299: High School Dropout to Highest Ranking Physician in the US

Session 299 This is a beautiful story of triumph, dedication, determination, hard work, and grit. Today’s episode is packed with amazing stories along with great insights and immense wisdom from someone who has gone through it all. If you’re on this medical school journey and probably thinking you can’t do it, then take some time to listen to this and be inspired! Dr. Richard Carmona served as the 17th Surgeon General of the US. After being homeless at one point, a high school dropout, and special forces medic, he found his calling for medicine. Then he worked his way up to being a Surgeon General, the highest position for any physician in the U.S. For more resources, check out all our other podcasts on the MedEd Media Network to help you along your whichever point you are in your medical school journey. [01:40] Interest in Becoming a Physician As a kid, Richard enjoyed science and learned on his own voraciously. Even in junior high school, he'd read books about anatomy and physiology. He never lost that interest even when he dropped out of high school. Raised by immigrant parents, they struggled and they were homeless. He'd describe their life as being in a survival mode almost every day. Along with that, there were a lot of distractions. On his third year in high school, he was asked to leave and then came back on his senior year, still taking freshmen and sophomore courses. He was 17 at that time. His counselors were very encouraging offering him resources. In hindsight, he thought that if worked harder at that time, he could have done it. But he didn't. So at 17, he was a drop out with no job and not much future ahead of him. So he enlisted in the army. [03:40] Enlisting in the Army Richard describes enlisting in the army as transformative. Without any tangible skills and with little knowledge of the world, he was made into a citizen and he was taught about duty, honor, country, responsibility, how to complete a mission. All those skills were so invaluable, which helped him through medical school. In fact, he believes this is what set him apart from any of his colleagues. "Having been in the military, having gone to combat, and all of the stresses associated with that - it made me a stronger person, a better person." In the army, he went to the infantry. There weren't so many jobs for kids with no experience in training so most of them were taken into the infantry. They are the guys who do the fighting. They teach you weapons and combat. He then went to jump school and became a paratrooper and volunteered for special forces. He got accepted and did pretty well in the testing so he became a pilot and chose special forces. Shortly after, he almost lost it saying he had to be a high school graduate to be in special forces. So he went to the education office, took a GED test, and so he got his high school diploma. He then completed his training in special forces for less over a year. He was a special forces medic and weapon specialist, where he got the training on top of the basic tactical training. [06:36] Being a Military Medic as His First Exposure to the Medical World Richard says being a medic in the military allowed him to gain exposure to medicine. He found it to be a humbling experience, making him see how little he knew even though he knew a lot more than people by the time he finished his training. "In the advanced provider program, which is a special operations medic, you're trained to be the doc. You're in austere environments." Being a special forces medic, you're the medical support for your teams in the most austere environments where there is no doctor or nurse. And back then, there wasn't any reliable radio communication. At 19-20 years old, he took care of gunshot wounds and indigenous forces with parasitic diseases and malaria, as well as delivered babies (twins) in rice paddies, which he did one time in the middle of a firefight. He found it to be very humbling being the only out there and you stand between a person living and dying if you haven't learned your lessons. You're the doc on the team but then you have the same responsibilities in conducting combat operations as the other team members. In the special forces team, they're all cross-trained so they can help each other out. What they had in common were being kids who had an immense responsibility to carry out missions with no supervision. As he looks back, he thinks it's scary to think what they're entrusted with. He served the military for a total of ten years until he ultimately became a Surgeon General, which is a four-year term. [10:15] Leaving Active Duty the First Time After finishing his first combat tour, he was already reconciled that he was going to make the military a career. He got promoted to being a commission officer and had a bigger responsibility. He was just going to stay in special forces and make a career. But his teammates and friends encouraged him to go to college. But he thought he wasn't really prepared for it. He recalls his high school counselors writing him letters in Vietnam, encouraging him to go to college when he comes back. In fact, one of his high school counselors contacted one of the local community colleges in New York City and found out they had an open enrollment program for Vietnam combat veterans. And even if you're a high school dropout, they'd give you a chance to matriculate for a year. So he got accepted. "I was more comfortable about going to combat than I was about going to college. I wasn't prepared." Though still young, Richard felt he was already like an old man with all the experience he had. And Vietnam was a tough time for them where most of them who were combatants were blamed for the war by