Featured Guests:

Shanu Agarwal, MD
Dr. Agarwal joined Summa in 2006 as an infectious disease staff physician and also currently serves as the chair of Infection Control. She has been instrumental in the growth of our infectious disease capabilities and, in collaboration with her many colleagues, has played a vital role in our ongoing response to the COVID – 19 pandemic. Dr. Agarwal became the Chief Medical Officer, Summa Health Medical Group in 2022. She will serve as a member of the medical group leadership team and will be responsible for providing medical oversight, expertise and guidance to ensure the highest standards of quality and service are maintained in support of our vision for population health. In addition to her work at Summa, Dr. Agarwal currently serves on the Alumni Board for Northeast Ohio Medical University (NEOMED) and the board of the Association of Indian Physicians of Northeast Ohio. She also is a clinical professor of Internal Medicine for NEOMED and has received numerous awards and appointments. Dr. Agarwal holds a B.S. from Kent State University as part of the B.S./M.D. Program in conjunction with NEOMED, and an M.D. from NEOMED. She completed her residency in Internal Medicine and fellowship in Infectious Disease at the Henry Ford Health System in Detroit.

 
Kortnie Broschinsky, M.D:
I grew up in a military family, my dad just retired after 30 years in the Marine Corps. I've lived in Virginia, Hawai'i, Japan, Maryland, California, Utah, and now Ohio. I went to high school in Maryland, and moved to Salt Lake City for college. I received my BS in chemistry from the University of Utah (Go Utes) and graduated in 2015, and then went to medical school at the University of Utah and graduated in 2020. During college I worked as a physical therapy aide and at a cookie shop (RubySnap, best job ever). My gap year between undergrad and medical school was spent re-applying to med school and teaching high school chemistry at a local private high school (Rowland Hall-St. Mark's) in Salt Lake City. My husband works from home full time since COVID and moved out to Ohio with me when we started residency in July 2020.

Transcription:

Scott Webb: In honor of National Doctor's Day 2022, I'm joined today by Chief Medical Officer of the Summa Health Medical Group and infectious disease specialist, Dr. Shanu Agarwal. And I'm also joined by Dr. Kortnie Broschinsky, she's a Summa Health resident. And they're both going to share their stories, their experiences working at Summa, and what excites them most about the future of medicine.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So it's really great to have you both on, we're going to learn more about each of you today, what you do, how long you've been doing it, what brought you to medicine and So on. And as we get rolling here, I'll start with you, Dr. Agarwal, why'd you become a doctor and how long have you been practicing?

Dr. Shanu Agarwal: The answer to the question why did I become a doctor I think has changed over the years. Back when I was, you know, 18, 19 and trying to look at what I wanted to do as a career, I wanted a career where I definitely had a lot of interaction with colleagues that I can constantly have that communication. And I've always been one who's been very helpful to other people. I've always cared for like my grandparents when they would visit from India. So I think in the back of my mind, I felt that I wanted to sort of incorporate that into a career. I did have family members that were also physicians. And so I think that, you know, that was kind of a stepping stone into me pursuing medicine as a career.

And so I have to say, when I was 18, 19, 20, probably 21, as I was going further into my medical school career, those were continuing to be the reasons. As I became a resident and then an attending, you know, I think it's evolved into not only some of those initial reasons why I went into medicine, but really, I think what I love the most about it is that it's unpredictable in a good way, that I can go to work every day and it's not just going through the motions from a certain time to a certain time. It's that I just don't know what I'm going to expect. So there's always something that challenges me mentally, just to have a new case or a new situation that may require me to read more and further my skills.

In the last three or four years, what I've realized is that, you know, even though you pick a certain field of medicine, there's always a lot of options to branch from that and use that as an experience to pursue other further things within your career, and I can get into those later. My whole reasoning has evolved over the last so many years. I've been with Summa Health Medical Group for 16 years. I started in 2006. So I'm going on my 16th year, but if you include my years of training, I've been a physician for 22 years.

Scott Webb: It's really great to learn more about you and really a fun conversation today, having a more experienced veteran doctor on and someone's who just kind of getting started, Dr. Broschinsky. So let's move over to you and kind of contrast what we've heard from Dr. Agarwal. What made you decide to become a doctor? Why did you choose the Summa Health Residency Program and so on?

