Engaging and Thriving with Dr. Arpana Vidyarthi

Beth Davies, host: It just so happens that a few weeks before COVID-19 swept across the world, I had a chance to sit down with a doctor, Dr. Arpana Vidyarthi, to capture her career story. She specializes in hospital medicine, a specialty that didn’t exist when she graduated from medical school, and I was interested in hearing how she discovered and got into the emerging field. Now, she’s on the frontline of the pandemic, making this episode especially timely.

Because the interview was done just before the pandemic began, I didn’t ask any questions about the crisis. I did, however, recently get an update from Arpana and will share this with you at the end of the interview. Now, let’s get to the episode….

The decision to become a doctor is just the first of many career decisions a medical professional has to make. What to practice? Where to practice? And, in what other ways do I want to be involved in the profession?

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Welcome to Career Curves where we talk to people who have interesting careers and explore how they got where they are. I'm your host, Beth Davies.

Our guest on this episode is Dr. Arpana Vidyarthi, who graduated from medical school in 1997. Through residencies, fellowship programs and further coursework, she developed expertise in hospital medicine. She also discovered passions for quality and safety, teaching, and leadership. She has built a career for herself that pulls together all of these passions and interests. I’m excited to have Arpana here to tell us how she has done this.

So welcome Arpana.

Arpana Vidyarthi, guest: Thanks so much, Beth, for having me.

Beth: I'd love to start by finding out what you're doing now. So tell us about where you are at this point in your career journey.

Arpana: Well, right now, I am doing something that's a little unique in my leadership and career path journey. I am wearing only one hat and that is being an Academic Hospitalist here in San Francisco at the University of California hospital.

So what's an "Academic Hospitalist"?

Beth: You guessed my next question.

Arpana: So the "hospitalist" piece of that is what my medical subspecialty is. That means that I'm trained as a general internal medicine doctor and then I sub-specialized in taking care of patients in the hospital. So I can take care of you if you go to your clinic and they say you need to go to the emergency room, and they say you got to come inside the hospital and spend the night. I'm your doctor. So I do general internal medicine in the hospital.

The "academic" part of that means that I work in a hospital that's academic, that teaches medical students and residents and fellows. That has research and PhDs and all of those other things. So what I do in my every day is I see patients with a group of learners and that includes residents, a couple of interns that are first year residents and medical students, sometimes pharmacy residents and others.

Beth: Does it also include coursework like in a classroom? Are you that kind of academic as well or is it really what I would think of as doing rounds and having people go with you?

Arpana: You're right there on the latter part of that. What I do right now and what my area of expertise is, is really the practical, clinical teaching, right then and there, on the rounds, on the wards. So it's the sort of stuff I guess that people would be familiar with. It's the Grey's Anatomy or House. I grew up in the days of ER. So it's that sort of stuff.

Beth: That's so funny. I was just about to ask you, "Is it what we actually see on TV?" because, of course, that's the image that's coming up for me.

But let's go back and meet the younger you. Tell me about your childhood. Where did you grow up and tell me about your family.

Arpana: So I grew up in a small town in Northern Minnesota called Duluth, Minnesota, and I'm the youngest of three kids. My parents immigrated from India in the 1960s and my father is a physician.

Beth: Were you encouraged as a child to follow in your father's footsteps and become a doctor?

Arpana: For me, in my early childhood, most of the people that I knew, that were grownups, were all doctors and so it was what I knew. It is pretty common. You'll find a lot of people in all professions actually that follow in their parents' footsteps. And I think some of that, in my case, it's absolutely true. That's part of what I saw. I didn't feel pressure growing up to be a doctor, but I certainly saw that as my career path from a very young age.

Beth: With that in mind, is there anything about the world of medicine that you think you were hearing as a child that had you say, "Okay, I'm understanding what it means to be in this field and what I'm going to need is..."Can you think of any way that it was shaping your thinking as a child?

Arpana: One of the things that was different for me growing up in a medical family, was I saw what the end of the path looked like. I had an opportunity to do some shadowing as a kid or people would be getting calls from the hospital and just overhearing them as I walked through a room and realizing that not much of what I heard was science. Most of what I heard and most of what folks talked about when they talked about work were people things. Maybe the experiences with their patients or the politics at work or whatever that was. But it was very people oriented.

So going into medical school and even preparing for medical school, it's really grounded in the slog and the science. And I did have that clarity of distance to be able to know what the end game was, which was – and I still believe this – that at least the type of medicine that I do is, it's a relationship profession. Absolutely.

Beth: Did you have moments when you were studying medicine that you thought, "It's science. There's a slog to it that I'm not liking," but knowing what you knew as a child helped to motivate you and pull you through it?

Arpana: That's a really nice way of putting it together. And in retrospect, yes, but in the moment, absolutely not.

I failed my first biochemistry test and I remember going to the professor. I walked into his office, I was like, "Look, I studied ethnic relations, women's studies and music. I need your help." It was really hard. It is definitely a slog, but that perspective really did help me make it through some of those different times.

