AAPM&R National Grand Rounds: Career Diversification: 3 Ways to Diversify your Career-AAPM&R National Grand Rounds: Career Diversification: 3 Ways to Diversify your Career (enduring)

AAPM&R National Grand Rounds: Career Diversification: 3 Ways to Diversify your Career (enduring)

Video Transcription

Sure. Hi. Hi, everybody. So I am Carrie Reed. I am based in Chicago here where I've been practicing for about 20 plus years now. And I am sub-specialized in sports medicine by  board exams, but my practice for the clinical period was basically a half outpatient MSK practice and half SNF practice for most of my career. And then we'll talk about a lot of the  non-clinical things tonight. I've done several of them, but right now my main position,  my full-time job is actually as National Medical Director of Rehab Services at Elevance Health,  which used to be Anthem. So you might know it by either name. And then I still practice one day a week to keep my foot in that door. Great. Thank you. Dr. Elizabeth Varghese-Kroll.  Hi, everyone. I'm Lisa Varghese-Kroll. I'm based in Maryland in the DC area on the Maryland side. And I am a physician advisor. I've been a physician advisor for over a decade,  working in utilization review for hospitals around the country. I spent 10 years with Optum  and now spent the last year with MedMetrix. I also co-host a podcast. So we'll talk about a couple of different non-clinical avenues that all three of us are in. But I have  private practice in Baltimore in the VA system in North Carolina. And yeah, I've really enjoyed  my foray into the world of non-clinical medicine. Great. Thank you. And last but not least, Dr.  Whiteson. Hi. Thank you for inviting me to speak. I'm Jonathan Whiteson. I work at Rusk Rehabilitation here in New York City. And clinically, I work in the field of cardiac  and pulmonary rehabilitation. I think I'm a bit of a rare hen in our field. There aren't too many of  us, maybe a handful. As we go through tonight, I'll talk more about some of my clinical work  and some of my obviously non-clinical work. I think as I prepared for tonight, I looked back  over my CV because it's been a number of years since I graduated residency. And I forget what  I've done and where I've been and where my fingers have been and what pies. But it's been a lot. And I'll talk a little bit about that in terms of how I reached what I'm doing now.  In terms of my non-clinical, I'll go into it in more detail. I host the Rehabilitation Medicine  Show on Dr. Radio. If any of you have serious XM, go to channel 110, 6 o'clock Eastern time,  and you'll hear the rehab show where I represent you, physiatrists. And if any of you want to come  on the show, always looking for guests. So you can email me another time. That's it for now. There's more to come. Thank you so much for that. So the way that we organize this is we  put some questions that we would like all panelists to answer. So we'll start with  the first question, which is what kind of clinical and non-clinical work do you do? And I will leave it up to the panelists to decide who goes first, but we would like to hear  everybody's experience, of course. So I don't mind going first, seeing as I was last to be  introduced, and my name is, you know, I always seem to be bottom of the alphabet. So I don't  know. I'll go first. I don't mind doing that. So in terms of clinical work, you know, my work has  been an evolution. When I finished residency, I took a sort of a non-accredited fellowship in  cardiac pulmonary rehab at Rusk. But as a junior attending slash fellow, it really allowed me to  do everything and anything, and I did. So as well as doing cardiac pulmonary inpatient work at Rusk,  I also did a lot of orthopedic rehab. I did pediatric rehab. If any of you know, remember Joan Gold. She's retired now, but a brilliant physiatrist in pediatric rehabilitation.  But essentially, from the clinical perspective, I, as a junior attending, took on everything and anything. I felt my training, you know, provided me with the skills to do that. My  inpatient, outpatient, I think the only field that I didn't really practice in was doing EMGs.  I never quite got the hang of EMGs. It wasn't my strong point. But other than that, I saw and took  care of really every single patient and really focused the early part of my career on inpatient  work. But hopefully you get from me, and I think it was sort of a way that led me forward. I never  said no to anything, and that really has been my philosophy through my career, taking everything on.  So, you know, certainly in the early part of my career, saw every single patient I could. Did  hospital, you know, consults, inpatient beds, whatever outpatients I could see. I took on  everything. I always made myself available and very quickly built a very busy clinical practice.  But over the years, focused much more where I really wanted to be, which was on cardiac and pulmonary rehab. But I think, you know, for the more recently graduated or younger  attending physicians, really taking on everything, you never know what seed you sow is going to reap  benefits. Sometimes they do, and sometimes they don't. And then I transitioned more from  inpatient into the outpatient sphere. And then as I continued in my career and my development,  I moved away a bit from the clinical work. And again, took on any opportunity that I could do.  So, you know, I mentioned before about Dr. Radio. So Dr. Radio is really a community service. It's  a community outreach, but it is an association, a relationship, a business relationship actually  between NYU and Sirius. And this started about 15 years ago. And at that time, there was a call out  to all the departments at NYU to say, you know, who would be interested in hosting a radio show?  And I had no idea what I was getting myself into. No idea whatsoever. I'd never done anything like  that before. But, you know, my naivety or stupidity or brazenness, I'm not quite sure which, I said, yeah, I'll do that. And I remember quite clearly that first show that I did,  I had no idea what I was going to say. I had no idea how to interact. I had no idea how to put  out phone numbers or interact with guests or people who called in. None whatsoever. Fast  forward 15 years, I was actually going to work out how many hours I've done this, but it's really  been about 45 weeks a year, two hours for the last 15 years. And it's been an absolute blast.  And I don't want to spend too much time talking about it at this minute, because I know Lisa and  Kerry want to talk a little bit about their work, but it's really been an incredible experience.  