Hello, everyone. Welcome to tonight's community session. I'm so glad you are all here with us. Before we get started, I want to review a few housekeeping notes. As a reminder, this session is being recorded and will be available along with the ability to claim your CME through the Academy's online learning portal. For the best attendee experience, please mute your microphone when you're not speaking. You are invited and encouraged to keep your camera on and to select and hide non-video participants. This will ensure that speakers are prominent on screen. To ask a question, please use the raise your hand feature and unmute yourself if you are called upon. Alternately, you can use the chat feature to type your question. Please note that time may not permit the panel to field every question, but we will do our best. Just a quick note about the Zoom platform, the microphone and video controls are located in the bottom left of your taskbar and controlled by the caret to the right of the icon. Red lines through the icons indicate those functions are off. Click them to turn them back on. Participants and the chat function are found in the middle of the bottom taskbar. You can bring those both up by clicking on each of those icons. The raise your hand function is located in the reaction setting on the right of the bottom taskbar. And to hide the non-video participants, you click on the three dots at the top and then click on hide non-video participants. Thank you all again, and I'm going to turn this over to our community directors. So welcome, everyone, to our early career physiatrist member community session. We're looking forward to a panel discussion today. And as they mentioned, we do want to make sure this is interactive. So if you have questions along the way, please feel free to raise your hand or enter questions in the chat box. So today's topic is what should I be asking that I'm not asking? Navigating new careers, career changes and career advancement for early career physiatrists. And I'm one of the session co-directors, along with Dr. Janessa Chang. My name's Elizabeth Martin. I am currently in an academic position at Vanderbilt. I am an assistant professor in the Department of Physical Medicine and Rehabilitation. And this is my second job out of training. I did my residency at NPMNR at Stanford and then did a pediatric rehabilitation medicine fellowship at Seattle Children's, which I finished in 2018. And I'm currently serving as the medical director of pediatric rehabilitation. So I just see kids. And part of my current job is building a new program at Vanderbilt. So I'll turn this over to Janessa to introduce herself. Hi, I'm Janessa Chang. I'm a community general physiatrist working in a private hospital based setting doing about 60 percent inpatient neuro rehabilitation, about 40 percent outpatient practice. With a particular focus on adult CPP patients and spasticity management currently. I'm about three years out from training. I went to the University of Pennsylvania for my residency. And I'm practicing in Washington state because this is my home state. So we have we're lucky enough to have a wonderful set of panelists today representing a variety of different areas and specialties. So I'm going to go through and just in alphabetical order, let each of you introduce yourselves. We're going by first name. Okay. Anne Hume, that's me on the left side of the screen. I'm assistant clinical professor at Indiana University, the School of Medicine and duly employed with our physician group based in Indianapolis. I am two years out of training. I actually was classmates with Janessa U Penn for residency and then completed a sports medicine fellowship at Loyola and took my first job with IU. I have primarily a sports medicine focus and see really all musculoskeletal conditions, but have I'm working to develop a performing arts medicine program and also grow our our female athlete program at IU. Hello, everyone. My name is CJ Plummer. I go by CJ. My first name is Clossill, but I go by CJ. I am at Vanderbilt Medical Center currently and serve there as an assistant professor. I'm our brain injury medical director there have also and I work. I work with Dr. Martin and Dr. Morgan, who are both part of this panel. So very excited to see them. I spend most of my time inpatient, but also have some outpatient clinics that help out with so very excited to be here. And I've been at Vanderbilt for three years and came here directly out of brain injury fellowship at University of Washington in Seattle. Hi, everyone. I'm Erica. I practice general neuro rehab and spinal cord injury medicine. I did my residency and my spinal cord injury fellowship at UW in Seattle. So I'm currently working for a rural health care system, a nonprofit as a hospital based employee in rural north central Washington. I'm a point seven five FTE employee. I do probably about 50 percent inpatient, 50 percent outpatient. And then prior to that, I was with a very similar health system, which is a more kind of suburban area, which is currently where it works for five years prior to that. All right. My name is Woody Morgan and I'm a professor at Vanderbilt as well. I'm spinal cord injury fellowship trained, studied my residency at Harvard Spalding and then spinal cord injury medicine fellowship at Craig in Denver. So I've been at Vanderbilt for a little over two years and I'm predominantly inpatient or the inpatient spinal cord injury service and recently been medical director of the spinal cord injury program. I also mix in some acute care consults every now and then to. Hi everyone, I'm Mary Dubon, I'm a pediatric rehab medicine and pediatric sports medicine physician at Spalding and Boston Children's Hospital. I did my residency at it was RIC at the time, but now it's really Ryan Ability Lab. And then I did my Peds Rehab Fellowship at University of Washington Seattle Children's Hospital, where the esteemed Dr. Martin was my co-fellow for one of the years that I was there. And then I came back to Chicago, did a fellowship in pediatric sports medicine through Northwestern Children's Hospital, which is Larry Children's Hospital, and then took my job outside of the two fellowships. That's the same job that I have right now, which is at Boston at Spalding and Boston Children's. I split my time between my two sub specialties. And then I do also have some protected research time, some grant funding, and a