WEBVTT 00:00:02.930 --> 00:00:05.610 Welcome to Our Voices, Our Future, the podcast 00:00:05.610 --> 00:00:07.910 where we amplify the voices driving change and 00:00:07.910 --> 00:00:10.390 equity within medicine and beyond. Brought to 00:00:10.390 --> 00:00:12.330 you by the Gender Equity Task Force, a committee 00:00:12.330 --> 00:00:14.410 of the American Medical Women's Association. 00:00:14.929 --> 00:00:17.109 We're here to challenge norms, break barriers, 00:00:17.230 --> 00:00:19.969 and ignite conversations that matter. I'm Rhea 00:00:19.969 --> 00:00:22.289 Manohar, and each episode will bring you candid 00:00:22.289 --> 00:00:24.570 discussions with leaders, change makers, and 00:00:24.570 --> 00:00:26.890 advocates working to create a more inclusive 00:00:26.890 --> 00:00:29.890 and just world. No more silence, no more waiting. 00:00:30.269 --> 00:00:32.710 You're listening to Our Voices, Our Future. Let's 00:00:32.710 --> 00:00:35.729 get into it. Today we're welcoming Ayushi Otterwall. 00:00:35.909 --> 00:00:38.789 Ayushi is a healthcare strategy consultant with 00:00:38.789 --> 00:00:41.070 a background in medicine and public health. She 00:00:41.070 --> 00:00:43.429 began her journey in medical school before transitioning 00:00:43.429 --> 00:00:45.929 into the healthcare industry, where she now works 00:00:45.929 --> 00:00:48.570 at the intersection of clinical insight and system 00:00:48.570 --> 00:00:51.929 level decision making. Her experiences navigating 00:00:51.929 --> 00:00:54.450 a nonlinear path have shaped how she understands 00:00:54.450 --> 00:00:56.950 healthcare, not just as a profession, but as 00:00:56.950 --> 00:00:59.030 a system. And she's passionate about helping 00:00:59.030 --> 00:01:01.729 others better navigate it. Thank you so much 00:01:01.729 --> 00:01:03.689 for being here. Thank you so much for having 00:01:03.689 --> 00:01:06.689 me, Rhea. So kind of to jump in, can you share 00:01:06.689 --> 00:01:09.489 a bit about your journey and what led you from 00:01:09.489 --> 00:01:12.870 medical school into healthcare strategy? Yeah, 00:01:13.549 --> 00:01:16.510 you know, I realized that at every stage of my 00:01:16.510 --> 00:01:18.769 career, it has taught me to look at healthcare 00:01:18.769 --> 00:01:22.590 from a different vantage point. I think my story 00:01:22.590 --> 00:01:25.810 actually starts before medical school. After 00:01:25.810 --> 00:01:29.650 university, I spent a summer in rural India working 00:01:29.650 --> 00:01:32.849 on this incredible public health project teaching 00:01:32.849 --> 00:01:35.909 basic life support to girls across dozens of 00:01:35.909 --> 00:01:38.170 villages and conducting a health needs assessment. 00:01:38.810 --> 00:01:41.969 It was the first time I realized that improving 00:01:41.969 --> 00:01:44.950 health wasn't only about what happens between 00:01:44.950 --> 00:01:47.890 a physician and a patient. It was also about 00:01:47.890 --> 00:01:51.969 education, access, prevention, and the systems 00:01:51.969 --> 00:01:54.510 that surround care. That experience stayed with 00:01:54.510 --> 00:01:57.569 me, and so I decided to pursue a master's in 00:01:57.569 --> 00:02:00.290 public health. At the London School of Hygiene 00:02:00.290 --> 00:02:03.209 and Tropical Medicine, I wanted to understand 00:02:03.209 --> 00:02:07.189 healthcare from a population perspective before 00:02:07.189 --> 00:02:10.710 jumping to clinical medicine. And after that, 00:02:10.729 --> 00:02:13.370 I started medical school at University of Maryland. 00:02:13.629 --> 00:02:16.750 And then life took me somewhere I wasn't expecting. 