MetaCast #04 - Insights from Australia to the U.S. with Siddharth and Nayruti Trivedi

In this episode, MetaCast features two exceptional guests: Dr. Siddharth Trivedi, a consultant cardiologist and advanced cardiac imaging specialist from Australia who completed a multi-modality cardiac imaging fellowship at Brigham and Women’s Hospital, and Dr. Nayruti Trivedi, who holds a PhD in science and served as a former research manager for the Cardiac CT and Prevention team at Brigham and Women’s Hospital, Harvard Medical School.

Join us as Dr. Siddharth Trivedi shares his journey from Australia to one of the world’s top medical institutions, detailing his experiences at Harvard. Discover the challenges, rewards, and life-changing opportunities that come with international medical training in a high-volume center. Dr. Nayruti Trivedi offers her unique perspective as a research manager, providing valuable insights into the world of medical research at Brigham. Learn all about their transition from Down Under to America, including the personal aspects of their journey. 

Creators & Guests

Host

Rhanderson Cardoso

Clinical Cardiologist and Cardiac Imaging @BrighamWomens @harvardmed | Former cardiology fellow @hopkinsheart @ciccaronecenter

Guest

Nayruti Trivedi

PhD in science and served as a former research manager for the Cardiac CT and Prevention team at Brigham and Women’s Hospital, Harvard Medical School.

Guest

Siddharth Trivedi

Cardiologist, CV Imager, Research, Ex-Advanced CV Imaging Fellow, Brigham and Women's Hospital, Harvard Medical School @BWHCVImaging @BrighamWomens @harvardmed

What is MetaCast?

The PodCast of the Meta-Analysis Academy!

Hello, everyone, and welcome to MetaCast, the podcast of the Meta analysis Academy. I'm honored to have here today with me Sidharth and Iruti Trivedi, who came from Australia to training the United States and will tell us a lot about this transition, having done residency, in Australia, then coming to the United States for a clinical fellowship. Niruti is a research coordinator, was a research coordinator here. She's gonna tell us all about that. So I'm very excited to have, Siddharth Trivedi and Niruti here with us.

Could you guys please start by introducing yourselves? Sure. Thanks, Anderson. It's a pleasure to be here. And hi, everyone.

My name is Siddharth. I'm a cardiologist from Australia. Did my training there in the land down under, and, completed internal medicine and cardiology training and a PhD in Australia before coming to the US for a post doctorate fellowship in clinical cardiovascular imaging. And having done 2 years here, it's been an amazing experience and I would strongly suggest anyone considering a fellowship in the US to to to consider this. Thanks, Anderson.

It was, it's our pleasure to be here. Hi, everyone. This is Neru Thitoorvady. I'm research coordinator, and, I have a PhD in marine biology. I have also got a post doc diploma in environmental management.

I worked at University of New South Wales before and then took a break from my career for a few years to look after my fa young family. And then when we moved here, I started working as a research coordinator in a medical field and had a great experience. That's amazing. We're going to talk about this position specifically that Niruti had here as a research coordinator because a lot of international doctors, medical students come here to United States and work as research coordinators so they can get their foot into the door in terms of research, and Aruti is gonna tell us all about that. So if you guys are new here to MetaCast, I just wanna give a general announcement first.

MetaCast is the podcast of the meta analysis academy. In this podcast, we discuss successful careers, topics that are relevant to medical students, doctors, to research researchers in the health care field worldwide. And then the meta analysis academy is a training program that teaches methods, statistics, and writing of systematic reviews and meta analysis. What we discuss here today is not affiliated with the institutions where we work here in the US or in Australia. It's our own opinion.

And then if you guys wanna join the meta analysis academy, we'd love to have you. Please make sure to join our wait list. And then the final announcement is that the meta analysis academy does not do publications for others. We teach you the methods and all the details on how you can do it yourself. So Sider, let's start with you.

Can you tell us why train in the United States? You did residency and fellowship in cardiology there, even a PhD you told me about you just told us, Why did you decide to come to United States to do additional training in cardiac imaging versus staying in Australia, for example? Absolutely, thanks, Anders, and this is a very good question, and a question that all young doctors should think about. So in any specialty in medicine, if you wanna be the best of the best, and if you wanna achieve the goals that you set out yourself to achieve, particularly in high end fields like cardiology, or gastroenterology, neurology, endocrinology, these are all specialties which require subspecialty knowledge. And nowadays, the practice of medicine requires subspecialty knowledge in in institutions that are highly rigorous and highly, high high value in terms of training and volume.

