Welcome to ASGE Endo Hangout with GI Fellows, Job Search and Contract Negotiations, Part 2. We have attendees joining us all over from the world, and the American Society for Gastrointestinal Endoscopy greatly appreciates your participation. My name is Ellie Vergara, and I will be the facilitator for this presentation. Now it is my pleasure to introduce our two GI Fellow moderators, Dr. Neha Hingorani and Dr. Jessica Damos, who just completed her fellowship as of yesterday. They will help facilitate the incoming questions. I will now hand the presentation over to them. Great. Well, thank you for the lovely introduction. Good evening, everyone. I'm Jess Damas. I first want to thank the ASGE for hosting this webinar tonight, to our panelists for participating and for showing their dedication to fellow education, and for everyone joining tonight. As mentioned, my name is Jess Damas. I completed my fellowship at Penn State Hershey and General GI yesterday, and I'm also boarded in obesity medicine and will be joining faculty at Hershey in the fall. My name is Neha Hingorani. I'm a third year fellow at Memorial Sloan Kettering. It's my pleasure today to participate in this as well and to co-moderate with Jessica and help facilitate passing the questions along. Now to introduce our panelists for today. So I'll first be introducing Dr. Jennifer Marenke. She is a professor of medicine and director of endoscopy at Penn State Hershey Medical Center, where her practice focuses on interventional endoscopy. She is active in the ASGE and is currently on the Educational Curriculum Council and the director of the LEAD program for 2021. Also joining us today is Dr. Mohamed Bilal. Dr. Bilal is currently an assistant professor of medicine at the University of Minnesota and an advanced endoscopist at the Minneapolis VA Medical Center. Dr. Bilal is passionate about medical education and completed a formal scholars in education program during his fellowship. He is a strong advocate of the use of social media in the medical education and advocacy as well. And finally, I will introduce our moderator, Dr. Delia Kahlo. Dr. Kahlo is a GI hospitalist, the associate program director for the GI fellowship and director of inpatient consult service at Memorial Sloan Kettering. Dr. Kahlo will now take over and introduce our topic for tonight. Thanks so much, Jessica Neha. Welcome to the second part of the ASGE session on job search and contract negotiations. The first part was discussed at the ASGE DDW fellow session. We will start with a presentation and then begin to answer audience questions. Please type your questions in the bottom of your screen in the question and answer section. You can begin typing them at any time. I will turn the screen over to Dr. Bilal to begin our presentation. Thank you so much, Jessica Neha and Delia for the kind introduction and the ASGE for having me and Dr. Moranke here. So today's goal is going to be discussed job search and negotiation. That's a topic very close and dear to all of our fellows as well as us who are involved in training fellows because truly it impacts how the future of our specialty goes. So the objectives of this session today is going to be to discuss how and when to begin the job search, how to find practices or institutions that may be looking for early career gastroenterologists, learn how to prioritize your needs and wants when looking for a job, discover what makes a job a good fit for you and vice versa, and how to go about the negotiation process. So the most common question that comes is, when do you begin job search? And the answer is, it's never too early. But when I say that, I also want to stress for those who are in their third year of fellowship or even the last six months of fellowship and you don't have a job search, you don't have a plan, that's also not late. So in your third year of fellowship, or if you're doing a subspecialty fellowship, like an advanced endoscopy fellowship, an IBD fellowship, a transplant hematology fellowship, that's all totally okay. I always tell our fellows and everybody who calls me is that I don't know any gastroenterologist who's unemployed. So we're grateful and lucky to be in a specialty where, where there's where we always there's always need for us for our patients in some place in the country. So that's just some reassurance if you're if you're if you think you're late in the in the job search game. So before you start job search, I think the most important thing is to define your goals. And you know, fellowship, you know, goes by in a way and we're all clinically busy trying to research, you know, or have work life balance. And before you realize it, it's time that you're, you know, thinking about my gosh, it's six months in one year, or, you know, I'm going to be an attending. And what do I really want? So what do you really want? You know, in your Do you want to do academics, do you want to do a private practice? Do you want to be, you know, is there a focus in a specialty that you want to do? Do you want to do like GI focus more on motility? Or do you want to be a GI hospitalist, for example, so you want to really focus and see what your goals are for a career and try to talk to as many people as you want or can to try to figure out try to understand your faculty and your mentors and how they're, you know, how they came by their decisions about their jobs and what sort of opportunities are available. And even though I'm an academics, but, you know, I will say that as fellows, sometimes I've noticed that people have a biased opinion about what academics is or what private practice is. People think academics means that you have to do research. That's not necessarily always true. And, you know, academics involves education, involves research, it involves taking care of complex, you know, clinical care that happens at tertiary care centers. So just because, you know, you're not interested in research does not mean the academics might not be a good fit for you. And similarly, if you're interested in all these three things, and even if you want to do research, you can still do research in private practice as well. So I think important to understand all those things and talking to people would really help. The second thing I think which is one of the best advice someone gave me is that you want to make a list of absolute needs or wants in a job. And the reason I put this, now it's my time is that this is probably the first time when you are going to be able to actually, you know, make like a full choice because now, you know, in med school, it's so competitive, you're just, you know, willing to get in where you want. And same for residency and same for fellowships. So this is now where you are actually, you know, have the choice to go where you are. So it's your time now. So make sure you get your list of absolute needs and wants. So for example, you know, if I'm an advanced endoscopist, and, you know, one of the needs that I have is that I absolutely want to start an ESD program. So I want to make sure that I am going to a place where I'll have the support of institutional departmental, you know, resources, equipment to start that. Similarly, if you're going into in, you know, if you want to go and you want to be like, I want to do a pure IBD practice, do you have an infusion center? Do you have a practice that will make sure that the patients that come to you are filtered to their IBD patients, and you're not going to be doing general GI or, you know, if you want or vice versa. So make a list of things that are absolute, you know, is if you're doing an academic job is a protected time, an absolute something that you need. So for example, if you're doing basic science research, you know, that might be something that you absolutely need. Do you need a research coordinator? Do you need, you know, so all those things are important. Then obviously, geography plays a big part into it. And then figuring out whether, you know, some people might be like, you know, I just want to stay in the East Coast and everything else is secondary versus some person would be like, I really want to have this kind of practice and location is secondary for me. And then work life balance. And, you know, you know how it's important for everybody or strongly encourage everybody to have work life balance. But there are obviously some jobs, you know, they can be part time or you could be doing four days a week or three days a week. And all that is OK if that's important to you and your and line up with your priorities. So making sure you really know what you want, because once you if you don't know what you want, you're going to have a hard time asking for it. And we're going to cover this soon. Dr. Moranke will go over all these negotiation tips. And then the other most common thing people ask is, like, you know, how do I start? Where do I find jobs? So, you know, it's it's it's not like a one shop all as there's no ERAS or or NRMP website where all the all the jobs are listed. So there is I'm sure there's other resources, but these are some of the resources that I used. So there are professional websites and I have no conflicts or to promote any. I use the website called Practice Link. And there are similarly other practice match other websites that have listings of jobs where you can actually put filters. Like, for example, if you only want academic jobs or people who have issues with visas and put filters such as those through those jobs, you will notice that a lot of recruiters will contact you. And this can be overwhelming. So, you know, you can have a non email that you don't really use every day to maybe list that email so they can contact you so you don't get like a slam. And remember, these recruiters are there to help you. So and your time is valuable and they're usually very flexible. So don't. So it's OK to say that, you know, I'm only available from this hour to this hour. And if you can manage it, that's fine. Otherwise, someone else can can can can reach out to you. And the networking, I think, is extremely important. You know, GI is a small community. So nowadays, you know, social media is an excellent tool to reach out to people. I see a lot of jobs being shared on on Twitter, on LinkedIn. Then this past year, obviously, unfortunately, we couldn't have in-person meetings, but otherwise that DDW meetings, ACG meetings, other GI, even regional meetings. There are sometimes career fairs. There are listings for those jobs and also meeting with people. So, for example, if you're really, really interested in doing academic practice in the Midwest, so meeting with the division chiefs or director of endoscopy or director of IBD or hepatology in those in those institutions and talking to them about ensuring your goals can go a long way. And you never know where an opportunity might lie. And if your goals align with someone else's goal, people can sometimes create opportunities for you. So never hesitate to reach out to people. You know, you can email them in advance or just go and formally introduce yourself. You know, this stage of our careers, we're all colleagues. So a lot of majority of people are very acceptable, especially in these meetings for other people reaching out and networking. And then word of mouth, you know, stay informed, ask your mentors about about these. And then our professional organizations, you know, the ASGE, the ACG, the AGA, they all are excellent resources. There's a lot of ads that come through their magazines, their websites. So so if you're not members of those societies, this is good incentive to be amongst all the other benefits that you get from societal membership. And what do you really need to apply? I put all these things here, but I just want to make a point, you know, you obviously need a CV. All of us at this point in our careers already have it. You know, keeping it up to date is generally a good idea. And those work. A letter of interest was something that a lot of people