lot of my academic work is in that overlap between those two areas. So pediatric adoptive sports medicine, which I'm building a program for here as well. And I am the assistant fellowship director for pediatric rehab. Hi, everyone, I'm Stephanie Tao. I am currently in my third year out of training. So like Mary, I also did a pediatric rehab and sports medicine fellowship. So I did my residency at UT Southwestern in Dallas, did my pediatric rehab fellowship in University of Colorado and Children's Hospital, Colorado. And then afterwards did a pediatric sports medicine fellowship at Children's Mercy in Kansas City. I'm currently in transition after my first job. And so my first job, I went back to UT Southwestern and I worked at Children's Health and Scottish Rite for Children during a mix of pediatric rehab, pediatric sports medicine and being the director of their adaptive sports program there. And also do some side work as the head team physician for U.S. Paralympic swimming. For personal reasons, we decided to leave Dallas, and so we just moved back to Denver. I'm currently in transition and transitioned into a role that is nontraditional. So I am working in utilization management for a company that contracts with a bunch of insurance companies. And a lot of the cases that I end up reviewing are pediatric rehab cases. So I think I'm probably, if anyone has any questions about alternative medicine stuff tonight, I could probably answer some of that. Thank you all. We're really excited to have you all here. And we have a really wide range of expertise, which is wonderful. We have a series of questions that we're going to go through the panelists and try to get everyone's opinion on and thoughts on. But again, we want to make sure that we're answering the audience's questions as well. So if you do have questions about anything that comes up for specific people or for the panelists in general, again, feel free to use the raise your hand function, put it in the chat box. Dr. Chang is going to help me keep track of the chat box as well. And then for the panelists, again, we're kind of going alphabetical here. But if you have something you really want to add, please feel free to jump in. But we're just going to kind of go through these questions, these general topics, and then get your insight into them. So we will go ahead. So our oh, and remember, remember alphabetical order. So remember who you came after. So for our first question, what was the deciding factor for you when you accepted your very first position out of training? And then in follow up to that, do you have any tips from your experience negotiating that position and looking back, would you do anything differently and why? OK. A lot of questions in the first one, but a few things that factored into my decision is where I initially thought I wanted to do more private practice. I have kind of a mindset of like, let's just get stuff done. But also decided that I really enjoyed teaching and some research, not much, but a little bit here and there, as well as clinical practice and kind of opportunity to advance within a health care system, which pointed me more towards academics. And geographically, I was open to really going anywhere, except maybe the East Coast, just because I'd been there and done that. And so mostly academics that I looked at, as well as one reason why I picked my current job over another pretty good offer was compensation. We were I was applying in the middle of well, I guess in 2019 to 2020 and then negotiating contracts in spring of 2020 where health systems were losing billions of dollars. Turns out they ended up doing OK during that time, but the chairs of various departments were pretty candid about how much money they were losing at some of the places I was talking to. So there were a few offers that were like way too low than what I was willing to accept. And I guess I in wrapping into that financial stuff, I kind of wish that I had a little bit or I felt like I had more leverage going into negotiations, because I felt limited in the fact that I knew where the world was and where health care was, even as much as any of us did at that point in time. But maybe I could have been more aggressive anyways. Can I ask you a follow up question to that? You mentioned that some of the salaries you're being offered were way too low. Did you have some ideas about what you were looking for? Did you have any like references or things that you were using when you were negotiating that? Yes. Some of it was word of mouth of what other people were getting paid in their first jobs. Like I wasn't willing to accept anything less than two hundred thousand dollars, which I know some academic institutions that was not their starting point. I used a couple different things. One, the Women's Physiatry Group has some information in it, but also a PM&R's survey. And I tried Googling like MGMA data. I think somewhere there's a 2018 version that's floated around. Yeah. And some of it was just knowing that physicians were typically underpaid and forced to work more hours. So, knowing that I wanted to get paid more because I spent too much time investing in myself. That's really helpful. I've seen a lot of conversations between people trying to get some ideas of what metrics are as they're going through this process. Turn it over to Dr. Plummer. Absolutely. So, you know, there were a lot of factors that went into my decision for right out of training. You know, one of them was geographical location. You know, I spent the year in in Seattle. And before that, I was in Texas and most of my family's on the south, sort of southeast region. And I had young children. I have a six year old and a three year old. And at the time, they were three and one. So we wanted to be closer to family. And that was a big part of it. But it wasn't the only thing. You know, I definitely knew I wanted to do academics, wanted to work with medical students and residents. And so that was a huge part of it as well. And then I would say one of the bigger factors was just the leadership that I'd be working with and kind of under. I, you know, kind of had opportunity to talk to a variety of places. And I really, really identified with the vision of the department in terms of the growth and the direction of that growth when I interviewed at Vanderbilt. And so really, really bought in quite a bit to kind of what they were discussing with me. And