So my thoughts were that I wanted to be an outstanding cardiovascular imaging specialist, not just a cardiologist, but also a subspecialty cardiac imaging specialist. And for that, I wanted to have a high end, high volume training program. And for that, the United States is second to none. It's a beautiful country which has outstanding institutions and some pioneering hospitals which have trained global authorities in their field. And so to be training here under some eminent physicians and researchers who teach you everything they know about science, medicine, and cardiovascular imaging was something that I really dreamt about.

And having done the 2 years here now, I feel that it was absolutely the right decisions because in a high volume center, the training you gain, the amount of knowledge you specialize in, and the empowerment you feel is absolutely unbelievable. So I think in terms of anyone considering a, specialty physician, career or a subspecialty physician career, they must think about, training at a high volume center and having a high end fellowship which will prepare them as physicians of the world to, not just practice medicine in an outstanding way, but to teach medicine to future physicians. So I feel three reasons that, one should consider a fellowship in the United States. 1 is high volume, high end training. Secondly, the ability to teach others in the future.

And thirdly, to be able to expand their horizons and learn in a do new environment, which that makes them a better physician overall. That's fantastic. And we're gonna come back to this and how was the application process. A lot of doctors internationally want to have this opportunity, and they're already trained. They already did residency, maybe even fellowship like yourself, and then they wanna you're gonna teach us all about how how this process was done.

But first, I want to ask Naruthi, how did you receive this news? You're not necessarily in the medical field, you're not in the medical field. And then Siddharth, you know, had this career there already, residency fellowship, and is like, let's go to America. Let's travel across the world. What did you think about this, Niruti?

It was challenging, but I was really happy for him because, it was his dream and he thought about it and he planned it, many years ago, and I was always supportive of his decisions and his career, enrichment. So I was very happy for him because I knew that he was applying and he was gonna do the, all the tests and everything. So, but making an actual move was a big decision, plus we have a young family. We have 3 kids. So, making a move with the 3 young kids is definitely challenging.

Initial settling was a bit more difficult because he was busy, and, these fellowships do demand a lot of hours from you. But once you settle in, this is a wonderful place. Like, our kids loved, exploring the outdoors. Just, like, exploring the Boston weather was very different for them, and having a life, in a different country definitely made them more resilient. And they can look back and tell their friends when we go back that they had a great experience, made some wonderful friends, at new schools, and had a wonderful time.

And even for us, initially, it was challenging because we are coming to a new place. Like, it's always the case when you come to a different place. You have to settle, you have to find the house, and everything, like everybody who has moved places know. But once you're settled Yeah. You can actually embrace the country.

You can feel there are so many opportunities for you over here to just grow as a person, as a family. And, personally speaking, it definitely brought all of us together as a family. We were supporting each other. We were happy for each other. We were, sad for each other at times.

If one person is feeling homesick, We have each other to support. So that, it's, challenging, but we took the news very positively. We told our kids, that it's a positive thing, that we are gonna move. They were excited? They were they were very excited, and, they took it very well, actually.

And, kids are more resilient than, adults at the time, so Yeah. They were very happy in their new schools, made lots of friends, and now they told all their friends, come and visit us in Australia, it's fun. Yeah, so for our audience listening in Brazil and other countries around the world, you know, if you're if you're a physician, and you wanna come and do a career in the United States like I did, I came here right after medical and did residency fellowship and stayed on into practice. And if you're still in medical school, it's it's better to do residency, of course. You If your goal is to come to United States and establish a career here, it's it's better to come out of medical school and then plan to do residency here.

But then if you have already an established career in your home country or if you want to establish your career in your home country even though you're in medical school, you can consider this great option, which is to get your training there, you can get to know people, you, you spread your roots, let's say, and then, you have an experience in the United States. You know the last metta sessions I recorded was with Metacast, excuse me, was with Andre Zimmerman who did the same, but he came to do a research fellowship and he told us all about that. So Siderif, let's go over that process. You know, once you you wanted to come to the United States for a fellowship in cardiac imaging, Sidharov trained in the same program that I did, 2 years, very busy as he was saying, great training, echocardiography, cardiac CT, cardiac MRI, nuclear cardiology. One of the very competitive programs in this country for cardiac imaging, at Brigham and Women's, Harvard Medical School, an amazing institution.

