All right, guys, we want to get started on time. So again, for anyone who came in, try to join our poll right up here. I think if it asks for a username, I think that's where you put in AaronYang927, and that'll get you into the poll. All right, great. Well, thanks again for coming. I think I'm personally excited for this talk, because this is a talk where we get to just talk about our lives. And again, it's not like we're presenting scientific data, but it's just, again, I hope it to be very interactive. And asking questions, I think this is a great opportunity just to talk back and forth. So my name is Aaron Yang. I'm at Vanderbilt. I really love this topic. I talk about it passionately to my trainees. And I think a lot of these things I didn't get at no fault to anyone else, because I didn't even ask these questions when I was becoming attending. So I'm excited to see all your faces, and I'm excited for this panel. And I really thank them for being a part of this. So we're going to start. Wow, people have already started answering questions. So my oldest daughter just turned 10, and this made me think of this question. So if anyone else wants to join, but it seems like 20 to 50s is really taking it. No one wants to be less than 10 years old. So it's very interesting. This is us to get to know you a little bit. And so I'd love to dig in deeper, but it seems like we already are in the stage of life that we really enjoy or looking forward to something. So this is very interesting. I'm going to take this all in. So this is our next question, because our panel is really going to take this information into their talk. So again, I'm curious to see what people say. Reading minds, wow. So not as many people want to be invisible or have superhuman strength. That's not as valuable, it seems like. We are all physicians, and here are going to be practicing physicians. So we want to read people's minds. I could sort of understand that. Awesome. OK. All right. So you guys think we know our audience panel? I think we're all good to go. So I have no relevant disclosures to this talk. My main disclosure is I'm still trying to figure it out. That's why we're here. I can say probably everyone else here is also trying to figure it out. I'm also trying to figure out as a parent. This is very apparent because my 10-year-old just started learning how to do PowerPoint slides. And out of the blue, like three days ago, she made a PowerPoint slide, and this was the first slide. It can be stressing. I was like, wow. It was supposed to be a PowerPoint slide about parenting. And I was like, oh my gosh. So that's what this whole talk is going to be about, is about my 10-year-old's PowerPoint slides that she made. This was her second slide. I added the picture, but she's got a lot of wisdom at 10 years old, right? And so I'm trying to be a good role model at home, but apparently, I need a 10-year-old to teach me how to be a parent. So I don't have all the tips and tricks that she put in because I don't want to share that with all you guys. No, I'm just kidding. So some of the learning objectives, you may have seen this online. But basically, I think that this panel represents a diversity of practices, private practice. People have changed careers, people who are somewhat of a research role. So I wanted to try to get as much different representation for you guys. I think that it'd be great to use their wisdom because I think nothing can really replace experience. So we can sit here and talk like we know what we're doing, but I think experience really teaches us a lot. And so for some of you guys, as you're going through your journey, I think it's helpful to just hear from other people who've had that experience. So why this topic? First, I'm not saying you are immature in a negative way, but it's just I have these things in our minds, but it's not fully come to maturity yet because we haven't been through that journey. Burnout, I mean, we talk a lot about this, but I think it can impact any of us. Typically, see a more early career, but it can affect us mid-career and possibly even late career. So it's not something we can avoid and just not talk about as much as we hear a lot about it. And I think that for a lot of us who've become an attending already, it's very clinically focused in terms of how we're prepared. There's not as much information about other things. And I was just thinking this last night, but you ask each other, you talk to your attendings every day in training, you say, how's it going? We always say it's good. But no one ever says, oh, it's been really crummy at home. I mean, there's just not that transparency. And that can be good and bad in some way, but we all know. I mean, life has ups and downs, right? And so attendings have ups and downs. But as trainees, we don't necessarily always see it because there's that relationship as a trainee and attending. But if you don't have that training, you don't know how you're going to handle it yourself when you become an attending. And so I think there is some things that can be helpful just by being honest and transparent to your trainees. And we don't do a lot of that. And lastly, I think that success can become very ambiguous. We work so hard to get to a certain point in your career. And then you say, OK, I'm finally an attending. Now what? What does success look like? Or five years into your career, what does success look like? We start thinking about it less and less. And I think that that can sometimes be hard because we're so used to striving and working hard to get to somewhere. So again, I'm excited for these four panelists. I think they can be a role model to a lot of people, although they will never admit that because they're very humble. But I think that I look at them and say, OK, they have wisdom at the very least, right? They've been through some things that not all of us have. And they can talk about the successes and failures. So I mentioned this for people who are also still coming in. If you can join us. And this will be on the top of the surveys. So this one is really where we get to know you as well. If you guys could put this in. Again, it's anonymous. I think it helps the panel also to know who they're speaking with. And I really hope someone puts E because I see a couple of people in here that definitely could put in E. I'm not going to call them out, especially my chair in the corner. I did want to call you out, DJ, but you know. All right, great. So I think we have a good mix. So this is fantastic. So here are our four panelists. First person who's going to speak is Dr. Aya Mukai. She's at Texas Orthopedics in private practice. And so I've known or heard about her even during residency at RIC, a.k.a. Shirley Ryan, but we're going to refer to as RIC moving forward. And so she's in private practice, orthopedics at practice. Prakash, he's at Shirley RIC. Oh my gosh, I almost went there. He's a sports medicine physician researcher. And Kim, or Dr. Barker, and she is at UT Southwestern. She's the program director and also does consults. And we have Juan Cabrera, who's also at UT Southwestern, does general rehab. And he's been through different careers. He was at Vanderbilt at one point, and that's how I got to know him and has a lot of wisdom through that and talking about going through different careers and jobs. And so again, I'm really excited. There's their social media, if anyone does social media. We don't have TikToks, not that I know of, but you might find them on TikTok. So this is how we're going to start. So we're going to do four truths and a lie. You may not even know these panelists, but you can make assumptions. You can judge them just by the picture I showed. But one of these are a lie, so I'm just curious to see what you think. So just you may get to know I to some extent. So, while this is going, I'm going to have Dr. Mukai come up and start her presentation. And you can tell your truth and a lie, whatever you want to speak on. I will. You're supposed to vote for the lie. Wow. All right. So, the lie is I don't play the violin, which means the rest of that is true. So, don't go Googling my name, because you'll see that adult movie star. And I'm hoping that the patients don't come see me because of that. I'm not sure if that patient that asked me about the anime character saw the adult movie part. Anyways, it's not me. So, all right. Let's see. How do I get to my... Okay. So, like Erin said, I am in private practice in Austin, Texas. I've actually been there since I graduated from fellowship, which is pretty rare. I'm also affiliate unpaid faculty at UT Dell Medical School in Austin, so I have residents rotating through my clinic eight months out of the year, because they only take two per year and I get them as a PG-1, 2, and 3. And currently, I am one of the co-editors of the Physiatrist or the Physiatrist Newsletter for the Academy. And before that, I