This interview is part of the series, Pathways to Practice: Stories from Underserved in Medicine, which features current residents, fellows, and recent graduates sharing their personal journeys – from formative experiences before medical school to the realities of being in their residency and/or fellowship programs. Each story highlights the moments, mentors, and motivations that led them to choose graduate medical education (GME) programs focused on medically underserved areas. Through these reflections, interviewees explore how their backgrounds and clinical education and training shaped their commitment to providing high-quality health care for all and influenced the paths they plan to pursue in practice.
Victor Sebastian Arruarana, MD is a PGY-3 internal medicine resident at Brookdale University Hospital and Medical Center in East Brooklyn, New York. Following his residency, Dr. Arruarana will complete an endocrinology fellowship at the National Institutes of Health (NIH), where he aims to integrate clinical care, prevention, research, and public policy to address health disparities at both the individual and population levels.
ACGME: Tell us about your journey and how it led you to where you are today, including about your medical school and residency or fellowship.
Dr. Arruarana: From the moment I began medical school, my goal was not simply to become a physician, but to use medicine as a tool to create meaningful and lasting change. That conviction was shaped early by hardship, responsibility, and direct exposure to health care disparities.
In Argentina, medical training includes a mandatory “rural year,” during which graduates work in rural and underserved communities. That year profoundly shaped me. I witnessed firsthand how geography, poverty, and limited infrastructure determine access to care, preventive services, and health education, particularly affecting women and rural populations. Many of the conditions I encountered were preventable, yet patients presented late due to lack of access and education.
While working in rural and underserved areas in Argentina, I became acutely aware of how limited health education directly affected outcomes. During residency in the South Bronx, I began to recognize that many of the poor outcomes I was witnessing were not failures of individual patients or a single specialty, but failures of the health care system itself, particularly limited access to primary care, preventive infrastructure, and continuity of care.
This realization led me to transition to internal medicine, where I could care for all populations and work at the foundation of prevention, education, and chronic disease management.
Background and Early Influences
ACGME: How did your background and early experiences help shape your interest in medicine and your understanding of health care disparities, especially in underserved areas?
Arruarana: Growing up with financial insecurity and experiencing housing instability during medical school taught me how fragile access to opportunity can be. Health, education, and stability were never guaranteed, and that reality has shaped how I view patients, not as isolated diagnoses, but as individuals navigating complex structural barriers. My rural year in Argentina was particularly formative. Working in underserved communities revealed how preventable disease progresses when access, education, and continuity are missing. I saw how limited infrastructure, long travel distances, and lack of health literacy directly translated into worse outcomes. Women and rural populations were disproportionately affected, especially when preventive care and follow-up were inconsistent. Later, while training in the South Bronx and East Brooklyn, I encountered the same patterns in a different health care system. These experiences reinforced my commitment to underserved care and shaped my belief that improving outcomes requires prevention, education, continuity, and system-level awareness, not just episodic treatment.
Choosing a GME Program
ACGME: When it came time to choose a residency or fellowship program, what inspired you to select a program focused on underserved areas, and which aspects of the program aligned with your goals or values?
Arruarana: I intentionally chose programs rooted in underserved communities because I wanted to train where disparities were not theoretical. They were daily realities that demanded engagement. My earlier work in rural and underserved settings taught me three lasting lessons:
- Prevention and continuity of care matter more than isolated interventions.
- Health outcomes are shaped by systems long before patients reach the hospital.
- Physicians grow most when they choose to be where they are needed, not where they are comfortable.
I developed a personal framework to describe three types of physicians: Drifters adapt to the system as it exists. Achievers master the system and succeed within it. Architects do both. They care for patients and pursue excellence, but also examine the structure and take responsibility for improving it.
These principles guided my decision to come to first the South Bronx and later continue my residency in East Brooklyn.
Experiences During Residency/Fellowship
ACGME: Can you share some of the most meaningful challenges and lessons from your residency/fellowship program working in underserved communities, as well as how they have influenced the kind of physician you are becoming?
Arruarana: One of the most important lessons systems fail patients. I routinely care for individuals whose conditions are inseparable from barriers such as housing insecurity, limited access to medications, fragmented follow-up, and low health literacy. A defining clinical experience involved a 25-year-old patient who presented with uncontrolled hypertension, a hemoglobin A1C of 11, and early organ damage. He had been followed closely by pediatrics until age 18 and then lost care for years. This was not a failure of the patient or family, it was a failure of transition. That experience led me to work with hospital leadership and pediatrics to begin developing a pediatric-to-adult transition-of-care initiative.
ACGME: What unique skills or insights have you developed through your residency program that you might not have gained elsewhere?
Arruarana: Training in underserved settings taught me how to practice medicine within real-world constraints. I developed strong skills in patient education, shared decision-making, and care coordination. I also developed a system-level perspective. Being embedded in underserved communities makes structural gaps visible leading me toward quality improvement, program development, and innovation.
Looking Ahead
ACGME: What does your future in medicine look like? Can you share the kind of difference you hope to make in underserved communities and any advice you have for physician learners considering similar paths?
Arruarana: My future in medicine builds directly on my present work and lies at the intersection of prevention focused clinical care, education, physician wellness, and thoughtful health system redesign. I hope to contribute to research and clinical innovation that strengthen the bridge between specialty care and primary care.
My framework of Drifters, Achievers, and Architects shapes how I approach both my present and my future. Underserved communities deserve physicians who are willing not only to treat disease, but to strengthen the systems their patients rely on. I aim to continue practicing medicine in a way that integrates patient care, prevention, research, and structural improvement. For others considering similar paths, my advice is simple: Underserved medicine will challenge you, but it will also deepen your empathy, sharpen your judgment, and clarify why medicine matters. Be where you are needed, not where you are comfortable.
ACGME: What are important considerations for graduate medical education programs to help prepare residents and fellows for practice in underserved communities?
Arruarana: GME programs must both prepare physicians for underserved practice and encourage, inspire, and motivate them to choose these settings. A critical element is intentional exposure. In Argentina, all medical graduates complete a mandatory rural year. A similar model adapted to the US context would ensure that every physician understands how access, geography, and limited resources shape health outcomes. Without exposure, interest cannot develop. Another essential component is formal education on health care disparities and social determinants of health. These courses should be widely available and encouraged or required, alongside webinars, mentorship, and teaching sessions led by physicians actively working in rural and underserved areas.
In Closing
ACGME: Is there anything else you would like to add we haven’t asked about?
Arruarana: One physician who deeply influenced my understanding of rural medicine is Dr. René Favaloro, an Argentine physician who developed the coronary artery bypass procedure while working in the United States. Despite global recognition, he consistently emphasized that before anything else, he was a rural doctor. He believed his ethics and sense of responsibility were shaped by years serving underserved communities. That perspective resonates deeply with me. Rural and underserved medicine reveals what communities truly need and where systems quietly fail. Exposure to these settings is not a detour. It is foundational training for any physician committed to prevention and meaningful impact.
If you are in your last year of residency/fellowship or a recent graduate serving in a rural or underserved area, and would like to be featured in a future post in this series, email underserved@acgme.org to share what you’re doing. Visit the Rural and Underserved GME section of the ACGME website to learn more about the ACGME’s work in this area.