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#129 - Dr. Katie Fritz MD MPH


Katie Fritz Neonatology Fellow Advisor Incubator podcast

Hello friends 👋


We have a great interview scheduled for you this week. We are chatting with Dr. Katie Fritz about how to approach the job search process at the end of a fellowship in neonatology. This was a highly requested episode and we hope you enjoy listening to it.

Happy Sunday!

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Bio: Katie Fritz, MD, MPH attended the University of Wisconsin School of Medicine and Public Health and completed her pediatrics residency and neonatology fellowship at the Medical College of Wisconsin. She is a neonatologist in Huntsville, AL with clinical interests including palliative care and chronic lung disease. Dr. Fritz also serves as an Envision Fellow Advisor, helping fellows through the job search process and is currently an AAP Training and Early Career Neonatologists (TECaN) Early Career Representative, as well. She enjoys traveling, especially to national parks, and spending time outside with her husband and two children, as well as reading and yoga.

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You can contact Katie by email at Katie.Fritz@envisionhealth.com

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The transcript of today's episode can be found below 👇

Ben 1:01

Hello, everybody. Welcome back to the incubator podcast. It is Sunday. We have a great interview scheduled for you guys today, Daphna. How are you?


Daphna 1:09

I'm doing great. I'm doing great. I think this is such an important topic. We've gotten lots of requests on it. So I'm glad we were able to finally bring on Dr. Dr. Fritz.


Ben 1:21

Yeah, and I think this is an episode where we're going to talk to Katie Fritz. Actually, let me just go through her bio quickly. Katie Fritz has an MD and an MPH. She attended the University of Wisconsin School of Medicine, and public health. She completed her pediatric residency and neonatology fellowship at the Medical College of Wisconsin. She's a neonatologist in Huntsville, Alabama, with clinical interests that include palliative care and chronic lung disease. She also serves and that's the reason why she has on with us today mostly is because she serves as the neonatology fellow advisor for Envision physician services, helping fellows through the job search process and is currently an AAP training and early career neonatologist early career representative as well, she enjoys traveling, she likes to go to national parks spending time outside with her husband and her two children. So we're very excited to have her on actually had I attended a conference for prospective fellow where she gave a talk and, and her compassionate and human outlook on the process of finding a job. Like right there. And


Unknown Speaker 2:27

that does not always feel very compassion. It's


Ben 2:29

so stressful. It is so stressful. You like you feel like? I mean, it's sad to say, but when you do apply for residency or fellowship, you say, You know what, even if I make it's not perfect, I can correct course. Because like, I don't know, maybe you're not the most happy fellow and the fellowship program you're in is good fit, but it's not a perfect fit. Well, you like what, the three years I'm going to matter there. But when it comes to a job, you're like, Oh, I better better not make a mistake, right? Like, because that could be like my job for the next 10 years. So it is very stressful in my opinion. But she had such a she had such a nice human approach and a very, very analytical outlook on all this process that I thought she was the one that when other fellows were saying, Hey, are you guys going to have an episode on this topic? She is the first name that came to mind. And I'm not surprised. And I'm not surprised that the AP is working with her as well. So so I'm very excited to have her on. Is there any announcement that we need to make Daphna about the incubator before we bring on Katie?


Unknown Speaker 3:32

Just that the shop is open. Sure the shop is


Ben 3:35

open. If you want to buy some some incubator swag, feel free to head on over there. Another thing that I want to mention is that we will be giving two webinars where there's been a lot of questions that I've been asked about, like, what are we working on? Can we for the people who are new to the incubator? What is the incubator? What is our mission? What are we doing? What are some of the offers that we have in terms of podcasts and mobile apps and all that stuff. So we'll be having two zoom webinars. The first one will be on Monday, May 29, at 9am. Eastern Time, and we will put the flyer on our on the front page of our website. And the other one is Monday, June 12 at 8pm. Eastern Time. And definitely I will be there to talk about what we've been working on talk about the Delphi conference, talk about upcoming things. And so yeah, so feel free to join us. Right, any anything else Daphna.


Unknown Speaker 4:30

Thank you got it. Alright, so


Ben 4:32

without further ado, please join us in welcoming to the show, Dr. Katie, Prince, Katie Fritz, thank you so much for being on the show with us this morning. How are you? Great. How are you? Well, we're doing good. This is a podcast that we've been really looking forward to recording. Specifically because all the trainees that are following the show are always asking when are we going to have an episode about job hunting searching for a job post? fellowship life. And and I have to say that it's something that is a big topic that deserves a great guest. And so the quest for great guests has come to an end you are here we are ready to talk about about young neonatologist entering the workforce. I guess we're gonna want to find out a little bit about about you and your interests and how you got involved in this. But I think people want to probably want us to start like right into it. And so I'm wondering if, if we could put ourselves in the in the shoes of graduating fellow? What, uh, what are the things that you shouldn't


Unknown Speaker 5:37

we were not that long ago, not too long ago.


Unknown Speaker 5:40

getting further away,


Ben 5:42

you know what happened? Okay, I'm going to take a break. I know we're supposed to start writing, but I was rounding the other day. And my, my PA said something to the effect of like, oh, I can take something about you as if I was not going to be able to put in the order basically. And it made me so old. Because that's what I used to do for my attending and I was like, No, yeah, he doesn't know how to do that. Like holy shit anyway. So, if we if we put ourselves in the shoes of a graduating neonatology fellow, what are what are the things that we should be looking out for when we are starting the process of seeking a job in neonatology?


Speaker 3 6:20

So it's a really exciting time in our careers. And I know when I was in the shoes of graduating fellows, I did not know what I wanted to do. And I wasn't quite sure even where I wanted to be. And I think the most important thing to remember is that this is finally the time, any young physicians life when they get to determine their own path, and we're not dependent on a match, and we're not dependent on the different requirements to get through training. And it's really the first opportunity to look at exactly what we want in a job exactly what we want our life to look like, and be able to kind of go out and find that.