told me that you need. But I've realized that you don't really you know, that's not a must. But if you're if you know what you want and that's OK, but I don't want to add additional burnout on preparing some of these letters and state personal statements, because I know that these all add up and we've been doing that for years in different stages of our careers. And then references. This does not mean that you need like a formal letter of recommendation from your program director. Like I said, it's a small community. So people will know people. So, you know, you're so so have three or four mentors that you know, that you work closely identified. So if someone asks for references so people could easily call them, reach out to them, someone that you know would would be accessible and available to pick up the phone and and answer any questions that an employer might have. Those are just pretty much all you need to apply for a job. Much different than than from a fellowship application. I'm going to hand it over to Dr. Moran. You will go over some of the principles of negotiation. Thanks so much, Dr. So I'm going to talk about a few key points about negotiation. And it's important to recognize that you will negotiate. And this can be an uncomfortable thing for many of us. For many of us, this is our first time negotiating anything really in life. And so it can be very intimidating. I think you should just kind of recognize that this is part of the job process. And this is actually a way for you to get what you need out of your out of your job. So prepare accordingly and use all available resources. And I'll get into that in a little bit about what those resources are. It's also important to look at the negotiation process as, you know, the the the team or the group or the person that you're negotiating with is your partner. It's your negotiating partner. Right off the bat, things should not be adversarial. You want things to be mutually beneficial. And it's also really important to identify who is the person who has the power to grant you what you are asking for. Right. So if you're having lots of conversations with, you know, say it's a private practice group and you're meeting with a bunch of the partners, you know, who are saying, oh, yeah, that that totally sounds reasonable. And yeah, this sounds great. But if they're not the managing partner or potentially an administrator of the group, they're not the people who are actually able to decide what kind of deal you get. So it's important to identify who that dealmaker is and then do your negotiations with that dealmaker. It's also key to show that you're a good person and you're negotiating in good faith. You're not trying to take advantage of anybody or, you know, get a supreme deal. It's going to be a raw deal for the other side. You want to negotiate in good faith and with integrity. One of the things that I think really kind of goes unnoticed when in the process of negotiation is being a good listener. So they're listening to you about what you are looking for and how you want to start your career trajectory. But you should also listen to them about what they need and what their expectations are and what your day to day is going to be and what their day to day is currently to really determine if this is even a job that you would like to pursue. You want to work towards a win win situation for both parties so that everybody feels good about this. Right. You don't want to be you don't want to start things off where your employer thinks that they maybe gave you too much or that you're getting a sweet deal because that's going to they're going to think of you in a negative light right off the bat. And so you want things to be a win win situation for both for both people. It's important to build a rapport and understanding with your counterpart, with your negotiating counterpart to help achieve an agreement. So what are some of the things that are negotiable? Right. So, you know, we always just think it's salary. Right. So salary is definitely negotiable. But, you know, I'll tell you, it's probably not the number one thing that defines a good job. So you want to ask around. Right. And a lot of there's a lot of regional variation in salary. There's differences between, you know, being an employed gastroenterologist, being an academic gastroenterologist, being in private practice. You know, how is your salary going to be determined? Are there guarantees? So for the first year or two, a lot of times there are salary guarantees that are independent of any RVUs or revenue that you might bring into the practice. And so it's important to determine, like, is that starting salary that's guaranteed? Is that even achievable after those, you know, after that first one or two years? Right. So what are the RVU targets that would be commensurate with that salary? Because if you're if you negotiate for like a super high salary, but then, you know, definitely want to have your Fridays off and definitely want to be out by three when you finish that period of time where things are guaranteed, you won't actually be able to maintain that salary. So you want to you actually want to be thoughtful about what kind of salary you're asking for and whether or not that's an amount of salary that you want to work for. And so that's obviously one of the one of the key things. And it's also important to determine, like, you know, if you can, what are other people getting in that position? Right. What are the partners making? What are the people who aren't quite yet partners making? If you're in academics, wouldn't it be great to know, like, what the what the starting salary of an assistant professor is in your institution for your specialty? It'd be really important to have that information. And a lot of times that information is not readily available. So if you can get it, you should try to get that information to use it in your negotiations. And then probably the second biggest piece is employee benefits. Right. So, you know, is your health insurance going to be paid? That's a huge chunk of money. You know, what about life insurance, malpractice insurance, things like that? Are they contributing to your retirement? Is there a retirement program? Is there an associated match with that? If not, can there be can there be an associated match? You know, are there any tax benefits associated with being in your position? Is there a tuition benefit? Right. So if you're at an academic institution and you've got either yourself who wants to have additional education or a spouse or children, is there a tuition benefit that goes along with working at that academic institution? And is that transferable to other institutions in the state or things like that? Those are all things that are important to consider. Are there child care resources available to you? Is there emergency care needed? You know, if you've got a kid with a fever and you've got to come to work, are there resources available for you so that your child will be taken care of even if they're not feeling well and can't go to daycare or school or things like that? Just some of the things that can potentially make your life a little bit easier. How much vacation time do you get? Right. So if you're if you're at an academic institution, a lot of times you'll get a set amount of vacation time that doesn't roll over from year to year. So you kind of use it or lose it. You may be able to negotiate for additional vacation time or CME days. What about, you know, CME money, CME funding so that you can attend different conferences or, you know, continue to advance your education? What kind of resources are available? And those are all things that you can negotiate. And if they say, yeah, you get you know, you get two thousand dollars a year for CME. Well, you know, you can always ask for three thousand dollars a year because you have specific goals or you're looking to gain additional skills that might require, you know, say, hands on training at the ASGI T&T center. You can try to get that rolled into some of your benefits. And then, you know, probably the most important thing is your schedule, right? Like what's your day to day going to look like? How many hours a week are you going to be working in general? Is that five days a week? Is it seven days a week? Is it four days a week? You know, what is that schedule? How does that work? And then, you know, another thing is since we're gastroenterologists, we work in a procedural field and there's a difference in the number, the amount of RVUs that are generated by a clinic day versus the RVUs that are generated by a day in endoscopy. And so you want to negotiate for what you think is a fair, you know, a fair mix of days in clinic versus days in endoscopy because that will, if you're in private practice, will ultimately result in a difference in how much you get paid and potentially even in, you know, paid jobs, in employed jobs and in academia that also makes a difference. Another key thing is, you know, what kind of administrative support will you have? So will you have an administrative assistant? Will you have a nurse that, you know, goes to clinic with you? Will you have somebody who's a phone nurse who takes care of all the phone calls that come in and can communicate with you and then get back to those patients about X, Y, and Z? Those are some really key supports that you should negotiate for so that you're not doing a lot of these jobs that can be dispositioned to other, you know, to other, you know, assistance in the healthcare field. So if you can get some of those key positions to work with you so that you can, you know, continue to see patients in clinic and take care of the hospitalized patients and do procedures, then that will make your life and your productivity a lot more streamlined. Do you have office space? Like, are you going to get your own office? Where is that going to be? Where is that office going to be located in relation to where you're doing your day to day work? Where is it going to be in relation to how many sites you need to go to? Things like that. Is there, do you get a stipend for furnishing your office? Things like that. That's an important thing, especially because it's, you know, it's a private space for yourself and you want to, you know, you've been sharing everything for all these years and you really want to have some space that's yours, you know, that you can set down your things. It can be private, you know, and I will say that, you know, there's pros and cons to having your own office. You want to be, I think that there's definitely an advantage to being close in proximity to your colleagues. I would say if somebody gave me the choice of having my own office far away from my colleagues versus maybe sharing an office with somebody else, but right in the mix, I would probably pick the latter because you get a lot of, you know, conversation about, you know, what's going on within the GI division. You hear about interesting cases. It's also great for idea generation and establishing camaraderie with your partners. So those are, you know, key things to think of. What other kind of supports are you going to have? Who's answering the phones, right? Like how many schedulers do we have? Do you have, you know, the place where you're looking to get a job, do they have the adequate infrastructure and support to help you achieve your goals as, you know, as a junior gastroenterologist? And if you don't have some of those things, if nobody's answering the phone and nobody's doing the scheduling, it's going to be very challenging for you to have a productive clinical practice. So it's important to get some of the details about that. And then, you know, even I had a senior colleague of mine when I was a fellow who negotiated for a parking space, right? So, you know, the way that where we parked was a good, you know, 10 or 15 minute walk from where we had to do our day-to-day activities. And he didn't like to wake up early in the