Member of the Month: Shiv Agarwal, M.D.

First-year resident changes career path for family medicine

posted 10.22.13

In his first year of residency at Fort Worth’s John Peter Smith Hospital, Shiv Agarwal, M.D., currently describes his health care career aspirations as “to be determined.” The trail that led him to family medicine wasn’t necessarily direct, but he knows he’s now in the right place.

After studying a variety of subjects during his undergraduate years at Duke University, Agarwal graduated with a bachelor’s degree in economics and biology minor. Assuming he would enter the world of global business and health care consulting, he took a job with Deloitte Consulting. From his office on the 25th floor of a Manhattan skyscraper, Agarwal reflected on the poverty he witnessed firsthand while on a trip to visit family in India. Before he knew it, he had returned to the Fort Worth area, near his hometown of Richardson, to study medicine at the University of Texas Southwestern Medical School.  

“Ultimately, I want to do something entrepreneurial with medicine that ignites change and enables the efficient delivery of excellent, altruistic care for those it serves,” says Agarwal.

Why did you choose family medicine, and what’s your favorite aspect of it? Were you inspired by anyone?
In medical school, I was amazed to learn about the rich history of the medical profession, the altruistic philosophies of its founders and leaders, and the ingenuity and innovation of the scientific discovery process. However, being a business outsider looking in at the medical system, I found medicine to be terribly inefficient, convoluted, and segmented. On an aid trip to Haiti after the earthquake in 2010, I realized that to best serve the most underserved populations in the world, I needed two things: (1) a very broad and deep medical skill set and (2) an understanding of human behavior, systems, and policy. However, I did not know how or what that skill set looked like until I discovered family medicine as a third-year medical student. I continued to search for the puzzle piece that would connect my medical education to my interests in business and philanthropy.

When I rotated through the family medicine clerkship, the pieces finally connected to form a complete picture. In family practice, I had found my Rosetta Stone. It was inspiring to see the way family physicians dealt with illness, not only focusing on the disease process but also considering the patient’s holistic psychosocial needs. Further, I found the variety of patients exciting, the long-term relationships rewarding, and the constant requirement to learn across all fields of medicine extremely stimulating. Within a week of beginning my family medicine rotation, I had found my place. My colleagues and I revitalized our defunct family medicine interest group, and I became active in the Texas Academy of Family Physicians. A flame inside of me had been ignited.

I have been fortunate to have the honest and whole-hearted mentorship of several people who I credit for guiding my path to becoming a family physician. Coming from an immigrant family, my mother has been one of my biggest motivators in pursuing the rigorous and righteous path while my father taught me to feel comfortable to take risks and challenge the status quo. My brother, wife, and friends have been my closest companions and confidants through the challenges of academia. Finally, I credit a set of people who I consider my “Academic Sages” — a set of professors, professionals, and physicians whose guidance has been invaluable: Mrs. Mary Eisenmann (J.J. Pearce HS), Prof. Tony Brown (Duke), Mr. Doug Standley (Deloitte), Dr. Jeanne Sheffield (UT Southwestern), Dr. Jackson Griggs (Waco Family Medicine), Dr. Dan Sepdham (UT Southwestern), and now Drs. Richard Young and Dan Casey (JPS). They have all contributed something unique and valuable to help me better understand the world.

It is important for me to be a member of AAFP and TAFP because:
When one person has a great idea and yells it down the street, maybe a handful of people hear about it (and probably think you’ve lost it). When thousands of people get together and announce a great idea, the world hears about it, and things start to change. That’s the power of organized family medicine in bringing change to a fractionated medical system.

What are you most looking forward to in your first year as a resident?
I’m a hands-on learner, so for years I have eagerly awaited the day when I could manage my own patients and personally feel the autonomy and responsibility of the practice of medicine. The transition from medical school to residency is a lot like trading in your learner’s driving permit for a laminated license and getting handed the keys to your dad’s minivan. In both cases lives are at risk and the responsibility is not to be taken lightly.

What advice would you offer to medical students?
I could offer medical students a simple three step plan that worked for me when confronting the daunting task of choosing a specialty:

1. Ask yourself how you define and measure the concept of “your greatest good” — is it the greatest good for the world? Your community? Your family? Or something else?
2. Then, truthfully evaluate your strengths through medical school and ask yourself how you can use those strengths to produce this “greatest good.” That’s your specialty.
3. Finally, when on the interview trail, ask yourself, which of the places you visited will enable you to grow your strengths in the greatest way to produce this “greatest good.” Throw aside distractors like prestige and pay and I think what you’re left with is your answer.

What are your future goals when you go into practice?
I want to find ways to deliver the most efficient, effective, and accountable care to as many people as possible — anywhere. That’s a lot of nebulous buzzwords especially in our modern era of medical acronyms such as PCMHs, QIs, and EMRs, but I think you have to start broad when dealing with something as gargantuan as health care. I’m still knee deep in the process of figuring out what all that looks like, but maybe it’s starting a private practice, taking on a leadership position, working as a health care consultant, or something completely different. I don’t know, but I’ll let you know when I figure it out.

What has your experience as a TAFP member been like?
I credit TAFP and its leadership in fueling my passion and motivation for family medicine. I remember learning about the TAFP conferences when I first rotated through my family medicine clerkship as a third-year medical student. In fact, when I first heard about it, I immediately registered for the very next conference, which happened to be a week away. On that initial drive down to Austin, I remember being quite anxious about being ‘the new guy’ amongst veteran family physicians from all over Texas. However, in true family physician form, I was welcomed and made to feel at home as a part of the profession very early on.

I felt that my energy and interests were not only recognized but also channeled in productive ways to better the medical system in Texas. From leadership positions to service opportunities, I quickly felt like I had a family at TAFP. Within my first years, I served as a TAFP student delegate to the AAFP National Conference and on various TAFP committees.

How can we attract more medical students to family medicine?
Honestly, I think that once someone experiences firsthand the virtues of the care a family physician can deliver, the profession sells itself. The challenge is acquainting medical students and patients alike to broad spectrum family medicine practices. Programs such as the Texas Statewide Family Medicine Preceptorship Program really addressed this issue head on, and I think further efforts in bringing full spectrum practice to major metropolitan areas will increase the eminence of the profession and highlight the value of access and continuity.

Tell me something fun and unrelated to medicine about yourself.
A few of my friends and I played in a medical school band called The Notochords. How nerdy is that? We played a handful of shows a year in various small venues and packed it wall-to-wall with friends who knew all the words to all the songs we played. Most recently, The Notochords flew back from their residencies and came together to play at my wedding. It was wonderful.

How do you spend your free time?
There isn’t too much free time right now in residency and we’re expecting our first baby. However, I still enjoy playing the drums, kayaking the Trinity River with my wife Danielle, and cooking. I’m getting pretty adventurous as a home cook, and I have been training to try out for one of those TV cooking competition shows like Chopped if I can get a couple nights off from ER shifts, that is.

TAFP’s Member of the Month program highlights Texas family physicians in TAFP News Now and on the TAFP website. We feature a biography and a Q&A with a different TAFP member each month and his or her unique approach to family medicine. If you know an outstanding family physician colleague who you think should be featured as a Member of the Month or if you’d like to tell your own story, nominate yourself or your colleague by contacting TAFP by e-mail at swhite@tafp.org or by phone at (512) 329-8666. View past Members of the Month here.