Daphna 6:59

Exciting is one word for that. I was terrified, terrified. I was feeling terrified. honest about that.


Ben 7:10

We're sure what do you think are if we had to categorize the types of jobs that neonatologist can obtain? I think most people are familiar with the famous debate of private practice versus academia. But it seems like it's much more nuanced than that, then it's not purely black and white, in terms of, of academia versus private practice. So what are what are the different tracks that are opening themselves up to to graduating fellows?


Speaker 3 7:35

I agree, it's an exciting time in neonatology because we have gotten away from the your academic and doing your research and or you're doing private practice, and there's nothing in between that setup. So there are, we move towards calling them academic and non academic jobs, because it's not just about whether you're going to do research, or if you're and then if you're doing private practice, that it's only clinical care, there are a lot of different opportunities to do a blend of those whether you are in an academic institution, or not. So I think when you're going into the job search, it's really important to look at what you enjoy most. And I was on an accelerated research pathway and fellowship, I did an extra year of basic science research. And as I came to the end of that, I realized I just wasn't happy in the lab. And I was so much happier when I was out, doing taking care of the patients and working with families in the NICU and doing my palliative care work and things like that. But it was a difficult decision to make, because I felt like I was already going down that basic science pathway and I needed to stay on it. So there are ways to do whatever it is that you want to do. And you can do that in different hospital and university based attics.


Daphna 8:56

Yeah, I feel like there's this misconception, especially for private practice that you, you know, you can't do research, you won't be teaching. And that's really just not the case. And I feel like I did not have a good understanding of that world at all. When I received a fellowship. And my faculty did a really good job, I think about trying to prepare us for the job market. But they didn't know either, right? Because they had been in academia most of their lives. So maybe tell us more about the myths.


Speaker 3 9:33

Sure. So you guys are a fantastic example of what you can do going into the private practice setting and you have a nationwide if not global educational setup here that is really impacting our field in a great way. So I think you guys are kind of exhibit a of what people can go out and do even in that not official university based setting and in a private practice job. So there There are a lot of setups, like you said that are giving people the ability to do quality improvement research, there even can be some university collaborations and a private practice job where you can do some basic science, if that's something you're really passionate about. And our field is so team based that we're always educating other people. So it might not look like what we're used to, with medical students and the interns and the residents coming through the unit, and doing official teaching rounds and things like that. But in my private practice setting, I find that I'm oftentimes teaching nurses in their, you know, different Welcome to the NICU classes and teaching them some pathophysiology, as well as working with nurse practitioners who are doing clinicals and orienting within our unit. And there are just a lot of opportunities for that. Within the field. I think the same goes on the university based side where there are a lot more clinical pathways and opportunities to do medical education, and more translational and clinical research. And not just all the basic science research. So the opportunities are all out there. But like he said, we don't really know what to look for what to ask for. Because we're only exposed to the traditional fellowship, kind of research based system as we're coming through our training.


Ben 11:26

What do you think? Oh, sorry, go ahead.


Daphna 11:28

No, I was gonna say another, I think one last misconception I had was that if you picked one pathway, or the other, that you were forever stuck in one or the other, or that there are these like two cohorts of neonatologist, right, and that they never crossed paths. They didn't want to talk to each other. They don't want to play with each other. And I just found that not to be true. And so I know that a little bit as well.


Speaker 3 11:56

Sure, absolutely. That's a really big myth that you set down your path. And there's absolutely no turning back or crossing over. I think the most interesting people who I've talked to and met with in the fields have had, you know, kind of winding roads where they do some, some work in academia, and maybe their family needs to make a move for some reason, and they find a private practice job that works for them and stay connected. The AAP is doing a really good job right now. And he can specifically of creating the all pathways group, and I think really bringing together people with similar interests across different types of practices. And that's been exciting to see that develop. I'm also on the, the sorry, I said that T can I met the section, but the section is doing a really good job with that. And the, among the training and early career, the T can Executive Council as early career private practice, Rep. And and that's another group that's working hard to not just be working with fellows and people who are going into their academic settings, but reaching out to private practice folks to keep them really involved in advocacy projects, and some of the Qi and clinical research that's going on in the fields.


Ben 13:17

So I guess we can we can start asking some difficult questions. But no, but when when we are what our I mean, I think when we are in fellowship, it is so well regimented, right, that we're so much. I mean, it's kind of crazy when you think about it, that the ACGME normalizes the, the experience, not completely, but for pretty much fellows throughout the US. And so then you go into your job, and suddenly you it's very variable depending on the institution you decide to work with. And so that's something that as a fellow, you don't really imagine that the institution that trained you, for example, will be a whole different beast when it comes to actually dealing with HR and contracts and all that stuff. So I am wondering if you could tell us a little bit about when when the decision is made right to say, Okay, I'm going to I'm going to try to apply for either academic job or or private or whatever type of job you decide to apply. But what is the process then, from this point? And what are the things that fellows have to be cognizant of, to avoid making mistakes during the hiring process that can impact them long term? And obviously, I'm referring to noncompetes and all those things, but how would you if How do you advise fellows on that on that front?


Speaker 3 14:35

Absolutely. So my first piece of advice is to start early, generally getting applications out the summer of second year into third year of fellowship. Good so behind you out exactly where you're supposed to be right.


Ben 14:55

Do you mean to say that you did this last minute? That is not like us? Yeah.


Unknown Speaker 14:59

Oh,


Daphna 15:01

I just wasn't ready to start hunting for jobs. But that is a great tip, that is a good tip, because then you really know what is available.


