Dr. Jason Strachan: Exploring Clinical Paths

Samantha: [00:00:15] Hi, this is Samantha and welcome to The Layman’s Doctor podcast. Today, we have with us Jason Strachan who’ll be talking about– a little bit about his journey. Just going to preface this. We still have COVID-19, so all our recordings are happening over the internet. So if you’re having any issues with sound, just bear with us. We have to stay safe during this time. Jason, thanks for joining us. I’m so happy that you said, “Yes,” to being a part of this little kind of series that I want to put together. I’m really excited speaking to you and getting to know how you got where you are. So can you just go ahead and give us a little rundown about who you are and what you’re doing now?

Jason: [00:01:04] Hey Sam. Thank you very much for having me on your podcast. I’ve heard a lot about you, only great things, for our long time. Observed you from afar. So I mean, this is really great to be a part of. All right, so a quick rundown on me. I have been a doctor since 2010; was in that graduating class. Worked in, pretty much, every hospital within SERHA between 2010 and 2019. Did some things outside. I’m in New York now for the past year and change, working in the medicolegal industry. So right now, a lot of the doctors will look at me and be like, “You’re the enemy,” because I help lawyers decide to– whether their malpractice suit or a claim has any merit or not. So I more see myself as a patient advocate now still. And then, I help doctors too because everyone will have a bad outcome and be like, “You know what? We want to sue.” But the majority of the times, more than 80% of the times, I tell lawyers that, “Look, what happened is not negligence. It’s not a standard of care deviation. The doctor didn’t do anything wrong. This is just a bad outcome.” So that’s what I do know.

Samantha: [00:02:25] Okay, great. Medicolegal: I’m really interested in that actually. I think that our framework here in Jamaica, we could get some help with it, some guidance. And I don’t know if you work with the laws and policies as well, or is just kind of privately about that. When you touched on SERHA– I just want to say that SERHA is the South East Regional Health Authority. So that includes, what, KPH, Kingston Public Hospital, the Bustamante Hospital for Children– or is it Bustamante Children’s Hospital?

Jason: [00:03:01] Whichever [laughter]. I think it’s BHC. I think [crosstalk]–

Samantha: [00:03:06] I always mix it up, Bustamante Hospital for Children. And then, I think Princess Margaret is included in that.

Jason: [00:03:13] It is. And Spanish Town too.

Samantha: [00:03:14] and Spanish Hospital as well. So those are the South East Regional hospitals. So did you go to Princess Margaret?

Jason: [00:03:22] I did not go to Princess Margaret. We had to deal with them when I was at Busta in Ortho. You get accustomed to the children from St. Thomas who drop outa de tree and come wid dem fracture radius or wa’eva; may need surgery. But the people at– but the doctors at Princess Margaret are so overburdened because, I mean, as you’d hear it on the news a couple weeks ago, it’s only two ah dem covering the entire hospital. So I mean, they will just call you and be like, “Hey, we have this here. This child needs surgery. Can we send them to clinic? When is clinic?” And we’ll be like, “Yeah, send them tomorrow.” And we just got accustomed to that.

Samantha: [00:04:03] Okay. So you worked in Jamaica for how long?

Jason: [00:04:07] From 2010 to 2019. So that would have been 10 years. I’d like to say I gave 10 in the pen.

Samantha: [00:04:14] Oh, okay. Okay. So can you, in that 10 years– and then you kind of pivoted to– did you specialize at any point during those 10 years?

Jason: [00:04:26] I didn’t. And it’s not through– it’s not because I didn’t want to; I did. In I think 2014, I tried to get into the Orthopedics program in– yeah, as in through KPH, and I had an interview; wasn’t successful so I didn’t get through. And then the following year, I could have as well. It didn’t work out. At that time, I think I went through the wrong application process the second time because my boss at the time had said, “Hey, if you had applied through the region at this time, you’d have gotten through. But you decide to just apply to UWI.

But there is so much misinformation and– for residency programs especially, if you’re not at UWI, that a lot of times, a lot of us who are in the public system can end up just having to take another year because you didn’t follow the right protocols or you don’t know the right people or it’s– there is a lot that’s– for young doctors who want to specialize in Jamaica, it– there are a lot of boundaries to getting into it if you’re not at UWI when you’re at the forefront of everything.

Samantha: [00:05:45] That’s really true because even getting the information about applying for DM programs, you have to ask around. I think that’s the best way to get it. And even the times that you have to apply, if you’re staying at your region, you have to apply for a training post, then you have to apply for the program itself. And that kind of information, I think we only recently got it just because during our orientation our SMO had kind of brought it up. Our SMO, won’t call their name, encourages their staff to go to the program and come back and become specialized and whatnot. So I know a little bit about that. I think that’s a good idea for maybe a future pod where we talk about how to get into the program here locally. So you applied twice, didn’t get through twice. At that point, did you think it was a setback or– how did you feel about that? Were you, I don’t know, kind of like, “Ugh, this sucks.”

