academic, large group, experience, as you're deciding on, this talk is practice matchmaker, finding your perfect fit, and as you've heard, there's a range of ways to do this, and so I'll ask maybe everyone to kind of do the same, a little bit of introduction, tell us about your training, your experience, and maybe a clinical research interest, and then we'll talk about some of the other stuff. So we'll see where the conversation takes us. And I appreciate the faculty joining in, if there's specific comments and things, because we have these four, but there's lots of interest and experience. My name's Melinda Rogers, I'm an interventional endoscopist as well. My training-wise, med school at Case Western Reserve, internal medicine residency, and general GI fellowship at Northwestern, and then my interventional year at UCLA. I'm currently, and I took a job from UCLA in the practice that I'm currently in, so straight out of fellowship. I work for, apparently, a large group, because that's what I'm talking about today. I didn't really realize that, but get into that a bit, I think. We're called Ohio Gastroenterology Group. We're a single-specialty private practice. OG. O-G-G? O-G. Yeah. And, yeah, so that's gonna be what I'm speaking about today, did I answer all the questions? Yeah, clinical interest. Oh, clinical interest. So, bariatric endoscopy was kind of my niche going into interventional training, and I still do that in my practice somewhat. I can answer more questions about that if you'd like, but I'm also really interested in quality in endoscopy, and so that's my role in our group, as I'm the quality police, as I'm referred to by my partners, so that's what I do. Thank you. Doug Adler. I'm talking about hybrid practice. I went to med school at Cornell. I was a resident at the BI in Boston, and I did my general and my ERCP here at Mayo Rochester, and then I went back to the BI for an EUS here. I'm kind of a macrophage. I do ERCP, EUS, I do a lot of third space, and I do a lot of endohepatology. I'm Tian Gao. I am gonna be talking about private practice, but I think my practice, the setting that I'm in right now, we actually wear many hats. I'm gonna actually leave the GI Alliance piece out of that for now as well. I did med school at NYU, and then went to Mass General for internal medicine, Boston Medical Center for general GI, and it was really during my general GI fellowship where I said, oh, ERCP, advanced endoscopy, really interesting, so I ended up also doing an interventional year at Maine Medical Center. I was Doug Howell's 25th interventional fellow and the first female fellow that he had, and so I finished fellowship in 2017, and at that time, going into my interventional fellowship, my daughter was one, and so deciding even between interventional fellowships, they're very different in terms of how busy you are, how much call you're taking, so even for me, that was sort of a pick and choose. I wanted a good work-life balance, be home for my family. My husband is full-time employed, but not in medicine. Same thing with looking for jobs afterwards. I think part of choosing that fourth year is that one, your job options may be limited, and it may be limited on a year-by-year basis even. Some positions will fill that year, some places will open, so some of it is just based on what year you finish and what's available out there. Others will just be also based on what you're looking for in a job as well, geographic restrictions. I wanted to be in the Northeast. Both of our families are there, and so that was important as well, and then I can sort of go into more detailed private practice things later. Morning, everyone. My name is Quinn Liu. I'm at Cedars-Sinai Medical Center in Los Angeles, California, and my background, I went to medical school, actually East Coast. I'm from the East Coast, Drexel Med, and then I came out to L.A. for my training. So I'm actually, I'm a pediatric person, like Dr. Fishman, I'm pediatric general piece and pediatric GI, and then I did an advanced year at Cedars-Sinai, and then I went back to Children's Hospital Los Angeles and was in the USC, the University of Southern California university system, and I was doing pediatrics and some adults, maybe like 20% adults, 80% pediatrics, something like that, and then one day out of the blue, my old mentor at Cedars-Sinai called me and said, do you want to come over and join the faculty group at Cedars-Sinai? So now, I am a faculty member at Cedars-Sinai. I am associate professor right now, so I'm gonna be talking about the academics part, and somehow I am doing now 90% adults and maybe 10% kids, but my clinical research scholarly activity mostly is in pediatrics and pediatric endoscopy, pancreatitis, since we do do those throughout the age group in terms of pediatric pancreatitis and adult pancreatitis, and clinical endoscopy. Tell me a little bit maybe how you decided on this model, especially with the interventional expertise we have, there are a lot of options, so what made sense or what other options did you think about and look at? So, I remember coming to this course. This is my first time back at this building since I was here for the senior fellows course, and if you would have asked me, and I had known that I had already matched into my fourth year and