David Quackenbush (Host): Welcome to the Golden Voices Podcast. I am your host, David Quackenbush, president and CEO of Golden Valley Health Centers. And today I am joined with, Dr. Isha Verma Thur, a pediatrician and regional medical director of Golden Valley Health Centers. Welcome, Dr.

Richa Verma Thakur, MD: Thank you. Thank you for having me.

David Quackenbush (Host): So, doctor, as you know, I have your bio in front of me, but this podcast is about journeys. I'm always fascinated with people's journeys as we've had conversations in the past about this. And so instead of kind of going through your, bio dryly, I think it's great for people to hear your story.

You have a very interesting journey. You have an international journey, which is, I don't, you probably don't really appreciate how unique you are to our world. but I thought it was, I thought it was it. You're very valuable to Golden Valley and I thought it'd be a valuable story to share.

So, to start, why don't we just talk about how, well, I guess there's the how and why, how and why you became a doctor in the first place. I.

Richa Verma Thakur, MD: Yeah, so when I get asked this question, I usually go back to my childhood days. I am from Argentina. I'm from Bueno, Argentina, but my parents are from India. And on my mom's side, there is a very strong lineage of doctors. My grandfather was the seventh generation of doctors, so I, do think there is a strong genetic component on in my life decisions, but I also had the opportunity to spend a lot of time with my grandfather.

I lived in India for four years. This was around ages of eight to 12 approximately. And he, again, he was a doctor and he had his clinic right across from the house, so I spent a lot of time with him, And that was my first exposure on what it really meant to be a doctor.

And, I guess HIPAA wasn't a big issue, but I did spend a lot of time with him when he was seeing patient's. So I really, I wanna say that's where the interest And the curiosity And in medicine started. And then as I grew older, high school And then med school, this, grew bigger and bigger.

It became more of a passion. And then going to med school was just a natural transition, I would say. following what I had started to grow interested in, and as medical school happened And then residency, it all just made a lot of sense as I was going through this career path.

This is exactly what I wanted to do, and. the first half of medical school, you're really just learning the human body, the basics of medicine. And then the second half is when you actually get to go to the hospitals, the clinics, and have patient, direct patient care experiences. And I will say that one of the things that.

Completely blew my mind in medicine. And while seeing patient's was the connections And the relationships that were built between a patient and a provider, to me it was very, humbling. And at the same time, very interesting how a patient will bring their emotional, physical pain and sometimes things that they don't feel comfortable sharing with their loved ones.

They will deposit all that. trust. In a complete stranger in a way. And then on this side, as a provider, you have the privilege, the opportunity to somehow help this person make an impact. that to me was, I think that when I started having those experiences with patient's, it just made it very, very clear that This is what I really wanted to do long-term.

so it's been like a sum of experiences that I would say made me choose my career path or. Made me who I am today.

David Quackenbush (Host): That's interesting. And obviously the family impact is, really resonates. golden Valley, as you know, we have over 300 some odd doctors on staff or contract, and I always like to re remind myself and other's that doctors are people too. And they have, just because they're a doctor doesn't mean they do everything or wanna do everything.

And lots of doctors, especially nowadays specialize. I'm just curious. Well first I assume your grandfather probably was a general practitioner, kind of took care of everybody for everything. that's my assumption. You can correct me if I'm wrong, but you are a pediatrician And we know there's plenty of doctors that don't wanna work with kids.

That's really nothing. That's just, that's why, I'm an administrator as opposed to a clinician. 'cause I'd rather help clinicians instead of actually help patient's, which I probably wouldn't be very good at. why did you pick pediatrics?

Richa Verma Thakur, MD: So, it goes all back to that opportunity to make an impact and help patient's. again, during med school you get exposed to the different specialties, and I remember my pediatric rotation was. One, the one that I enjoyed the most. it could be because I had great, great mentors and, the attendings were very focused on educating as well as taking care of the patient's.

So I think I had really good experiences there. But also, if I go back to the why I chose medicine, it was around being able to create an impact in the patient's life. And, I can say that if you can. Help a child grow, be with them when they're growing and be with their parents who have multiple questions.

You can kind of mold the adulthood of this child that you have been seeing since they were born. So that impact really is crucial to me as a pediatrician. and many. And the that I really, really enjoy is that we're talking about a patient that cannot really say what they're feeling for the.

Majority of their first part of their life. And you really have to do a lot of, understanding medicine just by seeing them and knowing, what could be the symptoms based on what you're seeing in the patient and based on what your parent is relaying to you. So there is a lot of, I won't wanna say guessing, but a lot of kind of putting thing one to one together to understand what's going on with the patient that cannot tell you really what they're feeling.

So it's another way of doing medicine that I think was very, very, it's challenging and very rewarding at the same time. And then again, it goes back to my idea of being a provider and creating impact in somebody else's life.

