Hello Friends 👋
We are thrilled to announce the launch of our new series of episodes on the podcast titled “MythBusters”. In collaboration with the American Academy of Pediatrics TeCAN team, we’ll be debunking myths surrounding work in the NICU and neonatology. Dive deep into these fun episodes available on the Incubator and Neonatology Review podcast.
For more insights into the TeCAN team and to get in touch with the panel featured in this series, please find the details below. Happy listening!
Dr. Anisha Bhatia (Chair) - Anishabhatia2@gmail.com
Dr. Ashley Lucke (Past Chair) - AshleyLuckeMD@gmail.com
Dr. Sasha Amiri - firstname.lastname@example.org
The transcript for episode 213 can be found below:
[00:00:34] Ben: Hello, everybody. Welcome back to the incubator podcast. We are back with a very special episode today. Daphna, how are you? First, I always have to ask, how
[00:00:43] Ben: are
[00:00:43] Ben: you?
[00:00:45] Daphna: Well, like, uh, we were talking about Off Air, we've really been looking forward to this collab. So, um, I'm pretty pumped that we were able to get five people all on at the same time. That's no small feat. And, um, I think we've got [00:01:00] some really good info to share.
[00:01:01] Ben: Absolutely. And, and this, this series is prompted by an email that we folks at TKEN about The busting myths in and around neonatology. And so we're going to have a special episode about that. We'll talk about the inception story of the series. And so, first and foremost, I'd like to intro introduce our, our, our guests, our panelists.
[00:01:24] Ben: Um, we have, uh, Dr, uh, Sasha Amiri. That's on with us today. He is a second year fellow in unitology at Rush University Medical Center. Sasha. How's it going Yeah, uh, we are joined also by Dr. Ashley Luck, who is the immediate past chair of TEACAN Hey, Ashley.
[00:01:46] Ashley: Hey, good morning. Thank you.
[00:01:48] Ben: And Dr. Anisha Bhatia, who is the current chair of TEACAN Hello, Anisha.
[00:01:53] Anisha: Hi, good morning.
[00:01:56] Ben: So, um, the inception story [00:02:00]
[00:02:00] Sasha: working
[00:02:02] Ben: about of
[00:02:03] Sasha: to
[00:02:04] Ben: in neonatology saying let's do a
[00:02:06] Sasha: to
[00:02:08] Ben: to of are hovering
[00:02:14] Sasha: certain myths residents
[00:02:16] Ben: guys begin and, is what is the
[00:02:26] Sasha: Yeah, absolutely. Uh, so one of the things we're always working on, uh, through TCAN is to outreach to, um, residents and try to showcase the field of neonatology and what makes our field so great to them. So, um, anecdotally, we've definitely all heard, um, certain myths among residents and medical students about, um, how things are in the field of neonatology and we wanted to either, Um, validate some of those myths, or, um, debunk some of those myths, or, or say that it's complicated, that things, you know, aren't black and white, and sometimes it's like that.
[00:02:59] Sasha: [00:03:00] Uh, so, we started off by, um, Surveying medical students and residents at different, um, uh, institutions to see, uh, what kind of, uh, statements or, or concerns that they've heard about our field and, uh, we took the ones that were most popular and we kind of distributed them out to our, uh, listservs of, of, uh, attendings and fellows in neonatology, um, in order to get basically a composite somebody Um, and we took, uh, the ones we saw the most and that's what this project turned into, uh, essentially a document to summarize, uh, all the different, um, uh, answers to these myths, uh, so to say.
[00:03:49] Ashley: Yeah, I think, you know, from the program director standpoint, which I feel kind of weird now I'm bridging that gap going from TEACAN [00:04:00] to a fellowship program director as an APD. One thing that's been really concerning for us is we see the past few years, there's more neonatology. slots open than what we've had applicants applying into.
[00:04:14] Ashley: And so what is the future of our field? You know, where, where does it end so that all of us on this call one day get to retire? Cause if we keep it this rate, none of us are going to retire. So not only filling the spots, but getting the best applicants with the most diverse backgrounds, the best perspectives and experiences.
[00:04:37] Ashley: From all the data that we know that if you have a doctor that looks like you, your care is probably going to be a little bit better quality and better outcomes, which I know you guys have talked about that in the past. So that was another big goal is there are myths out there and there are things that just kind of get passed on on the sites and the blogs and the social media accounts that [00:05:00] residents and med students even before they even become a resident are reading.
[00:05:03] Ashley: And so where is the truth? Because we really don't want to see people neonatologist.
[00:05:13] Daphna: Yeah, I gotta say I feel like um medical students and the the current generation is so Much better at like looking forward than I felt like I mean I had an idea of what I wanted to do But I was like i'll just go to my rotations and figure it out But now there's so many ways to find information, especially like you said through social media and on the internet that yeah Hopefully we can set I
[00:05:42] Ben: Yeah.
[00:05:42] Ben: call this the Amazon generation where we look for reviews and before making any decisions we go through this intense research process when I mean since I was a kid there was no such thing you just like go with it and then you say I'll figure out how
[00:05:56] Daphna: figure it out.[00:06:00]
[00:06:00] Ashley: The buffet line of pediatrics.
[00:06:03] Anisha: Yeah,
[00:06:03] Ben: Anisha, sorry.
[00:06:05] Anisha: would echo, um, Sasha and Ashley's sentiments, too. Like, especially the workforce component of it, and especially understanding that angle from some of the research that I'm doing with the section. Um, there's, you know, if you have fewer people neonatologists. And then when we talk about things eventually looking towards Maybe making a little bit of progress in our field in terms of work hour reduction to sort of align with other intensivists in our field.
[00:06:36] Anisha: It becomes really critical to like not only represent our field really well and bust these myths, but also like think about what. Our workforce looks like and the composite and the people that we enter into fellowship or welcome into fellowship, and that eventually enter our workforce. We really want to make sure those numbers match or exceed the number [00:07:00] of people who are retiring the fields that we don't hit that shortage.
