Rajee Hari:
Thank you, Dr. Bellur, for joining our Proteon Pulse podcast.
We are excited to have you as one of the first few interviewees for the podcast.
I really appreciate your time, and thank you for joining us.
Just to start, if you can introduce yourself and tell us a little bit about your background, that’ll be great.

Dr. Bellur:
Thank you for inviting me to join the podcast.
I really appreciate it.
My name is Shashi Bellur.
I have been practicing in Houston area, north of Houston called Woodlands since 1995.
So that’s about 27 years or so.
We have been in this area and in this community since then.
I got my residency done at Stony Brook University in New York, and then I did my fellowship at UT San Antonio with Cardiology fellowship.
I’m a practicing interventional cardiologist.
I predominantly work at Conor Regional Medical Center and the Methodist hospital in The Woodlands.

Rajee Hari:
Okay, thank you.
It’s interesting to see the 27 years journey of yours.
I’m sure you had your journey from India to the United States.
Can you give us a little bit of a light on the transition from India to the United States and your journey thus far until now?

Dr. Bellur:
Well, when we grew up in India.
India was a very different country at the time.
Most of the government policies were more on socialistic policies.
When we were in there, we faced a reservation system.
I’m not sure exactly, but very high numbers, like maybe 70, 80 or 90% reservation numbers.
If you’re trying to get into any kind of a program based on merit, it was really very hard.
I always wanted to do cardiology, but in 1985, when I was looking to do cardiology, there were only two seats available in the entire state of Karnataka.
And I think one was reserved.
It was one was reserved and the other was available, but the chances of getting is was nearly impossible.
The job opportunities were very minimal.
I distinctly remember after I finished my fellowship, next day morning, I woke up and I was feeling a little depressed. Because I was not getting any more, my stipend of Rs.750 per month.
And now I wam essentially I was without a job.
So where to go, what to do, what are the opportunities?
These were very serious challenges.
And there was no information available.
We didn’t have any internet or any other information resources at the time.
So most often you check with your colleagues or friends and see where the opening was, and you went to knock the door.
So that was a very difficult time in India.
But I did work at St.Philomena’s in Bangalore, and then I worked in Trichur for about a year, and then I got my green card, and then I immigrated to United States.

Rajee Hari:
So you came straight to Texas, right?
No, Stony Brook and then Texas.
New York, actually.

Dr. Bellur:
I had a research position at National Institute of Health.
So, I came in as a research person to NIH and I worked at NIH for a year and a half.
And then I had to take all my exams at the time to get back into residency training.
Along with my research job, I took all the necessary required exams and then I applied to residency and then I moved to Stony Brooks.

Rajee Hari:
Having been in Houston for 27 years that you mentioned, how do you see the change in healthcare system over this period?

Dr. Bellur:
I don’t know.
I don’t want to be skeptical.
The practice of medicine is the same as far as being a doctor.
Being a doctor, taking care of patients is the same.
People need you.
It’s the greatest job in the world.
It is immensely satisfying.
And particularly in the field of cardiology, when you see patients many a times it’s a life threatening situation.
So you do get involved in a life and death situations and make life saving decisions and procedures and patients remain immensely grateful.
And not only that, on a professional standpoint, it’s immensely satisfying to make a difference in a person’s, in a family’s life, it’s immensely satisfying.
So as far as being a physician and taking care of patients is the same.
But the things that surround it; the bookkeeping, the chart documentation, dealing with the insurance companies, the regulatory challenges, the hospital administrations and those challenges.
That can lead to somewhat frustrating situations at times.
But part of it I need to acknowledge.
Since we grew up in a different era and we practice in a different era, we think this has very burdensome or annoying situations.
But for people who graduate in recent years, for them that’s normal.
Electronic medical records is the norm.
Dealing with the regulatory or hospital requirements is the norm.
Dealing with insurance companies hassles is the norm for them.
So they may not feel the way I feel.
Because I’ve seen the other side of the equation.
So I have something to compare and contrast.
But if someone has the experience, is the only experience in the current working environment, they may not feel that burdensome.

Rajee Hari:
How has technology helped with cardiology practice?