did serve about five years on the board of the Academy. So I'm kind of talking about private practice, but also being able to incorporate some of my interests, so I'm not 100% just doing private practice. So just a quick little bit about my background. I came to the University of Austin in 1997, and I graduated in 2007, so I've been here I went to med school at Penn State in Hershey, and then I did my residency at RIC, the RIC. And then I did my Paine Fellowship at the UCLA Wesley VA Fellowship. So like I said, I took the first job out of fellowship since 2009, so I've been in practice for about 13, 14 years or so. And I considered a lot of things. Washington actually wasn't on my radar as a location, but I left my husband in Chicago for a year while I did my fellowship in LA, and he's like, I can't do any more cold. So you can do Florida, Texas, Southern California, somewhere warm, Arizona, that kind of stuff. So I was looking kind of warm. And then I just used my network in terms of people that I knew that I had built over years of coming to the academy meetings and stuff to kind of contact people in those locations to see how's your work going, do you know any opportunities, that kind of stuff. And then ultimately, I kind of narrowed it down to about three positions before I took the job, and at all three of those places, I felt like I had someone that I knew pretty well that they would be fairly transparent about their experience at that job, pros and cons and stuff. So I kind of knew what I was walking into, both the positive and the negative. And then, obviously, I looked at the contract and the offer on the table, and a lot of times, most of the offers looked fairly similar in terms of the money part, but I looked further into just the characteristic of the people that I'd be working with and transparency and what kind of data, because I'm a data person, and really kind of try to dig a little bit deeper than just the surface, what do they have to offer. The academy part, I joined as a medical student, so I saw there's some medical students in the room, so kudos to you for coming as a medical student. And then I rotated with Dr. Fuhrman when I was a fourth year medical student, and he was on the board of the academy at that time, and he had been very active on the resident physician council, so now it's called FIT, but he encouraged me to get involved. So as an intern, I got a little minor spot, and then as I advanced, I ultimately was allowed to be president of the resident physician council that gave me an ex-officio seat on the board of governors for the academy, so I got to know the board members and the academy staff and kind of how the academy works, went through some of the strategic planning, training and stuff to understand association management and just the specialty as a whole and what we were facing. And then, you know, as a fellow, I was part of the membership committee, and then just in terms of timing, the membership chair, Dr. Bagnall, had been tapped to go into the presidential line, and so he actually recommended me, although I had only had one year experience, to become the chair of the membership committee, and that's how I ended up on the board of the academy. I served five years. It was... I think I did like a two- or three-year term, and then they asked to renew, and then ultimately during that five-year term, I had two children, and I just felt like it was just a little too much to go to these meetings and stuff. So they allowed me to have this co-editor position on the physiatrist newsletter, which didn't require as many meetings, and I'll kind of get to that a little bit later in terms of strategy, in terms of saying no, but saying yes, and really being able to say, I can't do that, but I can do this. Is there something like this? Or this is the reason why I can't do that. Is there anything that would help that reason? So that's the leadership part, and then in terms of resident education, I always had some interest in academics and teaching, and so when Austin, there was word that we were going to start a medical school in Austin, Texas, we were interested, my partner and I, and so we had been in touch with Chris Garrison, who eventually became the program director, but we went through multiple iterations because of all the politics. We were supposed to be part of UTMB, and then became UT Southwestern, and then finally they set up a medical school in Austin. But because I'm in private practice, I'm basically an affiliate faculty, so I'm not really on a tenure track or anything like that, and then unpaid at this point, which is fine, because I enjoy the interactions and stuff like that. So in terms of my decision making process, I kind of wanted to put some pearls out there for those of you who are about to go into, or maybe early on in the career, just in terms of just balancing personal life, interests, and practice. So number one, I waited until I made partner to have children, and that's kind of a personal decision, but I felt like, okay, I'm going to work really hard for this many years, I have this many years to spare, I'm going to try to make the most of that time to build my practice and get to that kind of maintenance phase before I felt like I was ready to have children. I had to learn to let go of control, which is really hard, had to kind of start making decisions about what's really important. Do I want to spend my weekend scrubbing the toilet, or do I want to spend it with my kids or doing something that I enjoy? So there's no shame in outsourcing a lot of these things. I know it's hard, depending on your upbringing, to kind of feel like you can't do it all, but hiring housekeepers and nannies and babysitters and whatever else you need to really kind of do a lot of those things, to take some of those things off your plate can be very helpful. There are some virtual personal assistants and stuff too, so if there are things that you spend a lot of time on that you don't necessarily think is a really valuable use of your time, there's usually a way to outsource that. But it does involve you giving up control because it's not necessarily going to be done the way you would have done it, but you kind of want to keep that in mind in terms of what you're sacrificing by spending that time to do that thing. Same thing with work, so I kind of see that the same way. I was probably about two, three years, almost three years into practice when I made the decision to hire a mid-level, so I hired a nurse practitioner. I supervised her appropriately. I trained her very well, but I kind of saw that as kind of a way to outsource as well. So I keep a good eye on her and I cosign most of the notes and she's always talking to me, but I looked at my patient panel to kind of figure out, okay, well, if I see someone and I come up with a treatment plan, I'd send them to physical therapy, let's say. When they come back to do a check-in visit at that six-week mark or whatever to see how they're doing, does that check-in visit have to be with me or could that be with a nurse practitioner or PA? So really kind of looking... At that point, I had built up enough of a patient population that I felt like I could support mid-level support. So that's the kind of stuff that you kind of have to think about in terms of where you are in your practice. There's usually a building phase and I would say that the biggest learning curve is probably the first year. It'll take about six months to even feel like a real doctor, like you're actually seeing patients and not feeling uncomfortable or that little imposter syndrome thing. What really helped was having a group of peers that I could kind of regularly keep in touch with. So my co-fellows, because there were four fellows, we studied for the oral boards together and so we ended up kind of talking on the phone at least once a week just about different aspects of private practice. How do you handle this? Well, have you given a talk to the primary care doctors to market? Marketing is one thing that they don't really teach you in training and you feel... I felt really weird when I first came into practice that I had to knock on doors and the marketing person would take me to the primary care doctor's office and the front desk girl's like, well, where are the pens and are you bringing lunch? You can wait. The doctor's very busy, so you can wait right there and we'll let you know if he or she can even see you. It's so pretty humbling because here I am, I've arrived, I'm attending and I have so much to offer and then you realize fairly quickly that, huh, I'm just... I need to kind of figure out this market and figure out where the needs are and how I can make these connections. I remember when I was in residency, I did... Joel Press gave a talk about how he figured out referral sources and stuff and a lot of it is really trying to fulfill their needs. So not telling them what