Speaker 3 15:12

Yeah, exactly. And you can apply to private practice and academic based jobs. If you don't know what you want to do, I applied to what's probably, it's a lot of I applied to a lot of jobs, because I wasn't sure exactly what I was looking for. And so generally, I'll jump into the process a little bit and then get into your questions then about where, where potential pitfalls are. So in terms of finding jobs, using your context, within your fellowship, program, networking at conferences, and and then just kind of go into the AP Career Fairs and things like that online to look to find jobs that are open, are really good ways to get your foot in the door, you sometimes have to be persistent, because medical directors and busy practices, division chiefs, with with really busy groups in different different universities are getting a ton of emails, and they might miss it coming through. So don't be afraid to make a phone call, don't be afraid to reach out and check in again. Or do use any contacts that you have within that institution or group to make to get in touch with them and let them know that you're really interested, you certainly can just send a cold email, if you don't have a personal connection somewhere, that might be a little bit less likely to get replied to then if you say hey, I know Dr. So and So and have an email introduction there. But it could be a way to get your foot in the door. Generally, you will come and do an initial interview where you'll spend, do a dinner with the group or people from the division and then spend a day going through the NICU or NICUs talking to different people who work with the group. Sometimes you meet with nurse practitioners or nurses. And then some places are more formal than others in terms of the sit down interviews, and what kind of tough questions they ask and things like that. But you want to be really prepared to to tell your story and talk about why you're interested in that particular group or division. And and then just enjoy your time and get to know people because your potential practice partners are going to be a really big part of your life. And it's important to make sure that it's a good fit. Once you have done that initial interview, always send a thank you email and follow up. And then you'll hear back and if it's seems that there's mutual interest, you'll oftentimes be asked back for a second interview, I brought my family along to some of those because when we were looking at different places around the country that we hadn't spent significant time in, we wanted to see if it was a good fit for my husband and kids as well as me. And and then after that point, it will they if the group reaches out with a contract for you, then that's where all the fun reading and legal stuff. And all of that begins. Definitely, definitely I recommend having an attorney review the contract, specifically an employment attorney in the state or area that you're going to be working in noncompetes vary quite a bit from state to state in terms of the wording and the enforceability. And there's really no way to just Google that and feel confident in what's going on. And you want to pay attention to the type of malpractice insurance and make sure that you have tailed coverage. There's some good resources out there about that. As well as just going through the details of exactly what's expected. Make sure that the contract is lining up with the number of shifts or hours or call setup that you are anticipating based on your time with the group. So once you're Yes,


Ben 18:51

I wanted to interrupt you here one second, because I think you're mentioning a lot of things that are for me and for Daphna we're familiar with at this point. But for somebody who's entering this, this process may not be number one. I think it's very important to the last point you made not assume that because like Oh, I must have received the same contract as the other guys. And we all have the same contract. Like you were thinking like a fellow. And like that is not so no, yeah. And you're right. So look at the number of shifts, you're so right, because then you find out like, Hey, I signed up for more shifts on my contract. And my colleagues actually negotiated that and now I'm more


Daphna 19:23

or you might get a contract that doesn't tell you how many shifts. You are great. That's right.


Ben 19:26

Yeah. And then and then for the fellows who are who don't have never thought of malpractice insurance until now, what is what is tail coverage? Reading.


Speaker 3 19:37

That's an important thing. I'm not an expert. But you want to make sure that not only are you covered during the time that you're with that group, but that your malpractice insurance will cover you if you do go and work elsewhere or towards the end of your career. So if any claims come up, you're not left out on your own without that coverage there


Daphna 19:58

and that's it super important. I mean, getting your own tail coverage is like in the triple digits, right to protect yourself. And so I think, personally, I think nobody should sign a contract just to get support to coverage. But they are out there. They are definitely out.


Ben 20:15

Or they will tell you some people have done this where they say, Yeah, you tell coverage one year post contracts where it's like, right, one year post contract is not good for me as a neonatologist, because I'm still liable for some time.


Unknown Speaker 20:29

The statute eliminates absolutely


Speaker 3 20:31

right. And that's something as well definitely be familiar with is, wherever you're going to be practicing what what that statute of limitations looks like. So you can do the double check that your coverage matches up with that. Well,


Daphna 20:45

can we talk more about non competes?


Unknown Speaker 20:47

Sure. So sometimes, yes, go ahead.


Daphna 20:52

No, I was gonna say, I think sometimes the wording can be really tricky. I think by design, it's really absolutely. So maybe we can talk a little bit more about that. Yep. So the


Speaker 3 21:05

and again, I'm not an expert in this area. But certainly from going through the process myself and looking at some different contracts. It's something that I tried to get familiar with. So the like you said, the non competes can be written in different ways, most commonly their geographic area. And so the non compete will say that you may not take another job within this field, however, it's worded in statements of X number of miles for Y amount of time. And so if things don't work out in the job, but you and your family really need to stay put that can potentially limit you, or either you have to take a lapse in practice, or you have to go outside of that area. Now, it's quite variable, how enforceable non compete clauses are. And again, that's something to discuss with your attorney.


Ben 21:53

There's, there's I think, a federal push to try to make noncompetes illegal I actually, yeah, that's actually quite exciting for us. But I think need to add on to what you're saying, Katie, I think you also have to look these days where you're no longer dealing, most of the time, you're no longer dealing with the old school, single building hospital where you're dealing with health systems that have multiple sites. And then the noncompete can be worded in a way where it is that radius that you're mentioning, from any x, whatever name, put your name here, healthcare system site, which means that the circle becomes very, very large, because then you have multiple overlapping. That's right. That's right. And I think, and I think that could be that could be very damaging to a physician, especially, especially when you're not even working at those sites. So for example, if you say, well, it's it, you could technically say, well, the non compete is fair, because I am working at the west on the west hospital, and also in the main hospital. But when you're only located in one center, and your noncompete applies all the way to the northern hospital, that the healthcare system owns it. Yeah, I've seen people who had to leave the state to actually find another job. And that that is a big, big decision. So yeah, thank you for bringing that up. I wanted to I wanted to go back to something you said as well, which is, how important is it to find a group of people you get along with? Because you may say, Well, what's the big deal about that, like, I'm going to come do my shift, you know, and get on with my life. But I think you're absolutely right, the people you're going to work with, you really need to be on at least the same wavelength because otherwise you're in for a rough ride.


