Without further ado, I'm going to introduce our first session today. It's going to be called Survival Tips for Your Transition from Fellowship to Attending. And this will be moderated by Dr. Mohamed Saidi. Pleasure to have Mohamed with us today, who practices in Oceana Gastroenterology in California. Thank you, Dr. Cowan. Please allow me to introduce my both panelists, Dr. Mohamed Bilal and Dr. Jennifer Dodorsan. Dr. Bilal, currently he's an advanced endoscopist and an assistant professor of medicine at the University of Minnesota. He practices advanced endoscopy in Minneapolis VA Medical Center. Dr. Dodorsan is advanced endoscopy attending as well in a private practice at Wenatchee Valley Hospital and Clinics. With no further ado, please, Dr. Dodorsan, you can go ahead. Good morning, so I'm Jennifer Jorgensen, and I'm going to be starting this session. First I want to thank the ASG for inviting me, and I want to point out that I think it's really wonderful that Klaus has spent so much of his time as ASG president, past president, focusing on fellowship training and preparation. I know that I would have certainly benefited from many of the programs that he has developed for you. So as Mohamed said, I'm currently in private practice GI, but I was actually an Army internist for about 10 years, and then transitioned back to fellowship for four years at the University of Michigan. And quite honestly, that was my most difficult transition. But then after that, I transitioned into private practice at Confluence Health in Wenatchee, Washington, as he mentioned. And along the way, I've learned some things, and Mohamed and I have come up with what we're calling our top 10 tips to help you successfully transition from fellow to attending or practicing gastroenterologist, whichever path you may be taking. Some of these tips come from observations, and I can say for myself, personal experience, including mistakes that I made. So I hope this session will help prevent you from making the same mistakes that I've made. And a lot of it's just common sense, but I hope that we can provide you with a framework and some insight to help you make this transition successful. It's a really exciting time in your career, and you'll do great. So we have provided a handout that should be in your course materials that has our top 10 tips. But we're going to start with just sort of a broad overview. I'm going to take the first five, and then Mohamed is going to take the next five. And we'll leave most of this session available for you guys to ask us questions. So our first tip is, you have the most bargaining power before you sign your contract. And so it's important to work out the details of things that are important to you before you sign your contract. And it's not just about salary and signing bonuses. It's really your opportunity to negotiate any new equipment that you might need to do your job. I negotiated a four-day work week, which I'm glad I did. None of us are really very good at this. So really think about what's important to you and stick to your guns and, yeah, just negotiate what's important to you. The next tip is to learn as much as you can now. You know, in fellowship, we're kind of spoon-fed. You know, everyone's dedicated to our education. You get daily lectures. Your attendings are there for questions all of the time. But when you become an attending, even in academics, there's going to be much less focus on you. And so use every last day of your fellowship to learn as much as you can. Tip three is make copies of anything that you think you may forget. So some examples. I wrote down all of my cautery settings. I also took some handouts and materials, patient education handouts and materials that I thought were really valuable and met with my chief endoscopy nurse to take some protocols for things that we don't do very commonly, like Minnesota tubes. The fourth tip is work hard and make a good impression, but also try to find some work-life balance. And I know those two things are really hard to do at the same time. But you really only do get one chance to make a good first impression. So you want to present yourself as someone who's really hardworking and dedicated. But you also don't want to get burned out. So it's okay to set boundaries as long as you're willing to pitch in and help when it's really needed. Another just small tip there is I recommend, you know, taking a day of vacation after a week of call or a stint of call. It's amazing how exhausting that can be. And I didn't really figure that out until about five years into practice. And it's really helped me have better work-life balance. And then our fifth tip is find a mentor or mentor. So Klaus kind of alluded to this. You really need to build your network. You need to stay in touch with the people in your fellowship. And you need to build new relationships at your new institution. So these might be people within your department, outside your department, within your institution or outside. And, you know, we need mentors for everything. For clinical guidance, technical guidance, research, and just career guidance. So keep building that network. And I'm going to turn it over to Mohamed for the last five tips. Thank you so much, Dr. Jorgensen and Dr. Asadi. And also thankful to the ASGE member engagement committee for this invitation. So I'm actually, as Dr. Asadi pointed out, first year faculty. So I actually have been able to practice a lot of these tips this year. And I'm going to share what's fresh, how my first year has been truly, which I would say is surviving from being a fellow to attending. So our tip six is team building. And I don't think that there's been a time in my career where team building has been more important. Especially if you are going to be the alone advanced endoscopist in your group. And this is a different kind of team building than we're used to. Because you're working with endoscopy technicians, nurses, anesthesiologists. So it's really important to create a culture of empowering your team, where they can feel empowered to give you suggestions in complicated cases, where they know that