morning. He like always cut it close. So he negotiated for a parking spot that was like right outside endoscopy. That's negotiable too. So, you know, the short answer is everything is negotiable. Just try to be thoughtful about, you know, what things are important to you. Some other key points on negotiation. I think that, you know, when you think about where you're, where you'd like to be in a couple of years, it might be overwhelming right now. And you might not really know where you want to be in a couple of years, but try to think about what would be a good life for yourself? What would you be doing? Would you be doing research? Would you be doing teaching? Would you just be making a boatload of money? Like what is it that you would like to be doing? And work backwards from those goals, right? That'll help you to define your also help to negotiate your role, right? So if you, you know, want to establish a bariatrics program, that's something that you should negotiate when you're getting your first position so that you can have a, you know, be a key stakeholder in the planning of that program as well as direct that program. And so you want to get a lot of background work on what your institution or your practice or your region needs. Get, you know, the key necessary information that's important about if there's needs. If you can find that there's something that you're interested in that, and there's also a corresponding need either in the area or at that institution or practice, then that's a match, right? So you want to expand upon that and use that to your advantage as leverage. You also want to be able to explain why hiring you would be in the other party's interest. Why are you a good fit? Why would you be the, you know, why would they want you? Why would they pay more money for you potentially? But, you know, really the best negotiators are going to generate mutually beneficial solutions. That's the best case scenario for a long-term relationship. You're happy, they're happy, everything's copacetic, you know, all is well. That's kind of the best thing that you want to, that's what you want to strive for when you're negotiating. So I mentioned some background work and getting some of this background work, like what am I talking about, right? So it's important to understand, you know, the key aspects of the history of the organization, right? What's their mission and vision? You know, what have they excelled at in the past? Where are they looking to go? Are they looking to expand their footprint? Are they contracting? Are they building or are they selling? You know, things like that, you know, what is their overall trajectory and where, you know, what's their history? You want to try to get information about recent departures and additions to the division group or department. So, you know, there's, you know, an unstable leadership infrastructure that can be, you know, a little bit of a red flag. And so you want to know who's there and are they, have they been there for the long haul or did they just come in and how tenuous that is or stable is that. You want to get a sense of the long-term retainment or if there's frequent turnarounds or excuse me, turnover, are there any political issues between, you know, say like we work very closely with a variety of other services. Are there political issues between us and say colorectal surgery or surgical oncology or the cancer specialists or the minimally invasive surgeons, anesthesia, like what are those political issues? Are there factions within your group, right? So, you know, does everyone get along? Is everyone working together or are there, you know, sort of some political issues that need to be ironed out that it's not that those are bad things, but it's important for you to be aware of those things. Probably, you know, one of the most important things is what are the current needs of the institution or the group that you're joining and how can you fit into that need? How can you meet that need? Where does your institution or group excel and where have they struggled? Where have there been areas, you know, where are the areas of improvement? And those are both, you know, important for you to know as you're, you know, sliding into a position, you know, is it up to par? Are there areas that you need to work on and can you be part of that improvement or can you take that excellence even higher? You also want to be aware of the opportunities for growth and development, right? Because where you are, you know, as a fellow is going to be different from where you are in a year and a half from now, potentially, and that's going to be different from where you are in five years from now. And so, you know, for some people, for some positions, that job that you get when you're right out of the gates is the job that you're going to have maybe forever, and it doesn't change much. You continue to take great clinical care. Maybe your leadership within the group changes a little bit or your duties change a little bit. Maybe your schedule changes a little bit, but there's not a lot of change. In other jobs, you're expected to sort of advance and grow and your position evolves. And so, if that's sort of what the expectation is, you want to understand what those opportunities for growth and development are. And also, you know, for your professional evolution, what you're interested in now might be different than what you're interested in, you know, in, say, five or ten years, and so you want to be able to have those options open to you. You know, what if I want to, you know, what if I decide that, you know, motility is really where my interests lie and I want to develop a program that's kind of, you know, interactive between motility and interventional endoscopy, which is, you know, maybe ten years ago was unheard of, but now it's kind of that's how things are going, right? So, do you have the potential for that? Could you, you know, if you're an idea generator and you've got great ideas, will they be supported, you know, or do we just want to stick with what we know? So, those are kind of things you want to get a sense of the culture of the program that you're joining or the group that you're joining to see if it's compatible with what your interests are and what your goals are. Some tips for negotiation, right? So, you know, they always say never be the first one to give a number, so, you know, you can try that, but I have failed at this. You know, people have said, like, well, what do you think is a good, you know, a good salary to start? And I have said, like, you know, what I think is a good salary to start, but, you know, I've subsequently learned that that's, like, not the best thing. Like, you say, like, well, what do you think is a good salary to start with? And have them sort of start things, because if I say something, it might be way lower than what they were thinking, right? So, have them put out the first number, but you also want to not over leverage yourself, right? Don't say you're going to do X, Y, and Z. They're going to, like, you know, generate, you know, 80,000 RVUs every year. You know, do something that's suitable for you, that's attainable, but sustainable, and that will keep you happy and keep them happy. We generally recommend never taking the first offer, because everything's negotiable, so why wouldn't you try for a better offer? And they anticipate that you're not going to take the first offer. So, why take it? Just don't take it. Just say, you know, well, thank you for this offer. You know, this is, you know, I'm thrilled to be entertaining this, but I'd like some time to think about it, sleep on it. You can always blame a spouse or significant other. I'd like to discuss it with my family, blah, blah, blah. You know, there's any variety of reasons why you don't have to say right then and there that you're going to take the offer. So, you shouldn't take it. And it's also important, don't ask for things like, you know, you talk to your friends, and they might negotiate X, Y, or Z, but that might not be pertinent to your life. You know, you might have other things that are important, things that you need, and those are the things that you should negotiate for. So, a lot of this really is an exercise in, you know, being insightful about yourself and your life that you're trying to build for yourself, and think about the things that are important to you. Those are the things to negotiate for. And then finally, you know, any offers that you get, you want to get that in writing, have a trusted colleague or mentor discuss the position, review the contract with you. It's always a good idea to have an attorney look at your contract and see and make sure everything is on, like, up and up and there's no red flags. In the process of your negotiation, you know, I was talking about being a good listener. It's important to be a good listener and find the black swans. Those black swans are things that these unexpected pieces of information that can get you to where you want to go. They may open up a conversation. They may open up a door. By listening, you may find, wow, well, you know, you know, this group really needs someone to, you know, go out to an off-site and develop a clinic there. Well, that's great because that's what I would love to do because my family member lives out there. It would be, you know, very convenient to do that. And so, those are compatible things that you don't always get just by either looking on paper or having preliminary discussions for them. So, you've got to be patient. You've got to be a good listener. You've got to take your time to find these key pieces of information that are sometimes hidden, that can sometimes really open up a negotiation. You also want to pay attention to how people talk and act during a negotiation. What's their posture? What's their tone of voice? How vague or descriptive are they? I saw a study that showed tone of voice matters five times more than content. So, that's important for you as you're listening, but it's also important for them when you're talking. So, you want to try to take the emotion out of things. You want to express your integrity and your willingness to work, your good faith, but try to keep the emotion out of things. And then, finally, you know, try to come to a conclusion where both parties feel treated fairly because that's going to be the best solution for a long-term copacetic relationship. And that's it. Well, we already have some questions, you know, from the attendees that we'd like to address. We'll start off with one for Dr. Bilal. Dr. Bilal, could you please comment on how to prepare a good and strong CV, including kind of what to include on it, how to format your research, and other just tidbits on how to make it strong for your future possible employer? Yeah, I think, like I said, you know, by this time, you know, we applied for residency, applied for fellowship, you know, some of us have applied for subspecialty fellowships. So, we're hoping that we already have sort of some sort of a template to go by. But the other downside is, however, that a lot of the residency and fellowship templates are through ERAS. So, sometimes we don't end up getting an actual professional CV template. So, one of the advices I have is that most institutions have a template that your CV should format with, that your mentors would use for their promotions or for keeping their CV, which has, you know, educational appointments, teaching, you know, research, ongoing research, if you have any grants, if you have any publications, book chapters, all those things. So, getting that from your institution. Also, there are some universities that you could just Google and find their templates that are freely available for public use. For example, the Harvard Medical School CV template is available for anyone, you can format your CV accordingly. It has really nice sections like educational innovation, like the stuff that you would not usually account for in your