that I was gonna do this, and if you had asked me at that time what I would be doing, I would tell you that I would be sitting down there in the academic chair. That is 100% what I thought I was going to do. I had been told, and I believe that everybody does their best to give you accurate information, but I think that we all know what we know based off of our life experience, and so I was always told that if I wanted to be an interventionalist and do these cool cases, that I could really only do that in an academic model, and so for me, I was at the airport. I had just interviewed with my first academic physician, and I got a phone call from somebody that I had been to fellowship with. He was two years ahead of me. He'd also done an interventional year, and he's like, hey, would you be interested in joining this group, OGG? I said no, and so, and then we were just catching up and talking, and somewhere in the conversation, he dropped in, oh yeah, I get 10 weeks of vacation. As a fourth-year fellow, you're on a call every night. I'm like, you know, maybe I could visit my mom in the area. It wouldn't hurt to have the conversation, right, and so I went for an interview, and I continued to interview at academic practices and had several job offers from academic practices just because that happened to be what worked out that year, and I know that really varies from year to year, and it was an incredibly hard decision for me, and so I really liked one of the questions that came out on the last panel of what advice would I give to myself, and I'm really glad I had the conversation because I do think that ultimately, this has been a great fit for me, so things that I looked at when trying to choose, like I knew I wanted to be an interventionalist, love this, love that we get to do cool things, and that's what really motivates me, and I enjoy coming to work and doing those things. I'm one of five interventionalists in our group, so I represent the large group model. There are currently, I think, 51 physicians in our group. When I joined five years ago, I was the 26th, and so we experienced this massive growth post-COVID, and then, so there are five interventionalists. I'm one of five, and so when I joined the group, coming straight out of the fellowship, there was also some conversation about risk tolerance, and so you're still kind of trying to figure that out. There's a really big difference between like, yeah, sure, I'll do this really risky, interesting procedure because there's someone standing behind me, behind that plexiglass, and I can be like, hey, what do you think about this? I remember doing my first ERCP out of training, like, I'm gonna cut now, and there was nobody in the room that cared, and the tech kind of looks at me, and so that was a real reckoning for me, but the way that our group is set up, there are other interventionalists around me, so I have somebody that I can turn to. Like, if I have a difficult case that I can discuss with, I'm like our highest volume center. There are two of us there every day doing procedures, and so for me, knowing that I had that support transitioning out of fellowship was really important, and so that was something that appealed to me about the group, and then also, I think we've talked a lot about the work-life balance, which is another panel tomorrow that I'm also on, and so I have kids, I'm an interventionalist, I see my kid, I read to him every night except when I'm on call, pretty much, and so, yeah, I think just looking back at it, I ended up in this because I was willing to have the conversation, ask the questions. I trusted the guy who reached out to me. He has a lot of the same goals that I do in terms of what we like in practice and what we like to do. He might actually have a higher risk tolerance than I do, but, and so that was kind of how I ended up here. Thank you. Doug, you're a little bit, maybe tell us a little bit about your initial and maybe now, because we're gonna hear a bit more tomorrow. Right, I'm a little bit of a bent arrow. So I was very, very committed academics. I'd been in academic practice for 20 years. I was only one of two tenured full professors in the division at the University of Utah out of 25 faculty. I just recently had my 600th publication. I was very, very, very committed, and then when the University of Utah switched from salary to RVU model, it became much less appealing, and there were a lot of, there were other issues there, but that was kind of a big tipping point, and then I started thinking, well, maybe I should look at another institution, and then I went around the country, and I looked at a bunch of other academic jobs, and I came home, and I said to my wife, they all have the same problems. Like, why would I go there for the same problem I have here? I'll just stay here. And then I realized, I'm looking at the wrong jobs, and then I broadened my perspective very significantly, and I started taking job interviews at places I would have never considered before. I mean, I had grants, and then I ended up taking a hybrid position. I'm in Denver, Colorado. Technically, I'm an employee for Peak Gastroenterology, but I'm on permanent loan to Advent Health, which is a very large hospital system, and it's a true hybrid position. So I have medical