Providing Boots to the Bootless to Build a Black Physician Workforce - Dr. Russell Ledet, Co-founder and President, The 15 White Coats

DR. RISHI DESAI: Hi, I'm Dr. Rishi Desai. Dr. Russell Ledet is one of those people with a personal story and a string of accomplishments that leaves you in awe. He just completed an MD-MBA program at Tulane University. He's headed for a Triple Board residency in Pediatrics, General Psychiatry, and Child and Adolescent Psychiatry at Indiana University. He previously earned a PhD in Molecular Oncology and Tumor Immunology at NYU, and is a veteran of the U.S. Navy. He is also the co-founder, president, and manager of The 15 White Coats, a world-renowned organization dedicated to propelling underrepresented minority students into medicine. A very special shout out to Jill Cummings on the Osmosis team for first introducing us to Dr. Ledet and the great work he's doing. Thank you so much for being with us. 

DR. RUSSELL LEDET: Thank you so much for having me, Dr. Desai.

DR. DESAI: Definitely call me Rishi. I would be remiss if I didn't mention the fact that you're sitting right now in a library. Maybe we can just start with why you're there at the moment. 

DR. LEDET: Yes. The 15 White Coats, as Rishi just talked about, have partnered with a local hospital called Children's Hospital New Orleans. As part of that partnership, we've really invested ourselves in visiting local high schools here in New Orleans, and one of those that we're at now is Haynes Academy for Advanced Studies here in Metairie, Louisiana. We're here to give them two scholarships, which is the main focus of The 15 White Coats; to make sure that there's economic benefit and help for minorities.

DR. DESAI: That's awesome. I appreciate you mentioning that and putting a spotlight on that. You know, when I read your list of accomplishments, anyone listening and not seeing you would just naturally assume you must be about 100 years old, to have gone through those experiences.  But you're not 100. You've obviously done a lot in your youth and in your time on this planet. Maybe just give us a little bit of background: What got you first started in medicine? I also mentioned that your first post-graduate degree was in molecular oncology. Where was that interest coming from?

DR. LEDET: Yes. First thing, the medicine part. When I finished my first active-duty stint in the United States Navy, I had to get a regular job. While I was going to undergrad, I also got a job as a security guard at a local hospital in Baton Rouge, Louisiana. It was my first exposure to medicine—you know, the awe of seeing people walking around in white coats. I was in the emergency room, so you see all the trauma. I was like, "Wow, maybe this is something I can do with my life." Of course, you ask a million and one physicians, "Can I shadow you?" I can remember vividly a lot of them telling me, “Man, security guards don't become doctors, bro. You need to think about something else, but this might not be it.”

There was one guy, he was the chief surgery resident who needed help to get to the operating room. I helped him, escorted him, and I shot my shot again. He was like, "Yes, man, you can shadow with me." I actually stayed at the hospital overnight that same night he told me yes, and met him the morning of for rounds. It's been a roller coaster ever since with Patrick Greiffenstein, who's a trauma surgeon now here in New Orleans. 

That's kind of how I got interested in medicine. Obviously, I took a circuitous route. I didn't get into med school the first time because I struggled on that big MCAT test. I went to NYU to get my PhD in Molecular Oncology after a mentor told me he thought I was probably brilliant enough to become a physician-scientist and not just a physician. I took that chance. When I went there, I really went there with the idea of figuring out if there was something I could study that was directly applicable to not only my own life, but the community I came from. 

Prostate cancer is what I focused on. We really leveraged proteomics and bioinformatics to look at different oncogenic settings. That was my work, and I ended up focusing on molecular oncology and tumor immunology. That's how I ended up there. Obviously, prostate cancer is a health disparity. 

Then as I was finishing up my PhD, that's when I made the decision, "Okay, let me try for this med school thing again." But I felt like at that point, I was a pretty good candidate for a full ride. So, literally the same morning my second daughter was born, about 30 minutes later I got an email from Tulane. They're like, "Hey, we got a full ride waiting for you if you want to come here."

DR. DESAI: Wow.

DR. LEDET: So, I decided to come to Tulane. And as you know, when you get a PhD, you don't have to pay for it. So up until this point, I haven't paid for any of my education, which has been amazing. So, six degrees later, it's all been free. So, I'm pretty happy right now.

DR. DESAI: Wow, that's amazing. I'm just kind of putting myself in your shoes. Your daughter was born. Thirty minutes later, you're getting this wonderful news about the fact that you've got a great opportunity at no cost to you. That's amazing! 

Then the other piece of what you just said is interesting…when they said, "As a security guard, you're not meant to be a doctor, bro." There's a huge class issue, obviously, that is there. A lot of people have this perspective and maybe they wouldn't say it, so it's interesting that he said it so honestly. At least that was a very candid comment. 