Speaker 3 23:23

I think it might be the most important thing in the job hunt, because you are not just making a three year residency or fellowship, commitment here. The average physician in the US stays in their first job for about two to three years, pediatrics and neonatology stay longer, but still for a limited period of time. But I think the goal for most of us is to find a place that we're really happy and where we love to work and love to live, and to stay there for the long run. And if you are just not meshing and the personality front with the other people who you're going to be working with, it's going to be hard to be happy in that position, because you are working together closely for potentially years or decades. And, and it's really, it's really a great thing when you go into work and you enjoy spending time with the people that you work with. I know that my partners here in Huntsville, where I am, were a fantastic resource to me when I was moving to the area and quickly became great friends, which just makes that kind of work life balance and satisfaction so much better. So definitely it's we're always nervous when we go into an interview, right? And so you're going somewhere and you got your suit on and you're ready to talk to these people who you may or may not have met any of them before and you feel like you're in the hot seat and you need to, you know, be ready to answer the questions and prove yourself but you're also interviewing them. So keep that in mind when you're going out to dinner or when you're having lunch and doing the different kind of rounds of interviews that you really want to get to know the other people the best You can and, and get a sense of how they work together. It's okay to ask why people have left previously, I encouraged fellows to ask the question about turnover within the group, because that can give you a good idea of the culture. And you can do a little bit of detective work and try to track down some of those folks or get a better understanding if it seems like a few people have left in a fairly short time period, to try to understand that situation better. And it might not have anything to do with the hospital or the people or the what's going on there. But But it's good to kind of delve into that a little


Ben 25:32

bit is very different if you had turnover because three people went and retired rather than people who just abruptly got up and left. So I think you're asking for a


Unknown Speaker 25:42

year or two, we're miserable lab. That's a red flag. Absolutely.


Ben 25:44

Those are those are red flags. And to the point you were just making how as a fellow, do we, it's a difficult mental step to take, right? We've always been the ones interviewed, we've always been the ones trying to impress, to impress the medical school to impress the residency program to impress the fellowship program, I guess, fellowship, maybe a bit less. But how do we change our mindset? And what is the best way to do so to actually enter these interviews? Where Yes, we will try to give a good impression, obviously, but also start not being afraid to ask the questions because I see too many fellows who I work with, who just don't ask any questions, they just go the answer to the questions they're being asked. And they just then cross reference, I hope you take me and it's like, that's not the way it should be. So what is your advice to help make that leap happen?


Speaker 3 26:29

Sure. So I think fellows when they're going out for those first couple of interviews have to give themselves a big pep talk and, and remind themselves that this isn't a match, this isn't a list on your computer in their computer. This is these are job interviews, like what the rest of the world does, we just haven't had that experience for the most part, as we've gone through our training. And so just going in with the mindset of this finally being the time where we really get to choose our own pathway. And just knowing that after all the hard work and years and years of dedication that I was really deserved to find a great match and a place that they're going to be happy. And there's no way to get to the bottom of whether you will be happy somewhere unless you start asking some of the questions about what it's like there and how the group works together and what the culture of the hospital in NICU are, and things like that.


Daphna 27:23

Yeah, I was wondering what you guys thought about, I think when you're a third year fellow, you know that this time is going to come that you're going to be practice independent, you'll be practicing independently. But it is not until you like show up for your first shift. And you know, there's that joke where you know, stuff is going down. And you're like, you're really looking around for the attending. And you me? Yes. So what do you think is the best way to screen for like, what the mentorship will look like? And I don't I mean, that one in a scholarly work, advocacy, research capacity. But really like, what is the clinical mentorship and teamwork look like? What do you guys yes, the best way to evaluate that,


Speaker 3 28:06

that's really, those are really important things to get to the bottom of, I found in my experience, that really spending some time talking to the most junior member of our group was the most helpful because she was just a year and a half ahead of me, and so she could tell me, and luckily, it was, you know, really upfront and honest about the fact that yes, when the senior guys in the group say that their phone is always on their phone is always on and they want you to call when on, you know, day three, you get 23 week triplets, they're gonna come in and help you. That didn't happen. But I had some very early on. And I remember just looking at that one. I was it was like 9am first day, no prenatal care, estimated 24 weeks go to the delivery, and I looked around, but to all the fellows out there who are really nervous about that first shift, because we all were terrified at that moment in time. You're all so well trained, and you know what you're doing, and you're ready for this. And exactly, which said definitely just kind of make sure that you are comfortable with the clinical support and knowing who to call if you do have a really challenging airway. Or if you are in a situation where you don't quite know what the next best step is. But you know more than you think you do, and and the autopilot kicks in and it's gonna go okay,


Ben 29:29

but you guys are touching up on a point. That's very interesting, because I think there is there is room during an interview for the question of how does your group support Junior attendings? Both, like you said, both clinically, and then we can talk about scholarly stuff and outside activities, but also in fellowship, you've may have seeked, like you said, if not, you may have seek the attending for help. But as an attending, you still have a support system within the hospital and so, like, can


Speaker 1 29:57

you still seek out the attending branch? know if they're referred the attending your attending year attending,


Ben 30:06

right, exactly what what I referred to is, like we were mentioning like a difficult airway. Do we have an airway team in this hospital? Or am I it, and when I walk in this unknown, you are the airway team. And there's nobody else to support you from that front or difficult lines, you guys have a PICC line team. So if we don't have access, who's going to come do this and so even though you are not a fellow with an attending to sort of back you up, the hospital has systems in place to back you up where there's like, we support you with this. We have this team that drives our blood cultures. We have this team that does the lines we have this team that does the airway we have this we have that and that support system you'll you'll get to be familiar with and and rely on them. Same thing as consultants as well, you do we have the support from the consultants standpoint, and all these things end up mattering tremendously, because they do impact your impact your your well being as an attending, but right Kelly and correct me if I'm wrong, they are groups where there is no support for junior attendings meaning the there's like you're describing an ideal scenario where you said my senior partners had their phones on and they would come help, but they are practices where they were hiring you, because they were short staffed, and because they needed relief. So when you come in, you're supposed to provide relief and not provide the burden of work. And I think yet for a fellow that is ready to go and really wants that kind of excitement. I think this is a lot of fun. But it could be very frightening for someone who was looking for a much more structured progression towards the first few years of being an attending.


