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Med School Minutes
Med School Minutes is where we discuss all things related to medical education. Provided by Saint James School of Medicine, this podcast tries to educate students on selecting and successfully completing a medical school. Our topics are fun and educational, and our hosts are knowledgeable and fun.
Med School Minutes
Med School Minutes- Ep. 44- Two Healthcare Systems, One Doctor’s Story with Dr. Ivan Escudero
From navigating the red tape in the U.S. to tackling patient shortages in Canada, Dr. Ivan Escudero’s journey is a crash course in healthcare extremes.
Ever wondered what it’s like balancing two systems? Dive into his story, where every decision could mean the difference between life-saving care and waiting lists. Get a unique behind-the-scenes look at the real-life struggles and triumphs that shaped his career across borders.
#HealthcareSystems #MedicalJourney #SJSM #DoctorLife #InternationalMedicine #Residency #MedSchoolMinutes #Podcast #MedSchool #MedicalPodcast
Hello and welcome to another episode of the Med School Minutes podcast, where we discuss what it takes to attend and successfully complete a medical program. This show is brought to you by St James School of Medicine. Here is your host, kaushik Guha.
Speaker 2:Welcome to another episode of Med School Minutes, where we talk about everything MD related, with a focus on international students, specifically students from the Caribbean. Today we have a very interesting guest. We're talking to Dr Ivan Escudero. Dr Escudero finished his residency in the United States and then chose to start his own clinic in Canada, so he has a very unique perspective of working in both a privatized health system in the United States as well as working in a nationalized health system in Canada. So, without further ado, let's welcome Dr Escudero. Thank you so much for making the time, dr Escudero. I really appreciate it. You know we were briefly talking about how busy our alumni get, and I know how busy you guys are and we always appreciate any time that you give us. But without further ado, I would really like you to introduce yourself and tell us a little bit about your background, sure thank you so much for having me.
Speaker 3:It's a pleasure. You know anything for St James, such a great school, and I'm happy to be here. So, about me, you know I'm an alumni from St James. I went to Anguilla in 2014. Loved every minute of it. It was great. Loved the atmosphere, the beaches, the school. It was a dream come true really studying in paradise and then having the opportunity to do clinical rotations in the United States. That was great. I I loved it.
Speaker 3:Um, spent four years with saint saint james and then I ended up matching into residency in family medicine residency uh, beautiful, detroit, michigan. Uh, very robust still, it was amazing. It was my number one choice. Um, I was so blessed to have learned from some amazing, amazing attendings, so unique. I count my lucky stars every day that I met those people, made some lifelong friends, did some research as well. I'm also Canadian, if I didn't mention that, yeah, and did some research, published a few papers, co-authored them, some research abstract. I worked in the United states briefly in a rural setting, and then now I have my own clinic in canada. Um, I'm working there. I do some hospitals work, some some er work from time to time, uh, and it's great, it's, it's awesome, and everything came full circle. And here I am awesome.
Speaker 2:So, uh, you mentioned that obviously you're Canadian. You're back in Canada now. Did you find the residency match process particularly hard for Canadian students? Because we get that a lot from our students. Oh, canadians, it's just so much harder, is it, or is it not? Or can you account for it or prepare for it so that it isn't particularly hard?
Speaker 3:um, in canada, yeah, it's, it is a little bit more difficult. I mean, there's not a lot of residency programs uh, there there's, you can count them on your fingertips. Okay, um, there's a lot more in the united states and you know there's a lot more opportunity as well. States and you know there's a lot more opportunity as well. It's. I mean, you can also say that it's a little bit more competitive in Canada because there's so few residencies, but you know it's not impossible. But in order to stand out, you know, having a great application experience and so forth, it'll make the process a little bit more smooth and a little bit easier, especially you know, with interviews and so forth.
Speaker 2:But canada is a little bit more difficult but what about, as a canadian, applying to the us? Is that harder? Is that? You know? I know it's. It's got to be harder because the us uh programs are going to make visa for you.
