Podcast Episode 5 | Diversity in Medicine

With Dr. Narjust Duma: Co-founder of Latinas in Medicine, Assistant Professor & Thoracic Oncologist at UW Carbone Cancer Center

About the Prosperous Doc Podcast

The Prosperous Doc podcast by Spaugh Dameron Tenny highlights real-life stories from doctors and dentist to encourage and inspire listeners through discussions of professional successes and failures in addition to personal stories and financial wellness advice.

Shane Tenny, CFP® is our podcast host and Partner at SDT. He has lectured numerous times for hospitals and physician groups and, most importantly, helped hundreds of clients develop strategies to navigate through turbulent times toward their financial goals.

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Intro: 00:00 From Spaugh Dameron Tenny, it's White Coat Wellness, a show for doctors who are ready to improve their financial wellness. We know you work hard to help your patients, but you can't be at your best if you don't have your own finances in order. In White Coat Wellness, we highlight real life stories from physicians and dentists to educate, encourage, and inspire you to personal, professional, and financial wellness. Now from Spaugh Dameron Tenny, please welcome your host Shane Tenny.

Shane Tenny: 00:31 There approximately 870,000 active physicians in the United States today, and about 90% of those are white or Asian, but the trend may be shifting. Last year of the 22,000 medical school applicants that were accepted nearly 50% were from ethnic minority groups, so our topic today is diversity in medicine. We're joined by Dr. Narjust Duma. Dr Duma is a thoracic oncologist at the University of Wisconsin Carbone Cancer Center, and a Latina physician who completed medical school in the Dominican Republic.

Shane Tenny: 01:07 Dr. Duma was the 2018 Resident of the Year by the National Hispanic Medical Association, and has started a Twitter community called #LatinasInMedicine, which has grown to over 1,300 followers in just the last five or six months. I'm really excited to have this conversation today because I think I'm going to learn a lot along with you, and I will say as we dive in here that in our prep for the podcast, Dr. Duma was kind enough to say that I should refer to her by her nickname, NJ, so that's what we'll do. NJ, thanks so much. Welcome to the White Coat Wellness Podcast.

Dr. Narjust D.: 01:39 Thank you. Good morning. Thank for having us, I'm very excited to discuss this initiative with you.

Shane Tenny: 01:45 Yeah, thanks. Why don't you just start by telling me, and our listeners a little bit just about your background and your journey into medicine. I know you come from I guess a heritage of physicians.

Dr. Narjust D.: 01:56 Yes, I'm a fourth generation doctor. My great grandpa was a doctor that used to deliver babies and [inaudible 00:02:05] at the same time, if you're possible. Then my grandparents are doctors and both of my parents are surgeons. For that reason I'm the black sheep of the family because I didn't do surgery. It was expected of me to become a pediatric cardiothoracic surgeon, which didn't align with my interests. Originally from Venezuela, my father is from the Dominican Republic and my mom is Colombian. I grew up in Venezuela, and then I moved to the United States to do my clinical rotations. I met my husband, my plan wasn't to stay here my plan was to go back home, and share what I have learned in the United States. But my husband doesn't speak much Spanish, he's learning I think. So we decided to stay in the United States and I completed medical school, did some research in the middle, and then I moved to Rutgers when I was the internal medicine resident and then Mayo Clinic where I did my fellowship.

Shane Tenny: 03:06 With going to medical school early starting in the Dominican Republic and then matching for residency in Rutgers what was that transition like?

Dr. Narjust D.: 03:16 So I was very fortunate compared to all other international medical grants. I was able to do a very large number on my rotations in the United States. So I did rotations in Seattle at several hospitals, including the County Hospital, the VA. So why is there transition about cultural differences? I was more familiar with their rotations in the United States and back home. Something that I didn't found different was back home, the trainee tends to be more quiet and just follow orders. Here in the United States I found that we do have boys when we're sharing or thought process with the senior resident, or with the attendant.

Dr. Narjust D.: 03:58 So there was something different that it took me a few months because it may happen to a lot of medical students as well because you are the medical student and then you become a doctor in a matter of four weeks. So that's one of the things I found different. Something I'm very thankful as I trained in Rutgers University in New Jersey, so there was a lot of Latin patients so there was a lot of ... They have bias in my favor because they wanted to have a Spanish speaking doctor. So that made the transition easier because a lot of the hospital attenders wanted NJ because was on two Latinas in the whole class of 50. So they wanted me to be in the team because I speak Spanish. So it was good, there's also overwork, but it was good.

