SGU Alum’s Passion for Family Medicine Leads to AAFP Directorship

Advocacy seems to come naturally for Andrew J.P. Carroll, MD ’96, founder, owner, and medical director of Atembis LLC, an integrated medical-behavioral family medicine practice in Chandler, AZ. As a St. George’s University student in the early ‘90s, he had his first foray into advocacy by representing the University to ask the American Medical Student Association (AMSA) to allow the school to host the organization’s first offshore chapter and ultimately secured a charter.

Nearly 30 years later, having been elected to sit on the board of directors of the American Academy of Family Physicians (AAFP) for 2019-2020, Dr. Carroll will be able to channel his talents as part of a group tasked with advocating on behalf of more than 134,000 family physicians and medical students across the United States. The appointment is a culmination of his experience in practicing family medicine for more than 20 years as well as his passion and dedication to primary care.

“The grassroots family physician hasn’t been heard loud enough,” Dr. Carroll said in a phone interview. “I want to be that loud voice.”

Dr. Carroll started campaigning for the AAFP board position in 2018. He was elected during the AAFP annual Congress of Delegates which took place on September 25 in Philadelphia, PA. Among topics that are close to his heart: the nation’s shortage of primary care physicians. Dr. Carroll attributes the issue to a financial dichotomy between high debt acquired by students during medical school and the low compensation typically received when practicing primary care, which deters students from entering the field and instead choosing higher-paying medical specialties.

“A lot of physicians have ideas for solutions, but we don’t have a voice,” Dr. Carroll said. “The AAFP affords us that position. It’s important to have someone at the table who is actively speaking on everyone’s behalf. That’s the reason I did it.”

Dr. Carroll has been actively involved in supporting family practitioners in his state. In 2010, he was elected to represent the Arizona Academy of Family Physicians (AzAFP) at the AAFP’s annual Congress of Delegates—the organization’s governing body. He has also served the chapter in various executive positions including its past president (2014-2015) and remains today as a Board Member.

“When I first met Andrew almost 14 years ago, I knew immediately that he would be a leader,” said Laura Dearing, executive vice president of Arizona Academy of Family Physicians. “Dr. Carroll has always been giving of his time with our Board, to testify at the state legislature, and to promote leadership within the young physician community. His quick wit and empathetic nature have made him a superstar in the family medicine community in Arizona and in the US. Any state chapter executive would be honored to work with him because he is respectful, smart, funny, and most of all, nice.”

Dr. Bill Thrift, a professional colleague of Carroll’s through the AzAFP and a family physician in Prescott, AZ, said Dr. Carroll’s progressive way of treating patients while running a successful private practice will be a big asset to the AAFP.

“He is right in the thick of it and so his perspective comes from the front lines—that’s a good thing,” Dr. Thrift said. “We are more than proud of Andrew and we know that he is going to not only represent Arizona physicians well but represent America’s physicians well.”

On a local level, Dr. Carroll has owned and grown into an integrated care practice since 2003, offering services ranging from chronic disease management, behavioral treatment, and wellness consultations to interventional procedures and pediatric care among others, all in one place. In addition to traditional payer patients, he also cares for uninsured patients, those without a private or employer health plan, and those who are not eligible for federal or state insurance benefits by providing cost-conscientious care and arranging for diagnostic studies to be done at or near cost.

“If someone is having low-risk chest pain, I want to be his first call, not a cardiologist,” Dr. Carroll said. “It could be gas, it could be indigestion, it could be rib pain, etc., instead of a heart attack. We need to get back to the point in primary care where we have proven our worth to patients and they make us their first stop when something is wrong. We can only do that if we’re easily accessible. The current payment system does not allow for this.”

“The skill set we have as family doctors is suited for rural communities, but I am in the middle of a city,” he added. “People who choose us like to say, ‘hey, that’s my doctor.’ It’s about giving them a small-town feel and touch as the community’s physician—which is really what we are.”

– Laurie Chartorynsky

SGU Establishes New Alumni Association in Botswana

SGU launches new Botswanna Alumni Association

St. George’s University has announced the establishment of a new SGU Alumni Association in Botswana—the first such association in Africa, in a country where one in every five practicing physicians is a graduate of SGU.