Speaker 3:Um, I mean, at least for me, it was pretty straightforward. Um, I, I looked for programs that offered the visa, the J one visa, um, and I got a lot of interviews. I mean they there was no issue with me being Canadian and even for some of my friends who weren't Canadian or, you know, american, they didn't have issues as well. If a residency really wants you, they'll invite you out. They'll figure a way out to sponsor you. One of my friends actually got an interview at a hospital where they don't offer any visas and they made some exception. Oh, wow, yeah, so coming from Canada, not once was it ever questioned at all. It was very straightforward.
Speaker 2:I guess they're used to it okay, yeah, yeah, you know, uh, it's funny that you say that actually, but two years ago we actually had a student, a canadian student, who had exactly the same experience, and this was a big hospital system like unc, unc. It was a University of North Carolina hospital system.
Speaker 2:And they've never accepted an international student before and they liked her so much they went ahead and did it. In fact, the program director and the CMO directly called her up and said, hey, what do we need to do to make sure that you come to us? Yeah, and I was like, wow, yeah. So it sounds like you have a very similar experience, or like have experienced the same thing. The programs are more fixated on the candidate than they are about qualifications.
Speaker 3:Exactly. I mean, even in your interview process they'll ask you some questions that are out of left field just to see you know who you are as a person, right, but you know everyone doesn are as a person, right, but you know everyone doesn't matter where you're from. You know even St James like. You're qualified and you have the credentials to do residency and succeed.
Speaker 2:Awesome. So you said after you finished your residency, you went into a rural setting. Why was that? Because you studied in or you did your residence in Detroit, which is obviously a big metro area. Why did you choose to go to a rural setting?
Speaker 3:Well, I mean, I like rural medicine. It's something that always, you know, interested me, you know, serving people in the underserved area and in a rural setting. A lot of patients, a lot of people have multi-system diseases. They're, you know, they don't really have a lot of resources available in major metro cities and I'd be able to use my skills to, you know, help those people. Most of the time I'd be acting as their specialist, because there's no specialist available, there's no endocrinologist, so I'd essentially be acting as their endocrinologist or their cardiologist to a certain extent, um and be that basically main point of contact for their care.
Speaker 3:And I was able to use also my, you know, procedural skills as well in a rural setting. Even now in Canada, when I work in some places up north, those skills that I learned in my residency and when I worked in a rural area really helped me and it's great, it's something that resonates with me. My folks live in an underserved area and since they don't have any very little access to care, you know, I wanted to contribute back. I want people similar to my parents, to, you know, have that position. That's there, you know, and with those skills as well.
Speaker 2:That's awesome. So was it a big adjustment going from Detroit, Michigan, to a rural area, from lifestyle lifestyle as well as professionally, was it a big difference?
Speaker 3:Sort of. I mean, I've lived everywhere. I've lived in the Caribbean, I've lived in major metro city. I actually came from a very, very small town it was. It wasn't like a big culture shock. But you know, settling in, uh, you know it obviously takes some time, but it wasn't something like, yeah, um, totally out of you know, out of context, it was, it was, it was good, it was okay, it was all right yeah, because one thing I have noticed, and you know we have a big system in, uh, west virginia that we work with, okay, which is largely rural.
Speaker 2:But I visited west virginia several times, I visited kentucky, rural kentucky, um, and I've been to several like even in south dakota and stuff like that. But at least in the united states the term rural is not the same definition as what you would say a rural, even in countries like, say, australia or um, I'm originally from india. Like in india, rural means no sanitation, no water, no electricity. Right in america, rural means oh yeah, you have to drive 45 minutes in the closest walmart yeah.
Speaker 3:So, um, in your experience, is canada rural and america rural, equitable or or not? Um, actually, yeah. So in terms of medical care, yeah, I mean canada, it's a lot more pronounced. There's many, many millions of canadians without a physician, a family physician I think the latest report was 2.5 million Canadians without a family physician and and a lot of the areas. There's a lot of small towns and there's not a lot of major metro cities in Canada and it's so spaced out so it's it's pretty emphasized. I'd say it's you's a lot more pronounced in Canada than the United States and similar issues with distant facilities where to get certain types of procedures done, certain testing done. I think it's kind of the same in the States and Canada.
Speaker 1:But it's way more pronounced in.
Speaker 3:Canada, In my opinion at least.