Dr. Bellur:
Cardiology is ever changing, rapidly changing, complicated field.
And many a times, we don’t have all the necessary knowledge or information at our fingertips or within us.
Using medical records, electronic medical records, the data keeping definitely is much better.
Access to information, the patient’s chart is definitely much better and also tapping into the resources.
If there is a challenging case to search the web or search the necessary medical societies to look for solution in a complicated case is much, much easier.
In our early years, having knowledge was an asset because there was no easy access to the knowledge.
But now the knowledge is at our fingertips. You have a cell phone, you have the knowledge.
As long as you know how to use it, then the knowledge is easily available because of the technology.

Rajee Hari:
And even the medical devices, right.
Your operation room, all those amenities that are available now, I’m sure they’re far advanced than what when you started out with.

Dr. Bellur:
Because most of it’s all digitized now.
You can tap into the information.
Before, for example, if I had to do an angiogram, I had to go back to the hospital.
It was all recorded in a film, like a movie film.
So we had to put it on a projector and sort of review that.
But since it’s all digitized now, you can have access to all that information wherever you want on your cell phone or an iPad or a laptop or whatever, any kind of electronic media.
Yeah, that has been a huge change.
The technology has changed and as I said, generally cardiology is a very rapidly progressive and ever evolving technology.
For example, about ten years ago we used to cut chest open to replace a valve.
Now you do it through the groin and then a mini incision and then next day patient is going to go home.
So all those changes have changed rapidly.

Rajee Hari:
So when these changes come about, isn’t it challenging for physicians also to equip themselves and learn the whole process and reskill themselves to adapt to these new technologies?

Dr. Bellur:
Yes, sometimes it can be challenging too. Particularly because, again, in my field, since it’s a high risk and life and death kind of a field, so any new technology, for example, I can take an example of TAVR.
People can have a very tight valve, heart valve called aortic valve, and it is called aortic stenosis.
As I mentioned, about maybe ten years ago, we used to cut chest open and put in a new valve.
But now we can go ahead through the groin and put it in a cult tavern TAVR.
Even though, for example, I may say I have the necessary experience skill set for me to do that, there are stringent requirements for us to get certified to do that.
That means I have to go back to a center where it is being done.
I need to do minimum number of whatever 20 or 25 cases.
Then I had to make sure you go through all the checklist.
You had to conference with a CV surgeon to make sure the case selection is appropriate.
And then everything has to be documented to make sure your complications rate or everything is within the guidelines.
So there are very stringent checks and balances for any new procedures that comes along.
Sometimes it can be a hindrance because the bar is set so high for everybody.
It does not differentiate between the person who is doing it for one year versus somebody who’s doing for 20 years.
The bar is set high for everybody.
So sometimes one has to look at how much you want to do it because you need to shut your practice for a week to go and get trained somewhere.
So you have to look into all of that.
And each person will have to make their own choices.

Rajee Hari:
Question for the new medical students.
What do you think is a necessary skill set or what do you think is the necessary qualities that they need to become a cardiologist?

Dr. Bellur:
If you want to become a cardiologist, first thing is it’s a marathon, it’s not a sprint.
Generally you have to do very well in med school to get into internal medicine.
And once you do internal medicine residency, which is a three year residency, usually you have to be in the top five percentile to be considered into cardiology.
And the cardiology fellowship is three years.
And then in that fellowship you have to be the top guy if you want to get into interventional cardiology.
It’s a pyramid structure.
The higher you go, you have to be better at what you do and you have to be recommended by your attendings.
Those letters matter more than any kind of A grades.
Because not only, obviously intelligence, hardwork is given by the time you reach into medical school or residency and all that.
So generally, most of the time people bring into it.
But what matters or distinguishes people are how hard are you willing to work.
Are you meticulous in what you do, succinctness to details, perseverance, attention to details.
So those are some of those qualities that separates people out as you go higher up.
And a few degrees of separation may make a difference of whether you may be getting into a fellowship, but you may not.

Rajee Hari:
With COVID-19, being in a private practice, how did it impact your business?