[00:07:05] Ben: Yeah.
[00:07:05] Ben: almost like, uh, yeah, the pension plans in Europe where the aging population is forcing people to work longer now Um, so I want to before we begin because we've been teasing now these these myths and I guess We're going to dive into a few of them today. I wanted to To provide a disclaimer saying that obviously these are questions that we hope Um people are going to ask of you as physicians as trainees.
[00:07:30] Ben: Maybe they'll come from residents. Maybe they'll come from fellows Um, and we're going to give our opinion which is just that it is our opinion. This is what we perceive uh to be our experiences and there's probably going to be some bias in there that's going to be inherent to Our background and our and our training and our careers and so
[00:07:50] Sasha: do
[00:07:50] Ben: want people to feel like they don't have a voice.
[00:07:53] Ben: So, number one, if you have an opinion, please, you can email us and we'll be happy to read some of the feedback that you guys, [00:08:00] uh, send us. You can email the, the podcast, uh, through our email address, nicupodcast at gmail. com. And you can even suggest more myths as we record more and more of these episodes.
[00:08:11] Ben: But, uh, if nobody else has any, uh, other disclaimers or anything like that, I want to dive into our first myth of the day.
[00:08:18] Sasha: Let's do it.
[00:08:20] Ben: Let's do it. So, um, I guess the, the first myth that we often hear is that, um, neonatology is a boring specialty. It's a specialty where basically you deal with RDS, BPD and NEC and that's really it.
[00:08:33] Ben: And if you are a curious clinician, then this is not the specialty for you. What do
[00:08:39] Daphna: we all heard this from our, the PICU faculty we worked with, right? So of like, maybe PICU, maybe ER, maybe NICU, and they're like, oh, this is why you shouldn't go into NICU, right?
[00:08:50] Ben: love our PICU folks, by the way,
[00:08:52] Daphna: That's right.
[00:08:53] Ashley: Yeah. We do love our PICU folks.
[00:08:56] Anisha: Right?
[00:08:58] Ashley: think we've all heard that [00:09:00] though if it was boring, I don't think I could do it. Uh, I have some of the worst undiagnosed work ADHD, I think known to man. Um, so, you know, the idea of an outpatient practice and clinic to me, I think most neonatologists. That is not your idea of how you want to structure your day.
[00:09:23] Ashley: So, you know, the variability that's available in neonatology. So I would say myth, first of all, but you know, you could start your day going to a delivery, go round, and then you get called to. You know, do a procedure, you have a family meeting, you may do a complex prenatal consult, maybe the next day you're rounding at a community site, or you may be at a level four, you may be in the follow up clinic. Um, you know, part of my day is spent running neuro NICU rounds. So you can even sub sub specialize. I think, and this is congruent [00:10:00] with the feedback that we got is there's so much variability in the day. I, by no means, I think it's boring. But, you know, the flip side of that is you have to be ready for an unpredictable day.
[00:10:12] Ashley: So if you're somebody who wants to know exactly at 11. 15, this is what I will be doing. Maybe neonatology is not for you, because you never know what's gonna walk in L& D. You never know what parent is gonna, you know, need to have a meeting, uh, sort of unexpectedly, so... For people who are looking for a lot of variety in terms of practice settings, acuity levels, types of communication, you know, working with parents, to me that kind of embodies neonatology and we didn't even add in research, quality improvement, advocacy, all those other aspects to that.
[00:10:50] Ashley: Okay.
[00:10:51] Daphna: Yeah, I think we make a great point about the different types of practices. And there are, I mean, there are hundreds of ways [00:11:00] neonatology and split up your time, uh, you know, depending on where and how you work. And that's not even talking about the pathologies we see, which are getting more and more complicated, I feel like, every handful of years.
[00:11:15] Anisha: Yeah, absolutely. I think, um, 1 angle that I really appreciate is, you know, All right. Thanks. Especially when you are presented with multiple congenital anomalies and trying to get to the bottom of a unifying diagnosis and working towards that goal. And while you're also supporting their, you know, physiology, and also you're practicing on a spectrum to like, you might have the.
[00:11:39] Anisha: Some days where things are a little bit easier and you have your, you know, your feeder growers, and then on other days, you're doing high acuity resuscitations, um, you're doing, um, high acuity and sometimes life saving measures and the NICU. Um, and I just love the process of thinking through that physiology, um, [00:12:00] depending on the type of shock you're dealing with, for example, um, or sorting through whatever, you know, physiologic process that you're trying to kind of, like, get to the bottom of and overcome.
[00:12:11] Anisha: So, the problem solving aspect, I really enjoy and find very rewarding.
[00:12:18] Ben: Yeah, I think what's interesting about what you're saying, Anisha, is that number one, it combines a lot of aspects of a multitude of specialty. So I think to me, going to a delivery room really reminds me of when I was a med student and I was working in the ER where you're waiting outside for the ambulance to arrive with your trauma patient.
[00:12:37] Daphna: You
[00:12:37] Daphna: don't know what you're to get.
[00:12:38] Ben: Exactly, you don't know what
[00:12:39] Daphna: got an idea about it, but you don't know what it's going to
[00:12:41] Ben: and It from
[00:12:46] Sasha: the
[00:12:54] Ben: maintenance on
[00:12:58] Sasha: that's I [00:13:00]
[00:13:02] Ben: um, I think from standpoint,
[00:13:03] Sasha: things we be
[00:13:07] Ben: all these other specialties sasha any any thoughts on that question
[00:13:10] Sasha: Yeah, one last thing I'd like to add from the fellow perspective is, um, Because the field of neonatology is relatively newer than a lot of other fields of medicine, um, you know, our research is still limited and there's things coming out every day on different newer ways to do certain, uh, things. So that's, I think, what lends to the excitement of it is just, um, you know, how fast things are changing and what we used to do five years ago might not be relevant in five years.