Jason: [00:06:54] For me, how I look on these things is we have to keep moving forward. For myself, for my friends, for my peer group, we don’t stop moving. So whether it’s that we get– we progress the way we want or we don’t, the mission is the same. It’s advancement of ourselves and advancement of everyone around us. So I did not get through, but I said that, “Well, this is not for me.” And a lot of that maybe because of the position I put myself into or it’s just not things working out in my favor. So it’s just about what is the next way forward. And I knew that my next way forward was not me working as a GP until I retire. That’s not going to be it because when I finished– so, I mean, I guess we’ll go through this, but my trajectory took me through various things. I stopped working in the hospital 2015. I went private and then came back, but I was working in a private office at the time, and I was like, “This is not going to be it or me permanently. So what is the next step?” And then is when all of the US exams came into play, British exams came into play, industries outside of clinical medicine came into play and, I just decided I was going to research, I was going to dig in. And wasn’t an everyday thing to try to find my way forward.

Samantha: [00:08:41] So at what point did you decide that, “Nah, this is not it. I need to leave”? Was there a moment where you decided, “I’m going to work in medical legal,” or was it just, “I need to leave Jamaica. I need something else”? How did you get to that point?

Jason: [00:09:00] There was never a moment that I decided that I was going to leave Jamaica until I decided I was going to leave Jamaica. I actually thought I’d be living in Jamaica all my life. But when I did USMLE Step 3, that was in August of 2018 in Minnesota. After that, I just said– because it was late to apply at that point and I just realized it was too far in the game for me. By that time, I was eight years post med school. There are maybe, in all of America, 10 universities or 10 hospitals that will take you 10 years post. And I didn’t get an interview for any of them. I didn’t apply to any of—I didn’t apply to many of them. The year before, I had applied to hundreds; spent way too much money. So to answer your question more directly, there was no real time when I decided that, “You know, I’m out of Jamaica, I’m not going to do this again.” It just kind of worked out that way. And then, knowing that I had the green card, so I could probably work in something outside of medicine that I wouldn’t have to be sponsored because sponsorship is a major thing when you’re talking about working in America. I’m like, “You know what, let me see if I can fit into something outside of the realms of clinical medicine.

Samantha: [00:10:43] All right. So we have a lot to unpack here, a lot. So, all right, you—a summary: you did the exams, USMLE 1,2, and 3, right, and then– but you were also 10 years post. And then you said, I think– how do I phrase this? I think that for us, from my perspective and possibly a lot of other’s perspective is just, “Oh, you know, you do these exams,” and it’s always “these exams”. The specifics of the exams are sometimes very rarely spoken about. You do these exams, you apply somewhere, and then you automatically go into a program. You, up to now, you’re still not a specialized physician.

Jason: [00:11:33] Yeah. All right, the system isn’t fixed that way. And the system isn’t rigged. I mean, well, it’s rigged for American medical graduates. There’s no debates about that. I’m not wearing a tinfoil hat to say that. Most people in America would let you know– or people who would like to open their mind to understand the issues with the American system of matriculation for medical students for medical students, is that they prefer their US medical graduates. So that’s who they want. And it’s so much that there’s some states who do not allow foreign medical graduates in their residency programs. And how you know is because they’re like they don’t sponsor H1B visas. I mean, that’s another issue altogether, but you know that you can’t get in. Now, for me, I had– after I decided that I was coming here, I had let go all desire to be a specialist in a medical field because it wasn’t going to happen. The best time to do it, if you’re coming to America, is within the first two or three years; finish your med school. If you don’t do that, then you’re not going to get through. It won’t be easy. I mean, you can get through; people do. But the easiest time is early. I guess what I’m saying is I have– you take the time, you explore your options, and then when you realize that things aren’t always going to work in your favor and you just try to find the best way through.

Samantha: [00:13:20] I question I know a lot of persons might be wondering though, are you able to practice clinical medicine in the States now?

Jason: [00:13:27] No. I can’t. I’m not licensed here. I’m not licensed in Jamaica either because I did not renew my license at the start of this year. I could have; I had enough CME. I could have if I wanted to, but—so now, in my job, I act purely as a consultant in things that I practice. So I mean, I did the four years of work at Bustamante. And I learned so much Orthopedics in that time from Dr. Sawh and Dr. Blake that– I learned x-rays to the point that I’m reading x-rays now and I’m helping my team prosecute radiologists who can’t read x-rays. So, I mean, I pick up things– and MRIs and CT scans from—because even just as an MO, where I worked, it was so intense, and in a good way, that we learnt how to manage these things. You learnt, as an MO, how to be the one responsible for everything. So honestly, working with Dr. Sawh, Dr Blake for three years, that was a residency program to me. No one can tell me otherwise because we worked and we did everything.