Medical school, at least when I was going to medical school, traditionally, it's two years of what they call pre-clinical and then two years of clinical. Those first two years of pre-clinical were a lot of that slog of science. And then, when you're in the hospital being a medical student, it's very different because you're dealing with patients, you're dealing with teams. That human connection is going to help you excel. That was certainly my experience.

Beth: So it sounds like when you got to that point, it was more of what you had heard as a child that the practice in the field would be.

Arpana: Absolutely.

Beth: I have some more questions for you though about your childhood before we go on. So, we talked a little about your father, but tell me about your mother.

Arpana: So my mother's had huge influence on me. My mother grew up in India. She came to the United States as a young bride with two children and in her generation and her expectations of the world were to be a housekeeper, a wife and a mother. She didn't have the opportunities or the vision to do something beyond that. I'm not sure if she regretted it or not, but she's certainly instilled in her only daughter that I would work. And so that was a very strong influence throughout.

And I think with my dad, one of the biggest influences was not just to work, meaning have a career, but to work hard. As an immigrant coming into the United States, the early part of his career, he had to work very, very, very hard. It's the classic immigrant story. So the value not just of the outcome but of the process of hard work was truly instilled in me at an early age.

Beth: You mentioned a few moments ago that you were an ethnic relations major and I think you had mentioned a couple of minors there that didn't sound very medical related. So tell me about the college journey. It sounds like you very much knew you were going to go into medicine, but you didn't do what sounds like a very traditional premed type path. Tell me what was going on there.

Arpana: You know, Beth, in some ways that was very deliberate. So actually I will rephrase my answer to your past question. I think my early experiences of understanding what a career in medicine would be like absolutely influenced some of my decisions about how to get there.

I had a pretty strong sense that I would be able to learn the science and the foundational things that I needed to know to be a good doctor through medical school, but that this was my time, meaning college was my time to actually learn all the other stuff that may make me a really great doctor and were more interesting to me.

Beth: Interesting.

Arpana: So I did do the premed and that's one thing about being a doctor and being on this path that can be challenging to some. It's a long path and it's deliberate. There's a number of different things – prerequisites and those sorts of things and exams – that you need to do to be able to eventually get into medical school.

I also knew that that's not what I wanted to spend my four years of college delving deeply into, but I didn't know what it was that I wanted to delve deeply into. So I dabbled in a little bit of this and a little bit of that. I certainly liked history and political science and sociology. I played the piano and I've continued to play the piano, classical music, and studied music. And then when I started putting it together and had to come up with a major, I didn't have a passion for any one discipline. But what I did find when I reflected upon it was the things that really interested me were the experiences of people and specifically ethnic minorities in the United States.

So in my music classes I was really drawn to the experience of jazz. And in terms of history, I did a project on the Japanese internment. And then I think my senior project was something around women of color and health decisions. So I really found that I couldn't really fit into one specific box or one specific discipline. I found this theme that was in the intersection. There wasn't ethnic relations at the small liberal arts college that I went to, and actually that wasn't a field that was booming at all in most universities. So I made it up. So I did an independently designed, interdisciplinary major. And that's how my major came about.

Beth: While you were in college, were there any internships or jobs that you were working and if so, how did these help shape your thinking about what you wanted to do and be?

Arpana: So pre-college, college, post-college, I had a variety of jobs. I sold Birkenstocks at the State Fair. I did phone surveys for a prominent political campaign. He won that year. I sold jewelry at a jewelry store and I was the receptionist at a hair salon. So I had a variety of different jobs. Did they shape my career? I don't think that they shaped my career, but they certainly shaped who I am. I think through having these variety of jobs over time, in my youth, it taught me humility and I think that that's something I've carried through in my career and my life that has been incredibly important and probably a cornerstone that I think has really added to the successes that I have been able to experience.

Beth: Oftentimes I feel like younger people are looking for the step-by-step guide to go from where they are to where they want to be. So if somebody wants to be a doctor, they want to know, "Tell me exactly which internships I should have. Exactly what early jobs I should have. College jobs. What courses to take." And, I don't think traditionally on that kind of a list would be things like selling Birkenstocks at the State Fair. So did anybody ever put pressure on you at this time and say, "Arpana, if you're pursuing medicine, if that's what you want, you should be out getting jobs in the hospital during the summer." Was there that kind of pressure or not?

Arpana: As I look back, maybe it was serendipity and maybe it was perception. I didn't feel that pressure. It was probably out there, but I think that this gets back to the benefits that I had growing up in a medical family. I knew what that path looked like.

Also the benefits of the college that I chose. I chose liberal arts because, as you can tell, that's the way I think. The idea of liberal arts is that you have a broad-based education and then you specialize as time goes on. So my advisors in college and my mentors in college all absolutely helped guide me and made sure that I found time to actually take the courses I needed to. I certainly had to take summer school, but I didn't ask for much advice around the other stuff.

Beth: I think it's such a good lesson for people who may be listening and thinking, "I started in liberal arts and as a result now I can't go into medicine," and to say there's actually nothing that closes that door. In fact, it is probably still wide open for you.