[00:13:37] Ben: And I think that's a good point too, right? I mean, I I always enjoy looking at the books that the library gives away because they're too old And if you look in the neonatology section, right you you see
[00:13:46] Daphna: They haven't given them away yet.
[00:13:48] Anisha: No.
[00:13:48] Ben: Well, in the neonatology section, they have these, these like books from the 80s and like the, the, the, the, the table of content is thin.
[00:13:56] Ben: There's not much. And, and when you compare it to today, when [00:14:00] you see double volumes, thousands of pages, I think clearly this is no longer a boring specialty from a pathophysiologic standpoint. There's a lot of pathologies that we have to recognize that we have to deal with. Um, and I think. That transition sometimes can be missed by other physicians who haven't realized how fast our field has evolved since the 70s and 80s.
[00:14:22] Daphna: One of the other things I love about neonatology, I think makes it a stand out from basically anything else in medicine is when our patients come to us. Right. In your medical school, you're like, well, you got to learn about the past medical history. And we know that the babies have some quote unquote medical history because they're probably part of this.
[00:14:40] Daphna: Diad as a, as a fetus and we know, you know, maternal diseases affect neonates, but that's what I tell parents. Like, we're just getting to know your baby. There are so many things that we don't know about your baby because they're new and it's really like. Sometimes like detective work and trying to figure out, you [00:15:00] know, what, what is, you know, what are the genetics of this baby?
[00:15:03] Daphna: What are the underlying pathologies? What is unique to this baby just because of who they are as opposed to any other baby in the unit? What does their family bring to to
[00:15:16] Sasha: so
[00:15:16] Daphna: And think that's makes neonatology so special that every Every single new is like a puzzle waiting to kind of be discovered,
[00:15:29] Ben: So since I'm a big fan of Mythbusters, the TV show, I think we should end every myth with either a myth being busted, plausible, or confirmed, and what I'm gathering from the team is a unanimous busted. don't think, I don't think Neonatology is
[00:15:43] Ashley: It's really busted.
[00:15:44] Sasha: so.
[00:15:46] Ashley: We're biased, though. We need to put that disclaimer in there.
[00:15:49] Anisha: Yeah,
[00:15:50] Ben: that right off the bat, right?
[00:15:52] Daphna: But I would say all those other specialties are also biased when they're trying to influence people using this myth not to go [00:16:00] into neonatology.
[00:16:01] Ben: hmm. Um. I guess we're going to do one more myth
[00:16:06] Sasha: to
[00:16:06] Ben: this episode. um, this is a myth that again, comes up very often, especially from people who are not in neonatology. And this is the myth of people saying that the NICU is just a sad place and that it's a place where, uh, there's lots of sick babies, and this is where babies go to die.
[00:16:24] Ben: Uh, and so that's why you should stay away from the NICU because of sad of a place this is. Who, who wants to take this one?
[00:16:34] Anisha: Yeah, I could.
[00:16:35] Anisha: . All right. So, um, well, you know, Sasha and I are on different ends of the same institution, actually, and I'm out in the community is like a frontline position. So I'm. In the community when I'm on, it's really just me, um, on with a unit of about 10 to 15 patients. So, I think, honestly, the trend towards trauma informed care, um, and really trying [00:17:00] to understand parental mental health and well being, um, and just showing families that they have, And intense like wealth of support in the NICU, not only through us, the nurses, but also our ancillary staff.
[00:17:15] Anisha: I think that's, you know, really rewarding in some ways to help families get through a very, very difficult time and we hope that we can see them through, um, through the end with a good outcome. I know it's not always the case. And yes, You know, unfortunately, sad things happen. Um, we lose patients sometimes and it's devastating all around.
[00:17:34] Anisha: Um, but I think, um, what I find intensely rewarding is just. Being able to kind of, you know, relate with families and also, um, support them through, like, just an unbelievably difficult time where they're really seeking to control whatever they can, but so much is just simply out of their control. So, um, I would say that angle is what I really appreciate a lot about what we [00:18:00] do.
[00:18:03] Sasha: Yeah, I completely agree with that. One of the most gratifying things, I think, um, at work is having a patient who unfortunately has been in our unit for many months, um, because they were born very premature. Um, and now you get to finally go see them go home, you know. So, um, a lot of difficult call shifts with those patients, and they, you know, made a lot of staff assists happen, but, um, now they're in a better place, and they're able to go home with their parents, and, and, you know, there are very few things that I think compare to that level of, of, you know, rewardingness, so, um, that's really nice to see.
[00:18:38] Ashley: I feel like the NICU is just a place of profound experience, and it goes on all ends of the spectrum. I mean, we would be remiss if we didn't warn people who are considering our field that there are times of just deep, profound grief and sadness. You know, especially in the [00:19:00] unexpected. situations. But there is something that was different for me when I was thinking about PICU versus NICU.
[00:19:07] Ashley: It's so funny, Daphna, how you're like, PICU, ER, NICU. Literally, that was all of us. And at some point, we all thought we were going to be OBs. We all throw that one in there. Or MFM. I don't know. Anyway. But one thing that was different for me, and it definitely changed when I became a parent. So for anybody who's listening, who's also Coming to the decision point through the lens of also being a parent, there was something different about grieving the death or sudden, you know, devastating injury to a child that you have known for decades, you know, and, and seeing the varsity trophies and the pictures on the wall and the pic you, that was just personally, and this is total opinion personally for me, that was too much for me, it was a different feeling of loss.
[00:19:57] Ashley: Of I've just lost someone who for, you [00:20:00] know, 17 years has been an everyday, you know, part of my support and my life and my joy. It, I, I'm not trying to downplay it at all, but it is different when a family has an ultrasound of a baby they've never met. And they, they know from the beginning, you know, at 20 weeks, they, they know.
[00:20:20] Ashley: the same time they even know the gender, that this is just going to be a different journey for me. This, this is different. And, you know, we talk a lot in the NICU about parents who have difficulty with bonding and attachment. I got to think that there is some protective mechanisms to that because you don't know how it's going to go.