Samantha: [00:14:47] All right. Okay. So I’m really, really interested in knowing how you got where you are now because I– it’s like– I don’t know how to describe it. They don’t connect. You’re just like, okay, you did Med School, great. You tried to get into the programs; that never work out. And maybe also because of some– not really having the knowledge or not really having the support that you needed to get in, maybe? I don’t know. And then, doing  USMLE, and then now doing this. So let’s talk– I know a lot of persons are interested in USMLE. Let’s just have a little run down, or not maybe a little, but—no, because the truth is, when you talk about USMLEs, it’s just like, “Oh yeah, go and get– do your DM abroad. Just do USMLE.” And then you go, “Okay, but how?” And then there is almost nothing after that. And that was one of– I think that was one of the main reasons why I– I don’t know if you saw that I actually formed a group, a Telegram group.

Jason: [00:15:54] I saw. I see the group. I see the group.

Samantha: [00:15:56] Right. And it’s like we have persons at different levels of research in it. So my hope was that you could just– if we brought these persons together, then at least it would break down the– it would lessen the research time that you’d need. So it has maybe about 20 or 30 persons. If you’re interested in joining the group, you can simply send me a DM or an email, and I will send you the link. It’s primarily for Caribbean folk. So not just Jamaicans, but Bahamians, Trinidadians, and so on. But yeah, can you just talk to us about your process, about how did you– how did you go from deciding to do a USMLE to actually doing it. And I know you talked a little bit about British exams. I not sure if you did them.

Jason: [00:16:51] I did not do them. The thing is that– okay, so I’m a British citizen. So doing the British exams would have been really easy for me to matriculate into that process, but I decided against it.

Samantha: [00:17:04] So how did you go from deciding to do USMLE to actually doing the exam?

Jason: [00:17:10] All right. So for me, once I decided in—all right, so I graduated in 2010. I wanted to do USMLE in about 2011, but circumstances didn’t work out that well for that to happen then. So I was at Busta. My contract with Bustamante started in August of 2012. So it would be– it would end August 2015. Near to the end of it, I had applied twice to get into Orthopedics. Once was through the Regional Health Authority; one was through University. I was not successful either time. By the end of it, I’d become really disenchanted with the system and that I didn’t feel like I had enough guidance. And that’s not on my bosses at the time. I set that on me. I did not reach out to get enough information because if we’re to be honest, the information is not out there. There is no information that’s out there for us as medical officers or SHOs or interns as to the best way to matriculate through Jamaica’s healthcare system, how to get your residency and move forward. So at that point, I decided that I was going to do exams to leave. So it was either England or USA. And at the time, I said, “I’m a British citizen. I can do the English exams.” I’ve seen so many people do it, but the US exams seem a lot easier because if I did the US, I could get straight into a residency program from that. I didn’t have to go through any system like you’d have to go through in England or in Canada where if you get into those systems, you still have to go and work at the hospital first, and then get an attending or a consultant to vouch for you. And then you can– you’ll get through. But the American system, on the surface, appeared way more merit-based,  meritorious. But it doesn’t really bring to light some of the issues with it, I mean, which are chronicled well. So that is how I decided to leave that system.

Samantha: [0 0:19:23] Okay. I remember when you made your tweets, you made like a thread and you were saying that it’s not really based on merit, but also really kind of who you know and who you [having?] to vouch for you type of thing. And I know that one of the concerns that persons have now, especially international medical graduates, is the fact that USMLE is now going to be pass/fail. So now they’re saying if it’s pass/fail now, how will they– how will I be able to get into these things and whatnot? And I’ve actually heard quite a few people say, just from my own asking around and whatnot– because that’s– one of the best ways to get information is to ask people who have already been through it, right. They’ve really just been saying you kind of have to, I don’t want to say know people, but you kind of have to also know people as well. I can’t remember exactly what your thread was saying off the top of my head.

Jason [00:20:30]: Sam, I’ll get into it. Sam, you have to know people. And you have to know people who know people. And it’s not to say that there is nepotism or cronyism in whatever. The US medical system is no different from a lot of other industries in other places, right? So they [inaudible] that they want their own. So if you have done an observership or an elective or a sub-internship at a particular program, you are more likely to get in a program because you know the people there. They know you. They’re more willing to trust you than somebody who they have never met.

So what ends up happening is that there are some hospitals here– I mean, you have Jackson in Florida; you have Inglewood; Seton Hall in Jersey; in New York, you have Harlem Hospital; you have SUNY Downstate in Brooklyn; you have Flint McLaren in Michigan. Those are programs where you have– end up having a lot of Jamaicans in various specialties– and Jamaicans and Caribbean. And then you have Tallahassee Regional where you have a lot of Jamaicans,  UWI medical graduates there. You have a lot of Jamaicans there, Jamaicans, UWI Med School graduates.