that ended up being a huge, huge part of it for me. And then follow up question, tips on your experience negotiating first position. I'd say ask a lot of questions. And that's kind of for folks that maybe you consider mentors, for people networking laterally and asking others. I think that was mentioned as well previously. And getting a sense of ballpark of where other people are sort of landing. And of course, there'll be some variations and there'll be differences in the way compensation happens and how it's structured and modeled. And I certainly saw that during my interviews. But that was really, those would probably be the biggest things I'd say. And then don't be afraid or shy to mention all of the other places that you're interviewing at. And that actually ended up being helpful in my particular case. Just so it helps kind of show value. I mean, in terms of, it's always nicer when you are sought after by kind of more than one place. And so it gives you a bit of leverage as you are having those conversations. OK, so for me, one of the big factors was, like a lot of people, was location. We wanted to stay in the Northwest. Where we had been living, where my husband had a job. We liked the outdoors. Doing spinal cord injury medicine, I really wanted to make sure that I use that as part of my first job and had a fair amount of inpatient practice. I wasn't particularly interested in research. But I really, really liked teaching. So I had a hard time deciding between academics and non-academics. And honestly, when it came down to it, a big factor of it was compensation. And the cost of living in the Seattle, Washington area. And what was going to be kind of doable with the life we wanted to have. And luckily, for both of my jobs, even though they're considered non-academic positions, there are students that rotate through. And so if you are kind of worried about that, there are other ways to do teaching. And officially, whether it's with rotating students or even with staff education, particularly on like rehab units and things like that. I also, if you're doing inpatient, one important thing to look at is what the call schedule is, what the weekend coverage is, what your hospitalist coverage is, because that's really important, especially work-life balance is really important to me. What I would do differently. Sorry if you can hear a toddler outside my door. I think enough people have kind of talked about the compensation piece. But again, I think if you're doing inpatient, it's good to know how those responsibilities of shared coverage might change if other providers in your group leave and you're down people. And knowing when would you hire a locums, when wouldn't you hire locums. If you're in a non-academic institution, wanting to know, does the hospital have a vision for keeping a rehab unit around? We obviously know that rehab units, especially in community centers, are not permanent these days. And so you want to make sure that that's part of the hospital's long-term vision. Thank you. That's really helpful. May I ask a follow-up question? Of course. So since I know your training program, one of the things I was wondering, do you feel like when you went into that decision of choosing between academic and non-academic, had you had enough exposure during training? Did you feel comfortable weighing those options? I had almost no exposure with non-academics going into it. And it did make it hard. I think there was also a lot of guilt, particularly, at least in my case, coming from University of Washington and choosing a non-academic job, especially after doing a fellowship or a non-VA job. So I definitely kind of went into it blindly. But I'm really happy with the decisions that I've made since then. I think that's something that's really common across us coming out of training programs where we're training usually at academic centers. And so I think it's very helpful. I'll turn it over to Dr. Martin. I think I echo probably a lot of what other people said. For me, it's always the three things. It's kind of the people, the opportunity, and the location. For me, the first job out of fellowship, I wanted to be somewhere where I wasn't necessarily the only spinal cord injury provider. I wanted some sort of mentorship there. So that was something I was looking at, who you're going to work with. I had some connections and knew one of the other docs personally and the other one professionally. So I knew there were some built-in connections and level of comfort already. So that was nice. And then knew that there would be some sort of professional mentorship there as well. But then just the rest of the people in the group, who you're going to be interacting with every day. It's nice if you get along with the chair, but are you going to be spending time with him in and out every day? Or are you meeting the people on your interviews you're going to be sharing office space with? I think that's important. Do you fit in? Do you feel comfortable talking with him? Is a big thing. And then opportunity, just kind of what you're going to decide kind of what you want to do. Is it outpatient, inpatient? Is it a mix of both? Is it all consults? And then what that job looks like. I want to do mainly inpatient spinal cord injury medicine. And they were able to make that work here. And so I provided you all inpatient with some consults mixed in. And then geography and location, getting back to the South, Southeast was on the top of my radar. Just kind of getting back to closer to friends and family, and get away from the snow a little bit. Tips for negotiating. I think it's an awkward conversation to talk about money, especially first job out. I think a tip would be just to ask. I mean, if the number they're offering is not kind of near the number that is acceptable to you, I think it's always fine to ask if there's any wiggle room, or if you can add something to a signing bonus, or if there's any wiggle room to go up with that. I think it's just a conversation and a question you've got to ask. They can come back and say, no, this is what we offer to people right out of training, or what we offer to new hires, or anything. But I think it's worth the conversation and worth asking. And I don't know how you find the average. I think it's just word of mouth and kind of average starting salaries, or what other people got when they started. I think that's worth kind of asking around