So how was the process of preparing the, you know, the certificate, the steps having already done all the residency and fellowship in Australia? And then also how was the application process itself to get this, you know, highly sought position? Yeah, absolutely, and this is a very important practical point. And I would advise anyone considering a fellowship like this to plan early, that's the key. So even if you're in medical school or even if you have, trained as a physician in your home country, and you're thinking about doing a high end fellowship in the United States, plan early.

Think about which year or which years, are feasible for you to come here through the fellowship. And I would advise people to reach out to program directors and people in charge of the fellowships early, at least 3 or 4 years in advance of the fellowship starting. So I would advise people to come to conferences in the United States or internationally and seek out, people for pre interviews just to introduce yourselves and keep yourself on their radar so that, when the time comes, they know who who you are, you've already introduced yourself, and and that way you can establish relations early. I would advise getting their contact details and and emailing them after the conference saying that, you know, it was a pleasure meeting you and and here are my details. And And then once there is a a plan to to definitely commence a fellowship in a few years' time, I would suggest reaching out to them and giving them a timeline of when you intend to start.

And once there is, discussions on a particular year, I would then start getting your, practical administrative tasks in order. And these would include, first of all, passing the, USMLE steps. That's a must for anyone wanting to come to the US. They must get the examination dates early in their home countries, plan for steps 1, 2, and 3, and get those done as a priority. This is extremely important because even if you've expressed interest in programs, they will not formally interview you unless you have all the 3 steps done.

Once the 3 steps are done, you apply to the ECFMG for your ECFMG certificate, which is a formality once you've done all the 3 steps. So once you've got the ECFMG certificate, you will have an interview scheduled at the institution, a formal interview where you'll be interviewed by most of the faculty in your subspecialty. So for example, if you're going for a cardiovascular imaging fellowship, most of the faculty in cardiovascular imaging at that institution will interview you. And I would suggest interviewing at multiple hospitals and institutions because sometimes it might not be that you may be successful at a particular institution because it's a very competitive process, there's a lot of applicants, both from within the US and from outside who are outstanding candidates. So interview at multiple different institutions, and once you've had a successful interview, you will receive an offer, for a position.

And once you've confirmed in writing that you're accepting the position, then I would start planning for the actual practical move to the US. And that would include things like, finding out from current fellows or previous fellows about, various options for accommodation, various options for preparing yourself for the training, and preparing yourself for the rigorous 2 years or 3 years or or 1 year that you're gonna spend. So I would suggest planning early, figuring out the the timeline of your fellowship, pre interviewing with, faculty at conferences or through email, passing the steps once you have the, the exact year in mind, getting the ACFM certificate, and then hopefully your scheduled interview, which will be successful. That's great advice. And I wanna make it very clear that when you guys apply for these fellowships, having done training outside the United States, you apply and you compete with, you know, the broad pool of applicants.

So Sideraf was just very qualified, you know, interviewed really well and had a strong application, and then he had this this fellowship in a great prestigious institution. But you guys will have to compete with, you know, whoever else is applying for those positions and limited number of slots? Absolutely, absolutely. There are certain institutions where you'll be applying through a matching process, where you will rate the institutions that you wanna go to, the institutions will rate you in certain fellowship programs. Other fellowship programs take applications on a rolling basis, so you will just apply to the program director, fill in the details, fill in your USMLE marks and examination scores, and then an interview will be scheduled.

So it's a very competitive process, and in terms of the actual selection, there's multiple things that go into a successful candidate. These include the actual interviews, so I would suggest that if you do receive an interview call to prepare in advance for the interview, have a mock interview with a colleague or a senior, preferably an attending or a consultant in your home country, to figure out how things will go, what questions will be asked, to practice that multiple times. Also have excellent references. That makes a big difference because your references will be sorted out in terms of what you've done in the past and your, your training and and your abilities. And also in terms of making sure that your other administration process is excellent.

So, you know, make sure you write good covering letters. Make sure you write excellent follow-up emails. Make sure you're keeping in touch with people. Make sure that you are courteous and respectful. Make sure you you, you know, you follow the the the the important aspects of a a potential match in the future.