00:02:17.110 --> 00:02:21.610 My path became less linear. And eventually I 00:02:21.610 --> 00:02:24.330 transitioned into healthcare strategy and joined 00:02:24.330 --> 00:02:27.430 McKinsey. where I worked with health systems, 00:02:27.710 --> 00:02:30.509 payers. I worked with providers and government 00:02:30.509 --> 00:02:36.289 organizations. What surprised me was that I kept 00:02:36.289 --> 00:02:39.889 encountering many of the same questions, but 00:02:39.889 --> 00:02:43.270 now at the level of entire health care systems, 00:02:43.550 --> 00:02:47.870 I'd see incredible science, innovative therapies, 00:02:48.810 --> 00:02:52.449 dedicated clinicians, and yet so many good ideas 00:02:52.449 --> 00:02:56.270 still struggled to reach patients. So that was 00:02:56.270 --> 00:02:58.430 really the beginning of my interest in understanding 00:02:58.430 --> 00:03:02.310 how good ideas become real world impact. Well, 00:03:02.310 --> 00:03:05.389 that's fascinating. What was it like for you 00:03:05.389 --> 00:03:08.069 when your path in medical school didn't go as 00:03:08.069 --> 00:03:11.129 planned and you had to step away? Yeah, I think 00:03:11.129 --> 00:03:15.289 what stands out to me is just how abrupt the 00:03:15.289 --> 00:03:20.000 shift felt. I was navigating a lot. At once in 00:03:20.000 --> 00:03:23.620 my life and i think what made it difficult is 00:03:23.620 --> 00:03:28.819 that those things don't exist separately what's 00:03:28.819 --> 00:03:31.500 happening in your life doesn't just pause just 00:03:31.500 --> 00:03:34.919 because you're in medical training. And i remember 00:03:34.919 --> 00:03:37.240 feeling like time was passing differently for 00:03:37.240 --> 00:03:41.659 me compared to everyone else maybe you know having 00:03:41.659 --> 00:03:44.610 gone through. my medical education during COVID 00:03:44.610 --> 00:03:48.110 had something to do with that, but I did feel 00:03:48.110 --> 00:03:52.580 paused. And in medicine, there isn't really a 00:03:52.580 --> 00:03:54.780 language for that. You're either on track or 00:03:54.780 --> 00:03:58.599 you're not. At the time, it felt very visible. 00:03:59.000 --> 00:04:02.139 But looking back, I don't think of that period 00:04:02.139 --> 00:04:04.539 as something I lost. I think it gave me something 00:04:04.539 --> 00:04:09.120 incredibly valuable. It forced me to separate 00:04:09.370 --> 00:04:12.669 my purpose from my profession and my purpose 00:04:12.669 --> 00:04:16.050 has always been improving health care. The way 00:04:16.050 --> 00:04:18.930 I contribute to that turned out to be much broader 00:04:18.930 --> 00:04:23.149 than I had imagined. So kind of when we're thinking 00:04:23.149 --> 00:04:26.509 about this, when that happened, what did you 00:04:26.509 --> 00:04:29.009 realize about how the medical training system 00:04:29.009 --> 00:04:31.750 is structured and what it does or doesn't really 00:04:31.750 --> 00:04:34.870 prepare students for? I think medical education 00:04:34.870 --> 00:04:37.949 does this. Extraordinary job preparing people 00:04:37.949 --> 00:04:41.750 to become physicians but what it's less designed 00:04:41.750 --> 00:04:45.709 for is helping people navigate uncertainty when 00:04:45.709 --> 00:04:50.490 they're treading on that path. So there are mechanisms 00:04:50.490 --> 00:04:53.689 for you know remediation or taking time away 00:04:53.689 --> 00:04:57.829 but there's less infrastructure for helping people. 00:04:58.269 --> 00:05:01.949 reframe their identity or explore different paths 00:05:01.949 --> 00:05:05.189 within healthcare or even just to normalize that 00:05:05.189 --> 00:05:08.870 not everyone moves through the system the same 00:05:08.870 --> 00:05:11.870 way. And I think that's where people often feel 00:05:11.870 --> 00:05:16.069 most lost because the system is very good at 00:05:16.069 --> 00:05:20.370 supporting continuation, but much less equipped 00:05:20.370 --> 00:05:24.519 to support divergence. I think that's something 00:05:24.519 --> 00:05:27.160 that a lot of students experience throughout 00:05:27.160 --> 00:05:31.279 their medical education. And it's funny because 00:05:31.279 --> 00:05:34.100 we are trained and equipped to help patients 00:05:34.100 --> 00:05:37.399 deal with uncertainty and those differences in 00:05:37.399 --> 00:05:39.779 their life circumstances, but not necessarily 00:05:39.779 --> 