for other co-residents, or other faculty at your institution. Things like that might be helpful just to get a ballpark number. And that's actually something that I think has come up in a number of different forums, too, is trying to figure out what to ask for if you haven't had that experience before. Because there is such a wide range, depending on your practice location, region of the country, what you're going to be including in your practice, what your expectations are going to be with its RVU, or salary, and things like that. So if anyone, I know that there's a variety of resources through AP Menorah and through some other groups. You mentioned the MGMA. So if anyone has any of those links or things and wants to add them in the chat box, that could potentially be helpful for people as well. And I'll turn it over to Dr. Dubon. So I agree. I would echo what a lot of people were saying in terms of deciding factor. I was lucky in that. So I was looking for a job in 2018. So it was before all the craziness of COVID had hit. So I feel for the people who had to go through that during that really rough time, because I'm sure it was a different ballpark and seems like it's maybe getting back a little bit to normal now. But being PEDS rehab trained, there's pros and cons of that. From a salary standpoint, it's usually a con. But a pro is certainly that there's a shortage of us. So in terms of looking for jobs, it was fairly the places that I was interested in, I reached out, and I was able to get job offers. So I think like geographical location, I only reached out to and applied to places that I would be interested in staying at. So I think that was like even before I was making that final decision. So for me, the final decision came down, honestly, a large part in what the job was actually entailing. I am the second person who trained in the two areas that I trained. And Aaron Carlin had done the PEDS rehab and PEDS sports medicine 15 years before me. So I was like not really. I mean, I spoke with him. And of course, when I spoke with him, he was like, I'm the only one that understands you. You want a job with me. But because of that, I had honestly no idea if that was going to be looked upon favorably or not in the job market, because it's not like there was going to be anybody that was going to have posted, hey, I want someone that did these specific two fellowships and is going to split between these two jobs. So I felt like I was going in a little blind to the process, not knowing if it was going to be looked upon favorably or not. And fortunately, it was. But I think I really, similar to what Erica said, I did these two trainings. I wanted to make sure I was going to get a job where I was going to be using both of them. And so that piece was important to me. And then the other piece is on the PEDS rehab hat, inpatient is my love. And so I wanted to make sure that it was going to be a job that was more focused on that and less focused on outpatient spasticity procedures, which is a large portion of the PEDS rehab jobs that are out there. So for me, ultimately, it did come down to making sure it was a place and a job description that fit within what I was looking for. And then that narrowed it down to half of the offers. And then from there, so two out of four of the offers. And then from there, it did come down to the feel, which was a tough call between the two. But ultimately, I did train with a number of people who are here, even though I didn't train in Boston. I have actually two of my co-residents who were really good friends of mine are also attendings here and have cousins and family that's in the area. And then my family is three hours away. So I think all those factors were the things that I looked at. And then looking back, I know this is going to be something that everyone's heard before, but get things in writing. And I knew that going in. But when people are negotiating with you, sometimes it's harder than you think to get things in writing because they're going to just be like, no, yeah, that's a given. That's fine. But what I've recognized is that people forget conversations or whatnot. And so making sure that you actually got what was agreed upon in writing. And for me, negotiation took a long time because, again, I had a very specific vision. And as a new person, that can be really awkward because it's like, am I being too picky? Am I supposed to be asking? No. I would say if I were to look back, get everything in writing. One thing that's been interesting for me too is I'm in two different places. I'm at two different hospital systems. And so making sure, if you're in a situation like that, it's very complicated, making sure that all sides are agreeing on what you're looking for, what you're talking about. And one of those sides, the leadership changed since I've been here. And I've seen like, man, I really wish some of the things that I had discussed were in writing to make that transition a little bit smoother. I think that's a really important point that you make too that I've heard from others too is leadership can change. The people you were negotiating with may not be the people that you're working for, especially if you stay somewhere for a long time. And it is a way to protect yourself. So that's really helpful. Thank you. Dr. Tao. Yeah, absolutely. I agree. And I've seen leadership change quite a bit. And as we know, it's the great resignation right now too. I guess I'm an example of that. And so for me, similar to what others have said on this call, I wanted to make sure that my training that I specifically spent years on was going to be of value and used at my first job. So I think like Mary was saying, no one's really going to advertise a Peds Rehab and Peds SportsMed fellowship-trained job opening. If you see any job openings like that, it probably is because they already have someone in mind and they created that position for that person. And so I think for me, I reached out to Mary, Dr. Jubon, when I was looking for jobs, trying to get her mentorship. I reached out to a bunch of other mentors. I talked with my attendings at my fellowship program. And fortunately, because I knew I had to find a place that was going to create a job for me, I was able to get job interviews right before the pandemic and then was starting to negotiate right at the beginning of the pandemic. So I think there wasn't as much uncertainty at that point