Arpana: I would build on that to not even say it's "maybe" wide open to you. In my experience and many of the people that I've seen, in fact, it opens those doors for you. I've chosen to do academic medicine and I look back to my liberal arts background and selling shoes at the State Fair or all these other things that I did that have had more influence and impact on my eventual career path than much of the other things that I did to get into medical school or that I did in those first couple of years of medical school.

I always tell young folks that your job in your early twenties or through college is to learn who you are and learn how to think. And then our job as educators in professional schools is to help you understand the details and the content that are going to help you be able to be the professional that you want to be. But if you haven't learned who you are and how to think, it's impossible to jump to that very end point, which is creating the career that's going to be fulfilling to you.

Beth: I love that. I love that. I just want to like hold onto that here for a moment. But let's continue with your story. You did after undergrad, go to medical school.

Arpana: I did.

Beth: So tell me about that transition. Did you go straight from undergrad to medical school? How did you make that transition?

Arpana: So my goal was to get into medical school before the cutoff for deferring medical school and I made it, so I was thrilled about that. And I took gap year.

Beth: Why was that important?

Arpana: I wanted the gap year. I absolutely wanted the gap year. So there was a deadline by which if you could get into medical school, you could defer your admission.

Beth: I got it. I got it. Okay.

Arpana: So, it was a wonderful gap year because I had been accepted to medical school and that takes a lot of the pressure off. I think if anyone is able to do that, I think it's a wonderful way to be able to do a gap year.

Beth: And then what did you do with that gap year?

Arpana: I did all kinds of stuff. Two of the main things that I did: One was that I traveled. So I spent quite a bit of time in India. It was interesting because, at the time, I was trying to figure myself out and I had arranged for an internship there and did some travel, had some friends, spent a lot of time with family. And what I learned from my time there was that that's not where I was going to figure myself out and that was a phenomenal thing to learn and an a great use of time. And it gave me lots of life lessons that have helped me throughout.

Beth: What was it about it that made it the place that you weren't going to be able to figure this out for yourself?

Arpana: Although my heritage is Indian, my home and the influences and the cultural influences are very American. Definitely drawn from Indian roots and I identify very strongly as an American woman with Indian roots. So for me, Me wasn't to be found there.

Beth: Got it, got it. So at some point that gap year is going to come to an end, as enjoyable as it was, and the grueling medical school is ahead of you. Tell me about that transition and tell me about medical school.

Arpana: So medical school for me was really challenging. I was very lucky to get into my first choice medical school, which was close to home. It was the University of Minnesota and my family was very close by. It was a large school and I had gone to a very small, private, liberal arts college. So I was looking for a big change and a big difference.

My first couple of days of medical school, I looked around and I didn't look like anybody there. I didn't think like anybody there. I was really a fish out of water.

Beth: Did you think about dropping out at any point?

Arpana: I thought about dropping out every day. In fact, at the beginning of medical school and especially after I struggled with the first set of exams in that first month. I thought, "Well this just isn't for me. I'm not fitting in here and I have other options. I could potentially find great joy doing a PhD in a social science and being a professor." And that was certainly something that was on my mind.

It was one of those times in my early twenties that I actually, instead of pushing back on my parents, I trusted, and they said, "Give it six months. Just give it six months and if this really isn't what you want to do, then we'll figure out what the next step is."

And then during that six months, I spent a lot of time trying to figure how to actually re-think medical school. So instead of saying when people would say, "Oh, how's med school? Oh, it's grueling. It's awful. It's hard," I would come up with something very positive. It was probably one of the first times I had to dig deep and figure out a tool for resilience. Resilience and resilience building has played a large role in my life much more recently, but when I look back, that's one of the first things.

Beth: Do you remember any of the ways that you described it that didn't include grueling? And, of course, I'm thinking now, "That's exactly how I started my question of, 'Gee, how was medical school? It was grueling.'" But do you remember any of the ways that you described it that didn't include grueling?

Arpana: Absolutely. The people. Life is like that. Took me a bit to find my tribe and the friends that I made in medical school are still some of the best friends that I have. Those relationships were just so strong, and we supported each other through, and we studied together. The relationships were incredible.

It's challenging and there's something very motivating about a challenge. And once you can move past the grueling-ness and say, "Hey, is there interest here?" Well, it's very interesting and, "Can I live up to that challenge and meet that?" Then you're on a different path. Then there's something about purpose and that was fantastic.

Beth: Yeah, just that re-casting of grueling and challenge. They really are the same thing, but they mean something completely different.

Arpana: Absolutely.

Beth: I love that. While you're in medical school, are you required to pick a focus area? And if so, what did you decide to focus on?

Arpana: By the end of medical school, you apply to residency and so that's your focus area. I came into medical school really believing that I was going to do women's health, women's health in the community, and that's what I really wanted to do. One of the things that I did post college was to work in a women's clinic and I was a community organizer in many ways around women's health issues. And over the period of time that I was in medical school, I started realizing that when I was doing my women's health work and my rotations, it was interesting, but it wasn't what was driving me.

I kept going back to one of the foundational pieces of medical school and medicine, which is called internal medicine. So, for example, when I was doing my obstetrician gynecology rotation and we had someone who would come in with an asthma attack, I was really excited about that. But when there was a delivery and all the medical students are fighting over the delivery, I was in the back of the line. So, it was a big switch for me and that happened probably my last year of medical school. I realized I had to pay attention to that, and I chose internal medicine.