The association provides a platform for personal and professional development and aims to strengthen the ties between alumni, the community, and the University through outreach and regional events.

The establishment of the Botswana alumni chapter was announced by Dr. G. Richard Olds, president of SGU and Robert Alig, vice president of alumni affairs, at a special launch event on September 21 at the Avani Resort in Gaborone.

“The new chapter in Botswana will offer our graduates here the chance to connect with their fellow alumni in the country, and hundreds more in Africa and beyond,” said Alig. “We are thrilled to be launching this chapter which will assist graduates of SGU by strengthening personal and professional networks and laying the foundations for new ones.”

 

Earlier the same day, Dr. Olds led a workshop on “How to Get Into a Top Medical School,” as part of the Inspired Horizons international careers fair in Gaborone. Dr. Olds shared experiences and insights from his career in medicine and medical education, and spoke with prospective Botswanan medical students about applying to SGU.

“We believe the best way to give our students a truly global medical education is to foster a community of global scholars, who will go on to work as physicians and medical professionals all around the world,” said Dr. Olds.

Dr. Orapeleng Phuswane-Katse, a 2011 graduate of SGU from Mochudi, Botswana, now works as medical officer in at Princess Marina Hospital in Gaborone and is doing her residency in public health medicine. She welcomed the announcement of the new alumni chapter in Botswana.

“SGU gave me the opportunity to study in the Caribbean and undertake clinical rotations in the UK,” she said. “It was always my intention to return to practice in Botswana, and this new alumni association will be an especially valuable platform for connecting graduates working throughout the country and demonstrating SGU’s commitment to producing skilled, capable doctors through training and career development opportunities.”

In August, SGU and the Inspired Horizons Association signed a Memorandum of Understanding to further education development for Botswanan students and facilitate opportunities for cooperation between both parties.

Scholars From Botswana, Where 1 in 5 Doctors Graduated From SGU, Begin Medical Studies in Grenada

Aerial images of Sir Eric Gairy Hall and Andrew J. Belford Centre.

Three students from Botswana have taken their first steps towards a career in medicine at St. George’s University (SGU), the leading international medical school in the Caribbean, after being awarded full-tuition scholarships to study on the four-year MD program.

Wathata Onalethata Ntwayapelo, Lungowe Kabasiya, and Chevula C. Munaani arrived last month, in the latest example of St. George’s long-standing relationship with the Ministry of Health and Education and the Government of Botswana, which offers full-tuition scholarships to qualified students to pursue medical degrees.

Approximately one in every five practicing doctors in Botswana is a graduate of SGU—a remarkable demonstration of SGU’s commitment to training qualified global physicians to work across the world in areas of need. SGU is now the second largest source of doctors for the entire US workforce, and a further one in every five physicians in Trinidad and Tobago are also SGU graduates, underlining the exceptional range of career opportunities for qualified doctors trained in Grenada.

“At St. George’s University, our international student body has always been our greatest asset and building the capacity of young doctors in training to address global health challenges is part of our philosophy as a medical school,” said Dr. G. Richard Olds, president of St. George’s University.

“We recognize that there are two aspects to this: helping ambitious and qualified students who may not otherwise have access to a leading medical education to study with us in Grenada, but also acting as a provider of doctors for those places of need, helping to address shortages in healthcare provision and combating health inequality,” Dr. Olds said. “Few countries exemplify that better than Botswana, and we are tremendously proud of our joint achievements in this area.”

Added Dr. Olds: “We’re pleased to welcome Wathata Onalethata Ntwayapelo, Lungowe Kabasiya, and Chevula C. Munaani to our True Blue campus and look forward to helping guide them on their path to a career in medicine.”

SGU President Featured in San Francisco Chronicle

California’s doctor shortage is acute, with the situation poised to get worse. In an opinion piece appearing in the San Francisco Chronicle this week, Dr. G. Richard Olds, president of St. George’s University, shared why California needs more internationally educated doctors.

“International graduates are perfectly suited to meet the healthcare needs of historically medically underserved Californians,” Dr. Olds wrote. “Low-income Californians deserve access to high-quality care. The state needs more doctors to supply that care. International medical graduates can be those doctors.”

