Okay, so welcome everyone to the Kosher Physiatry Member May session. My name is Jordan Burkhardt. I am the Director of Member Engagement with AAP MNR. I have a few housekeeping notes before we get started. The views expressed during this session are those of individual presenters and participants and do not necessarily reflect the positions of AAP MNR. AAP MNR is committed to maintaining a respectful, inclusive, and safe environment in accordance with our Code of Conduct and Anti-Harassment Policy, which is available at aapmr.org. All participants are expected to engage professionally and constructively. This activity is being recorded and will be made available on the Academy's online learning portal. An email will be sent after this activity with a link to bring you to the recording and evaluation. For the best attendee experience during this activity, please mute your microphone when you're not speaking, although we may have more of an informal session today. And then if there are questions, you can either unmute yourself to ask, raise your hand, or you can use the chat feature and I can read it for the recording. And without further ado, I now will hand it to Dr. Krasna to share his information. Thanks, Jordan. So welcome, Evan and Theodore. We'll see hopefully some more people will come on. We had a decent number for registration. I think there was also a bit of focus by our members on the title of the Member May meeting, even though we did want to hit on some just general networking questions and planning questions for our group going forward. So I'm Dr. Krasna, I work at Johns Hopkins, I'm a brain injury rehab doc. And I'm four years out of training now. So I did a fellowship year and then been at Hopkins for four years. And you know, big thing we wanted to do this year was with, you know, just knowing what we've all been through as physicians who went through training and trying to think about what you all might be going into this year. Just wanted to be able to provide a space for you guys to ask questions, try and give some guidance if we can about navigating the process of whether it's applying to residencies, applying to fellowships or first jobs. So just some highlights I wanted to mention in case this turns into a recording or just if you guys can share with people who you know. One big one is just that this group is open to any members of AAPMNR, which includes students. So if students have joined as a member of the Academy, then they can also attend these Member May meetings. And then, yeah, I think if Theodore or Evan or either you are free to ask a question, we'd love to be able to give you some guidance. I can speak of my own experiences that I think both for training and then for first jobs, it's easier to be upfront with things and letting people know what, you know, restrictions you might have, be it with call or holidays that you need to be off, because it's easier for you to get a full answer from a program or from a potential employer when they know exactly what it is you're asking for. Even though some places have a sort of strict structure that they work with in general, there's often ability to make some accommodation. So if that's, you know, the call is typically two days, you know, someone's on call for the full weekend, you can likely find some colleagues who might be able to split the call. Holidays just depends on how they fall out year by year and trying to explain that sometimes is tricky to people who are trying to figure out, well, how many days off will you need? It's sort of very year to year, but it usually just falls down to being part of your vacation time. And yeah, I think then always just being ready to split and cross cover with others for whatever they might need help with is sort of the biggest, biggest messages you should be taken away from this. But wondering if you guys had specific questions, if there was a reason you wanted to attend this, I'm happy to try and talk through those things with you guys. And since you're both on camera, I'll ask you to just introduce yourselves quickly. Sure. Hey, my name's Theo. I'm actually a medical student. I'm a fourth year medical student at California University of Science and Medicine, interested in PM&R. So very much wondering about, yeah, finding a residency or how I could still keep Shabbat while in residency. So one reason I wanted to come here was, yeah, explore those avenues and hear from people in the field who are, you know, like yourself, Dr. Krasna, doing that very thing. Okay. Awesome. And Evan? Yeah, I'm Evan Zeldin. I'm at the University of Cincinnati. I'm a practicing physiatrist. I'm the associate residency program director and a bunch of other titles that don't matter, but nice to meet you all. Nice. So Evan, any potential things that are changing for you, or you may be going to help out with guiding Theo in addition to me? I can try to help out with guiding Theo in addition to you. I came because Lauren Shapiro told me to come. So I'm happy to meet people and discuss and do things like that. I thought there were going to be more people, which is what we talked about at the assembly, but I guess not. So yeah, we heard we'd have, I mean, Jordan said we had at least 11 registered, which is also lower than I expected because we had the other big order of business that I think is, you know, be nice to hear from just both of you since you did attend was the bigger question of what this group wants to be in the future. It's a pretty big question, but for that we had like 24 responses. So I had hoped that at least some of the people who were engaged in the survey that we did would want to attend to discuss it. But I had trouble finding what would be a good time. I was saying to Jordan, there was one of the other committees I'm part of is the CNS one. And the time they chose was just totally didn't work for me. So I had registered, but then I ended up not being able to make it because kids in bedtimes. But we'll see. We'll see if other people pop on. I know the other