Dr. Kortnie Broschinsky: Yeah. I had a bit of a more circuitous route to medicine, I think. I took a little bit longer to finish my undergrad. And part of the reason was I wasn't quite sure what I wanted to do once I graduated. I had a mentor. I was working in his research lab and I was working in particular with an MD-PhD student who really encouraged me over the four or five years that I was there to really consider medicine. And he sat me down one day and he said, "Kortnie, your personality is better suited for you to be a physician rather than a physical therapist." And I thought about that for a while and decided that he was right. I wanted to be more of a leader on the healthcare team, and be able to make more decisions and be at the head of somebody's treatment plan. And so that's how I found myself applying to medical school. But it took a little bit of time to kind of get there.

And then I guess the lessons that I've learned, kind of going through applying and going through medical school, what kind of drew me to my field as an orthopedic surgery resident, I knew I wanted to have a hands-on kind of job somewhere where I could be intellectually stimulated every day. I feel like every patient in every situation, there's a little bit of nuance and there's something to learn. Even if it's the same general kind of injury, there's always something a little bit different that you need to tailor to each individual patient.

Scott Webb: Yeah. And I'm wondering, you know, most of us have watched television, many of us watched ER and other programs like that. Going off script a little bit here, how accurate is that depiction of life as a resident in hospitals, you know, that has been portrayed on television? How accurate is that?

Dr. Kortnie Broschinsky: I would say it's dramatize, of course. It needs to be entertaining. There are some strands of truth. It's tough to be a resident. It's hard to be a trainee. What I think they really hit on is interpersonal relationships inside and outside of the hospital, and sometimes that can be really tough. Whether that's your friends, your family, your partner, to kind of maintain those relationships, and sometimes they don't always last and everybody has to make choices at the end of the day what's right for them, what's more important for them and how they balance their lives in and out of the hospital.

What I come back to a lot of the times is Brené Brown gave a great talk and she says, you know, with everything that you have going on, people often ask how I do it all. And she talks about how she's always juggling. And she says, "The important thing is I dropped the ball all the time, but the question is whether those balls are made of plastic or whether they're made of glass." And that answer is different for everybody. And you really just have to decide for yourself what your priorities are and what's important to you, and that's different for everybody.

Scott Webb: Yeah, I'm sure it is. And is there something specific you can tell us about the Summa Health Residency Program? You know, what really drew you to that program in particular?

Dr. Kortnie Broschinsky: When I was looking for residency programs, the big question you ask in the field of orthopedic surgery, the big one you ask is, do I want to go to a more academic program? Or do I want to go to a more community-based program? And I have a military commitment after residency. And so I knew I wanted a more community-based program to kind of mirror more of what my practice is going to be like when I graduate. And that's one of the things that drew me to the Summa Residency Program. The other thing was their interview process was pretty unique. Typically, interviews are done with batches of applicants and the way Summa did their interview process was they had an individual applicant come each day to really immerse themselves in the program and see what Summa had to offer. And I really appreciated that. I felt like somebody that they were genuinely interested in instead of one of 10 or 20 or even 30 applicants for that particular interview day.

Scott Webb: Yeah, I can see why that would be appealing. And Dr. Agarwal, why'd you choose to work and stay at Summa? You mentioned how long you've been there and, you know, Dr. Broschinsky is saying what drew her to the Summa Health Residency program. But as an employee, as somebody who's been there a long time, you know, who's been at this community-based hospital and this experience, maybe you can share that with listeners.

Dr. Shanu Agarwal: I would say at Summa Health, you know, the environment itself makes it so attractive for their providers and staff to stay here. Throughout the 16 years that I've been here, it's always been a very collaborative approach on treating patients. And, you know, whether you're in my specialty, which is infectious disease or your critical care or surgery, or what not, I feel as though when we take care of patients, we all collaborate so well. There could be disagreements on how we manage and treat patients, but it's always done in a very professional and friendly sort of way. You're more discussing the case versus someone trying to one up the other provider. I experienced a little bit of it within my residency, which was at a different institution where it was, you know, a tertiary care center and there's really that lack of communication. You really just write notes in the chart and you kind of move on. So I really liked that collaborative approach that I see at Summa.