you have to offer, but trying to figure out what are your pain points as a primary care doctor. I don't want to get that call about somebody still having back pain after whatever. Take that off my plate. Or if I have somebody urgent in my exam room, I want to be able to pick up the phone and call someone and let them get worked in. So I gave out my cell phone number a lot and I was worried at the beginning because I felt really uncomfortable if that was going to be a boundary issue or if people are going to call me at 9 p.m. about somebody's back pain or whatever. And I will say I've been doing that for 13, 14 years and I can count on my one hand the number of times that that number has been abused and I've gotten better at kind of setting boundaries and just kind of keeping that more professional in terms of boundaries and stuff like that. And then you'll kind of know when you get to that maintenance phase where you feel like you have a few pretty stable, good referral source in terms of patients and you'll kind of see how much of a wait there is to get in to see you with still some room to work in patients and stuff like that. And once you get to that maintenance phase, it's a little bit easier to kind of take inventory at that point to figure out, okay, what are my inefficiencies, where can I gain some efficiency, and what are some other things that I might want to take on at the same time? And then just a few just financial stuff that I wish someone would have told me. I mean, live like a resident for as long as possible, but I felt like it was okay to have some small splurges. I mean, you earned it, right? And so, I mean, I got an iPhone, which I'm very old, so I didn't have an iPhone as a fellow. I got a BMW convertible. I leased it, but it was fun. It was so fun before kids. So just little things like that that you can kind of afford, but you can enjoy. I think you can still do that without having to scrape by, and it might not be a BMW convertible for you guys, but whatever you want to do. Short-term disability insurance, I think. People talk about long-term disability a lot, and that can be pretty expensive, but short-term disability is pretty cheap, and you can get it through Aflac and other companies and stuff like that, and that can come in pretty handy, especially for women, actually, if you're thinking about having kids, because a lot of places, especially private practice, there may not be a paid maternity break. A lot of institutions do have that, but you'll pay for it somehow. Even if you're an institutional employee, if they're tracking your RVUs and you have a dip, you're going to pay for it somehow a little bit later. So to have that little cushion of some kind of short-term disability insurance that'll pay out during your maternity break, even if it's just to offset some living expenses or practice expenses, can be pretty helpful. And I'm glad I did that. I did that throughout the time that I decided that I was going to have kids. And then just in terms of taking periodic inventory of your outside influences. So where are all these needs coming from? And I think that's the part that can lead to burnout, because as physicians, we want to be everything to everyone, and not just patients, but employees, partners, physicians, and then your family and friends and stuff. And sometimes you feel like, oh my God, all I do is just give, give, give, give, give, and I don't have anything left to give at the end of the day. So really kind of looking at where those requests are coming from and what they're asking of you, and then making sure that those relationships are mutual. So if you notice that there's a pattern of somebody calling you with a crisis every time, but you don't feel like you could go to them with your crisis, that's an uneven relationship. So do you really want that in your life? And is that really a healthy thing to have? And those are things to just kind of think about, even as a resident too, because as soon as somebody hears that you're a doctor and you're in the family, you're going to get aunt so-and-so they haven't talked to you, or I just got a Facebook message from my high school orchestra person that I haven't seen or talked to in, good God, how many years? And he's about to have a laminectomy and he wants to ask me questions about his MRI. And I'm like, okay, can't do that through Facebook. But so you kind of have to look at the motivation of the people who are approaching you. And that's sad to say, but you do kind of have to understand how people look at you from the outside. You might feel like the same person as you were when you were a student, but as you become an attending, just your medical degree alone is going to bring things that people expect from you. So just to think about that. Same thing with financial literacy. I've seen so many physicians make really bad investment mistakes because we're really, a lot of us don't have the financial training to be able to really assess investment opportunity. And if you're in a good economy, you feel like, wow, I'm like a genius. I made this percent whatever return. And you kind of start thinking like, oh, I'm kind of good at this too. And a lot of times we're also not as good. We can be pretty trusting of people who come in with these secret deals that no one else knows about but you, and I'm just going to give you this secret deal. So you really want to be able to take a breather and really kind of assess it and be able to do your vetting and stuff. Just maybe have a sounding board of a couple of people that you trust and, or potentially even like professional, like an accountant, which might be helpful to you. So just know that you're going to get a lot of deals coming your way, but you have to be able to vet it. Because I have seen lots of pretty bad mistakes in terms of financial mistakes. And then starting the retirement planning early is good. You might think that retirement is so far away, but understanding where do I want to keep this safe chunk of money? How much do I want to be higher risk? And then if you're going to have children, investing in a 529 early can be very helpful just to have that fund. And then just a lot of, I had to read up on a lot of strategies financially in terms of HSA and other methods to start saving some of the pre-tax money. And then, oh my, I'm almost done, yeah, sorry, and then burnout prevention. So I kind of talked about the academy and leadership and stuff, and I really enjoyed it. And I felt really bad turning down the opportunity to serve on the board and do more time intense, but higher prestige or higher involvement kind of stuff. But I will say when I have had to say no, they've really respected it. And I usually kind of give it a timeframe. My children are eight and 10. I have maybe three or four years left before they don't want to spend time with me. So I really want to take that time, but I still want to stay involved in the academy. What are some opportunities that doesn't involve four or five meetings a year and conference calls every two weeks? Is there something else that I can do? So that's how I got the co-editor position is having that honest conversation about what I felt like I could give versus what they wanted from me and trying to kind of find that compromise. And the academy is great. I mean, they have so many volunteer opportunities that even a small role, you'll get a lot out of it. And the biggest part being just networking and meeting people and just the more perspectives you have, the better it is to get a lot of different perspectives to kind of figure out where you fit into that. And then having that social support, identifying who are your real friends. And I feel like I have different levels of circles and especially with COVID and politics kind of coming into the picture, I've kind of realized who do I really share a lot of my core values with and then who do I enjoy hanging out with, but not necessarily co-making decisions with. And then just social acquaintances and people that are kind of in the periphery, but I don't mind seeing socially here and there. So really understanding those levels I think is helpful just to kind of understand where my support can come from if I need it. And then having some outside hobbies and interests have been good because I think as you become a parent, you lose your identity as a person. Before you became a parent, you're just somebody's mommy for so many years that when they're ready to leave and you're like, oh my God, I spent the last, I don't know how many years raising these people and they're leaving and now what do I have for myself? Or you might look at your spouse and say, okay, we're looking at retirement. What are we going to spend the rest of our lives doing? And if you don't have at least some kind of interest that you can continue in a small scale maybe, you'll just kind of lose sight of who you are as a person