Beth: So point of clarification for me as somebody who never went to medical school. Earlier you mentioned that medical school is two years of coursework, followed by two years of clinical. When we talk about residency, is residency and clinical the same thing or does residency come after the clinical?

Arpana: Great question. I'm going to take it back even further. So things have changed a little bit, but in general, in the United States, you do four years of college. And I want to just be really clear about this. You can study anything that you want to in college and in some ways studying something that isn't a science, I think, is going to help you into your future, but also maybe make you a little bit more distinctive as a candidate.

During those college years, not only do you have to have a college degree, but you also have to do pre-medical prerequisites to get into medical school and take an entrance exam. Then there are four years of medical school to be able to get an MD.

Out of those four years, some of those years are pre-clinical, so mostly classroom learning some of the fundamentals of medicine, and some of those years are in the hospital attached to a team like one of the teams where I work right now, taking care of patients and learning at the same time.

So after those four years, that's when you do residency training. By the end of medical school, you will apply to residency. It's a funny, funny system. You go all over the country. You decide, for example for me, that I wanted to do internal medicine and there are maybe a hundred programs in internal medicine across the country and you apply to them. And you interview and they interview you. And then you make a list. You're #1 through... I can't remember how many you put on the list. Each of those programs also make a list. And a great computer in the sky called The Match, puts it all together and one day at the exact same time across the entire country, every medical student gets a little piece of paper and it says this is where you're going to spend the next 4-8 years of your life. That's called Match Day.

Beth: You don't actually, at that point, have a choice, I would imagine. If the match that came up is like, "Well it was on my list, but it was near the bottom and I really don't want to go to Cleveland." (And I picked Cleveland because it's my hometown. I feel very positively about Cleveland. Great medical facilities there, too). You don't really get that kind of a choice is what it sounds like.

Arpana: Once the match is done, the match is done. It's definitely an interesting experience. You see people that are thrilled on Match Day, you see people that are crying in the corner. It is the ultimate in giving up power in some ways.

Beth: Where did Match Day take you?

Arpana: It took me to Boston and that was an absolutely great experience.

Beth: How high on your list was that by the way?

Arpana: It wasn't #1. That was actually very significant for me. I did not match at the place that I thought I would match, and it was one of the first big failures that I saw as a failure. Very prominent place. Many people would have put this #1, but it just wasn't mine, and that was a significant episode in my life to manage through. That sense of not succeeding.

Beth: What ultimately pulled you out of that feeling of failure?

Arpana: Well I had to go.

Beth: Well, actually, you didn't have to.

Arpana: Oh, that's true.

Beth: Right?

Arpana: That's true. Yes, we could be having a very different conversation had I not done a residency. You're right.

I remember being on one of these Outward Bound activities. So I went to Boston, I got settled in, and the entire residency group goes to bond. I was at the top of one of these ropes courses looking out to the Boston Harbor. It was a crystal clear day and I was feeling very sorry for myself when I started. It had been weeks of feeling sorry for myself. And I looked out to the Harbor, and I looked around to these people who were for the next many years going to be my colleagues and ended up being some of these amazing people that I spent these years with. It was at that moment that I decided to engage and to thrive.

At the end of that day, this is one of these camp trips they had you write a letter to yourself and then they mail it to you like six months or a year later, and I had written exactly that. "Engage and thrive."

Beth: I love it. I love it. What's interesting about this part of your story, and you had mentioned it even earlier with starting medical school, was this conscious decision to say, "How I frame this is essentially a key feature of what the experience is that I'm going to have," and I appreciate how conscious you were in those moments.

So you've got four years. How did this continue to shape your thinking about the kind of medicine and the kind of doctor that you wanted to be, if you even wanted to be a practicing doctor?

Arpana: So I went to a residency, which is called Primary Care. I had mentioned earlier that when I went to medical school, I wanted to do women's health in the community. I moved away from the women's health piece because I loved internal medicine, but I still really believed that I wanted to do primary care in the outpatient setting in the community. So, I went to a residency that really specializes that, one of the best in the country for that type of medicine.

Over the course of my years, as my colleagues were focusing in on public health issues or doing their selective rotations out in the community, doing different things, I found myself at some of the tertiary care hospitals in the ICU. Again, I had to really pay attention to that and I realized, "My gosh, maybe I don't want to be a primary care doctor working in the community."

It sounds simple now, and even when I'm saying it, I'm actually laughing a little bit because I have the wisdom of years to know that these career curves are actually what make up the texture of life, but at the time it was such a big deal because I didn't know what to do. If I wasn't going to do this, what was I going to do?

Well, the complexity of care in the hospitals was increasing. The time pressures and the way things were reimbursed were becoming very difficult for doctors to be able to do both outpatient care and inpatient care. And there was a new specialty which was coming up, which was called "hospital medicine". California was leading this and I read an article about it and I said, "Gosh, that sounds like exactly what I want to do. I actually want to take care of patients in the hospital." At this point I had figured out I was very much a people person and I want to be able to take care of patients with these complex problems in the hospital.