their feedback is welcome. So basically, you are helping them help you. And then it's really important to teach them and engage them. And the other thing I think that I found personally very helpful was setting expectations. So set expectations with your team of what you want from them. But also set expectations, ask their expectations of what they expect for you. Because each institution, their nurses and techs are trained differently. Some are used to long wire, for example, in ERCP. Some are used to short wire. So setting those expectations might take a long way in helping your complicated cases. The next thing is probably all of us have heard throughout our careers as physicians is don't be afraid to ask for help. So it's important to demonstrate confidence. But also similarly important to not to be overconfident. No one expects you to know everything right off the bat. So it's very important to know who your local resources are in the hospital, whether nurses, administrators, as well as local mentors, even if you don't have one in your institution. So for example, if you're at private practice, you might want to know who the group in your closest tertiary care academic center is, or if you're an academic center, knowing who's your go-to partner or colleague, who's available for a complicated case, or if you have a complication during a procedure. Tip number eight, I think, is also very important. It's what we call in the handout is building your brand or your reputation. So in your first year or first couple of years, it's very important to build a reputation of being safe. So where your colleagues, your general GI colleagues, your referring doctors, your primary care physicians, they all know and they trust you that you're going to be a safe endoscopist. So it's okay to do innovative procedures, but as long as you don't bite more than you can chew. The second thing is once you start your job, it's very important that you realize and understand who your cross-specialty collaborators will be. So as advanced endoscopists or endoscopists, more often than not, it's going to be our surgeons, your intervention radiologists, your oncologists, your radiologists. So talking to them beforehand, introducing yourself, sort of sharing what your expertise or your skillset would be would be helpful. You don't want the first time you're meeting your surgeon is the middle of a, God forbid, an adverse event or a complication like a perforation is the first time you're getting to know your surgeon. And then building a practice or building a reputation is very different from being a fellow. So it's very important to build a reputation with your referring docs, with your general GI colleagues. So for example, if your referring doc sends you an EUS, it goes a really long way. If you can give them a call, email, or a note saying, hey, this is what I found. And thanks for sending this patient. And if I found a lymphoma, biopsy to lymph node, I'm setting up with oncology. That will go a long way in knowing and building your reputation regionally and locally and amongst your referring doctors. And educate your referring physicians. Tell them what new procedures you're able to offer if you know if someone has a colon lesion that you can offer EMR, ESD, for example. Tip number nine is if you're doing a complicated procedure, so for example, if you're the first one in your new area and you're doing a POM or you're doing bariatric endoscopy, it's very important that your team understands what this procedure entails. Your anesthesiologist, your nursing staff, they understand the recovery. So do a huddle with them. Make sure they're on board. What scopes you're going to be using. Are they familiar? Are they comfortable with all the equipment? Are they comfortable with any troubleshooting tips? And it's very important, especially if you're alone or even if you're in a group, that you have someone available. And nowadays, even if you don't have anyone available in person, maybe one of your old mentors or other, like Dr. Mertner pointed out, building this network, you might have an ESD expert that you might reach out beforehand and say, hey, I'm going to be doing this complicated case. Is it okay in the procedure if I need to FaceTime you or ask for a virtual advice? Because sometimes just a little validation can go a long way during a complicated procedure. And the last thing is, as you can do this, is, you know, none of us are going, you know, no world expert became an expert in the first year of being an attending. It takes years. And as long as you keep growing and keep soliciting feedback, you know, you can all achieve and accomplish whatever you want. So with this, we'd like to hand it back to Dr. Saadi for any questions that you have. Thank you. Thank you, Dr. Bilal. Thank you, both of you guys. Yeah, we have some questions here. We encourage all the attendees to send more questions if you have. So this question for Dr. Georgeson, one of the attendees asked, I'm going to read the question for you. I feel like fellows are not good bargaining or negotiators. I would think it may be easier to bargain in private practice versus academics. Is it all right to negotiate even if you are starting an academic institution without hurting you? Yeah, that's a really good question. And you're right. None of us are very good at this. And I don't know who asked the question, but women are sort of notoriously, you know, really bad at it, especially when it comes to money. But of course, you know, there are lots of things to negotiate other than just salary. I when I was looking for jobs, and granted, that was 10 years ago, I did look in both academic and, and private practice. And I would agree with you, it's you probably are able to negotiate a little bit more in private practice. But I don't think it's, you know, if something's really important to you, I think, you know, you should ask for it. The worst that can happen is that they can say no. And I don't think as long as you're not asking for something really outrageous, I don't think they're going to hold it against you. I got you. So no more