Speaker 2:So I mean you are particularly unique because you obviously studied and worked in the US system, but then you chose and now you have your own practice in Canada. What was the process like? And obviously you were originally from Canada and it seems like you wanted to get closer back to home, closer to your parents. What were the other than these? Were there any other major driving forces? Are pace scales the same in usa and canada? What was the driving force for you to actually move back to canada?
Speaker 3:because we honestly, we don't really see a lot of uh, our alumni, canadian alumni, go back as soon as you did so I mean, you know, I, I, I was dead set on the united states, you know, and the united states provided me with that opportunity to live the american dream um it's something that I I I dreamt about ever since I was younger, you know, like fulfilling that, that dream, getting the opportunity to to work in the united states.
Speaker 3:You always hear about the opportunity and everything, and even with the pay right. Um, there were some changes in in circumstance, that you know. I can't really get into too much detail with, uh, you know, my former employer, um, you know, contractual right, of course issues.
Speaker 3:And then, um, you know, coming being a Canadian citizen, that that's where my home is, that's that's'm from, that's where I was raised. And you know, I said, well, I'm gonna be working in canada. Um, I, I took the leap, went back to canada and went through the process of getting my licensure, my certification and then I said you know what?
Speaker 3:I've always dreamt of having my own clinic one day, whether it's in the united states or whether it's in Canada. And now that I'm back in Canada, I took that opportunity and said let me, let me go ahead with this. And you know, I also maintain my, my license as well in the States. But OK, yeah, it's kind of a unique feature. Got to train in the United States, had that opportunity, and now I'm back in Canada my whole country.
Speaker 2:That's awesome. So you said that you had to go through the paperwork. Was the paperwork process easy? Is there a lot of reciprocity with Canada and USA?
Speaker 3:Canada has gone a lot better in terms of having physicians return back to Canada if they trained in the United States or if they trained abroad. It's a better process now, um, it's, it takes a long time, um, but the paperwork it's pretty straightforward and, depending on which province you plan on working in Canada, the colleges are very, very friendly. They're very nicer. They can answer all your questions. Very friendly, they're very nicer. They can answer all your questions. I've I've called the, the ontario college, several times to figure out everything else that I need to, and they're so friendly. They said, yeah, just do this and this, okay, and it's very, very straightforward okay, so it's not like a crazy complicated process like I've heard.
Speaker 2:Uh, especially in countries like, say, for example, india, nobody really knows what's happening. There's no clear answer.
Speaker 3:Well, they use the ECFMG to validate your credentials and your residency. So you know my residency is amazing and they communicated that to the ECFMG and it was very straightforward. I mean, my residency program, they're excellent. Everyone there is on top of their game From other places, I mean, I really don't know, so maybe kind of delayed. You know, translated and so forth, so it really really depends. But for me at least it was pretty smooth and anyone else who does a residency in the United States it should be pretty straightforward.
Speaker 2:So you mentioned that Canada is open to foreign physicians who are trained abroad not just the United States and I know that Canada has a massive dearth of physicians across the board and Canada doesn't have the number of applicants that say America has with its 350 million population. Can you tell me a little bit more? Do you think and I know that you don't have first-hand experience of not being trained in the US, but if somebody were to train in somewhere like the Caribbean or Europe, what is the process for them? Is that? Do you know if it's any different, or is it easier, is it harder?
Speaker 3:From what I know, that Canada, you know, they consider the training equivalent in certain countries, not all countries. Okay, it's the uk, um, australia, um, the united states, I think singapore and I think hawk, I think, I believe, I'm not too sure and obviously, if you train in canada, right, um, but uh, they consider it equivalent. I know that there's a few physicians from the uk who are from the canada and it's it's clear to quibble with the training From other countries. It doesn't mean that they cannot come back to Canada. I think there's a separate route that they have to do, like a study, assessment or something. I'm not familiar with that, since I didn't go naturally, naturally.
Speaker 2:Naturally. So now comes the most interesting question, to me at least, and that is USA is a commercialized, privatized health care system with it. Canada is a nationalized health care system that kind of follows the pathway of the uk with the, with their national health services, nhs and whatnot. Really, you've worked in both and not just work, you actually own a business in canada, a clinic in canada. Can you tell us from your experience, what do you think, from personal experiences, what systems? What were the pros of an american system and what were the pros of the canadian system? Let's start with pros and then we can get into cons.