David Quackenbush (Host): Yeah, that's great. Thank you for that. A little bit more about your journey because now you are in California, you're in the central part of California. Having grown up in Argentina with an Indian background, can you tell folks, 'cause you and I are very familiar and a lot of folks are familiar who work with community health center or low income families, that there are, there is a tremendous amount and value of doctors from all over the world taking care of our patient's.

At Golden Valley, we celebrate diversity. We have. 30, about 30 international medical graduates on staff. It's a point of pride for us. but there is a journey that you all have to go through to become a doctor in the United States, And then California is kind of one more level of detail beyond that.

So, so take us through the journey that you had to go through to end up at Golden Valley.

Richa Verma Thakur, MD: Yeah. So, My journey started in Buenos Argentina. That's where, I was born and brought up with, like you said, my parents. Being from India, the Indian culture was always very present in our family. We celebrated all the festivals, we had all the awesome food at home, And we visited family a lot.

and as I said, I lived in India for four years as well, where. my first contact or my role model, my grandfather was where the, first interest And the first, decision, if you wanna say unconsciously, started around being in the healthcare, in the healthcare world. And then again, we went back to Argentina, where I completed my high school And then started medical school.

So I did my medical school in Argentina. At University of Bueno Aires, where, the first half was more around understanding health. Care or medicine. And then the second half was about seeing patient's. At that time, I did my rotations in the public health system of Argentina. So I would say that that's also was my first exposure to serving underserved, uninsured, or underinsured patient's.

Fast forward, I, decided to come to the US for my residency training. At that point, it was more of a decision around, I wanna do something different. I've, all I've done is gone to med school and study a lot. I wanted something more challenging, something more fun to happen in my life.

And I had some friends and family members who had thrown out this idea about being able to do residency in the us. So I started. Doing my own research on how could that be a possibility, and I was able to get a residency in New York, so my residency was in Manhattan.

And the Mount Sinai Amherst program, which was very unique in its way that we had, the opportunity to rotate in two very different setups. So on one hand, we would do some clinical rotations and inpatient, service in Mount Sinai Hospital, a large academic hospital, upper East Side resources were not, was not a problem.

From the healthcare side And also from the patient that, we would see in that setup. And then we would also spend a lot of time in a community hospital in Queens. And that's where we would see patient's who did not have, routine access to healthcare, who would not have, who did not have insurance, or who would be underinsured, or who very, very diverse, ethnic background.

so those were the two exposures that we had and. I will say that that was the experience that made me realize where the highest need is, and it was definitely in this community where there was a lack of resources, but there the need was really high. So, it really made my decision to practice not only in primary care.

But also in the underserved community. at that point, once residency was done, I knew I wanted to do primary care. The next question was where, and my, at that point, boyfriend, now husband, he is, in the biotech and biopharmaceutical field, And we made a combined decision that we would move to the, to this side of the country.

Yeah, it was both of us. I'll say that. we made the decision to move to this part of the country. The weather And the work options for him were, more, robust. And also, I, was in touch with friends and, previous graduates from my medical, residency on people who had already been working in Golden Valley.

So again, different opportunities came through. And then when I. Got through the interview process for Golden Valley Health Centers. I remember we toured at different sites. I was given the option to, to either, work at Los Banos Clinic or Merced Clinic. And at this point in, in, after having done residency, after seeing what primary care meant, and after knowing what practicing in a rural community meant, I really had the idea of being the rural doctor.

Living in a small town, knowing the community that I was going to be working with, knowing my patient's, where do they go to school? What's happening in the community? All that to me was very important as a pediatrician in primary care. So I remember I chose Los Banos because I felt like that was a smaller community compared to Merced, and I wanted to have that experience of being the community doctor.

So. My journey in Golden Valley started in 2016. It's almost gonna be 10 years, which is crazy and exciting. my first job after residency. So it's, been a whole journey. And again, I started, practicing in Los Bonos. I remember the clinic, had re had lost their full-time penetration a few months before I started, so we almost lost a lot of patient's around that period of time.

So, when I joined it was also a matter of bringing back those patient's back to care. And I think, that was a lot of, it was a really interesting path because again, I, it was now kind of my responsibility also to bring those patient's somehow back and make them, trust us back that we now have a person that's gonna be seeing you.

It's gonna be permanent here, and, you can come back to care. We'll take care of you. So that was part of the first few years in the journey. and. A few years after joining Golden Valley, there were a few opportunities to get more acquainted with healthcare on the administrative side, on the leadership side.

So I then, started the role of regional medical director in around 20 18, 20 19, And then slowly, grew more into the direction of clinical informatics, which started mostly around the time where we decided that we're going to switch our EMR, we're gonna implement a new electronic medical record.

And that's where I got more involved in the informatics area. It started as a small ask, like, Hey, we'll be just consulting you in some clinical build. And it slowly became a completely different and big, big, big. Project more than project our, how we did medicine organization. That's how what it became.