thing that throws me off, Evan, this is probably your time zone. So this is noon for you. So that's a. So yeah, it is. I'm on the Eastern time zone, since that is Eastern time. That's down the cusp. Sorry. Yeah. That was the other issue is it was in central time zone. So I was trying to get us a noon lunch talk, but it was only noon for some. And Theo, it's, I don't know, morning for you, I guess. I'm actually also on the East coast. So yeah. Oh, okay. I know. Yeah. Well, so the, I think the biggest thing for residency, you know, it's really hard for us probably to give you any guidance on prelim years because there's so much variability both year to year and like different types of programs. I don't know if Evan, you had any luck with trying it or if you know anyone who did a Shomer Shabbat intern year. I don't. Yeah. I, I did not have luck, Theo. I did. I had a pretty good time of it because again, different call structures at different places. They didn't have sort of the golden weekend where I did intern year. Every weekend you were on, you were just either on Saturday or Sunday and you were either on as a long call or a short call. So either just rounded and got out once notes were done or you stayed till the night shift came because of that structure. You did the same number of things, it's just, you did a Saturday short and a Saturday long and a Sunday short and a Sunday long. So what I usually did was I was able to trade with each rotation, Hey, I'll just do all the Sundays. And so I did two Sunday shorts and two Sunday longs. Again, it all worked out being even in terms of the number of calls that were taken in the number that were long and short. And you know, I see when other things was hard to switch and get coverage for and, and holidays are definitely tricky as a, as a PG one, but overall it felt a lot more manageable than I was anticipating for intern year because places I did training you know, there was the golden weekend and the black weekend and no one wants to break those up at places that have them. Yeah. I think that's a really good point. And I think some people have requests, religious, other that they expect coverage and not reciprocation. And then some people go into it with the swap reciprocation mindset. And if you go into basically any request in residency or in practice with a, I have this request and I will reciprocate and I will swap and I will do the exact same amount of work or maybe even a little bit more work than my colleagues to make sure I can do this. Things usually go over. Okay. It's when I, I want to celebrate Shabbat, but then I also want to warp be off sun. Like if you're like, it's a additional time off and not my time off, then I think that goes into a, that can, where you get it in trouble. Exactly. Exactly. And then like, like I've been saying, that's applies both to residency as well as jobs with jobs. It's a lot easier in some respects because again, you tell them at the outset, they might hire you differently. They might pay you differently. There's a lot more that can be wiggled around. Residency is pretty cut and dry, but because things are done as a rotation, depending on again, how open, and now I'm thinking more about as a, as a rehab resident, how open they are to the idea, they can build it into the schedule. So swapping it's, it's stressful and you're not guaranteed, but if a residency is truly open to the idea and there, there was a list when I was applying that even listed like the intern years that had a Shabbat spot, they were pretty highly desirable and hard to get. But in theory, they could manage one person who didn't do Saturdays and they'd work it into the schedule. In rehab, that's a bit easier because again, just what our calls are like and at different institutions within that, there's also the, you know, what call is and what you're comfortable with for Shabbat, right? So if what you're doing is just being ready in case there's a medical emergency, then, you know, more people feel comfortable doing that maybe than just saying, I'm going into write notes on every single patient, you know, those, those are big, different, a bit different to some people. To some people it's like, it doesn't matter if I have to be there, then that's not ideal for, for a Saturday or Friday night. Yeah, I definitely had times where like I took calls, slept over even though I was only on during the day shift and then left after Shabbat because there's a call room. And so those are, again, things that can be done to try and optimize it, even if you're not getting the, the full Shabbat off that you were, you know, thinking of again, Evan, I don't know if you agree with this, but I think it's good to, and he's a program director. So he should know, but I think it's good to tell them at the outset, not just that you have the swap mentality, but just like, Hey, this is, this would really help me, you know and again, Evan can say more than I can about what you're allowed to and not allowed to say in an interview, but if you are saying, I want to do this program and I would, you know, if I can get this Shabbat spot, if they can accommodate it, then they kind of know also that, that there's a really good chance you'd want to come there, that you're going to rank them high. because if there's other places that don't have it, and this is important to you, then that's going to be the place you're going to want to rank higher. Yeah, I second that completely. I think, so medical school interviews are weird because you just want to say and do anything to get a spot and get into medical school. Like it's, why did you choose this medical school? Because I got in. Like that's medical school. Residency is so much a finding the fit and it's a weird mentality for medical. I mean, I had a very hard time getting into that mentality when I was interviewing, but ultimately I don't know you, but I assume you are probably a very qualified applicant. You know, if you look on like charting outcomes and stuff and you're in the right like part and all