because people still thought that the pandemic wouldn't be that bad. For me, it was deciding, OK, which programs would have the ability to be able to let me practice both Peds Rehab and Peds Sports and also build an adaptive sports program and really support what I wanted. And so I think, like Dr. Morgan was saying, mentorship was really important to me. And knowing that I had strong advocates for me in the departments, of course, compensation was a factor. But I would say that your base salary is not the only thing. So my fellowship director had recommended, since I was going to be the director of the adaptive sports program, he said, hey, sometimes programs give you extra stipends for being a director. And so I asked for it, and my chair gave it to me. And she also gave me an extra half day of admin time. So I think time is also an important factor, which also includes your call schedule. I was able to negotiate no call at my first job because I was also doing sports medicine coverage. And so it just depends on who you're talking to and what their needs are in their practice. I also was able to negotiate some research funding. And so that was helpful. I think what I didn't realize was our residents were not allowed to rotate with me at Scottish Rite, and that's because that's a funding issue. And so I think asking some of those questions on what your practice setting is going to look like. I think multiple people on the call have already said clinical site, asking where are your clinical sites. I tried to get that in writing in my contract, but sometimes you can't get everything in writing because you have to have a little bit of flexibility and understanding that practices can evolve sometimes, too. But I think I had some things in writing that were like the intention is to not have me doing XYZ things. And so tips for negotiation, other things that people haven't said, I think having your mentors look at things. I asked my mentors since I was in academia if I should hire a lawyer because I think that's a common question that people often ask. My mentors had told me for academics, most institutions are pretty straightforward with their contracts. So instead of hiring a lawyer, I just had a bunch of different mentors look at my contracts and give me different perspectives. I was able to negotiate education funds and extra stipend, less clinical time and more admin time for my administrative duties, call support. As a team physician, I also wanted to make sure that the institution be able to support me in providing malpractice and support my time doing that. That was a little tricky at my last institution because I was the first one in the department, apparently, to have done that. Whereas now talking to other places, they're more familiar with that. And so I think that's important to bring up as well. All right, so moving on to our second question. So what features of your position and or your overall career have led to the greatest job satisfaction for you I know some of you already kind of mentioned that in the first question. And also, what are some aspects of your current job that's keeping you there. So, I want to real quick, actually ties into this. So one thing that I found and I heard a lot of people on the panel, kind of understand what they wanted. And that is really helpful going into looking for jobs as well as negotiating, because if you don't know what you want. It's really hard to figure out what the best fit for a job is. And I'm. I tell a lot of my adolescent patients frequently, and I asked them hey what do you want to be when you grow up. They say I don't know or maybe they have something in mind you know that's cool I don't know what I want to be there. So, I think it can continue to change and evolve. Seeing that from, you know, mentors and other attendings but really trying to figure out what you want. Now as well as in the near future can be really helpful. And some of that is identifying what in your day to day job and life really does provide satisfaction. I've been asking this question a lot of myself. So, a few things some of it I mentioned earlier is like growing, some of these programs and getting to connect with maybe athletes in different areas then we think of as typical athletes. You know I'm working I, we have a contract with Butler University dance medicine or dance program, which is apparently one of the top five in the country, no idea until I started working with them. And they're fantastic. And that's like something that keeps me here, you know, working with them I seen many of them in clinic. In the last few weeks, but they're there's something that keeps me at this job and and seeing how the our role is a team as a medical team sports can can really impact their lives in a positive way, as well as how can we apply it more into the community and globally is kind of fun. So program development. That's something that's keeping me here. Yeah, I would say I piggyback on some of that for sure, you know the growth and the ability to see that growth. You know with being in the position I'm in right now for three years and you know there's a lot, which that goes into a newer sort of department and building and growing a new program and so I think it's, it's nice to start seeing some of the, the, some of that payoff as you're seeing growth and adding faculty and seeing the development of the team that you're working with individuals on that team that's probably one of the biggest things I've really been kind of thinking about recently and and have really been enjoying. And then, you know, that that goes into some of their retention as well just really wanting to, you know, really working with a great group of colleagues. And that's kind of, you know, in a variety of different domains so you know obviously faculty, but then also, but then also, you know, some of the therapy teams, you know with the with what we're trying to grow on the inpatient side of things as well, and outpatient so just just all of those things that really led to a lot of satisfaction for me. I've also enjoyed seeing the progression of resident of our residents you know with being here for three years now you, you really get a chance to think last year we graduated the class that I started with and so seeing their full sort of my first cycle of any kind of their full cycle through his was was really a lot of fun so that's what I'd say. Okay, so I think for