Speaker 3:Right. Right, I mean like my clinic technically, you know I run it and so forth, but you know I have one of my partners manages everything, so it's technically under their umbrella. But yeah, in the United States, I mean, having your own clinic is essentially like a thing of the past because it's really dictated by insurance companies and the reimbursement as a solo practitioner is extremely difficult now. That's why it's a lot of hospital systems. Our physicians work under or with a very big group of physicians systems. Our physicians work under or with a very big group of physicians. Um, a lot of docs are at the mercy of, you know, the insurance companies, so forth, and it's it can be very tired, it can be very cumbersome with the paperwork and the history of tasks as well. Um, you know you can get burnt pretty quickly, but it it's, it's good lif. Well, depending on where you work and the model that you work at.
Speaker 3:In Canada, a lot of the physicians there it's through the government and the government is the one that deals with the payment and so forth and reimburses the physicians or organizations. It is totally different and the pay scale as well varies. You can get paid very, very little or a lot, and it's socialized as well and it's dictated by the government, but there's not that much red tape as opposed to the United States. Yeah, in terms of billing and so so forth, right, and especially with diagnoses. I know that in my residency training, like my residency training, like I, I have nothing but high regard for my training and I learned about billing and this was in the United States and having certain diagnoses were very important. Like you want to say hey, like uh, for example, like acute on chronic kidney disease secondary to uncontrolled diabetes mellitus, dk. In canada it's not really emphasized, but when diagnoses, so it can be a little bit different, but you know the the underserved population is is kind of the same in both settings. Hopefully that answers that question.
Speaker 2:No, I think it does. I think this was a real eye opener, because you said that the US system has a lot more red tape. Usually, that is something that people do not associate with the privatized system, right for more of like the insurance companies in irrespective.
Speaker 3:Yeah, like I I, for example, I have. I prescribed insulin. It was simple insulin, nph for one of my patients and I needed to do a prior and that was a mind blow for me. That patient needs that and it's like what's the purpose of this, you know, whereas in Canada that's not really, there are some things with insurance companies, but not as emphasized as it is in the United States.
Speaker 2:Okay, interesting, because one of the biggest arguments that a lot of you know this is a political debate as a nationalized health care system versus privatized. In the united states at least, they keep talking about how uh are are because of the privatization there's price gouging, all these negative things that happen, and but one of the big things that people actually mention about the benefits of privatized healthcare is that it is efficient and there's no red tape. But here, as a practitioner, you're saying it's actually the opposite. Because of all these oligarchy players that are controlling the system, you end up doing more red tape, though it's not necessarily mandated by the government.
Speaker 3:Exactly. I mean, and the thing is it's something a lot of people don't realize that you know, insurance companies really dictate how physicians should practice, which that should never be the case. That you know. I can prescribe you a medication. That is perfectly what you learn in medical school, what you learn in residency. Insurance company says, no, we're not going to cover that at all. And then you have a patient who cannot afford anything else and it's like this is I'm now my hands are tied, essentially right, and with that privatization, many, many patients are able to, you know, see specialists or see other physicians or nurse practitioners or PA, and they have the freedom to do so. Right, whereas in Canada, you know, in order to see a specialist, you have to see your family physician first. And you know, if I prescribe a medication, the government I mean some medications are covered, but it's not like they say, hey, this is rejected, you need to do a prior off, unless it's like private insurance.
Speaker 2:But, um, yeah, it's kind of like those, those little nuances, those, wow yeah, and and from from a time standpoint for a physician, by your estimate how much, beyond hiring like if you're a small clinic that you own in the United States beyond hiring a specialist who's going to code all of these things for you how much time do you think that this takes up for the physician in the United States?
Speaker 3:I think you know, if it's an independent physician, it forever. And that's why you know having a clinic of your own is almost a thing of the past. That's why a lot of employers now would have billers, coders, so they take care of all that and kind of alleviate a lot of that administrative burden on the physician. Um, you know, but you're essentially at the mercy of their policies, want, um, but I mean it, it varies. It varies depending if you work for. You know certain, you know fqhc, for example, another big hospital system. It it kind of varies okay so.