 

Op-Ed: Why California needs more internationally educated doctors

This article was originally published in the San Francisco Chronicle on August 31, 2019. St. George’s University has obtained the rights to republish the article. 

California’s doctor shortage is acute. More than 7.7 million Californians live in federally designated “primary care health professional shortage areas.” Only about 40% of the state’s primary care needs are currently being met.

This situation is poised to get worse. California isn’t producing or recruiting enough new doctors to replace those who are retiring. Meanwhile, the state’s population is rapidly aging. To keep up with demand, the state will need an additional 4,100 primary care doctors by 2030.

Dr. G. Richard Olds is president of St. George’s University

Already, many low-income Californians find it impossible to get the health care they need. Many patients enrolled in Medi-Cal struggle to find doctors who will take their insurance.

To their credit, state leaders recognize that there’s a problem. The state recently began forgiving medical school debt for doctors who commit to treating a certain number of Medi-Cal patients. That’s a commendable step. But wiping away doctors’ debt won’t do much to alleviate the inability of many state residents to access care.

To really address this problem, California needs to increase the supply of doctors. It can start by recruiting more graduates of international medical schools.

Many “international” graduates actually hail from California and would jump at the chance to serve their home communities. (A growing number of Americans choose to study at medical schools abroad, partially because of the high cost of U.S. institutions.)

In February 2019, the California Future Health Workforce Commission released its plan for boosting the supply of doctors in the state. In addition to loan forgiveness, the commission floated other ideas, like increasing the role of nurse practitioners and offering scholarships for students who commit to working in underserved areas.

Noticeably absent from the plan was any mention of recruiting more international medical graduates to California. International graduates are perfectly suited to meet the health care needs of historically medically underserved Californians.

According to a report from the American Immigration Council, more than half of international graduates work in places where per capita income is $30,000 or less. Compared to U.S.-educated physicians, doctors trained abroad are more likely to treat Medicaid patients.

International medical graduates also disproportionately practice in areas with large minority populations. About 25% of all doctors nationwide graduated from international medical schools. But in places where more than half of the population identifies as Hispanic, more than 36% of doctors are international medical graduates.

That’s important in California. More than half of Medi-Cal enrollees are Hispanic, according to 2013 Kaiser Family Foundation data.

Some people erroneously believe that international medical graduates are less qualified to practice medicine than those who graduate from U.S. medical schools, but their graduates are held to the exact same standards as U.S.-trained doctors. All medical school graduates who wish to practice in the United States must pass all four parts of the United States Medical Licensing Examination. Aspiring physicians are tested on topics ranging from the cardiovascular system to population health.

Medical students must also train in clinical settings prior to graduation. Some international students train in the United States. Unlike students from U.S. medical schools, international students are required to work in teaching hospitals with residency programs. Working in close proximity with practicing residents provides international graduates with experiences that help them thrive in their own postgraduate work.

California desperately needs primary care doctors, but only 41.5% of seniors graduating from U.S. medical schools in 2019 chose primary care as their specialty. Meanwhile, roughly 70% of international graduates chose pediatrics, internal medicine, or family medicine in this residency match cycle.

Recruiting more doctors from international schools won’t just address the primary care shortage — it’ll improve the quality of care in the state. One study published by BMJ, a medical journal, found that patients treated by international graduates had lower 30-day mortality rates than those treated by U.S.-educated doctors.

Low-income Californians deserve access to high-quality care. The state needs more doctors to supply that care. International medical graduates can be those doctors.

 

— G. Richard Olds

 

SGU Vice Chancellor Featured On RealClearEducation.com

An op/ed piece by Dr. Richard Liebowitz (right), vice chancellor of St. George’s University, recently appeared on realcleareducation.com. In it, he explained the crucial role that international medical schools play in training highly qualified students that eventually become much-needed physicians in the United States.

“The odds of gaining admission to U.S. medical schools are growing longer,” Dr. Liebowitz wrote. “But bright young Americans don’t have to give up their dreams of becoming doctors. They can turn to top-notch international medical schools. Their future patients will surely thank them.”

SGU Grad to News Anchor: Liver Donation to Sister is “Ultimate Altruistic Act”

FOX & Friends host Ed Henry announced on Sunday that he will soon donate part of his liver to his sister, Colleen, who requires a transplant to address a degenerative liver disease.