[00:20:40] Ashley: And so as a parent, you know, if you open your heart up a hundred percent, That hurts a hundred percent, you know, two hundred percent when it doesn't go well. So I only bring that up to say there are periods of that. There are absolutely days and I think, you know, it lives on with all of us forever. We always remember those cases, [00:21:00] but there's so many more moments of joy that outweigh those.
[00:21:06] Ashley: And for me, I always approached it that there's sadness in all of medicine, you know, even in ambulatory outpatient, you know, well child visits, there's a lot of sadness now. Um, and there's a lot of chronic disease. There's a lot of social situations as luckily families are feeling more comfortable disclosing things to us and involving them in their story to where we can hopefully, so, you know, emotionally support them.
[00:21:33] Ashley: My best friend's a general pediatrician and she's got some really heavy days as well. So I would say just medicine in general can sometimes be very sad, but you have to look at what's the, the join to sadness ratio. And if that's tolerable for you, then that's a field you should explore. Because, you know, people would probably say the same thing about picu, he monk, er, you know, everything has [00:22:00] sadness.
[00:22:00] Ashley: And so finding the joy and seeing what the, the future life is that we grant through neonatology, you know, the years gained. think if you're a forward thinking person, then that's where neonatology is a good fit.
[00:22:13] Ben: What an interesting point you're making because you're right. I mean, there is, there is loss in every aspects of the hospital, but in the NICU, it almost as if it's the loss of the potential for something rather than the loss of, of things that you've bonded with, that you've built memories with. And, and that's things a little bit less, as you say, cause it, it still stings, but it's not, it's not this, it doesn't have the same impact.
[00:22:36] Ben: And I think. To echo some of the points you've all made which is that we've been giving our opinion as well on a lot of these myths But some of them are substantiated with data and so when you look at data from the NICU the outcomes for babies are excellent and you look at survival rates and And so the the majority of babies who are admitted to the NICU are babies of I would say more [00:23:00] mature gestation So not a hundred percent of our census are 22 weekers So they actually compose the minority of the census and they're the ones with the worst outcomes and so what you realize is that the field is dominated by a population of patients that inherently, thanks to the evolution of our specialty, do have phenomenal outcomes.
[00:23:22] Ben: And so I think that, like you said, while there are, there are, it's just, we all have this bias, right, where we retain the things that hurt more than the ones that were pleasant. So you, you don't. Feel the same joy and you don't the intensity of the feeling is not the same for every discharge home than the ones that you lose And so there's this imbalance that you always feel but in truth Most of our patients go home do well return a few months later and they're doing good and they're eating and they're walking And I think that's that's very reassuring.
[00:23:54] Ben: So
[00:23:55] Ashley: Yeah, and a testament to our colleagues who follow our patients up, [00:24:00] know,
[00:24:00] Anisha: Yeah, I do have a role and follow up like, a few times a year. We do, we do like 1 follow up visit for a lot of our patients. I think that they're under the cutoffs. If they're born under 32 or 34 weeks, they qualify for follow up at least for one visit. And I just find that so rewarding. I mean, especially when you knew this was like a high acuity resuscitation or, um, you know, it was a patient you cooled.
[00:24:26] Anisha: They once started off really sick and then they're actually thriving and doing really well and follow up. That just shows you, I think that's immensely gratifying because you see like the fruits of your labor. You see, you know, families that are thriving, um, who are, you know, Maybe if they hit a couple of bumps along the way with access to therapies and things like that, like, I love that extra checkpoint so that we can, you know, bridge that gap and make sure that they're getting the right referrals and getting access to speech P.
[00:24:55] Anisha: T. O. T. if that's what's needed to really support the best [00:25:00] possible outcome as they go through their early childhood years and beyond.
[00:25:05] Daphna: And if I can put a plug because we're trying to get more people that are interested in palliative care into, into primary neonatology. Um, I think, um, on the other end of the spectrum, right? We, like you said, most of our babies do well. We love seeing their success in follow up clinic. And, there is a population of babies that no matter what we do based on their clinical picture may not survive.
[00:25:38] Daphna: And I think we still have this opportunity to provide, um, you We don't say death with dignity so often in the NICU, but that's still what it is about these little humans whose lives will be short and their families who, you know, regardless of how long they've known this human, this is a trauma they carry with them for [00:26:00] the rest of their lives.
[00:26:01] Daphna: And we really have an opportunity, um, to create. Um, some memories for them, let them feel like parents for the time that they have it, make the infant's passing As comfortable as it can be and as informed for the parents as possible And so, that's something that we do in in neonatology and we You know, we're time period to maybe engage this family in this really emotionally, um, impactful time.
[00:26:32] Daphna: And, um, you know, walking with families and supporting families is. Is one of my favorite parts of the job and sometimes that is Unfortunately around death and dying but it's not like our job ends, you know, that's just part of the job that can also While emotionally, you know, every loss is is devastating.
[00:26:56] Daphna: I think can also be rewarding [00:27:00] as a Um, you know healthcare professional minikyu
[00:27:05] Ben: and so I guess we can leave this one at maybe plausible because There are some sad moments,
[00:27:10] Ashley: complicated.
[00:27:11] Ben: Oh, there we go. It's complicated. We'll leave it complicated. I like that one. Okay, uh, we're gonna close this episode and we uh, thank you all for your time. We'll see you all on our next Mythbusters episode.
[00:27:23] Ben: Ashley, Anisha, Sasha, Dafna, thank you all so much.
[00:27:26] Sasha: Thank you.
[00:27:26] Daphna: bye everybody
[00:27:27] Anisha: Thank you.
The transcript for episode 214 can be found below:
[00:00:34] Ben: Hello everybody. Welcome back to the incubator podcast. We are back with another episode of myth busters in, uh, neonatology for medical students, residents, fellows, and a young career neonatologist. We are joined with our amazing panel, Dr. Ashley Luck, Dr. Anisha Bhatia and Dr. Sasha Amiri. How are you guys doing today?