So that transition happened over my four years and I was extraordinarily lucky to have an extra year of residency called a "chief residency". That gave me that extra year to think about this a little bit. But the other thing that was fascinating about chief residency is you are primarily an administrator. You're kind of a middle manager. You're the person that's in between the residents and the administration, and you dive into learning how to be an administrator and a manager. And I loved it. Some people hate it, some people loved it. I absolutely loved it. I liked making the schedules. I liked going to meetings. I liked managing conflict. So that was another great thing to learn.

So, I came to San Francisco actually to find out more about how they were structuring their training to be a hospital medicine doctor – I don't even think we were calling ourselves Hospitalists yet – and they had a fellowship available. After some conversations and some interviews, I was selected to be a fellow here. So, right after residency – well not right after, I took about six months to travel – I came out to San Francisco to start a fellowship in hospital medicine and clinical research.

Beth: Tell me about that move and getting started in hospital medicine.

Arpana: Well, something very significant also happened to me in residency, which is I fell in love and that's always a nice thing to do during really difficult times. So I fell in love, I got married and then we moved to San Francisco so I could start my fellowship in hospital medicine. And it was fantastic.

Fellowship is a great period of time where you're a doctor, so you've got a little bit of confidence under your belt, but you're still a fellow so you can still ask a lot of questions and doors are open to you. UCSF, just like many of the other academic medical centers across the United States, is just an invigorating environment. You have phenomenally smart people, great mentors, great science, cutting edge things that are happening. The teaching milieu is just exciting. It's just a wonderful place, so for me as a fellow, it was a fantastic place to continue to learn.

So, the normal trajectory for someone in academic hospital medicine, that was kind of on my track – residency, chief residency, fellowship – would then be to pursue a career in research. And, boy, I saw most of my colleagues doing that. So at the end of your fellowship, the expectation is you'll write a big grant, you'll have a really big idea, you'll get this grant, and then you'll do that for the next multiple years.

Beth: But we already know that you are a strong people person. And so I can just imagine that this was creating a rub for you. Is that accurate?

Arpana: Absolutely, and what's interesting is that while we know now that I'm a strong people person, I didn't necessarily know then, and the influences and forces of what's happening around you, certainly can play a role.

Beth: Yeah. You're caught up in the current of that and almost start to flow with the current.

Arpana: Absolutely, but I stopped the current. I remember at that point that I had to make a decision. I actually went to one of the top researchers I could find and I had coffee with him and I said, "Tell me about your everyday life." He told me about his everyday life and he loved his career and his everyday life. And I left that coffee saying to myself, "I could never do that. I could just never sit by myself for that long and actually think for that long." It wasn't the career for me, so I really didn't know what I was going to do once again.

I felt pretty lost because here I was. Now I had deferred getting a real job for multiple years and it was time to really start thinking about where my career was going to take me.

Beth: So now that you're not on the current that had an automatic flow, how did you figure out what that next move was going to be and what did you decide?

Arpana: So not only was I off that current, I didn't really see very many tributaries either or ways forward, but the thing that I had was I was at an institution that is incredibly innovative, with great ideas. You can imagine the entire field of hospital medicine was born at UCSF. And I had great mentors.

So one of my mentors, he loves to talk about seeing tea leaves, and he said, "You know, I think what we're going to see in the United States is an explosion of trying to understand hospital systems." I did have an interest in hospital systems administration and education. The research that I had been doing during my fellowship was actually on the duty hour reduction for residents. What was the implication on the system? On how we think and how we learn? This lended itself, I guess, loosely to quality and safety.

I remember saying to him, "I don't even know what that means," and he said, "You know, this is one of those that you just really have to trust me." And it was a leap of faith.

Beth: And what did it mean?

Arpana: Quality and safety is now a very established career and focus for multiple people in medicine. It's really looking at how we organize the systems of the hospital to be able to deliver safe care. But it was just starting when I was finishing my fellowship. So I didn't know what a root cause analysis was. I never heard of the word Six Sigma. And I thought Lean meant trim and fit.

So once again, I had to really lean on what I had learned in residency, which is, "You know what? You can figure this out." So, through self-study, through building colleagues across the nation who were kind of doing the same thing I was, through mentoring (great mentors!), and through just other resources, I was able to start building a career path in quality and safety.

Beth: Is it something that you do instead of seeing patients or is it a dual type of role?

Arpana: Great question. I'm going to back way up again. This is a piece that I forgot to tell you about.

The other piece that's academic medicine that is different from going to medical school and being the doctor who actually sees patients is if you're going to stay in academic medicine, you tend to have a balance. So you have your clinical time where you see patients, usually with your all of your trainees and teaching on those wards, and then you have an academic focus.

Beth: How do you get work life balance when you're doing all of these things?

Arpana: So I feel like we could talk for hours and hours and hours about work life balance. For me, in fact, wearing multiple hats and doing many different things gives me more energy than it takes away. Work life balance for me looks very different than it may look for someone else.

