SELMA – In an effort to train the next generation of doctors, Valley Children’s Healthcare has partnered with Kaiser Permanente to bring its pediatric residency program to Selma. The program just started in July at the local Kaiser Permanente facility on Highland Avenue with two residents.
Drs. Rhobe Brager and Dani Santi are the two new interns who are working under the direction of pediatricians Drs. Anna Dimailig-David and Soledad Raroque.
Dr. Dimailig-David said she sees the mentoring program as passing on the torch of compassionate health care to the next generation of doctors. The need is especially great in the Central Valley where historically there has been a shortfall of medical providers.
The Healthforce Center at UC San Francisco’s 2018 workforce assessment showed that the San Joaquin Valley has the lowest ratios in the state of licensed medical and osteopathic doctors, nurse practitioners, registered nurses, marriage and family therapists, licensed counselors and licensed social workers per 100,000 people. The region also has the second-lowest ratios of physician assistants, clinic nurses and psychologists per capita.
“We want to train the future generation of pediatricians,” Dr. Dimailig-David said. “We know for a fact the Central Valley is pretty much lacking in physicians. We’re hoping, after their training, they’ll be able to stay here with us and work here in the Central Valley and help with the shortage of doctors in the area. They’ll be future colleagues as well, so that’s a nice thing to look forward as well.”
Valley Children’s started the pediatrician residency program in June 2017 where doctors in their residency stage of their education attend rotations with mentoring pediatricians already in the field.
“We have four residents at the First Street Kaiser [in Fresno] and we just started with two here in Selma in July.”
Dr. Dimailig-David said the residents have already finished four years of pre-med education, four years of medical school and will now spend another three years of training in their program. If they have an interest in a sub-specialty, then it’ll be another few more years of education, depending on the training they want to pursue.
She described Dr. Brager and Dr. Santi as eager, hard-working and driven.
Every day is different but includes conferences at Valley Children’s in Madera, rounds with the doctors or, if they’re on call, a return trip to see patients as needed.
“Mostly we have newborns and it’s a well-baby visit, or sometimes it’s the removal of a foreign body or treatments. They enjoy learning these new things, so that’s good. If Dr. Raroque sees something interesting, or the nurse practitioners see something, they share those cases with our interns so they can learn a lot.”
Dr. Raroque agreed the residents are very enthusiastic and are “like sponges who absorb everything. I hope they get what they want from the program and we’ll be able to provide that experience and education to help them grow to be the pediatricians of the future to replace us. We’re getting old. We need new blood because we certainly have a lot of population that needs them to serve the community.”
The residents will learn valuable skills in their out-patient setting, Dr. Raroque said, from how to conduct well-child and sick visits, give immunizations and interact with families and patients.
“They’re going to grow with the families and grow with the patient so they need to get a good hands-on experience. We’re hoping, when they’re done, they’ll be the ones taking over.”
Having worked at Valley Children’s previously, Dr. Raroque said she likes that as a doctor, she gets to know the patients, their families and their medical needs.
“Interacting with families, you get to know the patients. I like getting to helping them grow to be young, responsible adults. That’s the difference. You get to know the families more and the patients and sometimes they send you pictures,” she said holding up a picture of newborn twins. “You feel fulfilled seeing the family grow, taking care of the siblings and then the new ones. It’s like a family and community feeling.”
Dr. Rhobe Brager was born and educated in Stockton. She completedherundergraduate and master’s degrees at the University of Pacific there. Then, she continued her education at Touro University, an osteopathic college in Vallejo. She said it was during a rotation while back in Stockton that her son, now 3, became ill and that sent them to the Kaiser Permanente there.
“I was a third-year med student at the time and I was rotating at the hospital where I was born at. I’d made an appointment with the chief of pediatrics, Dr. Grey, and told her I’d love to come back home. I asked if there was a need and she said, ‘oh my goodness!’”
Now with a home in Clovis, Brager said she’s “happy to be back. [San Jose] was a nice place to live but it’s very expensive. I didn’t grow up in Fresno, but I feel like it’s where I should be. It’s very family friendly so I’m excited about staying here.”
Brager said she chose the pediatrics since that’s the rotation she truly looked forward to the most.
“It was interesting working with adults, but I just really felt at ease working when I did the pediatric rotation in my third year. I was at the newborn nursery and I just loved the babies. I did a lot of outpatient clinics then, too. They’re not just tiny humans, they have their own physiology. Kids, in general, bounce back. It’s good to see them go from not doing well to being so much better.”
Brager encourages students who are interested in medicine to keep pursuing it, even if they don’t take the typical route into the career.
“Even if you don’t think you’re good enough for it, if it’s something you really want to do, keep working for it. That’s my advice since I didn’t do the traditional route.”
She also had the added responsibilities of parenthood to juggle, but felt driven to continue.
“I also took maternity leave after having my kids. It’s still possible. There may have been times where I thought, ‘is this really what I want to do?’ But I had to keep going. I put so much time and effort into it, so it’s hard to turn away from something you’ve worked so hard for.”
Dr. Dani Santi
Dr. Santi spent her childhood in Caracas, Venezuela, moving to the United States when she was 13. She graduated high school in Chicago and stayed there for her medical training. She earned her M.D. at Chicago Medical School and also completed a Master of Science degree in healthcare administration at Rosalind Franklin University.
Since her grandparents and several cousins are doctors, medical careers seem to run in their family.
“I’d hear my grandmother talk about what she did in the ER that day, so I’ve wanted to be a surgeon since I was 10.”
A cousin’s treatment for cystic fibrosis helped Santi realize just how valuable a pediatrician’s care could be and since she prefers working with children, this field was the perfect fit.
“I like working with kids. [They] are really resilient and for the most part, honest. But mostly, it’s the resilience. They pick up, no matter how hard it’s been. They move on, get better and they’re positive.”
Dr. Santi said her career goals include working in an underserved community. Her next educational goal involves a fellowship, and she’ll be coordinating with her fiancé and his medical career goals, thus it’s undetermined at this point where she’ll finally wind up. In the meantime, she’s focused on building rapport with Selma and surrounding area patients at Kaiser Permanente.
“I’m hoping to learn how to provide the best care with the amount of resources allocated to the area.”
A check-up that day was for a 23-day-old Martin Smith. His mother, Elizabeth Smith, had brought him and Dr. Santi was glad she was able to start seeing him for check-ups.
“It’s really cool seeing the baby as a newborn and when they’re getting bigger and cuter. You’ve already established rapport with the family, so that’s nice. They know you, come to you for advice and can tell you’re interested that their baby’s getting the best care.”
For young community members interested in a medical career, Dr. Brager encourages students to look into getting hands-on experience as soon as possible.
“Expose yourself to as many opportunities as you can and see if there are any shadowing opportunities. Do well in school and get involved to see if it’s what you really want to do.”
Locally, the University of California, San Francisco - Fresno offers a Doctors Academy at Selma, Caruthers and Sunnyside high schools.
Kaiser’s doctors have mentored students through the Doctor’s Academy previously and say that it’s a good first step towards a medical career.
“It’s important to inspire these even younger students who dream of going into medicine,” Dr. Raroque said. “We always tell them inspiring stories. These are kids with different backgrounds [but] they have this dream and this vision, so we help them with that vision.”