[00:00:54] Ashley: Great. Great to be back.
[00:00:58] Ben: Daphna, how are you? I skipped you. I'm
[00:00:59] Daphna: [00:01:00] doing great and that's okay. I'm not offended. We do, we wanted to hear what we were so interested to hear what our panelists think all the time. So definitely checking in with them first was the right thing to
[00:01:10] Ashley: about
[00:01:11] Ben: Um, so the myth I would like to explore today is the myth that comes up quite often that neonatology is a lonely specialty. You go into neonatology and then you start working and you're by yourself. You work with nurses and you work with other types of providers, but this camaraderie that you would get another specialty working with your peers, meaning people who've done the same training as you, is not there.
[00:01:34] Ben: Um, what do you have to say about NICU being a lonely field?
[00:01:39] Ashley: I would say. I guess I'm kind of, you know, I still think about this myth, like, what do they mean by this? You know, because you're surrounded by people all day. You're never really alone. There's even times where you're like, I just need a bio break, guys. You know, I just need five minutes alone. Um, I'm an [00:02:00] extrovert.
[00:02:00] Ashley: I like being around people. I need to have a lot of socialization at work to be happy and I feed off that energy. So, I don't feel alone, um, and I guess I would have probably pretty high standards personally for, you know, being lonely, being that I want to be around other people a lot. Um, I don't think that we function in this vacuum alone.
[00:02:25] Ashley: You always have the other neonatologists who are on service with you. You do have all the nurse practitioners, which, you know, if you're a fresh grad and you're working with a nurse practitioner who's been practicing for 25 years, Chances are they've still got quite a few things to teach you, um, at least that's been my experience,
[00:02:44] Daphna: that.
[00:02:45] Ashley: know, the matriarchs of the unit, as I called them when I was in training.
[00:02:49] Ashley: Um, but I don't think that we can think about our work camaraderie only as the people who are in front of you anymore. [00:03:00] That's one of the things I love about TCAN's sort of peer networking because I've had a lot of times where I was really stumped on a case and I just got on our TCAN curbside WhatsApp group, which, you know, you can, anybody can go to the website and find the QR codes to join the WhatsApp groups and the signal groups.
[00:03:21] Ashley: Um, but I think that, you know, I can communicate with all my former co fellows, my former attendings. People who I've never even met before, you know, on the signal groups, like I said, where I send out a text, like, hey, does anybody have any ideas for an airway clearance regimen? And I get all these texts back from people all over the country, people who are Combined trained in Palm and Neo. So there's this whole peer network that we don't even fully take advantage of yet. I think we're just starting to get there, but I would disagree. I feel like I'm surrounded by people and I'm [00:04:00] constantly interacting with other people
[00:04:01] Anisha: yeah, I would echo that.
[00:04:03] Sasha: I think on its face throughout training it might seem like you're surrounded by less people because typically your medical school class will be bigger than your pediatric residency, um, class, which is usually bigger than your, um, NICU fellowship class. So it might seem like there's less people around you as you go through training, um, but Like Ashley said, uh, throughout your training, you'll, you'll stay in touch with the people that were close to you that you really bonded with and exchange contact information and still try to, you know, um, contact them in the future when you have a case that's dumping you or when there's something you want to see how their institution is doing as opposed to yours.
[00:04:42] Sasha: So, yeah. You know, these connections really stay together. And especially through your professional career, through organizations like Tea Can, you keep making lots of new friends. Uh, so there's, you know, always people around you.
[00:04:59] Daphna: And [00:05:00] he said, did you
[00:05:00] Daphna: have something you wanted to.
[00:05:03] Anisha: just like a small comment about, you know, the importance as, as, um, Ashley and Sasha have mentioned the importance of kind of building your networks throughout, you know, your training, your residency, your fellowship and beyond. Um, that's very important. And like some of the tea can social networking that's been created.
[00:05:24] Anisha: I mean, there's a lot of untapped potential there in terms of how we could, you know, really best learn from each other to establish, like, best care plans and best practices in our individual units. Um, and and to give that the, the comment of loneliness, some credence, I can kind of understand maybe. Um, how in some practice models where.
[00:05:49] Anisha: If you might be the only position on and, you know, you might be the only position on call for a given setting, then maybe that could potentially lend to some feelings of [00:06:00] loneliness and, um, you know, and I think that's understandable if, uh, if some sentiment about, um, loneliness at work has been, um, has been reflected in that comment.
[00:06:15] Anisha: Um, I don't think that, yeah. Um, that feeling is not valid at all, but I think it's definitely valid depending on the practice model you're in. So I think, you know, when you think, when I think about that comment, I really would want to push people to really think about what is your practice model look like, who are you working with, who are your equivalent peers?
[00:06:35] Anisha: Will they be your phone a friend if you need it, you know, like do you have that kind of like Open line of communication where you can ask a question no matter how silly you might feel for asking it And um not feel any fear of like retribution or any fear of judgment um, that's really the kind of practice model you really want to seek out and And that's hard to find and and I think that um [00:07:00] You know, I think that's, like, a really important thing to consider to kind of, um, if there's loneliness that's being experienced by neonatologists in our field, I would hope for them to kind of think about these things and, you know, really consider, like, their goodness of fit at a given at a given place.
[00:07:15] Anisha: And, um, if it's not a good fit, like, what, what specific things do you need to seek out that would make it a better fit for you so that you're feeling less lonely and more supported.
[00:07:26] Daphna: Yeah, I think that underscores such an important point of, of some introspection about what do you really need, what is your personality type, um, and are you at the right place to meet those needs. Um, I'll say as the, you know, devil's advocate as they say, you know, there was a time period where we were covering level twos.
[00:07:50] Daphna: I really found that for me personally, I found that very isolating, covering a level two for a week at a time, um, was really isolating for an extreme extrovert like [00:08:00] myself. And I know I have colleagues who totally dig it, right? They loved it. And so I think it just really is about Knowing yourself and understanding what the job responsibilities are, and do they align?
