Hello everybody, and good afternoon. My name is Greg Warswitch. I'm the course director. If you hopefully are tuned into the leadership and opportunity pathways and tools, early, late and mid career. This year I get to be the moderator and speaker I want to thank Dr. Brandi Waite, this course has been her brainchild and putting together. So, I'm a physiatrist here at the Mayo Clinic in Jacksonville, Florida. I have the pleasure of moderating, I apologize in advance we just heard Dr. Julie silver silver talk about diversity. However, I looked at our speaker panel and for the others of the four other speakers three are sports and musculoskeletal physicians. So, Dr. Bell and I will try and add the diversity to the group. With that being said, I think we have a poll, a couple poll questions and Charlie I think you were going to advance the poll questions for us. I'm going to ask those in the audience on taking the poll if everybody there could at least identify this is more for us to know who's in meeting, and try and gear some of our talk to those areas. Okay. Hopefully, everybody's had a chance to do that, and you can see our results there, 46% academic, 25% private, 13 employed, VA, government, eight, and others, eight. Next question, Charlie. Next slide for the poll. Thank you. Other thing is, boy, how many years have we been out? If you look at my hair, I'm kind of down even farther, many years out. Yeah. All right, Charlie, I think we've had time there to see our results. Quite a few greater than 15. Next slide, please, Charlie. This has two questions, whether you did a fellowship post-residency, and if you're a member of the AAPMNR committee or task force. And, Charlie, we see the results of those. So, 56% did some type of fellowship, and 70% are a member of some committee. I mean, 30%. The 70% that answered no, I'd encourage you, find ways to get involved. I've learned much more from the people and gotten much more out of being involved with committees. And with that, I'm going to go ahead and pass the baton to our first speaker, Dr. Joanne Borgstein. And, Joanne, I'll let you introduce yourself, and you're the leadoff hitter today. Thank you. Thank you. All right. Can I be heard and slide seen? We good? Yep. Okay. Thanks, Greg, and to the entire group of us. It's just very exciting to be together even for a few minutes on this Zoom chat. And thank you, everyone who's attending this afternoon. Next year, hopefully, in Maryland, we'll all be together again in person. So, my presentation for the next 10 minutes is going to be talking mostly about fellowships and a bit of a medical education pathway. I have no relevant disclosures. My only disclosure is my hair is a little shorter now, not quite gray yet, but I'm sure that's to follow. And so what's really the path to get from being in residency or fellowship to getting to be a fellowship director? How do we get there and what resources are available? So my path was one of not necessarily setting out to be a fellowship director, but being in the right place at the right time with the right sense of, I guess, priorities. So in 1992, I moved up here to Boston and the Harvard department started in 1995. In the early years, we were primarily inpatient focused with less outpatient, as were many of the department and residencies. And by the early to mid 2000s, it became quite clear that we needed to expand, grow and give credence to more outpatient musculoskeletal sports medicine. So recognizing that need and being in a position and a great academic institution with good support, myself and Kelly McGinnis, who helped outline the process, were fellowship founders and myself, the initial director. A few years after that, less than 10 years after that, our department had grown so much. Again, giving my interest and excitement about our division and leadership, I was able to become chief of the division. So that kind of brings me to mid, I don't know what point I'm in now, mid plus career. And I think it's really important to state that these are things I view as things that we share. So especially to talented, younger, earlier career folks, if we can establish these fellowships and then and train the next generation, I think that's the appropriate time for the mid plus career people to step aside and potentially have a broader view in your health care system or in your department or others. So I have passed that baton on to Kelly McGinnis, who's wonderful. And Christine Eng now runs our sports ultrasound program for the residency. So I've been able to pass that along and empower others that I think are terrific. And in place of that, as division chief, I've also been very involved in a new initiative that's been across our entire health care network called Mass General Brigham. We've had a sports medicine service line project for the past two years, and I've been helping to lead that effort, especially in regenerative sports medicine. So stepping away from the fellowship directorship has allowed me other time to look more broadly across our system for ways to lead and contribute. The question then, how does one start a fellowship? We interview many fellow applicants during the year, and often there are many who are looking to go back to their institutions and start a fellowship. Well, I have to think you have to recognize that there are two models. There's the academic model for which you need to generally undergo ACGME, graduate medical education accreditation through your institution. You have to have a supporting institution. You have to have the clinical expertise, and you need to have a funding line. And of course, written into this is often academic and educational requirements, opportunities, as well as research. In our institution, these need to be funded directly by the institutions. We are not allowed to offset the fellow's salary with clinical revenues. There are some institutions where that's allowed, but our academic healthcare system does not allow that. A very good and valid other opportunity is to set up a private practice model, and there are many, many excellent people in this country who have good fellowships that are housed within a private practice model. This is usually based on volume, clinical expertise, and is more often than not a focused clinical fellowship, but some of our great leaders, certainly in sports, have been in private practice and contribute greatly to the educational offerings of the academy and beyond. There are also private practice groups that do good research. These fellowships are generally funded by clinical revenue and are predominantly clinical. Just as a point of reference, the ACGME has guidelines, and I just put this in here because it was a little daunting initially to go through the 50 pages of guidelines and requirements for personnel appointments, the educational program, evaluations. What really helps is having a very good administrative program director to work with and to lead you through that process or help lead you through that process logistically the first time. The other thing that one really needs, of course, is clinical manpower and expertise. As we just got approval for a second sports medicine fellow using our division as an example, we're going to be up to 22 members of the