In fact, I don't like to use those words. How I've chosen to do that is to integrate my life. I see myself as a hospitalist, as an educator, as a mom, as a wife, as a daughter, as a leadership consultant, as an executive coach. All of those tied in and I bring all of those to the table in almost everything that I do.

That said, I didn't know that back then, in those early days when I was working in the hospital, doing academic hospital medicine, building this career in quality and safety, having kids, building a life as a young mom. It was incredibly challenging.

Beth: There is, though, a parallel between this intersection that you're talking about now and the major that you created for yourself as an undergrad, which is pretty interesting. Just recognizing the value that comes from the connectedness and that wholeness of all of us. So I just really appreciate that.

So you're in this quality and safety role at UCSF. How long did you stay in that?

Arpana: I did a lot of quality and safety work in multiple different fashions and multiple different roles for about 10 years.

During that journey, I started realizing that it was hard and at the end of every checklist where I couldn't actually make the improvements that I wanted to, it was because of people and they were causing my problems. The checklists weren't enough and that's when I started thinking about, "Well, what can I do? Where can I turn to start thinking about how to influence people? How to change people's behavior to improve quality and safety?" And that's when I really discovered this world of leadership development.

I had a great opportunity to do a two-year program through the California Health Care Foundation. That was on top of everything that I was doing, but it was phenomenal. It just sparked or ignited in me a passion for thinking about that people side of process improvement.

Beth: You mentioned that you got this two-year opportunity with the California Health Care Foundation. Do you remember or can you think of how you actually got that opportunity?

Arpana: Thanks for asking that question. You know, what I've always hated is when people talk about their career paths and say, "Oh, well it was just luck that I found myself in that place," because I don't find that helpful and it's usually not true. Chance favors the prepared mind.

As I was going through my journey and some of my work, I was always open. One of the rules that I've had for myself is have coffee often with random people. And in my coffees, I would share some of the challenges that I was having about improving processes and all these different pieces.

One of my mentors mentioned to me that there's other ways to approach this and this is from the people side of it. And he really introduced me to this fellowship. He had done it already and he was a very senior person in the organization.

I reached out and I found out about what the fellowship was, what it was to offer. I seemed pretty junior for it, but I said to myself, "You know, why not?" So, it's not just luck, there's a little bit of elbow grease in there and making those opportunities.

In the middle of this, I had my second child and it was a phenomenal experience, but it definitely pushed me to that point to saying, "Okay, you know what? I think after this experience it's going to be time to move back a little bit and really figure out what's next."

Beth: And what happened as you stepped back to figure out what's next? Where did that take you?

Arpana: That took me to recognizing how much I enjoyed that experience. How much it taught me about myself and changed the way that I do my work. And so, as every good academic would do, I then created leadership programs based on a similar platform of that program for others.

One of the things that UCSF is great at is allowing for creation of different opportunities. So for the latter part of my time at UCSF, I ran two or three leadership programs actually for junior doctors, a national program for more mid-level doctors, to teach them these skills around leadership and management, which is something you're not taught in medical school or residency, but once you get to a certain point in your career, these are essential skills.

Arpana: At the time when I was starting this, medicine had not figured that out yet. I think medicine's come a long way and many of those opportunities exist now, but at that time there were very few.

Beth: I just want to go back to pointing out the fact that I said that you graduated from medical school in 1997 and so we're really only talking about things that have happened in the last 23 years, so that still is a very recent history. I think sometimes when people are junior in their career, they think that the world is already created and already written, as opposed to the fact that there actually can be still a lot of change and they can be part of that leading edge. So it's not that long ago that it was the other way.

Arpana: Absolutely. That's advice that I would give not only to physicians, but to people in any field: create it. As I look back, every job I have had, save one, every role, I created. Some of that was deliberate, but some of that was having an idea, seeing a problem, finding a solution, and then communicating that to the right person, who then would turn around and say, "Well, okay, why don't you actually do that then? Fix that problem." Which then led into a role which then led into a career path.

Beth: That's a great summary. I believe right now we've got you doing leadership development, you're teaching, which means also that you see patients because that's part of what you're teaching. Are you still doing quality and safety at this point too?

Arpana: I'm still doing quality and safety.

Beth: You're doing quality and safety. But at some point, all of this comes to an end. Tell me about that.

Arpana: So one of the things that I didn't learn back then was with every new role you should actually get rid of a role. I hopefully have learned that lesson. But one of the great things about academics is you get a sabbatical. So after some time at UCSF, I was promoted and one of the things that comes with the promotion to associate professor is an opportunity to take a sabbatical.

My husband and I, we had always talked about living outside of the U.S. At this point, I'd been in my career about 10 years, as had he, and this opportunity for a slight break really seemed like the right time.

Now if you look beneath the surface, that's a great story, but there was probably a lot of other things going on. Quite honestly, I was burnt out. So the opportunity of a sabbatical gave me the cover that I needed to be able to take the break that was required.

What I've learned from that is that, I couldn't just take a break. My professional identity and personal identity are intertwined. So it's much easier to say I'm on sabbatical, rather than I'm slumming it.

Beth: And where did you guys go?