[00:08:16] Daphna: And if they don't align, maybe not being
[00:08:18] Daphna: afraid to see what else is out there because there's so many, um, different kinds of practice opportunities. So, I, we've, I moved. I've picked a place where I don't cover level twos by myself anymore, and I'm Mm hmm.
[00:08:32] Ben: But that's all very interesting, right? What you guys are talking about. Number one,
[00:08:35] Ben: I think what I'm gathering from your last point is that figure out where you are at the level
[00:08:40] Ben: of your career. Because I think if you are a junior faculty, then maybe the place where
[00:08:44] Ben: you're going to cover by yourself may not be the best place for you, because you may want to have the support of more senior attendings in your first few years as an attending.
[00:08:51] Ben: And then maybe you'll feel more comfortable transitioning to. A staffing model, like Anisha was mentioning, where maybe you will be the only neonatologist on call. But the other [00:09:00] exciting thing, in my opinion, is the fact that our community is a community of, it feels like a community of extroverts, where there's like a webinar every afternoon.
[00:09:08] Ben: Like if you want to connect with neonatologists, there's something. There's something on my calendar every afternoon, whether it is Vaughn, whether it is the AP, whether it is TK, there's stuff happening where you can get on a zoom and interact with your colleagues. Uh, we organize our field is small, so there's collaboratives for everything and you can organize yourself and join the BPD collaborative, join all sorts of collaboratives.
[00:09:31] Ben: And so I feel that overall, while even in the rare cases where you're staffing models. Puts you in a place where you are the only neonatologist on it does not Preclude you from engaging with your peers and your colleagues And so I think that to me is what
[00:09:46] Ben: makes me feel like this is busted.
[00:09:49] Ashley: Agree.
[00:09:50] Daphna: Agreed. Yeah, I think so.
[00:09:53] Ben: All right, we're gonna call it a day for today Thank you guys very much, and i'll see you all on the next episode
[00:09:58] Sasha: See you next time. [00:10:00]
[00:10:00] Ashley: Thanks, Ben. Thanks.
[00:10:02] Anisha: Thank you.
The transcript for episode 215 can be found below:
[00:00:34] Ben: Hello, everybody. Welcome back to the incubator podcast. We are back with another episode of myth busters for neonatology, um, uh, fellows, medical students and residents. We are joined with our amazing panel, Dr. Ashley Luck, Dr. Anisha Bhatia and Dr. Sasha Amiri. How are you guys?
[00:00:52] Ashley: Doing great. Good to hear from you guys again.
[00:00:56] Ben: Daphna, how's it going?
[00:00:57] Daphna: I'm still chuckling because [00:01:00] you dropped the myth, uh, on us right before we started recording
[00:01:04] Ben: wanted to surprise everybody. So the myth we're looking at today is the myth of uh, prospective fellows, I guess going into fellowship in neonatology because they say oh, This is a field that makes a lot of money. And so i'm gonna i'm gonna be so rich by being a neonatologist Um, what do we say about that? Everybody's point, by the way, for the, this is a, yeah, this is not a video podcast, but everybody's pointing fingers. Um, and so I'm going to get started. I'm going to get started because I'm not, uh, I don't think I'm, um, there's, there's not too much taboo about this. And I think it's a, it's an easy answer from the standpoint of really depends.
[00:01:49] Ben: It really depends. Uh, and it is not, um, you are not becoming, uh, um, a spine surgeon that, that, that those guys who are in the stratosphere [00:02:00] of the, the highest paid physicians. Um, but, um, I think neonatology in and of itself is not a single career choice that will by default lead you to, um, an impressive, uh, salary or income.
[00:02:15] Ben: So. Um, I think that's that's my first my first point of discussion.
[00:02:21] Daphna: but I do think we have some data to share on, on this, right? And this is something actually for those up and coming in neonatologists that the neonatology community is working really hard about because in. In general, um, the, uh, neonatologist, um, has a really high kind of, our view, relative value unit per clinical FTE or full time equivalent, um, and we know that our kind of ratios for how much work we do and how much we get paid are.
[00:02:58] Daphna: Not as good as some of the other [00:03:00] pediatric subspecialties. Um, so that's something that Especially the TKAN group is really working very hard to modify and set some national standards for and so my hope is for really early career neonatologists and people who are Just considering the field that that the work life balance is gonna potentially improve Significantly, but I think you made a great point Ben that there are again lots of different practice Options where your pay, the pay is quite different depending on what you do in neonatology.
[00:03:35] Anisha: Okay. So here's some prelim thoughts on this topic. Um, yes, it is true that there is a national movement to really try to standardize and correct for a number of hours worked in a year. Um, the amount of, um. Clinical effort as well as, um, if you're an academic model, like the amount of academic time that is spent, the amount of [00:04:00] research time that is spent to comprise 1.
[00:04:02] Anisha: 0 FTE and how hard you work for a given salary just so intensely, broadly varies across our field. And as intensivists, we do deserve to kind of. Better align those expectations, um, both amongst our community of neonatologist, but also with hospital administration to kind of make sure all our values are getting to a middle ground in terms of alignment.
[00:04:29] Anisha: Um, so when you think about things like compensation, I mean, I'm going to just start by saying like no amount of money is going to buy any level of mental health or satisfaction for you. So if you're thinking about like.
[00:04:46] Ashley: Uh,
[00:04:46] Anisha: A particular subspecialty within pediatrics and money is a factor. Let that not be your only factor of consideration.
[00:04:58] Anisha: You're going to have to find [00:05:00] something else that particularly drives you and motivates you in this field. Otherwise. Even if you're, you know, um, achieving a compensation point that you feel satisfied with, but your work life balance is compromised in the process of that, or maybe, like, your psychological safety at work is not exactly what you hope for it to be, then that, like, no amount of money can buy that for you, like, so then you really just have to consider what your individual values are at the end of the day.