the public. When really, they were just the pawns of the game and the agents of execution. They were only given orders and carried them out. Nowadays, people already understand that whether you agree or disagree with the war, the young men and women who serve are heroes no matter what because they're serving the country as what the leaders asked them to do. [13:01] Community College Experience Richard was under a reserve status and went to community college. He describes it as a humbling and sometimes embarrassing experience. He took remedial courses for almost a year. During those times, he worked various jobs being a police officer, paramedic, registered nurse, and a PA. They're basically all the skills that he learned in the military that he was able to translate to the civilian world so he could work and make a living to go to school. While he may not be the smartest, what he had was discipline. He understood he had a mission and that he had to achieve certain milestones. He knew the timeline and what resources he needed. He got up earlier than most kids. He does his personal training every day to keep himself in shape, taking night runs and doing all his exercises. He eventually applied to a number of medical schools and got into several of them. He already transferred to California to finish his college in Southern California. He did very well, being an A student and got honors. He ultimately decided to go to the University of California, San Francisco. There were 150 kids in the class, all were A students in college, and all they wanted was an A in medical school. But his goal was to become a physician so whether he graduated with 1 or 150, at the end, people are still going to call him doctor. [15:50] Fighting the Impostor Syndrome Richard says you just need to push on. He was humbled many times sitting next to people that fully understood equations and science that he was interested in but didn't have the knowledge they had so it took him a while to catch up. "My mission was to get through this, and to get through it, I need to catch up with these people. And if I could, maybe surpass them in some areas." Richard admits you'd feel unworthy at times and like you don't really belong there. But he just kept driving forward. He wasn't going to give up. So he worked as hard as he could, volunteering for every rotation that nobody wanted. He hardly took any vacations. During his free time, he'd go to a clinic and volunteer for something. He actually finished medical school in three years. He skipped his last year, graduating number one in his class. Then he started a surgical residency at the University of California. Richard explains that he had superhuman persistence, perseverance, and judgment which were all skills he learned in the military which made him look smarter than he was. "I was average intelligence but I had superhuman persistence, perseverance, and judgment, as well as the ability to focus on my mission. All skills I learned in the military." [17:45] An Immigrant Story of Perseverance and Dedication Richard talks about his family. His parents were good people. His dad had trouble expressing his love for his children. While his mom was almost like a single parent. Though married, she took the burden of raising them. There were times they had no money, became homeless, and bounced around. She'd take a job working night shift and then during the day, she'd come home and dress the kids to school. Richard has two brothers and a sister who passed away of cancer a year ago. His sister had a tough life as well as a little girl. His younger brother followed him into the army and spent 30 years in special forces. He retired as a Sergeant Major. He was also a high school dropout coming in, but came out with a college education, and spoke Russian, Arabic, Spanish, and English. At one time, he completed all of the special forces courses and became one of the special forces team leaders. His other brother chose a different path, worked hard his whole life and retired working in different businesses. Consequently, they all made it. "We all made it. But my mother's encouragement, my mother instilled in us this: the land of opportunity, don't let it go to waste, and get your education because nobody can take it away from you." All that being said, Richard credits his mom for all the encouragement and instilling in them the value of education. His mother often spoke in Spanish and English, but she spoke 5 languages which are self-taught. She knew music, arts, geopolitics, etc. She challenges them everyday with stuff they have to know to be productive in the world. She'd encourage them that they don't have to get pulled down like everybody else in the neighborhood. She told them that they can escape and their ticket to escape is getting an education. So she'd make them read and go to the library. The women in his life were the ones that drove Richard the hardest and made him appreciate that he could achieve much more than anybody in the family had ever achieved but he just had to work hard. [21:10] His Journey in Medical School Richard points out that what really drew him to become a physician can be summed up in one word - caregiver. He loves being a caregiver. He loves helping others. Whatever it was, he felt good helping people. Today, he does things on a policy level and big business where he could have an effect on the population and work with underserved communities, do things that will improve the health, safety, security of population and family. And he feels good about this. Coming into medical school, he already knew he wanted to be a trauma surgeon. He loved every rotation though so he'd have second thoughts each time. After doing a month in the psychiatric unit, he left with more