other CV. Like for example, if you helped as a fellow, help develop a medical school curriculum, or were part of a committee. So, that has actually sections for that. I would say that put everything in your CV, because it's your CV. So, everything that will be in there would talk highly about you. So, anything that you've done, nothing is short. And you don't know when you are applying for jobs, someone else might see something that they're passionate about in your CV that you might not have thought that was like super important, and then might have an opening and opportunity. For example, like I mentioned earlier, that one of the things that I was passionate about was medical education. And all my job interviews that I went to, people cared less about my advanced endoscopy skills, and cared more about how I would be able to contribute and do undergraduate and postgraduate education. So, for me, that ended up being a more important aspect and more attractive quality that people liked in jobs. And that in turn, I was able to leverage and use as a negotiation tool, and get what I wanted in terms of my clinical work, which is advanced endoscopy. So, that was a good learning point for me. So, just make sure that no matter what kind of job you're applying for, same for private practice jobs. A lot of private practice hospitals have students, NP students, PA students rotate through them. So, you don't know if you did education doesn't mean it's completely, you know, not going to be helpful for a private practice job, because that might be something that's valuable to your employers. And not to forget that you end up in a different role of education, like training your nurses and techs as well, if you're doing more, or if you're starting like a motility program. So, all those aspects you might not think. So, if you've done anything in your professional or extracurricular activities, I would say you highlight all of that in your CV. Wonderful. Thank you. That was an excellent answer. The next question I'm going to direct towards Dr. Kahlo. When looking at different hospitals, say you don't necessarily know the program very well, who do you typically, or who should you consider reaching out to in order to find out if a job opening is available? Is it hospital program managers, coordinators, the physicians themselves? Do you just consider cold calling groups? Do you have any recommendations regarding that? So, I think first, as a fellow, you should kind of probably go to your leadership, your program director, your chief, if, you know, they're approachable. People, you know, as was mentioned before, it's a very small world, and people will often know each other. So, if you're truly interested in a particular program, I would contact them first just to see if they, you know, have someone they can put you in touch with. It's always, you know, a little bit easier to get in the door or have your email address to, you know, somebody, you know, kind of connects you. If they don't, I would just reach out to the physicians because oftentimes they're, you know, things are not always publicized in academia or even in private practice. A lot of, you know, things are kind of by word of mouth. So, there may be bigger advertisements for big academic centers that are trying to fulfill a very particular role, but for private practices, they may not be advertised. I think when I finished fellowship, I actually went into private practice initially for family reasons and geography of where I needed to be, and most of the things I got were really, like, we're looking for someone who could do this, or they were looking for someone who could do that, or they wanted a female gastroenterologist. That was the one unifying factor for everything. They were all male practices, and they wanted a female to kind of diversify a little bit and bring in a different, you know, group of, you know, patients. So, I would reach out to the physicians directly because oftentimes people are looking or thinking about looking, and it's not necessarily public, but I wouldn't feel shy, especially as a graduating fellow, you know, saying that you're interested in meeting and, or that, you know, it's, and I would send along your CV. I would send along a short, you know, cover letter or email because, of course, everyone's busy. There's tons of emails coming through. You want to get your point across, like, in the first two paragraphs. I'm so-and-so. I'm from here. This is where I've trained. I'm interested in this, and I'm looking, graduating this time. Do you think there'd be a position available? And, you know, you know, phone number. Can we talk? And, of course, attach your CV, and oftentimes that is enough to kind of get you an email back or, you know, you know, kind of get you in, or at least a conversation on the phone, which I think is, even would be the first step before even, you know, coming for an interview, but, you know, just to see if there's, like, mutually, you know, mutual interest that, you know, it might work, but, yeah, I wouldn't. I know it's really hard as a fellow, and cold calling is also challenging, and, you know, it's easy for me to say, but when I was a fellow, I was like, I don't know. What do I do? Do I, can I just call? But, you know, you kind of have to just, you know, you're, you'll be a colleague in a year, you know, and it becomes a little bit easier, but you shouldn't feel shy about reaching out and, you know, looking, you know, you know, saying, you know, can you just hire me so I could hang out and just pay me? You know, you have something to contribute, and I think that's what you have to keep in mind as you're applying as a fellow. You are going to be contributing something. You're going to be a working member of whatever group you're joining, so, you know, don't be shy, but, you know, have some humility, and, you know, short, sweet, and, you know, like a good CV, you know, is concise, you know, all the relevant things, but concise so that people can quickly review it, and, you know, I would go directly to the physicians. I don't think I would go through hospital administration. That just ends up on someone's desk, and then has to go to someone else's desk, and I think that, you know, that proposes barriers you can avoid. Wonderful. Yeah, I guess the worst thing they could say is no, so it's always always pays to try. Dr. Marenke, it looks like you want to add on to that. Well, I have a question for Delia about the joining a practice that's all men that are specifically looking for a woman, so that seems like it could potentially be great or could potentially be terrible because, like, what are their motivations for having a woman because we know that a lot of, you know, usually women prefer to have, you know, may prefer to have a female gastroenterologist, but a lot of times some of those issues that are associated with that may be related to, you know, chronic conditions that don't necessarily require a lot of scopes or might be, you know, might require a lot of clinic time that isn't exactly reimbursed at the same level, so do you have any input about that having been through it? So I think that, yes, I agree with that. You know, I ended up seeing some chronic disorders, men, with kind of similar chronic disorders, and, you know, when you're starting out you're not going to get the same endoscopy time as an established person because obviously you don't have any patients, so I would get some rollovers from, you know, people, you know, that they didn't have time to see or needed urgent scopes, but then it is, you know, you have to figure out how you're going to build your practice because, again, you really need the endoscopy time. I mean, you could spend three days in clinic, but, you know, we're also gastroenterologists, we were proceduralists, you know, three days in clinic is just not enough, going to be enough to kind of keep you happy, for the most part, is, you know, most gastroenterologists really need to do procedures, and it does affect your income and it does affect your RVUs, and that, you know, kind of was kind of was a problem. I think, you know, that was an issue with kind of all of them. I ended up picking a place that was going to work just, you know, for my family because my husband was out there and, you know, we had two small children at the time, so I didn't want to, you know, none of us wanted to be like a two-hour commute away, you know, in case something happened because it had happened in the past and then we got nervous, but yeah, I think as a woman, I think it's something to certainly keep in mind, it's something to ask, you know, like if they give you a day or half a day of endoscopy, you really need to say how, you know, you need to just kind of be clear and say, well, how am I going to grow this, you know, you need to just be very candid about it. I think, you know, and it's hard to know, like, you know, like I mean, I asked for things, I negotiated things, but it's hard to know what is appropriate to ask, especially when you're starting out and it feels awkward because you don't know what to ask, but I think as a female gastroenterologist, I would ask like how, you know, what am I going to end up seeing, is it going to be focused only on this, because then the patients that call in for new appointments are going to be directed towards you and they may only direct those patients towards you. And, you know, I trained at Memorial Sloan Kettering, so I didn't, you know, I wasn't, didn't see tons of functional bowel, you know, disorders. I mean, I had enough to manage it, but not so that it was be, you know, I was going to be like a specialist in it. So that was, you know, and then, you know, contributed to, you know, job unsatisfaction and things like that. But I think you have to say, you know, I, you know, if, I mean, if that's something you want to do, then you can say, yes, this is something I want to do. I want to, you know, focus on that, or this is not kind of what I want to do and I want to know how it's, you know, how my patients are going to be directed towards me. I mean, if you're, of course, getting into this, you know, area now where you're negotiating your contract, you know, how is, how is my, how am I going to have patients directed towards me? Is it going to be only women? Is it going to be only these things? And if it's something you, something else you want, you have to kind of say that this is what you want it to be. And ultimately what, you know, how many days of endoscopy you'd want, do you want to be equal with the partners? I mean, the highest earners are the ones that have the most endoscopy. And those are usually the senior partners or the managing partners that have the most endoscopy time because, you know, currently that's where the reimbursement is. So I think it would be helpful if you spoke to another, you know, like as a trainee to talk to another, you know, other female gastroenterologist and kind of see what, you know, kind of questions to ask and, you know, as you're going through the interview process, because that part is a little bit harder to figure out. It's a little nebulous, like kind of how things are going to be, you know, shifted towards you. Yeah. It almost sounds like if you were, if a person was in that situation and invariably they're going to get, you know, a lot of perhaps like functional patients or patients who need reassurance and need a lot of contact, that it almost seems like it'd be reasonable to ask for support in the form of a nurse or, you know, some support right off the bat to help you manage those things. Yeah. Actually, that's actually probably what I should have asked for, but I didn't know to ask for that. Or how the office worked, like there were medical assistants and there was nurses, but then, you know, it was like, oh, they work for everybody. But, you know, it's kind of like, what does that mean? And I'm like, well, they don't, you know, like I wasn't like the biggest part, you