I've learned a lot. In fact, I've learned so much from the guests that I've had on personally. It's  been tremendously fulfilling. I've learned a lot from the people, the public. It's really a public  facing show. The public who've called in and asked their questions, I've learned a lot from them too.  But, you know, when we think about how do we not just affect and impact the person sitting across  the desk from us in our office and how do we reach out and really do community outreach and affect  positively many people, Dr. Radio has really provided that opportunity. And especially  through the pandemic and through like a year, a year and a half of the pandemic, every single show  for all the doctors who did Dr. Radio, it was dedicated to COVID. And I think that was just  such an incredible public service and outreach and try to debunk the myths and spread the right  word. So again, I can talk more about that and some of the other things I do, but I'm going to stop there.  I can go next. To give a little background, although I entered undergrad as a pre-med student,  I did always know that medicine was my destiny. I was also a broadcast journalism major and was  really immersed in that world throughout college. I was an intern at Warner Brothers in Hollywood.  I interned with Sanjay Gupta at CNN. And then, you know, as everyone on this call knows, once you  start medical school and go on to residency training, you are more than immersed in that world. And so it was a good decade of really thinking of nothing but medical training and  how you can best serve your patients as it should be. And after residency, I did primarily outpatient  MSK and inpatient TBI, a good mix of the two between VA and private practice. But  are you able to hear me now? Okay. Came to feel that I was, you know, really just missing some of  the skills and some of the experiences that I had had in being in journalism. And it was that  that really prompted me to kind of look around and see what other people were doing with their MDs,  really. I was just curious. I wasn't really even thinking necessarily of making a change.  But I happened to go to a conference called the SEEK conference, which I think we'll talk about a  little bit later, but SEAK, which is a conference that, which is an organization that holds a  conference on non-clinical careers for physicians each year in Chicago, and was just really blown  away by the creativity of my, of my fellow physicians, the amazing things people were  doing, really thinking outside the box. You know, I mean, people, physicians who had like almond  businesses, flavored almonds. I mean, just not that flavored almonds were ever my dream, but I was just  so impressed that somebody else had, had, had thought of this, had conceived it and had made  it part of their life. So for me, it was very inspiring to really kind of think about what I  wanted to do, what I felt, how I felt I had been gifted, how I could best use my medical training  to help others. And I ended up through a variety of, of interactions and occurrences, entering the  field of physician advising, which I've loved, and I'm now fully non-clinical. So essentially what we  do is we contract as consultants for hospitals around the country, help review their cases, both  in real time and retrospectively to determine the proper level of care, whether this patient should  have been inpatient, outpatient observation. And then we support them through the entire appeals  process. So that involves appeals letters, peer to peer discussions, and also testifying as expert  witnesses at ALJ legal hearings. And for me, it has been a, like just a really wonderful use of  writing and public speaking training that I had missed and that I really enjoyed kind of exercising  those muscles again. But also as a physician, I felt very much and still feel very much that I am  doing a service for our patients collectively. It's just a different service. So we support the  hospitals. Our goal is to help ensure that they're appropriately reimbursed when insurance companies  don't necessarily want to do so. Somebody needs to do that work and I'm so honored really to be  doing it. And I feel like I'm really able to make a difference for our fellow physicians at  all these hospitals around the country and for the patients that they see. Similarly to what  Jonathan was saying, during the pandemic, I also really started to notice the misinformation,  the disinformation that was inadvertently and deliberately being spread. And this was really  affecting not just people sort of abstractly, but people in my immediate circle that I could see  were genuinely frightened by their lack of understanding of how to debunk some of these  myths and really what they needed to do to protect their family. So it was at that time that I started  with a very close physician friend of mine, our podcast, Health at Home with the Hippocratic Hosts,  which is a health and parenting podcast. And I really have to echo Jonathan. So it's been three  years and I feel like I've learned so much from our guests, so much from listeners that have been  so generous with their thoughts and their ideas and what they wanted to know and topics that they  requested, experts that they requested. And it's been a blast. So I've really enjoyed that, which  also has been an extension of some of that communications training. And yeah, I'm happy to answer any questions about that as well. All right, I guess I'm up.  So that was actually very interesting hearing both of you guys talk. I mean, I already know  both of you, but I've already learned more about you than I knew before. But part of what was  interesting was just realizing that there's a lot of parallels here, which is now, Jonathan,  I won't say I never said no to any work that came my way. I'd love to be able to say that, but  to the point of really trying to get your fingers in everything, it sounds like we've all kind of  done a lot of things, both in the clinical and the non-clinical realm, sort of taking advantage of  all the opportunities that are there. And that is, I'm hearing now that that is a common theme,  and I think has served me really well. And obviously the other, our other panelists here as  well. So I already covered most of my clinical, I'll add that, because I think it adds context  and again, sort of more breadth of experience context that I primarily, for six or seven years  of my practice, I was in, it was essentially an academic setting. I had a faculty appointment  at Rush Medical Center here in Chicago, but was working for a private practice group. And we had a residency associated with that group. And then the hospital I was at had its  own residencies, like in family practice and other primary care that would rotate with us.  