questions than he learned. To him, every rotation was a gift. Each rotation was just incredible. He remembers the day they took their final exam on microbiology and parasitology in his second year of medical school and aced it. He explained it was the same final exam that he took in special forces 20 years back, where he treated malaria and a bunch of other diseases. "A lot of the things I learned in the military helped me to understand the context of what I was learning since I had gone through it reverse order. I was doing those things long before learned the in-depth science that we learn in medical school." By the time he got past his second year, he wanted to be a surgeon but he couldn't figure out how he could do everything since he loved everything he was doing. By the end of his third year, he actually didn't realize that he had already completed medical school and he had done really well. An intern had dropped out of the surgery program in the first week of July so the dean told him that the chairman of surgery wanted to talk to him and offered him the internship without having to match. He initially declined knowing he had a year of electives that he wanted to but he eventually did it to save money. So he wanted his internship during the first week of his fourth year which was all electives. He graduated After he finished his internship, he still went back and graduated with his class to be with them even if had already technically graduated the summer before. [26:50] Stop Blaming Others, You Can Get It Done! Richard shares his wisdom with those students who still continue to blame their surrounding, their friends, their parents, the system for why they can't be a physician even though they're trying. "You can go through life blaming everybody else for problems. Nobody said it was going to be easy... the only easy day was yesterday." Richard says that sitting around and blaming your parent or the environment, etc. won't get you anywhere. But figure out how to navigate that system. Figure out how to beat the system. Work a little harder. He failed many times but he kept coming back. He didn't give up. The military is what really helped him to understand how much potential he had when he didn't have confidence in himself. While his path in the military worked for him, it might not work for anybody else. But he explains there are many success stories of people who just looked beyond the headwinds of struggles and challenges. They did succeed but they stayed focused. Richard tells kids in a similar situation to his as to what is holding them back. There are scholarships available and schools. You just have to work and you may have to work harder but it can be done. You just have to put your mind to it. "You could work and you may have to work harder than somebody else but you can get it done if you put your mind to it." [28:50] Succession Planning "When you make it to the top and you take that elevator to the top, make sure you send it down for somebody else." And once you become successful, you can help others behind you and you become their role model. Richard recalls that when he was working as a registered nurse when he was in college, a lady who's the head of social work, told him that he's going to do pretty well. And she reminded him that "when you make it to the top and you take that elevator to the top, make sure you send it down for somebody else." And he never forgot this! Years later, he understood what she meant. For those who have received the benefits that a society can give, not just doctor, anything, and you come from those humble beginnings, what are you going to do to make it better for the people? Richard calls this succession planning, getting other people in there and helping them. So he does the best he can to spread the word. Richard admits he was still having the impostor syndrome in spite of all the As he's getting. But it was the focus and discipline that really got him to do all of it. "You have those doubts until the day they hand you the diploma. And even when you get the diploma and you're a doctor, it starts again when you're an intern or a resident." [33:20] His Role as a Surgeon General Richard never planned on being a surgeon general. When he got out of medicals school, he thought he was going to be an academic surgeon, finish his training. He was a general vascular surgeon sub specializing in trauma, burns, and critical care. He was going to climb the academic food chain and just do that. "Life is what happens when you're planning." Over time, he got drawn into being chief of service and head of this and that and studying the first trauma EMS system, etc. He ended up running a hospital and a health care system in a public hospital. He never planned any of those things and just opportunities that arose and people with authorities that approached him. As a professor at the university, he went back to get a Master's degree because he knew he needed more information to be competitive in these new areas he was working in. Then he was called and asked if he was willing to go back on Active Duty as the president was looking for a new surgeon general. Thinking he didn't have the pedigree, not politically connected, and didn't hang around with those people, he went ahead and did the interviews anyway thinking there was no downside. Eventually, he kept moving and got the White House and the West Wing interviewing him and he was the last guy standing and got the job. "It's an extraordinary responsibility to be the so-called top doc. You pretty much subordinate your life for those four years at that terms because there are so many things happening." As the Surgeon General, his job description is "to protect, promote, advance the health safety and security of