Shane Tenny: 04:46 And it sounds like there was I guess you said unusually favorable or helpful because you did a lot of rotations in Seattle and then you had a large population that needed your specific skillset both in medicine and with language. Were there setbacks or frustrations or things that you faced that as you made the transition or even into fellowship?

Dr. Narjust D.: 05:08 I think one of the challenges is that I didn't fit the box. I wasn't the standard medical student, I wasn't the standard resident. I'm very research oriented, and I try to apply that to my practice as well. So besides being a Latina and being proud to be a Latina, I was also very indeed into the research. So one of the frustrations was I would say no, the assistance trying to force me to be somebody I was not to get comments like, Oh you are too Latina. Okay comments, and my outfit was common because I shared this on Twitter a few months ago as I used to wear colorful outfits. I grew up in Venezuela, I went to school in the Caribbean, if you have white clothes and colorful clothes it helps with the heat.

Dr. Narjust D.: 05:58 So comments like, "Oh that's a very yellow dress." Or, "Why they're so yellow." Or, "Oh, so colorful." And I really, despite the phrase, you're too Latina because what that means being too Latina? Who there establish that standard? So that was one of the frustrations was that I didn't fit the box of being this type of resident, or this type of medical student. And that affect us I know my self esteem, and my wardrobe because I started wearing more black and only until the last few years I feel more comfortable.

Dr. Narjust D.: 06:33 And that's one of the reasons we created the community because I didn't have other Latina to say, "Hey, is this happening to you?" And then I felt that was all me. I was the one that was being too Latina and to realize I wear yellow is fine. It took a while. So I think that was one of their frustrations when you're trying to be put in a box where you don't belong, and they don't have anything to compare with because there's no, the Latino residents, or the senior Latino residents. So I think that was one of the biggest frustrations for me.

Shane Tenny: 07:09 And almost the biggest frustration. It sounds like it was just the cultural loneliness that you felt.

Dr. Narjust D.: 07:16 I think that was one of the challenges. I did have my best friend as one of my core residence. But when you have a bit large class, and you're in several hospitals, you're not like to see each other every day. So I think isolation is a problem for many Latinos in medicine. And also the challenges or role models. If you can do better if you can see somebody that has done it before you. Because there's examples and as this whole sharing experiences and learning from another people I do have a few senior Latinas in Rutgers, but as always, I wish we had more, and we're hoping to get there.

Shane Tenny: 07:59 Yeah. And since our White Coat Wellness Podcast here is built around the concept of just overall wellness, and we touch on financial wellness. I guess one of the other questions I wanted to ask you is just how you've kind of handled the financial learning curve that can be daunting for everyone going through medical school residency, transitioning into practice. What's that learning curve been like for you and as you've gotten married to someone from another culture and just continued your training?

Dr. Narjust D.: 08:27 I do have to say when you're a medical student you are expecting the check as a resident and then nobody tells you that 33% or more is going to be taken for other reasons. So I always say when you're a medical student, you are in a negative balance because you're paying to work. And then I was fortunate to have a scholarship so I didn't have any loans, but then you have higher expectations. So that first paycheck when you're a resident and then when the first paycheck comes and is significantly lower what you expected then it's important to know that you make decisions, smart financial decisions right before the paycheck. Because otherwise it would be a challenge.

Dr. Narjust D.: 09:08 I think for me, my husband is great with finances, he has a degree on it. But one of the good things about being a residence is that you're so busy that you don't have time to spend the money even if you want to. But Amazon wasn't that big when I was a resident so that's like six years ago. I think now maybe more challenging, with Prime Day and like you can order anything. So I think my recommendation to people that just become a resident in July 1st is like chill in the Amazon. There's a lot of things that you won't need and a lot of things that you won't use because you are a first year resident and you're a first year fellow.

Dr. Narjust D.: 09:53 With people that have loans I think is important to have a financial advisor because these are large sums of money that they own and there are interests, they're refinance. So I think that would be important. It is a challenge to transition from a resident to a fellow because then you're expected of making more money again, but you're just making the same money to just have more years under the belt. So if you have loans I would recommend a financial advisor. Don't buy things on Amazon that you don't need and the paycheck is going to be smaller than you thought.

Shane Tenny: 10:27 And with you coming out of fellowship, and just recently transitioning into practice at the Carbone Cancer Center, one of the things that we often talk with folks about is the transition stage. The couple of months between residency and when you start, when maybe you don't have any benefits, your paychecks, there's a gap in paychecks. How did you prepare for that or what sort of financial considerations should people be thinking of as they prepare for that transition into practice and go through kind of that desert period of resources and paychecks?