So all of these things are critically important when you're going through the application process. Yeah, no doubt. And we're we live in the world of cardiology and cardiac imaging and, but in cardiology, you guys can apply for different fellowships too. I had, when I was at Hopkins, for example, one of the structural fellows was a fellow from New Zealand, a great guy, really great fellow, great teacher and really skillful too in doing interventions. He had done medicine, cardiology, coronary training back in New Zealand and just came to learn how to do structural heart interventions.

And then he went back to New Zealand as well. If you're an ophthalmologist, you could do a fellowship in retina or whatever. So these opportunities for advanced training in the United States are widely available. You do have to make sure you have a a competitive application. As Sidharth mentioned a lot of the different components.

I would also add to make sure you guys have also a strong CV in the sense of publications and research just because at least where I come from, it's not really emphasized during medical training, during medical school, and in over here in the United States, it's something that they'll pay particular attention, especially if you're applying for competitive fellowships. Absolutely, and even if it includes things like conferences, presenting at a conference, an abstract, getting your name on a paper as a second or third author because you've helped out. All these things make a difference. Every single line in your CV counts. And so as Randerson said, I would highly recommend any medical students or junior doctors to make sure they start their research careers early because that will really help them to, to to be successful in the in the interview.

Right, in my own career, I didn't have the I didn't do a PhD like Sidharth did, so and I didn't have formal research training during medical school or immediately after. So when I matched into internal medicine to get these competitive fellowships, I really learned how to do meta analysis. So it was really transformative in my own career and it's one way that you guys, wherever you are in the world, can learn how to how to do these publications. Speaking of research, Naruthi. So, Siddharth was busy here working 80 hours a week as a imaging fellow, you know, protocol in those cardiac CTs and reading until late in the day.

And then you, were here, you know, with your family, with the kids, but also you took on this position of a research coordinator. And I know people are they send me message all the time about this. They say, Randerson, I I got this offer for I saw this opportunity for a research coordinator. So can you explain to us what is this position as a research coordinator? How do you got involved in this, particular position?

And then what it was like? It's, so the first thing I did was it took me about 4 months to get my work authorization card. That's the first step I did. Once I had my work authorization card, then I started applying, and Brigham is really close to our home, so I went to the careers website on there and tried looking for something which is more aligned with my field, and obviously, I have never done a I've never worked in the medical field before, but I had a manager, management experience, so and I worked in university in a really busy center before, so, I applied for a job, got interviewed at Brigham, and, got offered. And, every country has their own management field, which is a little bit different from each other.

So I definitely learned a lot on my job, particularly at the institute I worked, had really good research management programs, already designed, and they had these short courses, which I did, which taught me a lot. In research management, over here at Brigham, I managed mainly the IRB submissions, for example, the institutional review board, how they take up your new research projects, what are the different ways you can apply for any project. So, for example, each project goes in a different way based on what kind of project they are, what kind of research they are aligned with, whether it's from the industry sponsored project, or is it more like a faculty, wanted to do something and they are starting off that project, so, then we can apply for the NIH grants. So each, based on what kind of research agreement they are gonna have with Brigham, you have to have a different project based applications. And, I definitely I did not know a lot about them, so I did all those courses, and, learned on the job a lot about it.

In terms of the research coordination, you do a lot of the IRB reviews, you, do a lot of, interaction with the industry, with the NIH, You submit the grant applications, with your sponsors. Sometime, you also look after how your research is organized. Like, for example, one of the roles I had was to just maintain the existing IRBs, which we already had. Anybody new joined our group, I had to make sure that before they touch any data or any patient information, I had to make sure that they are part of the IRB and they had enough training, to be added onto the IRB. When we deal with the human subjects, it's a compulsory thing that unless you have those trainings, you are not supposed to touch any of the, confidential information.

So that was something, important part of the role of a research coordinator. And other than that, just keeping the entire group organized, attending the weekly meetings and just keeping everybody informed, keeping everything, all the documents, protocols, everything in line and, making sure that everything is saved properly, everything, any data which is going out of the institute is unmined properly, and no, private information is going out. Those kind of things, definitely. We also did a lot of, data analysis and stuff like that. But overall, just helping the group stay focused and, manage their projects, which run smoothly for everybody else.