There's also a big race issue in America, and I'm just curious, what has been your experience earning this many degrees as a Black man? Was it something that you thought about actively as you were going through the process, or something that you kind of reflected on after the fact?

DR. LEDET: Luckily, actually, the chief editor at Nature Genetics called me and asked me if I would pen my feelings as to what this journey has been like traversing science and medicine as a Black man. Obviously, I'm a Black man, but also culturally, there are a lot of aspects to my visual that can, in many ways, cause people to rethink who I am due to my hair and my beard and even the way that I talk. So, I wrote about it and I titled it “Bootless,” which is after a phrase that was said by Martin Luther King in 1967. He was interviewed, and somebody asked him, "Why is it that every other race of people who come to this country can lift themselves up by their bootstraps?" He made the comment, "Well, the difference between us and them is that they were given things to help them get started, and we were left bootless to pull ourselves up by our own bootstraps." 

It's a cruel jest to tell someone to pull themselves up by their own bootstraps if they don't have any boots. I very much felt like my journey was bootless. What that means is that I literally figured out everything along the way. It was ad hoc, the entire time, just flying by the seat of my pants at every step. Like, "Oh, I'm finishing undergrad, and somebody told me I could be a PhD student.” My main motivation for going to get the PhD was the fact that they were going to pay me $48,000 a year to learn. I've never heard of anyone ever having that ever happened to him! So, you know, I took it. Then obviously, coming here, it was a money motivation because we had two kids. 

You know, the one thing I can say is that there were people along the way who were willing to hold my hand. Not hold my hand in such a way that I couldn't walk on my own, but they held my hand and said, "Hey, turn this way, don't turn this way. Talk to this person, don't talk to this person." 

 

There's this guy, Dr. Vladimir Svetlov, he's a protein chemist at NYU who came from Russia. This is the weirdest relationship in the world, but he's probably my best friend and one of my biggest supporters. He just gave it to me straight, and really helped me to understand how I traverse this world. He would tell me how the world views me without telling me. Because they obviously are never gonna tell me personally, so they would just tell him. He'd be like, “Oh, let me go tell him how the world sees him.” He helped me to kind of see where the pitfalls were, and get around them. 

DR. DESAI: So, you've had at least two major types of education. One we've been talking about, which is your graduate degree and postgraduate degrees. The other type of education is the one that comes with parenthood, right? You have two kids, and I imagine you've learned a lot by raising those two kids. We were kind of joking about that right before. But you had a conversation with your daughter, and I believe she was around nine years old at the time. Tell me about that conversation. What was the context? What time of day? Just play that out for me, and then how that evolved into The 15 White Coats.

DR. LEDET: Yes, it was July 19, 2019. It was the summertime, and one of my best friends—he and I were getting our PhD together in the same lab—he came down to visit me here in New Orleans from New York. We both went to Historically Black Colleges and Universities, so black history is really important to us. We were going to make a trip down to the Whitney Plantation which is in Edgard, Louisiana, about 45 minutes outside of the city, and I strong-armed my daughter into going. I told her that she wasn't going to tennis practice today. She loves tennis. She wanted to keep playing, and I was like, "Nah, today, you need to take a day off and come with us." 

She was grumpy and when she got there to the grounds, she didn't really want to pay attention. You know, she kind of was upset. Then, that exact same slave cabin that we took that photo in front of, she walked in, and it was like the ancestors slapped her in the face or something. She just kind of wandered off on her own, and she came back to me with this stare in her eye like she really understood the power of what the moment was about and what the grounds were about. She started asking questions and paying attention. 

We were driving back to New Orleans after the whole trip was over. She interrupted a conversation between Philip and me and shouted, "Dad, I finally understand why it's such a big deal, being a Black doctor in America." I was like, "Oh, this is interesting. I've been trying to tell you for forever, that this is significant." She was like, "No, no, no, I understand it now." I was like, "Oh, well tell me why." She was like, "Well, just think about it. We just left a plantation. There was a time when people who look like you and Uncle Phil, y'all couldn't be doctors, and I'm riding in a car with the two of you, at the same time.” She's like, “We've come a long way." I was like, "Yes, indeed, we have. That's what I've been trying to tell you." 

I looked over at Philip after the conversation had subsided, and I told him, "Man, I've got an idea. I think if I got together some of my classmates and we went out there, all Black, with our white coats on, we could show the world how far Black people have come." Because if you think about it, that photo is so striking. It's the juxtaposition of a system that was in place that never intended for us to be who we were. The fact that we can stand in front with all of that power and stink on our face, and all of that sassiness, is amazing. It's striking. It's something that will live forever to illustrate just how far we've come.

DR. DESAI: When you shared that idea with folks, what did people think? I mean, I've seen the picture, so I know already, but before you took the picture, it was just in your head. So, when you shared that picture in your head with people, what was the response?