of that, then it's just finding the fit. And it's, you want to find a program that works for you based on how you are and how you want to live your life. And that is different for different people. For some people, that's proximity to the beach. For some people that's proximity to their family. For some people, it's observing Shabbat. Like you got to figure out what your priorities are. And when you interview with a program, I would bring that up because you, if that is your, you know, rank your priorities, but that is one of your top priorities. You should address it because there are going to be programs that are more or less flexible on things and it's different things for different programs, but I wouldn't really want, we could accommodate it. It's easy. It'd be awesome to know about it. Like just not in a bad thing, but just like, I would love to know if this is your priority when interviewing you, I cannot ask you that that is illegal and against the match. And that is a match violation. I can talk about it with you if you bring it up to me, but I can't ask you what your religion is and then questions about your religion moving forward. But if you want to talk about that, I wouldn't be happy to talk about that. And we could figure something out here. We like, again, on the whole swappy thing, if you're like open to it, like we have, so the thing that gets tricky is there are specific requirements for you to graduate from residency. And some of them are literally like hours worked, days on service. Like for PM&R, you're required to work at least five days a week on an inpatient service minimum. And you have to do that for 12 months a year to graduate. Like that's a definition. So if you, for whatever reason, we're going to take away from that and then intern year, there's even stricter requirements and more stuff. So if you were to take away from that, it gets like tricky from a literal graduation requirement. So if we know that at the beginning, beginning, beginning, beginning, that's super helpful. Now, if this is like a middle priority for you, like you decide your priorities are close to family and best training program. And then this is like in the middle and you hope your program can make it work, but it's not the end all be all, then maybe don't bring it up in an interview and do it a little bit later as a, Hey, you know, like sort of a vacation. I'm not saying Shabbat is a vacation, but kind of like a vacation request type of thing where it would be nice if I got Memorial day off, or it would be nice if I didn't, it just, that's your priorities. I don't know your priorities. You have to decide that because I can tell you, you will not get all your vacations and Shabbat and this and this, and it's a lot of give and take. This is one of those fields. Wow. Thank you guys. I really appreciate that answer. It's definitely something I've been thinking about a lot in terms of the idea of like reciprocating. I was always, this is one thing I've talked to a couple other residents that I know they're trying a program similar, or at least working something out on their own program where they say, okay, I'll be working every Sunday, every Christmas, every whatever holiday, as long as I can get X, Y, Z days off. And it's, it seems to be a definitely case by case basis, but I've heard it helps tremendously because I hate coming off, even in my own rotations where I said I had to take off a couple of days for Passover. And I'd say, I'd love to like work these extra days. A lot of people were confused, but it ended up working out at the end, but it definitely required, it necessitated me being very specific on how I can provide a, in return for anything I'm taking out. So yeah, that does make a lot of sense for sure. Yeah. And then, you know, I think just for your future reference, and in case we do decide that this should be a recording, if we find that this was useful enough, you know, a similar thing then happens as an attending, which is right, that question of, well, how's the call structured? And also like, what is important to you in terms of observance? Because there, again, there's places where you're only going to be in there for an emergency. So even if you're on, on Shabbat, you know, it's kind of the way that doctors have traditionally done it, where I'm on for emergencies, because, you know, in rehab, there's on an inpatient unit, medical emergencies. We don't necessarily need to see the person who's coming in with, you know, new back pain as an emergency, unless there's red flag symptoms, but we, you know, if someone's all of a sudden becoming medically unstable and the resident on call needs to ask for guidance, that's something, again, some physicians might be okay with, others might not. And there's, again, different programs where that's all that call is, versus there's other programs where no call is, you go in, you see every patient, even if they're stone cold stable, because we don't know that unless you've seen them. And so it's just different mentalities at different programs. And yeah, just a thing for, you know, if you're in an emergency, for your next stage of training, once you've gotten through this fun aspect that you're in. Yeah. But in general, I would say adding to that is different residencies have different call structures too, where I trained the expect. So one there's in-house call. So some people live in the hospital. It sounds like that's what you did in residency. Two, there's home call, which is what we have at the University of Cincinnati, but also where I did residency at ECU, but they were different. At ECU, the expectation was if there was a patient who was in any way, potentially medically unstable, you were to go into the hospital on your call and physically assess the patient yourself. So that might not be in your idea of what Shabbat should look like for you. Here at University of Cincinnati, the expectation is you take the patient phone call over the phone and you do not have to go into the hospital under any circumstance. So