00:05:42.899 as students to deal with differences. That's 00:05:42.899 --> 00:05:46.620 a great reflection. So what kind of support systems 00:05:46.620 --> 00:05:49.279 were available to you and where did they fall 00:05:49.279 --> 00:05:52.470 short when your path became nonlinear? Yeah that's 00:05:52.470 --> 00:05:54.930 a really important question there are support 00:05:54.930 --> 00:05:58.310 structures absolutely things like academic advising 00:05:58.310 --> 00:06:03.129 student affairs offices mental health and counseling 00:06:03.129 --> 00:06:07.089 services that. You are able to take advantage 00:06:07.089 --> 00:06:11.209 of and even formally policies what i found is 00:06:11.209 --> 00:06:13.910 that many of them. You know are designed to help 00:06:13.910 --> 00:06:16.389 you get back onto the path not necessarily help 00:06:16.389 --> 00:06:20.470 you navigate what it means if your path changes. 00:06:21.269 --> 00:06:24.769 And looking back, some of my greatest support 00:06:24.769 --> 00:06:28.370 came from conversations with mentors, even mentors 00:06:28.370 --> 00:06:31.670 who had nonlinear paths themselves, and people 00:06:31.670 --> 00:06:35.029 who reminded me that one chapter doesn't define 00:06:35.029 --> 00:06:38.250 an entire career. How did that experience change 00:06:38.250 --> 00:06:40.389 the way you think about healthcare, not just 00:06:40.389 --> 00:06:43.129 as a profession, but as a system? I think my 00:06:43.129 --> 00:06:47.089 perspective shifted when I stepped far enough 00:06:47.089 --> 00:06:51.220 and gave myself enough space to reflect. Because 00:06:51.220 --> 00:06:54.079 stepping off the path gave me a perspective I 00:06:54.079 --> 00:06:57.379 didn't have when I was on it. And I started noticing 00:06:57.379 --> 00:07:01.319 things like how much the system assumes continuity, 00:07:02.060 --> 00:07:04.839 how much weight is placed on specific moments, 00:07:04.860 --> 00:07:07.720 and how narrow the definition of success can 00:07:07.720 --> 00:07:11.040 be. And I found myself asking, OK, who is the 00:07:11.040 --> 00:07:13.639 system actually designed for? Tell me a little 00:07:13.639 --> 00:07:16.980 bit more about that. What did you start to realize? 00:07:17.279 --> 00:07:20.300 Yeah so i realize the system assumes people can 00:07:20.300 --> 00:07:24.120 move forward consistently without interruption 00:07:24.120 --> 00:07:27.819 but in reality people are navigating health challenges 00:07:27.819 --> 00:07:30.879 family responsibilities they're navigating financial 00:07:30.879 --> 00:07:34.660 pressures and burnout and there's very like little 00:07:34.660 --> 00:07:37.660 built into the system to absorb that in your 00:07:37.660 --> 00:07:40.959 work now. Where do you see similar patterns of 00:07:40.959 --> 00:07:43.439 misalignment or rigidity showing up in the broader 00:07:43.439 --> 00:07:45.959 healthcare system? Yeah, so one of the first 00:07:45.959 --> 00:07:50.019 places I saw this was in clinical workflow. Working 00:07:50.019 --> 00:07:52.759 in strategy, I'd see some tools like nuanced 00:07:52.759 --> 00:07:56.779 communications designed to reduce physician burden, 00:07:56.779 --> 00:08:00.720 and on paper, it makes complete sense. But what 00:08:00.720 --> 00:08:03.639 stood out to me is how sensitive adoption is 00:08:03.639 --> 00:08:08.160 to small disruptions. And I think that connected 00:08:08.160 --> 00:08:12.000 me back to my own experience in training, because 00:08:12.000 --> 00:08:15.100 when you're already operating a capacity, even 00:08:15.100 --> 00:08:19.019 small changes feel like really big. So if a tool 00:08:19.019 --> 00:08:21.379 adds even a little friction, it's not that people 00:08:21.379 --> 00:08:23.259 don't believe in it, it's that it just doesn't 00:08:23.259 --> 00:08:25.420 fit into the reality of how they're working. 00:08:26.339 --> 00:08:29.139 So that's the first example. Another example 00:08:29.139 --> 00:08:34.539 is misaligned incentives. And I saw this with 00:08:34.539 --> 00:08:37.820 therapies like GLP ones, right, from Novo Nordisk. 