know, I was like, they were for the other kind of senior people that had a higher volume. So yeah, I think that that's a very good thing to negotiate actually, if you're gonna have a practice like that, because there are gonna be lots of phone calls and there's gonna be a lot of handholding and reassurance and it's hard to, you spend your whole day just answering phone calls. That's really not kind of what you signed up for or really productive in any measurable way. I mean, you are doing patient care, but they can't measure it. You may be doing nothing, but according to something like, well, you don't have that many RVUs, you don't have that many new patient visits, you don't have, your visits are 45 minutes long, they really need to be 15. It's hard to do that in 15 minutes. So you're constantly running late. So yeah, if you have some, that's a good thing to negotiate if you end up in a practice that is similar to that. Thanks, Dr. Callow. Next, we have a question for Dr. Moronke. So multiple studies show that women are really poor at negotiating. Do you have any advice for young female fellows who are looking for that ideal job and just getting the confidence to perhaps negotiate as they should or as a male counterpart might kind of inherently? Yeah, it's tricky, right? It's tricky. So the data shows that women don't negotiate as much, but the data also shows that when women negotiate more aggressively, it's perceived in a negative way. And so it's very tricky. It's sort of like a double-edged sword. And so I think one of the ways around that is trying to build relationships with the people that you're negotiating with. Try to get them to know you, know what's important to you and vice versa. So that when you are negotiating, they have an understanding of why it's important to you and maybe more willing to grant you X, Y, or Z. And also it gives that more information about you sort of shows your value to them, right? And so you may use that time where you're kind of spending time together and negotiating, talking about the practice, maybe a chance for you to highlight how good you are. And so I think it's tough for women because you wanna get what you should, what you're worth, right? You should know your worth and negotiate for that. But it is still riddled with the likability issue of kind of being aggressive about your negotiation. I don't have great advice other than to, building a relationship with that party may help you get what you need. And also they understand that that's what you need and why you need it, and that may be beneficial. And kind of bouncing off of that question, but not just strictly to females, just all fellows who are just fresh out of fellowship and may have a crisis with imposter syndrome, any tips from all of our panelists on how to kind of get past that and work through that and really build up the confidence to be an attending? Yeah, I can speak to that. I think, so imposter syndrome is rampant among many of us, right? Especially among junior colleagues and then it's predominant in women. I think one of the things that helped me was observing others do their job. And that really helped. I think over time, I had one of my initial mentors was like a maestro at doing ERCP, he could do ERCPs with his eyes closed. And it's like, wow, that's amazing. I can never do it like that. But he was sort of the exception. And I looked around and saw, I watched during live cases and I watched when I was visiting other institutions, how they were doing things. And then those data points, I was like, well, I can do this just as well. And that was really key for me. And I think I kind of haven't been plagued with imposter syndrome since then just because of that data or information. And so not everybody is an advanced endoscopist or focusing on scoping. So they might not have the same way to get information about how people are doing things. But when you look around and you see how people are doing things and you recognize that you're on par with those people, then that kind of gives you the internal confidence to know that you're doing the right stuff and that you're right there with them. Dr. Keller, Dr. Ball, anything to add to that? That was really great. I mean, I think it's like Dr. Marinky said, it's prevalent in women and underrepresented minorities in medicine, particularly. I think that you kind of fake it till you make it. I mean, if you feel like, I mean, there's some truth to that, right? I mean, you made it through fellowship, you made it this, I mean, you're an accomplished person, right? Everybody here is an accomplished person. We've done things that are very challenging. We've given up lots of years of earning income and traveling and other people that your age that have like houses and all kinds of other stuff, and we've delayed all that. So we are a strong group of people and we're knowledgeable and not everybody knows everything. And there's always, things are always changing and there's always room to learn more. And I think that if you feel like you don't learn something or you go and read about it or you ask someone you trust about it and you can just kind of keep on going and then you realize that you actually know more than you think you do, or there'll be someone that doesn't know as much as you know about something. And that you take that, it's really just a spectrum of knowledge and ability. And I think you just kind of have to keep that in mind and you just have to keep telling yourself that you can and you will. And I think it's hard coming out because that first year is challenging because you're going from being supervised and suddenly there is no supervision. Yes, you have colleagues that you can bounce things off, but they're gonna be senior and you're like, I don't know, is that a dumb question? Should I ask that? Should I not? You may feel insecure about even asking the question. And you realize that that first year, you are kind of the end, you are the one making the decisions. And that takes a little bit of getting used to. But with time, the second year becomes a little bit easier. The third year becomes a little bit easier. I think with time, you become more comfortable in your own shoes. As you meet the new fellows or you meet medical students or you meet residents, then you realize that now you're a leader and now you're teaching others things that were taught to you. So it takes time and there may always be a little bit of hints of it, but I think you kind of need to reassure yourself by where you are, I mean, by where you're standing. I don't know, Dr. Bilal, do you have anything else to add to that? I see you nodding. So maybe you agree with some of it. Yeah, absolutely. I think, you know, I'm eight months as faculty now. So we'll tell you there's, you know, every single day that these thoughts come. So I think the most important thing I will tell you is that if there is any faculty who tells you that when they transitioned from fellow to being an attending, and they didn't have those thoughts or feelings, they're lying. So know that that has been unanimous to all of us. And I'll, you know, give you like a personal example that I went into my first year of CP, you know, I'm in a, like I said, I don't have a senior colleague or any partner who does advanced endoscopy where I am. So I remember finishing my first year of CP and I did like, I don't know, like three occlusion cholangiograms, if Dr. Moran, you know what I mean? You know, and I look at the nurses and I'm like, are we done? And they're all just like quiet and looking at me and they're like, I don't know, are we done? And I'm like, well, someone's got to make this decision that we're done with this. And, you know, and I'm done with the procedure. And, you know, and that, and they, you know, yeah. So I think the two most important things I think that have helped me in this situation is one, is it's okay to be vulnerable. You know, we talk a lot about the vulnerability and leadership and in medicine, I think we sometimes take that, can take that as a weakness. Oh my gosh, if I don't know, like I'm the physician, I'm the doctor. Like, I think that's, it's okay to be vulnerable and be like, you know, especially in a procedural fellowship and say, you know what, hey, I have never used this dent before, but you know, you're trained endoscopist or, you know, you've never done a poly, you might not use this XYZ clip or snare, but you know how the basic principles of polypectomy, right, if you're a gastroenterologist and you, even if you haven't done that one scenario, you've probably seen them in your fellowship. So one is that it's not something that can wait, you know, can you bring the person back? Can you call someone? And it's okay to take a moment and even FaceTime someone, a mentor or a colleague, if you're alone in a practice and, you know, have your nurse call someone or ask your nurse in tech or, you know, an industry person and be like, hey, I just, you know, can you just make sure like, this is how we use it? And that's okay. And people will respect you and appreciate you more because you're, by doing that, you're entrusting them with a responsibility, your team, and you're indirectly empowering them. And the second thing I would say is that, like Dr. Merangi said, is that, you know, you have to constantly compare your growth with yourself. So even now at eight months of my, you know, as a faculty, I was thinking about, you know, on day one, I couldn't have found this thing, or I couldn't have done this as comfortably as I did this. I couldn't have done this procedure in 15 minutes that I did today, you know, in just eight months. And, you know, if you're, same thing will happen. So I think constantly compare your growth with yourself. Don't think like, you know, if I think like, oh my gosh, you know, I can't handle it like Dr. Merangi does on my first day of an attending, that's not gonna happen, right? So you just have to sort of compare your growth. And that's the advice I give fellows during their fellowship is don't compare your growth with, you know, your other co-fellows. Compare yours to yourself and see how much you've come forward. And I think then you'll realize that you're doing good. And before you, like, you know, the other thing, like, you know, I remember my first colonoscopy, the nurse asked me, so do you use a cap? Do you use a cuff? And I'm like, I don't know. I just use whatever the attending used to use. So you'll develop your own style, you know, as you go forward. And I have in the last eight months, and I'm sure that, you know, two years from now I'm doing this webinar, I'll have, you know, I'll think about all the things I used to do in eight months as faculty. And I'm like, oh my gosh, that's how bad I was, you know? But that's, it's not, you're constantly, you know, you just have to remember one thing. You just have to make sure that you're not doing anything to harm the patient and everything else, everything else is negotiable, is negotiable. Yeah, I mean, I completely agree with those points. And also, you know, one of the things is sharing of information is really empowering, but it also gives you a little bit more confidence, right? So, you know, some of the things that I think have been helpful for me is that I have not, I'm generally not afraid to ask opinions about like, hey, how do you manage this? What's your favorite thing for this? You know, whether it be a technical aspect of a procedure or how another institution is running their endoscopy unit. We have a great network of people, especially in the ASGE, a bunch of endoscopy nerds who love talking about this stuff. Like, so I inquire about like, how are you doing X, Y, and Z when COVID hit, it's like, nobody knows what to do. And it's like, I don't know what to do at Penn State. Like, so, you know, kind of being vulnerable and reaching out to other institutions about how they're doing. It only gives you information, but it also lets you know that what you're