and lose a lot of enjoyment from your life. So that's pretty much all I have to say. Is that good? All right. Awesome. Thank you, Ai. That was great. So we'll have a time for questions at the end. So next up is Prakash. So again, take a look at this and I think if you can spot, he even stood up so you can just judge him by just him standing here, which one of those you think is a lie. So, oh wow. Okay. My wife does like that show. No, it's clearly, all right, thank you so much. A lot of judgments here, I feel, that I've made. Actually, I set myself up. I'm glad, well, most of you don't know what cricket is, so it doesn't, not really a real sport anyway, is it? Right, so, all right, so the lie is actually, I met my wife at a party when I was dressed as Batman, so that is the lie, and I have a picture, I think, on the next slide. What were you dressed as? I was dressed as Gandhi, actually, so Gandhi's probably turning over his grave because he's probably not having a Jack and Coke in his hand whilst meeting his future wife, and that's me meeting Wycliffe in the, I'm sure I broke some law by taking a picture with him at the Immigration Services in New York, so, and he wasn't too happy about it, but he did it, so, yes, that's a lie, so I want to thank Aaron so much for putting this session together, and inviting me, so hopefully most of you won't switch off while I talk about research, and research, building research into clinical practice, and so sorry about the cheesy picture here as well, I just can't update this slide every time, so I was gonna quickly go through me, so I did medical school in the UK, my accent is not fake, I often say that, I have to say that in presentations, I was very sad yesterday, someone said to me that your accent's becoming Americanized, so it was very hurtful, so I'm gonna put on a very thick accent for the next 10 minutes, so when I was in medical school, very interested, my father is an orthopedic surgeon, so I was very interested in musculoskeletal research, he definitely was a big impetus for me to go into potentially orthopedics, because we don't really have PM&R as a field in the UK, and then, so I initially was an orthopedic resident in the UK, done a lot of research, but then I was in the OR, and I'm like, man, I really don't like this, I wanna get to know my patients, I like the rehab course, so I actually told my residency director about this, that I'm thinking about quitting, he's like, take time out, do your PhD, because I was due to do that earlier, so I came to the US, and I didn't come to a place that most people would think of, that a guy from London or England is gonna move to, I moved to the University of Missouri, that was because I had a foremost mentor of mine that I met in medical school, so I had opportunities to go elsewhere, but I chose to go somewhere where it wasn't about the name, it was more about the mentorship, and I think that really impacted my career. Then, I found PM&R because I'm the chair of the program at University of Missouri, and PM&R was on my committee, and his name is Greg Werschwitz, who many of you know, so he became a big advocate for me, and remains an advocate for me in my career, and said, you should think about PM&R, did a rotation in it, I loved it. I did residency at Pittsburgh, predominantly because of the research opportunities and mentorship that I received there, and I'll talk about that in a second, and then I moved to, formerly known as RIC, but Shirley Ryan Ability Lab at Northwestern to do my fellowship and stayed on as faculty, and then I have some research grants since I've been there at that time. So, when I was, oh sorry, taking a step back, one thing I do wanna say, I've talked about my father, so when I was making my decisions, there's this dichotomy sometimes between what your parents want you to do and what you want you to do, particularly coming from an Asian background, and I always used to follow what my father said, and so he was very disappointed when I was choosing PM&R and leaving orthopedics. He didn't really understand the field, and often said you should do something that everyone knows what you do, do rheumatology, do family practice, why are you doing this bogus specialty? And so, he used that term. So, I do say that to say that sometimes you have to go out on a limb and do things that are not necessarily gonna make everyone happy, and I did take a risk, and a lot of it was my wife who told me you need to follow your passion. So, I often say I did a trifecta of disappointments, and residents have heard me say this. I quit orthopedics, I moved to America, and I didn't marry an Indian girl. So, just also remember, and now they're very happy with all of those decisions that I made. So, that's the other thing to remember. So, this is something that I often ask my, whenever I'm giving away my interview questions to residents or fellows, but this is what I ask commonly, is when you grow up, what do you wanna be known for? What is your vision for your career, right? And this is a gut check that I do on a yearly basis about my own career, and what, you know, some of it could be related to your professional life, some of it could be related to your personal life, and I think it's important to sort of have some sort of strategy of what you wanna be in the long run, because I think that's pivotal in making sure that the things you're doing and saying yes to match to that vision. So, when my last, these are the last few days of my residency and fellowship. So, the residency in Pittsburgh, the fellowship here, and as I transitioned out of both of those, I did that gut check about what do I wanna be, what is the kind of person, what is the values, as Dr. Mukai talked about, that I wanted to push forward, but also what was it that I wanted to be known as in the long term. So, you know, during residency, I did the RMSTP program. Many of you, I think some of you in the room, do this program. It's run through the AAP, which is really to embolden clinician scientists in the field, and I found that a really good way to find the vision that I had, wanted to, for my own career, particularly through networking with successful clinician scientists in the field, and definitely I would encourage all of you to think about this program. And one of the biggest things that came across from that is that to be a successful clinician scientist, you really need to dedicate sufficient time. Now, that sufficient varies by institution, but, or by the position that you're in, but most of the time, it's like 75% research, but I know very successful clinician scientists who, or clinician researchers, is that they, you know, they can do it in 25% time, where they're predominantly clinical, but they engage in research as well. So it all depends on where you think it's going to fit. And then this is sort of the other part that you have to think about when you're trying to incorporate research into your career. So at the top is obviously a clinician where, you know, you're doing maybe more outcomes-based research. We can talk about a clinician who does industry-sponsored research, a clinician scientist, which is really my domain. There's some people who don't sleep at all, or do a mixture of everything, which is pretty crazy. I think Dr. Kennedy's in the back there. He definitely does a lot of that. And so, but I think that those, and then there's those who decide, you know, I don't want to ever see a patient again. I want to be a researcher for my full career. And that's not something that I wanted to do. So then when we think about then how, what, you know, when you're taking a new job and you want to be this clinician researcher, even a clinician educator, it's also important to think about what is the expectations of the institution you're going into? So for example, in my institution, most people start at the instructor level, and there's not that much gain from going in this academic promotion schedule. So going from assistant, associate professor, but it is important for a researcher to go on that track, right? So that's another thing to think about is the expectations. Are they purely monetary expectations of your institution or is there academic expectations as well? And what is the payoff if you go down that road and improve your academic standing? The next is then to think about the amount of time that you want to dedicate for research, right? And so, as I said, I'm really in that 75% domain. I find that that domain really helps me to be a successful, what I've considered to be somewhat successful researcher, okay? And so I think without that, there's no way I'd be able to do some of the things I'm talking about. Sorry, it's like automatically going through. So what I wanted to do is then to think about what was my vision, right? So this was my vision that I wrote down when I became an attending. So it was to lead a multidisciplinary research division