And they don't have to worry about just the admin tasks, like just updating the IRBs or just dealing with the industry sponsor, billing issues or anything like that? So IRB, as Niruti mentioned, is the institutional review board. A lot of you guys may know this, for example in my home country as ethics committee. They make sure they approve the study protocol and that everyone is doing what they're supposed to be doing in terms of research ethics and standards. Now, Ruthie, so as you described it, it sounds like it's a lot of administrative work, you know, as a research coordinator.

For physicians specifically who take on this position with the interest of getting publications done. They wanna boost their CV to apply for residency or fellowship, and then they also want a paid position. So a lot of times people do research coordinator position because you can offer those you can get those 2 things. Do you think on your role, with all the involvement that you had in research, as these results start to come out that it would be feasible for a research coordinator to get co participation, maybe potentially even lead projects at some point? Yes, absolutely.

It completely depends upon what you want to do and what background you have. I did not have a medical background, so I did not do the, data analysis, and I focused more on keeping things organized. But if you already have a medical degree or if you have a medical background and you want to do something of your own, there are a lot of opportunities. All these projects I mentioned, they also had, opportunities to have, like, a sub project and do a small data analysis, do publication out of it. And, there is big projects going on which has specific protocols, but there is always, sub products of that big registries and stuff like we know.

So they, they can definitely have the publications from it. They can definitely, their publications, posters, presentations, and, attend the conferences and things like that is definitely possible. Great. Yeah, it's a great opportunity for people to come and get research done. Obviously, the alternative for an international medical graduate, if enduring research in the United States, is to take on the position of a research fellow, and those are obviously good too.

And then those you really have more the expectation of doing and leading research and doing data analysis and writing. Some of those positions can be volunteer work, like you don't actually get paid the research coordinators positions because of the administrative work and because funding that you have from the research, IMGs, international graduates, to do research in the United States. So it's also a popular resource for IMGs, international graduates, to do research in the United States. So definitely consider that as an option. There is a lot of administrative work.

You've heard Niruti explain this, but you can get research and publications done. Just to wrap up this topic, Niruti, we had an amazing group here. So obviously, that's a big part of the the experience and and being a research coordinator and being part of a research team. So and can you just comment a little bit about that, about just the group and how that was positive in your own experience? Sure, so, I was very lucky to be part of the group I loved working with, and everybody was just so focused on actual research and dedication towards getting everybody involved.

So even though, like, it's one person who's leading the research, there's always multiple people involved behind the scenes, and the group I worked with was a very cohesive group. Everybody supported each other. Like, one person is doing something and if they need help, all they need to send is a Teams message and reorganize a Teams meeting and just work things out. That's the best part about working here in the U. S, that, the team effort like, somebody said once that team actually stands for, like, together, everybody achieves more.

And I could seriously feel that because everybody was just so ready to help and encourage each other to just make sure, oh, let's let's publish this paper. Let's work on this. Oh, let's, do create this cohort. And it was, it was really great to see because we have a team of wonderful people, people who are, service stations, for example, or data analysts, IT specialists, and obviously, like cardiologists. And everybody is just so cohesively worked together to get things done, and it was amazing to see.

And my experience with the team was great, and it involved wonderful people. So that was, I was just very lucky. Yeah, it's a great place. Just picking up on that point, actually, with just what Nerdy was saying, with a research role, but with a clinical role as well, one of the great things about doing a fellowship in this country, in the United States, is that you are with some amazing people from around the world. You are with co fellows from some of the best hospitals in the world, and they've come here to the United States to further their training.

And so being part of that team gives you a huge boost to your confidence, to your outlook in life. You develop lifelong friendships, lifelong collaborations, and that's definitely one of the huge positives of doing a fellowship in the United States. So definitely I would echo Naomi's sentiment that even in the clinical work, there's a huge collaborative and a very facultative approach to teaching, learning, innovation, science, and the friendships you form are just beautiful. That's amazing. And, Sidharth, let's talk a little bit about the differences between medicine in the United States and Australia, the culture differences, the system differences, what are your thoughts on that?

Yeah absolutely, very different places, so Australia is a very public hospital ingrained system, so it's a universal healthcare for all. Every single person, every single citizen of the country is given free treatment in all the hospitals, and so there's a lot of burden on the government to shoulder the health of the population, to make sure that there's a lot of funding for public health campaigns, There's a lot of funding for research and for making sure that all cutting edge technology is used for the help of the common citizens. So in that sense, it's a very different system to the United States, which is more of a private healthcare system where each institution has their own governance structure, their governance board, own financial structures. So that way it's very different in the sense that things get done differently. There may be a little bit more of a justification that needs to be given in Australia for certain tests and procedures.