So it was kind of a hybrid of private academic, but it felt very academic. And then I, when I  had left there, I had gone into private practice, really solo private practice. And so I was  it wasn't my own clinic, but I was the only PM&R doctor and really the only physician really practicing allopathic medicine. There was complimentary, like acupuncturist that was  there. And so sort of some, an integrative clinic that would have different practitioners plug in,  but effectively it was my own solo PM&R practice. And I'm still, that's still a practice that I'm  in today, actually. So it's, it's been probably about 10 and 12 years that I was, that I've been  doing that. So that's sort of the clinical setting there. And then I've given talks again,  where we're invited, I've given talks to sort of stay in touch academically or, or with our system, our specialty society here. And so, you know, it just keeps you in touch doing,  you know, I think different things like that. And then, you know, it's, it's, it's, it's, it just keeps you in touch doing, you know, I think different things like that.  Non-clinically, I also like Jonathan, in, in prepping for the talk tonight, going back through my resume, you sort of forget all the things that you've done. And it was, it  was a, a breadth of non-clinical things that I had done that just, again, opportunities presented  themselves, or I just decided that was a good direction, wanted to try something. And so I,  I also had sort of had to write down a list of things I do. I mentioned I'm in the insurance  world now, which I've been in this position for about five years now. And I can talk more about  exactly what I do there, but it's essentially a subsidiary of Elevance Health, which Elevance  Health owns all of the Anthem Blue Cross Blue Shields that you, you know, depending what state  you're in, you may have an Anthem Blue Cross Blue Shield, that's Elevance. And we're part of their  subsidiary companies. We're sort of like their equivalent of UnitedHealthcare's Optum. If you've,  I mean, Dr. BK mentioned that, but, but for those who've heard of Optum, it's sort of the equivalent  of that. So I'm not on the payer side of it, but I work with the payers all the time. They're our  clients, both the Elevance company that owns us is our client, but also non-Elevance payers,  so other health plans or people like Walmart. I actually don't know if Walmart's one of our  clients, but you know, something like a Walmart that would, that would self-insure. Anyone who's  sort of a payer of a health plan, you know, who is a health plan is our client. And so I do  clinical, I write clinical guidelines, develop and, and sort of oversee, I won't say I run,  but sort of oversee UM programs in my space. And then also do a lot of clinical programs that,  that we develop that again, are sort of in, in some way, shape or form, I feel like in the  rehab space or that we should be taking leadership on, get to develop some of those clinical programs  as well. And those become products essentially also so that payers may buy those clinical  programs for their membership. And then otherwise, like I said, I've been doing that for five years,  but you know, everything from, I was, I did a lot of medical legal expert witness testimony  over the years, probably about 15 or 20 years, been doing that. And then I've done a lot of  medical writing more for lay publications or lay websites. I was an English major in college,  so you're probably hearing a theme that's sort of your, your interests all along your life, sort of, you're able to integrate those, you know, as you move forward in the path here.  So I've done a lot of writing, I've done, I did some blogging as well. I was CMO of a medical  device startup company for about a year and a half. And I was medical consultant for a TV show.  I mean, just, just random experiences, but they all, you know, they all sort of add up and they  all, you know, one begets the other. And so it is interesting to see how they tie together and how  you can take advantage of those opportunities. So I think we'll talk more about that tonight,  but that's sort of my path here, my background. Perfect. Thank you for that. We have a follow-up  question. Why did you look for a career, for career opportunities outside of the traditional  clinical work? And Carrie, maybe we'll start with you. Sure. You know, there wasn't one reason.  I think as I was thinking back on it all, I think it was a combination of things. One is just, I had a real diversity of interests. And so everything from, like I mentioned, English  being my background, that was my, my college degree and enjoying writing,  presumably having some skill at it. There was sort of something to offer in that realm.  Then there were sort of the category of, you know, are you running from stuff or are you running to  things? And so some of it is a little of both, you know, I felt at some point a little burned out.  I felt like I was really swimming upstream to be the doctor I want to be, like the quality of doctor  I want to be and not shortcutting things or even maybe more concerning sort of putting myself or  my patients at risk by doing things like that. And I, so I just felt like I needed, I didn't want  to be beholden to the clinical at that point. It just wasn't like serving my needs, like life  balance, all of that. I was a single income household. So, you know, I just, it just wasn't  doing it for me, but I still enjoyed it. So I was trying to find essentially other revenue streams  that would then allow me to do medicine on my terms was how I always sort of put it. I actually  became a commodities trader was the first thing. I'm just, you know, a little random there, but that  also was part of having diverse interests. I really enjoyed finance and markets, business investing,  that type of thing. So that just was a way to not combine them both, but to do both, you know,  they're completely separate obviously, but the diversity of interest led me somewhere else. And then the running two things, which is, you know, I wanted something that was  just the sheer, just having more than one thing, you know, more than one iron in the fire  was appealing to me, you know, having something that was more moving parts, combining business and  you know, a whole bunch of other areas. And I'll just say, for instance, like in my current job,  I'm part of a big team. So I may be working with marketing one day and writing algorithms another day and giving clinical talks sort of thought leadership another day  and writing articles, you know, another day. So it's just the actual diversity of things that was  a big appeal to me as far as that category of things I was running to that just clinical practice couldn't really provide for me.  