So what happens is that the program coordinators are there and they know the residents there, and the residents are Jamaicans or Trinidadians, St. Lucians, Bajans. So that creates a pipeline for us. Why? Because the senior residents, the chief residents, junior attending are going to be like, “This person, I know them.”  What that does is that it makes the program coordinator a lot more open to interviewing you, which is where it all begins. If you can’t get an interview, then you don’t have a chance. So if you have more– and it goes to more to representation, [inaudible] representation, Caribbean, Jamaica. When you have people there who can vouch for you over people– because they’re a lot more likely to give someone from America who is not nearly as good, a lot of the times, as we are coming from Jamaica. They’ll give them a chance because they’re like, “Hey, this person went to Wesleyan or Yale or whatever or UNC. But the thing is that we have one in Jamaica. I mean, there are some offshore places, but I mean, I haven’t met any doctors here who are better than we are. They’re not even close. But they have the connection because they know of them. So when Jamaicans go to these other places and excel, they’re like, “Hey, we got this from Jamaica.” So this person interviewing is from Jamaica or wants an interview and is from Jamaica; let’s bring them in. So that is why the networking makes the difference that it does.

Samantha: [00:23:36] Just listen to this, it sounds kind of like of a daunting, procedure because it’s not just saving money and studying. Now, you have to think about, “All right. How can I get these connections? Who can I reach out to?” And I think this is where mentorship comes into play a lot. And Jason, I’m so sorry for your DMs because you just list off a whole bunch of universities. I know after this, people are going to be like, “Hi Jason, I’m a whatever, whatever, whatever interested in doing USMLE, trying to look for a university. Is it possible that you can blah, blah, blah?” I can see that happening because, yeah, you’re– especially because just from what has happened in Jamaica, you seem willing to give the information and help out the yutes dem a likkle bit.  

Jason: [00:24:33] Definitely. It’s my job. When I was more of a senior as a medical officer, I thought my job then—even when I was a final year student, I tried to ensure I taught the third years and fourth year. When I was an intern, I mean, even residents now who are probably attendings would tell you that I tried to ensure that they learned. I took them aside and I tried to teach. My thing is that it has to be- it’s a group effort; it’s a collaborative effort. I can’t I have this knowledge and not try to impart it to other people. I’ve been through the process. There’s no value, there’s no sense in people going through what I went through when they don’t have to. So if I can provide an avenue where people can jump the missteps that I made and just go through the important things, then I think I’ve been successful because I don’t need people to go through what I went through. I want them to just be successful going forward.

Samantha: [00:25:42] Okay. So we’re still on USMLE. Just, can you give a breakdown of what the exams are? I know that there’re some of us who are absolutely clueless. I was. I think I only recently learned that it’s actually three exams. I always thought it was just one multiple-choice exam.

Jason: [00:26:00] Four exams, Sam, four. Four of them.

Samantha: [00:26:02] Wait, it’s four?

Jason: [00:26:04] Well, three steps but four exams.

Samantha: [00:26:09] Oh, okay.

Jason: [00:26:10] Right. So let’s go through them. So now, let’s go to step 1 first, step 1. And I have had people in my DMs. They’ve reached out to me, people in med school. “When is the best time to do step 1?” And I’m saying in third or fourth year. If you have parents who are fortunate enough to be able to allow you to get the head start on life that you can get, and you can have– you can do your step 1 in Med School, do it. It’s easiest to do then because it’s fresh. When I did step 1 five years after I finished with Med School, so that’s eight years from pre-clin,  and I swear to you, so many of the things that I learned, I didn’t– I never learned them in my life. Either that or it was so far gone that I just didn’t remember them. So the best time to do it is when it’s fresh. Now, it’s pass/fail. So that’s great. So you don’t have to worry about getting in the 260s or 250s or anything. And then people are getting like 200s or 201s. No. You just pass it. That’s fine. It’s a pre-clin exam. It’s difficult. It takes time. I think step 1 takes about four to six months of hardcore preparation. And then, of course, you have to do it in America. If you’re from Jamaica, you going take the trip to like Florida or wherever and go and do it. If you’re in Trinidad, Trinidad has USMLE centers. So they can do it there. [inaudible] for that. For step 2, step 2 has two parts. Step 2 CK, step 2 CS. CK, clinical knowledge, is like– it’s like your MBBS exam. It’s like your final year exam. There is nothing in that that you did not learn in MBBS. So it’s great to do in final year or internship. And you just do it and get it over with. It’s not harder than MBBS by any means. And then, you have step 2 CS, which is your clinical skills evaluation, which if you are in Med School or internship, you do not need to practice for this. I prepped for this in two weeks after being out of Med School for– at that point, it would have been six or seven years. And it was routine.

I mean, I practiced on a friend that I was with at a time. I did my examination practice on her in two weeks. There’s a first aid book for step 2 CS. And step 2 CS, honestly, checks how empathetic you are, how well you can communicate. And it’s very little about– you don’t do your OSCE exam stuff. It’s a very focused– you see someone with a DVT, that person comes in with a red mark on their calf, and you just examine that and you document it. It’s eight hours of attrition. It’s not difficult. The only thing you need to ensure that arrangements are good because it’s in– it’s only in five states, and you just– I think it’s a Georgia, Texas, Pennsylvania. It’s in California and Illinois. But in Atlanta, there is a hotel that is right there, right by the exam centre. Now, if you let them know that you’re coming to the step 2 CS, they give you 50% off.