division, so we have a lot of person power to provide clinical opportunity and education. I just put this list up of prior PASOR legacy award winners. There may be others that I'm not thinking of, but I just highlighted three of just the most outstanding people in our field who have non-ACGME accredited slots and fellowships, this one in private practice, this in private practice, that are often very competitive and sought after opportunities for fellowship education. The other thing about fellowship is it could be a place where you lead yourself to, and it could be a place that you stay, but then there might be an opportunity to take it the next step and advance your career in medical education. In the past, and I love Debra Weinstein is just leaving our institution at the end of the month, but she's always been a good resource for us in our department, and I love chronicling her career. She started as chief resident at Mass General Hospital, then became internal medicine program director, then became the vice president for all graduate medical education across our healthcare system, and just recently announced that she was going to be heading over to University of Michigan to be an associate dean and chief academic officer for Michigan Medicine. Certainly, if there's folks out there who are interested in medical education as a career path, as Debra's fond of saying, it used to be volunteer work, but it need not be, but this is something you need to plan for, and we'll talk a little bit about that in a moment. If you want a career in medical education, you need to decide at the outset, do you want your strength and focus to be clinical teaching, educational scholarship, in other words, how to teach, how to develop curriculum, aspects of education, burnout, diversity in medical education, or do you want to have an administrative leadership role in the medical school or in your healthcare field? You need to really pick a track early on. You're not confined to it, but it's great to know where you're going so you can get the right resources and mentorship in place. I just thought this was really interesting because there's things you don't think about that you might actually learn in a clinical educator track, such as curriculum development, assessment, how to mentor, how to give feedback, how to do educational scholarship and quality improvement. Then there's the other aspects of what does it take to be a leader? What are the kind of skills that you need to be able to bring to the forefront to do this? I just leave this here for you to look at later on. These are just some examples, at least in our medical center and institution, of opportunities to advance your education to that end if you want to be a leader in academic medical education. There's a master's in medical education. There are experiential cohort models where you can go for several months with a group of people to learn more about medical education. In addition, your own institution, if you're in an academic institution, probably has excellent resources for how to start a program and how to advance and be mindful of the opportunities in your healthcare system. Of course, the ACGME website is full of information for you, as well as specialty-specific education that is available through the AAP as well. With that, my take-home points are that fellowship leadership really begins with clinical expertise and institutional or practice-based support. Medical education as a career is not one thing only. It's multifaceted, and it might behoove us to select a medical education path early so that you can avail yourself of additional focused mentorship and education. Thanks, everyone, for your attention. I really appreciate it. And we'll now pass this off to our wonderful Dr. Brandy White. Thank you. Thanks so much, Dr. Borgstein, for the wonderful pearls that you've shared here. I'm going to pull my slides up for everyone. And hopefully everyone can see. So thanks so much. I did want to take a moment to just let everyone that's attending know that if you have questions, please go ahead and put them in the chat. We'll be monitoring that so we can hopefully answer the questions either along the way or at the end if we have time. So my name is Brandy White. I'm a professor and the section chief at the University of California at Davis. And my segment here will be on academic, professional, and strategic growth. I don't have any relevant disclosures. I do some advising but not relevant to this. And I'm going to pull here to what my goals are for my segment of the talk for this next 10 minutes. So while my focus is on academic, professional, strategic growth for early to mid-career, I will be drawing some parallels to private practice. I know 25% of our group is in private practice. So look out for those ties there. So I hope to share a bit with you today about understanding timelines and tracks for promotion and strategic growth, identifying resources at your institution to help you grow. And this number three is really applicable across the board. And that is creating a dossier for your promotion that has a strategy that's really well aligned with your departmental and institutional promotion tenets. So no matter where you are in private practice or academic medicine, it's hard to plan strategic growth and merit in promotions if you don't know what ranks you can ascend to or to which you can ascend. So my action item, I've got a couple of action items on my slides to really give you a goal for what to do, is really in your first year in practice. And if you've missed that first year, then just make yourself a new first year and start now. You should meet with your chair, your section chief, your medical director, whoever it is that's the boss of your section. And that meeting should be specifically about the promotion and strategic growth process that's at your institution. So that you have some sort of a roadway or map of knowing what you can accomplish and where you might go. I put a little bit of my journey here just to outline where the steps might be. So in academic medicine, you progress from assistant professor to associate to full professor. In a private practice, you may be a staff physician to a partnership track to partner. But wherever it is that you are, there are certain steps that you have to meet. And there's a timeline between those steps. And at my university, instead of reviewing your packet for promotion only at the time of those steps, at the University of California, we actually have an external committee that's outside of our department that reviews our packets every two years. So every two years, we get an interim review of the steps that we're taking to make sure we're making integral steps in all the areas where we will be assessed for promotion. So my recommendation, your next action item, is if your institution or your organization does not have a formal interim review process, that you ask for one with someone that's in charge and can give you some feedback to make sure you're not woefully deficient in an area that you really need to progress. Understanding the timeline here is really key, too, as well. It will vary from department to department or practice to practice. But what you need to know is if there's