Also, the colleagues that I have now were hired pretty much at the same time. And we've just been not only good friends, but the work environment, I mean, you've got to be able to come to work and enjoy those that you're working with. And I think that makes a big difference, especially during COVID. I spent so much time at the hospital that this was like my second family and you need to be happy where you are, where you work.

And then the other thing I would say is throughout the years, I felt like if there were any sort of visions I had for my office of where I wanted to build, I ended up building like a travel clinic for our travelers to make sure they got preventative health and vaccines. I had no pushback. I think that anytime you have a vision that it's only, you know, to better serve our patients, Summa has been very supportive of that. And they're also very supportive of their providers and staff wanting to pursue other areas within their career and they've always been supportive and very supportive on education for medical students and residents. So if you want to start a new course or do something, I've never had any pushback from that aspect. So I think they really promote growth and opportunities for their providers.

Scott Webb: Yeah, it seems they do. And Dr. Broschinsky, you mentioned your mentor earlier who kind of helped you find your way from, was it physical therapy to your career path now, wondering if you'd go into a little bit more depth and maybe just in general for would-be doctors, for future doctors. You know you want to help people, right? You know you want to cure people or whatever it might be. But how do you find your way to exactly what you want to do?

Dr. Kortnie Broschinsky: I think the big question that you have to ask yourself is, and this is what we ask medical school applicants all the time, is why do you want to be a physician and not another sort of provider? Why not a nurse? Why not a therapist? Why not a PA or an NP? What makes you want to be a physician? And I think that takes a little bit of digging because there are many different roles within the hospital and on the healthcare team, and everybody wants to help patients and everybody wants to take care of them. Everybody has some affinity for human biology or anatomy or science. That's kind of why we're all drawn to the field I think initially. But what really separates I think people into their role on the healthcare team is how exactly they want to help people. And I think identifying what your reason is kind of helps push you into your role in the healthcare team.

And for me personally, what really drew me to say, I want to go to medical school as opposed to physical therapy or opposed to whatever role on the healthcare team was, I want to be the person that's in charge of the treatment plan. I want to be the one that's driving this patient's care. I want to be the quarterback of the team. And that's why I decided medical school was the best place for me.

Scott Webb: Yeah, I love that. I love that analogy, kind of being the quarterback. And what would you tell somebody who's maybe not quite as far along as you are who's still looking to make these decisions? You know, maybe something that you wish you knew before you got started, or before you started your residency program.

Dr. Kortnie Broschinsky: I think once you decide that this is what you want and that you're willing to work for it, I think that you need to know that it's going to be hard and it's not meant to be easy. It's meant to challenge you because that's how you grow and that's how you get better. I think the other thing is you need to go into your education and your training with very clear priorities and understand that it means that you're going to have to sacrifice part of your life and a part of your time, and you're not going to have time for all of the things that you would like to do and you have to be okay with that.

For myself, I had a very clear list of two or three things that were the most important to me. And as long as those two or three things got taken care of, everything else extra, I got to do I saw it as a bonus. And I think that's part of the reason why I did well in medical school. And I came to the residency and I was able to match into the field that I did because you have to be dedicated to those two or three things and say, "I'm okay letting these other priorities go for a season while I focus on my goals and while I get through my training."

Scott Webb: Yeah, I see what you mean. As long as you still have a little bit of time for Netflix. That you still have time to relax and unwind and do a little bingeing, I certainly hope so. And, Dr. Agarwal, I want to ask you how medicine has changed since you started? You've been at it a long time. And do you think the field has become more inclusive or more diversified from when you started? And maybe you can give us some examples of just how medicine or hiring practices or all of this has changed during your tenure.

Dr. Shanu Agarwal: Yeah, medicine definitely has changed since when I started back in 2006. Just things like charting. I mean, charting was so different, that for so many years we did paper charts. Now, it's like if the computer system is down, it's like my hand starts to hurt if I have to write a whole chart up. We used to have paper charts, so, you know, eventually we moved to an electronic medical record. And so with that also, I think, came a lot more ownership that physicians had to take as far as how are they documenting? Are you documenting the right stuff? What we're looking at now, the trend is really looking at more quality measures. Are you providing more quality care versus seeing so many patients in a certain amount of time?