questions, but I have a couple questions like piggyback on what I said, when I was interviewing, one of the advices I got, especially for academic jobs is a lot of the salaries are, are more or less fixed. And it's hard to bargain. But what you can bargain for is some of the resources that you get. So for example, you might not be able to bargain a, you know, a $50,000 raise in your salary if that's the standard for that institution, but you could bargain, for example, having a protected time, or if you want to do, you know, more endoscopy time or more inpatient or less inpatient, or if you wanted a research coordinator. So some of you could, you could use your bargaining power as a junior faculty at an academic institution for some of those additional resources as compared to financial. That's at least some of the advice that I got that I found was very helpful. Thank you so much, Dr. Bilal. Looking at the data, guys, I mean, I see like 80% of people who get hired the first year, they change their job. I mean, when I looked at this, I said, you know, there's a reason behind it. So my question to both of you, how you, how you really choose the right job for you, whether you're in academics or private practice? How do you say like, you know, this is the right job for me? I mean, what, what did you use, like in terms of using, you know, what tools you use, I to choose the right job for you, whether in private practice or academics? Yeah, I think that's another great question. And, and actually, I know during the, the third year fellows course, or the advanced fellows course that, that Klaus had a session specifically on how to choose the right job, because it is a really complex answer, or complex question and problem. And there's so many different things that go into it. And I actually gave that talk last year. And so I did a little bit of research and, and it seems like, from what I read, a lot of people really choose their first job based on, on location. And they don't consider a lot of other things in that equation. And of course, there's so many other things to consider. But if you're, you know, if you're really focused on one geographical area, you kind of limit yourself. In my opinion, I think the culture of the organization is probably the most important part of that. You really want to be joining a group that has your same values, as far as how to take care of patients and how to practice medicine. And it, you know, it's, it's more than just salary and location. So you really just have to take in the entire picture and consider everything and, and, and try and find a place where you think you're going to fit the best and be happy. I know that's a really generic answer. But like I said, it's like, we could talk about this for hours, quite honestly. I got you. This is this question for Dr. Georgeson, I mean, here, Mr. Dr. Matthew Berger asking, if I have particular interests like IBD, is it reasonable to bargain for clinics dedicated to those areas of private practice? Oh, I think so. And in fact, if you're interested in IBD, I have a job for you. So my phone number is 253-720-1109. And you should call me, seriously. No, I think it's very important. If you have an area that you're really interested in, and that's going to make you happy if you're able to concentrate on that particular aspect of GI, then I think you should absolutely include that in your bargaining. And really, if you're interested in IBD, that is going to be a huge asset to a lot of academic and private practice groups. I think this question for Dr. Bilal, here it says, as a new attending, how do you deal with the pressure of the RVUs? It seems like even with academics, there's some more and more pressure for clinical productivity and RVUs. I think that's a great question. And I think that's where what I sort of alluded to earlier is that where it could be challenging to sort of bargain financially. These are some of the things that might be that you could bargain. For example, you could bargain to have a lower set number of RVUs in your first year for the same financial productivity that you could later on in your career. And I think that's why before you sign your contract, making sure that a senior colleague, a mentor, a friend, or even a lawyer goes over your contract and can help you advise with those things. And I think that and try to determine what's reasonable, talking to other partners in that same practice and talking to them and understanding sort of what their workload is, how many procedures or clinic patients they need to see to be able to do that. And then sort of trying to self-reflect and see if that's something that you feel like you're ready for it right off the bat or not. And if setting a lower target the first year, I think most jobs do allow that at least for the first couple of years, or I've even seen up to three years. But if not asking for that is completely reasonable. And I think those are some of the subtleties of the contract where you just need to make sure that you've gone and use your bargaining, I think, in that versus trying to think about more, another 20,000 or 30,000 financial gain is at least what I think would be helpful in that scenario. There's another question here says, what are your tips on how to negotiate your contracts for both of you guys? So I would just say, you know, be upfront, straightforward, honest, don't be too pushy. As Mohammed said, it's really a good idea to have a lawyer or someone with a legal background review it just to make sure that there's nothing, you know, no red flags. Talk to your colleagues, see, you know, see what their contracts are looking like, compare notes. I don't know what else do you have to add, Mohammed? Yeah, I think one of the advices that I got was, you know, just sort of enlist one of the things that are really, really valuable to you. Like, for example, do you really want to be able to do Barrett's work in your practice? So to make sure that you could use in your initial contract, but you could use that to make sure that you have all, you know, RFA equipment, cryotherapy equipment, and all those. So make a