So, I humbly asked at that point our CMO if I could divide my roles from being regional medical director and, informatics just to dedicating more time and informatics so I could give it my a hundred percent. And, so This is where we are today. I'm still seeing patient's. I still go to clinic.

I think that's. Probably the most, happy part of my week when I'm in between my patient's. And then I still do, my informatics role the rest of the days.

David Quackenbush (Host): I wanna talk a little bit more about your current role, but I wanna go back real quick. because you, just kind of, you made it so, you made it sound so simple from going to, going from Manhattan to Los Banos. Man, you know, Los Battles for our audience is a.

It's still a small rural farm worker town. I mean, obviously it's grown like every other town in California, but it's still, small in our clinic. There's kind of, a symbol for healthcare there. I mean, what was the culture shock? What was the shift? it's interesting how That is the vision you had in your mind that you actually made come to life, which is fantastic.

but any, just thoughts on that culture shift And the transition, 'cause you went from a very small, a very big place to a very small place, and you went from East coast to West coast. Just any comments or thoughts on that?

Richa Verma Thakur, MD: yeah, it is definitely a cultural shock, from very. If you wanna call superficial things like having to drive everywhere, not having a subway or a train, which I was so used to really more, again, practicing medicine. One of the things that I learned very early on in my residency program is that.

You do. Medicine doesn't change. The human body doesn't change. Disease doesn't change. But how you practice medicine, how you practice that art changes based on the resources And the community that you have around you. So that I think, was the cultural shift, right? Like again, we're still practicing in an underserved community like I did in.

Queens, but now you are talking about, like you said, different rules or regulations in a different state. you have, even though you're still serving underserved patient population. We didn't have migrant workers there. We didn't have the concept of you're going to see this patient for a certain months And then you're not gonna be able to see them again until a few more months.

So those were things that I had to learn and I will say I'm grateful, grateful to the staff in the LOS Clinic. This the clinic. Center managers, supervisor, the MAs, they were the most welcoming people. When I joined the clinic. They got me very up to speed on how things function in the community as well as in the organization.

And, that cultural shift was very, very easy with that support. They felt me, they make me feel really, really welcome And so did the community. You know, again, it was a small community, so. You very quickly. You probably went to the same grocery store, you probably went to the same gyms with your patient and their parents And the school And the events.

So that made it really very easy for me to transition to be part of that community and felt welcome by the community And the site. And then, yes, I mean, it still was an adjustment, right? I was moving from one place to another, from one side of the country to another by myself.

So had to grow up really fast in the personal side about, again, had to learn how to drive, had to, learn the basics about really being in a very different community. And it was a transition. It was a lot of fun. It was a very steep learning curve. but I really enjoyed it.

David Quackenbush (Host): you would literally like see the patient's when you're running Arids on the weekend. You would see your patient's

Richa Verma Thakur, MD: Especially, it would happen. It would happen a lot and it would also, happen in the pharmacy. your patient's like, oh yeah, I'm here picking up your prescription. Yeah. They're like, well, can you clarify this for me? I don't really know how to take this. I'm like, yeah, I'm here.

Might as well, or My favorite thing was going to, to the gym seeing the parents or sometimes even the patient's at the gym. and now I'm going into details, but it was to the point where I knew the UPS delivery guy. I worked out with him, and he would come to the clinic and ask me, do I deliver your packet here or at home?

Like, it became that kind of. Beautiful, community. I loved it there.

David Quackenbush (Host): Well, going to the gym is one way to hold your patient's accountable too. Right?

Richa Verma Thakur, MD: If

David Quackenbush (Host): If they need to lose a little weight or, that's actually pretty good. And the other thing I wanted to mention, because people, wouldn't know this just off the, just by, watching this, but because, the majority of Golden Valley patient's are, immigrants and, and large portion of them speak Spanish.

And I mean, you being bilingual Spanish. I would assume really helped in that transition to Los Banos. 'cause all of a sudden a completely fluent pediatrician was plopped in Los Banos and I'm, I would assume that was probably celebrated by the community.

Richa Verma Thakur, MD: Yeah, I never really realized what it meant to be bilingual until I did my residency. 'cause again, Queens we have. A large Hispanic patient population, but also, like you said here, in Los Banos and, in California in general. I think it, patient's really appreciate it, and I will be honest, I love being able to communicate and get into that connection with the patient in their own language.

It makes things so much easier. There is no room for interpretation. There is, it's way more easy for the patient. It's way easy for me as well to be able to have that connection with them. So, it was, I think it was welcomed and will say from my side, it was very exciting as well to be able to speak the same language as my patient's.

David Quackenbush (Host): That's great. I mean, the cultural linguistic competence for our patient care is very important. So you have a a somewhat of a unique role for us here because you're a regional medical director, which you have some peers that kind of had the same time. Title and have had the same role.