me one of the really important things is to be surrounded by colleagues and have folks around you that really have like that common vision and common goal for for what you want your, your career and in your department to look like. I recently you know had had a job switch to kind of cut back on FDA, mostly related to having a kid but it was really important to me to know what my job duties were and it was really important that when I went to work in the morning. That was when I started my day and when I left, and I was done seeing patients, I was done for the day and then I wasn't bringing work home with me and that I had a less on call and weekend responsibilities. I thought that I was interested in kind of kind of moving up the proverbial food chain if you want you know wanting to do kind of academics and being professors and then I kind of realized that was actually a lot less important to me and what mattered more to me, similarly to kind of what and said is kind of program. And then staff development and QA projects I've been able to get a lot of fulfillment out of that and just kind of a little bit unrelated question but I think it's important to say is that when you're looking at like kind of what you want in your job also think about And how, like, where are those priorities and how are they going to fit in your career like his family a big priority is your you know hobbies a big priority do not want to sit in traffic for an hour and a half, you know, every day, because everything that you. I've seen this like online before everything you say yes to you have to say no to something else and whether that's within, you know, you're outside of work life or you're in work life so I'm paying more attention to that has definitely helped me have a good job satisfaction. Thanks for saying that Erica. I think some of the things keep me at the current position is it's the same things that drew me in where some of the people and colleagues, I mean not just immediate colleagues that were inpatient but everyone in the department from outpatient. There's a just a very collaborative Nature here and then also I think asking about how your department interacts with other departments and Other sub specialties that are going to kind of be part of the continuum of care for your patients and I found Fortunately here it was very easy very collaborative and I have the surgeons spine surgeons numbers I've done social things with them so it's it's So it makes it super easy to get in touch with them or text anybody. If there's any any Issue that pops up. So I found that that's been that's been great. Not something I even really thought of. I mean, I know, going into it, you kind of ask like, you know, what are the ancillary services available at the rehab hospital, but also I think, you know, asking maybe You know how to interact with the spine surgeons or neurosurgeons or pediatricians or neurologist or whoever you kind of interact with regularly as part of your job might be another good question to ask. Yeah, so, um, I think When I think about like the best job satisfaction. I mean, it all comes down to like doing what I feel like I was meant to do and why I went through all the training to do Like today I got to sign a letter that will hopefully get a kid who has been with the most amazing foster parents for the past several years finally get the adoption that, you know, and like I get emotional thinking about that. And like, I'm getting to work with A kid and a family who's awesome. And like, that's because I'm at a big academic center where I'm taking care of a lot of complexity and the patient population that I'm really passionate about taking care of. So I think for me, it's like those clinical moments. You know, and then also like from a research standpoint, like I see research is kind of, for me, the reason I'm interested in it is because I realized that like The reason I did two fellowships was because people in Peds Rehab seems to not really know that much about like if a kid was like I have shoulder pain like they'd be like, okay, and keep on going because that wasn't necessarily their area and I felt like in sports medicine clinic if They're in pediatrics medicine clinic kid with a disability came in. That just never happens. Like anytime I rotated through some like there's this whole group of kids that nobody's knowing what to do with And I have access to that. And I think that I'm kind of like doing the roles that I was intended to do. So with research. You know, I'm working with Sherry Blalat who if anyone knows like adaptive sports medicine is, you know, she's a huge like, you know, leader in that area. And the two of us just put a grant application in on Monday. That was like my dream grant that I've been dreaming up for years and so like That was all with that same intent in mind of like leaving something behind after, you know, my time in my career and my time here has passed like still being able to say like yeah now life is better for these kids because of it. And so I think like I needed to be at a place that had enough resources enough infrastructure and mentorship support to be able to help me meet those goals. I would echo. I mean, I'm the last one. So I echo everyone and everything that everyone has said so far. For me, I'm a people person. And so if I'm working with people and I don't feel supported at work or I just feel like, you know, someone's kind of not on my team sometimes or we're not on the same team or we're just not get like it's miserable for me. And so for me, My greatest job satisfaction is getting to interact with people who I feel like we're all cohesive and collaborative. And, you know, I think that was a little bit of a, you know, that I left my last job for multiple reasons, but I think one of the issues was that there were so many departments siloed at my last institution. It was really hard to feel that collaboration. I think Another Thought is that Look at your department leadership and I know you know we talked about sometimes department leadership can change, but At least the known leadership looking at what are they supporting in terms of activities for their faculty. If you're in an academic center or if you're in private practice like what is your leader supporting your Your physicians to do the partners, because I think sometimes you can see in some departments. There's like clear favoritism and that Person's like, yeah, we're