All right, guys, so the purpose of this session is, it's called, which practice setting is best for me? And so we just want you guys to get different perspectives, right? So Paul just gave you your private practice perspective, I'm going to give you a little bit of a talk on academics, and then Linda is going to talk about being in a large group practice. And there's no right or wrong here, as he mentioned. It's really about fit, and many of you may go from one to another, from one practice setting to another practice setting over the course of your careers. And so I think it's helpful just to get different perspectives. I know there's a lot of third year fellows here. Of the third year fellows, you guys have, how many of you guys have jobs already lined up? A few. All right, good. Good. And I still think it's relevant for you guys, because if you have a job in, say, academics or private practice, you can hear more about it. And if you decide later on in life that this is not the right fit, and you want to make a jump, you can always do that. All right, so I'll talk briefly about academic medicine, because I do want to get to the panel as well, and then I'll open up to questions. All right, so just quickly, disclosures. All right, so academic medicine is defined as a branch of medicine pursued by doctors who engage in a variety of scholarly activities. And you guys all know this, right? You guys are all fellows. You guys are basically in academic environments all the time now, and have been so during your training. Typically involves research, teaching, and leadership. And there's no one role that's identical, right? So academic MDs, if you see, are mentors in GI or internal medicine. They have multiple responsibilities. They all do different things. Yes, they take care of patients, but after that, they have a lot of other responsibilities in addition to their clinical care that you've probably noticed, which I'll go into. So academic medicine, I think you look at this at this Venn diagram, right? There's the patient care component, right? We are physicians after all. There's the medical education component, right? You guys are fellows. We have to train GI fellows, residents, med students. There's a research component, right? Many of us do research, publish. And along with that comes taking care of complicated patients, right, in academic centers, training future physicians, and then the ability to do innovation and research. And just briefly, there are a bunch of different tracks that are available now in academics. Physician scientists, the clinician, clinician scholar, clinician administrator, and every institution is going to be different, right? So this is not specific for any one particular place, but these are the tracks that are now typically available at most academic institutions. So there's one, the physician scientist, which is somewhat clinical, but mostly research, and you have to attain research funding in order to continue your careers at these places. There's the clinician, who's essentially full-time clinical, right? There's really no expectation to do research. Their job is maybe to take care of patients at an academic center. They may teach fellows if they come and rotate through their clinic or on inpatient service. There's the clinician scholar or the clinician educator track. It's 80% clinical. You still have to produce some research. It's typically some sort of clinical research, whether it be case reports, you know, presentations at DDW. You've got to give papers, publish papers, give talks, so I'm somehow involved in the fellowship program. And then there's this clinician administrator track for clinicians who evolve more in the hospital system, right? And that's their role. So getting into research, teaching, and leadership, all this has to be balanced against clinical demands and RVUs, right? So RVUs are relative value units. You may have heard about these units. This is how they measure productivity for physicians. I won't go into much detail today about it. We have a talk about it tomorrow, but the idea being this is how you're compensated nowadays, right? It's not about how much you publish necessarily. A lot of times you're being compensated based on your clinical productivity, which is measured in RVUs. The start-up packages with protected time are much leaner, focused, and often contingent on translating the research into money. Researches and opportunities have contracted over time. There's no tenure available for most places now unless you're on a research track. And academic promotion generally depends on productivity, again, it could be clinical productivity or academic productivity with publications. So what to expect? You have to do work, you have to teach, you may have protected time, especially if you're doing research, but the expectation is that you will eventually obtain independent funding. You'll get some research support, administrative support, obviously get a salary and some benefits, and then there's a link to promotion based on which track you're in. I'm going to go through some of this quickly because I want to give the panel more time. So you can't play the game unless you know the rules, all right? So if you're going to academic medicine, you've got to know the rules of promotion so that you can get through it and stay in academics, right? So make sure you know the own institution's rules for promotion and tenure. Again, many places don't give tenure anymore to clinical faculty. Excellence typically plays a lot of value on research publications and requires excellence in your field of promotion. So from an assistant professor to associate professor to professorship, you need to meet certain criteria. So for clinical excellence, you want to do proper training. We talked about this in the last session. If you want to do advanced training in hepatology, IBD, advanced endoscopy, you want to maintain your skills. So you want to go to a place where you can keep up those skills, develop a niche, whether it be a disease process or a particular procedure. And you want to be able to acquire new skills, right? I think that's what you're hearing from the panel as well, right? That over time, you don't want to just be narrow-minded and do the same thing over and over again. You want to try to gain skills over the course of your career to keep yourself relevant. In terms of teaching, you want to master a topic so you can teach, say, the fellows. Requires patience. So I'd say, particularly now as fellows, remember what your experience has been. Remember that first time you scoped. Remember the first time you had a complication. The first time you had a complicated IBD patient. Because when you become an attending, the number of times where I say, oh, when I was a fellow, I remember going through this experience. I think it makes it particularly relevant to the fellows as you try to teach them. It requires time and effort. So teaching takes time. You could always do the procedures faster on your own, right? But teaching requires you to have the patience to teach the fellows. Innovation, in terms of teaching, and expect more from your students, but be prepared for less, right? And that's just the idea that I think we all have this expectation of what the fellows should know or should know coming into the training. Not everyone's had the same experience in the past. So be able to kind of bring up the whole group, start, assume that everyone knows nothing and kind of teach them as you go. This is research talk. You need mentorship in your environment. So if you're going to do a research career, you want to have strong mentorship wherever you go. And you want to assess the environment in which you're working, right? So do you have the patient population you want to work with, are you able to get samples and procedures, collaborators at that institution, what databases are available, need to write grants, need to publish, and requires determination and persistence. So last few slides, you want to build your reputation in academics, right? So you want to share your experience at local conferences. So for example, we have a UCLA GI conference every year we put on for the community. So putting your name out there by presenting at this course or at DDW, accepting speaking invitations, volunteering for committee assignments like the ASGE, try to develop your own niche, and then collaborate widely. So just some concluding thoughts on academic medicine. So academic medicine may be the ideal job you were imagining when you first decided to go into medicine, right? I think a lot of us, because of the experiences we've had as internal medicine residents and fellows now, I think you look at your mentors and say, this is the type of job I wanted, right? Think about your personal statements you wrote for GI fellowship and why you went into this field. I think a lot of us think and only know academic medicine at this point in your careers. There's no single model for a successful career. So if you understand what to expect in the promotion criteria at your institution, contributing to your field is gratifying, right? That means including teaching fellows, doing research, and taking care of your patients. And ultimately, you want to follow your passion, right? Do what you think is best for you or you think is right for you, depending on what you want to do with your training. And that's it.

practice settings

academic medicine

roles and responsibilities

tracks within academic institutions

promotion criteria in academic medicine