a hard stop somewhere, say, if you don't promote from assistant to associate by year nine, will your contract be non-renewed? That's something you'd want to know before year eight and a half when then you're stuck with six months to try to fill in a bunch of gaps. So ask for that review. This slide, the words on this slide are mostly for reference if you want to come back to look at it. The theme of this slide is that you need to know what counts for your specific pathway of promotion and strategic growth. So within any organization, there are different pathways. It might be a research pathway, an education pathway, a clinical pathway, an RVU or partnership pathway. And what counts for promotion or growth in one line does not necessarily count in another line. So you need to know what counts for you and your pathway. That's why that meeting with your director can help you target the things that you should do and maybe also the things that you should avoid. This slide, the action on this slide is probably the most important one of all. And that action is engagement. So nobody cares more about your promotion and strategic growth than you do. So you cannot sit back and wait for someone else to tell you, take this step, do that step. You need to be engaged in directing that pathway. One of the ways that you can do that specifically at academic institutions is to get involved with the offerings of the Office for Faculty Development. We frequently get emails from them that talk about different workshops or lectureships that you can attend. A lot of times those just get thrown away. But I really recommend looking at those. My personal goal has been to attend one faculty development offering per year. And that's been very helpful in my strategic growth. You know, the office offers these particular workshops about things that they think are important. And so if you're getting more education in the things they find important, that's going to help you for your strategic growth in your organization and your promotion. But outside of that office, you also, of course, we all know how the importance of faculty mentors and sponsors or other advisors that can help along your pathway. And that could be a whole weekend conference on its own. But looking to people who have leadership roles like your department chair, your medical director, your division or section chief. Of course, those are obvious places you can look, but do not overlook other people who have been successful but don't necessarily hold leadership titles. So say there's someone else in your department who's already successfully promoted to associate or someone else in your medical practice who is already promoted to be a partner. Take time to have coffee with them and find out what pearls they have to give to you. And that might actually be someone, you know, in another department if you don't have someone within your own department that you can identify. And here I really want to talk about what's in red, like it's in red on my screen so you know it's important, is how important it is to seek diverse opinions. We all know that unfortunately not everyone gets promoted or strategic growth equally. Sometimes personality, favoritism, conscious or unconscious bias, racism, ageism, ableism, there are a lot of things that can affect, effectively block your strategic growth and promotion. And there are ways that you can sidestep that or be, go on the offense about how to address it. So specifically if you're in a group that's been historically underrepresented in medicine for some reason, you need to seek some counsel from people who look like you and sound like you, other people in that group. They'll have specific pearls that are applicable to you, but do not fall into the pitfall of only seeking advice from them because you need to look at your promotion pathway through multiple lenses. The lens of the people who share your underrepresented status, but also those who don't. And vice versa, if you're not in an underrepresented group, don't negate the offerings that someone could have that has been in an underrepresented group. They might see other pathways or opportunities that you might not be aware of. So really to actively combat inequity in promotion and strategic growth, you want to prepare your offense and your defense. I'm a sports med doc, we're going to talk offense and defense. The rest of my talk is going to focus on that. So your first offensive step is in addition to all the people I've already mentioned in academic institutions, there's also an office for academic personnel. They're the ones that really approve the promotions from assistant to associate or full. So while you might not meet with someone in that office every year, every other year, I strongly recommend that once every five to seven years, you make an appointment to meet with the boss of that office. If you're in private practice, the boss of your organization in order to review your CV, your contributions, maybe get some feedback from them on where they feel you're light or missing. And the action here really is to get your work in front of the decision makers and seeking allies who are involved in the promotion process for your strategic growth. The next step in your offense is to create this dream dossier, right? The packet of information that you submit to be judged or viewed by your colleagues, both inside and outside of your department. You need to find out early what goes into that promotion packet. And regardless, whether you're in academics or private practice, everyone has a CV and you need to update your CV regularly. You can forget to include things. And my strategy for that is I keep a little sticky note on the bottom of the screen for my computer. And whenever I agree to do an outside speaking event, to teach a new course, to do a new lectureship, to do some shattering, I write it down on the sticky note. And when the sticky note is full, then I know, all right, this week I have to take an hour to update my CV. And you should include everything you do on your CV. If you are doing it as a doctor, whether someone at your interest institution asked you to do it or not, you're representing your institution and that should count towards service to your institution for growth. And so you need to control the narrative around the things that you do to make it very easy for the people reviewing your opportunity for promotion to tally your contributions. So say something like media appearances. Someone might look at that and say, oh, that's just a frivolous thing they do because they want to see their own face on the screen. Right. But if you're helping your chair write your letter, you might phrase it this way. During the review period, I participated in 15 media interviews representing our hospital, enhancing our public health education in our region. Preparation for and participation in these interviews usually takes two to three hours for a total of 40 hours of service that I've done in service of the university with my media engagements. Boom. Now they understand what you've put into it. It's not just you trying to see your pretty face on TV, but there are a lot of things that we do that others don't understand. So the action here is to make it easy for