students, residents, general GI fellows, exams fellows. I have a study coordinator. I have an IRB, but I get paid like a private practice doctor. So when I kind of saw that, I was like, time to go. So I left, and nobody at the University of Utah thought that I would leave, and then I gave my notice and walked out. So I've been there three and a half years now, and it was the best decision I've ever made in my career. Great. Tough bet. Yeah. Well. Like, if you're not happy, you gotta go. Don't stay, because it's not gonna get better. Correct. So I think, you know, sort of when you're looking for jobs, you have to be honest with yourself first, right? Pick the job that is the best fit for you and your family, not what you think your mentor or your program director would want you to take a job, because that's not gonna lead to happiness down the line. All right? So you are the most important thing first. So when I was looking, you know, again, thinking about interventional family life as well, I didn't wanna be in the office, in the hospital, past, you know, five, 6 p.m. And so I interviewed at a couple practices. One, they were super excited. Dana Farber was building, you know, an oncology clinic next door, and they're like, you know, I met with the CEO of the hospital. He's like, you'll be our first, you know, interventionalist. We'll get you all the brand new equipment that you want. I'm like, whoa, whoa, whoa. I am not ready to take on this endeavor. I'm brand new at a fellowship. I need a backup in case I need to phone a friend, right? So how I ended up in my current practice, again, not an advertised position. So this is where you really want to, you know, if you are looking at a particular location, see if any of your attendings know anybody there, make a phone call. A lot of job opportunities are not advertised, all right? It never hurts to cold call a place, email an office manager, email the chair of the division. You never know what's gonna open up. And so my introduction to my current practice was through a phone call. Wasn't even on my radar to look at Rhode Island, but said, hey, why don't you come on down? And someone had mentioned that, you know, it's really a mix of how well you interact with your colleagues. And I felt that click right away, right? Jobs, the stuff that you do every day, there's just gonna be different permutations of that. But, you know, are these people gonna be supportive of me? Do I feel like I fit in this community? And I think that's not something to be, you know, really understated as well. So what I do on a day-to-day basis, our full-time equivalent is four and a half days, and we all do clinical work. Rhode Island is a very complicated GI environment, so our private practice, which was a group of nine, a third of us are women, four of us do ERCP, and I'm the only one that does US. The other three ERCP docs are over 60 years old, so if anybody's looking for a job, general or interventional, come find me. And I would say about 40% of my office is, I still see office patients, and we actually take some pride in doing a lot of our own follow-ups instead of, you know, utilizing APPs, you know, NPs, PAs. I get a lot of patients that transfer to me. I, you know, I like my old doctor, but I could never get in to see them. I only saw them for the procedure, and then all I saw was the PA for a follow-up. Patients don't like that, especially for referring docs. You know, they send patients to you, they want you to see the patient, not some PA or NP who, you know, don't have the equivalent training. And so, Rhode Island being as complicated as it is, I have a clinical faculty position at Brown, so we don't teach fellows, but we do have residents and med students that rotate with us through our group. There is a separate group of gastroenterologists employed by Brown, a separate group of gastroenterologists employed by the hospital system known as Lifespan. They're kind of pseudo-merging, but there are only 12 of the core academic faculty. A little over a year ago, I also took on the role of chief of endoscopy at our hospital, the Miriam Hospital, so with that comes a lot of, you know, improvements in quality measures, and so now all of a sudden I am on leadership meetings with the hospital, you know, sedation committees of what do we do with GLPs and SGLT2s, and then someone decided, hey, you'd be a great person for the medical executive committee. Would you like to serve a two-year term? So I actually wear multiple hats in private practice, but with that said, it can all be done. My day starts at eight, so I'm a little bit different. I didn't want that half day. I wanted to get out of there at four o'clock every day to pick up my kids from school, so most days I'm out of there for 4.30, I'm done. What exactly was the question? I don't know what the question was anymore. How did you end up in your job? No, I'm trying to figure out how to flip it a little bit, but you know, kind of how you chose your current, probably for you, your current position, you talked a little bit about it, but maybe how you integrated all of your interests. I mean, in all fairness, I mean, academics is kind of what we're kind of growing up into, right, so it's a little bit more easier, and it's like, oh, this is what I want to do instead of looking