00:08:38.940 --> 00:08:41.860 And these are incredibly effective treatments. 00:08:42.320 --> 00:08:45.620 I think a lot of people use them now. But access 00:08:45.620 --> 00:08:50.100 is shaped by pair decisions, cost, administrative 00:08:50.100 --> 00:08:53.840 complexity. And what struck to me is that the 00:08:53.840 --> 00:08:57.179 person who benefits, which is the patient, isn't 00:08:57.179 --> 00:09:01.149 always the one making the decision. That creates 00:09:01.149 --> 00:09:04.110 a disconnect. The system doesn't naturally resolve. 00:09:05.649 --> 00:09:08.370 And then the third place I saw this and probably 00:09:08.370 --> 00:09:11.210 the most interesting to me was the last mile 00:09:11.210 --> 00:09:15.230 problem. So there are some digital therapeutics 00:09:15.230 --> 00:09:18.409 like paratherapeutics, FDA approved, evidence 00:09:18.409 --> 00:09:22.669 -based, but adoption still struggled because 00:09:22.669 --> 00:09:27.230 workflows weren't set up, reimbursement was evolving, 00:09:27.710 --> 00:09:30.629 integration into care wasn't simple. And I think 00:09:30.629 --> 00:09:34.370 what stood out to me is we spend so much time 00:09:34.370 --> 00:09:37.370 getting to the right answer, but not enough time 00:09:37.370 --> 00:09:40.309 designing how that answer actually gets used. 00:09:40.769 --> 00:09:43.450 For someone who feels like they've fallen off 00:09:43.450 --> 00:09:46.450 track in medicine, what advice would you give 00:09:46.450 --> 00:09:50.070 them and how do you think they should think about 00:09:50.070 --> 00:09:53.029 moving forward? I think I'd tell them something 00:09:53.029 --> 00:09:56.509 I wish someone had told me. It might feel like 00:09:56.509 --> 00:10:00.419 you've lost momentum. It might feel like you're 00:10:00.419 --> 00:10:03.500 alone, but that is just not the case. You may 00:10:03.500 --> 00:10:07.639 have gained perspective. So don't be afraid. 00:10:07.840 --> 00:10:11.799 Don't be afraid to ask for help early or to lean 00:10:11.799 --> 00:10:17.240 on mentors or to talk to classmates. Find communities 00:10:17.240 --> 00:10:20.279 like AMWA where people are willing to have honest 00:10:20.279 --> 00:10:27.049 conversations. I think I realized Very far out 00:10:27.049 --> 00:10:29.629 that there's so many people going through these 00:10:29.629 --> 00:10:32.870 diverse experiences and remember that one chapter 00:10:32.870 --> 00:10:36.389 doesn't define your entire career for me my path 00:10:36.389 --> 00:10:40.070 change but my purpose didn't. And you know i 00:10:40.070 --> 00:10:42.190 still wake up everyday wanting to improve health 00:10:42.190 --> 00:10:44.470 care i'm just doing it from a different vantage 00:10:44.470 --> 00:10:48.190 point and if there's. One thing that this journey 00:10:48.190 --> 00:10:50.289 is taught me that health care doesn't just need. 00:10:50.490 --> 00:10:53.210 more good ideas, it needs people who can help 00:10:53.210 --> 00:10:56.950 those ideas reach patients. And that's the kind 00:10:56.950 --> 00:10:59.909 of work I'm excited about. Well, thank you so 00:10:59.909 --> 00:11:03.090 much for sharing your perspectives and your experiences 00:11:03.090 --> 00:11:06.210 with us here today. That's a wrap on this episode 00:11:06.210 --> 00:11:09.190 of Our Voices, Our Future. We hope today's conversation 00:11:09.190 --> 00:11:11.590 inspired you, challenged you, and reminded you 00:11:11.590 --> 00:11:13.769 of the power of raising your voice. The fight 00:11:13.769 --> 00:11:16.070 for equity doesn't stop here. Join us in the 00:11:16.070 --> 00:11:18.409 movement. Subscribe wherever you get your podcasts. 00:11:18.809 --> 00:11:20.809 If you loved this episode, share it with someone 00:11:20.809 --> 00:11:23.830 who needs to hear it. Until next time, stay bold, 00:11:24.090 --> 00:11:26.029 stay vocal, and keep the conversation going. 00:11:26.549 --> 00:11:28.190 This is our voices, our future.