other people to tally your contributions. But of course, there will be roadblocks that you'll need to hurdle. And now we're going to talk about your defense. OK, so if there are weaknesses in your CV, attack those weaknesses. You need to strategically, graciously accept and decline opportunities to strengthen the holes in your packet. If you feel like your contributions are being overlooked or undervalued, use that technique that I had of tallying the weeks, the hours per week, per hour, per month, per year, so people can understand what you're doing. If you feel that your contributions are still being overlooked, then you need to take a hard line and decline the undervalued work that's not moving you forward. Or if it's something that really feeds your soul and you love it, but it's just not helping you, then you need to look at your work-life balance and know that that's what you're doing it for. If there's something that doesn't feed your soul and doesn't promote you along the way, then get rid of it, because we only have a certain number of hours to give to everything we need in our lives. And if you're unfortunate enough to have an unsuccessful promotion or feel like you've been stagnant in your promotion pathway, you need to seek some transparency in the decision process and find out what specifically was lacking in your packet that made you not get the promotion in your practice, that gave someone else the partnership, and find out where those holes are so that you can fill those holes in on your next step. And if you feel that you've done that, you might seek an appeal. We know, I know people in our organization who were not promoted, who then sought an appeal, but you better have evidence if you're going to ask for an appeal. And one way that you can do that by collecting evidence and getting real, you need to save the packets of people that you review, like you're asked to review for other people in your department, save those somewhere so that you can compare yours to theirs. And if you look about the same and they're getting promoted and you're not, then you've got some grounds to ask for an appeal. And if you do move forward with an appeal, or if you suspect that there's been any bias or inequity in the promotion progress, you need to have your evidence and then seek counsel and alliance with your Office for Equity, Diversity, and Inclusion to help you along that pathway. And do remember that the best defense is a good offense. And with that, I will pass the ball to our next illustrious speaker, Dr. Catherine Deck. Thanks so much for your attention. Thank you, Dr. Waite. It's my honor to be able to be part of this representative group of leadership. There's a lot of talks during our conference this year, and this one specifically is focusing on leadership opportunities. There's so much here. We've got 10 minutes each, so I'm going to go straight to the slides. I will mention that I'm a professor currently in the Department of PM&R and in the Department of Orthopedics. I'm an Assistant Fellowship Director. I have no disclosures, but leader involves a lot of skills that are soft and are hard skills. So when we think of experience, all these things that you see are experiences that I had during private practice. I've had five different private practice settings, one of them being my own practice that I started from ground zero and sold or merged with another company, and now I'm in academics. So you can do things to build your dossier for academics because I became a professor when I came into the department. So one of these things we look at in private practice is what are your big time goals? Get diversity. Get the experience. Community, committees, doesn't have to be just in your practice or in your hospital setting. So you want to make sure there are diverse opportunities. That's skill acquisition. That's what builds that culture of leadership, that matrix of leadership as we talk about in healthcare business. So you want to be a leader. I liked this. I saw this in another board type of representative slide that someone had shared, and it's about becoming a leader. The COGS, the biggest one is the small task. When you start out as a doc, you're going to get small tasks. You're not going to get the leadership role. So do good. Make sure you take those small tasks. Don't turn them down. Don't wait for the big jump that's coming. Then you'll get more responsibility. When you get more responsibility and do a great job, then you learn more about your organization or the committee or the organization you work for, and you also build that knowledge skill set that acquires a competency and understanding the language and the culture of that organization, which helps you in your promotion. It helps you in the leadership goals that you may have. So there's really an evolution that needs to happen. I think when I sponsor and mentor young starting early physicians, many want to jump immediately forward, and yes, you can get a title, but can you develop that leadership potential that continues the trajectory? Sometimes it doesn't work the way you think it will, so it's important to take the small tasks and do the diverse spread of your experience. So let's take it in a couple different boxes. I'm not going to read the slides, but I want to make a point in private practice. You need to see patience. There's just no way around it. It is about revenue, and every time you take time away from seeing patience and you're not getting paid for that time that you do, it does affect your salary, your revenue, your ability to support the practice, but it's really important as you and your career, thinking of your brand, thinking of the relationships you're making, so you're always listening. You're always reflecting. You're always looking at things that are out there and what types of things you should be going after. So, many say, well, I've got to go into academics. Some of my fellows and residents tell me that because they want to teach, but I would say I got to teach medical students. I had a high school curriculum. I had rotators with me from the university. You get to teach in private practice. You just need to make the time for it, so I am a Marvel fan. Not everyone is, and I had to look at things a little differently. Early on, I thought about weaknesses. How do I tackle my weaknesses? I want to grow in my practice and I want to grow into leadership, but there's a reverse thinking on that. The neurocognitive pathways we want to develop are positive. We need to focus on our superpowers. There's an organization called CliftonStrengths. This is not an advertisement for them, but just as an example, they talk about building your strengths and focusing on your strengths. You're aware of your weaknesses, but you're programming your strengths and you're focusing on building those strengths. The other thing I want to bring up is a lot of us in medicine are overachievers or perfectionists. When we say, complete a list, write down everything that you think about that you want to do in your career, all of us are like, great, I'm going to take that, check it off, and I'm going to keep moving down that list. When I get to the end of it, I will be a leader. I will be successful. That's not how it