So I think that that's been a really big change versus way back, I just I think there wasn't as much ownership put on physicians at that time compared to now. We want to meet certain quality metrics and because were really focusing on the patient and we're trying to do whatever we can to provide that comprehensive care for the patient. So I think that medicine's definitely changed from that aspect.

And the other thing is there are definitely more opportunities for, let's say, women in medicine or even if you're of a certain ethnic background or something. I think those opportunities, they really encourage women and that whole diversity component is there. Also, I think that we have become more educated in general from looking at providers from so many years ago where we are more sensitive to patients that identify with a certain gender or they have certain sexual orientations. We've developed clinics. A big thing that we've developed in the last so many years is our Pride Clinic, which really is specific to taking care of patients who may have certain sexual orientations or gender identity. And we have providers that are sensitive to those topics.

So I think we've really come a long way from where we were back from 2006 to 2010. COVID has been a huge teaching point, learning point. We saw that COVID affected certain socioeconomic classes and we saw this disparity in health and we became more aware and, you know, now moving forward, we really need to hone in on how do we provide preventative health to these individuals that have these disparities.

So I think that we're really keeping up with the times as far as making sure that we provide that inclusive care. And so those inclusive opportunities are not only for our providers for their career growth, but I think we're becoming very inclusive as far as our patient population and where we need to hone in on where the care is needed.

Scott Webb: Yeah, I couldn't agree more and just so much to unpack there. But first of all, I have a 14-year-old daughter who wants to be a doctor. So great to have, you know, both of you on today. And I'm definitely going to make sure that she listens to this. She'll like tune out dad, of course, as she always does. But hopefully, she'll pay attention to both of you. And in regards to Summa, I've done podcasts on the Pride Clinic during COVID you mentioned. I've had two African-American doctors on to talk about why it's difficult for African-Americans to be vaccinated, the natural distrust that African-Americans have about vaccines and medicine and all of this. I've been really proud to host for Summa over these few years, which really started at the beginning of COVID and just how proactive they've been, and really trying to understand, as you say, the quality measures. How do we find out exactly what people and the community need, want, expect from us and then deliver that to them? And I'm sure you're equally proud to be a member of the Summa community.

Dr. Shanu Agarwal: Yes. Especially during COVID, we went out to communities, provided vaccines, provided testing. I think over a weekend we did thousands and thousands of tests. So, that's another reason I think being at Summa, they're very community-focused, which I think is really important. I really think that their residents are getting some really good training. Being here at Summa, it's just a great segue into people having their careers and forming their careers and being a part of that community and helping the community that they're going to be a part of.

Scott Webb: Definitely. And Dr. Broschinsky, and I know that you mentioned that you're going to be serving after your time as a resident. You're an awfully ambitious young woman. It's pretty amazing to hear your story. I wanted you to maybe share a piece of advice from a professor, mentor or doctor you're working with now at Summa, something that's really stayed with you.

Dr. Kortnie Broschinsky: One of the biggest pieces of advice I have gotten from my more senior residents, my attending, is the reminder that we're no longer in a phase of our training where there is a very set, rigid curriculum where everybody, if they go through the program and they go through the process, will end up with the same result. We reached a point in our training where your skills will reflect the effort that you've put into your residency and the opportunities that you've sought out throughout your training. This is your education and it is up to you to be your own advocate and to make the most that you can out of, in my case, my five years as a resident. It sounds like a long time, but I'm almost done with my first two years already, and it has gone by so fast. I can't even tell you. And I think that's been the biggest takeaway that I've gotten so far as to make the most out of all of the opportunities that I have, because in a few short years, it's going to be me making the decisions and it's going to be me that's responsible for these patients.

And that could be somewhere in a military hospital here in the United States, I could be deployed, I could be in the middle of the Pacific Ocean. And so that's what's really hit home for me, is really taking ownership over my education and making sure that I'm getting everything out of it that I need to, and that's asking for things that I want, or I think that I need from my program director or my chiefs and saying, "Hey, I feel a deficiency in this area. This is what I want to work on. How can we make that happen?" And really being honest with yourself about where your deficiencies lie, so you can attack your weaknesses and you can become a better physician and better surgeon, in my case, for my patients.

Scott Webb: Yeah, it's very cool. And what are you excited about the most when you think about where you are today almost two years into your residency? Where will things be in five more years or ten more years? And is that what excites you about medicine?