We do have a couple of questions that have come in. Does anyone have any experience with direct care models of, I'm sorry, for PM&R?  I see it more often for primary care models, not for rehab medicine.  Melissa, what do you mean by that? I wasn't, I'm not sure. And I would, I would open it up to Ayana, a doctor. I'm sorry. Not a question. I said that's a question in the chat.  It is a question in the chat. Yes.  Yeah. Can you explain? Sure. Good afternoon. Good evening, everyone. So I'm not, I presume that you're not familiar.  A lot of primary care physicians are moving to direct primary care models where it's almost like a membership model or concierge model for primary care services.  And I was just wondering if anyone is familiar with that in a PM&R realm.  Thank you. I'm unmuted. So I'll just start.  I'm not, I mean, I love the idea. And I also thought of that years ago as a potential direction,  but I don't actually, I don't have an experience with it or know of any models that exist for that. I'd love to hear other thoughts on that.  Yeah. I wish I could say that I had experience with it. I don't.  You know, I've heard of some of the challenges of implementing that in the rehab space,  but it doesn't mean it's impossible. So I too would love to hear if someone has successfully done it.  Hello, David. Can you hear me?  Yeah. Yeah. I think what she means is something like concierge or direct primary care. Something like concierge or there's a business, I guess that's national, it's called MDVIP.  I know two doctors, including my former primary care doctor that did it. Somehow they have a legal way of allowing patients to still stay on insurances  and you get reimbursed by insurances, but somehow there's some legal loophole where patients pay $1,800 a year for their services to get more access to them.  And I kind of laugh, it's basically what conscientious doctors have been doing all the time  for many decades, but haven't got paid for. And I think part of it is to push back that doctors are  just fed up with not getting paid adequately for their time and just being burned out. Little aside, Jonathan, when you spoke about, I guess, taking everything, it really depends,  I think, on how old you are and where you're on life. I'm to the point where  I joke, I say I'm like a very intelligent whore. I don't get paid for my time. I have a daughter who's like in her 20s, gets paid ridiculous money to babysit wealthy people  on the weekends. And you also hear about nurses that are striking and other businesses and doctors  in general, just for the codes that we build, we're not getting paid nearly adequately for my  time. And that drives a lot of people to go elsewhere. And I see my patients and I'm glad I'm treating them, but I'm at the same point, admittedly, very resentful. So I, myself,  do medical legal work, not malpractice work. But one question I would have as a side after  for Kerry is how did you get involved with that business, your medical, legal, and how did you  pursue it? Was it independent? Was it with a group? And to Ayana, I guess the difficulty is  I don't have a lot of practices that I, I don't have a lot of patients that I see regularly.  I used to have like 60 patients 10 years ago that I saw monthly for narcotics, opioids, I'm down to gladly six. I either booted them because they failed drug tests. They either  left because I wasn't giving them what they wanted or just attrition. And I'm glad for that. It's  become too over-regulated. And you, when you try to really help people out, you just get beaten  over the head. So unless you have a large practice where you can dismiss like two thirds, and that's  what these two PCPs do. They had like maybe a thousand people. They lost two thirds of them,  but then they have enough people that are wealthy enough where I am in Fairfield County, Connecticut,  one of the richest counties in the country that can do that. But if you're an MSK and you have  a poor population on ones that are strapped for cash, it's not going to work out, unfortunately.  I think, I'm sorry, Dr. Jonathan, I was just going to jump in. I think that people are doing  it with two different models. And I appreciate all of your comments. I definitely hear your  frustration, Dr. David. And I think a lot of that, a lot of us are feeling that right now.  So I completely appreciate what you're saying. I think there's two different models. I think  there are some who are doing a membership model where they may not be accepting insurance at all.  There are others who are accepting maybe only Medicare and maybe even also Medicaid dollars,  but primarily Medicare and not accepting private insurance. Or they leave the option available  where the person has the membership, but then for some services, they may still bill to their  insurance for those things outside of the monthly fee or the yearly fee or whatever it is. For  myself, very similarly to Dr. Jonathan, I have allowed myself to see a wide variety of people,  though the focus of my practice, I'm the medical director for the stroke program at our hospital.  So I see a lot of stroke patients. I went through the process of getting my secondary board  certification in lifestyle medicine as well. And I've combined that with my stroke practice. But I also have patients who have chronic disabilities or people who have aged out of  the pediatric realm and need ongoing rehabilitation care because of their ongoing spasticity management  or other chronic disabilities, but also amputees. So I do think that there are opportunities for  physiatrists to have patients who are more regular physicians, but to your point, regular patients,  but to your point, if you're doing more MSK, then obviously that's going to be a lot more episodic  compared to what some other people are doing. But I just wanted to give that additional insight into it. And I appreciate everyone's time in sharing your experiences.  So going back to our question in terms of why did you look for career opportunities outside of the traditional clinical work?  Dr. Jonathan, would you like to, would you care to share? Yeah, I'm happy to share, thank you so much.  