list of like maybe one of the five or six most important things to you. As someone mentioned, like one of the things that's really important to them is to be able to do a dedicated IBD practice. So that would be a nice to sort of try to get in their contract and make sure that they have, you know, a dedicated IBD nurse, for example. So I think some of those things that someone pointed out to me or gave me a suggestion or advice was to make a list of the things that are most valuable to you and try to ensure that those are the top four things that I really, really want. And you'll see that if you're really most employers, they want you to succeed, because they know that if you are successful and happy is what's going to bring the best out of you. So I think most people will try to accommodate if you have reasonable and genuine, and especially if you're passionate about certain things in your career. But of course, there's other scenarios. So that's why what Dr. Jorgensen said, it's always important to get a legal expertise on your contract. Thank you, Dr. Belal. This is a question for you as well. It says, Dr. Belal, what made you choose a career in the VA? You know, to be frankly honest, so I had a visa requirement as well. That was part of that. But I think now that I've been there for one year, I would say that the VA career is actually, for me, has been incredible. And I'm really happy that that ended up being a choice for me. I think one of the things that's important to know is that there's a great work-life balance. Second, it's important to understand the VA works a little differently from others, that what is your VA catchment area? So for example, I'm at the Minneapolis VA, which covers, you know, our catchment area goes to Minnesota, Wisconsin, the Dakotas, and Iowa. So that allows a lot of the big referral base to come into. The other thing is that, the other nice thing about a VA is that if there is a facility that is being offered in another VA, it's very easy to bring that service to your VA. From an equipment standpoint, I've noticed that as long as we're offering evidence-based services to our veteran patients, the VA is very good about making sure that we have the available resources and the facilities I need. You know, in addition, there's excellent benefits and great work-life balance. So I think all those things were important for me. And a lot of the, you know, for me, the Minneapolis VA was in a major city. There's a lot of sometimes, I always tell people that, you know, people always say that there's a lot of saturation in advanced endoscopy. I always say that, you know, it's, you might have saturation in a couple of big cities, but there is, it's an evolving field. There's, people move a lot. It's a dynamic, so it's not a constant saturation. So it allowed me to practice in a big city like Minneapolis, which opens a lot of doors and collaborations. So those were the things that, you know, were important to me. And that's why I chose, I chose that, I chose that job. Thank you, Dr. Balal. This question, particularly for prior practice, it says, any early career advises to set yourself up on a good path for promotion or partnership in the first year or two? Yeah. So at least at my institution, it's pretty easy to make partner. I mean, we just, I mean, if you're a hard worker, if you're clinically competent, if you get along well with your colleagues and your nurses, you're going to make partner. So, you know, I think just taking into account the, you know, the things that we've been talking about today and doing your best job, and I don't think it'll be a problem. Thank you. There's, there's this one quick thing. Yeah. For the academic institutions, you know, my, my, my division chief, you know, went over with me what academic clinical tracks are available. So for example, there's a master educator track, there's a clinical research track. So knowing what track would best suit you and knowing the requirements, because some of those requirements might be very easy or low hanging fruits that you need to check off all the boxes. So knowing those requirements early on, and then channeling your energy to meet some of those requirements might be helpful in academic promotion. Thank you, Dr. Bilal. Here, it says, good question, actually, is it harder to switch from private job to academia or vice versa? Which one is harder? Yeah, you know, I always had the impression when I was a fellow that, that if I chose to go into private practice, I'd be, I'd be closing the door to academics. But I actually don't think that's the case. I have been doing private practice for nine years. But I've kept in touch with a lot of people in academics, and I, and maybe they're just paying me lip service. I don't know. But I feel like if I ever chose to go back to academics, I would be, I would be welcomed. I would say that, you know, obviously, I'm very early on in my career to know that. But I think what Dr. Mergener pointed out, is building your network through organizations like ASGE and the programs that offers, you know, you're always linked, it's a small community, and multiple opportunities will, will, will come up. So I think if you're, if you continue to build upon your network outside of your institution, you know, I think that that shouldn't be a problem either ways. There is a related question here says, what tips do you have to sell yourself in academia, if you really don't have sufficient research productivity, but you truly, truly love the academia, including the teaching and other resources? How do you sell yourself for this job? You know, I think, I think that that the concept of academia, that we always had in our, a lot of fellows have in their minds is that, oh, do I have to be doing like, you know, high end clinical trials or lab research. But that's not really true. And you know, the three pillars in academics are, you know, research is only one of them, you know, education and clinical care is, is similar. So if you're passionate about those two, and if you're dedicated to education, for instance, is one of your passions, which is one of my passions. But