Because it's a public health system, every dollar counts. Whereas in the United States, because it's a private healthcare system, there is more of an acceptance of investigations or procedures. So that I thought was a very big difference. When I came here, I found that that was quite interesting. The second thing is that the because of the Shia population of the medical community here in the United States, the training program is very intense, very rigorous training program.

So a very much a very high volume training program, very busy, extremely hardworking interns, residents and fellows. Whereas in Australia, the medical community is smaller, plus the population of Australia is much smaller. So in terms of the rigorousness and the amount of training and the amount of hours that physicians spend is probably a little bit more optimal in the sense that there's a better work life balance, there's more time for one to sort of focus on their own health and their own well-being as well, whereas here in the US, it's a very intense program, But having said that, it also trains you to be an outstanding physician with great knowledge and skills. So I think both systems complement each other, and there's a lot to learn from each of the systems. And having trained in both systems, I feel that I've got a really good idea and a really good understanding of what works best for patients and our community.

And that's one of the huge things also of the fellowship in the US is you learn something about a different training program which you can either continue with, you train in the US, or take back to your home country. Yeah, we would definitely not get this many cardiac MRIs in Brazil, maybe the same in Australia, right? Absolutely, I mean each test has to be justified with the government and it takes a lot of, as you know, the healthcare expenditure in every country is extremely exponential at the moment. So there's a little bit of understanding within the medical community there that you know, every test should be justified and rationalized. But having said that, patients do receive the best of care as well.

So overall both systems work extremely well. And what's it like for physicians in general in Australia, meaning like compensation, I don't know if you have numbers or just in general terms, and, what's it like to work in Australia as a physician under the system that you described? Absolutely. I mean, medicine is a very, very well respected and rewarding, career in Australia. Physicians are thought to be ambassadors of the society and are highly regarded, first of all, in the community.

Secondly, the training pathway is probably equivalent to the United States or any other country. So the training program is extremely rigorous and trains excellent doctors who have evidence based knowledge of pretty much every single subspecialty. Thirdly, in terms of remuneration, physicians in Australia are probably in the top 10% of income earners in the country. So it's an extremely rewarding profession financially. Obviously depending on the subspecialty or the specialty, but just give or take, generally speaking, physicians are well rewarded financially so the compensation is very, very good.

And it has a great work life balance as I said. So because of the fact that the country doesn't have that much of a population compared to the US, the amount of strain on the medical workforce and on medical resources is considerably less. So as a result, there is more of a work life balance there. And for physicians who are trained overseas, Australia has now started to open up the country to migration for physicians. So if an overseas physician is interested in practicing in Australia, or establishing themselves in Australia, they can actually pass a couple of exams.

It's like the USMLE steps, but much easier, a theory exam and a clinical exam, and once that's happened, they can actually practice in Australia. There's a huge demand for doctors in the rural areas of Australia. And after working under supervision, for a certain period of time, the doctors can actually get specialist recognition if they already have a specialist training in their own country. And that's the same process if they don't yet, if they wanna go and do do residency over there, they'll pass the same exams and then they have to apply for residency, what's it like to apply for residency in Australia? Yeah, absolutely, so if there are physicians who have just finished and they pass these two exams, they can actually apply for these pre vocational training programs or residency training programs.

And, they may have to accept programs in the rural areas initially because the urban areas are usually oversubscribed by the city applicants or the applicants in the big cities, but the rural applications are always, always looking out for overseas graduates. And so there are many residency programs in the rural areas which are crying for overseas trained graduates. And after working in the rural areas for a few years finishing your residency, there's many opportunities in the cities and in the urban areas. So I would say strong opportunities for residency training. May have to spend a few years in rural areas, but then the future is really bright.

Nice. That's that's great. You know, a lot of IMGs, international medical graduates interested in the US, of course, but there are plenty of other great countries in the Australia, for example. You mentioned that it's a public healthcare system, you know, let's say, I'm not sure how much a doctor makes, but let's say, what's the tax burden on that physician salary in Australia? In the United States, just for reference, at the top bracket, what a physician would make in private practice, for example, probably looking at 37% federal income tax plus 5% state tax like in Massachusetts.