Dr. Bellur:
It was very challenging because of the fear of the unknown, particularly in the early phases of COVID in 2020.
And each day was very fearful.
But we did follow all the necessary guidelines, whatever the CDC guidelines are, we were very much aware of what was going on.
We took all the precautions, but still the fear of the unknown.
And then once we started getting to know what COVID can do and how people were getting affected on getting into the hospital.
The mortality rates with COVID was very difficult and challenging.
But having said that, as physicians, not necessarily the office personnel, as physicians we are trained to work in all environments, all situations.
We deal with infectious disease.
Like when I was doing my residency, the AIDS, HIV became rampant at the time.
That was again a fear of the unknown.
Nobody knew what it was.
And there was a concern about getting HIV and dying with HIV.
So there is certain element of you got to do what you got to do kind of an approach if you’re a physician.
But coming to the practice, it was very challenging.
But PPP helped us because we had to shut down the practice nearly for six to eight weeks.
So PPP helped us.
We did take a hit from the practice point of view, but knowing what was going on in the country and knowing that many people have lost their loved ones and they could not even see them in the hospital in their final days.
Compared to all those challenges the average citizen faced, some of the financial challenges we faced was it paled in comparison.

Rajee Hari:
Coming to the staffing industry, what has been your experience with medical staffing industry?
Have you worked with staffing agencies or have you interacted with or have you seen the growth of the industry from the hospital or physician perspective?

Dr. Bellur:
Definitely. It’s a growing industry.
Unlike in the past, the physicians generally went into areas through word of mouth or where their family was, and they got into a community.
And once you started your practice, more or less, you stayed there until you retire.
That was the model most of our generation followed.
But the younger generations are following much more kind of, I need to go to a place where I want to go.
And they have their own reasons for selecting a geographical area.
So they may need more information as to the hospital settings or practice settings, what the demographics are, what are the lifestyle opportunities that place offer.
So they have become much more picky, or I shouldn’t say picky much more selective in as to what they want, where they want to work.
Because their lifestyle decision on the choices are important parts in decision making for them if they want to start a practice.
So that way, having somebody headunter or services that can find an appropriate practice or an opportunity that suits their lifestyle and what are they looking for, I think that will really help them narrow down the choices and pick the place they want to be in.

Rajee Hari:
I’m sure that you casually did say that, ‘oh, I came here and then I went there.’
But it’s been a journey.
It’s not an easy journey that you’ve gone through.
It must have taken a toll on your personal life, your work-life balance.
What were the struggles that you faced and how did you handle that?

Dr. Bellur:
One of the things I think we all know, that the challenges we face is driven by the necessities and the challenges we’ve overcome, not face the challenges we’ve overcome.
And the way you face the challenges depends on the necessity.
When I immigrated into this country in 1988, my wife was pregnant with the first baby. And she chose to stay back in India because she needed help with her mother to have the baby at the time.
And then I was starting a new job in a new country.
And then that job I had no previous experience with.
So I had to start all over again.
Learning the job in research field.
And at the same time, I had to take all my exams all over again to get back into residency.
I had done my residency in India and I was practicing there for a couple of years.
So now I had to go back to basic medical school subjects, the entire four to five years of medical school subjects and then take exams.
Not only pass and we were required to be in the top ten or 15 percentile to even be considered for any residency program.
So the challenges were you’re an immigrant trying to break into your new country, there was a cultural adaptation.
And I vividly remember we were not used to having a Metro card, ATM machines, we are talking about 1988.
There was no ATM machines in India.
There was no metro in India.
So when we came in here, everything, including ATM machine, a Metro, an Escalator, everything was a very new experience.
So in that new environment and it was cold.
I came in in February, so it was cold, which I never experienced.
Challenging weather pattern.
Leaving all of your family behind, getting into your new job and then getting ready to take all the necessary exams, the amount of material you have to cover, it was intense.
It was probably, I would say, 14 to 16 hours a day, seven days a week.
But if you have the drive and you know where you want to go, and you’re willing to do whatever it takes to reach the destination.
There was a necessity because I’m in a new country without any backup support system.
Failure was not an option.

Rajee Hari:
See, that’s what we always think, right?
As immigrants, failure is not an option.
You have to just plow through everything. Absolutely.
As a medical staffing company, we strive to provide the best possible candidates for the hospitals, for clinics, for specialty groups.
What’s the suggestion that you have for small businesses who are just starting out like us?