Mr. Henry and the FOX & Friends team were joined on set by transplant hepatologist and gastroenterologist Joseph Galati, MD ’87, who shed light on what to expect as he undergoes a major surgery to help his sister.

“Your donation is probably the ultimate altruistic act of selflessness,” Dr. Galati said. “The main thing is that, during this recovery, you may wake up in a day or two and feel absolutely awesome, but then four days later, not feel so good. In your recovery, you have to be able to deal with the ups and the downs and try to find a middle ground so that you have really good expectations. It’s going to be a process.”

Dr. Galati’s practice, Liver Specialists of Texas in Houston, treats patients suffering from both acute and chronic disease. He also serves as the medical director at the Center for Liver Disease and Heart Transplantation at Houston’s Methodist Hospital and is president of the Texas International Endoscopy Center.

SGU Grad Reveals “The Truth About Caribbean Medical Schools”

For Jessica Willett, MD ’13, St. George’s University was her first-choice medical school. The education and experience she had at SGU have propelled her to become an emergency medicine physician at San Joaquin General Hospital in French Camp, CA. She set out to learn from an international faculty, with an international student body, and through international experiences like the St. George’s University of Grenada School of Medicine/Northumbria University four-year MD program (formerly the Keith B. Taylor Global Scholars Program), and as a physician and board member for Flying Doctors of America. With philanthropy high on her list of values, she appreciates the opportunity to practice medicine in underserved and underdeveloped communities throughout her medical career.

KevinMD.com recently published her story titled “The Truth About Caribbean Medical Schools,” in which she stated, “I suspected that SGU held unique options that would help me to mold my career down the road, and I wasn’t wrong.”

Cancer Survivor Sets Sights on Becoming an SGU-Trained Physician

NJ.com recently caught up with CityDoctors Scholarship recipient Timothy Malone, whose journey to becoming a first-year medical student at St. George’s University included a long bout with Hodgkin’s Lymphoma, with which he was diagnosed in 2010. Below is an excerpt from the NJ.com story.

Once he understood what a doctor does, Timothy Malone knew that’s what he wanted to do with his life.

The kid from Mahwah was only 5, maybe 6-years-old when he made that decision.

Malone’s thinking wasn’t challenged — until his health tilted out of control in 2010.

Constant headaches came out of nowhere in high school. He lost 30 pounds, thinking that was normal for a 16-year-old teen getting in shape. He had a pale complexion and itchy skin that bled from his scratching. Doctors thought he had allergies. A chest x-ray saw something else.

“That’s when they found the tumors,” Malone said.

He had Hodgkin Lymphoma, a cancer that affects the lymph system, turning his life upside down.

“I wanted nothing to do with hospitals,” Malone said. “It made me want to run in the opposite direction.”

But Malone, now 25, is sprinting back toward his childhood dream. He’s a first-year medical student in Grenada at St. George’s University, which has a teaching partnership with the Bergen County hospital that helped him beat cancer.

From U-2 Pilot to OB/GYN: A Veteran Reflects on Her Career Path

When Cholene Espinoza, MD SGU ’15, looks back on her childhood, she remembers imperfections and failure.

“I was always kind of a screw-up as a kid,” said Espinoza, chief resident in Cedars-Sinai’s Department of Obstetrics and Gynecology. “I started first grade when I was five, so I was always feeling behind and was often put in the corner for being disruptive in class. I was independent and never really fit in to the traditional educational system.”

For years, Espinoza struggled to focus academically and socially, but the summer before seventh grade, she had an epiphany: “I remember telling my mom I didn’t want to be a loser anymore.”

She hasn’t let her mom down. Espinoza’s stellar career and life have played like a Hollywood movie with her roles including—an elite spy plane pilot; a passenger originally scheduled to board one of the ill-fated planes on 9/11; a wartime journalist; a Hurricane Katrina volunteer; a published author and, finally an OB-GYN who has a profound reverence for human life.

As Veterans Day approaches, Espinoza, an Air Force veteran, reflected on the meaning of the day and how her own service changed her life and set her on her path to becoming a physician.

“What is would say to veterans is, ‘thank you. We’ve served together, you kept me safe and there’s not a day that goes by that I don’t appreciate you in every way,” Espinoza said.