You know, I guess there's something in our innate personality, something that brought us to medicine, something that brought us to PM&R  and that makes us individuals.  I am a person who sees the cup three quarters full even if it's empty.  And I make myself, I don't make myself, I just seem to enjoy everything.  I, it's how I see the world. And, you know, I want to bring that perspective to my patients in every and any which way that I can. So I wanted to find other ways to spread a message  that I thought had relevance and to affect in a positive way people's lives. And the more pies I stuck my fingers into, the more or the greater reach I had  and I could actually spread my message. Dr. Radio is a community service and I see it as such. And as I said, and I'll repeat it,  never more has it touched my soul as during the pandemic when there was just panic and desperation, my own included,  but where I could bring calm and reason and hopefully a measure of the truth as we understood it as it evolved to people, general public, who were understandably very scared.  So that community service is, it's an honor. It's an honor to have that MD, that stethoscope, that privilege, and that's how I saw it.  Variety is the spice of life. I've always loved doing lots of different things and it's kept me interested. I think of, you know, at the circus, wherever it is,  the sticks with the plates spinning and I'm spinning it and I go to spin the next one and the next one, the next one, I come back and spin the first one. I love that challenge.  So it fulfills something in me.  The more I've done and the more I've taken on, the more opportunities have come my way. I've talked about Dr. Radio. We also have at NYU a podcast I'm involved with.  Sometimes, you know, I do media, either TV or press. I don't necessarily go out and look for it. It comes to me through our press office, but I never say no to it.  And then, you know, I've always lectured. I've always lectured at the academy, at the annual assembly. And when I started doing it, it terrified me.  And the more I did it, the more I learned and the more people I started to meet and then people asked me to get involved. I was on, you know, one of the special interest groups,  if we remember that far back. I was in 2000, I had to look this up, 2000 to 2004, the secretary to the cardiac rehab special interest group.  Then I was on the general and medical rehab council as vice chair of communications.  People came to me, the more I put myself out there, the more people came to me and the more variety I had.  And fast forward to today, you know, in March of 2020,  no one knew anything about COVID.  And then we heard about long COVID, what did we know? But through the academy, we set up this past collaborative and people said, well, who's gonna see past patients,  you know, COVID patients. And again, I said, okay, I'll do that. I had no idea, no one had any idea about COVID patients but no one else did.  So, you know, we had to help this population but what did it lead to? I met a whole group of people that never really met and interacted with before.  They've become friends and colleagues. We've had opportunities to travel the country, even internationally to lecture,  which has been amazing.  You know, I guess the more I opened my mouth, I was asked to be the vice chair of the Specialty Brand Expansion Committee. That got me a seat, I will do actually,  on the board of governors of the AAPMNR. What a privilege, just because I kept talking and someone thought that what I said made sense. I don't know if it does, it's great.  And then I was asked to be the co-editor of the physiatrist. So every other month, if you read the physiatrist, you'll see a piece from me. Again, another wonderful opportunity  to bond with you 10,000 physiatrists and share an opinion, share, you know, thoughts and ideas.  Why did I look for career opportunities outside the traditional clinical work?  Because I can serve the patients that we take care of. So I could serve you, us, each other, our field, my medical center.  I love it. It's just so much fun and it's kept me buoyant. It's kept me happy. It's kept me from, I guess, turning sour.  Thank you, Dr. Jennifer and Dr. Elizabeth.  Yeah, thank you. I would say for me, it was really two factors. One, that I just really missed my previous journalism experiences. I had gone eight or 10 years of medical training  without really doing anything in that realm and just missed it. That was just a big motivator for me. And the other thing was echoing what Jonathan and Keri have said,  which was saying no to nothing and recognizing that opportunity begets opportunity. So, you know, I was a Doximity fellow for a year, ended up being a writer for doximity.com.  As a result of that, was asked to be a founding member of the medical advisory board for a new company called Andwise, which has been a fascinating experience.  So I think just being kind of open to the opportunities that come your way, recognizing that you may not know where that path leads,  but if you are at all looking to do something different, it will probably lead there. And so I think having that kind of outlook has been really helpful.  Perfect, thank you. We'll move on to the next question. And it is, how did you explore your options and how did you come to understand your motivations for doing non-clinical work?  We'll start with Dr. Jonathan this time.  How? I think personally, be bold. Don't be afraid to fail. I don't think there's any such thing as failure. I know we all make mistakes because we're human,  but, you know, like I said, when I got on Dr. Radio the first time, I'm sure I failed every second of every word that I said. It was not easy, I didn't know,  but I tripped my way through and I got some guidance and advice and I became more polished. When I first stood up to make lectures,  I didn't know how to interact. I didn't know how to position myself and I've got better and I continue to learn, but you have to be bold.  You have to step outside of yourself.  Ask to do things, volunteer. I think, you know, I understand, yes. I mean, we all need to make a living and we don't get reimbursed so well  and, you know, the cost of living is going up, but, you know, there's still time.  I believe in our lives, we make time to volunteer and to say, I'll do this. I mean, all the work that I do for the academy is volunteer work,  but I'm privileged and I'm thrilled to give my time. And, you know, my third point, I think, is how is find a mentor. You need someone to bounce ideas off  and you need someone to help steer you. And sometimes you need someone to put in a good word for you. If you really want something,  I don't have a problem with that. If someone comes to me and asks me for help to try and achieve something, I will do whatever I can to help them. I mean, that's the initiative  that I think we all like to see.  