Rajee Hari:
Thank you so much Dr.Hiray for joining us.
This is Proteon Pulse and it’s our pleasure to have you on the podcast today.
I would like to request you to introduce yourself to the audience.

Dr. Hiray:
Sure. Thank you.
Thank you, Raji.
Thank you for giving this opportunity.
I really appreciate I know you for last 20+ years and I see your progress and it’s amazing.
You are an inspiration to all of us, not just our generation, but the younger kids.
I’m Dr.Nita Hiray, I’m an anesthesiologist, did my MD anesthesia from India too and came here back in nineties and had the pleasure to just continue what I love to do as an anesthesiologist and did my anesthesia residency here at Bella College of Medicine in Texas.
I have been in practice since 2001. Recently I changed my practice module. I was with a group practice and just working for a well known group in Houston and decided to take a plunge into just going into private practice all by myself.
So got that courage to just give up this secured work I had and went to work just for myself and then now finding another groups to work with and working on my terms as an anesthesiologist in her fifties.
And I’m very inspired that I have taken this step.
So I can decide when I want to work, I can decide when I want to take my vacation because I love to travel. So I have my own 1099 and I’ve been working with one group because work as anesthesiologists are in great demand nowadays.
So the work has been good for me.

Rajee Hari:
Excellent, excellent.
Thank you so much.
That is what I was trying to ask as my second question was having worked in a hospital system and then moving into your own 1099 practice, right?
I mean on your own, this is definitely a change.
What are the pros and cons of this change?
I would ask.

Dr. Hiray:
So the pros for this is you are your own boss.
Yes, you do work for another group, but then you can definitely decide how much you want to work, how many hours you want to work, when you want to work.
The other advantage, because of the demand, you can demand that, okay, I really want to do this.
This is what I prefer to do than taking care of OB patient.
I don’t do OB or CV anesthesia. So taking care of OB patient or CV patient we have reached after 20+ years of practice, we reach to that stage that we know what is the niche we want to develop.
And for me, I love to do endoscopies and anesthesia.
So that’s where I’m working and doing those cases and I really enjoy working that way.
The cons are you have to have your own liability insurance.
The health insurance another issue.
If somebody is not in good health to have your own health insurance or if you have a spouse, then you can count on your spouse continuing helping you with your health insurance.
But for me, I’m a single free bird, freelancer anesthesiologist. So really by touch of the God it really worked that I could just get a good health insurance.
And my liability has been also perfect for me. I’m with TMLT Texas Medical Liability Board which has helped me for last 20 plus years.
So I continue with that same liability insurance and that has really worked well.
So there are pros and cons too.
You need to have a good health insurance, as all of us know in us.
But you also need to have a good liability coverage too.
So what is the difference between being an independent consultant versus the local tenants?
There is not much difference.
But for locum tenants you don’t know whether you are going to have an opportunity to work next month unless until you are working with a wonderful recruiter who gives you monthly assignments. Yes.
As the cons are, if you work you earn, if you don’t work, you don’t earn. Yes.
So then that is the difference between 1099 working for another group as compared to the locals and plus then you have to travel to another city or another city and that’s wonderful opportunity.
I see myself doing that in near future, but I still am enjoying just this small change right now.
But in near future I see myself doing that too.

Rajee Hari:
Right, but one question is you said that as an independent consultant you need to have your own malpractice and liability insurance.
But for a locum tenants it’s usually given by the staffing agency or by the hospital.
So you don’t have to worry about that part of it.

Dr. Hiray:
Sometimes it is like that, sometimes it’s just if you have work just for one or two days, then it’s not covered.
It’s preferred that you carry your own liability insurance. Okay?
And plus if you carry your own liability insurance, that is your pros because then it gives you the freedom to work at many places too so that is negotiable point.
That is negotiable point.
If you have coverage, then you can negotiate that you want to get more per hour because you have your own coverage. Right?

Rajee Hari:
So you did mention about the recruiters and staffing, right?
What is your thought process as far as the Met staff is concerned?
What is your viewpoint of the industry in general?

Dr. Hiray:
Medical Staffing Industry pre COVID and post COVID I would like to see this that way or five years before and now things have really made all of us aware of the value for spending time with family.
Post COVID yes, not just my generation of people, but the younger generation also has changed their view of how much they want to work, how much they want to spend time with their family.
So the staffing really suddenly everywhere there is a shortage of not just the physician but the allied physician component too.
Like PAs, nurse practitioner for us, like CRNAs and anesthesia assistants.
So there is complete shortage because everybody wants to just work for certain hours because they want to have their family life too.
So that has really changed the whole dynamic of medical professions too.