Speaker 3 31:35

Absolutely, I think it's important to request a shadow period at the beginning, not because you need any clinical support or training, but so you understand those systems that are in place, and you can be with one or the other neonatologist as they figure out what to do when they're having trouble getting a line, or they run into a difficult situation with an airway or anything like that. And you can actually in real time, see how it works in the hospital, make sure you've got all the phone numbers that you need and know who to contact and also get to know the electronic medical record system. Because if you're going if you're going from Epic to Cerner or something totally different. There's a pretty big learning curve and you don't need to be on called dealing with emergencies. While you are trying to understand the system that you're working in.


Ben 32:23

This episode is proudly sponsored by red meat Johnson recognized Johnson is dedicated to the research and development of nutrition products that help support baby development at every stage, including an extensive and female portfolio for premature and low birth weight infants learn more at HCP dot meet johnson.com. Excellent.


Daphna 32:42

I think it really calls for some real like introspection about yourself. Right? Which I think I'm still I'm still doing I'm still learning. Right now. What in what situation in what type of team? Do I function best? Am I happiest? You know, Ben and I have been in two different at least two now what I guess three, four different hospital systems, right? And, you know, we've been in really big teams where they're like five Doc's on and a bunch of other people around. And or we've been on small teams where you're the only doc in the hospital for like, a week. Right. And so, you know, I think I think all of those opportunities exist in neonatology and all of them are right for somebody, but you have to decide which one, you know is right for you. And I guess I'm thinking, you know, we don't always get it right on the on the first try, or the second try. And, you know, I think sometimes it's scary to change jobs. If you feel like it's not the right, fit, I wonder what guidance is there for, like, you know, how long should you give it at a place before you decide if it's the right fit or not leaving? I feel like my right fit now. But I know a lot of people who are clearly not there, you know, they're right, fit. But you also don't want to leave too soon. So any feedback about right or maybe right, so we have some mid career Neos who who may be still wondering the same things. Yeah.


Speaker 3 34:30

So in talking to fellows who are then transitioning into their first job, it seems like about six months in is when people feel like they hit their stride. And they understand the system. They understand how things work, and they have a little bit more of a sense of is this a place where I'm feeling good about my practice? If I feel like a you know, feel like I'm settled in and doing well and then really, it can take a year or two though before I think you have a really good sense As of Gosh, this has given me the career satisfaction that I'm looking for, am I in the right place not only in terms of the team setup, like you mentioned, but with acuity and being, you know, some of us will look at jobs that are in level three Nikki's that have a lot of preemies and a lot of acumen in that standpoint, but transfer out all their surgical patients. And maybe you feel like it's just really important to be able to take care of that subset of babies and need to go looking for something, something different. But generally that six months to a year point. Few people I've spoken with who are really struggling and feeling like this just isn't right. That's, that's at the year, they're ready to start looking and potentially make a change. I'm still sticking with the first job that that I took. So I'm not an expert in that. But I don't know if you guys can speak a little bit more to you know, that timing.


Ben 35:54

I think there was a podcast I was listening to. I think it's a diary of this diary of a CEO by I forget, Stephen, anywhere from the UK, where he had on Simon Sinek, who was talking about he was talking about this in the context of getting a raise, which we're not it's not worth talking about yet. But but he was asking about different podcasts, it's a whole different pocket, was asking the question about like, how do we how do we find fulfillment in our work? And how do we know that we're in the right place? And he was saying there's a famous question people ask you on interviews, which is where do you see yourself in five years, right? And it'd become cliche, and it's now very, very old fashioned. But he said, there is a point to flip the question on your employer, and then go back to your employer and saying, Well, what do you see for me and five years in this institution? And based on the answer they'll give you, you'll have a very clear sense of whether you're fitting in whether they value you and whether they have a plan for you, because somebody who clearly has a vision for you, which by the way, may or may not be the right one. But then you say, well, they this is not they have a vision for me that is not aligned with what I want. Or you say, Wow, they've they're thinking proactively, about how can I grow into the role? I think this is a very, very valuable experience. And this is something I've still in stolen from him. And I've done with our bosses and asked many times, and it's and it's what gives me the satisfaction of being happy at my job and seeing that there's there's progression. But I think that's something that's very interesting. Because if the plan is just for you to come and do the shift, and you're like, Man, I wanted a little bit more than that, then maybe start considering start considering options, start considering maybe having a discussion with your team about about what I guess would be my next question, which is, what are some of the things that we as a fellow where we're kind of we're kind of stupid, right? It's like, what is the acuity? How many babies? How many ECMO? How many, how many surgical, right? But we don't tend to think of asking questions, or we can even ask us about research. But what about other things like administrative advancement in terms of leadership in terms of leadership, if you're in an academic institution within educational programs? How do we ask as a fellow applying for a job without sounding pompous right now without saying like, without being the prospective the fellow who's applying for his first job? Like, is there a path for me to be in medical director? Right, which it's very right. Obviously, you want me in that role? Exactly. But how do you ask about the potential for you to grow in those in those areas, during those interviews to see if if there is potential there for for you.