Arpana: We moved to Singapore. Duke Medical School had opened a medical school in Singapore. I was able to create an opportunity for myself there. My husband works at a large multinational and their Asia headquarters were in Singapore and we moved to Singapore.

Beth: I'm a little confused. When I think of a sabbatical, I think of an extended vacation. It's an extended time to go tour Singapore and other close by countries. But you just mentioned that Duke was there and had a facility, which sounds again like work. What did it mean to have a sabbatical?

Arpana: So, I was definitely working at Duke NUS, which is National University Singapore. I was teaching a course. I was mentoring some students, but this was a very different pace and level than I was doing it at UCSF.

I also used that time to breathe, which honestly, I had to learn how to breathe, but once I learned, I did it with gusto. I took up tennis again. I spent a lot more time with my kids. We traveled tremendously. I love to scuba dive and so we did a lot of that. It was a really wonderful time. The idea was that the sabbatical would be 12 to 18 months, and we decided to stay.

Beth: So, a question for you there. You had mentioned that the sabbatical came with the promotion to a next level. If you're deciding to stay, I imagine that includes a conversation that says, "Thank you for that promotion, but I'm no longer going to be taking it. Is that accurate?"

Arpana: Yeah, I had to quit my job eventually.

Beth: And how did you do that? How did you manage that conversation and that transition?

Arpana: It was actually fine. One of the other things that I've learned is that even in medicine as in many different career paths, there's structures and there's relationships, and the relationships are far more important than the structures. My old boss was one of my mentors and a very good friend, so the conversation that I had with him was quite simple. My connection to UCSF was still very strong. I was still being invited to come back and forth, and teach for different types of things. Those relationships were still very strong and they were very welcoming to me for when and if this time in Singapore were to come to an end to please let them know.

Beth: So the doors stayed open.

Arpana: Absolutely.

Beth: So what did you then do in Singapore?

Arpana: I spent time there really focused on medical students, which I hadn't spent as much time before, teaching and doing some mentoring.

What I learned very quickly was what I thought I brought to the table was not necessarily what they needed. That is a lesson well learned: to recognize that the skills that you may not even think are important skills. It's really based on what the needs of an organization were. So, teaching a course in clinical reasoning for me didn't seem very difficult because it was such a part of what I did in my everyday life at UCSF, but in Singapore, there wasn't somebody who had that skillset to be able to create a course or create a course in that way. So I did some of that.

I did quite a bit of research. One of the things that I realized was I had so many papers sitting on my computer. Why were they not done? I hired an editor and I said to her, "I don't want you to edit this and help me get this out the door. I want you to teach me the process of how I can actually be more efficient and effective in my writing." That was in some ways really fulfilling because at that time of my career, I actually wanted to be less people oriented, and so it was a great time to sit, reflect and write.

Beth: I was hearing again this research part coming up, but you responded to it quite differently at this point. And when you say writing, were you writing articles? Did you write a book? What was the outcome of that?

Arpana: So most of the writing that I do are academic articles, and the research that I do is different than maybe other people would think about it. I do educational research. I think about how a course affects how people, how students think and what they do. And, I do health services research. Thinking about how a system change may impact an outcome such as patients or providers or behavior.

Beth: I'm smiling because what you're saying essentially is that you did research that creates an intersection between the things that you had developed interests in as opposed to probably back earlier in your career where it would have been somebody else's path and now it could be your own, which really fit much better.

Arpana: Absolutely.

Beth: And how long did you end up staying in Singapore?

Arpana: We stayed in Singapore for eight years. The first couple of years as I mentioned, we're breathing and then after some time I realized that it was time for a new challenge. I looked around and I found a wonderful opportunity to go back to school.

Over this period of time, I was really making the switch from quality and safety to leadership development. I had done quite a bit of that at UCSF, but that's not an easy sell for many places and for many people. I also realized that I wanted to understand this field more and it was time to challenge myself, so I went back to school. I spent just over two years getting a master's degree from INSEAD in an executive master's in change, which is really Individual and Organizational Psychology.

Beth: Did anybody at this point tell you this is a crazy idea; you already have a medical degree? Why would you be going back for a master's degree?

Arpana: The person who was saying that to me the most was myself. I think that sometimes you just have to jump, and it may or may not be rational, and you may not be able quiet that self-talk, but you just have to follow your instinct and just jump. I have to say, I'm very glad that I got over all of that because it was a life changing experience.

Beth: How did you put it all together after you got the master's degree?

Arpana: Well, one thing I did was I got a new job. I took on a role as the chief of the division of general internal medicine at the University Hospital in Singapore. In terms of putting this together for myself, it was very seamless. Through my experiences over time with many of the leadership development that I had personally done, I recognized very clearly that it made me a better manager, a better doctor, a better teacher, a better wife, a better daughter, a better mom. All of those things combined. So, having done this deep dive and during my master's degree, I learned quite a bit about organizations and individuals, but I probably learned even more about myself, and that's part of what it is, I'm told, to study psychology.

Beth: So thinking about the eight years that you spent in Singapore, what were some of your big takeaways about living overseas and working overseas?