out, because it's not like you get clinical training in a private practice group and hybrid groups and whatnot. So, you know, I don't want to be disingenuous and say, oh, this is all what I want. I mean, I went to medical school thinking I was going to be a general pediatrician, and now I'm, you know, other than being a surgeon, I'm like on the other side. So, you know, your interests change, and part of it, in all honesty, it's like how much in academics for me was it that I wanted to continue to try to be in clinical research, and not saying you can't do that outside of like a university system. You can, right, but maybe when you start off, you kind of have to feel more comfortable doing it in that system. So, you know, I just kind of just stayed with the whole university system, and that's how I stuck with it and continued to just build up my clinical research portfolio the best I can. Part of it was also, you know, I met Dr. Fishman really early in my career, too, and the networking, whether it's in academics or other things, is very important. Sometimes you've got to either take the call or, you know, make the phone call, too. I was introduced to Dr. Fishman by my, like, co-fellow that was graduating. Then again, if I took a phone call about 10 weeks of vacation, who knows? I mean, it's one of those things where, you know, certain things pique your interest. So, but it's one of those things where coming from somebody who thought there were going to be something else in their career and now it's something else, like if you keep your ears open and just your mind open, like when my mentor called me and said, do you want to join us at Cedars, and knowing what that volume and knowing what they do, and I was thinking, how come you're not calling your other adult GI trainees? Part of it, honestly, was just because of what they were looking for, not as much as say, oh, I want someone who could cut out everything and do this, more as a, you know, we think you would fit more in the academic culture that we want to continue to build, and really just the, just the group itself in terms of how we would fit in. And, you know, it depends on what kind of, like, open-mindedness versus, like, what kind of mindset, you know, the places you want to go to, that does make a very big deal in terms of, like, how your career may continue to unfold, as, like, one of the previous panelists says, like, who you work with makes a big difference, whether it's, because the culture is set by your boss to some degree, too, right? So, if you're working, you know, your hospital, like they said, if so, our system, the core group you're working with, it's not just the colleagues, your nurses, your techs, you guys all really work together well. When I was going to Cedars, I knew it was a good group, just not because of the faculty, but because of the staff around them, too. So. Thanks. Maybe we'll start with Mel, and kind of, what's a day in the life, or a typical day in life? Is there a typical day in life? I don't know. I don't have one, but. I don't either. It's hard to talk about a typical day in the life, because day to day is different. I have had one of those days where I drove to what is typically my home office, and I get there, and I'm like, look at my calendar. I'm at the wrong place, and, like, have to go over to the hospital. And so I have to check my calendar every day to kind of figure out where I am that day. So, for us, like, I'll just kind of, you know, a little bit to me, a little bit generally about my group, and try to answer the question. So, there are 50 of us. There are five interventionists. We have four transplant hepatologists, and then everybody else kind of falls into the general side of things. We cover, I should have thought about this, six hospitals. I only go to two of them. So, we only do interventional procedures at two hospitals, because it's really important to us that we maintain high volumes, that the staff has high volumes, and that we only have the surgical oncology, surgical backup of those two, happen to be trauma centers. And so, I do see patients in clinic. So, I do do some general GI. It's hard to kind of break down exactly what my percentage is. So, I have clinic. I have a lot of pancreatic biliary patients that I see in my clinic, but I have some general GI that I see in my clinic as well. I don't really see IBD or hepatology. If I do, I'll see them as an initial visit if they happen to get spaced, and then, like, we'll move them over to one of my colleagues that has that area of expertise, which is nice. And then, when I am at the hospital, I never have any general GI at the hospital. My days at the hospital are all interventional. And I have days at the hospital where I'm not one of the rounding physicians. So, we round once every six weeks. You'll have a rounding week. That's true for everyone in my group. And for me, I'm only ever scoping. Like, I will have some patients that I'm seeing in consult, but we have, one of our general GI doctors is like the consult doctor, like they're out rounding, seeing patients in the hospital the whole time and I'm scoping. And between might go up and see someone on the floor if they're having a complication, but it feels very similar to what I saw during my life as in academics as well, in