works. When we look at lists, lists are a way to frame your reference, frame your direction. Focus on the top five on that list. Don't try to tackle all of them. Now, let's move to what we call the mid-career. In private practice, it's hard to understand. I think the early, mid, and late career comes sometimes from an academic mindset. Since now I've said in two different arenas of care and careers, three to five years would be considered early, but in private practice, two years could be considered early career, and two to five years is mid-career. Again, if you're a physician that started at 45, you may be retiring at 65, so your time frame of what early, mid, and late career is is a little different in the private practice world. I think one of the things that's important is you're still needing to be productive. This is the place where you should have negotiated well, and you have an idea of your partnership track, or at least what niches you're going to go after to build the organization as a whole to make them better. There's a lot of work you're still doing. This is also a stressful area because in mid-career, you're starting to get all those opportunities you worked on in early career. You're starting to have to balance other things that are important to you. I had all three of my children and raised them during my private practice side of life, and any time you have to take time away is revenue that you don't get, so you have to think strategically on how you continue to get paid or have some type of revenue stream, so it's important to look at this mid-career area and think hard about what are your goals. When we look at mid-career in private practice more so than an academic, we're really doing the strength-weakness type of facilitation of making you the better brand, the better practice, the more patience, the expansion, the collaboration. You're not so much looking at a strategic service that you have to do because that fits your scholar committee or your representation for your promotion to associate or professor, but you are looking for strategically what can you do in the community, what can you do nationally and internationally that helps build the brand of your organization or your practice. This is also a time after five years to take a look. Am I on track? What is my career plan? Is our fiduciary leadership to our organization to represent them well and to help them grow? Some of the things we think about at this time in our career, since I told you I was in five different types of settings and started my own practice from grounds up, there's times where you're reflecting, is there leadership for me here? Is there a growth opportunity? Do I have a voice in making a change or creating better? Are you impeded in any way? Are you hitting a wall and you just can't get over it or go through it? Some people find in mid-career that they shift their priorities or they change their practice just because that particular group may not be the one that is meeting their needs. I have to say, if you're a square peg trying to fit in a pegboard of round holes, it can be very stifling and impeding to your advancement if you're looking at leadership. It's important to reflect at five years. Then there's this area called mid or mid-late, late career. I still think I'm in my mid-career. I've been at it now for 27 years, but to me, it's still my mid-career. I think that it is more classification of what type of practice you're in and what you're looking at for your future goals, your succession plan. You've worked so hard at what you want to do for this practice or this organization. Now leadership comes in, completely changes everything. You no longer have that young colleague that you hired to succeed you because they've made cuts. You can do the best thing, plan for it, and still life can change. You have to have plan B and strategies about what you want to do with your career. Then advancing your passion is really important. If you're looking at this time at research in private practice, you really should be shooting to publish, really making a change, not just to do case studies, because it's really hard to do research in private practice. That's one of the things that people like. They go to academics, but you can do research in private practice. You just need to change what you're publishing or what you're going after at different stages. The other point to make here is there's even more responsibility. Sponsorship is probably where you can sit higher now than you could in your first two or three years in an organization, in a private practice, or in the academic world. Sponsorship is not an aged biased thing. You don't have to be old to sponsor someone. There are young leaders that can sponsor older members that may have that as their goal to proceed in an academic educational pathway. These types of things, sponsorship, require more ability to know your network, to know your transparency, to know the culture of the organization, and to make sure you can fit the needs of the person you're sponsoring to the goal that they have. We were asked to share a couple different things that we saw. Obviously, I'm female, and so gender differences is something that I've lived throughout my private practice. It's there also, not just in academics. One of the points I saw was a lot of research going on in academics. Didn't hit me as hard as it did if I was in academics to see some of these roles, because I didn't have those roles in private practice, but definitely identified with the fact that as a woman, I was put forward for mentoring, education, marketing. That's wonderful, but you have to step out. You need to get involved in the finance. You need to do the governance types of policy strategic planning to give yourself that different experience, because 10 years of the same experience is not 10 years of experience. Spread it out, get a diversity of experience. Then the other point from this slide is, if you negotiate a salary your second year out, you know what your salary was that you negotiated, but for some reason, if you stay in the same area, things happen. People know what your starting salary was. It tends to be where you start, not the fact that your colleague may have started a little higher. That base salary, that first salary that you negotiate is very important. From the standpoint of COVID, I only had 10 minutes, so I want to hit the high point on this slide, is blue zones. Old book, great book. A lot of areas that I've looked at in life about balancing work and career. I think that balance in life is the wholeness that we strive for as physiatrists for our patients. We're looking at them having this interaction, being active, but one of the things we've seen in COVID is isolation. Some of our social sciences are really teaching us what that isolation has done to us as physicians, the burnout rates, but also to the patients, to the public, to the healthcare progression, to that wholeness that we strive for as physiatrists. So I think it's really important that, yes, we get better at our virtual skills. These Zoom meetings, they can be fun and very educational, but we really need that social integration, that community, even in our career, not just in what we do with our kids