May 23, 2017

ER Doctor Transitions Into Teaching – As Told By a Curious Surgeon

Dear Readers, you are in for a treat today with this guest post by my client Dr. Sue Zimmermann, an orthopedic surgeon. As part of her career transition process, she met with and interviewed one of my former clients, Dr. Rob Baginski, who made the leap from Emergency Medicine into teaching in 2013.

Before the interview, Dr. Zimmermann shares some of her journey. Take it away Sue!

I started working with Heather over a year ago. At that time I had been in clinical practice as an orthopedic surgeon for over 23 years and was very unhappy in my job. I loved doing surgery and taking care of patients, but I was tired of being on call, having increased pressure to do more, being micromanaged by administrators, and feeling anxious over not being able to help everyone. I was planning to retire in a few years, and I wanted to plan for my future career doing something I was passionate about. The coaching process was my lifeline; it gave me something to look forward to, and every step I took brought me a little closer to my new career. I started teaching at a local medical school as a volunteer, working with a small group of students doing case-based learning. I discovered that after each class, I felt energetic and excited. It was not only rewarding to connect with students and guide them through the learning process, it was also fun! I decided that I wanted to incorporate teaching into my future plans.

The future arrived sooner than I had expected. I was recently laid off from my job with no warning, and I suddenly had a lot of time to explore a new career. It was a shock, but my preparation over the past year gave me a head start. Heather introduced me to a former client of hers, Dr. Rob Baginski, who had been a full-time Emergency Medicine physician and is now the Medical Director of the Physician Assistant program at a university near me. We initially met for lunch at an art museum, and during our conversation he told me about a program which brings PA students to the museum for lectures on the relationship between medicine and art. I was also able to observe one of his courses. What follows is our conversation about the path he took to become a professor at this university in Boston.

SZ: What were you doing before you started teaching? 

RB: I was working as a full-time EM physician. I had worked in various settings – a trauma center, community hospitals, and freestanding ERs. I started working with Heather as my coach because I just didn’t feel fulfilled in my work.

SZ: How did you start teaching at the University?

RB: Believe it or not, I was driving down the highway and I saw a sign advertising a teaching position at the PA school. I decided to apply for it. As part of the application, I had to give a lecture to the committee. My lecture was on Evidence Based Medicine, which is a big topic nowadays, and I was hired.

SZ: What previous experience did you have that helped you get the teaching job?

RB: I was a clinical preceptor for both medical students and residents. I had also given a lecture series for paramedics when I was the Director of EMS at a hospital where I used to work. I had also been an instructor in Health Sciences at a local community college for a few semesters prior to applying for the job at the University. Finally, I provided lectures and didactic instruction for the Emergency Medicine residents at a local hospital program.

SZ: What is your schedule like? Are you still doing clinical practice?

RB: Yes, I am still working one day a week in the ER. I teach four days a week, and as part of my position I serve on several academic committees. Most full-time academic positions require some committee involvement. I also do a lot of work outside of class preparing lectures, writing syllabi, grading assignments, creating exams, and evaluating students. As part of my job, I need to be current on educational theory – which is very different from clinical practice. For example, schools are emphasizing “differentiated instruction” to address students’ different learning styles.

SZ: What are some of the differences between teaching PA students and medical students?

RB: The PA program is two years; the first year is didactic and the second year is all clinical. So we have to teach a large amount of information in one year. Our curriculum includes traditional lectures and exams, and obviously the students have to prepare for their Board exams. We also have three medical simulations per semester. The simulations involve clinical scenarios in which the students have to make a diagnosis and come up with a treatment plan. We have different scenarios for each discipline in the health science school (i.e., nursing, physical therapy, physician assistant), and we conduct interprofessional simulations as well. Some of the simulations are geared toward diagnosing and treating illness, while others deal with, for example, how to give bad news to a patient and family.

SZ: What is “interprofessional” education? I’ve heard it mentioned a lot recently.

RB: Interprofessional education includes different disciplines in health care, such as MD’s, PA’s, nurses, pharmacists, physical therapists, etc. Students are taught to work as part of the health care team, using case-based learning. A lot of schools are moving toward this type of instruction.

SZ: Do you have any advice for physicians who want to go into teaching?

RB: My advice would be to get as much teaching experience as you can. The pay for part-time or adjunct instructors is minimal, so expect to be basically volunteering your time in exchange for experience and to extend your CV. You can approach schools in other allied health professions, although nursing schools tend to prefer nurses as instructors.