the United States." He's the commander of the U.S. Public Health Service Commission Corps where your officers are at CDC, SAMSA, NIH, all the federal acronym agencies, state health departments, and has medical officers in embassies around the world, WHO, the Pan American Health Organization etc. Richard describes how immense the portfolio is that you're dealing with areas of prevention, preparedness, health disparities, health literacy, global health, health diplomacy. Moreover, this changes with each generation as well as the needs of the nation at the time the surgeon general comes in. "My definition of luck is the intersection of preparedness and opportunity, and recognizing opportunity when it's at your doorstep." [40:00] Breaking Up the Plague of Politics Richard imparts his wisdom to students who are starting on their journey to medicine when many people in it are trying to get out of it. Don't forget the immense opportunity and responsibility you've taken on. Don't shy away from the challenge. "It's you that has the potential to fix the system. The system is broken. It is perversely incentivized." Richard reveals the perversity of politics. In fact, in one of his presentations, he talked about the plague of politics. Often, it's one of the malignant things we face because it's about partisanship and you can't have rational discussions in these political environments. Instead of having a reasonable discussion with elected officials about the needs of the people and how to accomplish that, instead, you get to witness a fight where one party blames the other. And nothing gets done. Each party blames the other for it. Unfortunately, people don't get the representation we need, the selfless service that the public deserves. One side wants to take all and they spend more time and resources beating up the other. Richard says that the challenge before all the new young doctors coming out is how to crack that system where we can get people to represent us. Whether you like it or not, it's the political system that we have that gives authority to all of those agencies that pay our healthcare, that gives the rules and regulations for healthcare, CMS, Medicare, Medicaid - that all comes from the elected bodies that we have elected. "Let's figure out how we can crack this problem of this hyper-partisanship that creates a gridlock that doesn't allow us to use all of our faculties to the best benefit of the people." [43:55] How to Get Involved as a Premed Student Richard suggests getting involved with organizations that are there to help improve the health safety and security of the nation, like the American Medical Students Association. Many medical schools have free clinics that you can participate in. Primarily, start to learn about the political system where you live. Where is the power, where is the authority? Learn about the committees that have jurisdiction for funding programs and projects at a local, state, and federal level. "Learn how the system works so you can become part of that system and influence decisions so that they will be made in a selfless manner for the better of our society." Sadly, most elected officials are more worried about getting re-elected and keeping their party in power. Therein lies the problem. Understand those dynamics and figure out what you can do to change those dynamics so you can have a rational discussion and begin to incrementally solve the problems before us on behalf of the American people. There are always people who won't agree with you. But democracy is predicated, uncompromised and if we can do as much as we can for most people, that's about as good as we can do on democracy. But be fair and partial. Serving as a surgeon general, Richard's job was to always look through the lens of science and make decisions and recommendations based on the best science that would benefit the people of United States, and in many cases, allies that we work with. [47:00] Richard's Last Words of Wisdom for Premed Students You can do it. Do the best you can in any one of those jobs to make whatever geography, society, that you're responsible for, better. And never forget that it's an immense privilege to serve. When you get there, it's an extraordinary privilege. "It's about selfless service, subordinating one's own interest for that of the patient. You will miss birthdays, parties, and vacations sometimes. But to me, that's a privilege because you get to help another human being through maybe the most trying times of their life." And if you're working with underserved populations, often, you may be the most important person that person ever interacts with their whole life. And sometimes, all the patient needs is a hug or a handhold. Develop a patient-doctor relationship because it has therapeutic value. Again, this is a privilege of being a caregiver. So don't lose sight of it. It's never going to be easy. The only easy day was yesterday. "Every patient doesn't need a prescription, but almost every patient needs a hug or a handhold or a reassurance that you're going to help them through whatever they going through." Stay focused on your mission and work through all the variables that contribute to you being successful in that mission. You can do it! You don't have to be smart. An average person working hard can get through medical school. It's a privilege to serve. Never forget that privilege. And once you get there, you'll be humbled. You'll love what you do. But your whole life you're going to be second-guessing yourself because all medical school does is open the door for lifelong learning. "Only a few people are afforded that privilege so don't forget it and just work hard for it." Links: MedEd Media Network

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