or friends. So think about the fact that social isolation affects the healthcare provider as it does the patients. And then I've got some resources. I actually have like a stack of books. I could just have thrown a picture up of all these books, but I wanted to give you just some key ones that you can go back to when you look at the talk later. And then I've got my five take-home points. Of these five, review your strategic plan. Really do it every three to five years when you're in private practice. There's changes you may make. And then the other part of it is, is as you progress in your career, remember to have fun, because fun makes a big difference when things start to come at you and you fail at succeeding at some of the things you strive for. And my kids think my photography hobby is a real nuisance. This is kind of an example of them enjoying my photography time, but they are part of my career. So I wanted to make sure I shared that with y'all. And I appreciate your opportunity to speak. I'm going to hand the baton to our final runner in the relay. Coach Greg will take it away at the end. Dr. Kathleen Bell, we all know her. She's very experienced. She's our next speaker. Thanks, Dr. Deck. So what I'm going to talk, I'm really going to focus on mid to late career in my little talk here today. And I'm going to talk about things that we don't talk about very often, and that's failure, and how it plays into advancement as a leader. And also looking at late career, I'm talking a little bit about sort of unwinding and how one gets to that point and what things you have to think about if you're in a leadership position. So I will always think, maybe because I've raised three children as Dr. Deck, maybe that's why I always think of things in kind of a developmental fashion. And I always look at, you know, my babies, the medical students, the trainees, the fellows, and then you move ahead to, you move ahead towards toddlerhood and the first couple of years that you're out where you're really learning to function independently. And it's often really, especially if you go into private practice, it's often somewhat of a jolt to find that. Operating in private practice is a little bit different from being resident and fellow. So often an interesting transition for people. In childhood, you're now a more mature physician, but you're still operating, hopefully, with some good parental guidance. So you have some sort of mentorship helping you move along. And then you kind of get to that point in your career, whether it's private or academic, where you're in your teenage years and you're able to walk and chew gum at the same time. You're balancing your career, your family life. You've got a little bit more of a straight path ahead of you at that point. Then you kind of get at a certain point into adulthood or your mid-career. And again, I'm not sure where this is for people and it might happen at different times for different people. I've had a career that's had some fits and starts to it. So, for instance, I mean, I really didn't get my first grant until I was 40 years old. So it's a little later for me maybe to get into mid-career than it might be for other people. But at that point in time, you're starting to attain first early and then more advanced leadership during this period of your career. It's the time of your career where you really do have, you have the opportunity to innovate, to build, to really change things because you have enough street credibility. You have enough experience to be able to do that. It's your opportunity at this point to really become a mentor and to really build your business, really expand and build and make it what you want. And then of course, there's what I like to call nowadays, the age of wisdom, because I'm there. I don't know that I'm really wise, but it's better than calling myself elderly. And that's the late career. At this point, you're probably in a peak leadership position probably where you're going to be in terms of your career. You potentially have some national leadership opportunities and you're at the point in your career where you're starting to think about your last will and testament, like what comes next in my career? What can I do? How do I, all the things that I've built over my career, how do I pass that on and ensure that it survives to the next generation? So one of the things that I wanted to spend a few minutes talking about was the whole concept and issue of looking at achievements and failure. We, in order to get promoted, in order to get the next institutional appointment, all that sort of thing in order to become a partner, we have to achieve. But what we don't talk about very much is failure and resiliency. Resiliency to me has always been a rather difficult concept to put my arms around because it seems kind of vague to me, but I thought about it a lot recently. And it seems to me that resiliency really is learning how to make failure into achievement. So it's really being able to take failure and to step back and be able to analyze what happened, why it happened and what you would do to make it an achievement. So two of my heroes I've listed on here, one is Melanie Stephan. Dr. Stephan was a postdoctoral fellow in 2010 when she had an essay published in Nature, which was a CV of failures. And it's a short essay, but it's a lovely essay that kind of talks a little bit about learning from failure. Well, this was tucked away nicely in Nature for years until Dr. Haushofer, who was a Princeton professor, decided that he found this essay and decided he thought this was really an interesting thing. So he produced his own CV of failures, which was quite extensive and put it up on the internet. And it became absolutely viral. And if you go on today on Google CV of failures, you can look at a number of people who are out there kind of demonstrating what has happened in their life. And in one way, I like to talk about this because people come up to me all the time and say, oh, Dr. Bell, you know, you're a role model. You've been so successful. You've had millions of dollars of grants and you've done this and you've done that and you're married for 42 years. And I kind of my eyes, you can't see them, but invisibly my eyes are rolling into the back of my head because I know what underlayed a lot of that. And I'd like to share with you what sort of things I really did deal with and I had to turn into achievements. So first of all, there were the medical schools that did not accept me. In fact, my alma mater did not even give me an interview. I was insulted actually at my interview at Jefferson and I was turned down by, I would say, one of the lower rung medical schools in my area. University of Pittsburgh did wait list me. There were two of us who applied for the PM&R summer internship in my medical school. I did not get it. There were residency programs that didn't really want me. It's a long story on how I got into the University of Washington residency, but it really revolves around the fact that they wanted my husband. I had an academic career that just plain old failed. And I left the University of Washington in 1986 when I realized I had not taken control of my own fate. So I got to spend much to my own advantage about five years