Espinoza’s Military Career Takes Flight

At 17, Espinoza enrolled in the United States Air Force Academy in Colorado Springs, Colorado. In the 1980s, when she was a young cadet, the Academy limited female enrollment to just 10 percent of a class. (With those gender restrictions now gone, last year’s freshman class at the Academy was about a quarter female.)

“Like anything in life, there were moments when I struggled, and things or comments happened that shouldn’t have,” she said. “But it taught me to surround myself with supportive, good people and to work through the hardships.”

A Path Discovered

But more hardships were to come. Around Christmas of her sophomore year, Espinoza’s father died. The shock and grief soon led her to an unexpected, but clear path.

“I was taking a course in glider flying and it enabled me to get over my father’s death on some level,” she said. “Flying came natural to me when nothing else in my life had.”

After graduating, Espinoza served as a flying instructor for four years, and later, she was selected as a U-2 spy plane pilot for the 99th Reconnaissance Squadron at Beale Air Force Base, California–the only U-2 squadron in the world.

U-2 spy planes are single-jet engine, ultra-light gliders that maneuver on the edge of the earth’s atmosphere. Designed to avoid enemy detection, the planes are equipped with sophisticated instrumentation that provides vital intelligence, day or night and in all-weather.

In a 12-hour mission, the aircraft can capture extraordinarily detailed imagery of a country the size of Iraq. And while much about the aircraft remains classified, Espinoza points out the planes do far more than reconnaissance—they also aid in peacekeeping and directing humanitarian aid.

Flying solo missions in U-2 plane can be an otherworldly, almost spiritual experience, said Espinoza. Wrapped in the cocoon of her space gear, she can sometimes still feel the stillness of the open sky and the brilliance of the earth.

“I would fly across Europe all night and it felt as though I could just reach out and touch the stars,” she said.

But along with the beauty came harsh reminders of the chaos on the ground.

“I would fly over beautiful civilizations like France and Germany, but when I made it to my target areas, it would be pitch black,” she said. “Then, I would see a flash of light and know it was a blast, and that meant someone is killing or someone is dying. It always gave me reverence for how fragile human life is and how unjust war is.”

Espinoza observed war from the quiet remove of a spy plane, but with each mission she would feel a stronger urge to assist those affected on the ground.

“I couldn’t directly help people from the stratosphere and that propelled me to eventually get out of the Air Force cockpit,” she said.

From Above 70,000 Feet to 30,000 Feet

Espinoza left the Air Force for a career in commercial flying with United Airlines and then Emirates Airlines–allowing her to travel to every continent except Antarctica.

“As a commercial pilot, I had to be broken of my ‘single pilot mindset’ and not disregard input from others,” said Espinoza. “Success was based on the efficacy and quality of the entire crew.”

Espinoza was working for United Airlines on September 11, 2001, when terrorists hijacked four aircrafts and slammed two of them into the World Trade Center, one into the Pentagon and the fourth in a Pennsylvania countryside.

She was not scheduled to fly the fourth plane hijacked that day, but was supposed to be a passenger. The flight boarded in Newark, and was supposed to land in San Francisco. It never made it.

“I was living in New York City at the time and had just accepted a bid to be a captain out of San Francisco,” said Espinoza. “I planned to take the flight as a passenger to find a new home in San Francisco, but the crew desk realized I had gone over my flight limitation hours, so the first leg of my trip was cancelled and I wasn’t on Flight 93.”

Espinoza’s United Airlines colleague and former Academy classmate, Leroy Homer, Jr., was co-piloting the airplane that crashed in Pennsylvania.

“I knew Leroy since I was 17 and had just seen him in London on a layover,” said Espinoza. “He was happier and more content than I’d ever known him to be, showing me pictures of his daughter and wife. I often think of him that day in Hyde Park, with his smile, wishing I’d been there for him on that flight.”

Espinoza’s Service Shifts from Sky to Ground

The events of 9/11 soon led her to take a pair of three-month leave from United Airlines to cover the Iraq war as a civilian radio journalist. Her first tour was with the Marine Corps and the second, and third with the Army. Espinoza worked as an embedded journalist for Talk Radio News Service (now Talk Media News), which gave her an opportunity to come face-to-face with war—both its injustice and its heroism.