that investigates and develops treatments for knee osteoarthritis, because that was a lot of the research that I'd undertaken. So how was I going to achieve that vision? That's really the mission or the short-term goals. So the first is the institution I was in. So the institution I'm in is at, formerly known as RIC, Shirley Ryan Ability Lab. And so the institutional ethos when I joined was this idea of clinicians collaborating with researchers, right? And so that really fit in with what I wanted to do. So when you're thinking about this sort of research career, it is really important to be in a department that's going to support your philosophy on research. So this idea of clinicians working with researchers and me being in the middle between those two worlds is exactly fit in with what I wanted to do. Then you want to think about how you're going to develop that program. So the first is my passion, right? So my passion is optimizing the care of patients with OA. But the next is then to think about what are we doing now? So figuring out what's going on in the institution. So asking the right questions when you join your institution is critical in developing that vision. So I wanted to, when I looked at our research, we was really very heavy clinical. We really known clinically, but there wasn't much research going on specifically in OA. And so what could we do better? Well, my skill was maybe to bring in this translational musculoskeletal research program. So I reached out, the other part that's critical as well is to reaching out to your mentors, okay? So as I thought about this vision, I reached out to my mentors, my mentor from my PhD, my mentor from pre-residency, who's my PM&R mentor, my mentor in residency and my mentors in fellowship. And these are all very well-known people in the field. And my PhD mentor gave me an outside perspective as well. So reaching out to your mentors and engaging them to help you decide is also really important. And you don't always have to take the advice of your mentors. Like I didn't take the advice of my dad, but he's still happy. So what are we doing now? So when I went back and I started to develop this vision, what I wanted to do was this transition between clinical care and research. And that was really the big focus as I developed this vision that I was talking about earlier. So creating this type of goal, building this research in my clinical practice really took time and it took a team. So firstly, I had to realize that we, NeoA is only a very, very small component of what we have in our clinical practice. There are many other musculoskeletal conditions as well as adaptive sports that have opportunity to do research in. So I was allowed to hire a couple of people and this is essentially a lot of the people that I initially hired was a research engineer, a research assistant, but then I started engaging a lot of the trainees within our institution at the Shoddy Ryan Ability Lab and Northwestern more broadly and our residency as well. And so the next phase was then things that we developed early. So we developed a research registry and I'm not taking credit for all of this. This was through our institution. We had regular musculoskeletal research meetings which helped with that. We started to recruit patients in our clinics for research studies which actually improved the engagement of our patients in our clinical practice as well. We started to do studies to understand what our patients go through. We're in the middle of Chicago, but understanding why weren't patients engaging in physical activity as we wanted to. What were the socioeconomic issues that patients go through to actually wanting to engage in physical activity or some of our treatments as well? And this did gain us some notoriety within the hospital in terms of a research program. The other part that my mentors also tell me is the idea of being an effective leader. So I took on this role as a research lab leader, right? And so what I knew was my strength was being able to collaborate and talk to people. But what I was not great at is often organizing this structure. So I started to engage with people who'd help me, for example, develop a research registry in our practice. But the other part that is also critical that I think a really good effective leader is is giving other people opportunities and engaging them in things that they really enjoy doing. And I think that's what I started to do as we go forward. And I'll come back to that in a second. So this was sort of the vision that I outlined for our chief medical officer in terms of what I thought we could develop in osteoarthritis care in our institution. And then I started to realize where some of the skills that we would need potentially to develop that as well. And this is some of the ways that we wanted to do this individualized process of musculoskeletal care. It's still ongoing, but these are some of the areas that we sort of are focusing on as well. And then this was my first ever diagram that I developed for my vision of my career in terms of being an osteoarthritis researcher. I'm not self-absorbed that I'm in the middle of every diagram that I ever draw, so I apologize for that. But it was to understand who are the mentors internally that I could develop. So this was in a research grant that I applied for, but it was to understand where would I fit in in terms of the osteoarthritis care in the future. This was the moments that I shared with my family of the first big grants that I received, which was a very happy moment. And then, but then getting back to giving other people opportunities. And so this is really where I want to sort of end with is this idea of who are the people to give opportunities to? And in my institution, I would say my biggest satisfaction that I've gained in my career is incorporating residents and medical students into my research. Because that's an opportunity to give to them, and that's an opportunity to mentor the next generation. Sad for me to feel there's the next generation, that means I'm getting old. So what I, so a couple of pearls in what I do with residents. So the first is, I really engage residents in things they want to do. Not to just give them a research project that I think I want to do, but more I develop a research contract with them in terms of a plan of their research project that we're going to develop together. Oh, sorry, sorry, okay, I can do it. So then I start to think about the research domains that they may be interested in. You know, medical, these are sort of areas that our musculoskeletal division is engaged in research, medical education, performance, adaptive sports, degenerative conditions such as OA, and then health outcomes. And so, as I said, that initial vision was just to look at treatments for knee osteoarthritis, but now we're looking at this whole remit of musculoskeletal disorders. So our research program has grown. We're looking at multiple different avenues, applying for grants in multiple areas, not just knee osteoarthritis. Though, to be a successful NIH researcher, you still have to focus, and that's still my focus to some degree. We're doing well. This is not to toot my own horn, but this is more to say a lot of this is due to the residents and medical students that I've worked with. They've been successful getting research grants. They have presented their research at national meetings. I don't work with a resident unless they're trying to get a manuscript out. That's, it's not just an abstract. They've won awards at national meetings. And I think in the institution, it has given me some administrative role now officially, which has been valued by the institution. So, and so, as I said, and I think it's also engaged many of our patients. Last slide really is to say, the big thing to say when I think about developing this research career is saying yes to everything won't help you, but saying no to everything also won't help you. So really choosing those things that you want to do that are gonna fulfill your long-term vision is important. Faking interest, I can spot a resident that I know is a medical student that clearly is not into the project, that feels they just have to work with me. That, so, not that everyone wants to work with me, but I do think that that also leads to issues where someone doesn't complete something. Not asking for help, so just working in your silo is also really bad. Not highlighting when something goes well. It's, in the UK, we're very, we have a stiff upper lip is what they say. So we're very humble. We don't like to brag about what we do, but it is important to, when you have big events that occur in your career, to highlight those to other people. Not giving others opportunities, thinking you're the only one that's confused. Understanding when certain mentorship relationships aren't working. It might be me with a resident or it might be with someone