in private practice. There were chair positions I did not get. Did not get the chair position at the University of Washington. Did not get the chair position at Indiana University. They both got great chairs, by the way. By the way, grant submissions that weren't successful. I stopped listing them after a while. There are so many grant submissions that weren't successful. It's kind of ridiculous. So there are many, many more. Papers rejected. Oh, I just can't list how many papers have been rejected. Too many to count. Many revised and resubmitted. Many resubmitted many, many times. Many resubmitted to other journals. So, you know, just a process of looking and trying to enhance that and try to get that darn data published somewhere. All the times I was not successful in being able to recruit faculty, many, many times. And then we get into the personal. The times I forgot to pick my kids up from an activity. The times I had to miss a school activity. The times I kept my poor husband waiting over 15 minutes for me to show up. It was usually way over 15 minutes. So, you know, all of these things, I think, could be looked at as failures or could be looked at as opportunities to step back and say, why did this happen? Do I care that it happened? And what do I do about it in the future? So this is where resilience comes in. This is the opportunity to really look at yourself deeply. This is a picture of Joan Samuelson. I've always idolized Joan Samuelson. And this is when she was 60 years old and she was running in the Boston Marathon. Now, Joan Samuelson had won the Boston Marathon and maybe more than once, I'm trying to remember, in her career. This was putting herself on the line at age 60, coming back to run in the Boston again. So I think that some of the things that you can do in order to really enhance your resilience is first of all, keeping your eye on the goal and keeping your eye on the long-term goal. Short-term goals are great and you need to have them in order to get the long-term goal but you're really looking in the long run of big wins, not the small losses. Now, the small wins might help you get to the big wins but you don't wanna be devastated by the small losses. And so I think it's a time to sit back and take a look at why did you have a small loss? The other thing though, is to really step back also and adjust the goal because you may fail at a goal and fail at a goal and sometimes step back and say, am I really failing at this goal or am I going for the wrong goal? So I think you need to take a look at that because you can't win them all and sometimes you really do have to step back and change your goal. Make sure you have a cheerleading squad. Keep your own mentors. It doesn't matter how late you are in your career, you need to have mentors that are helping you go through every stage of your career. When I was thinking of taking a position as a chair, that I called many different chairs across the country. I called Diana Cardenas. I called Steve Flanagan. I called Flora Hammond. I called many people to get advice about whether to take the position and to get advice about what to do. Training and practice. Leadership training courses are important. Doing retreats with yourself or with others to be able to step back and look at your goals and do your strategic planning. Physical fitness, incredibly important. I'm serious, you must stay fit. There's no way that you can advance and be successful in either academic or private practice if you don't stay fit. That means you need to exercise, you need to eat well and with intention, and you need to be able to sleep and get away from work, including your cell phone. And you see my recommendations. You cannot get cell phone reception in the Grand Canyon, Antarctica, or the Amazon jungle. I've tested them out for you. Mental fitness. Find a way to support yourself. This might be things like meditation, counseling, mentoring, might be girls' night out, might be Sunday football, might be religious services. But find whatever it is, even if you don't do it all the time, but that you have a lifeline. And to keep your primary relationships strong. Make sure that your family relationships, your partner relationships, your mentor relationships are strong. So I wanted to talk a little bit about the very end of career in terms of succession planning and retirement issues. Physicians retire anywhere between 60 to 90 years of age. And there's not a lot of information on whether they do full or part-time retirement. And there's basically no information on physiatrists. People retire early because of low job satisfaction. And in physicians, that means that they have a perception that they can't control their job, or they have dissatisfaction with things like board certification and other types of low morale. They might have burnout from excessive work. And I think we're seeing some of that, particularly in the last two years. And they just may be experiencing poor health or having problems with psychological distress. Delaying retirement. There are lots of different reasons people delay retirement. They may be highly satisfied with their career. They may have some institutional flexibility. They may have a real feeling of responsibility for their patients. They may have a desire to be healthy, financial reasons, or, and this is the saddest thing to me, a lack of interest outside of medicine. For non-academic practices, I think when looking at planning for retirement, I think that none of us really want to lose people before we have to lose them. As you all know, bringing on, say, a new physician or something like that, you lose a lot of time, you lose a lot of money. Up to par in terms of their practice. They may or may not be the right one. And this is true for either non-academic or academic practices. So if you can keep a successful, efficient, good doctor in your practice for a little bit longer, it's worth doing. So thinking of things like flexible hours, sabbaticals, managing the bureaucracy, maybe changing what the work content is, changing the type of patients somebody sees, giving some other kind of administrative opportunities. And then opportunities to build knowledge, volunteer and attend meetings can help as you're aging to keep you really sharp. In academic practices, I wanted to talk a little bit about succession planning for department leadership, knowing that retention rate for academic chairs is about 70% at five years. One of the biggest things that I think you have to do in position of leadership is to start right away building your bench. I mean, that's probably the most important thing you have to do. I've been in my position as chair for over seven years now. And I started six years ago building my bench. So you really have to start giving leadership training to people that are in your practice or in your department. You have to let them know how the budget works because none of us in medicine come by this naturally. So you have to share financial knowledge, give them step leadership opportunities, really encourage things like institutional committee participation and national committee participation because it teaches you so much. Identifying potential leaders. There's a lot of potential things here listed that I wanted