Is it similar like that in Australia where you're having a big chunk of your salary going for taxes, I suppose? Unfortunately, yes, taxing, tax is a big problem in Australia as well. It is quite a significant part of the income. I would say 40% would be the income tax rate overall there, for physicians. Because physicians then do it, as in any country, the income tax is depending on your income, like with different slabs and different brackets.

But the physicians will always be in the top bracket. So usually for the top bracket, the income tax would be 40 to 45% for every dollar you earn. But that's after you earn over the certain amount. Until then, it would be the like 30 to 35%, 20 to 25%. Progress.

So it is a major amount once you reach that threshold. But having said that, there are many ways that physicians can optimize their tax and optimize their savings. A lot of physicians have invested in various aspects, including either trading or real estate, etcetera. Physicians also have great returns on mortgages or credit cards. And there's a lot of rewarding things that happen as physicians.

So overall, despite the tax burden, the physician community does do quite well in Australia. Nice. Very good. So, you guys are headed back to Australia, sad for us, a big loss for Boston and for our program. Narut, are you excited to go back to Australia now after 2 years?

When I initially came here, I just, I never imagined that I'll be working and working at such a wonderful place. So, didn't think of it much when we arrived, but when we are going back and having said, I worked for almost 2 years with you guys, and, it was a great experience. Definitely a bittersweet moment for both of us because we loved this place so much, but every good thing comes to an end, kind of, so our time here is coming to an end, and, our family is one of the biggest reason we are moving back. Otherwise, we may have stayed here, but our entire family is in Australia, so that's the reason we are going back. And, like Sadat said, obviously, it has a lot of opportunities back home, as well, for both of us to join back into the research world or into the clinical field.

So, when we think about keeping all the aspects of our life balanced, we wanna see our kids grow up close to their cousins and their grandparents. Yeah. I totally get it. No, after hearing Sidaraf talking about Australia, maybe I'll join you guys there too, you know, it sounds like a great place for sure. And Sidaraf, I want you to explain a little bit, what it would take for you to stay if you'd had decided to stay.

I know you may have looked into this a little bit, and that is a major question that the international physician community has, which is, okay, I didn't do residency in the United States. I can do a fellowship. We already talked about that. And what comes next? Do I have to absolutely go back or is there a way for me to potentially stay in the US after the fellowship?

Absolutely, now this is a great point, and the traditional view has been that one has to have residency training in the United States in order to be able to work as a faculty or as a specialist in the United States. But that has changed in recent years. And so from what I know, many states in the United States have different policies. And some states require the overseas trained graduates to work as a fellow for a year or 2 years on a limited license, under supervision. And then those states will actually offer them a faculty position based on their training and their fellowship, and the physician will be able to work as a full faculty member in that state.

And that basically means that they are able to practice in their specialty, and then they can pass their board certification exams during their practice. So for example, if they were to join as a faculty this year, they can practice they can pass their board certification exams later this year or next year, so that they are then formally recognized as specialists. But even prior to board certification passing, the physicians can practice their specialties because certain states have opened up and have said that they're happy to give full licenses to these overseas trained physicians who have done fellowships for a year or 2 in their states. Having said that, there are certain states who do require a little bit more time. So, they might require 3 years of fellowship training in that state prior to, a full license being offered and prior to the physician joining as a faculty member and practicing their specialty without supervision.

Once that happens again, they can do their board certification exams, after they join as faculty. But the previous traditional view that residency in the United States is a must for anyone to settle here is no longer the case now. And so everyone should look at the state that they would like to settle in, and certain states have definitely opened up a lot more for overseas trained physicians, and I would certainly encourage everyone to look at the policies in each state. And those states, to be clear though, that supervised practice doesn't necessarily need to be in that state, for example, right? So like you train in Massachusetts, if you wanna go to Tennessee now, you already have 2 years of supervised experience in the US, correct?

Absolutely. The state doesn't require the training in the US to have been done in that state. They recognize training anywhere in the US, so that is not an issue. Yeah. And like you said, like once you've got that position and you've met the requirements for a full and restricted license, that's it, you're done.

Absolutely. And then all you have to do is just get through the board certification process in your particular specialty, whatever it may be. And so then that can be done as you go along and as you're a faculty member, whenever convenient for you, you may do those exams. It's not as if you have to have board certification prior to joining as faculty. And by the way, the board certification is standard for American trained physicians during residency and fellowship too.