But I've had several mentors and I keep looking for new mentors, not in a way to use people, but in a way to be able to polish what I can give to others.  And I think when you're asked to be a mentor, it's quite a thrill as well. It's quite an honor. So when you ask someone to mentor you, you're honoring them,  but you're also helping yourself grow.  Last point, don't say no, always say yes and see where it takes you.  Dr. Carey, do you have something to add in terms of your motivation?  I think I covered a lot of my motivation in sort of the running from things and also running to things, just diversity of interests.  I wanted to answer, this kind of ties into how you explore your options too,  but I think it was Dr. David who brought up not the medical legal work, how I got started in that,  or maybe you just threw it out to the group. But, because I think some of those practical things,  that's really helpful as well. Just literally, how did it happen? In Chicago, there is a small physician led group that sort of acts as almost like a clearing house  where insurers and attorneys and people who basically need experts go to them and they find them the right witness locally.  And so that's where the bulk of my work came from. And that was just sort of happenstance. But, since I started with them 15, 20 years ago, I know there's a lot more  of those types of things nationally. So I wanna say expert consultants, or there's really a variety of them that serve that same function, where you essentially sign up  to be part of their panel, so to speak. And they reach out to you with cases that are appropriate for your specialty and you confirm whether that's the case or not,  whether you think it's appropriate for you to do that type of case or not. And they handle whether it's in your state or not. In other words, they're not gonna give you one  where you can't be an expert witness because it's out of state or something like that. So it's good to go through a company like that.  I find a lot of people have been doing it for a long time. Essentially repeat customers. I've had some attorneys come back to me with just subsequent cases  that just came directly back to me, as opposed to going through that third party. I always refer to that third party. Even in depositions, I used to refer to them  as sort of Charlie's Angels. They're like Charlie and Charlie's Angels. They just sort of call you out of the blue with an assignment and you decide  if you wanna accept it or not and go with it.  You're in control of that.  And so I think there's a lot of opportunity for that. And Lisa had mentioned, what was it, SEEK, right?  Lisa, I think you'd mentioned SEEK before, S-E-E-K. I don't know if there's others like them or if they just have a monopoly on this  because the only people I get advertisements from through the mail are them. So I'm assuming that most of the people or at least a good number of people on this call  get mailers from them. I don't know if that's true, but over like 20 years, I've gotten mailers from them. They're always forefront in my mind  as a great resource for these non-clinical options. And in particular, they do, I know for sure, offer like specific courses, let's say, on medical legal consulting.  And so if you go to a course with them, you're sort of on their panel as well. And I think you have to pay to be on their panel. I'm trying to remember years back,  but I never did it because I had this other work, but I think you pay to be on their panel, but you make that back within like two hours of your review time for a single case.  So it made sense and it was a way of feeding you, getting plugged in to that type of work. So there's definitely a lot of ways to do that,  much more now, I think, than even 20 years ago that make it easy for you. Like I said, I'm happy to be a resource for people  to tell you the ones that at least I'm aware of, but I'm sure there's many more than I'm even aware of since I'm just not looking for it now,  but there's definitely opportunities for that. And what was the other thing? I'm just switching gears a little bit and then I'll pass it on,  but we keep coming back to this theme of just, take opportunities as they present and then those lead to more opportunities. And some of these things you can just,  and it also sort of addresses the question of whether we took these opportunities when we were fully employed or while we had a job already or not. And I've had a little of both,  but there are things that even when you're doing your full-time day job, you can still sort of sow seeds for moving other directions. So I had started a blog  and honestly, it was through that blog that I became CMO of this medical device startup company. Someone contacted me essentially through that. They had seen what I was writing.  I was right in line with what they were developing. They contacted me literally out of the blue and that began a good relationship and a good position and it didn't last long.  I mean, it was exciting while we were doing it. I actually don't even know if it worked out to this day because that was probably about six or eight years ago  that I left there, but I learned a lot from it. And that was great for my resume than when I'm looking for a job like I have now in the corporate world.  I mean, those types of things just build upon each other. So there are things you can do when you're still in your full-time job, even a burned out job that are just easy enough  for you yourself to just start on the side  and then build it and they will come to some degree.  And then when I was in that group practice I was mentioning, sorry, I got sick starting yesterday, so I might be losing my voice, but when I was in that full-time practice  and really getting burned out and looking for something else to do, I just quit sort of cold turkey. I didn't go to something else at that point.  That's where commodities trading came in. It was something that was totally in my control schedule wise to do or not do,  but I wasn't employed. And so that was a period where I didn't have a full-time job and it gave me more time to look for other opportunities, things to do.  So it just varies, but there are ways to do it sort of no matter what your situation, I think.  