Dr. Kortnie Broschinsky: I think some of the things that excite me about the field and kind of moving forward are the different advances that we have with things like-- I'm on my pediatric rotation right now and just the different kinds of advances that we've had in the last however many years about how we treat different conditions. We have a club foot clinic, we have a brachial plexus clinic and we have other, congenital anomalies that we see every day at Akron Children's. And it's interesting to think how 10, 20, 30 years ago, outcomes for kids that had these different conditions were much poor. And now we have better solutions for things like scoliosis or things like club foot, or these other conditions that we see for these kiddos.

Scott Webb: I've really enjoyed this. Hopefully, you both have as well. Dr. Agarwal, I'm going to finish up with you. I want to ask you what keeps you motivated when times are tough? And we know that times have been tough over the last two plus years, even for an infectious disease specialist. And then also what would be your advice to medical students that are beginning their medical journey, something that you wish you knew when you were younger before you got started?

Dr. Shanu Agarwal: You know, I would say COVID definitely the last two and a half years, especially in my specialty, was really tough. I think I was at the hospital, I think, the first six or eight weeks every single day. And you know, I was sort of learning in real time just with everybody else. I mean, I was trying to learn from what was happening in Michigan or some of the other states that were experiencing the big surges before it came towards us. And then trying to educate a whole bunch of people, other providers, nurses. And so I sort of became the point person in these last two years. And it was tough. I really wasn't seeing my family very much at all. But what did keep me motivated is that random email or that random text I would get from somebody and say, "Thank you so much for what you're doing and keeping our mind at ease during these tough times." And that small encouragement made me want to do more. It was like the fuel I needed to keep going. And then also knowing that when I came to work, everyone was in the same boat. We were all trying to do the best for the limited resources we had with medications and whatnot for our patients. And all the clinical trials were still going on, so we didn't know if one treatment was going to work versus another and trying to have those discussions with families. So I think knowing that everyone around you was in the same boat and that you were all together in this, and again, like going back to having that Summa family, it motivated me to do more and it really kind of took away from any sort of anger or if I was feeling low or I felt like things were tough. I think it kind of took away from that and it really made it better. So I would say that those were some of the things that kept me motivated.

And advice for students, my big thing, I think, when you're in medical school, you've got a bunch of friends, you're all hanging out, you're in the same boat, you're going to class together and whatnot. I think when you get into your fourth year and getting to the residency, students branch out, they choose different specialties and whatnot. And I would say when you become a resident or become an attending, you know, depending on what specialty you are, sometimes you develop different sort of attitudes now that you're the leader. I think sometimes some folks may lose that humbleness or respectfulness for others. Never forget why you went into medicine. You went in to, obviously, take care of patients, but you're going to be a role model. I mean, a role model needs to be humble and respectful. So never forget no matter what position you have within the hospital, whether you're in an admin position or you're the only provider that does a certain type of procedure, I think it's very important to not forget that.

And also, always take care of yourself and I wish when I was younger and stuff, I focused more time on myself. You know, I feel like I let certain things go and I think it's important, whether it's you need that 20 minutes to watch a silly Netflix series or something like that. I think it's really important to keep you grounded and to keep your day going on. So you have to find time for self-care, to do something fun. I think that that's really, really important because the happier you are with yourself and how you feel about yourself, you're going to provide that best care to your patients and you're going to be that much of a better person that other people want to be around with at work.

Scott Webb: Yeah, well, that's perfect. This has been a really inspiring conversation today. I've loved just learning about you both and what brought you to medicine and what keeps you focused and what you're looking forward to. I wish we could speak all afternoon. I wish my daughter was here to be a part of the conversation. Just really inspiring. Thank you both and you both stay well.

Dr. Shanu Agarwal: Thank you. Thank you so much.

Scott Webb: National Doctor's Day is March 30th, 2022. Share your appreciation to the physicians in your life. Visit summahealth.org/doctorsday to send a digital thank you note. We're sure they'd be thrilled to know how their hard work and dedication has contributed to your health. And while you're spreading thanks and appreciation, we'd appreciate a share as well. If you know someone who would enjoy listening to the healthy vitals podcast, tell them about your favorite episode and be sure to like and subscribe on your preferred listening app. I'm Scott Webb. Stay well, and we'll talk again next time.