that sense at least. I have days where I do general GI endoscopy, where I'm doing colonoscopies in one of our endocenters and I have like a 90 plus percent female population, kind of similar to what Ashley was talking about too. In our group, the breakdown ends up being, I think we're like 30% female from a practitioner standpoint and so those of us that are female practitioners end up just getting a lot of the female patients on our schedule just because they self-select toward that. The same is true for my clinic as well. I take 22 nights of call a year. I'm on ERCP backup more than that. I think I'm on ERCP backup, any week that I'm in the hospital, I'm the ERCP backup person. And I never, wherever I start my day is where I finish my day, which I think is a little bit different than some private practice models. And so if I'm in the office, I'm in the office all day. If I'm at the hospital, I'm at that hospital all day. Like we've tried to be very intentional and thoughtful about staffing appropriately because that can be a big drawback to quality of life of you're in the office, then you have to go to the hospital and see patients or whatnot and that's not how my particular practice is set up. Largely, I think because of our size. And so that's one of the benefits to being in a large group model is the economy of scale in terms of what we can do from a staffing standpoint, from a negotiation standpoint, from our hospital contracts, insurance contracts, things like that. So. You have 30 people in your group, something like that? 50. 50. Do you see half of them most of the time, some of the time? Great question. So of the five of us that are interventionists, I see them all the time because there's always two of us at our main hospital. And so we get to see each other a lot. And there are some of my general GI partners that I don't see as often. I see my hepatology partners all the time because they're also always at that hospital because that's where we do most of our like more complicated liver patients end up being. Then as far as the rest of my colleagues go, no, because we have like we have six offices throughout the like Columbus area, but we have journal club once a month where we get together at a restaurant and we have like a different focus each month. There's an esophageal journal club and interventional hepatology. And so I see them then. I see them at our partners meetings. But in a clinical setting, there are some that I can go a long time without seeing. Doug, how about you? So I'm like a farmer. No, it's true. I'm up at four. I'm up at four every day. I'm from four to six. I work on GIE and I work on my publications and my research. And I'm typically in the hospital by 6.30. First patient's consented at seven. Scopes in at 7.15. I do about 10 to 15 advanced cases a day. I often post my schedule on Twitter so you guys can see it. I only work four days a week. I work Monday through Thursday. We're typically done by about 5.30 or six. And then I'll come home, eat dinner, and then I'll typically exercise. Like I ride a bike pretty religiously. Put GIE to bed, check on GIE, make sure it's okay to go to bed. That's what I call it. I say to my wife, I gotta put the journal to bed. And then I'm in bed, lights out at nine. That's how I get up at 4 a.m. Because I've been in bed for seven hours. And then on Fridays, I'm off. I don't go in ever on Fridays. And on Fridays, I work on research, GIE, and I do consulting. So it's pretty busy. I mean, I do, because I work four days a week, I'm still 100% FTE. So I have to produce a full week's work in four days. Right, so they don't say like, oh, you just have to hit 80% of your RVU target. I have to hit 100% of my RVU target in four days, not five. Doug, can you actually also talk about the general gastroenterologists in your group as well? Just because I know we're interventional heavy, mainly because of the hands-on sessions. But if you can specifically talk about the general GIE for them as well. So our group is spread across a couple of states, and there's multiple practices in the state. So I think there's like 30-something of us in peak overall between Colorado, Wyoming, and there's one other state. So when I got there, I was the first to do the four-day-a-week. And then other people were like, hey, how come that guy, because in life, you don't get what you deserve. You get what you negotiate. So I negotiated a four-day-a-week schedule. And then other people, including general GIE, started saying, I want four days a week too. So I actually, for better or for worse, I affected the group in that way. The general GIs tend to do three days of scopes, two days of clinic. I do three and a half days of scopes, one half day of clinic. And I almost exclusively see new patients. So my nurse practitioners see all the follow-ups, pretty much most of them. It's very, very busy. And we all kind of cover the floor every day. Like in our hospital, our hospital is about 400 beds. So all of us are kind of covering the floor all the time our nurse practitioners or the fellows see the consults first and they kind of know like, oh, this should go to this person or this should go to that person. So like, we're kind of all on call for the floor every day. And they just kind of know like what to bring us based