Samantha: [00:29:38] Jason, mi sorry fi yuh DM dem. All right, I don’t think we’re finished.

Jason [00:29:44] All right. So step three is different steps. Step 3, generally, you don’t have to do that until after your first year of residents. So most people don’t do step three before they get into residency, right? I did step 3 trying to get into residency as a kind of a Hail Mary, a kind of a last Hurrah. So I was like, “Screw it. Let me do it.” It’s two different days, an eight and a six-hour exam. It’s almost like you are– step 3 is for people who already have a medical license and they’re accustomed to practicing with people. And it’s about getting accustomed to the system that they have, for you to put stuff in. It’s not difficult. None of the US exams are as difficult as what we go through for MBBS. I guarantee. Which is why you have a very high rate of matriculation for people in Jamaica who want to go– who decide they wanted to go to America and put the time, the effort, the finances into it, because the time, the effort, and the finances are all necessary. It’s an understated thing. You spent so much money in trying to do this.

Samantha: [00:30:59] You want to give some, I mean, some ballpark figures? Like what? And what are we necessarily spending on, things like that?

Jason: [00:31:07] Sure. Sure. All right. So you’re USMLE step 1 is going to be about– I guess by know, it’s going to be about $1,000 US. Your step 2 CK will be about the same. Your step 2 CS will be about double, probably about 2000. Your step 3 will be about 1,005. But then in between all that, you have to factor in the fact that whatever resources you’re using is going to be an issue. You have to pay for those. And then there’s the travel because you have to do all these in America. So you might have to pay for your plane trip, of course, your plane fare, and your hotel fare for other things. So I think the whole process as– and we’re not even getting into applying for places and those interviews. Just to do– leave out step 3. To do step 1, step 2 CS, step 2 CK, and be able to be ready to practice medicine in America as a Jamaican, you’re looking at, honestly, about 6,000, 7,000 US.

Samantha: [00:32:18] Wow. That’s basically one year of our school fee. Well, no, no, no. That’s the sponsored, that’s the—if you’re sponsored. Wow. So 6 to 7,000 US. That’s really expensive.

Jason: [00:32:32] Of course, that’s spread out. That’s spread out over a few years, of course. But yeah, [inaudible].  

Samantha: [00:32:37] Yeah. It’s still expensive if you consider persons who have loans, other bills, children, have to take care of relatives. That’s a pretty chunk of money.

Jason: [00:32:52] It is. And then on top of that, you have to remember your first few years as a resident, you’re not really making good money. In America up here, especially like in New York, you probably going to make—your first year you may make like 55,000 for the year, then next year, you may make like, what, 58, and then 61. And then it’s after you finish residency that you start to make a lot more money. It starts to shoot up after that. But yeah, I mean, as a resident here, you’re not making great money. You have better working conditions than in Jamaica because, of course, they cap the amount of time you can be at the hospital, but you’re– it’s tough. It’s a struggle, especially in the city itself.

Samantha: [00:33:34] Okay. We’re about to move on from this conversation. This is about you and alternatives pathways, right? We’re not going to get into the residency program and all of that in this podcast. We’ll maybe address it in a next one. But you did all of that now, you spent all of that money and you didn’t get into a program. How did you transition from– how did you transition into where you are now? Because you did all of that. How did it happen?

Jason: [00:34:15] Well, I decided that I was not going to practice medicine in Jamaica in about 2018 or 2019, definitely 2018. So by the end of then, I was– I realized that I was not going to get into residency; I guess you’d call it du jour in the way that was going to be typical that Jamaican– we’d just work, work, work, and then get into a residency program. It was not like to be that way for me. So I thought that I would come to America, having the green card, and just get into an industry, get into whether it’s a medical assistant role, which is what a lot of Jamaicans ended up doing here, medical assistant, and then work there, work as an assistant to a doctor at that particular office, get them to write a recommendation letter for you wherever they studied, and then hope that pushes you to get to an interview when it’s time. And that tried and true and has worked for many people, for Jamaicans and otherwise.

For me, I think at that point when I realized I didn’t get through, I just decided that this was not what I’m supposed to be doing. If it was, then I would have gotten it. Otherwise, you know what, let me try and find another way. So I never even thought of medicolegal. What happened was that I thought of more health– the field called Health Informatics. With Health Informatics, that’s more like coding, medical auditing, stuff like– which is a major [industry out here now?]. So with that, they’re talking about whether it’s medical liaison work, whether it is just ensuring that the coding, the auditing of all these things is in line.