Perfect, thank you so much. In the interest of time, I'm just gonna move to the next question or Dr. I'm sorry, Melissa, I'm sorry. I know we are pressed for time.  Can I just share something really quick? Because the first part of that question is how did you explore your options? I'm happy to put some resources in the chat  because I think those tangible resources can really make a difference when you're feeling kind of lost about where to go or how to even start.  Like Kerry said, the SEEK conference for me was such a group of supportive individuals, people who had been there, who had all sorts of opportunities I had never even thought of.  And I've been a speaker for SEEK in the years since many of the SEEK alumni have now started resources for people who used to be in their shoes.  Those things have been incredibly helpful. And there are also physician coaches out there, physicians who themselves became fully non-clinical  and are coaches coaching other physicians in how to make a massive career shift like this. So I'll put some of these things in the chat.  Perfect, thank you so much. Our next question is what skills or talents are you using that you're not able to use in your current clinical position?  I'll probably start with Dr. Elizabeth.  I think I touched on some of this. For me, I really felt like writing and public speaking were not necessarily things. I mean, certainly we do use those skills as physicians.  There's no question that communication is a big part of the physician-patient relationship, but I felt that I wasn't really doing that on the scale  that I had in the years prior to becoming fully immersed  in the world of clinical practice.  In the world of medicine and of PM&R. So for me, being able to talk to people all over the country every day, I love that. I think it's just fascinating.  You get to see also just even like diagnosis and treatment trends, you know, this strain of influenza is showing up in Louisiana and we might see it in three weeks in New York,  you know, things like that that I just think are really interesting. And being in the world of physician advising, definitely physiatrists are a minority.  And I love that too, because it makes us more valuable. So being able to teach our fellow physicians about physiatry, about what rehab can offer,  what patients really require inpatient care, whether or not a policy says they do, again, I mean, I feel that's a tremendous honor.  Great, Dr. Jonathan.  It's a difficult question to answer. I don't think, I mean, I think I bring my passion and my personality and my DNA to my clinical work and to my non-clinical work.  You know, I don't know. I don't know if I have different skills and different talents that I bring to the radio, to the academy work that I do, to the writing I do.  I think I bring myself and it's in clinical work and non-clinical work. Maybe I'm backing out of that question a little bit, but I am answering it as truthfully as I can.  I'll just jump in and say that there are some,  I guess we've already alluded to so far, but the writing, for instance,  as well as, I don't know what you call it, business knowledge. I mean, I don't have an MBA, but just the business interest or knowledge that I can bring to it.  The nice thing is I'm not the business person in the grand scheme of things. So it's not like they're dependent on me to do that, but those are the types of skills  that I wouldn't really be using in my clinical position so much. Perhaps if you were in administration, I guess clinically you would, but not to the degree I think that I am now.  I think more, what strikes me more is the skills that are translating to my non-clinical work from my clinical. I mean, even just working in teams,  as PM&R doctors, that's something that we excel at. That's sort of what we do.  Those types of skills that translate, I think are probably the most interesting  or just the knowledge that you bring to us. Maybe it's not even a talent, but maybe I'm going off topic here, Lyssa, but it's not,  like all the non-clinical things I'm doing, and it sounds like the same for my fellow panelists, really depended on me having a solid clinical foundation. It's why I still practice  and why my employer still likes the fact that I practice, even though it takes a day of the week out of dedication to them and their work, because it just, it keeps you solid  for what you need to contribute in whatever other non-clinical role that you're in, whether that's as an expert witness and you've got to have that confidence  that you know what you're talking about, because you will be, obviously you're being challenged, you're being questioned by attorneys, or whether it's an insurance company,  depending on me for sort of the thought leadership on value care or where PM&R can fit in. Whatever it is, it's, you're bringing that clinical to it,  and I think that's what makes you valuable in here in the non-clinical jobs in a lot of ways.  Great, thank you, Dr. Carey. Dr. Reza, is there anything to add?  No, thank you. I think I covered that. Then we'll move to the last question that we have, and how do you blend your clinical with your non-clinical work  so that you are successful at both?  We'll start with you, Dr. Carey.  I started to answer the chat, so I've got to read the question again. How do you blend your clinical work?  I'm not sure I have more to say on that, other than what I was mentioning with maintaining a foot in the door clinically. It sort of feeds my non-clinical work.  Dr. Chauhan or Dr. Elizabeth, anything to add on that?  Is there anything that you need to do to blend them to be successful at both, or do you think that one influences the other? I think for me, I'm fully non-clinical now,  but I definitely have many, many colleagues who continue to practice, and I think it's really a matter of just deciding what you want to do. I think it's, like Carey said,  I think you can very much be a boon if you continue to practice, but it's certainly not necessary. In a lot of ways, it allows you to focus fully on whatever your new path may be,  and I think it really depends on what is best for you, taking into account whatever family obligations you may have, whatever your personal professional goals are.  I think it's kind of freeing to know that really both are possible.  Great, thank you. The last thing that we have on the docket is just talking about the types of non-clinical careers. I think that you all have alluded  to some of the stuff that you do, so this is more a conversation and an open forum to you guys for you to discuss the types of non-clinical careers,  not only that you're investing your time in, but also things that you would recommend a recent grad or something like that to pursue.  