However, you are part of the medical informatics team, which I'm sure when you came here 10 years ago was probably not existent. And it is becoming more and more important, not just the Golden Valley, but just the healthcare in general. You mentioned our electronic health record, epic, but we are also implementing some AI innovations and healthcare is just going in that direction.

talk a little bit about why that interested you And what you see, kind of the future of medical informatics. I mean, really for community health centers like ours.

Richa Verma Thakur, MD: Yeah. So my journey in informatics really started, when organization made the decision that we're gonna be switching EMRs. And This is back in 20 17, 18. The discussions started, of course, the implementation came later on. I got involved, initially more as in, Hey, we need somebody who can be our clinical counterpart to answer some clinical questions.

And I didn't, I don't think I knew what I was getting into when I accepted to be that clinical partner. And the more I got to, be, part of the implementation decision-making questions that would come up, it just that my interest really grew a lot because I started realizing.

How technology really can impact every aspect of. Healthcare, and if you put it more in a granular level, all these decisions and discussions that were happening on the side would impact how the patient gets their medication in the pharmacy, how the provider places that order, what should we be doing so that that's easy for the patient And the provider So, really started me showing that part that I was not very familiar with before in terms of how this little clicks or decisions that we do have a larger impact.

So. as we grew in the journey of the implementation, my role started becoming more and more, more informatics rather than just medical director. And it was taking a lot of my time in a good sense. 'cause again, there was a lot of work that needed to be done. It's a big deal to implement in new EMR.

So, the more I learned about it, I got more and more interested. And the nice thing is that when you are going through this implementation, especially for us that we went live with Epic, EPIC does offer a lot of training or resources for those that are involved in this decision-making that have not been exposed to informatics per se.

So at that training, you learn more of what I like to call the geeky things in the background, the software, the more it perspective of informatics. That I think was also pretty cool. I mean, I, I had never thought I would be interested in all those things. The more exposed I got, the more, I got interested.

And again, it was one of those situations where you realize that small decisions have a huge impact in the end. so that was, another reason why I decided to kind of get more and more involved in this. I always say this, but we are very lucky in our organization.

We have a very robust, IT team and a very, IT team That is always open to partner with subject matter experts, So, It doesn't feel like an isolated decision. The decisions that are made on the IT side are very well informed or very, very well backed up by the different subject matter experts.

So, that partnership I think is key for any. Person doing informatics or any organization, if you wanna say, to have a fluid, partnership between your operations, your medical side, And the IT side. And like you mentioned, This is almost like a new career. I wouldn't say new because this informatics has been there for the really, for the longest time.

But now with. How technology is advancing Informatics has started to play a really key role in the organizations. It used to be more in the background, and now they're more in the decision And in the upfront, sector of organizations, to the point that we have now roles and there is actually a fellowship that people can do as they graduate from medical school That is focused mainly on informatics.

And like you mentioned, in our organization. in any organization, implementation of EMR is not a one andone thing. You constantly are working to make things better and easier and effective for your staff. So you start looking at everything That is available out there in and outside your EMR. Again, with always the why in the back of your head, That is, how do I make this effective and efficient for our patient's and our providers?

So. informatics is, there's so much opportunity, and especially now with, like you said, AI coming And in, actually anything in healthcare, right? AI is starting to make its appearance. So there, the opportunities are even bigger now.

David Quackenbush (Host): Yeah. Thank you for that. You've had quite the, it's interesting because you've had a journey, but you've also had a bit of a journey here at Golden Valley, which is great. so my last question for you, which I like to end with is. I mean, you probably don't even think about this.

you've had a pretty robust experience. I mean, the, you've had the immigrant experience, you've had the health professional experience, you've had your experience here at Golden Valley. for people listening, what advice would you give them to consider in their own journeys?

Richa Verma Thakur, MD: I would start by saying always have your why. The reason why you chose a career very, very present. It doesn't, I mean, I can talk from the healthcare side, but if you think about it, it applies to any career. You always choose a career because you're passionate, because you are interested in something.

And that should always be present. healthcare, per se, can be challenging, can be frustrating at times. And if you don't have your wife very, very present and, Present in every decision that you make. it can be challenging, right? But it, easy if you go back to the reason why you chose something.

and always be humble, be curious, be open to learning, constantly, whether it is with your patient's, if you're a full-time provider, if you are. leadership, be humble to work with other people. 'cause you're never going to be, you're never going to know everything. So being humble and open to learn more every single day.

I think those would be, my recommendation for anybody who's starting any journey, whether it's in healthcare or not.

David Quackenbush (Host): That's a great place to end. I appreciate you joining us on the Golden Voices Podcast. I appreciate you and your leadership and thank you for joining us.

Richa Verma Thakur, MD: Thank you, David.