I actually got a job in California before I got this one now. That was lined up with one of the healthcare agencies over there. But it just didn’t– it just wasn’t as good as this one I have here. So it’s going to– if you’re like me, you become so hyper-focused and driven about how to make it forward. How am I going to do this? “All right, this is not my path now. I’m not going to be treating patients going forward, so what am I going to do?” And then with Healthcare Informatics, you start to think about what certifications you need.

So there are a bunch of certifications to get. And then there’s some that don’t require you to have the certifications and will pay for you to get them. So it’s just that in America and in places outside of Jamaica, you have so many places that want doctors to work for them. But they don’t want– they want an MD or medical degree, but they don’t need you to be seeing patients day in, day out. So it just kind of made sense.  

Samantha: [00:37:21] Somebody somewhere just had a, what’s it called, a lightbulb come off in their head when they’re just like, “Wait. I can do other things with my medical degree other than see patients?” And I think that for a lot of us, that’s all we think we can do with it, just– because I have a friend who works in– is a doctor, works in medicine, but mostly the tech kind of stuff in medicine. And I’m just like, “Wait, you can do that?”  And I was just about to ask you: did you have to get– did you have to study anything else? Did you have to get any more credentials to do what you’re doing now?

Jason: [00:38:08] To do what I’m doing now, absolutely not. I mean, I suppose we’ll get into that at some point, but you don’t need any more credentials than I do know. It’s fun. I study more now than I did when I was an MO. And when I was an MO– when you work with Dr. Sawh [inaudible], you work. He’s the best boss I’ve ever had. And when I see him, he and I still talk. I saw him– I was in Jamaica in November for a wedding and I saw him [inaudible] again. I spoke extensively. I have so much respect for him. But you work; you work really hard because he pushes you because he wants you to act like you are a program resident. That’s his expectation of you and I respect that. But up here, for the stuff that I’m doing now, you don’t– as in there are other things I could have been doing that if I was doing them, I would need other certification. But for this, no. I’m fine. I have more access to articles now than I ever did. And I just read those.

Samantha: [00:39:32] Okay. So let’s go right into that then. How did you get where you are now? What was your process?

Jason: [00:39:44] Okay. My process was I was applying for– so this would have started right after I finished step 3, which would have been August 2018. I didn’t apply to– the year before that, I applied to more than 100 places for USMLE spots– after USMLE for spots. I hadn’t done step 3. And that cost me– Applying for places, if it’s a lot, will cost you more than 2,000 US. I got no interviews, so it was a waste of time. I mean, for me, because I didn’t get anywhere. If it was successful, it wouldn’t have been a waste of time. But by the time I’d done step 3, I had already come to the realization that that’s a very good chance I will not get in.

Whether that’s a combination of the fact that throughout Med School, I was– I mean, I was a good student. I wasn’t the best student by any means. But I was a good student. I focused a lot on building the hall. I lived on Preston. I was focused on building the hall and ensuring certain things. I was in charge of orientation for many years. So when in 2018, end of that year, I decided that I’m not going to close off any opportunities and just say, “You know what? I have to be seeing people.” So I started looking on whether it’s ZipRecruiter or Indeed or LinkedIn for– and then I Google searched for jobs for doctors outside of Medicine or nonclinical jobs for doctors.

And I started seeing that there was a thriving industry. And then I started seeing so many doctors who did not want to practice medicine anymore. And I had a few friends. I mean, talking about guys like Maurice Taylor who was president of JAMSA– or not president of JAMSA, president of my year’s class and other things. And he had not practiced medicine since he graduated. And he’s living in Canada and he’s happy. I saw him one time at Strictly 2K and he and I spoke briefly. He just seemed happy. And I’m like, “Wow. Okay.”

And then I saw other people who were very happy having their degree and not practicing medicine. I’m like, “All right. Well– and you know, I could do this. But you know what, let’s keep this Medicine thing here just in case we want to do this.” And I just started searching and me, the person I am, I’m extremely driven. I don’t really need anyone to push me to do anything. I just said, “You know what? Let’s just go.” And I just kept going down a rabbit’s hole over and over and over, and trying to see various job opportunities, whether it was in the US or Canada or UK, Australia, Greece. I was seeing them. And I was emailing.

Sam, I promise you, I applied for at least 1,000 jobs within medicine, whether it’s a business aspect of Medicine– you’re talking like venture capital, like big pharma, stuff like that. And I got more than 500 noes. But you get one yes or two yeses and that’s it. That’s all you need it. You shoot your shot and if– all you need is one person to believe in you. And I was lucky enough to get that.

Samantha: [00:43:37] Wow, I’m just– I think we don’t talk about it enough, that there’re other things you can do. Because I think even for me, it’s just like, “All right, I’m not really into ward Medicine. I can’t, deal with it. Right? Ward Medicine is not for me.” But then, you start thinking about private practice, and then private practice is just like, “Hmm. Okay, private practice,” whatever, whatever. And then for persons who aren’t really happy with either of those things, when you start thinking about, “Okay, what are my alternatives?” it gets a little bit more difficult. Most of us don’t really know– or a lot of us don’t really know persons who, as you said, have studied medicine and are no longer doing it. And then, we don’t really know what else is out there. And another thing is maybe some of us don’t want to leave Jamaica. You get me? I don’t know. And I’m not sure if you’d know much about that, but if I don’t want to leave Jamaica, what are my other options working as a– working as something else in Medicine, but not seeing patients. I don’t really know.