Speaker 2:But does that mean that in canada you can go ahead and say you have two, two doctors, two physicians, very good physicians, they can start a clinic.
Speaker 3:But it sounds like in the USA that can't be, that two physicians just cannot start a clinic months and even the reimbursement is very, um, okay, so a lot of physicians, there's no financial incentive to do so. Okay, that's pretty limited, whereas the, whereas canada doesn't have that. It's, everyone is covered regardless.
Speaker 2:Um, and they were depending on the, on the code that use a billing code, you get reimbursed out of money okay, yeah, wow, yeah, um, in the us is there, would there be a situation where a patient essentially gets a treatment because, say, for an emergency situation, the insurance doesn't really cover it and then the patient can't really pay, but then at that point the clinic or the hospital system or the physician ends up putting the bill. Is that a likely scenario in the united states?
Speaker 3:sometimes it does happen, it does okay, um, you know it it's. It happens more often than you think okay so, yeah, that's, that's not something totally foreign, but yeah, yeah, it does happen. Okay, and there's sometimes I mean, for example, this is a classic example of medicare um, like a decubitus ulcer that it may happen that occurs while the patient is admitted in a hospital. Medicare will not pay for that patient's visit. Wow, it will cost the hospital a lot of money.
Speaker 2:Wow. So are these scenarios likely in Canada at all, where the hospital system or the clinic or the physician they're out of pocket, trying to care for a patient essentially?
Speaker 3:Yeah, there are a lot of social issues in Canada as well. You know, it's not a one size fits all. It really depends, you know. I know that Canada is trying to improve on that and implementing a lot of social services, but sometimes there's not a lot of resources, especially in the rural areas, so it's kind of a shame. But yeah, sometimes hospitals have to eat the cost for a lot of things. It's not available.
Speaker 2:Right. So one great thing anytime this debate comes up about which healthcare system is better Canada or USA, or privatized versus nationalized and one of the examples that they keep saying is that, oh, there are no practitioners to really do processes that are not necessarily required. And now, by the Canadian health system standards, a required process may it's not just plastic surgery or to make yourself look good, something that doesn't necessarily kill you. So, for example, you know, I know a particular person who's had a very open hernia and apparently in Canada this would be considered to be an elective procedure because they can survive by having somebody come and change the dressing twice a day through a third-party nursing practice or whatever. But the quality of life was such a dramatic change when you have to change your dressing twice a day from a professional versus if the wound is completely healed and cured and whatnot, and it's done through surgery.
Speaker 2:So I was told that in Canada a procedure like that would not even pass muster and would not. You would be on a wait list and this could be years before anything gets taken care of, Whereas in the United States, as long as you had insurance, you just shopped around for a surgeon within about a week, week and a half, everything was taken care of. Is this a real scenario? I mean, I've I've heard this in political debates, talked about this a lot. I've you know, and this particular incident was a real situation that I experienced. Or like a foreign year and dear one.
Speaker 3:Um, is this a likely scenario, or from your experience, or um, honestly, it hasn't been too too long since I've been practicing back in canada for me to say, god, like 100, without a doubt. But. But I've seen instances that were kind of like very important. Okay, um, you know, need and sometimes, um, some specialists depending who can flat out reject the referral, um, so, yeah, it's possible. Um, but you know, I I think the canadian system is phenomenal, it amazing. It not only gave me an opportunity, but there may be some flaws, yes, but I think Canada is striving to improve that every single day and every single physician that works there does everything possible for their patient and is fully capable of helping them. But, yeah, I think some of those scenarios with that, if it's surgical, that's more of like the surgery realm to deal with, but yeah, sometimes in the family medicine clinic, it's kind of like all right, let's take this approach, let's go down this avenue to find what we can do, okay, yeah, that's very interesting.
Speaker 2:So there is some truth to this thing that because you know, recently I visited the United Kingdom and met a friend of mine and he was saying he and his wife haven't been. They've been on a wait list to see a general practitioner for their annual checkups. They're healthy, young, relatively young, healthy people and they said that they haven't been able to see a general practitioner in three years. Um, in the uk this is um, and I was like, yeah, that's never going to happen in the us, because us it's the other way around, where the general practitioners are.