Yeah, I have to say to this, I would add, and when I think of clinical, I think of hands-on clinical patient work, but the departmental administrative work,  if you work in a department and you can get involved in administrative work and take your skills in terms of listening and communicating and negotiation,  I think there's a tremendous role, and again, I've grown that within our department, but then also volunteerism, again, it's not just the AAPM and all that I've been involved with,  but I've also been on the board of the AACBPR, that's the American Association of Cardiovascular and Pulmonary Rehab, my specific area,  but if you're in spinal cord or brain injury or oncology, there are other organizations that you can also be involved with and take your skills non-clinical,  but your knowledge and your expertise in this field of PM&R, but also develop those communication and business skills. When we talk about value-based medicine,  value-based care, it is really about efficiency, and efficiency is all about giving better care for less cost, essentially, in an efficient way, and that requires an understanding  of the business model of medicine, and I think that can be done very well by getting involved with the associations that you're involved with, so I would add that to this list here.  Anything to add, Dr. Carey or Dr. Elizabeth?  I would just say that while this is a good list, it's certainly not comprehensive, so if you have your own ideas or you have no ideas, either way, there's a lot more out there,  which I personally found very encouraging. I really wanna try to, you know, try to just give some encouragement to those on the call up there.  I know that sometimes this journey can be very frustrating. It can, you know, really put you in a place of a little bit of despair,  so just know that there are many, many of your colleagues who have been down that path before, and there are a lot of bright things at the end of it,  so really, it's more a matter of kind of deciding what fits you rather than wondering whether there is a place for you, so there are, this is a great list.  There are also lots of other things that are a little more obscure. You know, I'll give an example, like a medical spa, for example, or medical advertising, life insurance brokers.  You know, there are all sorts of very interesting things, medical coaching, which I actually personally know several people who are doing,  and people are making full-time careers out of these, so I really think that it's limited only by your imagination and it's not as daunting as it seems.  There really are many, many people who have resources out there, especially people who have already made this transition are even more willing to help  as I think all of us on this panel are as well.  Yeah, I guess I'll just echo that, which is this is, I mean, a great start of a list, but it's such an immense list, things you wouldn't even think of,  and that's where some of these conferences that we keep mentioning, like the SEED Conference and similar ones, come in so handy. I mean, medical artists, you know,  things that you just wouldn't even think of on your own or didn't know exist, even if you were sort of interested in something like that, that's, to me,  where the biggest value of that type of conference comes in is giving you the possibilities and just the inspiration to realize all the directions, because some are, you know,  if you're looking for something that's more just an expansion of your practice and you just want to diversify a little bit and maybe a new income stream  or just from an interest standpoint, be able to do something else along with practicing, or if you want to completely leave practicing, there's really just a variety  of the types of nonclinical careers  that, like I said,  there's no way you can think of all of them on your own, and it might even spur you just inspiration-wise to think of new ones that they're not even presenting,  but they just get your juices flowing as to what other things to do.  I will say the one thing, you know, as far as practical tip coming out of conferences like that as well,  are just things like how to do a LinkedIn profile,  really tangible, practical tips  that tell you, you know, the best way, you know, number one, to get off your butt to do it, that sort of inspired me to finally like make that move.  I, you know, it was always on my to-do list and it made me just finally like hunker down and do my LinkedIn profile. Literally, it was like three months later  when the job I'm in now came to me through a headhunter. I mean, I wouldn't even have known to apply for this job. It wouldn't have caught my attention.  I was looking at a completely different direction, but this came to me and I thought, wow, that fits, you know, that's a great opportunity. And it only came because I'd filled out  my LinkedIn profile fully. So I know we only have a couple of minutes left. I don't want to dominate the time, but I think there's just basic tips like that that are very helpful.  Yeah, I would agree. You know, one example is if we've spent our entire careers in medicine, we're familiar with CVs, but might not be familiar with modern resumes  and that kind of training, just like, you know, education on things outside of medicine. Those kinds of conferences are very helpful because I felt like medicine was all I knew.  One question that came in the chat is if any of you know those physicians that became coaches, did they have to pursue coursework or certification in coaching?  I just answered that, that yes, generally they do. Because if you want to attract, you know, clients who can A, afford to pay you and clients who, if they can afford to pay you,  they're going to choose the coaches that can get them the farthest. So typically to give you that legitimacy, certification is necessary.  Great, and we are at the end of our time. So I wanted to thank you so much for the time spent with us. I think this was a very good conversation. As I stated in the beginning,  this recording will be available in the online portal that we have at AAPMR, PMNR.  But again, thank you so much for your time. We look forward to hosting you again very, very soon. And everyone, please check the chat for resources.  Thank you. Great, thank you so much. Everybody have a good night. Thank you, everybody. Thanks, Lisa. Thank you. Bye-bye.

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