Jason: [00:45:08] Fair. Well, let me say this because there’s a lot there that, I guess, we can unpack. Let me say that five years ago, I would have never imagined that I would leave Jamaica– not five, six, in 2014. Never. I thought I would have spent every day in Jamaica for the rest of my life. “Jamaica nice. Yow, nah leave.” But the reality is that for doctors in Jamaica, if we don’t start to think outside of the bubble a little bit, outside of the box, then a lot of us are going to be unhappy.

I mean, I have friends who have decided to go to other industries. My friend, Natalie Walsh, she’s with Sagicor doing very well now. You have other people who are– Leighton, [inaudible], Dr. Myers, he was really deep into his residency, but I told him when we were very fresh from Med School, because he was my– we were in the same year. I was like, “Leighton, you’re going to be one of the best DJs in the Caribbean. That’s what you need to focus on.” But not everyone will have their niche market like what he has. He’s a testament to rising above and moving on. Leighton is great.

But for us who don’t have those skills, those great talents outside of Medicine, it’s just that how are we going to take or medical knowledge, our skills that we’ve learned in these five years and find a way to move forward. Not as easy. Jamaica and the Caribbean on a whole has not created avenues for us to use our medical degree outside of medicine, and that’s a shame that it is. That’s what happens in a third-world country. In developed countries, that’s there.

I guess what I would say is don’t feel like– don’t settle for what you are in now just because you think it’s the only way forward. I think then, you end up doing a disservice to yourself, and then by extension, to your patients. You need to know that, all right, this is what we’re going– this is what I want to do. I wanted to treat patients or I want to practice Medicine. Then, how am I going to be most effective? Is it going to be impatient care? Is seeing patients day in, day out for me? I did it for 10 years and I could still do it. But after a while, I mean, what’s the value?

I mean, I love doing it. You get a steady– I’m not going to say a great; you get a steady paycheck. And then, the whole private practicing thing in Jamaica is a sham. If you don’t know the ins and outs of private– I did private practice for a year while doing different things. And there are certain ills to this that are very much unknown and not discussed as much as they should be because– you need to understand all the ills that come with private practice before you decide that this is what you want to do.

Anyway, to get back to my point, I think there needs to be more open spaces where we can– and it needs to be encouraged for older, more senior doctors to talk to doctors like yourself, other doctors who are just finishing Med School, in internship, so there’s a pathway because the system at UWI now where you have your academic advisor is outdated. It’s archaic. And it’s just going towards, I guess, you getting into a residency program.

But what if residency is not for you? Residency isn’t for half of the doctors in the program because– in Med School, because we all have different things we want to do in our lives. So I think that’s where we need to start, as to the guidance of young doctors into knowing the best way forward.

Samantha: [00:49:47] All I could think about when you were talking is– you know AIM? Nicole McLaren-Campbell’s AIM?

Jason: [00:49:54] Yes. I don’t know it, but [inaudible].

Samantha: [00:49:54] A Medicine version of AIM where basically – I think what she does – I’ve never used it because, obviously, I studied here – is she kind of facilitates persons who want to go abroad to study, to get so and do it affordably and whatnot, right? So I was just like, “Hmm.” Because I just know that people are going to be asking you because we don’t know where to get this information. And I’m just thinking here like, “Wow, how can we get this information out there?” I am trying to do my part as best as possible. That’s really the point of this, but at the same time, you’re right. We need to encourage doctors to talk about it and move past that whole advisor thing. I don’t even think– I don’t know who my advisor was in Med School.

Jason: [00:50:56] Me neither.  

Samantha: [00:50:57] So I don’t really know much about that. But just a touch on the private practice thing. You said, “Sham.” What you mean by that?

Jason: [00:51:12] Sam it’s a sham, right? Leave the rhyming out. Now, look, right? So I was working in somebody else’s practice for a year and it was good. It’s only a year? I feel like it was more; may have been more. Anyways. No, actually probably closer to two years. Now, what they did was that– it was 50/50. Any patients that came in, I got 50% of whatever procedure I did or the visit. So the visit would cost like– so like 2 grand, 2.5. I get half of that, whatever. And then, of course, after all that, that all gets taxed and you have to report it and all of that, so.