to bring up, but I want to specifically talk about the desire to lead in diversity and equity. People may not know that they have a desire to lead and they may not have had the experience of leadership or not because of who they are have not been looked at as leaders. You have to pull those people out and you have to dig farther than just saying, oh, they don't have a desire to lead. You've got to spend a little time and make sure that that's really the case and that they're not just evaluating themselves by someone else's criteria. When you're leaving a leadership position, not just a chair position, you have to think about what you want to do because it's pretty hard to think about just cutting things off after you've spent 40 years in the profession. So you think about, what value do I bring to my organization? Can I continue to do something that will bring me good feelings and also bring value to my organization? Maybe you take on a different role in the department. You have to reevaluate what your personal and family goals are. My plan for retirement is, and people probably know that I'm planning to step down as the chair of my department. I actually started, and again, six years ago, thinking about how I wanted to step down eventually because I knew how old I was when I started this job and knew what I wanted to do in the long run. And the first thing, as I mentioned, was leadership development. I now have a very strong middle management in my department, very strong. And that was one of the big things I did, being very transparent about finances and financial planning in my department. Everybody knows what we have in the bank. Everybody knows our ins and outs. And what I did this year at the beginning of the year was that I started a strategic planning effort that was not led by me, but was led by the other leaders in the department. And so everyone is taking responsibility for making sure the department is moving forward this year and next year during any kind of a change in leadership. So again, looking at the later parts of the career, you find that there are many things that are important to you. My research is important to me, my trainees in clinical care are important, but my family is important as well. And you can see all my little pumpkins on here along with my children. And so, looking forward to making sure that you can get to this point with honor, dignity, and a future. Thanks. Greg, you are back up if I can figure out how to get out of this. There we go, well, as we started at the beginning and we had a lot of great speakers, I was left, I have some slides there people are happy to go through but because of time constraints you're lucky you don't have to listen to me. Trying to follow Dr. Bell is like trying to follow Tom Brady of PM&R at a position. So it would be nothing but a letdown. But I will say I made a couple points, Dr. Borgstein mentioned there's a master's of education. I don't have that on my slide if people want to go for master's, Dr. Waite, great point, know your blind spots. If you don't look for them, you'll never find them. And I learned this later in my career, talk with people who don't look like me, who aren't me and ask them, have the tough talks, tell them why, what am I different, what am I missing? Dr. Deck, I hate you, skill acquisition and balance. Skill acquisition, that's part of getting an advanced degree or not. Do I think you need one? Well, back in 2000, I got one, but I think now there's enough courses out there on leadership. Skill acquisition does not equal leadership. Skill acquisition allows you to potentially become a leader. Dr. Bell, I just hate trying to listen to you anyway, you're so good. You think you have a few failures, I fail every day. But I have the best coach ever in the world, my wife, so everybody needs their support systems and you mentioned that. Dr. Bell, we have one question in the chat and with time running short, I'm going to ask you that. I'd hate to get into a fight with you because you would bite, scratch and claw my eyeballs out. You're competitive as hell, but you're the most humble person and the most, how do you keep that balance? Because to keep the fires burning, you have to have that desire you have, but yet you're able to keep your humility and it draws people to you. Any thoughts or secrets? Because we know it's a work done. Honestly, Greg, I think that maybe a lot of my approach to things is that I started out in this business as a nurse. I was very hands-on taking care of people at the bedside and maybe dealing with physicians from a different angle. I still can make a bed and I still can change a chuck under a patient who needs one changed and I do on a regular basis. I think that that really started me thinking of myself as really part of the healthcare team and even though I might be a leader, I have always been firmly part of the team. Yeah. Good. I could ask the same question of everybody as we go around. Dr. Borgstein, any thoughts? No, I can't. I can't top Dr. Bell. That's great. Yeah, but I'm sure there's a lot of people sitting out there who are going to take the baton and leadership on. Dr. Waite, you're well on your way. Any thoughts for us? Last part of the shot. I saw a message in the chat saying, one way that we can really assist with improving the diversity and building your bench and bringing up the next leaders is really to talk about the process of advancing your career over time. I think that's great. I think that we need more talks like this. I'm glad this is going to be recorded because going head-to-head with John Finoff and the other Paralympic talk that were happening at the same time was really tough, but I think it's great that we'll have it recorded. I agree, learning early how to build your career and then as you grow, learning how to build the careers of those coming behind is really the key to success. Yeah. All right, Dr. Deck, we got a hit on you and then we're going to have to close up shop here. I will just say really quickly. I never thought I'd go into academics. I love private practice. I found a place where I wanted to make a change and do some strategic stuff, so then I changed. That's where I think people on this call need to think. It's not like you go to one business and you stay in that business. You may start in academics. You may go to private practice like Dr. Bell mentioned. Please think about your five-year plan and check it out. Yep. I would echo that. Having been in private academics, now an employed physician, and enjoy. Someone mentioned have fun. I have fun every day. This panel gave me fun, energy, and that's why I encourage everybody. My last slide was all you got to do is step up to the plate. We're going to, you know, professional hitters, three out of 10 hits. Wow. Kathy, you talked about resiliency. Seven failures, three successes, and they're considered superstars. So keep that in mind. With that, I want to thank everybody who's on. We please ask you to fill out and be honest with your evals because we try and look at that and adjust courses that way. So thank you, everybody. Bye.

leadership

career stages

diverse experiences

mentors

leadership skills

failures

resilience

retirement planning

succession

work-life balance