Daphna 38:21

It might be a red flag, if they tell you they're going to need you as medical director and,


Ben 38:27

fellow, this is a true story, by the way, we're going to have to tell stories. But I saw a fellow applying for a job telling our medical director, when he asked Where do you see yourself in like 510 years, like in your chair, and that was


somebody somebody so so maybe that's not the best advice to follow. But there is there are so many programs that fellows are not aware of for career development that hospitals have that universities have where you can actually get extra diplomas. And it's important to ask those things because they will make the job even more appealing to you.


Speaker 3 39:07

Absolutely. And there is nothing wrong with asking, What are your leadership pathways or what are your medical education pathways? And how do Junior attendings or assistant professors get involved in those those types of roles, and certainly not suggesting that that's where you're going to be in a very short period of time. But asking for the future and when, when universities and when groups hire a new neonatologist, they're making a really, really big investment. So it is in their best interest for you to demonstrate your long term commitment and that you're being really thoughtful about your career path. So that's going to reflect positively on an interviewee. When they are asking about those different possibilities, I think that it also it segues a little bit into some negotiation for what's going to help set you up for success. And that can be on in any type of a job. I think it's it's probably most clear in an academic based research job, when you are asking about the progression and promotions and and then you need to negotiate for the protected time for the lab space for the brief for the resources, the personnel that you need in order to be successful. And it's an everybody's best interest for the people that they hire. And for you to go ahead and be able to do the work successfully. And to get your grants and get your publications and progress through the system. It can be a little bit trickier when there isn't a designated pathway like in academics. But certainly you can request if you are interested in a master's program to go ahead and be the go to person and bioethics for the group, for example. Or if you want to go down a leadership pathway and look at, like you said, a university certificate program or something like that, you can work that into your contract is something that the whatever entity is hiring you is supporting financially and potentially timewise as well. So you can ask the questions about what these things look like. And then once you have a contract in handy, you can have the discussions about how to help you be most how they can help you be most successful, and get in there.


Ben 41:29

I want to ask one more follow up and enough time promised. But what do you tell two fellows, I think there's a very interesting case scenario where you can interview in a program that is not fully developed yet, but has a lot of promise. And sometimes the group will make that promise they Oh, we're trying to build this and we're trying to build that. But at the end of the day, there's at the time you're interviewing, there's nothing out there, right, but but they have all these lofty goals. And I think sometimes it's a very conflicting position for a prospective attending to make a decision between it's super exciting to be involved in the building. But on the other hand, I have no commitment or guarantees that any of that stuff is going to pan out. How do you sort out this murky water a little bit more to decide if this is a place that is truthful to their goals or not? In your opinion?


Speaker 3 42:15

Absolutely. I can give a personal anecdote about that. Because I came here to Huntsville to interview and knew it was an area that we were interested in as a family, but didn't know a whole lot about the hospital system. And turns out, it's a big grown community. So at the time I interviewed, it was a 55 bed, level three NICU with an average daily census somewhere in the 60s. And I said, Oh, that sounds sounds like a pretty, pretty busy place. And I really liked it when I went through and met everybody. But that kind of I talked a little bit when I interviewed with the hospital leadership about, you know, plans for growth, and I wasn't given really clear answers, like you said, you can you can say, Oh, absolutely, we're gonna grow this unit. And it's gonna be big and beautiful and take care of everyone. But it's, it's hard to take that a little bit at face value. And so I went back to medical director when we were after they had offered me a job. And I said, like, come back to is I'm concerned that the hospital isn't investing in the growth and that it's not going to be able to reach this potential. And he came back pretty quickly with a set of blueprints, and some communication from the hospital about this next big expansion and how it would be moving forward. So you can ask for some sort of evidence that the resources are there, or that the plans are there. And it's never a guarantee that things are going to reach that next point. But But certainly, if you have concerns or reservations, it's really important to get those addressed. And then you see what the person who you've been communicating with, whether it be division chief or medical director, what the response is, and if that gives you a little bit more peace of mind, or if you say this might be too big of a chance for me to take at this early point in my career. But that's


Ben 44:10

such a key point. You're right. It's it's such a key point you're making, right? If the hospital is aligned with the group or with the physician, in the end, there's resource being allocated or set aside. I think that's the best in my opinion. That's actually my my rule of thumb is probably the best signal that the division is going to be effectuated. Because the because too many times there's like you said, there's these empty promises. And then you say, Where are the resources that are being set aside that this is going to eventually see the light of day, and there's crickets and that's when you sort of take care


Speaker 3 44:44

if you're able to if you have another opportunity that might be that might be part of the decision making there?


Daphna 44:51

Yeah, one of the only things I think we haven't touched on yet we've talked about, you know, how can I get involved what are the pathways, but I think Good question is also like, what other things are expected of me outside of my clinical and or pathway related duties? Like, how many committees like how many you know, because something I was surprised to learn on the trail was, how much unpaid work was, was to be expected to be in certain places. And that's true everywhere, right? Like, we're all getting involved on our personal, you know, passions and professional passions, you know, in pitching in and doing our part and creating policies and protocols in the unit. But some, at some institutions like free work is like the mainstay. And so that's definitely something I would inquire about. The other thing I was interestingly interested to find, and I want to hear your opinion about this. I always anticipated going to a place where they were already doing this stuff that interested me. And what I found is so many places, and we've talked about this on the podcast all the time, especially during journal clubs. No physician can know all the things about all the things right, so you find that in even say, in private practice, where people aren't doing research on a particular thing, there's a point person for like, respiratory, and there's a point person for nutrition. And I didn't realize how valuable I could be is coming in as the point person for my personal interests like palliative care and neuro development and family centered care. And so what do you say to people who say like, well, I like this place I'm interviewing here, but nobody's doing what I do.