Speaker 2:Literally the systems are sending you messages, emails, text messages like that any which way you can to come in for your annual checkup, and I, and I really appreciate that, to be honest, yeah, um, and whereas my buddy in the uk was saying that that's not, that's not how and he lives in a more rural area. He doesn't live in london. Yeah, um, he lives in a more rural, uh village near portsmouth and he's like it's been three years. There's just no physician physician comes. They have a clinic here and that clinic has not had, uh, an actual permanent physician for a very, very long time.
Speaker 3:Yeah, I mean, um, my, my office manager would, uh, would tell me, hey, this uh patient here has been looking for a family doc for five, wow, and I would have patients who would come in and say thank God, you are here, do not leave. I've been looking for three, four years or my only family physician either passed away or retired and we have no doctor whatsoever. Okay, and and yeah, like many, many patients are very grateful for that, and you know that. That that's why I got into medicine, you know like like it's.
Speaker 3:It's not about the money. For me it is not. And you know, one could argue that you get, you get paid like very well in the united states, right, but for me it's about delivering care to patients. I love my patients. I have this very good patient physician relationship with every single one of my patients and they matter a lot to me and I take that time and effort.
Speaker 3:That's why I got into family medicine, because because these people need care, they need they do not have anything. Some of them don't even have voices and for, like, figuratively speaking, and now I can act as an extension of their family, to be a voice for them when they don't have a voice, and when I do, uh, some locum up north, like it's my opportunity to give back to them, to help them out. That's why I got into medicine and it it's, it's something I cherish every single day. So when I hear patients say please don't leave, like that resonates with me. Oh, like, like it means a lot, like thank god it's been five years, yep, don't worry, you're in good hands, I'm gonna take good care of you.
Speaker 2:That's awesome. Um you mentioned that uh physicians in in uh us don't make as much money as physicians in canada no, no, sorry, I meant to say in the us, they, they would make, they would make a lot oh, okay, okay, like, right like a significant, much more.
Speaker 3:But you know, in Canada it depends on the model in which physicians, you know, work For me because I'm a solo practitioner and so forth. Coming back, you know, I'm focused more on delivering high quality care and whatnot and I'm not after the money, Right. And I love teaching as well, Right. So you know, teaching medical students and having them with me and all that that means a lot more to me. Awesome, yeah.
Speaker 2:So one thing is so. I mentioned right in the beginning of the podcast we haven't had that many students from Canada who finished their residencies in the United States like yourself, right. Very few of them have gone back and every time I've spoken to them they've always mentioned that the salaries just in Canada don't equate to salaries in the US. So the very fact that you went back clearly shows your passion for the subject.
Speaker 3:Yeah, I mean, it fits my personality so well. Yeah, and the states like I mean, with the privatization you can make a lot, a lot of money, and that's a family physician. You can right make more than some specialists.
Speaker 2:Yes, in canada, no not even close, but kudos to you. For me, you know, I mean literally doing what doctors were meant to do, yeah, helping people. That is really amazing, absolutely. And I know you mentioned that you like training, teaching students. I know you are going back to St Vincent later this year, in a couple of months, a couple of weeks actually, yeah, and we're hoping that you get to interact with some of the students and inspire them with this amazing story. But why don't you tell us a little bit about your time in St Vincent? You're from Anguilla, you about your time in St Vincent. You're from Anguilla, you weren't actually in St Vincent, but what it means, like going back to St James and to see the development of St James in a different island. I know we're a 25-year-old school and you're a part of our rich history.
Speaker 3:Yeah, I mean, going in Anguilla was wonderful, it was incredible. I miss it every single day, just being in shorts and flip-flops going to lectures and just that one-on-one with the professors. I wouldn't change it. For the rest, if I could do it all over again, I definitely would do it.