[00:05:31] Anisha: Um, yeah. The other thing we have to consider too is again practice models when we talk about things like You know, um hospital employee positions and the differences in the business models of hospital employee versus private. Yes, it is true if you're in a private model, um, there is potential for more Um, monetary compensation.
[00:05:51] Anisha: However, you have to consider the differences in the work that you'll be doing. Um, and if you enjoy that work, or if you don't enjoy that work, and if you really absolutely don't enjoy that [00:06:00] work, then no amount of money is going to, you know, buy you happiness, um, in that workplace setting. So you have to kind of consider, um, kind of balancing that.
[00:06:10] Anisha: Um, and it is true, you know, even working in a, um, a children's hospital, academic, Or hospital employee position. Um, that while that compensation might seem a little bit more, there are, um, bonus metrics that do help catch those individuals up to, um, attain a salary. That's very much on par or exceeding. Um, And also, um, aligning the work life balance component as well.
[00:06:43] Anisha: Not saying not speaking for all practice models, not speaking for all hospital employed or academic positions. Um, it's a whole process and journey that when people are doing their job searches, they have to really explore these factors and really take a cold hard look. At [00:07:00] what that job offers to them and what they really actually need in their own lives.
[00:07:03] Anisha: And I think it's very okay for fellows and early career NEOs to really have that, um, component of self advocacy for what they need. Um, and what they value and, um, advocate and negotiate for what they want for a particular. Um, job, or at least just put your values out there so that you might attain some level of middle ground before you accept a position.
[00:07:30] Ashley: I think there is some data out there. So if I put myself in the shoes of a resident or a medical student who's considering neonatology, you can find some information. to your state but also nationally if you search. And the AAP actually, even in 2011, um, had an article in Pediatrics that was titled Differences in Lifetime Earning Potential for Pediatric Subspecialties.
[00:07:56] Ashley: So if you just wanted to look at the PEDS specialties, [00:08:00] you know, most of us, our heart was set on PEDS early on. So if you're considering different pediatric subspecialties, they actually have a graph that I remember being shown this when I was a resident who had already decided I was doing neonatology and I, it says there are only three subspecialties according to this paper. That have an overall positive, you know, lifetime, um, financial status in terms of you don't lose money by going to fellowship and that's, you know, assuming that the three years you're not in fellowship, that you're paying off loans, investing wisely, building wealth, starting your retirement funds, you know, all those things that, uh, We all like to say that we're gonna do, it's on the to do list.
[00:08:46] Ashley: Oh yeah, I gotta get my financial stuff in order, you know? Still, and you never achieve that. When do you ever check that off, right?
[00:08:54] Daphna: was like, it's, it's on my to do list actually, so.
[00:08:57] Ashley: I've made all the money I need to make, you know?[00:09:00]
[00:09:00] Ben: Yeah, you're coming back from a long shift and it's financial well, well being versus ordering out another takeout because you're just too tired and it's like, I'm just going to order food out.
[00:09:08] Ashley: Yeah, am I gonna watch a Netflix show and fall asleep, or am I gonna get online and research the different types of, uh, retirement funds?
[00:09:17] Ben: Roth, Roth. Yeah.
[00:09:20] Ashley: right, according to this paper, cardiology, pediatric critical care, and neonatology were the only three sub specialties that were listed as a Financial benefit of going to fellowship.
[00:09:31] Ashley: Um, I think like Aneesha said, that depends on how you practice. Um, that depends, you know, I, in emergency medicine has a very small positive blip, but I would say that there's so much variability across the board that you shouldn't decide where your passion lives based on a chart of positive financial, you know, um, potential.
[00:09:53] Ashley: And then if you search, there's actually, um, a National Society of High School Scholars. That [00:10:00] actually has doctor salaries according to a Medscape compensation report in 2020 where physicians self reported their income. And I'll let you all guess what is at the very bottom with an average of 232, 000 a year salary?
[00:10:16] Ashley: Peds. There are certain, and number one is orthopedics, number two is plastic surgery, number three is ENT, you know, but even they list orthopedics at 511, 000 a year. I'm pretty sure that's sorely underreported. Um, so, you know, you just have to think
[00:10:35] Daphna: neonatologists.
[00:10:39] Ashley: oh yes, you know, do I want to be a spine surgeon? Um, definitely not. There's no myth, myth to that, whether that's true or false. But, um, I think it, like Anisha said, it depends on practice style. I would say statistically and just by the information, yes, neonatology is one of the better paid [00:11:00] specialties within pediatrics, just by nature of being able to bill critical care levels and the number of RVUs and the length of stay and all of those things that get factored into that, which I had no knowledge of how any of that worked when I was in training. But do I feel wealthy? I would say yes, but my answer is because I don't have to worry about whether I'll have money for my housing for my children to have healthy food. To have whatever supplies that they need to thrive. I can take a nice vacation, you know, a couple of times a year. I'm not talking about going to Bora Bora every month. That's also on the bucket list. If I have my retirement funds in order, I'd probably be able to do Bora Bora every month. But, um, you know, I feel wealthy in that aspect. I don't worry about financial strain. Um, I do have student loans. That's definitely a thing that you have to talk about if you extend your fellowship and what is the negative impact of that.
[00:11:58] Ashley: Um, but [00:12:00] I guess it's just relative. So if I had to answer, you know, it's complicated.
[00:12:05] Daphna: yeah, I think it's a good reminder that, that, I mean, the average salary nationwide here in the U. S. as of 2023 was about 59, 000, right? And so, um, you know, compared to the bulk of Americans, I mean, neonatologists are doing just
[00:12:24] Ashley: and our patients that we see every day, right?
[00:12:26] Daphna: Absolutely. Um, and so I think we really have to consider that perspective.
[00:12:31] Daphna: If you only compare yourself to the, to the other physicians in the room, then, then you, you may feel slighted at times, um, because I think we work just as hard, um, and in some areas harder. Um, and we have to remember that our, our population is Not all physicians, right? So,
[00:12:52] Ben: Yay. It's an interesting myth because it reminds me a little bit of some of the things we experienced when we're in college, right? Where you have a few pre meds who are like, Oh, I want to become a doctor [00:13:00] because I want to be rich. And it's like, and then you have the people who are studying finance or like, this is a stupid idea.