that might be a little bit more okay with how you observe Shabbat. And it's a big thing to clarify on resident, on rotation, sorry, on interviews, because there's these two terms, but they can mean very different things. In-house call just lets you know that that's where you sleep. If you're doing a 24 hour shift and home call just lets you know, that's where you sleep. But some in-house programs, you round on every patient, some in-house programs, you do not round on every patient. And same thing with home. Some they'll have you round and then sleep at home. Some they won't have you round at all. And like Evan's saying, some of them, they'll call you and you just deal with the phone call versus having to get in and drive. And so, like I was saying, when I did my intern year, I slept there because we didn't have any home call. And so if I was doing, even though it was just a day shift when I was in ICU, if I was on, you know, on Saturday, I just slept there Friday night. So I woke up Saturday, I was in the ICU, and then I went home after Shabbos ended. Even if it was a little after my shift had ended, I just stayed a little bit longer versus other rotations where it's like, that's not really feasible. They don't necessarily have a bed for you. Yeah. They should hopefully have a bed. That is an ACGV requirement. Well, for the resident on call, but if you were not yet on call. Correct. Okay. Correct. For the resident on call. Yes. I'm not a program director, but I do know that our program, when we've had times where we needed someone unexpectedly to stay over, we will also find a bed. So even if it's, there's a requirement that if a resident's in the building, they need to have the place to sleep. So like storms and things, we have to make sure we're meeting that requirement in an unexpected fashion. So I would think there might be something if you really needed it. But again, hopefully you might be able to find a place that even just working out ahead of time, it kind of gets worked into the schedule. Yeah. And I mean, if you're willing, if taking phone calls fulfills your obligate is fine with you in Shabbat, we wouldn't have to like here, change the structure in any way. Because Friday, we do work, we're gone well before sundown. Usually we round one weekend day, and that's usually Saturday because of other people's religions. But we could flip that to Sunday because of, you know, your religion, like, you know, for rounding together, then we'll just do it on a Sunday. And, you know, we just, and you would take phone calls the rest of the time. If that works for you. If that doesn't, then that's a different story. And it could be probably I see. Okay, seems like there's definitely a few options out there. Thanks. Yeah, but you should find this out when talking with programs because home call is very variable. And I think even though we didn't get necessarily as many people as we'd hoped for this meeting, I know that I think you might have been in email context with me, Theo. Yeah. And so, you know, any residents who are currently in residency are probably the best people to email and ask for some guidance on what's going on currently at residencies because programs shift their structure all the time. So, you know, what I knew as the list when I was applying might be different than what the list is now. And, you know, programs merge and reformulate themselves. So it can get a little confusing. But I think, you know, it's a good field to be in, in terms of what, you know, what the structure typically is like. And then also the fact that it's a very collaborative, team based specialty, people are usually willing to sort of cross cover, you know, it's part of the culture anyways, when people want to offer their own holiday or vacation, someone's got to cover it. And so it's just, you know, whether as everyone was saying, it's a program where you're doing that ahead of time, and it's all built in, or, you know, more month to month, week to week having to be on it, which can be a little stressful. Yeah. Dr. Krausner, you said you're at Johns Hopkins? Yeah. Oh, okay. I think I know a resident over there. He's actually the one that told me about like, how I can probably make this work. And was it Elliot? It is. Yeah. Yeah. So he's great. Definitely good contact. And, and, you know, he rotated over here. So he met people and got connected. You know, I think when he was a student, I, he asked similar questions, I tried to give him similar answers, like, here's the program I was at, here's places I had heard of that I looked into. But like Evan saying, really, what it comes down to is asking when you're on the interview, because I didn't know what would be possible at our program. But it turns out it was something that was workable for him. So yeah. Great. Following in someone's footsteps will make your life a million times easier than having to explain this from the start. Right. Yeah. So I already set the precedent. It's just easier to, right. You can follow that, right. The only negative is everybody's observance is different. I mean, I don't know, maybe you're going to do exactly what Elliot's doing, but if you, for whatever reason are more or less observant than Elliot, you might run into some weird. Yes. Why are you guys different from each other? It is that Judaism has various levels of observance and different terminology. Right. Yeah. I had an attending once who was like, I told him everything. And then he was like, okay, well, what's your rabbi say? And I was just like, what is it? You know, you have to check it with the rabbi. So as the rabbi said, like, the rabbi says what I said, he's like, okay, fine. I'm like, okay. But there's just, yeah, it's different. Everyone's got a different exposure to it or experience of it. So yeah. Yeah. Again, if a program is willing to accommodate, they'll likely be open to understanding that there's a difference. So you don't have to worry about it, but yeah, it definitely can.

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