Like I did in internal medicine boards, cardiology boards, CT boards, echo boards, MRI boards, nuclear boards. We are particularly penalized for doing cardiology in so many modalities. But this is standard practice or standard pattern for even US doctors to just have to do board certification after finishing a training in a given specialty. Well, very good. This has been excellent.

Sidharth and, Naruthi, we're gonna miss you guys a lot here in Boston. You know, what's, what's, what are you guys gonna mostly gonna miss here about Boston as you go back to Australia and have brilliant careers over there? I think, the company of our colleagues with whom we worked over the last few years and, the pure joy of enjoying the research with the with the great minds, so definitely we'll definitely miss that. We'll definitely miss the Boston winter. We don't get snow there, so yeah.

You're gonna miss the winter? We have we have never seen snow, so this was our first experience. We definitely enjoyed it, Not so prolonged, but It's so long, right? Yeah, but we're gonna miss our wonderful friends we have made, and those friendships are for life. So, we'll come visit you guys often, and you guys are most welcome to come back, and we'll see you there.

I mean, Boston is a great place. We're gonna miss the history and the tradition here. We're gonna miss the amazing pioneers who settled here, the great faculty, and the great medical breakthroughs that happened here. And it was such a privilege to be part of an institute where some of the most amazing human medical breakthroughs have happened. So I'm gonna miss that science, that innovation, that research, that cutting edge clinical medical field and focus.

And it's such a thrill to be part of that amazing atmosphere and to be training with amazing faculty and fellows. It's just been a huge blessing. So that's certainly something that I'll personally miss. And then of course the enterprise and the beautiful value of this amazing city of Boston, which has got such great educational institutes from Harvard to MIT, and just the sheer stimulation you gain from being such a wonderfully educated city. It's it's just an experience second to none.

And then from the US as a whole, we're gonna miss this beautiful land of, of warm, friendly people, of great citizens who have great pride in their country, and who really work hard every day to sustain their country and to uplift their country. So I'm going to miss that workplace, culture of hard work and sincerity and dedication. We're going to place the we're going to really miss the beautiful variety of the United States. You know, every state here is different. We set out to visit all 50 states of the USA, but we couldn't.

We visited 32 states. And in our journey, we realized that every state is so beautiful in its own way and we're gonna miss that variety, that richness of culture, that richness of its people and we'll take all that experience back to Australia and hopefully come back here and stay in touch with everyone. And we're certainly gonna miss you. On a personal note, I had the privilege of working with SIDARF over the last 2 years and it was always a joy in our reading room, you know, the collegiality and the friendship, you know, it's such a phenomenal, not only trainee, but person. We're gonna miss you guys.

Niru did the same also, in our research group. So, it was fantastic to have you guys both here and I'm gonna miss you. We'll have to visit you in Australia. Thank you, Anderson. Well, no matter how many words we can use to describe your inspiration and your enlightening nature for all of us, the words are too short.

What you have done in your life with regards to medical school training, residency training, fellowship training. You have worked so hard to achieve your dreams. You are such a great mentor to future medical students, future junior doctors, future fellowship applicants, you know, they look up to you and they see you as someone that they can become, and that must give you a great sense of honor and privilege and pride and I myself see you as a role model, as a friend, philosopher and guide and thank you for shining your light on us, for teaching us, and wish that you grow further and further in your career and enlighten many more lives and teach many more young students in your life. Thank you, Rensen. Thank you, sir.

Thank you so much, Rensen. It was wonderful, wonderful to get to know you over the last few years and get to know, get to work with you, and we are very, very happy to call ourselves your friend. Thank you so much. This means a lot to me. So guys, this was, Metacast, where we discussed successful careers.

We had the great opportunity today to listen to Siddharth Trivedi and Niruti Trivedi teaching us all about, you know, being a doctor in Australia, coming to the United States, going back, research coordinator position. And and also I want to invite you guys to watch the other meta cast sessions. You can go to our webpage and see other successful stories. I also want to invite you to participate in the next edition of the meta analysis academy. If you're interested, there's a wait list.

We'd love to have you in our program where we'll teach you skills in systematic reviews, meta analysis, you're gonna learn methods, statistics, writing so that you can do this independently, help you to get research to advance your career. Thanks very much for watching. This was Meta Cast. Thank you, Sudaroff and Aruti. Thank you, Anderson.

Thanks everyone. All the best.