going to support this person and doing all the things. And it's like, well, what about all these other people who have great opportunities and potential to So I kind of looked at that for mentorship and I saw that that was my last institution. Our last year did a phenomenal job at that. I just providing people Not just mentoring, but sponsoring them for different opportunities. And then also looking at how is your institution supporting what physicians do right like we all went into Medicine, probably not just scribe all day, probably not just in front of the computer all day, but to interact with patients and and do the things we love and so I know like when I left Scottish right they were just starting to look into opportunities to provide like use AI as an app to write our notes. Which is amazing because notes take up so much time and I hate writing notes. And so, you know, at maybe asking about that when you're looking at jobs to because that can help with your job satisfaction. Thank you. That's really, that's really helpful. And I'm definitely hearing a common theme where we're all spending a lot of time with the other people at our workplace. And so having people that you work well with having people that inspire you having things that make your day to day. A little bit more positive definitely makes a huge difference in your job satisfaction. So some of these we sort of covered. So I want to skip ahead just a little bit in the interest of time as well because I think this is another important question. So it may not be pertinent to everybody, but for those who have made a career change or career shift or just diversify their skill set after training. What advice can you offer for those who are taking the first steps in this process. And are there any pitfalls to avoid. So I haven't transitioned. But, um, one thing that I, I don't, this is not going to answer this question. But in negotiating when thinking about your career, it's really important to not only ask like, or get along with your staff but understand who's with you at each clinical stage. And what their roles are, who's going to be screening your inbox if anyone who answers those when you're away who like scans in your papers and helps fills out disability paperwork if anyone does. Because all of those logistical things take up time and if it's three different clinic sites and three different groups of people and no one helps each other and no one knows what the hell's going on like it gets really frustrating and adds to the time that you're supposed to be signing notes while taking care of patients and answering phone calls. So, know what the numbers of staff are and that their roles are specifically laid out. Which now someone can talk about their transition. I also have not transitioned but I was just going to say one thing on the question. I do frequently circle back on what I'm spending my time on, and whether or not that is something that I should continue spending my time on. I can touch base on at least diversifying some skill sets after training. I had an interest in teaching and education and so I've been involved in some, I guess, inter-faculty teaching seminars through Vanderbilt, and one of the things I learned from one of the mentors is like, you know, kind of what CJ was saying, just discussing, you know, reassessing what you're, what you're going to be doing. When people are going to be asking you to do a lot of things to kind of make that decision of, you know, is it going to help you? Is it going to help you financially? Or is it going to help you academically, like advancing your career? Or is it going to just fill you up from a well-being satisfaction standpoint? I think those are the three points that one of the mentors brought up. I think that was a really good point and kind of three things to assess saying yes or no to these things and always re-evaluating that. So I've been able to at least expand some skill sets in teaching and get involved in that and shortly going to be doing some more kind of workers' comp training and assessment and almost being like a workers' compensation consultant for some of the other positions. So I think that could also, you know, so I think there's some things you just got to look at, you know, is it going to add more time? Is it just be more workers? Is there going to be some skill set that you can add to your resume and or to help support you and possibly jobs down the road? So I also didn't switch jobs, but I guess I can speak to the diversity of skill set too. So I always knew I was interested in academics and I think it was always hard for me to kind of balance like two different clinical subspecialties. Plus like I like research, I like teaching and I kind of wanted my job to be not, I definitely wanted a decent portion of my time to be non-clinical working on some of those academic things. I'll be honest, that was a really hard thing to negotiate at a lot of the places that I was negotiating with. And I think, you know, I don't have a PhD after my name. I do have a research background, but, you know, it was just hard when you're asking already for two different subspecialties and then, you know, you're not looking for a K award, quite frankly. And I didn't, I knew the K award process wasn't going to be the right one for me because that's 75% research. And so 25% clinical was at 12.5% in each of my two subspecialties. I thought that was going to be a really difficult thing to do. So for me, I think the big change that I've been doing is trying to get myself more well-known as a researcher to help buy myself out some more and more time for that. And so that was, again, like the huge grant that I just put in. I've gotten two smaller grants now, which again, it's just like all of it is just like stepping stones to the next process. And so, you know, I've been trying to make sure like my research and everything is getting published and presented at meetings to try to make that change. Because I think that it is hard as a clinician to be recognized as someone that's doing more research if you don't have an NIH grant or otherwise. And so for me, it's been still in process of working on that, but, you know, reaching out to the grants office and letting like meeting with them, letting them know my interests. And I had this great discussion with somebody and then she announced her retirement three months later and she was the person that was