Dr. Narjust D.: 11:02 I think it's just preparing ahead of time. We save money because we know is important to take time off between your fellowship, residency, and your faculty position. This is the only time you're going to have these amount of time off. People told me I shouldn't work but here we are doing the podcast. But I think saving is important. There's also the insurance challenge which, if you do have COBRA, which will help you but it's really expensive. So I think preparing ahead of time because we all wait for this moment when you finally finish training, but there is a gap can be up to two months gap. So if you save ahead of time then you can enjoy that time off and also do some travel as you haven't been able to travel for a while. So I think preparing ahead of time is the best advice I can give anyone.

Shane Tenny: 11:56 Absolutely. Well and you mentioned two months, sometimes it can even be three or four months depending both on when you start and when your first paycheck actually comes. [inaudible 00:12:04], some places just pay monthly and so you end up even though you've started, you still have to wait another month for the paycheck to show up. So definitely planning ahead is good there. I want to talk a little bit more about the Twitter community you started with some colleagues in just a minute when we get back from this break.

Will Koster: 12:23 I'm Will Koster and on this episode White Coat Wisdom, I want to use my time to talk about credit cards. The things we tap, swipe and insert without even blinking an eye. Nowadays, everyone is obsessed with points. People fight over the check at dinner just to get the rewards. People open a new credit card each month because there's some flashy introductory offer. I'm here this week to tell you that no amount of miles, points, or rewards, is worth carrying a revolving balance on your credit card. Now I know there are a special circumstances and there are 0% offers on some cards, but the point I'm trying to make is that credit cards are a tool that can be beneficial for things like cashflow management. They're not made for points. They can be detrimental to your financial situation if not used with caution.

Will Koster: 13:12 Don't let the points drag you into a battle to make ends meet each month. It's like the ocean, my mom always taught me to have a healthy respect for the oceans power. I'm going to teach my children to have that same healthy respect for credit cards. Bottom line, stop focusing on the points and think about what you're buying before you tap, swipe and insert. For this episode's White Coat Wisdom, I'm Will Koster.

Shane Tenny: 13:39 So I know you started the Latinas in Medicine Twitter community with some friends recently, I think. Can you tell us a little bit about that and just kind of where that came about?

Dr. Narjust D.: 13:49 So the first thing is the #LatinasInMedicine wouldn't exist without Dr. Mora and Briana, which is a medical student in New York city, she's MD–PhD student. So everything started in a Friday we haven't got ... I know Dr. Mora for a while. We're will for the National Hispanic Medical Association and I connected with Briana a few months before and if I can tell you it was a Friday, I tend to do most of my social media when I'm in the elliptical, because then I can exercise and do social media at the same time. So I'm on the elliptical on a Friday afternoon and I send them a message, it's like, “This is it. We need to create a community. I'm so tired of this thing. I'll be an isolated, not knowing anybody.” And getting people direct messages about no knowing anyone about being the only Latino resident in the entire institution or being the first Latina.

Dr. Narjust D.: 14:46 So then I remember I couldn't log in my phone. So then somebody went and opened their account quick and then Dr. Mora register the hashtag. So because I'm pretty sure a lot of people have similar ideas and there's a similar group in San Diego that has a different objective that we do. And then by a matter or an hour the group was formed. Then we have several phone calls about what our goal was and how we were going to distribute the work. And in a matter of say two days we have 100 followers. And if you're new to social media, taking the first 100 followers takes a while. So we were very surprised and like a week we have 200 followers and we have polled the members to see what they will like this group to be. So what it is today is thanks to all the input for all these Latinas that are like, “Oh, we want to do a book club.”

Dr. Narjust D.: 15:44 So we have our first book club two weeks ago. And then is a virtual book club, and then we have the mini interviews where we interview Latinas that are in the different parts of medicine and then they share the stories and everything has to be shared in 280 characters. So it's great because it's precise, concise and you can read it quickly. So we are adding more things every day and we're hoping to do some webinars coming up that we can share with Latinas, so instead of like a small community and now we're creating resources, test all the Latinas to give them tools for training and after training.

Shane Tenny: 16:29 And what's been some of the feedback that you've heard? Like what has this meant to the people that have connected with you through this community?

Dr. Narjust D.: 16:36 I think for some event it has been great to see that first there's other Latinas that have completed training that we didn't die during training and that we learn to be ourselves during training. So that's one of the ... I would say the number one feedback because like, "Thank you for sharing your story. I thought I was the only one that was feeling isolated." And also sometimes people drive when they share their misery together. So the whole thing about being too Latina has been a common thing as well. So then we help Latinas how to like feel comfortable with themselves and also what to answer when you are ... How can I say, presented with this phrase about being too Latina. So we have great comebacks now and-

Shane Tenny: 17:23 Yeah. Maybe you should form like a Latina in medicine pride day and everybody wear yellow dresses on the same day around the country.