“I departed Iraq from mobile hospital in Iraq and there were surgeons trying to save children who had limbs blown off from mines and ammunition,” said Espinoza. “The medical teams were trying to make something right out of something so horribly wrong. When you’re in the middle of a war, you see the destruction and insanity of it, and then you see these beautiful acts.”

Espinoza witnessed how war changes people.

“In order for me to overcome what war had done to me, I needed to engage and fix what was broken,” she said. “That’s what inspired me to leave the cockpit for good and directly take care of people by switching careers from pilot and journalist, to doctor.”

But before taking care of people as a doctor, Espinoza’s desire to serve brought her to Mississippi’s Gulf Coast in 2005 after Hurricane Katrina.

“On our first trip to Mississippi, my spouse and I connected with a small community and fell in love with the people and their struggle,” said Espinoza. “We realized how many people drowned from the storm because they didn’t know how to swim, since there were no community centers or public swimming pools.”

So, the couple made it their mission to change the community’s access to water safety by raising money to build a public swimming pool. Amid rebuilding and spending all of her down time and vacation days on the Gulf Coast, Espinoza penned a novel, Through the Eye of the Storm: A Book Dedicated to Rebuilding What Katrina Washed Away.

“I realized each of us has something to give and that gift is desperately needed in our world,” said Espinoza. “For me, being gay had not stopped me from serving two of my greatest loves in life, God and country. This book is the story of my life, the lives of truly heroic Americans and the transformation of my spirit that took place unexpectedly in this small Mississippi town.”

The proceeds raised from the book, which she wrote and published in less than one year, supported the rebuilding of one of the most hurricane-ravaged communities on the Gulf Coast. The writing process helped Espinoza accept herself completely.

“It wasn’t until I was out of the service that I wrestled with my own identity,” said Espinoza. “In the service, I didn’t have relationships with women, I focused on flying. I had tried to deny that part of who I was but realized through the writing and humanitarian process a stronger desire to live authentically.”

Becoming a Doctor: Her Final Mission

In 2009, after what many would consider an already fulfilling and long career, Espinoza started her journey of becoming a doctor. Then 45 years-old, Espinoza started over with preclinical and then graduated from St. George’s University School of Medicine in Grenada, West Indies at the age of 50.

“I have the distinction of starting menopause and residency at the same time,” Espinoza jokes.

Espinoza started her residency training in Obstetrics and Gynecology at Cedars-Sinai in June 2015 and is scheduled to finish this coming June. She has been accepted to be re-commissioned into the military as a Reserve U.S. Army OB-GYN. She can be deployed to any medical surgical unit, nationally or internationally.

“Military medicine is what first inspired me, but I thought I was too old for the military,” said Espinoza. “But they desperately need doctors.”

While she’s not serving on Reserve duty, Espinoza plans to work in South Sudan, a struggling country where she has been working and traveling for over six years–first being trained by the South Sudanese when she was a medical student–not teaching and practicing as a doctor.

“With each trip, I can do more, because I’ve learned more here at Cedars-Sinai.”

Above all, residency has been the challenge of her lifetime.

“With medicine and obstetrics specifically, there are no permissible errors,” said Espinoza. “It’s the same as flying jets–there is a certain level of intensity and desire to execute perfection, which drives and motivates me to work harder every single day.”

But, as Espinoza knows, whether in war or in medicine, mistakes are inevitable.

“I start each day with a sense of humility and respect for human life and for people across all socioeconomic levels,” she said. “That humility comes from seeing a lot of bad things happen and knowing I, too, have made mistakes. But every day is an opportunity to try to do better, let go and forgive ourselves.”

And at a time in her life when many people would be slowing down, Espinoza is relishing her uncharted journey ahead.

“I have been blessed with a rich life and experiences, but without question–the most magical, beautiful thing I have ever experienced in my life or career is being in the room when a baby is born,” she said. “Any pain, loss, or hurt parents may have previously felt evaporates the split second their baby is born. Witnessing and participating in birth is the privilege of a lifetime.”

This story, video and photos originally appeared on the Cedars-Sinai Medical Center website. They have been published here with permission from Cedars-Sinai.