else. So that's important to think about. Straying from your vision, forgetting about your hobbies, forgetting about your family, all really, really important things to think about. We all have imposter syndrome, which is probably the big thing that a lot of you have, and I commonly have that. My wife thinks I'm only up here today because I have an accent. So I do totally understand any of you who say that you feel that, but it is, having that vision will sometimes, and having more substance to go with that vision has really helped me build my career. These are my collaborators. Don't need to go through that. This is probably the most important slide in my mind because I wouldn't be here without many of the residents, medical students, or mentors I've had in my career. And this is just a summary of a lot of the residents that I've worked with over the years. And I would encourage any junior faculty to really engage your residents in your career because they can really help you. And then the final part is obviously really important is having family behind you. My dog's name is Biggie. And I really, that first slide, I really wish he could talk to me because he would tell me some real pearls about what I'm doing wrong. But sadly, he can't talk to me. But also don't forget about your family because that's really important. That's it. Thank you. Nothing like a significant other to keep you in check. I can relate. So next we have Dr. Kim Barker. And so she's also standing here so you can make a judgment call. And so again, putting your questions, I will say she definitely did put my life in danger in the ice storm in Dallas. And so you don't have to put B. Okay, you guys got it right. So I do not speak Vietnamese much to my parents dismay I was born in New Mexico And so I did I did ballet folklorico in in high school And I did dance on a carnival cruise ship doing ballet folklorico, and I did almost kill Aaron Yang And that's why he didn't come to UT Southwestern, I guess. Oh No, he had he has a wonderful job. I enjoy my chair. I love my chair And so I have no financial disclosures I am a poor academic general physiatrist and I married a poor academic general internal medicine physician But I do have disclosures. So a lot of what I'm gonna say is just kind of based on my personal life It does reiterate some things that you've heard about mentorship and kind of weighing what you want to do But you know, it's just kind of what my story is kind of a little bit of what my husband's story is as well And you just can take take of it what you will I am a grad of Rehab Institute of Chicago RIC so tree of life forever and RIP Henry Betts So when you're starting I um, let me start out I I Moved down to UT Southwestern Karen Kowalski was the chair and she had a job. She needed an inpatient rehab physician That did medically complex and that's exactly what I wanted to do She's like, do you know how to take care of LVAD patients? I said, yes, I would love to and so that's how we ended up down in Dallas And through the years she has been a wonderful mentor and sponsor for my life A lot of people think we moved down to UT Southwestern because my husband actually grew up in Plano in one of the suburbs But it was really because of my my job opportunities and we Again to the dismay of my parents. We took a while to have kids So, but it did allow me to say yes to a lot of things So there are opportunities that came up in the department or in a PNR or a P and I was I had time to do it and that's actually part of the reason why it took us a while to have kids because I knew Kids were time-consuming and they are and they're wonderful, but it takes up it takes a lot of time So I did as much as I could early on It also helped me meet other people at UT Southwestern so a lot of what we're talking about or earlier was Mentors within physiatry, but I found mentors outside of physiatry very helpful at my institution so one of my favorite people with two of my favorite people was One was general internal medicine and she has been super helpful and her husband has actually been super helpful in my career and then the other one is Sharon Reimold, who's a cardiologist who's also been very helpful in in Getting to different clinical community opportunities at UT Southwestern So network with it if you're at an academic institution network with the other Specialties that are working with you or may not even be working closely with you because they'll bring opportunities You you do also have to be mindful So, like I said, I did a lot of stuff before I had kids so I had more time But once I started to get a little bit busier, you have to figure out which opportunities are Meaningful to you or may get you into the path that you want to go to go down And you have to have good mentors to kind of help tell you guide you what you should say Yes to what you should say no to what is What really will benefit you in the long run? I'm gonna use my husband as an example. So he is One of the student affairs deans at UT Southwestern and he started down that path doing clinical informatics Which is absolutely not at all related to being student affairs dean But he just wanted to branch out and do something that was not clinical and when he was doing informatics He met some people and he talked about how he's really he's really interested in teaching and teaching med students and from that clinical Informatics he became internal medicine clerkship director and then from that he ended up as student affairs Dean so Sounds very roundabout to do clinical informatics and then end up as that was the leading opportunity to be in student affairs Dean But that's kind of how it worked out for him. He said yes and figured out and other opportunities came from that So next okay, but then once you have those opportunities once you are student affairs Dean or I am residency program director It becomes a lot harder because you have a lot more Responsibilities, right and then you got to figure out all these other committees that I used to do Can I still do them while I'm residency program director? How do I figure out how to? Juggle all of that. I was actually talking to Somebody from the the a BPM and R because I've always wanted to be a part two examiner But I can't or I had not been Because I do a oral board review course for our alumni and that's a conflict of interest However, I'm sorry Audrey and I don't know if Annie's here. I decided to volunteer this year. So I will not be running the mock oral board review course But I had not done something that I wanted in order to do something else that was also meaningful to me Which is making sure that my residents and my alumni are successful. So you just have to weigh the pros and cons And when you're doing that you have to you just have to Make like Elsa and let it go realize that you can't make everyone happy. Just try to make yourself as happy as possible. So Be mindful of what? What responsibilities or obligations that you give up in order to take on other ones? Another example is I used to do the the SAE Writing for a for a PMR and I loved it. And if you ever have the opportunity, it's a lot of fun But I did it I got another opportunity That kind of Conflicted with the timeline of the question writing so I had to let go of that and I asked Megan Struble before I left That's like in a few years when I'm done with this responsibility. Can I come back? It's like sure come back just email me so you just kind of again you just have to juggle and you just have to Kind of get over get over your losses. Just mourn it for a little while and get over it You Can also I don't do this very well, but I'm still trying to learn delegate So you can't be responsible for everything and it's kind of the whole outsourcing that I said But you can find other people whether it's clinical work or residency program director or education that can do other things Hence, you know, there are very competent faculty at my department. They can also run the mock oral board course So I am going to outsource it or delegate it to someone else and that also actually just gives them the opportunity more junior faculty To do to technically run a course or a curriculum and put that on their CV. So it benefits people down run You also have to be organized I think that's something that you don't really Think about but when you have all these leadership positions or just the responsibilities You have to be organized and that is definitely one of my strengths. I was the administrative chief when I was resident. I Did tell Jim Sliwa. I the first few years of residency. I said, oh, yeah, I think I'd be I'd like to be a program Director someday. I think that sounds fun. And then I was administrative chief and then on my exit interview he asked me if I still wanted to do and I was like F no And then I am still now I'm program director But you do you have to be organized you have to