Dr. Bellur:
It is going to be challenging, of course.
Just like any other field, whenever you new, you’re new to your field.
It’s always challenging.
Because you don’t know what doors to knock on.
You never know how many doors you need to knock on.
And you never know which door is going to get open.
And sometimes you may have a great opportunity come up.
But there may be unforeseen factors: politics, immigration policies, COVID.
There may be so manyu nknown variables which you have no control with.
Then the question is how much I’m going to plough through this?
How much I’m going to continue to work on it to make my dream come happen>
And many a times it’s probably important to keep in mind all it takes is one break and keep in constant search for that break.
That break can open up a lot of opportunities and even the most successful of people.
If you go back to Steve Jobs, for example, his Apple original Apple.
They were struggling and then they had to go to Bill Gates from Microsoft asking for some investment.
And Bill Gates, if I remember correctly, invested about $150,000,000 or something like that.
And that gave Steve Jobs working capital to revamp the Apple products.
And of course, we all know what happened after that.

Rajee Hari:
I know it’s just ploughing through again, right?
Failure is not an option.
I really would like to get some stories out of you on your experience.
Just a couple of stories, interesting aspects that was memorable, that changed your life or gave you that AHA moment or made you realize that, wow, I’m in the right profession.
Even one or two stories, that’d be great.

Dr. Bellur:
One thing again, as I keep saying, I work in a critical field.
And some of the things it amazes me, it’s in my face to say how life is so fragile.
We all think we live eternally, but in this field, the field constantly reminds me that life is fragile.
Each day we live is a blessed day.
Each breath we take is a blessed breath.
Because you never know whether you’re going to get a next one or not.
Why would I say that?
I have seen cases where I would think there is no way this person is going to be alive.
And they recover from it or they walk out of the hospital.
And I’ve seen cases, yeah, no problem, this guy should be fine, whatever.
And then they’re just peril and then their time is up, they just don’t make it.
And I’ve seen patients who are young, who came into my office complaining of some chest discomfort, 22 year old. And that patient had torn his iota, which is a main pipe coming out of the heart.
And that’s an extremely life threatening situation.
If you don’t pick it up right away and then handle it right away and get it fixed right away, that person is not going to make it.
And it’s a 22 year old.
And I’ve seen a 25 year old lady who had delivered a baby, who was having chest discomfort, was treated with antacids for in his stomach and she ended up having heart attack.
And I had to put in two stents in her.
She was a 24 year old female.
So whenever you see these kind of these are outliers case wise, but it tells you nobody is immune from uncertainty.
And again, life is very, very fragile.

Rajee Hari:
We are eternally grateful to the doctors for helping us and for keeping us all alive, I would say so.
Thank you so much.
Anything else that I have not asked you that you would like to share about yourself.

Dr. Bellur:
One thing is, if there are any indoctors who are listening to it, is to be aware that is still the greatest profession in the world.
Unfortunately, of late, it is being turned into a job, but it’s still a little bit of calling.
And if you love what you do, if you are in the right reasons, being a doctor, if you find a place where you love to work, there is no job like it.
People whom I had treated 20 years ago, we have such a bond.
Even today, after 20 years, it’s no longer just a doctor and a patient relationship.
It’s something that goes beyond that.
The trust, the faith in you, the hope they express and the confidence they have in you, how somebody can take their life and put it in your hands, trust you, that you’re going to do the right thing by them.
I don’t think in any other field people will automatically, unconditionally, without being asked, do that.
People don’t trust $10 of your money with other people.
General people.
Here, they come in and trust their life and put it in your hands for you to do the right thing.
And that is very humbling to be in that position.
And where you’re going to make life and death recommendations and decisions on someone else’s life.
And also it tells you the importance of what you do.
To be grateful, to have had the opportunities to do that for a number of years.

Rajee Hari:
Thank you so much.
I’ve really had a great time.
Really appreciate it. Thank you so much.
I hope we can have you back in few more months to give us a little bit more interesting stories about your journey.
I’m sure you’ve had lot of interesting interactions with other physicians or patients and we would like to hear about it.
But thank you so much for your time.
We appreciate it.

Dr. Bellur:
Thank you very much, raji, thank you for having me.
You have a great day, okay?

Rajee Hari:
Absolutely. Thank you. Take care. Bye bye.