Rajee Hari:
I’m aware of the fact that telemedicine is not an option for anesthesiologist, right?
You’re hands on, you have to be there to take care of patients.
So what is your thought process?
Is telemedicine medicine care to stay in general or how has that impacted health care and has it at any point impacted anesthesiologist?

Dr. Hiray:
Telemedicine is here to stay.
I see that most of the primary care really love doing telemedicine, not just a primary care.
Radiologist and so many other fields are really very comfortable doing telemedicine and that is also working from home or working from a place where you can take care of younger family members and things like that.
But as an anesthesiologist I don’t think that is ever going to be working.
We do use telemedicine for pre-operative preparation for the patients and follow up for the post-op to see if we have done a block or for acute pain control systems.
We do use the telemedicine but during the procedure you have to be our feel is blessed that we have to be the hands on and that is the beauty of being an anesthesiologist.
You have to be hands on and it is a wonderful job security too.

Rajee Hari:
I know, I agree with that.
Totally agree with that.
So what exactly do you see as a pain point for anesthesiologist?

Dr. Hiray:
Major pain point for anesthesiologist is we are always working behind the scene.
We are always mostly in the OR.
We just get minimum time to spend with patients and most of the patients don’t understand that we are the lifeline for them, right during those critical hours there are ups and downs and we are the lifeline.
Most of the patients don’t understand.
I treat my patient.
Every patient is special for me and every patient I treat as my family member.
So if I have to just start an IV also I’m like okay, please help me get not to hurt this patient.
I want to do my best just even to start an IV to the patient.
So that is the problem with the pain, with being an Anesthesiologist is patients or other allied professions don’t understand the work which goes behind to take care of the patients and to bring back that patient safely into the recovery room, into the post-op care.
That is the pain of anesthesiologist that people don’t understand what goes behind.
But still younger generation because the field has been so lucrative.
Reimbursement has been wonderful.
So for recent last five to six years, anesthesia has come up again and just few weeks ago there was a match and all the positions get matched completely 100% and most of the top 10% of the class is opting to become an anesthesiologist.
So that is a very good news for our profession.

Rajee Hari:
I mean, as you said, it could be the understated profession but then it’s actually the most important part of this whole operation procedure and totally understand where you’re coming from.
Coming back to the students, right?
You just mentioned about match.
What is your strong advice that you would give for students who want to pursue medical field?
What should they be going into the whole profession?
What mindset should they have, number one?
And for students who are in the final year, what is your advice for them?
What do you think that they should be looking forward to?

Dr. Hiray:
For medical students or younger students who are joining medical field, my advice to them is pick up a specialty which is hands on where you are going to do the procedure.
That is what is going to differentiate you from a PA or nurse practitioner or for my field as a cRNA or anesthesia assistant.
When you are doing the procedure after your medical school training, that is what is going to differentiate more for you as anesthesiologist, as an ENT surgeon, as a general surgeon, as
a gastroenterologist, cardiologist or cardiothoracic surgeon.
So these are the field, radiologists.
These are the main hands on field which are going to differentiate you from the people of allied profession, health profession.
So nothing wrong.
I guess we do need wonderful primary care, but nothing wrong against those field because I know so many younger generations are motivated to make that change into the healthcare system.
So we do need those primary care physicians too.
But if you have a chance, pick up a specialty which is going to be procedure oriented.

Rajee Hari:
And for students who want to enter the medical field, what do you think their mindset or their skill set should be to enter the medical field?

Dr. Hiray:
The love to take care of patients.
It is a long route, but if you really love the profession.
You will be happy because that is what all of ushave, that pursuit of happiness, not just monetary happiness, but moral happiness or giving back to the society.
So if you really love to work with and make a difference for your patient, then this is the field you need to be in. It is a noble profession.
You get so many blessings.
I always say it to my kids that oh, because my patient blessed you, you are getting that blessing.
The thing is I come from a family of physicians too.
So I always tell my mom and when my papa was alive, I used to always say that we have got that blessing because so many people gave you that blessing and that got continued to us my papa was a wonderful, wonderful family physician back in India.
And I think that this profession is so respected and noble that you have to have that love for the profession, then only you can continue.
There are many ups and downs in the profession too.
And the whole healthcare system is changing because I think physicians are not good business people.
We are just worker bees.
So things have changed.
But with younger generation, I would say that they just have so many other options to become lead a profession or lead a hospital, become a CFO or CEO with their background as coming from medical profession.
Those things I would like to see more as compared to somebody who just does his MBA.
Nothing against MBAs, but it will be wonderful to have physician oriented leadership for most of the hospitals.

Rajee Hari:
What was the event that happened in your life that was more memorable and it was something that changed your perspective about healthcare?

Dr. Hiray:
That’s a very good question.
Just taking care of the patients or my personal?

