Bair and Tyler Johnson, MD, Salles shares fiercely honest accounts about the difficulties she has faced as an immigrant, a minority, and a woman in medicine. Her stories are by turns saddening, shocking, and amusing, but ultimately inspire us to reflect on the part we can all play to create a more just and inclusive path for current and future physicians.
In this episode, you will hear about:
- 2:11 Salles' path to medicine and her regrets along the way
- 7:11 The social pressures within medicine to overlook the downsides and hardships of a medical career
- 11:02 Why Salles chose surgery as a specialty
- 14:12 How, upon accepting her first academic position, Salles found herself in an environment that did not adequately support her surgical practice and her research
- 23:03 The systemic and cultural factors that led to the lack of support she faced
- 29:57 Salles' research on gender equity in medicine
- 32:13 The challenges of life as an academic physician
- 36:47 How Salles made the decision to put herself over her career and leave her academic position
- 41:12 Why it can sometimes seem that hospitals are exploiting physicians
- 47:32 Advice on how institutions can better promote diversity, equity, and inclusion in their culture
Following is a partial transcript (note errors are possible):
Bair: To kick us off, can you share with us what first drew you to a medical career?
Salles: Well, I do not have an inspirational story, I will tell you that. I was an engineering major, biomedical engineering major, in college and for various reasons decided I didn't want to do that as a career. And then it was a very rational process of like, okay, I have taken these courses, what career pathways are available to me with these courses, you know, without having to repeat or take extra long to complete my undergraduate studies, and medicine was right there.
You know, I had all the things. So I was like, yeah, that seems good. Being a little glib about it, I mean, I did really love math and science and had done a ton of service work all through high school and college. So I thought this would be a good way to use my interest and passion for science and working with people to try to do something good.
But it's very shallow if you think about it, that rationale, and sometimes I say I'm probably one of those people who should have gotten screened out in the med school admission process, like I had not shadowed literally anyone. I had no doctors in my family. I really had no clue what it was I was signing up for, but somehow I snuck through.
Bair: Well, I mean, at what point did you realize that, yes, this was the right choice after all?
Salles: ...
Bair: Hopefully you're ...
Johnson: That qualifies as one of the top five most pregnant pauses we've ever had on the podcast. I'm not sure how you quite convey the full weight of that pause, but that was amazing. Rewind. What Henry meant to say was ....
Salles: No, I mean, I cannot say with certainty. Actually, I can probably say with certainty medicine is probably not the right place for me. But yeah, I would not say I ever had a moment when I was like, "Yes, this was the right choice, I am on the right path, everything's great." Like I never had a moment like that. In fact, I'm a person who, for better or worse, my disposition is to always be questioning and doubting. It's not particularly healthy.
But when I started medical school, I was like, "This is not what I was expecting or hoping for." You know, people who know about medical training know that the first 2 years of medical school are spent really memorizing a lot of things. And of course, those of us who get to medical school usually have quite a large capacity for memorization. So that's not the problem. It just felt like such a dumb thing to do. Like, why do I need to sit here and memorize things? I much prefer deriving formulas and understanding why and how things happen than memorizing like steps in a cycle that no one understands the rationale behind. Because like, we don't know why things happen. And so that was really frustrating to me. So I took the LSAT because I thought maybe I would couple medicine with law school. Maybe that would be a better fit for me.
Johnson: That was the moment, Henry, when she was studying for the LSAT. That's the moment she realized ...
Salles: Well, I talked to a lot of people to get advice, and the general consensus was, you know, maybe do third year with the first full clinical year that we do in traditional med schools and then decide, and if you really don't like third year, then maybe apply. So I took the LSAT; I did not apply. I went into third year -- and third year, to be honest, is like pretty fun. You learn a lot. You're constantly in a new environment and it's challenging and it's different. So, you know, a lot of it is acclimation.
And I thought, yeah, okay, like maybe one of these things would work for me. And then I ended up choosing surgery, which we can talk about that decision if you want. But anyway, I chose surgery and then most surgical residency programs, especially at academic places in this country, require or incorporate a few years of doing something else. Traditionally, it's like a basic science experience, but in the last decade or 15 years or so, people have started doing other degree programs like MBAs, MPHs, or whatever -- just other professional development experiences.
So anyway, during that time, that's when I actually got my PhD. But also during my PhD, I thought, I don't know if any of this is right for me. So I went and did an internship at a management consulting firm, ended up just doing that internship and not going on to a career in management consulting.
But I share all that to say, like I'm constantly questioning whether I am on the so-called right path for me. I know that there is no one right path, but am I doing what makes the most sense for me in my skills and my interest? And yeah, again, I'm not sure that's a good trait, but that's what I do.
For the full transcript, visit The Doctor's Art.
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