[00:13:04] Ben: Like, this is not how you,
[00:13:06] Daphna: that's right. If you really, if you really want to be rich, you didn't, you didn't go into medicine if
[00:13:11] Ben: Medicine is not the the best ROI when it comes to years years of investment and and return on investment And I think from that standpoint, I think it's a it's a silly, uh way of thinking about it But it reminds me also of something. So that's when I work for a staffing company and our ceo. Jim recton is a very I would say a very enlightened businessman because he was talking about Compensation as as a package that people have to see and that should not just include pay and he always says We we have to see the the clinical environment that we provide uh our physicians to work in the the kind of Flexibility we have we have to look at the benefits that we have and then you put all these things Into a package and you say do I how do I feel about the entirety of this and looking at?
[00:13:58] Ben: Simply the [00:14:00] gross annual income feels feels very reductive. And so I think that um Yeah, everything that's been said about numbers is, is true. But like you guys also said, you look at what is the emotional toll of working these hours? Like these are, these are difficult hours to work in. These are sometimes very technically difficult because when, when you're putting in a chest tube, you, you are doing something that, that is very, very stressful.
[00:14:23] Ben: And look, looking into that, you put everything together and then, and then you can, you can sort of. Decide whether that's the right kind of lifestyle that that you want. And so, uh,
[00:14:35] Ashley: And the resource, no one can put a dollar on this time.
[00:14:38] Ben: Yeah,
[00:14:39] Ashley: I have definitely learned that if you ask me, would I rather make, you know, 200, 000 more a year versus have 20 percent more of my time, I'm going to take time every, you know, that's the resource
[00:14:54] Daphna: and I, I mean, I've literally done that. I, you know, I decided very early on, I work [00:15:00] 7 compared to the rest of the group, and that was, uh, worth the trade off for myself and for my family. It gives me the opportunity to do the incubator, which I don't know how Ben fits into his schedule. Um, but, yeah, thinking about also, right, what, what is the balance with what else is going on in your life outside of work?
[00:15:23] Anisha: I think these are all really great points. Um, and I'm with you, Daphna. I work, um, point eight, which works for, um, my family set up right now and just kind of where I'm at generally with. Life, um, and having young kids, a young child right now, um, and, and, you know, it can vary for different people and it doesn't always have to be this way for, um, both women and or, you know, men in our field too.
[00:15:53] Anisha: Um, and I think that really is where it really underscores the importance of really trying hard to standardize hours [00:16:00] and the amount of effort that is invested to, um, meet those clinical hours per year that comprise. Um, part one part of the compensation package of a of a contract. Um, the other thing I would say, too, is when we consider our salaries compared to like the national average of, um, Americans, like all comers, not just positions only.
[00:16:23] Anisha: Um, we also have to really keep in mind that debt to income ratio that we've kind of. You know, alluded to, um, that actually is kind of mentioned to, um, when we think about, you know, the amount of debt and the potential amount for payback, especially if, um, a loan forgiveness plan is not in a given person's future.
[00:16:44] Anisha: Um, some of like the financial optics, it does matter and it should matter and that's okay for for those people. Um, so I think. A lot of, you know, Americans, like, as far as the debt that's incurred from, you know, [00:17:00] medical school and beyond, whatever it may be from undergrad as well, um, for for physicians, it's potentially anywhere from 4 or more years of schooling that, um, that has resulted in additional debt accumulation.
[00:17:14] Anisha: And so. Um, when we think about compensation and, you know, strategies to kind of move away from having that debt and getting to a point where you're hopefully debt free, that compensation aspect, um, really, uh, really is something important to consider in terms of how one might meet those financial goals
[00:17:35] Ben: Yeah My friend said oh so so you owe a very nice house after you jump when you just as you as you're beginning to work your you you have to pay back the the amount of like a Very fancy home and it's and it's something that we uh, yeah, we tend to always Uh take our debt for granted. We're like, oh we operate we're like, oh, yeah I have like a few thousand dollars a month.
[00:17:53] Ben: I pay
[00:17:53] Daphna: No biggie, yeah.
[00:17:55] Ben: biggie, and it's like
[00:17:55] Daphna: just weighing over our heads.
[00:17:57] Ben: it's a mortgage.
[00:17:58] Ashley: a couple SUVs
[00:17:59] Daphna: [00:18:00] That's
[00:18:00] Ashley: you
[00:18:00] Ben: it's That's exactly right. That's exactly right Um, I think this was uh, I think this was a very interesting conversation. I wish we could talk about this longer Um, but I think I think that uh for now, um I want to say that this myth is busted just because it's the wrong perception I think this is never should be the uh, the the prism through which uh, We approach our specialty and so for that alone i'm going to say get out of here.
[00:18:26] Ashley: I agree. Thank you.
[00:18:27] Ben: Okay, good
[00:18:28] Daphna: is the definition of rich anyways? Does it have a definition?
[00:18:32] Ben: Um, there is a very um, um, um, there's a very nice, uh in in judaism We have this uh, this book the the maxims of the father and it says a person who is rich as a person who's satisfied with his lot And I like that definition. So if you can find the satisfaction with what you
[00:18:48] Daphna: Well then I don't know, when you say that, I'm not sure the myth is busted.
[00:18:52] Ashley: If you ask a financial planner, they would say you have enough money to cover your lifestyle and fund your goals. So it depends on what your goals [00:19:00] are.
[00:19:00] Daphna: And your lifestyle.
[00:19:02] Anisha: right. Yeah,
[00:19:03] Ashley: Bora every month Daphna, let's do it.
[00:19:08] Ben: Thank you guys very much we'll see you we'll see you all on the next uh on the next episode of mythbusters
[00:19:13] Ashley: Thanks guys.
[00:19:15] Anisha: thank you.