on our interest and expertise. The general GI people, they aggressively pursue the call, right? So that's like, the call is paid. That's a big difference in academics. You're just on call, you just suck it up. And a lot of private groups, you get paid to take call and it's very significant. So like, I don't do any general GI call, but like, if somebody ever says like, hey, I can't take my call, does somebody want my general call? It's like sharks, you know, when there's blood in the water, like everybody wants the call because it's so, it's such a big deal. Thanks, Doug. So we're gonna transition now to take some questions. I'm gonna also invite Stephen Kaptick from GI Alliance down to take my seat. Can I just make one quick comment before we transition? The part about private practice that sets apart is, every private practice is different in how it's structured. It's usually you sign a contract for generally two years as an associate where you earn a salary. It's a trial period for you and your potential group that may offer you partnership. Just be careful when you sign that initial contract, some questions are how many associates ultimately get offered partnership, stay on for partnership, right? You wanna watch out for the groups that will just turn through associates and never offer you partnership. Does the group own their own surgical center? That could be something that is very lucrative for your potential buy-in. Do you own real estate? What other ancillary income are there? So I think that really is a different aspect of private practice and all models are different. Some are very much eat what you kill. You have, I used up a ream of paper. It's gonna come out of my own billing. Some private practices like our group, we're shared everything. So we share our overhead entirely. I'm happy to chat more after this is over as well. There's so much to say about interviewing with a private practice and I have lots of comments about it. I have to catch up because these guys got a lot of extra face time than I did, but I just start off. I went to med school at Vanderbilt, residency in Colorado and fellowship at University of Tennessee. I am a medical GI hospitalist. I've never seen a clinic patient in private practice. I don't have to do any research. I don't live my life like a farmer. I try to stay up as late as possible, hopefully with a glass of wine, doing admin work and putting my kids to bed and I try to go in as late as possible in the morning. Never start a case before eight o'clock. So there's different models all around and you'll find what works best for you. But there's also the one thing that Dr. Adler mentioned, you have to understand if you're a different model as a hospitalist, I can never get paid the same amount as someone who's sitting in an endocenter churning out 18 screening colonoscopy a day. So you got to make sure when you come into your model that you know where the money is and you are paid equitably for what you do. And so I have to take care of the sickest of sick and do crazy patients that I'm never gonna get that kind of volume. So what do I need to do to make sure I protect myself? I get paid the average salary of our clinic partners. And so my role there is I don't have to worry about do I need to get that next EGD on to pay the mortgage? I know that I'm getting paid no matter what. I can focus on taking care of these really sick patients and my partners don't want to come into the hospital. They don't want to step foot in there. They don't want to take care of a bleeder or do an ERCP patient. They want to sit and churn and burn in the endocenter. So there's different models for everybody but ultimately you got to figure out what works best for you. We have a couple questions from the virtual audience. The first one is a little bit geared more towards private practice. So do you ever do research as part of private practice? If yes, what type of research? And then does it always have an affiliation with a hospital and always associated with inpatient time? Yes, so that's a great question. So usually in private practice, if you do want to do research, nobody's going to stop you from doing it but it's all on your own time. You're not going to get protected paid time to do research. One of my partners, IBD is a specialty, Samir Shah. So he was actually the recent past president of the ECG. So even in a private practice model, you can certainly become successful in that realm as well. And now with GI Alliance and maybe some of the GI Alliance folks can speak to that. There's a lot of great research opportunities that are coming as well. And again, it's all optional. It's not mandatory. If it's something that you still want to do, it's definitely something that's still possible in a private practice setting. We have, the GIA has a nationwide research pipeline. We're trying to make sure that we open it up to all the divisions. Locally, we have an IBD center of excellence. So we have a lot of IBD studies going. We do have a medical director of our research program and we do give them some dedicated time and compensation for that because it benefits our patients and it benefits the group, but it's not like standard at every location you're going to be at. Even in our academic centers, I mean, when we do multi-center