Arpana: So living and working overseas, I'm going to take those two separately. In terms of living in Singapore as an American expatriate in Singapore, one thing that was so different and part of my everyday life was living a global life, a truly global life in Singapore. It is such an international city. There was no prevailing accent because everybody had an accent. It's just that everybody's accent is different. There was no majority, there was no minority because there are so many different people from so many different cultures of so many different languages and so many different colors that it just was. Everybody was different and being able to interact with all of these different people who came with different perspectives was incredibly beneficial.

Working outside of the U.S. was fantastic. Huge life lessons. The prestige of being an American doctor coming to Singapore got me in the door, but it did not get me to success or to making a difference. I really had to learn about navigating politics, building relationships, understanding different ways to influence. These are classic lessons that you may learn going through life or working in different organizations, but when you're doing that in a different culture where the differences are so apparent it's like growth on steroids.

Beth: So we are sitting in San Francisco. Tell me about that transition.

Arpana: That's pretty recent. I moved back to San Francisco just a few months ago. I am at UCSF now and UCSF is still the same place that I remember in terms of the culture, the invigorating environment, all of those different pieces, but in many, many, many ways, a very different organization, so I'm having to get to know it in a way that I would in a new job.

But the other piece of it is it's really nice to be able to come to somewhere that has some familiarity and that comes down to relationships. That's been one of the themes for me throughout my career: building, maintaining, and being fulfilled by relationships. I have wonderful friends and colleagues that I'm able to reconnect with again by being back.

Beth: Well, wonderful. Thank you so much for sharing this whole story.

I have four more questions to ask you. We call these the lightning round. My first question for you is what would you say is the smartest career move that you made, whether intentionally or accidentally?

Arpana: Well I'm going to talk about two.

Beth: Okay, you can have two.

Arpana: So the first one is accidental and that was that first decision I made early in my career to take that first quality improvement job. It was truly a leap of faith. I really didn't know where it was going to lead me. I didn't know if this was a career path that was sustainable. I didn't even know what it meant, but I trusted in my mentor and I trusted that I would be able to figure it out. So that was a bit accidental and it really laid the foundation for many of the other opportunities that I've had.

Beth: And what was the other one?

Arpana: The second one was to marry well.

Beth: What do you mean by marry well?

Arpana: I think the person that you marry can absolutely make a difference in your career. I'm talking about being a partner in terms of navigating careers, pushing me when I needed to be pushed to grab that next opportunity when I may not have had all the confidence to do it, or to support me when I needed cover in stepping back.

My husband and I talk quite a bit about careers and we truly partner in helping each other progress our careers. I think that partnership cannot be underscored enough.

Beth: If you could have one do over, what would it be and why?

Arpana: My one do over would be early in my career to slow down a little bit. My second maternity leave was a few weeks and I just hadn't learned that everything really will be fine if I'm not there actually doing it all. Had I slowed down, I not only think that I would probably have been happier, but I certainly would have been more effective.

Beth: What's one piece of career advice that you wish you could go back in time and give to your younger self?

Arpana: Breathe. I would say just breathe. That if you are truly genuine to yourself and if you work hard, things really do work out and be open to changing the definition of working out.

Beth: And then my last question for you. How do you define success?

Arpana: My definition of success has certainly changed over time. Right now I define success by being able to help others around me thrive in ways in which they otherwise wouldn't, be those people students or my colleagues, my superiors, my friends, my kids. At this stage of my life, it's really about engendering other people's abilities to find joy.

Beth: And to thrive. And for that, I have to say thank you so much for being a part of our podcast because we are also trying very much to help people thrive and find their paths and do it through hearing the stories and advice of such accomplished people like you.

So thank you so much, Arpana. I've really appreciated you sharing your story. It's been fascinating on many levels.

Arpana: Thank you very much.

Beth: And now, here’s the update I promised at the beginning of the episode. 

My executive producer, Dan Henkle, reached out to Arpana to check in with her and find out what role she’s playing on the medical team at UCSF. Here’s what she reported: 

"As an academic hospitalist during COVID, I am certainly spending more time in the hospital caring for patients. I am re-learning to "lead from where you are". Importantly, I am actively practicing the leadership that I usually teach – trying to communicate clearly and confidently while authentically acknowledging the uncertainties and subsequent stress within my teams. I am also bridging my Singapore experience to the US by making connections between hospital systems and creating collaborations. I authored an article for the Journal of Hospital Medicine titled Understanding the Singapore COVID-19 Experience: Implications for Hospital Medicine to share the insights more broadly. Lastly, I am practicing, espousing, and teaching resilience within my teams, colleagues, family and friends." 

Arpana, on behalf of the Career Curves team and all of our listeners, I want to thank you and express our deepest gratitude for the work you’re doing. We have made a donation to the UCSF COVID-19 Response Fund in Arpana’s honor. We’ve put a link to this fund on our website, careercurves.com, if you would like to make a donation, too. 

Also on our website, is a link to the article Arpana recently wrote for the Journal of Hospital Medicine. 

Finally, please share this inspiring episode with your family and friends. If you share on Facebook, LinkedIn, Twitter or Instagram be sure to tag us. You have no idea how happy this makes us. 

That’s it for this episode. As always, thanks for listening.