Rajee Hari:
In your hospital experience, taking care of patients when you are in the professional field. Right.
There must be something that must have happened to make it so memorable and you feel like so good about yourself.
You’re like, this is why I am in this profession.
That kind of a momentum.

Dr. Hiray:
When as a young resident, I did my anesthesia residency back in India too. Yes.
So, as a young resident in Mumbai, I had the opportunity to work at Tata Memorial Hospital, which is a cancer institute.
And as a resident, when I saw the extensive nature of cancer. We don’t see here that much as facial like mandibular cancers and tongue cancers.
When I saw those patients and you see the hope in them post procedure, you see that any cancer surgery, post cancer surgery is a mutilating surgery.
It actually has so much anatomical changes in you.
It makes so many anatomical changes in you.
Not just facial cancers, but the breast cancers and all these.
It changes so much for that patient.
And when you see those patients with that hope into them yes, that was the changing point for me.
I was just 22, 23 year old, but I felt that, oh, we can give that hope to these patients.
We can say that okay though these are mutilating surgeries.
But life still has so much to offer to you.
I think that was a changing point for me to get really motivated to do what I love to do.

Rajee Hari:
I mean, totally. Anything, right?
Whatever the doctors do, it definitely touches everybody’s life.
That’s why it’s called the noble profession. In India, we call doctors as Gods for reason.
That’s what it is. So thank you for sharing that.
Another interesting question that popped up in my head was, if you have to go back to your 18 year old self, what would you tell her that would change the path that you have taken so far?
What is the advice that would it be the same?
Or would it be something that you would tell, oh, please don’t do this, but go back and do something else?

Dr. Hiray:
To my 18 year old, I have lived my life to the fullest.
So I will always say that you have picked up a right profession.
As a 21 year old, I was the youngest in my class and when I came home and told my mom that my eye that I want to become an anesthesiologist, everybody was like, what?
You cannot pick up this profession. You cannot be just following another surgeon and working for somebody else. I said, no, that’s what you think.
But for me, I want to decide my own hours on my own terms.
So I know that this is the field I really want to work and get into.
And the whole family was making fun of me, but I’m like, no, I know exactly what I’m doing right now.
Please let me do this.
And I really love what I do, really.
I love being an anesthesiologist.
The best part is we start early morning and I never took calls.
So if we are done, we are done really early by 03:00 and then you have rest of the day to do whatever else you want to do.
And I have always done that, pursued other interests, my yoga, my social life, my family.
So I always have done that.
So for my 18 year old myself, I’ll say that you have done the best you so far and continue living life to the fullest.

Rajee Hari:
What more can we ask for?
Coming back to your yoga and your hobby? Right?
I mean, I’m aware of what you do and I’ve always admired you.
We’ve always shared that bond between us.
My question to you is how has yoga helped your profession?

Dr. Hiray:
That is a wonderful, wonderful question.
As an anesthesiologist, we are the lifeline for the patient. Yes.
Not all the cases go well.
When that stress happens, when you are losing an airway or patients are not doing well in the or, that’s the time you really want to have the clarity of mind.
The steps have to though we go through that so many times.
The drill and actuality is so much different.
Yes, but the stress you have, how you project or how you control yourself during those stressful situations.
I know, most of my nurses have told me this and we hardly see other anesthesiologists working together.
Yes, most of the time you are just one person working.
Most of the nurses have told me that you handle things so differently than other anesthesiologists who go through these difficult airways or difficult cases that they start throwing tantrums, they start throwing stuff because I want this.
You are just focused.
This is what I need.
Get me this, get me this.
I need this mask.
I need this thing.
So that clarity I feel has come with my yoga practice.
I don’t lose my temper.
I don’t like to yell at my nurses because my patient is not doing well but that communication scale the clarity I think has come due to my meditation practices and my yoga practices.

Rajee Hari:
Thank you so much for sharing.
I thought it will definitely help anyone out there who’s listening to this as well.
As a woman in science, as a woman in medicine what is your thought about the leadership and the potential of women in medicine?
What do you see and what is your advice to the women who are coming into the medical field?

Dr. Hiray:
As a woman I think.
We are stronger than we think.
We are more beautiful than we think.
We have more to achieve than we think.
So we should not limit ourselves because we are women in fact we know how to handle, how to manage not just the family life but so many aspects of life.
Take care of your finances.
I’ve learned it hard way take care of your finances, keep what you earn to yourself and then you decide but there is no limit for a woman.
We should not limit ourselves at all at all.
We should not limit ourselves world is there to explore and spread your wings.

Rajee Hari:
Absolutely and what’s your advice to the women who are coming into the medical field not to limit themselves one it is not an easy road.