helping me out with finding grants and such. And so, you know, things transition and, you know, pandemic happened and all that. So I think, you know, keeping persistent with it and keeping yourself out there and letting people know that you're serious about the transitions. I also took the most life-changing, fantastic course. And I will say it was for women physicians and there may be similar courses for, you know, other groups, including obviously men and like other groups that have, you know, had some, you know, like issues to what women physicians deal with in terms of implicit bias and otherwise. But I can put the information in the chat for any women physicians that are interested in it. It was the Brave Enough group, which is a female anesthesiologist who basically had a life-changing situation happen in medicine where she almost dropped out. And she, that was kind of the aha moment that turned her to this idea of trying to help people go through difficult career like processes. And I think that going through that course, it was 12 weeks and every week we had a half an hour lecture and then had a debrief about it. It went through all these processes of like, why are you doing, why are you saying yes to the things you're saying yes to? What is your motivation? What is it that you really want out of your career? And that really helped me say no to the things that I needed to say no to. So I can't reiterate that enough. And like, I know there are mentors out there that say, say yes to everything. But I think that's a recipe for burnout, quite frankly. And I think that I tell my mentees, even to me, don't say yes on the first time someone asks you something, tell them thanks so much for that. Let me think on it and at least give yourself a night to think on it before you take something on. So I did make a big career change, although I'm still probably going back to clinical and academic medicine. It's just not quite yet, maybe in the next year. But there were multiple factors that I had to consider. And I want to acknowledge it can be really scary, right? Like there's a lot of anxiety around depending on what type of career change you're considering. For me, I was, you know, I don't know if I was burnt out, but I was nearing burnout, at least at my last institution, because of a lot of different factors and just the setup of how things were. And I found out that some of my other colleagues were also feeling the same way. And they had recommended, I found out that some of them had been seeing this amazing psychologist in the area who also used to be at my last institution, left academic medicine, went into private practice, and she was super helpful. And I think just sorting out all of my emotions and my thoughts, because I just, it was like all sitting in my head and all tangled up. And I was like, I don't know what to do, right? But I know that like, I'm having conversations with my friends, I'm like, if I died tomorrow, would I enjoy what I did in my life? Right? And so I think that was a big step for me to, one, you know, I think, sort out all those thoughts, work with my psychologist. I started over, I think, a little over a year ago, I joined, I started learning more about other resources. I know some other attendings and mentors who had done some side gigs in non-clinical care, like expert witness testimony. And so I started reaching out to some friends who were doing some non-clinical, and I say non-clinical, but you're still using your clinical skills just in a very different way. But some other jobs. And I think the tricky thing being an early career physician is that we're just leaving training, right? And like, if you're like me and Mary, who did like three years of fellowship, we're like really behind financially compared to our friends and family. And so that can be stressful. But I started joining some of the, like, if you're on Facebook, there's some really great groups. Remote Careers for Physicians is one. Physician Side Gigs is another one. I started learning from what other people were posting on there, talking about, you know, it's about doing what you love, but having the financial independence to do that, right? And sometimes early career physicians don't have that luxury. And so for me, it's like, my thought is if I go back to clinical medicine, you know, maybe I keep my utilization management job as a side gig, and that way I can always, you know, transition at different ways if I need to. So just be able to say, hey, I want to do the X amount, X percent of clinical time. And if that institution is not able to financially support me, I have some other ways to support myself that I still find gratifying. Another, if you are interested in any what we call non-clinical or, you know, alternative medicine careers, because I know I've heard more people become interested in some of these things. And I know I recently posted a job posting for our company on social media, and I got a lot of interest. And I know when I left my last institution, two people were asking me, how did you get into that? And they were really curious about it, too. Another book I would recommend is called 50 Non-Clinical Careers for Physicians, and it talks about a lot of different things, things that you can do in education. I know there have been a bunch of physicians who've gone into life coaching recently. And so exploring some other avenues that, you know, you feel like are gratifying and good use of your skills may be helpful, too. Thank you. That's really helpful. I think that, especially for those of us in medicine where we've been in training all of our lives and doing what people have told us we're supposed to be doing, making a career change, going into something new, even taking just time off is a really scary thing. So like you were saying, Stephanie, it takes a lot of bravery to go through that and to figure out what is meaningful in your life. But at the same time, I think that you can come up with something pretty powerful after doing that. So I wish I had hours more to pick all of your brains. This was really, really wonderful. But we're coming to the end of our time. So thank you all so much for your insight. This is going to be recorded, so it will be available for others to watch later on. So thank you.

panel discussion

factors

first positions

geographical location

career growth

compensation

job satisfaction

work-life balance

career changes