know like what is important I don't know if I did it on this. Nope. I'll go back this I am very much like a to-do list maker So I have things prioritized like what needs to be done today Or what needs to be done this week and what needs to be done kind of like this month? And I have that to-do list and I know what and it's both like personal and work wise I mean I have things like I need it. I need to return this thing I need to drop it to the UPS store before Amazon doesn't let me return it I have those kind of things on my list, but you have to be organized to try to manage all of your responsibilities But you have to be flexible. And so this is when you know kids Come into the picture and they do not allow you to be flexible. So the picture on the left is my son Benji when it was he was he was born in April and then I Technically officially became program director when I came back from maternity leave in July So he was an infant during my first interview season when everything was still in person And he had hand foot mouth on one of the interview days So he got kicked out of daycare which is the like big fear when you have a kid when you have a young kid and if you don't have a nanny and They go to daycare. The fear is like, oh god, please don't let them have a fever or I'm gonna give you some Tylenol and ibuprofen and I hope you stay a febrile long enough for me to To get through what I need to this morning And so he I had to go and pick him up Between when I do the the program overview when I actually started doing interviews and I was lucky enough at that time one of our Coordinators Kimberly King loves babies and she was fine with a febrile baby My current coordinator and back then to Terry does not like anybody who is sick So do not go anywhere near her if you think you have a cold, but Kimberly King was like, I'll hold your baby And so she did she just kind of held Benji the whole morning and then afterwards when I found out his hand foot mouth I texted her and let her know but she was fine and Then the the picture on the right is Benji and Ruby there. I I had to use the daycare That's kind of on campus. And so a lot of the faculty use that that daycare and one of the days I can't remember if the power went out or like the the The plumbing was gone so they just had to close and it was just you know everyone all the faculty are freaking out because they have to go and pick up their kid and There are quite a few faculty members in the human art department at that time that use that daycare So we were all picking up our kids at that time. And I said, you know what? I I'm just gonna order pizza and any kid that wants to come and eat pizza before they go home or whatever can just Come over and so we had like a little pizza party In my office and then eventually that was in the morning and then eventually my husband had admin time And so he picked up the kids and went home But you just kind of have to learn to be flexible during the pandemic, especially The number of times that the kids had to be quarantined at home Thank God for telehealth and virtual meetings because that allowed us to be at home and still kind of work But the kids were running around But you just you kind of have to give yourself grace that your plans did not go the way that you wanted them to go And then just still keep trucking along And then so the other thing that I found really important is incorporate what matters to you and so I you know I said I postponed having kids but my family and my kids are the most important thing in my life. I also Very much value working. And so I have never shied away from telling them that I'm a doctor and that these things are important to me that the you know, I call He they all know that my that my husband works with medical students and then they just they think the residents They just call you my work friends But they know that that's important to us. They my husband gave grand rounds like ages ago when my daughter was a baby and so Grand rounds starts around the time that daycare open so we couldn't we couldn't drop them off to daycare so they came to grand rounds and I'm also lucky that you know, Kim and R is fairly laid-back I don't think he would I would not be in the reverse order if he if I brought the kids to internal medicine grand rounds No, but Kim and R allows for that. So this was Ruby's first grand rounds is on Grit and resilience and she's pointing at the short grit scale And then Benji was in the audience watching with me. The middle picture is one of the resident social hours So I took the kids to that to the social hour and they kind of awkwardly conversed with adults And then Benji went to want the the incoming med students first-year med students have a kind of like a camp during orientation week So Benji got to go to camp this Pseudocamp this week this past year and again meet the medical students that are so important in my husband's life So just do you know incorporate your kids or your family into your work life? They'll know why it's meaningful to you and why it's a little bit easier when you can't go to like your family or your kids school functions because they know that it's important to you and that you're not just ignoring them. They'll understand that it's important to see to see the patients that you see. They'll still give you guilt. So my my son is in first grade and he hates he hates his after-school care program now. So he actually told me, mommy can you see the sick patients earlier in the morning so that you can pick me up from school? And it was so terrible it broke my heart and part of me was like well yeah I consult these I can but then I thought no that's just stupid. I said no it's important for mommy to take care of these people and it's important for them to get better right? And he's like yeah but I just want to be at home with you. But that's okay because they'll learn and they'll understand it and I think I reflect back to my mom and who kind of was the main breadwinner of my family and she did not put a ton of she she's she was not passionate about her career but I did know it was important to her and important to work and I think that's what's ingrained into me now. So just make sure that you let your kids know what you're doing and that it's important. And then so these are just some again some resources in case you wanted to read about kind of work-life balance which is kind of what I was talking about having a leadership role and figuring out how to have a family. What else? Rules, academic medicine because I'm in academics but not everybody goes into academics. I acknowledge that. And then why I kind of like the why generation why yuppies are unhappy. This just kind of goes over expectations and reality mismatch and why you might not be super happy. It's just different. You go through med school and residency and you've never had this real job and you don't know what to expect. So just it's okay to change jobs. I did not change jobs when I first started but it's okay. There's just everyone does a different thing. Thank you. All right. Well thank you guys. So we'll go on to our last speaker. I didn't know how we're gonna fill an hour 15 minutes but it's like oh my gosh we have 11 minutes left. You guys have questions after we'll be up here. Please feel free to come up and ask questions. So last speaker is Dr. Cabrera. So we'd love to hear sort of his journey as he's been through different practices. So if we talked about imposter syndrome, if you did not wake up it with imposter syndrome, try following these people and then coming up and talking about your career. I will, for the sake of time, we'll go ahead and tell you what the lie is here. I did not complete a brain injury fellowship. I am board certified of brain injury medicine. However, that part of the talk that I'm going to talk that I'll be pointing up pointing out is that there's different ways to get to what it is that you're passionate and want to do. Pretty close. Pretty close. I actually almost put it in here but I don't think my wife likes it to be seen too often. So okay. So I'm at UT Southwestern by way of a lot of different places and I'm gonna take you on a picture journey of all of my different stops in my career and how I'm the black sheep of this group. Everyone else here started their career and still is there successfully. I joke that I have failed at multiple jobs but have failed upwards and feel like I've grown from every experience and that's what I hope to pass on. I have no disclosures. I am totally winging this talk. If you can ask Dr. Yang, I gave him this presentation Tuesday, I think. So I have no idea what I'm doing. I'm very blessed to have people, mentors, and people that helped me figure it out along the way. I did start off, I did medical school at the University of South Alabama College of Medicine in Mobile and was very happy to be there. It was a great opportunity. I