Dr. Narjust D.: 17:34 I think we are ... I cannot say too much about this, but we're going to start a campaign about what Latinas dress and what people expecting us to dress like and we're hoping that despised having a yellow dress that doesn't mean I know opposition. There's an association on insulin oncologist and insulin and scientists. So yes, we're getting there. We're getting there.

Shane Tenny: 17:58 Yep, yep. I know you've been involved in other advocacy and leadership in medicine, talk a little bit about your work there.

Dr. Narjust D.: 18:07 So our work in education is focused on diversity and inclusion and I think diversity and inclusion go together. Diversity is important because the US population is very diverse in there's several things that I want to use my example. So a Latina and a lot of Latin patients are told that they're not compliant because one of their stereotypes, but there's a lot of behind this. There can be a language barrier, why they don't take their pills. They don't understand when they have to take them. Especially do you have a translator or, do you have a few stations I believe to speak Spanish, but doesn't really. Or there is a cultural belief, or there are believe in alternative medicine.

Dr. Narjust D.: 18:53 So I think having diverse doctors will be able to understand these unspoken factors that also affect our patient's health. In addition, if you have a Latino physician and you're Latino, there are things that, [foreign language 00:19:09] that we can understand. For example, how to find a middle point between using your own remedies, but also using the standard medicine. How to negotiate with your patients. So if you have diverse doctors they will be able to provide some of that understanding that you cannot explain in the books.

Dr. Narjust D.: 19:32 When you're in general medicine you can say, “Oh, they are cultural differences.” But there's so many cultures, even within the Latin community we are so different. We're clumped in these big group but we're very different. So also the point about diversity we in medicine is that it will help the younger generation. See that yes you can be a doctor, yes you can be faculty, yes you can be a scientist. And the second part is inclusion. And this is something I make a lot of emphasis and is because diversity is inviting you to the party, inclusion is asking you to dance.

Dr. Narjust D.: 20:12 So if you are hiring diverse doctors just because you want the picture to look good, then that's also a problem. And that's called tokenism. When do you hire the Latin, the African American, or the other minority groups doctor to put it on the front page or hospital? Or to put it in a big sign and the pharmacy, but then that doctor is not given any opportunities. Or is actually being told that he or she is too Latina. So, I think a lot of my work is about, yes, we need diverse doctors, but we also we need to understand that we need to give those diverse doctors opportunities to thrive. So, the whole thing about going to the party and dancing [inaudible 00:20:58].

Shane Tenny: 20:59 Yeah, I think that's a great analogy that even helps me to kind of understand your work and your perspective on it. And as you raise the issue of inclusion being asked to dance, what have been some of the things that either you've worked on or that you see as being ways that the medical system, that hospitals, that institutions can help promote inclusion or kind of remove some of those stigmas or the barriers.

Dr. Narjust D.: 21:29 I think that one of the first thing is to invite these doctors to be at the table. As an organizations are trying to make a difference or trying to invite these doctors to editorial boards. But we are still very behind. So I think we are learning about gender differences and how to invite more women to be part of the larger societies, larger journals, we're still lacking behind about is not only about gender, it's also about racial and ethnic differences because we cannot measure every physician with the same grow ruler because their opportunities have been different. Especially for minorities, they encounter a lot of challenges right before they get into medical school and we all medical schools. So we can all expect everybody to come for a private school or go to a private college.

Shane Tenny: 22:18 So there's this angle of diversity within the health care community and beginning to spread the word that we want more than ... I think the statistics I've seen are about 4% of physicians are Latino. Maybe it's less than that or somewhere in that range, but the work of inviting more Latinos into medicine as a career and giving them the comfort and the boldness to be part of that community. But then also as you were referencing the creating an environment that better serves the Latino community when they come in for, well first of all, making them feel comfortable coming in for care and treatment, right? When there's different cultural concerns or fears or confusions and then creating an environment that is effective for providing them the care they need. Is that, am I kind of understanding what your perspective is there?

Dr. Narjust D.: 23:17 Yes. I think that's one of the most important points about diversity is that we are here to take care of patients and providing that connection with physicians is priceless. If you can trust your doctor then you would do better.

Shane Tenny: 23:34 Yeah. Yeah. And so what do you see in the time that you've been in the States and in the medical community and moving from rounding in Seattle to residency, to fellowship is the trend improving?