Speaker 3 46:50

I agree with you completely to see that as an opportunity. It can be even a little frustrating to go say if you go into a place and they have a really well established chronic Lyme disease team and program and your true passion is chronic lung disease, you're going to be starting is kind of the low person on the totem pole in a well established group that's probably functioning pretty well, and not have that same opportunity for advancement and leadership as you are if you go in somewhere where there's really room for you to create something new. It's important, though, to talk to the folks you'll be working with and your leadership about how open they are to that. And like you said earlier, definitely think there's some places that just wants you to show up and do your shift and take good care of the babies and move right along. So you want to make sure that you have the support of your medical director and anyone on the administrative side of things, to go ahead and work on 70 policies and protocols in an area that you think needs some improvement and has as an opportunity for leadership. But it certainly can be a way to really get into something that you're passionate about and be able to make a difference and the place that you're working.


Daphna 48:02

And I do think some people do want to just come and do their shifts, and that's okay, too. But you want to make sure that you're at a place that that values that as well. Right. You mentioned negotiations, and we're getting we're getting to the end of our hour. And so I think we would be remiss if we didn't talk about, like how much negotiation is too much negotiation like what like, what should people feel okay about asking for no matter what, and then like, what are the like touchy subjects?


Speaker 3 48:34

Absolutely. So the elephant in the room is always the salary, right. And there are good resources out there where you can look at kind of what the salary ranges are, they're pretty, it's a pretty significant range. And and get a sense of just making sure that you that you fall in line with that university based jobs to understanding are generally pretty set and what those salaries are. And the where the place where you have room for negotiation is the other things the tuition assistance, if you want to go on for a Master's, if you want to have if you need lab space, if you need to protected time, if you want to reduce the number of calls that you're expected to do or the time on the weeks on service. That's really where your room for negotiation is. You have to be realistic, and you have to understand what the needs of that particular group are and and see if you can come to an agreement with something that works well for both of you. in private practice, there's sometimes the potential for more of a discussion in salary. But there's so many different setups for private practice and you really have to get to understand the business of it. So there are a handful of true private practice groups out there where you're responsible for your own billing and getting you know, getting paid from the insurance companies and everybody is kind have their own entity within that group. There are some that have partnership tracks where you may or may not be expected to buy into that partnership. So you're salaried for several years and then buy in from there. And then there are the setups with Envision who we work for, and men next who are going to have the the kind of more standard contract and that they that they do for the groups that that work for them. And so you can always ask the question, I think, instead of those saying, I just want to make as much as I possibly can, you really have to sit down and consider what the most important things are to you. If it's money, if it's time, if it's some other sort of a resource, and then work together in a respectful way, with the people who have offered you a job to come to an agreement that works for everybody.


Ben 50:50

When when we are talking about the looking for a job, I mean, that's a hard question for me to to enunciate. But there is this there is this stigma right around like, you should be in a there's no, no, I'm going to talk about personal experience, because I guess that's the only thing I can talk about. But when I finished fellowship, there's this stigma of like, the proper path is a large university that will force enter, right? And if you're not seizing those opportunities, then you're wasting your life, basically. And how do we escape this pervasiveness? Because on the one hand, it is not like it's a toxic path, either, but it it may not be the right path for you. And I think there are lots of fellows who go to interviews and for example, they say, Oh, they don't have cardiothoracic surgery over there. And they say, oh, then the hospital suddenly falls lower on their sort of list of places that are potentially suitable, when in truth does that does that really matter? And and how do we demystify the process? So what are what are your tips and tricks that you give fellows when you advise them around this, this sort of aura around certain certain hospitals and institutions versus others?


Speaker 3 52:01

Oh, absolutely. We've all been really good students for a really long time. And when you feel that there is the right path to take, and the one that's been demonstrated to you, I think we all feel some degree of responsibility to continue on that academic pathway, and doing the research and contributing to the field. It's hard to break out of that expectation without actually seeing what's out there. And I think at the end of the day, there are so many little babies all around the country who need to be taken care of and taken care of well, and and we have to give ourselves permission to make that, you know, a priority, not a priority in our job search. Because a lot of us, a lot of us went into the field, because we just love the clinical work and are gonna get the most fulfillment and be the best doctors that we can be by going out into those busy clinical settings, where we're just seeing a whole lot of babies and taking good care of them. And then there are those of us who are more research minded and really have a passion for that. And they're great pathways to take advantage of it and, and help us all learn more about the latest and greatest and ways that we can do our job better. And so we need all of those people to be part of neonatology and, and part of advancing our field forward, I think and so but sometimes we have to give ourselves a little bit of permission to prioritize what we are most passionate about and what we're most interested in and will make us happiest. Even if that hasn't been what we've seen demonstrated to us during our training


Daphna 53:38

one at least to explore those options. I think I understood that. That every center was a major academic. The truth is that most babies in this country are not cared for in major academic centers, right, just because of the sheer number of hospitals and babies delivered. Absolutely. And so that is not something that I really understood. And like you said, I think it takes all all of us across the spectrum to to, to bring the best care for for all these babies.


Speaker 3 54:14

Absolutely. And there are so many. And there are level fours out there that are staffed by private practice groups, there are, like I said, I'm going to busy surgical level three unit that that takes care of an absolute ton of babies that I love the clinical work that I do. So there are things that I didn't realize were out there, I thought that level threes were places that were at delivery centers, and as soon as there was a complication off, they went to the academic center. And that's not true in many places. But there's really no way to know but then to other than to go out and interview and check out different places and find the one that you get most that you're most excited about and it's the best fit.