Speaker 2:St Vincent, I'm looking forward to it and, yeah, I'm looking forward to seeing students and, you know, hopefully, you know, encourage them to really follow their dream, you know, and perhaps maybe they get into family medicine as well, and you know, and you know, and we need practitioners like you who truly, you know, are passionate about the subject, to talk to these students, because one thing that I've noticed with a lot of the newer classes, that we've seen a lot of the older classes they genuinely get in because they're passionate about the subject. Passionate about the subject because I'm going to be very honest, there's no other profession in this planet where you have to work or study as hard not study as hard as you have to do in medicine. Absolutely, um, and the amount of time, commitment and effort that goes into becoming a physician, at least in the united states, it's unparalleled there. There's no other country in the world or no other profession in the world where you'd have to put that kind of time commitment in order to do this Is it.
Speaker 2:However, what we're beginning to see is that and I think that this is kind of an offshoot, I mean we're going on a little bit of a tangent here, but.
Speaker 2:I have to rant a little bit, and I think social media has a huge role to play, because people started talking about their salaries and income, and when you take a physician who's been practicing for 10 years, the income that they're going to make it's unparalleled that in almost any other profession they're not making that kind of money. Now, the issue is that, no, the social media conveniently cuts out the fact that this person probably spent anywhere between 10 to 16 years. Uh, just being able to lay the groundwork. To have to start from ground zero, yep, and then they work for 10 years. So those are some of the things that are omitted.
Speaker 2:So what we're beginning to see is a lot of students coming in that are entirely focused on the paycheck and having a personality like you, who is truly in it for the passion. I mean, we have a ton of alumni who are very similar to you, but you being able to address the students would make a world of difference to them. Yeah, that you know, because you had all these choices, but despite that, you chose to literally give back to community. Mm-hmm.
Speaker 3:It's yeah, it's honestly it sounds cliche, but you know I love being part of the community. That's how I was raised, you know, very family oriented, very, very tight knit, and I grew up in a small community and you know that's my personality and you know, telling any student chasing after the money, you'll never be happy, because it can go like that in a heartbeat. And I've seen people where it happened, you know, and even in my residency training, right Like the, my associate program director, my program director. They were so inspirational, they were incredible. The faculty and their dedication to the underserved area was unparalleled. It was amazing.
Speaker 3:So I was able to see that firsthand and I'm like you know what, thank God I'm in this program. Amazing, so I was able to see that firsthand. And I'm like you know what, thank god I'm in this program, thank god that I got to see this firsthand right? Um, you know, at the end of the day you'll be getting a good salary in the united states, for sure, but if you chase after money, you won't be happy. You won't be happy and it'll just be a rabbit hole that you're gonna go into. And you know, once that's all gone, you should have something that'll make you feel fulfilled. That's why I love teaching, that's why I love giving back to the community, because that that gives me it's, it's like my vice. It really is right, right so well, I trust me.
Speaker 2:If I had vices that are that good, I mean, my wife would be very proud of me.
Speaker 3:I can tell you that yeah but it's funny you mentioned like social media does have an influence. Like, oh, a day in the life, like a dermatologist, like that, like that's cool, that's awesome. For me, with family medicine, I don't know what I'd see next, and that's why I like variety as well. And yeah, no matter where you work in the States, like employers will give you a very good contract, right. So it varies, but you know, the whole point of studying medicine is to help people.
Speaker 2:Yeah, yeah. I would even argue that somebody who is not passionate about the subject, which is what we're seeing more and more of people, would be like oh, I saw this tv show and this looked great and I want to join it, but what you see in a tv show is number one, an embellishment, any, every tv show yeah yep, yep, um.
Speaker 2:But number two is that what you're seeing on the tv show is probably after 10 to 16 years of work that an individual physician would have to put into, even be yes, recording at that level. Yes, you know absolutely, and these are things that that, like Grey's Anatomy, doesn't talk about this that, oh, hey, yeah, by the way, this person went through three board exams and how many state board licensing tests and how many failures and how many broken relationships and how many all-nighters.
Speaker 2:Nobody talks about all that, right, exactly. And that's when you have these youngsters come in, because even med school is not easy. Um, especially in a program like, uh, st james, it's an accelerated program, it's tougher, it's harder, um, these are all things that students completely tend to ignore. And then when the going gets tough, you know the people who aren't cut out for it are just dropping off like flies of that pond. They were like whoa, this is not what I signed up for. This did not nothing like what I saw on tv, or this is not nothing like what I saw on tiktok exactly, and like residency too.