DR. LEDET: I think there were some people who were kind of hesitant and were like, "Whoa, this is kind of edgy." But then I had classmates who were like, "Nah, we need to do this." I remember in the email I sent out, it said, "We're going to take an iconic photo, something that will really illustrate just how far we've come." But it was also a remembrance for us, too. 

Because med school, as you know, is draining. It takes nearly everything you have out of you. You need those moments of reflection. Sometimes it's with your grandparents and sometimes with a kid, but for us it was like, “What would it feel like for us to go back and remember the cost that was paid for us to be here, with the brutality of the moment?” It really felt like it was something we needed to do, and people were onboard. So obviously, 14 people came along for the ride. We got the job done and now we have an organization that's really thriving. 

DR. DESAI: Whenever I've been part of something that feels edgy, or bold, there's always another part of me that's scared or fearful or worried about, "Am I doing this right way? Is this going to be disrespectful in some way? Is there some angle I'm not seeing on this?" I'm curious, when you were going through that decision, maybe driving to the plantation about to take what would be a very iconic picture, what were the thoughts in your mind? What were the concerns in your mind?

DR. LEDET: I think the biggest thing that I was worried about was exactly what you just said: How edgy is this? Are we going to get in trouble for it? How's it going to be received? We knew we would release the photos, so I really was worried about what did other people think. But as you said, I've had a lot of schools of knowledge to go through. The one thing I've learned is that you can't really control what other people think, but what you can control is what you think and your intentions. I think I really banked on that. I had classmates, really close friends like Sydney Labat who were like, "Nah, this is what we need to do. If we're going to do something iconic like this it’s the right thing for us to do." But I definitely understand those feelings and I still have those feelings to this day, with almost every decision I make.

DR. DESAI: Bring this full circle for me. I'm imagining you on this plantation, your ancestors maybe slapping your daughter, in a way, like you said, and then your daughter having this idea with you and your friend in the car. Then you take the picture, you share the picture, your daughter presumably has seen the picture. What are her thoughts when she sees the picture? What does that mean for her?

DR. LEDET: Yes, I remember we were on the Kelly Clarkson show. It was actually my first time hearing my daughter say that. She was like, "Now I kind of have the cheat code to becoming a physician." She's like, "I know exactly what I need to do. But I also know exactly who I can turn to when it's my turn." 

Even if it's just one child—obviously, we want it to be millions -- but even if it's just one child, we've done our job. To hear my own child say, "My dad is someone who inspires me”… as you know as a parent, it's something you pray to every God on the planet for. We're really excited about it. 

DR. DESAI: That's awesome. If people see this, they might think, “Okay, so this is about representation. I get it.” But it's more than that, right? It's about Black physicians actually improving health outcomes. So, help walk me through that and explain that in your own words: how does that actually help improve health outcomes?

DR. LEDET: We know that physician-patient discordance has a huge impact on the outcomes of patients. Whether or not patients are compliant, whether or not patients follow up, and how willing patients are to share information with you, is really based on this cultural competence piece. It’s obviously important for those physicians to have the knowledge base, but also the experience and sometimes even the outward appearance -- all of those things are important. So, the only way that we can really do that is to diversify medicine. Not only diversify medicine from the perspective of thought processes, but also to diversify medicine by the people who are in it…the people donning the white coat on a regular basis. 

As you know, the cost of medical school is extremely expensive. The cost of getting into medical school is somewhere between $2500 to upwards of $10,000 to apply one time. If you think about that, and you take into account the economic history of our country for minoritized populations, there's an imbalance and incongruence there. We're trying to figure out a way to lessen that economic burden such that people can really focus on the things that they need to do to get into medical school: doing well on the MCAT; getting all of those letters of recommendation; the shadowing and all these other things that they need to do. If you're working a job, you don't have time to do those things. We want to pay for those MCAT books, and pay for the UWorld subscriptions, and pay for their AMCAS application, and everything they need—hotels and flights and stuff like that -- so that they can actually get into med school. That's truly how I think we will diversify medicine fast.

DR. DESAI: It sounds like, in a manner of speaking, you're creating the boots that you were talking about at the beginning. Is that a fair way of putting it?

DR. LEDET: Yes, exactly. The way I think about it is, as somebody who's traversed this system, there's a lot of people who are bootless. If you understand what the boots are, then you're able to provide them. The fact that we've gone through this entire process helps us to understand what the boots are. It's our job to do that.

DR. DESAI: You started this conversation talking about your experience as security guard. Then a person kind of smiled on you and gave you a chance and you took it and you ran with it, and you've been running ever since. We started talking about the fact that you're in a library right now. You're giving out this sum of money, this scholarship. Have people approached you and said, "Hey, I'm a security guard. I'm…fill in the blank. I'm not meant to be a doctor, but I want to be. How do I do it?" I'm curious, what your response has been if that has come up for you.