research and even our U01s, we're collaborating with a lot of our colleagues in the region. I mean, we collaborate even with like Kaiser is, I mean, they're a huge system. So many patients. So it's not just academics, it's the Kaiser system, the private practice that sometimes in your systems are now being associated with. So it's, you know, you could do research. It just depends on the situation and the environment you're in. And I would answer similarly, like there are lots of research opportunities available. We also have a medical director for research that runs all the clinical trials that our group is participating in. And because of our volume, because we are so big, we have the ability to collaborate with academic centers and things of that nature, but it's not selective in anything. You can choose to do that. Your promotion or anything else isn't going to be based on that, but it is going to be on your own time. It's also really important, like the word research is being thrown around here and it means extremely different things in different contexts. Like for example, in most private groups, research means a vendor comes to you and says, hey, we want to enroll patients into this trial that we've done all the work on. We'll pay you X dollars per patient you enroll. Whereas we're in an academic setting, it's more like investigator initiated. Like you think of a project, you write the IRB, you do the study, you write the paper. So those are completely different kinds of research. So like that's both research, but that's very, very different. I'll just make another comment that we kind of try to pigeonhole even ourselves into this model of clinical research and education where advocacy, quality, male mentioned. So there are these other branches now within what we do and I don't even know how you put an editor into that mix now, what category that would be in. But it's not just the old school triple threats. We've got quadruple and quintuple threats too. So great. Other questions from the group? Yeah, I mean, I think we're closing it. Oh, sorry. I just have a quick question for a GI hospitalist gig. It sounds like a really appealing job. Some things I guess I would have hesitation towards is because you're doing only inpatient, can you comment on doing that right out of training? Because outpatients are, I guess, easier scopes and where you learn the most from and you can kind of build your volume that way. So is this something that you did right out of training? And can you comment on if that's something you would recommend or something maybe down the line? The answer is it depends on you. I came out, I went to a three-year fellowship program but I got ERCP trained. There's not many places that do that anymore. And I kind of looked at it as I said, this is a good opportunity for me to get high volume right away and feel like I can really not lose those skills and feel like I'm not comfortable to do it. So that's how I looked at it. But I always knew that I had people behind me who had done many more scopes than me. At that time, the ASGE president was in our group and so I felt like I could say, hey, this ERCP might be a little bit complex, can you just, I'll put it at the end of the day and you come up and be my backup for it. And so I think as long as you know you have some backup, it's fine to do it right out. But you wouldn't wanna go someplace and just be like, oh, we need someone to do ERCP and we don't have anybody, you're gonna be the person right out of the bat or you're gonna have to take out that five centimeter right colon polyp day one. Maybe not the best practice to be in but definitely find that kind of overall setting that works best. Most of the programs now with GI hospitals have multiple people there, so you can do it. Great. Yeah, I think. We have like one more question from the audience. Oh yeah, great. So this is a little bit of a varied question and maybe each of you can just say what, from your own practice, what both the interventionists and the Gen GIs do. There is a question about could you discuss salary and how many hours you typically spend at work and then how it's split between clinic and endo. And if you don't wanna talk about salary, perhaps you can talk about like what specifically or how you're paid, like what are you based model or something like that, salary, and then how your time is split between endo and clinic. Rapid fire. Rapid fire. So academic, coming out, we all hear you don't get paid on the lower end and honestly, that's not untrue. But it does take time. So in academics, it's varied. There's RVU places, I'm salaried. I hit a certain RVU mark that's, frankly, it's not difficult for us because we're interventional GI, but in some of my other colleagues who are more IBD based or motility based, it is more difficult for them. But and their RVU level is different. Like of course, our RVU level is higher. And then every academic place may have different incentives. Like the previous institution I was at, no bonus structure. My current institution, I get a bonus once I hit an RVU and then once I hit something else and hit something and then there's a plateau. I mean, basically after a certain RVU level, you don't get more basically money. And we hit our RVU levels before the academic years end. And