Dr. Narjust D.: 23:46 I think there are more efforts to invite more minorities into medicine, so I think we're getting to the part of diversity. I think we still have a lot of work in the part of inclusion and I think as we get older, I have developed these Latinas in medicine, physicians are also, we have grown and we have become stronger to this process. We're fighting together to get to that part because six years ago we were first year residents and I think the #LatinasInMedicine have help us connect to each other and also to make sure we are all one voice and I have two is not only in internal medicine, there's a great group of Latinos working in surgery because we need doctors of any type.

Dr. Narjust D.: 24:38 So I think the efforts are better than when I was an intern, but we're still lacking the inclusion. And I think we are suffering more for tokenism now that we were suffering from a few years ago in that people now know pay looks good to have a minority doctor. So I think a lot of minority doctors may be put it in the pictures now instead of six years ago. So I will say we are better or there's a lot of room for improvement.

Shane Tenny: 25:10 Yeah. And so what would you ... As we kind of get ready to wrap up here, what would be your encouragement to program directors or hospital administrators or those in leadership now that hear you talking and say, “Yeah, I want to create a more inclusive community.” What are some of the things that they should be doing? And maybe I'll ask a piggyback question of that. For those that are listening that are in the Latino community, or the Hispanic community, or the Asian, or the black community, what encouragement would you give to them based on your experience?

Dr. Narjust D.: 25:44 So to the administrators and the program directors I always say that diversity drives excellence because when you have several opinions several ways to see a problem, that problem can be solved better. In addition, we are here for our patients and our patients are different. We come from many backgrounds. So as you have to offer a patient a surgeon or a tumor and you ask to offer a medical oncologist, we will be able to afford several types of doctors.

Dr. Narjust D.: 26:13 And for all the minority students and I want to share with them that it is possible to reach your dreams, don't state work, you may find obstacles, you may find unconscious bias. We also offer unconscious bias I want them to know that they are not alone. There's a group knows that we are doing this together and if they feel like one day is a bad day, one day they have been discriminated all doors and our direct message is open, we are here to listen to them, we're here to amplify their goals and amplify their accomplishments. So in summary, yes we can do it and it would take work, but we're getting there.

Shane Tenny: 26:58 Excellent.

Will Koster: 27:03 On this episode of White Coat Achievement, we're highlighting a physician who is helping promote diversity in the medical field, specifically in the demographic of black males. Dr. Dale Okorodudu or Dr. Dale for short is a pulmonary and critical care physician at the Dallas VA Medical Center and he is the founder of Black Men in White Coats. Dr. Dale noticed a problem less black men were applying and enrolling in medical school while he was at Duke University, a study came out that showed in the year 2014 less black men applied and enrolled in medical school than in the year 1978 that's staggering.

Will Koster: 27:42 So Dr. Dale and his colleagues sat around an iPhone camera propped up on a wallet to start making videos to promote awareness of this issue. Out of that, Black Men in White Coats was born. They have a strong online presence and community. They've hosted youth summits and now there's a Kickstarter to help them fund Black Men in White Coats, Rise Up!, a documentary film that brings awareness to the lack of black men in medicine. If you're wondering, the Kickstarter reached its goal of over $100,000 raised and that's phenomenal. As always, if you know someone who wears a white coat and is achieving something noteworthy, please send us an email, we'd love to hear about it. But again, this episode of White Coat Achievement goes to Dr. Dale Okorodudu in what he's doing to change not only the perception of black men in medicine, but black men in America. Keep doing what you're doing.

Shane Tenny: 28:36 Well, NJ, Dr. Duma, thank you so much for being with us today and just starting the conversation. I would say to those listening if you want to continue the conversation with NJ, again, it's @LatinasInMedicine on Twitter. I want to thank you so much for listening to this episode of White Coat Wellness. You can stay in touch with us or other colleagues, physicians, dentists interested in wellness and financial wellness through our White Coat Wellness Facebook group, the link is on the show notes below. You can follow me on Twitter @Shane_Tenny, T-E-N-N-Y. And if you've enjoyed today's conversation, would you mind giving us a shout out and a good review on Apple iTunes or Google Play, that'd be super helpful. Make sure to subscribe, so you won't miss any of our future doctor stories. And if you have ideas, questions, suggestions for future topics or guests, you can drop me an email directly, shane@whitecoatwell.com. Thanks so much. We'll see you here next time.

Outro: 29:32 This episode of White Coat Wellness is over, but you're not alone on your journey toward financial wellness, Spaugh Dameron Tenny has been helping physicians and dentists with their financial planning for over 60 years, and we'd love to answer any questions that would be of help to you. Visit sdtplanning.com today and take your financial wellness to new levels. Once again, that's sdtplanning.com and we'll see you on the next episode of White Coat Wellness.