SZ: Do you miss treating patients? Doing procedures? I think I would miss doing surgery.

 RB: Well, I still do some surgery. I am a volunteer at a local aquarium, and I was asked to assist with a gastrostomy on a seal! I couldn’t find any seal anatomy references, so I read up on dog anatomy the night before – I figured it couldn’t be that different. When I arrived at the aquarium, I found out that I would be the surgeon, not the assistant! Fortunately the surgery was successful and the patient is doing well. I have also assisted with mandible resections and digit amputations.

SZ: Wow! So maybe I can still find a way to do some surgery in my future career. Thank you so much!

RB: You’re welcome – I’ll let you know about coming in to observe one of our simulations.

Postscript: I was able to attend a simulation a few weeks later. The students were given a scenario of a patient in an emergency room. They had to speak to the “patient,” examine her, and come up with a differential diagnosis and treatment plan. There were distractions coming from a “nurse” going in and out of the room and from the patient complaining of pain and asking for relief. After the simulation, the instructors met with the students for a debriefing.

I was impressed with the simulation, which was quite realistic. From my research, it appears that medical education is moving toward more simulation and case-based learning. Some schools are drastically cutting lectures, and are instead having the students learn the essential facts on their own and coming to class to apply the material. I think it will be a great improvement over the endless lectures that I attended in medical school, and I’m looking forward to becoming more involved in medical education.  

By Sue Zimmermann, a recovering orthopedic surgeon who lives in Massachusetts. 

A big “Thank You!” to Dr. Sue Zimmermann and Dr. Rob Baginski for their great contributions to this blog!

 

 

Considering Pharma? Check out the DIA 2017!

pharma reseracherLast year was a big year for pharma at the Doctor’s Crossing. Four of my clients landed great jobs in pharma and I attended the inspiring world-renowned pharmaceutical conference – The DIA Global (DIA – Drug Information Association).

One of my four clients had no prior pharma experience and she is now working happily as a Drug Safety Officer for a large pharmaceutical company. She is proof that you can get into pharma without having experience in clinical trials or research. 

In my on-going efforts to learn more about pharma, scout for opportunities for clients, and get a better feel for the community, I attended the DIA’s annual conference in Philadelphia last year. I was one of 6,454 participants and I loved every minute. There was an electricity in the air which I attributed to being amongst so many bright individuals who are passionate about improving the health of patients in profound ways. Before I share specifics about the conference, I want to give you an idea of positions open to physicians in pharma.

  1. Drug Safety Officer  (Pharmacovigilance)– involved with reported side effects from drugs, labeling, SAE’s (serious adverse events). Can include involvement in preclinical studies. clinical trials and post-market stages. Public education.
  1. Medical Monitor – advises on clinical trials, planning, and implementation. Monitors patients enrolled in trials for safety, side effects and suitability for study enrollment and completion.
  1. Clinical Trial Researcher – participates in and oversees clinical trial design and implementation. Actively involved in running trials and design.
  1. Medical Affairs Director– bridge between drug development, marketing, and public education. Involved with medical information, communication, launch and post-market strategies.
  1. Medical Science Liaison –a knowledge expert in a therapeutic area, develops relationships with KOL’s (Key Opinion Leaders) externally, resource for physicians in practice; educational and communications role. Frequent travel.
  1. Medical Writer– prepares regulatory documents, slide decks, scientific articles, white papers, covers scientific and medical conferences, etc.
  1. Regulatory Affairs Director – knowledgeable about FDA regulations, prepares and submits regulatory documents, negotiates for market authorization for drugs and devices, keeps informed regarding legislative changes.
  1. Health Economics and Outcomes Researcher (HEOR) – concerned with the cost-effectiveness of drugs and devices, value, as well as the impact of treatments on patients.

 For a more complete description of these positions for physicians, please click HERE. (Note – the job opening links are no longer active).

Click HERE specifically for the Medial Science Liaison.

Sameer Thapar (PharmD), Director of Global Pharmacovigilance for Oracle, and one of the speakers at the DIA, shared a simple way to think about the complex array of jobs in pharma. He said, “There are the Makers, the Sellers, and the Defenders.”  The Medical Affairs and Medical Science Liaison positions help to bridge these three areas (my addition).

When considering a transition to pharma, you may wonder whether or not you would miss patient care and if you’d feel like you were making a difference in a meaningful way.

Dr. Kelly Curtis, my former client who now works remotely as a Medical Director and Medical Monitor for INC Research said this about his transition, “I find non-clinical work very rewarding and feel like I make more of an impact on the future of oncology in this role than when I was in academia.” 