then, so I think it's all different in terms of where you are in all frankness in life because my junior person wants more RVU base and honestly right now, I don't. So it really just depends on where you are and everyone has different financial basically situations. I don't know what an RVU is. So it's true. So in my practice and true for a lot of private practices, and it's very regional dependent as well, depending on what part of the country you're looking for to settle in. The initial associate salary for private practices can be a little bit lower than for example, hospital employed groups, large multi-specialty groups. The caveat is once you hit your full partner buy-in, your income increases. It can increase a lot depending on are you getting now distributions from your cervical center. If your group owns a surgical center or multiple surgical centers, is your group only 100% of that surgical center or are you sharing it with other groups, et cetera, other streams of ancillary revenue, pathology, anesthesia, that all factors into your final salary in private practice. I think our group, we don't work too hard. We value work-life balance. We see new patients are booked for 30 minutes, follow-ups 15 to 30 minutes at your discretion now that we can bill by time. My IBS patients, great. I will sit there and chat with you for half an hour gladly. And our surgical center is very efficient. So 30 minutes for colons, 30 minutes for EGDs, 45 minutes for doubles and we're very much on time. What else? Yeah, that's probably private practice in a nutshell in terms of payment structure. We are a base salary. You have an RVU target. RVU is a relative value. Yes, yeah, I never had to go, yes. I think she actually was joking. In terms of how it would affect my income. I'm gonna teach them about RVUs tomorrow, so we're in for it. And then when we hit our target, you start to move into bonus and then you get a certain dollar amount per RVU and then as you hit other targets as you go, the amount you get paid per RVU rises as the year goes on. So like some people kind of really, really pour it on those last few months of the year. Because you can't, no, it's just true because you've hit your goals and you're kind of in like the sweet spot of that graph and you're approaching the asymptote and people just like, I mean, put them on the schedule, put them on the schedule. People go kind of crazy in the end of the year. So I think that my answer is probably pretty similar to Tien's. I have no idea what my RVUs are and I don't know how productive I am. We are, which I thought was unusual for a private practice group, but we're a shared profit model and so I get a salary, then I get paid every two weeks and then we get distributions quarterly from our clinical side and from our endoscopy side because we own all the things and that's the vast majority of my income is from that. I think that the nice thing for me as an interventionist going into private practice is so because I'm not productivity based, like I can do a three hour ERCP or what have you and it has no impact on my earnings. I will earn the same as somebody who's in one of my endoscopy centers doing 18 colonoscopies. And so it actually works very well for our group. We're very selective in who we hire because we are a shared productivity model and so for somebody who is not motivated and who doesn't pitch in and help out, like you can potentially benefit from that structure, but so far we've been very lucky and have not had that issue. We have a very collegial, when the team wins, everyone wins. Our goal is to take good care of our patients and go home and have dinner with our family. When I started 15 years ago, our model was kind of when you came in as an associate, you were getting paid kind of below market and it was that whole you gotta pay your dues for the fact that you're gonna make so much money in the future and get to buy into all these ancillaries and times have changed and now we have our model is more of we wanna have our associates be paid market value just similar to what you'd get in an employment model from the hospital but then have all the benefits that when you become a partner then you have access to the ancillaries so we can recruit better, we can provide people that you're all young, you're coming someplace new across the country and you wanna buy a house, you wanna start a family, you're not feeling like you're getting screwed up front and have some of that money in your pocket so it's a little bit easier to make that transition and we wanna invest in these people as being the long-term fix. As an associate, there's usually a productivity bonus. You're never gonna meet that when you're in the hospital. But as partnership, from a partnership standpoint, it's the eat what you kill model. Everyone you see, you bill for it and whatever your receipts are, that's what you get and so for me as a person who makes the average, I encourage all of my other partners not to take any vacation, to work on their days off and to do as many colonoscopies as possible because then I make more money. Well on that, we're gonna end this session.

gastroenterology

career models

private practice

academic practice

hybrid practice

work-life balance

compensation models

interventional endoscopy