Speaker 3:like you know, residency is hard, it is extremely hard. So I think you know expecting everything to be, you know, on a silver platter no, that doesn't happen. There are countless nights where I didn't get sleep and whatnot, but you know, I was hungry for it, I was passionate about it, right, and I wanted that me and my friends, my colleagues but I was able to de-stress as well. But there's a lot that you have to go through in order to reach that level, right, right?
Speaker 2:right? Well, I mean Dr Escudero. Thank you so much for your time, but before we leave I do have one final question for you. Sure, so for students who are already in our program, say hypothetically, when you go in a couple of weeks you're going to meet a couple of them and usually when I ask, hey, what do you want to be, it's usually always something ultra sexy, like the most common answer is cardiothoracic surgery. Because I don't know, maybe it just rolls off the tongue better I who knows what it is. But incoming class md1, we always ask, okay, what, what would you want to be? And the hands go up and it's always cardiothoracic surgeon. I don't know why, but these are obviously students who are thinking about the end result and not all the work that has to go in. What advice would you have for the students coming in to an MD1 program now?
Speaker 3:I'd say take it step by step. I mean, every single physician, whether it's a cardiothoracic surgeon to pediatrician, cardiothoracic surgeon to pediatrician, have has to learn this um, but don't go chasing after the final result. Take everything step by step, day by day. Absorb this information, learn, ask questions, ask why, and then, when you do your rotations, you'll be be able to, you know, get a better glimpse of that. But going in an MD one, take it day by day, one day at a time. You know, give it your all every single day and everything. There's light at the end of the tunnel. Every day it's a new chapter, it's a new blessing. You know.
Speaker 3:So, learn about, you know astrology, learn about the biochemistry, and that eventually, time's going to pass by and you're going to start learning about the pharmacology and you're going to start learning about the physical examination. Everything's going to come into place right. And then now you'll start saying, maybe I start want to do this. If you don't want to do that, take it every single day, one step at a time, and don't look at the end, because you'll miss the enjoyment, literally. You'll enjoy it too. Go to the beach, go enjoy, sometimes, relax, spend time with friends. But just take every single day, step by step, and get tons of sleep as much as you can, because once you start residency, you won't get sleep. Oh wow does.
Speaker 2:Does that ever get any better? Because I heard for surgeons they're like yeah, we're lifelong residents yeah, yeah, for I mean does that get better for like you?
Speaker 3:guys. Eventually attending life is very, very, um. Okay, you know you can set your schedule to a certain extent, but, um yeah, family medicine, I'd say, has a lot more work-life balance and you can, you can do everything. But you know, for those incoming md1 students, take it day by day awesome well.
Speaker 2:Thank you so much for your time, dr. We're so excited to have you on the island and I know, uh, we're actually creating some buzz around you and you your visit, so it's some of our students, so you will have one full day if you want. That is, to address the students and talk to them and meet them. Yeah, we're also organizing a health fair when you're going to be there, so you might have, uh, exposure to the local population. I know you've done this in anguilla when you were there, yes, so now you're going to do this in St Vincent and I think you're going to be meeting a lot of our board members and stuff like that.
Speaker 1:Absolutely.
Speaker 2:But thank you so much for your time. Thank you as always. We really appreciate it. I know you've helped us so much in the past with open houses and student referrals and things like that.
Speaker 3:We really appreciate it a lot, absolutely. Thank you for having me, and you know St James, you know, has always been there helping achieve my dream, so it's the least I can do.
Speaker 2:Thank you so much, dr Escudero. It really was eye opening to learn about the differences in a privatized and a nationalized health system and how you, operating in both those systems, really worked for you. But thank you so much for giving us those insights. We really appreciate it. And thank you so much for your passion and all that you're doing for the Canadian community at large. But again, if you like the contents of this podcast, please follow us on any of the platforms where you prefer to get your podcast from, be it spotify, google, apple, you name it. And don't forget to like and follow and download as many episodes as you like. But but one thing always remember there is no shortcut to becoming an MD.
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