doing is sort of, you know, right up to par with everybody else, you know, and so that kind of can give you the confidence. I think having a growth mindset and not being afraid to, you know, ask advice, ask opinions, ask for information helps you continue to grow rather than if you're sort of in your shell, protecting yourself from, you know, any vulnerabilities or things like that. I think that that's where people start, you know, kind of shrinking in terms of their abilities rather than exploring them. Awesome. All great responses from everyone. Thank you for your thoughts and your experiences from all of this. And it's reassuring to hear that it does get better and everyone's in the same boat overall. I'm going to switch more to a private practice focus now because we're so used to being in an academic center, going through a residency and our fellowship, and it's kind of a black box, so to speak, or just a very unknown area for a lot of us when we're going out into the job space. So does anyone have any thoughts about anything in particular to ask private practice groups, specifically private equity firms are becoming a greater trend in the market. And are there any thoughts on that or anything to look out for when it's affecting a person's contract? And then additionally, is it any thoughts about discussing partnership or the requirements to becoming a partner, especially in a private practice setting? And when is it safe or okay to bring up those topics? So, I mean, I guess I could speak to it a little bit. There's less and less like independently owned private practices. I mean, at least, I mean, in the Northeast where we are, a lot of things are being taken over by large hospitals and other private businesses. And I think it's becoming harder to survive, although people are trying to stay as independent as possible. Because it does affect what your income is going to be, how you manage things, you have less say in how your business is run. And then you kind of have to know when you interview with someone, I had one example, I thought I was interviewing with one person who seemed like it was part of a solo practice. So I went to meet him and he was nice and I liked him. I was like, oh, I could work with this person. And then I had to meet go for a second interview. And that was like a pet, which I wasn't expecting. And then it was like a panel of people like administrators, like the CEO of something, the VP of something else. I was like, who are these people? I had no idea that I was even like inter, like that the guy, I guess his practice was bought out by a larger entity. So when I walked into an area where I, they didn't really, it was odd because it was like a panel of people, but they didn't really have anything to ask me about like my experience because none of them were medical people. They were all administrators. So I guess they were kind of just asking like, well, what do you want to do? And I was like, I don't know. I guess they were just asking like, well, what do you want to do? You know, I just kind of served, I don't know, trying to figure out like what I wanted to make. And I just was unprepared because I didn't realize that that's what it was. And that's not how it was built to me as. I think, you know, it kind of depends on the area of the country you're in a little bit, but certainly you should, you know, I mean, you're not going to ask on the first interview, you're just kind of getting to know them, right? Do you, you know, or is it, you know, I mean, are they reasonable? Can you have a conversation with them? Is there a mutually beneficial relationship? Do you think you could work there? Do you think you could live there? You know, you just want to get to know them a little bit, know a little bit about the practice. You know, once, you know, you both have to express interest, you got to, you know, kind of sign up for a second date, you know, like, do you want to talk again? And if you do, then that would be the, you know, time to ask more questions. And often, you know, you should go, if you can go first, like a second look, you know, go to a day and say, you know, spend the day at the practice and see kind of how things are run because, you know, they'll, you know, people will be on their best behavior for like an hour or so. But then during, you know, you're walking around and, you know, the office and you're, or you're sitting with someone, you know, seeing how the, you know, a nascent and seeing the flow of the office, how people are interacting with the patients are like, where, you know, where everyone's sitting, how long things take, you get a better sense of, you know, how everybody works together. So I would do that. And then I think once, you know, if you're interested and they're interested, then they'll, you know, they'll offer you a job. And then of course, then there's, you know, kind of the whole contract, you know, they'll issue you a contract or not, but I, you know, it's very fair. And I would certainly ask, you know, is this a partnership track? Am I going to be an employee or am I going to be able to buy into the practice? And what does that mean buying into the practice? Is that mean you're just going to buy into the actual practice or if they have an ambulatory surgical center, are you going to buy into an ambulatory surgical center? So you have to be very specific because one practice I interviewed with was very hazy about, yeah, you can buy into the practice. But I was like, well, what about the surgical center? Because then I saw other people, other physicians that were not part of the practice owned shares in it. When I, you know, I just, you know, Googled it and looked it up and the answer I got, I didn't understand it all. And I was like, is it intentionally confusing or is it that I just don't understand what they're saying? And then, you know, I kind of inquired more and then I kind of kept, you know, because it's something just didn't sit right with me. And I really liked the person I interviewed with. I like, you know, I really, you know, could see myself working there was the right location, but something didn't seem right about, and I, you know, I didn't ask specifically to see financials. I didn't want like to see it, but I was like, well, is there something you can show me that suggests that, you know, I could have a share in this or, you know, but it was unclear. It was, you know, well, we'll see what happens in a year or two, you know, probably, but I'm not sure. And I was like, well, then what's the point? Then what am I buying into? Like I'm nothing, there's nothing to buy into. You know, you can, you could be called a partner, but that would, I don't know what that, that doesn't really mean anything. And then the other one was like, you know, we're just opening up a surgical center. So I was like, well, do I get to buy into that? And then that seemed more clear that yes, you will. Once you've made so many years and you've reached so many RVUs and you have to make a certain percentage of what the higher Cerner does, et cetera, et cetera. So that was at least targets to go for. You know, and I was trying to, and again, what do these RVUs mean? You have to make like 4,000. I'm like, all right, well, I don't know what, I mean, I'm not doing interventional procedures. I don't know EGDs or, you know. So then you ask, well, what does that, what exactly does, you know, what does that mean? You know, like how many endoscopy days do you see? Like what, based if I do this many RVUs, what do you think my maximum attainable salary could be? You know, what, you know, could I afford to live in this location? You know, do I have to go like move, like, I don't know, an hour away because, you know, based on what my salary is. So you, I mean, you have to, you know, once you kind of know that you are interested in them and they are interested in you, you have to ask all these questions. I mean, they're reasonable questions to ask. I mean, how do you know what you're, you can't, you know, you're not signing up. So far we've trusted the process. The process has been, you know, you go through this, you apply for that, you submit your paperwork, you go interview, there's a match. You know, you don't feel like you're, you know, you feel like everything is just kind of, everyone's going through the motions and you feel like you trust the whole process and that's the way it works. And it will eventually, you know, it will get you to where you want to be. This is different. This, you have to actively, you know, seek out and question. And if it doesn't make sense and question in a different way, talk to them, talk to a different person. Like Dr. Marinky said, make sure you're talking to the person who can make these decisions because other people will say, yeah, sure. I mean, I think that sounds reasonable. And then you realize that the person who's saying that isn't really have any say in that, can't actually make that decision for you. But, you know, ask as many questions, visit. If something doesn't feel right or doesn't seem clear that you can explain it to somebody else and it's not clear. You know, you should be able to explain your contract and what exactly is going to happen at what time point or what you should be able to explain the whole thing to somebody else so they can understand it. But you're like, well, maybe in two years, you can, you know, you can, I mean, I don't know. It's so, I don't know what that means. And I ended up not going with that practice because I just, even though I really liked them, I mean, it didn't pay as, you know, the salary was a little bit less, but I liked them so much that I didn't really care about that. The location was a little bit better, but this haziness surrounding the surgical center, I didn't feel comfortable with. And I had to cut my losses and I moved on. So you have to ask as many, you know, you can't be shy about asking questions because you're signing a contract. It's not so, you can't just like walk away from it. You can't just be like, hey, I don't like it. I'm just gonna leave, you know, I'm quitting. I mean, there are repercussions potentially related to that. You know, there's restrictive covenants. There's, you know, now you may not be allowed to work in that area. Now you may have to move your entire family. I mean, there, so you have to be very clear on what can happen and understand what everything in your contract is saying, you know, what everything in your contract is saying. I got a lawyer to review my contract because it was like, you know, 15 pages long. And I got some stuff, like some stuff I kind of understood and other things I didn't, but he, you know, went, I mean, I spent a thousand dollars, but it was, you know, a good thousand dollars because I understood everything I signed. And I knew that if I, you know, you know, the one thing he said to me, he's like, you know, when you go into a contract, always have an exit strategy. I mean, you know, hopefully everything works out and it'll be your job forever. But we know that that, you know, most people don't stay at their first jobs, they move on. So you have to know what your exit strategy is. So worst case scenario, you know, you don't like it, then what, how can you leave? And, or your husband gets transferred or you have to move for family reasons. I mean, it'd be a variety of reasons why, you know, you can't stay. You have to know what that means, what you're left with, and then, you know, kind of, you know, how you get out of it, you know, and then what implications that has for where you can work. So it sounds like a, I mean, it's again, a long, complicated process, but you gotta understand, so you have, you can't be shy about asking questions because you're protecting your livelihood and, you know, your family's future. There's a lot that goes into it. So now that maybe I made it sound that really scary. I mean, it doesn't sound, it's not that scary, but, you know, I'm trying to impress upon