DR. LEDET: Yes, I think it's happened to me multiple times. I actually just recently had my Match Day video go viral. As a part of that, there were so many people who reached out to me and were like, "Yo, somebody told me that because I was a janitor, I couldn't be a lawyer. Or because I was this, I couldn't be that." So obviously, I've been able to resonate with their story. But I've also been able to understand that now I'm in a position where not only I can inspire the next generation, but I can figure out a way to be the resource for that next generation. That's literally what we're doing now is figuring out a way to create animation that speaks to the cultural sensitivity and cultural competencies necessary, and raising money putting this photo in every classroom we possibly can, putting books that are culturally appropriate for children in these spaces. That's where we are now, man. It's our job now with The 15 White Coats, and I think we're doing a good job at it.

DR. DESAI: Maybe you can give me your thoughts on other groups that are doing good work. We know COVID has put a lot of attention on the fact that there are health disparities in race, and everyone kind of wrings their hands about it and talks a lot about the fact that it exists. I know it, you know it, but walk me through groups that are doing something concrete that you feel is worthwhile, or you feel really strongly about. 

DR. LEDET: Yes, one of the ones that comes to the front of my mind is Project Diversify Medicine, which is run by a physician. I think she's a family medicine physician, or maybe an internist, who's been doing a lot of work on how do we diversify medicine by taking into account the cultural aspect of this entire process? Meaning that you can keep your hair and keep your beard and keep your representation, but also be brilliant. She's really bringing forth the idea that you don't have to change yourself culturally to be brilliant, and I think that's extremely important because the biggest component of becoming a physician, a lawyer, or anything, is the confidence piece. The imposter syndrome, I think alone, can defeat a lot of people's tries at becoming whatever it is that they want to be. I think that's extremely important. 

Also – and this is not just because I'm on this podcast -- Jill Cummings at Osmosis is a friend of mine. She's kept me abreast of what Osmosis is doing. I think what you all are doing is brilliant. I think the way that you are really having these important conversations, and purposeful or intentional conversations, is important, especially with the platform you all have. I think oftentimes people miss the mark. They have these huge platforms, then they miss their opportunity to be an influence. The biggest part is the conversation. Once we have the conversation, then we can really put in policy and drive money in the right directions, to really make a difference. That's two that stick out in my mind. 

DR. DESAI: Thank you for the kind words, that's very generous of you. I'd like to take this opportunity maybe to broaden the conversation to any topic that you think right now is a bit of a knowledge gap for folks, maybe a bit of a myth, maybe something people don't fully understand or appreciate, a nuance maybe, that you see among med students, or let's say, early students in the health system. What would you say to those folks about something that you've learned along the way that maybe they are maybe slightly off on, or, as I said, have a myth around? 

DR. LEDET: Yes. Every patient's room that you walk into, think of them as a family member. Not just cliche, like, "Oh, this is a family member," but genuinely as someone that you have some sort of connection with, you have an endearment with. I think that level of care and that level of connection that you have with a patient is the difference between extremely effective and long-lasting care, or just a transient experience between a patient and a provider that really doesn't get to the heart of, “Can we change this patient's course of survival?”

Everybody has, at least in my opinion, a soul, and they have this moral compass. Especially if you're a physician, you have a moral compass, hopefully. I think we have to use it more when we interact with patients. We have to remember that being in medicine is a privilege. It's the highest privilege in the world, because we manage the one entity that everyone owns that you can't get another one of. Your life and your health is something that you can't just go get more of whenever you feel like it. If you get to the end of your shelf lifeand you’re like, "Oh, I'm gonna go get a new heart, I'm gonna go get new lungs, I'm gonna go get a new brain”…it doesn't work that way. We have to remember that these people are giving us an opportunity to manage something that is extremely important and valuable to them. If we take that into account, we'll be much better clinicians.

DR. DESAI: I appreciate you saying that. I think one other thing that reminds me of is that, as a clinician, whenever I do have those moments -- when I stop and think about a person as my mom, my dad, my kid -- it's much more rewarding. My own cup gets filled up. It's the days when I'm stressed and tired or whatever, when it all felt really transactional. So, in a very self-serving way, it actually makes life a lot better for you when you take the view that you're espousing.

Listen, I know that you've got a pretty exciting event coming up right now. I don't want to take any more of your time, but I do want to say thank you. Listening to you speak and tell your story is really, really inspirational, and your nine-year-old is very inspirational as well. Thank you for sharing that very personal anecdote with us, and for everything you had to share with us on the podcast today.

DR. LEDET: Thank you so much, Rishi. It's been great.

DR. DESAI: I'm Rishi Desai. Thanks for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together.

DR. DESAI: I'm Rishi Desai. Thanks for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together.