The sham of it all was that I was at a very reputable place in Portmore, so my volume was high. Now, I was working in somebody else’s practice. Now, if you want to start your own practice, that’s difficult. So when I see young ladies like Jade Jeffrey, Dr. Jeffery– she and I had spoken a bit recently and she’s been–  her mobile medical thing has been amazing, and I encourage people to donate so that children can get the medicals. But to get people, to get patients when you’re private, it’s so difficult because it’s like– after a while, it’s like you’re pitching your services. You’re like, “Why should I–?” It’s like you’re trying to tell them why they should trust you with their life. And if you are a young doctor, like two, three years out of Med School, rightfully so. Why should they trust you with their life?

So you have to find a medical system or you have to find a medical practice or something where people are going to believe in you. And they either believe in you or they don’t. They want you there, and then it just depends on your client retention skills. And then people become so extremely picky about– all right, they like this; they like that; they don’t like this. But if they like you, they’re going to bring their entire family to you.

So I mean, I was working in Portmore at the time, and I had a lot of repeat clients and people who would call me at off-hours and people who only want to see me. And that’s more because of, I guess, my ability to talk to them and interact with them, rather than my medical skills. I mean, I think I’m still perfectly good medically, but it’s– there are so many things about a private practice that you don’t learn in Med School.

There’s the human relations, marketing aspect of things that you do not know in Med School because in Med School, a lot of the times, you end up just being– a lot of medical students end up being a bit arrogant and pompous, and I mean, I guess that’s what medicine teaches you. But outside of that, it’s about developing your skills as a human and ensuring that you know how to be a business person. That’s what a private practice is about, and if you don’t master that, you’re not going to be very successful.

Samantha: [00:54:32] Well, there are a few topics there that need to be talked on. Each of them would be like an hour conversation or more because we are definitely approaching that one-hour mark, and a lot of things have been touched just on the surface. But I think that you have given us a really good synopsis– maybe not synopsis. We’ve gotten a really brief summary of how you did what you did. Even from just listening and talking to you and getting a few more ideas about things that we can talk about and whatnot. But I really want to thank you for sharing this valuable information with us. And boy, Jason, mi so sorry fi yuh DM dem. I apologize in advance for your DMs because I know you’re going to be like, “Oh yeah, just DM me if you have any more questions,” blah, blah, blah. But either way, I think you’ve already put yourself out there on Twitter. Yeah, man. I’m so sorry. I’m so sorry.

Jason: [00:55:39] [inaudible]. How I see it is that if I can get people to– because I’ve had people DMing me and asking about the US system. If I can get more people to be more educated and to take their future into their own hands, I’m willing to talk and dialogue, whether it’s through WhatsApp, through Twitter, through video chat, Zoom, Google Suites, I’m willing to do it. I think it’s a way that I can give back. I mean, I’m giving back in other ways, but– I’m 10, 11 years in now. I think it’s more about ensuring that doctors that are coming up now have a much clearer path than we did 10 years ago. So I mean, doctors like yourself, all the doctors who are just finishing now, you guys– it’s about creating an avenue that we can have this discussion. And it’s not uncomfortable. I try to be as welcoming as I can. So that’s how I do.

Samantha: [00:56:35] All right. So how can we reach out to you?

Jason: [00:56:38] Easiest way is on Twitter, Flassknows, F-LA-S-S-K-N-O-W-S. It goes off of Bo Jackson from Sports: Bo Knows. That was a popular thing in the early nineties. Yes, I’m old [laughter] [inaudible]. Sam, you weren’t born yet, were you, Sam?

Samantha: [00:57:00] I was born in ’95, sir.

Jason: [00:57:03] [inaudible] you were not born yet. You don’t know about that, but that’s [all right?].

Samantha: [00:57:06] No [laughter].

Jason: [00:57:07] [inaudible] I’m just telling you. But anyways [laughter]. But yeah– or on IG @iamflassman. Or you can email me, jason2k10@gmail.com. I’m very open to receiving emails, texts from people, from young doctors, whether they’ve finished Med School or in Med School, wanting to know the best way to go forward because I didn’t have it, and it’s so important because it helps to kind of guide you to your way forward. So I’m available for that kind of stuff.

For me, it’s just about ensuring the doctors have a voice because I think we have not had a voice and people have the wrong idea with us. I’m not excusing bad behavior on the part of some people. I’m just saying that I think we, as a collective, need to kind of band together and ensure that we are all moving forward in the same direction because it’s tough. And it’s a lot of work. So I just want the best for everyone.

Samantha: [00:58:14] Okay. Thank you again so much, Jason. This was a very informative conversation. If you’re listening to this podcast and you liked it, please share it with your friends. Please rate it and leave a review. If you want to reach out to me, you can always follow me, message me on Twitter, @thelaymansdr, which is @thelaymansdr. Or you can email me, @thelaymansdoctor@gmail.com. Thank you again so much for listening. I’m really excited. And Jason, it sounds like you will be coming back on this pod, so.

Jason: [00:58:50] I will be coming back.

Samantha: [00:58:52] Just waiting for that.

Jason: [00:58:53] Just call me. You have my number, right? Just call me. I’m here.

Samantha: [00:58:55] Okay, great. Thank you again so much. Until next time.

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