you that it's okay to ask these questions. You wanna ask them at the right point, but they're absolutely necessary. I think you're highlighting the seriousness of what you're getting into, which is important, I'm sure. Just stepping away from that topic, Dr. Awal, a question for you. What would you say to an organization that gives you an offer during the relatively beginnings of your job search and you really like them, but, you know, it's your first offer and there's a lot more, you know, you'd like to look into and see what else is out there. How do you deal with that kind of situation? I think it's tough and, you know, I think it depends on individually. You know, I think if you know that that's the, you know, if you know the organization well, and if you know that you're getting compensated and getting everything that your other partners and colleagues are getting because a lot of the academic institutions or for example, like VA jobs, like the salaries are salary, there's not a whole lot of negotiation and salary, not a whole lot of negotiation and support, whatever it's available, it's available. And if your other 10 colleagues are getting the same and that's what, you know, and you're getting more or less the same, then you know that they are being honest and fair to you. And if, you know, geographically and everything else, why does it make sense? That's great. Now, personally, you know, I always tell my mentees and, you know, is that it's always, you should always look around because you don't know what else is out there and how much, you know, it might feel good to you. And I think, you know, early on, I think Jess or Neha, you brought up this point that is, you know, fellows, you're sort of living in a bubble, right? You've only seen your institution, you've only seen your, you know, how things work. If you, you know, some people have done residency and fellowship at the same institution, you have no idea how things are like outside that institution. So I think, you know, job search is not, the way I look at it, it's not just a going and doing negotiation, but also sort of expand your horizons, you know, expands your network, see how things are done differently. And you might be surprised and you might not know, you might not know what you're looking for until you go there. So I think that at least going to a couple of places to just make sure that, you know, what you're getting is what you really wanted, because right out of fellowship, you might just not, you know, might not have seen things from a different lens, might give you a broader perspective. But on the other hand, you know, if that's, you know, your family's there, you know, you have significant other who's there, you know the institution or organization well, there's absolutely nothing wrong with taking it if that's all you want. So, you know, at the end of the day, it comes down to, again, to that first couple of things that we mentioned, you know, know what you want, list out the things that you really want, you know, because it's sometimes hard to even know what you want. So just make a list, you know, think about it, self-reflect, talk to your mentors and analyze your personality and what your goals are and just figure out that you're getting everything you want because in the end, there is a job that will have whatever you want out there for you, you know. Wonderful. So we have just a little under 10 minutes left in our discussion. So we're gonna try to combine some questions together. So I'll open this up to Dr. Meranke. So we talked about, in addition for women generally, or the stereotype is that they're poor negotiators. In order to try to prevent the gender pay gap that has been discussed before, what is a good way or are there any resources to find the salary in the local area? You know, who should you be asking about what the typical salary is, where to look for, or the expectations of salary increases, both in a private practice and an academic setting, especially with professorship and things such as that with academics? Yeah, so that's a great question. You know, I think in academics, both times during my job negotiations, it was like, this is what an associate professor makes, this is what an assistant professor makes, this is what a professor makes, this is what the chief makes. And that information was sort of taken from the MGMA spreadsheet that you can get. You know, and there's, you can either pay for it, or a lot of times if you're on any kind of like Facebook physician groups, they will sometimes post MGMA data, you know, based on your specialty and where you are in the country. So that kind of gives you a little bit of a benchmark. The MGMA stuff, you know, is there's, I think there's one for academics and there's one for private practice. There's also a Sullivan-Cotter kind of scale of salaries. And then there's also, I think free is an annual Medscape survey, which is, you know, published on the internet. If you Google kind of Medscape survey, depending on your location and your specialty, they may be able to give you, you know, general information about how much you can expect to make. A more kind of direct route would be to, you know, ask if they can tell you what the salaries are of the partners, you know, of what is, is there a base salary and what are the, what's the general bonus for each of those partners in private practice? And, you know, is it, you know, what is the formula that they do for calculating bonuses? Is it, you know, every number of RVUs past a certain threshold is, you know, pays a certain number of dollars per RVU, you know, you can get those things. In terms of, you know, equity in pay, it's a little bit tricky, right? Because we don't have laws in our country that say that it's, you know, illegal to pay a woman less for doing the same job. We don't currently have that, right? And so, so there's really no repercussions if there is a gender pay gap. You know, one of the things that I thought was key about some academic institutions is they started publishing their salaries, including bonuses and, you know, showed that they were having, you know, equitable salaries at kind of all levels. And so I think if we continue to encourage that behavior, this might be less of an issue, but for right now, it still is a concern. And so, you know, I think at least, you know, for me in my day-to-day, I feel, you know, you wanna be paid what you think you're worth. And if you feel like you are paid what you, you know, what you're worth, then you will have some satisfaction, you know, and, you know, hopefully you're working with good people who are not gonna take advantage of you. And so there's really no way, unless you see the numbers themselves, to confirm that. But if you surround yourself with good people and people who are supporting your career, you might be able to like sleep well at night, you know, just even if you're trying to think they have your best interests in mind. And sometimes that peace of mind, just knowing that you've done everything you can to surround yourself with good people who are, you know, who are gonna be paying you adequately is enough. And, you know, sometimes you don't need that data because right now that data is very, very difficult to obtain. And some, just add one thing. I think public hospitals, or at least in New York City, the it's public, like it's public knowledge. You can Google it somehow and look it up and look and see what everyone in that, like it'll have their name and what their salary is, which is kind of odd that it's so easily accessible. But then I agree, it's very hard to kind of figure out what, you know, I mean, you could ask your friends and kind of see, you know, where they started off at or where other fellows started off at a couple of years ago and see if it seems reasonable for what is the region you're in. It varies a lot by region also, I think. Super helpful. So we still have a handful of questions. So maybe we can try to answer as many of these just as quickly as we can, because I'm sure people are really curious. Dr. Callow, for private practice, do you know if going through a recruiter is necessarily a good idea? Because some people have heard that they might take a fee that, you know, can come through the employer, but inadvertently affect your salary, is what they've heard. So can you shine on some enlightenment on that? Yeah, I mean, you know, I spoke to a couple of recruiters just because I figured I should at least listen to what they had to say. And in the, you know, I needed to stay kind of in the New York City metropolitan area. And for that, they were not, it was not helpful at all. It might be, if you're looking more broadly, I, you know, I don't, I, I mean, they still call them. I guess I put my, I should have put another email. Like I think some, Dr. Gallal said, and I put like my regular email and I still get like calls and texts. And do you want to go work at so-and-so? Do you want to go work? It's in New York. I'm like, that's 300 miles away from New York City. That's not close. It's not, don't make it seem like it's a commutable distance. I didn't find them helpful. And then when I reached out and I said, oh, I wanted to, and then like no one ever got back to me. So I was like, I don't know. I don't know. I didn't find it helpful, but I mean, I think it's at least worthwhile to at least see what they have to offer. I mean, you don't have to sign up for anything. You don't have, you know, probably you could find all these jobs on your own. I mean, it kind of maybe saves a little bit of the footwork. They may put you in contact, but I don't think they had any jobs that are not public knowledge. But it's certainly, you know, you could talk to them and just kind of see what they would do when, you know, just to kind of see what your options are, you know, especially if you're in a particular area that maybe they serve. Before you sign up with them, I, you know, I think that that's reasonable, but then I would see if you could just, you know, kind of do it on your own. I don't know. I don't know. They probably, I mean, they probably are paid by the place that's, you know, trying to fill it, but those jobs are probably harder to fill. The ones that I see are ones that are like, you know, not in the most desirable areas that people are having a hard time filling, you know, unless there's a reason for you to be there, people don't necessarily want to be there or, you know, prefer to be somewhere else. So, you know, those might not even be areas you're interested in. I guess if you have a match, maybe they take the money, but I don't think they would take any money unless you actually end up taking that job. So, I mean, I think it's worthwhile. You know, I say like talk to everyone, see what everyone has to say, and then kind of, you know, it's a learning process and you see who's helpful and who's not. Awesome. Dr. Marinky first and then Dr. Bilal. Yeah. So I have a little bit of input about this. When I was looking for, you know, my first job out of fellowship, I was contacted by a recruiter and he actually matched me with a group that I was, you know, very much interested in and would have been a great alternative for me. It was a private practice group. And when I talked to them about, you know, the recruiter, you know, they had used this recruiter for years and they were just like, you know, basically like, you know, time is money. And so if this guy saves us time, then he's worth the like however many tens of thousands of dollars they'll pay him to have a match. And so it doesn't, my experience was it didn't affect me maybe in some back way would have affected my contract if I had signed with them, but the practice is paying for the recruiter, sort of like the seller pays the real estate agent fees when they're selling a house, right? And so, you know, a lot of them felt that it was just like a time is money type thing. And they wanted to get a wide, you know, a wide range of