you'll be surprised that a lot of programs are in need for associate directors, site directors, you know, for evaluation, those are all cumbersome tasks that don't usually always come with, with protect a lot of protected time. So if you're passionate about those things, and you know, if you research not your main focus, that does not necessarily mean that it's closing the door to academics. Not to say that a lot of the tertiary care centers also have take on really complicated cases. So if you're passionate about sort of managing those cases, you'll still have a door and an opportunity to work in academic centers, at least that's the feeling I got when I was on the interview trail for my jobs last year. And this this brings me to this question, really important one, especially with this situation of COVID-19. When do you start looking for a job? When is the right time? Is it a year before? Six months before? What do you think? What do you guys think? I think it's never too early. I know, you know, we hired someone as a first year fellow. So he didn't join our practice for about two years. But I think in order to give yourself enough time, so that you can really consider your options, visit the places that you really like, and probably visit them twice, I think you should probably start at least 18 months prior to the end of your fellowship. Was he IBD? I'm just kidding. Motility, even better. Well, some of the attendees got a job already, so an IBD. Another question, what are the upcoming areas in GI that can be suggested to current fellows to sell themselves better? I'm sorry, what was that? What are the upcoming areas in GI, I guess, areas of interest that can be suggested to the current fellows to sell themselves when they find a job, when they're looking for a job? Well, I think it's most important to really figure out what it is you enjoy, because you don't want to sell yourself on something that you're, you know, that you're not passionate about. Because once you sell yourself, you're kind of stuck there, you know. So if you don't love IBD, and you sell yourself as an IBD person, I don't know, that doesn't make for a very good fit. So, I mean, personally, we're looking for IBD, hepatology, therapeutics, and we're kind of looking for everything. But it seems like IBD has been the hardest for us to find, but that's just one person's experience. But really, I think you just need to figure out what it is you love to do. Thank you, Dr. Hutchinson. Another question here says, do you have any suggestion how to avoid burnout? Do many institutions offer an admin day to minimize bringing a lot of work to home? So I can comment on that. Yeah, I mean, burnout is a big problem, especially this last year with COVID, because we didn't have, you know, those personal interactions and things like that. I think it's important to find an academic job or a job in practice that really focuses on physician well-being, that has a program in place to address these things. It's not just the amount of time you spend at work, it's how you spend your time. So finding an institution that is working on maximizing your efficiency with, you know, the EMR, that values time off, that gives adequate vacation. It might not be the practice that pays the most, but you need to find that balance of what's important to you. So looking for jobs that have adequate time off and physician support, I think, are important, and adequate staffing too. It's really hard to do a good job if you don't have adequate MA support and those sorts of things. That includes MP and PAs, Jennifer? Yeah, I would say so, yeah. Okay, Dr. Bilal, this is a question for you. It says, do you have any resources for visa holders for academic jobs, Serge? Most of the online resources are general and don't support visas like J-1. Yeah, I mean, unfortunately, it is a little bit of a challenge, but, you know, what I tell every single J-1 applicant who's ever called me is that I don't know a single gastroenterologist who was on a visa who's unemployed. So there, you know, eventually you'll, if it's any reassurance, there's always, there's jobs, but like I said, a lot of the VAs offer jobs. There's a lot of academic institutions that are in states where there's a dire need. So you could still work there for a few years and continue to stay in academics. That might not be the ideal geographical location for you, but there are great academic institutions. So I think you're just, if your passion is to be in academics and that's the most important thing for you, like it was for me, there are jobs. You just have to be willing to branch out for a few years and think of that as a different opportunity, maybe of building a team, building a department somewhere else and a different challenge for a few years. But I definitely think that there are jobs. Thank you, Dr. Bilal. Our last question will be, if you are negotiating a job for advanced endoscopy and they are looking for a special focus like ESD, which you may not have necessarily be trained in, but would like to develop a niche, how do you negotiate that? They tell you like we want you to be our ESD doctor and you don't have training in that. How do you negotiate that? I think put it, put it in your, put it in your contract. The ASGE has, ASGE has excellent programs where it offers scholarships for, and grants for you to be able to go to other countries, to go to other institutions, to be able to do that. A lot of recent graduates have taken use of those opportunities. Make sure that all the ESD equipment is, is tailored in, in, into your contract. And, and I would even, you know, meet the surgeons in that, in that hospital as a part of your job interview process. So you know that there is a divisional and institution-wide support for you to, for you to start that program. Thank you very much, both of you. Thank you, Steve, for this opportunity and ASGE for allowing us to be part of this panel. With that, I'll turn the mic to you.

Survival Tips

Transition from Fellowship to Attending

Dr. Mohamed Saidi

Negotiating Contracts

Work-Life Balance

Building a Network

Avoiding Burnout