Dr. Hiray:
During I had to do my residency here and take care of my younger kids and I now look back and wonder how did I do this?
What was the force behind me to help me get through this?
Many times driving early morning to go to medical center I used to have tears in my eyes that my kids if they are sick I used to literally have tears in my eyes that I have to leave a sick child home but there are many limitations but still continue achieve your dreams and the success is just few steps away.

Rajee Hari:
Oh that’s awesome. That’s so true.
I’m not sure if you had to go through the J1 visa or any of the visa processes.
If you have gone through that then can you share a little bit of your journey through that?

Dr. Hiray:
I was not on J1 and luckily I didn’t opt to go on J1 and that helped.
I took a break in between so I could be just on H1 and H2 but I got lucky not to go on J1 because I know my ex was on J1 and there was lot of hindrance for them he could have done if he would not have been on J1.
And recently I was talking with another physician too because the limitations of J1 are really you have to have a practice which gives you opportunity to convert that J1 to H1.
And then seven year limitations of J1, one during your residency and fellowship or whatever more you want to achieve.
So those are the limitations of visas coming for physicians coming from other countries.
But luckily, I did not have that.
Luckily, I did not have that.

Rajee Hari:
Final question for you is going to be about IDA, the Indian Doctors Association.
I know you’re one of the founding members of that.
Can you share a little bit about what IDA is?

Dr. Hiray:
So, Indian Doctors Association is a group of physicians in Houston.
I’m a board member and helped to start a Greater Houston North chapter for them.
Why I got into this is as a physician coming from India, indian origin is one day I was doing a case, and this was when suddenly people were asking for birth certificates.
And I know which year I’m talking about.
Yes, asking for talking about somebody’s birth certificate or passports and things, that we are sitting and doing a case in the OR.
And suddenly one of the nurse who is of a Caucasian nurse says, oh, at our hospital, so we need to start asking for a passport.
I just could not believe that I was hearing that in the OR.
I literally got up and said to that nurse, I know she’s a victim of the circumstances or the media.
I said, do you even understand what you just said?
I said, the gravity of this.
Do you even understand what you just said?
I said, look at this room. All of us are passport holders here. I said, including you.
You just got lucky that your grandparents were the passport holders, not you, to come here.
But look at this.
I said, both these physicians in this room came here to make a difference. And to achieve not just our dream, but to make a difference for the healthcare system here.
And where we have reached is because we have worked for it.
We had the option of not to do our residences and we could have stayed home, but we have worked for it.
And that was really a tubelight moment for me.
Just wake up call that I need to have a group of physicians where if something like this comes up, it’s good to have a bigger group to go as compared to a single physician to go.
And that was the turning point for me to get involved into Indian Physicians Association.
Indian Doctors Association because whenever you go as one physician for anything, it doesn’t have that merit as compared to 60 physicians going and saying, this is not right. We need to change this. Yes.
So that, I think, was my turning point to get involved with Indian Doctors Association.
We do wonderful things.
It is our best way to recruit or do your networking as well as we have scholarship for not just undergrads for med students.
We want to mentor the med students and undergrads for the professions or shadowing is also another options with so many of us.
So it’s a wonderful way of getting involved and making that difference in a bigger community.

Rajee Hari:
Great. Thank you so much.
What’s your advice for staffing companies like us?
What would you tell us that would definitely help us grow in this field?

Dr. Hiray:
For staffing, I think it will be I have not used any of the staffing companies myself, but it will be nice to have a clear application form.
Like when I was going through this, I was like, okay, let me see if I get some Locum things.
The thing is, the application form was for me was asking so many personal things that I felt that, oh, why do I have to give so much of my personal information to somebody which I don’t know whether I’m going to work for them or not?
So the icebreaker should be to start that communication with just first few steps instead of going into detail.
And then once you achieve that first few steps, then it is easier for physician to give more information to the staffing company because we get so many texts and emails from so many of the recruiting companies.
So that will be a nice way to do it.
There is a huge demand for staffing companies, especially anesthesiologists now.
Almost every week I get two or three texts that we need locum here, we need locum there.
Luckily, I have been so busy that I do not have to choose that option.
But I know few of my colleagues who are only doing locum.
But again, they are doing locum on a permanent basis, like monthly basis. Right.
So that will be another good option to give that just not for a day or two.
But here I have a week of option for you or a month of option for you.
So I think most of them are looking for that long little long term.
I’m very proud of you, what you’re doing, continue doing this and there is a huge work to be done, I know, behind the scenes, just to bridge that gap between staffing company and find the right fit for everybody.
But I know you will do. Great.

Rajee Hari:
Thank you so much. Thank you so much.
I really appreciate it.
Thank you so much for coming on our podcast and we really appreciate your time. Thank you.

Dr. Hiray:
Have a wonderful day.
Thank you.
Thank you for giving me this opportunity.
Thank you and good luck to you.

Rajee Hari:
Thank you. Dr. Hiray.