applicants from around the country. And a recruiter is more capable of doing that than someone locally. So I don't have anything negative to say other than, you know, I mean, you may be plagued with random, and I'm still plagued with random emails. Like, hey, would you like to, you know, you'd be a great fit for general gastroenterology in Atlanta, Georgia. And it's like, well, I don't do general gastroenterology. And I, you know, so, you know, you're a little bit plagued with that, but I don't think it's a bad thing for as an applicant. I don't think it's a bad thing to go through a recruiter. Yeah, I was gonna just add on similar to what Dr. Moranke said. I think that the other thing is like Dr. Moranke said, time is money. So, you know, recruiters are, you know, like we get so much spam email, it's sort of like telemarketing. So one of them might be worth something. So what I always tell people and the way I sort of dealt with them is like, you know, if they say, you know, there's this, I'd literally reply to an email or text be like, you know, academic advance, do you do academic advance? And I don't say, thank you for your email. I appreciate you reaching out, you know, because for me, like I'm, you know, an advanced endoscopy fellowship trying to do a job search. I literally come on a procedure and I'm like, get a text message, I'm like, do you do this visa? Do you do academics in this? And they're like, oh, you call me if you need more information. And I don't respond, you know, while others are gonna be like, oh yeah, this is the opportunity. This is like, you know, within the city, they have a residency program. I'm like, no, I'm only interested if there is a fellowship or advanced fellowship program. And they'll be like, sorry, we don't have this. So, you know, don't be afraid to be very to the point. Like I said, this is your time now. You are extremely valuable. You've trained at least six years. So do not sell yourself short. You know, you are an important commodity, important, so feel free to be, to negotiate, whether it's with anyone or even with a recruiter and on your terms and your time. All right, perfect. So we are going to do one last question and then we'll start wrapping things up. So this probably might be a brief question. I'll open it to everyone. As APPs are becoming more integral into the GI practice, do you, any of you foresee there being an issue with workflow, whether either supervising or having certain aspects of your patient care either being taken over or being affected by NPs and PAs being present in practice? I mean, I can start. I work as a hospitalist and we do have APPs or two PAs that support our consult service. I think they were trained or we trained them. I mean, it's the first time we've used them. We've had them about two to three years. We train them to do very specific consults that we deem are not really learning experiences for the fellows after they've done, let's say 10 PEG consults or, you know, dysphagia or some, you know, something like that. And then we train them and, you know, they become really good at what they do. I mean, they're really good, you know, with doing the same consults. And they spend a lot more time with the patients that fellows don't have, you know, fellows are like kind of process of trying to learn and, you know, trying to manage multiple things, you know, manage endoscopy, manage consults, you know, follow up on clinic. The PAs are really focused on what they do. And I think in the end, I think it's complimentary to patient care. I mean, at least in that particular setting. And I agree, I think it has to be like a very focused thing and it has to be, you know, very supervised because there are times when I've changed, you know, plans or management based on, you know, kind of just reviewing things with them. I mean, you know, our hospital tends to use a lot of APPs like in clinic and things like that to support. I don't think, well, we have some, we have one so far, maybe getting another one that supports like our hepatology clinic. But again, small group of patients, very focused problems, mostly follow-ups and things like that to kind of support, you know, in other words, very busy practice. I mean, we don't have anybody doing scopes or anything like that. So I can't comment on that. And I think that is better done by gastroenterologists, even, you know, I know surgeons do them and, but, you know, we have, our volume is higher or, you know, our sequel intubation rate is higher, our complications are lower. I think that it should stay and be done by gastroenterologists but that's just my personal opinion. Yeah, I would agree with those comments, especially when it comes to, you know, others doing endoscopy. I think that there's such a wide variety in quality of care that can be delivered. And I think that I would, I still feel that, you know, scopes should be restricted to physicians. There's a reason we go through this training program. And if we determine that that training program is not needed, then, you know, I think that we're probably going in a, not a direction that would be good for us or for healthcare in general. I think that there is a complimentary role and an ancillary role for sure. And I think that, you know, in my practice, we have a PA that works with the interventional team and she's critical to us being able to get through our advanced endoscopy workflow and provide, you know, open access outpatient advanced endoscopy with appropriate follow-ups and stuff. So if we didn't have her, we wouldn't be able to do the amount of cases or the quality of cases that we do really. And she's, but you know, she's very well supervised. She's inherently very intelligent and has great insight. And so, you know, my experience with our PA is that it's a pleasure working with her, you know, from a grand, that's just one instance, but like from a grand scheme, I think that there's a role for everyone in healthcare and just delineating those roles is important. That's some good insight, definitely on a very kind of changing with the years kind of topic. So we just wanted to squeeze in one last question, mostly because I think that this might be relevant to a lot of people applying, what to do in the case where your home institution offers you a job, you're lucky enough to get one through them, but you still want to look elsewhere and kind of know, you know, what the options are, you know, what the options are, maybe in a different geographical location, and you don't want to offend anyone. You don't want to ruin any opportunities or relationships at home. And you're still, you know, considering them as somewhere you'd like to go. How do you handle that potentially awkward situation? So congratulations on them wanting to keep you. That's very complimentary, obviously. I think that they want you to be happy and they want you to succeed. And, you know, I think if you're honest and you tell them that you're considering another location, I don't think there'd be any hurt. I mean, there wouldn't be any hurt feelings. I mean, it could be a variety of reasons why you would want to do that. Maybe somewhere you want to live, maybe it's where your spouse wants to live or where you have other family. There's lots of motivations for, you know, potentially not staying at your home institution. And sometimes, you know, kind of walking away and coming back, you know, brings a lot of insight also. And maybe you just need to see new things. But I think that the people that trained you and want to keep you care about you and want you to be in a place where you are going to be happy and succeed. So I don't think you have to worry about having hurt feelings. I mean, you're not going to say it in an obviously, you know, rejected way. Like, oh, I could never stay here. This place is terrible. But, you know, you would say, you know, you're flattered, but you feel that you need to consider other locations. And I think that they would be understanding. And I think that if you chose to stay, I think that offer would still be open. I can't imagine how a place that would be otherwise. Yeah, I concur too. Just piping up from my own experience because it happened to me and I ended up staying at my institution. But I think it would be a red flag if your home institution wouldn't let you kind of spread your wings and look at other options. Not only does it make you more marketable for your own institution because you know what other practices are like and could potentially add that to the group that you're coming back to. It just is kind of good quality care and yeah, overall. And it would be, I would find that to be a red flag if they wouldn't let you look elsewhere. And I would just add that, you know, honesty, be honest with your, you know, a lot of people sort of worry about this and, you know, think that if I share this information with my, you know, division chief or program director, they're gonna be hurt, but actually it's the other way around. So if you're honest upfront with them, take them into confidence. You know, I'll probably 98, more than 98% of divisional chairs and if not 100% will be supportive of that because eventually they just want you to succeed as alumni, as a fellow. So that's what I had to add. Yeah, I agree with all that. I think that, you know, yes, you should be flattered and you should feel great about yourself that your home institution, you know, wants to keep you despite, you know, you going through three years of a very, very challenging, difficult time, right? And so they've sort of seen you go through that whole process. They want you, they wanna keep you on faculty and that's all very flattering. And I agree that, you know, I think that they should almost expect you to look like what place wouldn't want you to look around because, you know, if you're happy and content with the decision that you made, knowing that you looked around and you chose them, you're going to be a much better long-term, you know, member of the faculty or the group than if you were restricted from looking around and are always wondering what's out there, right? So, you know, yeah, go look around, you know, see, make sure this is the job for you. And then if you come back to us, we know that it's a good fit and you know that it's a good fit. And that's like worth way more than, you know, trying to control, you know, where you're going or what you're doing. So I agree with Dr. Domison that if they are not giving you the time or space to look around, then it's definitely a red flag. Okay, I think it's 9.28 now. So we're going to wrap up. That was a great session. We had a lot of excellent questions and hopefully we gave you some good answers or at least some thought-provoking answers. I want to thank Dr. Bilal, Dr. Moranke, Dr. Damuth, Dr. Hingorani for their time, participation, expertise and support for the session. We're going to save the date for another chat. Coming up August 5th, an Endoscopic Evaluation and Management of IBD. So hopefully you guys can all come. Thank you again, Dr. Callow, Dr. Moranke, Dr. Bilal and our GI fellow moderators, Dr. Damuth and Dr. Hingorani for this excellent informative presentation and being here with us tonight. Your experience with these learning events is important to ASGE and we want to make sure we're offering interactive sessions that fit your educational needs. We would like you to go to the networking lounge where we've added a quick survey that takes less than a minute to complete. We would greatly appreciate your help with that. We also have placed a document, tips for transitioning from fellow to attending to the meeting info in the lobby. In closing, thank you again to our panelists and moderators for this excellent presentation and thank you to our audience for making this session interactive. We hope this information has been useful to you and your practice. This concludes our presentation.

ASGE Endo Hangout

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