Ben 54:56

So then, to that point, how do you balance then A place that may seem like a good fit, but that's that also may not. So the best case scenario is you find the best place the best place you're looking for in the in the geographical location you're looking for. But then how do you balance that? That imbalance where, where you may have a great place, but that's not really exactly where you want it to live versus a place where you're not if you're not sure this is the best fit, but it's exactly where you want it to be. How do you negotiate those things? And what do you what do you tell fellows who are asking those questions,


Speaker 3 55:28

there's always going to be some give or take, there's not the absolute perfect job or living situation out there. For any of us. In my situation, it resulted in a ridiculous spreadsheet that listed every single factor I could think of, and my husband and I, you know, put different percentages weight at different ways. And, and even though we had a sense of what we were going to end up doing it, it helped us to just almost put numbers to it and make some sense out of these all these different factors, whether it was the level of the NICU and calls from home versus being in house and what the area was like, what the schools were like transportation, just all those different things. We just got them down on a spreadsheet. But in the end, it was it was kind of the the gut check. And the thing that felt right that that was the way that we that we ended up going. And luckily, the spreadsheet supported it when I waited a certain way. It was all good. But it's a tough, tough decision, you like you said, you can make a change if it's not what you expected it to be if it's not the right place for you geographically or workwise. That that can change in the future. But I love helping fellows try to put all these pieces together to make the best decision they can with the information that they have and where they are in life at that moment.


Ben 56:53

But what do you think is the best way to involve your loved ones in the decision when you're looking for truly.


Speaker 3 56:58

So like I mentioned going to their second interviews and bringing my family along was was great. And I felt a little bit silly asking, but the couple places where I did go to second interview, were really very open to it and supportive of it. Because obviously, it's it was a big move and a big change for our entire family. For a spouse, or a partner, definitely the job opportunities have to have to be really carefully considered for them as well, if you're looking for a move, and then with my kids were pretty young, when we did this, I think if I were looking again, in the future, they'd have to be a bigger part of those conversations about where you're going and what's there and all of those exciting but kind of scary things. So but definitely bring bring your family along for the ride and, and make that decision together.


Daphna 57:52

i Before we wrap up, I know that T can has a lot of opportunities to help prepare people for the interview process and pass that tea can for those who are not have not become a part of it yet. It's for the first seven years, right? Correct. So why people should get involved with the ATT cans. Sure,


Speaker 3 58:14

there are some really fantastic resources, you can check out their website through the AP to see what some of those are. The ones that I really have enjoyed the most are the job search webinars that they do. And they do private practice. They do academic they talk about some degree then applications and negotiation and things like that. And so they really bring in people from around the country to speak to what to expect in the process and help fellows or early career folks who are looking for perhaps another job, get prepared for that job search to get also does really great advocacy work and has done a really nice job of finding ways to include fellows from around the country as well as early career folks. So you can boost your CV a little bit and be a part of a really big exciting project. There's really something for everyone there. And like I said, our section and the AAP are doing a great job of expanding to all pathways and doing their best to include folks who are in all different types of practice within our fields. So we can learn from each other and work on some exciting projects around the country.


Ben 59:28

Katie what what prompted you to want it to your fellows advisor Why did you want to do that? That sounds it sounds like it's it's it's being another kind of physician and


Speaker 3 59:41

for sure. So I I just after going through an extensive job search myself and being very confused about the process and am I going to do private practice or stay in an academic setting? What do these things look like? And while I had some fantastic research mentors Send great attendings in fellowship, there weren't people who had been in the same spot that I was in at the time that I was going out to interview and make some of these decisions. So once I got settled into my job here in Huntsville, and working for Envision, we got involved in a fellows conference that we do every year early in the summer for second year fellows. And so we bring in people from around the country to talk about different clinical topics and research presentations, all that good stuff. So that kind of evolved into me doing more work with the fellows who are reaching out and a part of the conference to talk through the getting your CV ready working on your cover letter, how to find the jobs and go into the interview and contract process. So it's something I really get excited to do. And I hope that folks who are feeling a little bit alone like I did during that process, just know that we're out here and happy to chat and, and, and help them through the process. Because it's a really exciting time.


Ben 1:01:06

Yeah, we'll definitely link that on our on our episode page. It's a great it's a great place to just relax and for if you're a fellow just like brainstorm with other fellows and with attendings, and with people like you, yeah, so it is definitely a great place. I wanted to thank you for taking the time to come on the show. And we will definitely have will link your email address if anybody wants to be in touch with you as well. Absolutely. Why don't you address one thing that we did not speak about which we did so on purpose? Obviously, there is potentially a lot of questions surrounding loan reimbursement and income based repayment. But I think that is an extremely complex discussion. That probably warrants I know that Jimmy Turner has podcasts and about this specific topic. So obviously, this is a very complicated situation, depending on whether you are an American Graduate, an international graduate, whether you are in an anyway, for profit, nonprofit, there's a lot of variables. So that may be something that we'll do part two on, but we did not, we did not forget that. It's just that it's it's something that could not be addressed diligently in the format that we've selected today. So we need to talk about


Speaker 3 1:02:16

now it does sound like another podcast, but certainly something to be thinking about. And that is I was missing that saying that that can be something that can be negotiated as well, during the contract process about looking for some loan reimbursement, and also asking those specific questions about whether an employer would qualify you for loan forgiveness, and making sure that you're you're set up on that pathway if it applies.


Ben 1:02:43

Absolutely. Katie, thank you so much. It's always a pleasure talking to you. Thank you for having me. Thank you, everybody. Thank you for listening to the incubator podcast. If you liked this episode, please leave us a review on Apple podcast or the Apple podcast website. You can find other episodes of the show on Apple podcast, Spotify, Google podcasts, or the podcast app of your choice. We would love to hear from you. So feel free to send us questions, comments or suggestions to our email address NICU podcast@gmail.com. You can also message the show on Instagram or Twitter, at NICU podcast or through our website at WWW dot v dash incubator that org This podcast is intended to be purely for entertainment and informational purposes and should not be construed as medical advice. If you have any medical concerns. Please see your primary care professional. Thank you


Transcribed by https://otter.ai


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