was, I grew up in Birmingham, Alabama. I was born in Guatemala and I can talk about that if anyone's interested, well how I ended up in Birmingham. But finished here and like many of the people in the room, did not have a great exposure to PM&R. I just knew that I did not fit anywhere else in medicine. All my rotations didn't work out for me. So I needed to go somewhere and wanted to find a place where I could be exposed to the entire breadth of PM&R. And I also wanted to use Spanish. Having been born in Guatemala, I did not get a chance to do a lot of that in Mobile. And I knew that that that's something that would mean a lot to me and my parents. Again, a lot of us are talking about disappointing parents. Yes. So I thought I was leaving Mobile and I was going to bring PM&R back and I was going to change the landscape of Mobile, Alabama with rehab. So I went to the University or UT Health Science Center in San Antonio. Had a great experience there. Had a lot of wonderful mentors. Did get that exposure to the entire breadth and depth of PM&R, which was very important to me. I also knew that I fit very much into the PM&R world and this is where I needed to be. I also realized that it didn't have to be in San Antonio to speak Spanish and I would never lose it because it was a big part of who I was. And then I also learned very quickly I would not be returning to Mobile because I met this wonderful lady who is my wife, who is an orthopedic surgeon and is either the villain or the hero in this story. She's a lot of the reason why I've made a lot of these moves. Okay. So, you know, she's not here to defend herself. So she's an orthopedic surgeon. I'm two years ahead of her. So she had three years left of her training before we could leave San Antonio. So I took my first job at the VA Center. This is a picture of the VA Hospital and then the Polytrauma Center. I was very blessed to have had mentorship and the ability to help build that program. So the outpatient and inpatient program at the Polytrauma Rehab Center there. And then during my time there, the all the eyes that you saw in the first slide turned into wheeze. It was my wife and I. October of 2010, we had our first child. And all of a sudden we have to juggle that. The juggling gets a little bit more complicated when you have a baby in the picture. And then my wife finished her residency and wanted to do a fellowship in sports and shoulder. And all of a sudden the decision was out of my hand. I don't get to decide where I get to stay. I had a great job. I had great mentors. I liked what I did. But it wasn't possible for us to stay there. So I had to be flexible. And one of the things that allows me to do that is I took that breadth and depth of PM&R and kept it with me. It was important for me to be able to be whatever it is that I needed to be for my family so that we could move and go where she was. She had talked about San Francisco. We had talked about Florida. And you know we ended up in in Nashville, Tennessee. And I'll be the next slide. But one of the things that my mentor, Dr. Dimitri, who gets a very rough-and-gruff reputation, this is the last thing that he told me before I left San Antonio. He's like, never miss the chance to hold your child because in all the books and all the papers that I published, I probably did not hold them as much as I did. And that solidified for me that I had to be family first. You can't just say family first. You had to actually walk the walk. And that was something that I was gonna try to commit to for the rest of my career. So I went to Vanderbilt. And you can see in this picture, if you look, I'm hiding behind Dr. Yang. Again, falling behind a whole crew of really remarkable people. This is the picture of the gentleman that we admitted who was 627 pounds when he got admitted to the hospital at Vanderbilt. We admitted him to rehab. He was weighing 500, aggressively diuresed, and worked with him. He discharged at 350 pounds. And the last time I talked to him, he was at his goal weight of 200. So two physician careers are not easy. Show of hands in the room, who has a partner that's in the healthcare field? Yeah, it's not easy. And then contracts and fellowships, and if the timing isn't perfect, it is a challenge. Again, PM&R is that field that you can see everyone from pediatrics to geriatrics, from high-level athletes to very critically ill patients. You can do everything. And my ability and comfort level to do all those things allowed me to flex to be the father and the husband that I needed to be from my family. So one of the hardest things that I had to do in my career is walk into the office with Dr. Frontera, who was the chair just before Dr. Kennedy was, and say, look, I have this opportunity to be closer to my family. And he gave me his blessing by saying, you know what, every one of you, and he was telling me, we should re-evaluate our career, our goals, and where we are every three to five years. There's nothing wrong with having started down a path and saying, you know what, I need to course-correct a little bit, and that allowed me the ability to do that from my family. So I was recruited to this hospital to be the medical director of inpatient rehab. It was a community-based hospital. So I went from the VA to academics to now I'm in the community-based in a private model. I was hospital-employed for three years, and then after those three years they didn't want to pay for me anymore, so I ended up joining with US Physiatry and stayed on for another two years. I learned a ton while I was there. I learned that I have... he was my second child, now he's a middle child, but he's crazy, so I had to be more flexible than ever. Everything they say about middle children is 100% true. Leadership opportunities, research opportunities, these professional aspirations that sometimes are hard to grasp when you're early in your career or in training are out there if you're willing to do that. The saying yes is good. Having the mentorship and the background to say yes appropriately and succeed is just as important. I was the vice chair of clinical or the vice chief of staff for this hospital. I learned more doing that than I did as chief resident of all the other academic positions that I had. I learned a lot about dealing with people and taking care of patients and juggling my life. I also... those opportunities again, I got to be a wound care specialist there because they needed somebody and, hey, PM&R does wound care, so I was a medical director for that clinic. I dabbled in a lot while I was there because the community in Clarksville, Tennessee needed it, and I was comfortable enough to do it and had the training. So my satisfaction in my career was less about what title I had, but how was I able to take care of the people that I cared about, family and patients. So after a while, we realized that Clarksville was not where we wanted to finish our careers, so I cold-called Kathy Bell and came to UT Southwestern. I started my career in the bottom left corner at Frisco as an outpatient. Now I'm the medical director of the inpatient unit at Texas Health Presby. I tried to get away from inpatient, but I kept coming back. And since then, we've introduced our third child. I have a Diego, a Gabriel, and a Mateo, and in March of next year, we're going to finally have our little girl. So I would put a poll up there of, I need girl names, desperately, so come find me and give me some girl name ideas. That PM&R has allowed me to be the person that I needed to be for my family and my career. So those of you that want to go into fellowships, they're fantastic. I highly recommend fellowships for people who are passionate. Don't lose that beauty that PM&R has. There aren't many specialties that allow you to have that breadth and depth of exposure to patients, and if you can keep that, you can transition through jobs into different jobs and still have an impact, not just on your patients, but also your family. So these are these crazy ones right now. This was just last weekend, so they grow up fast. They really do. We need a girl. There's a lot of boy here. So thank you very much, and we have about a minute for any questions. I was gonna say, if you sent the slides earlier, I would have added that. Procrastinator. I had some pre-set questions up there that we were gonna ask, but obviously we only have a minute left, and I think we just, it was just great for me to just sit here and listen to all you guys, but I think it's better served, you know, if you guys have any questions, we'll be up here. Feel free to come up and ask any questions, but anyone want to be brave and just take the microphone for one question with the 30 seconds and left counting? Or girl names. Or girl names. Awesome, guys. Well, thank you so much for your time and attention and coming again.

knee osteoarthritis research

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