I personally know a pediatrician who works remotely for pharma and he does a few pedi-urgent care shifts a month to keep his clinical connection to patients.  Although maintaining some degree of patient care while working in pharma is not the norm, some doctors find ways to do this through volunteering, medical trips abroad, or attending in a teaching setting.

The satisfaction from helping an individual patient can shift to helping entire populations of patients. Dr. Larry Brilliant, who gave the DIA 2016 Keynote address, recounted his fascinating involvement in eradicating smallpox and his on-going efforts to prevent and treat blindness in millions of individuals in developing countries. You can read about his amazing life’s work intertwined with his spiritual journey in his hard-to-put-down new book, Sometimes Brilliant

Here are some of the Hot Topics on tap for DIA 2017:

  • Data/Big Data/eHealth – informatics, data integration, bioethics
  • Disruptive Innovation – innovative science, technology and therapies: stem cells, regenerative therapies, gene therapies
  • Medical Affairs – MSL (medical science liaison), medical writing, medical affairs roles throughout product lifecycle
  • Patient Engagement – patient-centric practices, advocacy, culture, tools
  • Safety – best practices, post-market safety considerations, monitoring
  • Regulatory – advertising and promotional laws, regulatory writing, document management, compliance
  • Special Populations – Rare diseases, pediatrics, women’s health, aging
  • Preclinical and Clinical Development – discovery, clinical research, recruitment, clinical trial data disclosure, outcomes, statistics
  • Value and Access – drug pricing, reimbursement, access, real world outcomes

For additional information on the Hot Topics for DIA 2017 please click HERE.

For the Agenda for the DIA 2017 please click HERE.

I particularly enjoyed a panel presentation on “Big Data” with oncologist Dr. Brad Hirsch, CEO at SignalPath Research. Dr. Hirsch continues to see patients as well as work in pharma in the areas of informatics, innovation and gene-based therapies. You can tell he loves caring for his patients, and also being at the cutting edge of finding cures for the cancers that threaten their lives.

If you’re considering pharma, attending the DIA will give you a deep dive into this area, as well as the chance to make helpful networking connections. And your attendance would be an undeniable indication to any hiring authority of your genuine interest in this career direction. This is just one of a number of ways to increase your chances to land a pharma job.

Even though my time at the DIA was beyond busy, especially since I made a point to network at all of the exhibitor booths (pens anyone?), I left energized and uplifted. Call me pollyanna, but I felt that I was among a large group of people who really care about giving patients the chance for healthier and longer lives.  As physicians, and as individuals with loved ones, we know personally how devastating having an untreatable condition is, or having a poor quality of life due to illness. Pharmaceuticals are, of course, only part of the answer to good health, but when nothing else works, the right drug is truly a miracle.

The DIA 2017 will be in Chicago, June 18 – 22. 

 

 

 

 

 

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Using Your Internal GPS for Career Change

Is your internal GPS telling you it’s time to change your career direction? Is it saying “Recalculate! Recalculate!” but leaving you stranded at the crossroads, failing to provide any further instruction?

If so, it can feel overwhelming, daunting, and confusing.

 

give-me-a-map-woman-final

Uncertainty is uncomfortable. It’s natural to wish for some kind of roadmap to guide us through a process of change.

It makes sense that we feel this way. To become a physician, we had every step mapped out for us. Yes, it was quite a climb, but even Everest has a summit and there is one way up. If you don’t give up and make it to the top, you win. There is guaranteed employment, a career with status, and a paycheck.

 

stair-step-cartoon

 

There is a sense of security in such a well-trodden path where the finish line is visible before you even start. However, as our high physician burnout rates reveal, there is no guarantee of happiness. There is no certainty that the rules of engagement won’t change or that expectations will be met.

The shifting sand at the top of the seemingly sturdy staircase has left many considering other options. Instead of using the staircase that guided us, we now have to create our own path.

If we were wired like Lewis and Clark, we wouldn’t have gone into medicine. We’d be bushwhacking with Sacajawea by our side, discovering new lands – not practicing evidence based medicine.

But in spite of our predilections, we may find ourselves staring into a great expanse of non-clinical career terrain, wondering where even to take the first step?

Since we don’t have the prefab staircase outside of traditional practice, we have to use a different approach. Siri had the right idea. We need to use our internal GPS. We need to be able to listen to ourselves and hear our own guidance.

The connections may be a bit rusty if we’ve had to push down that inner voice in service of our career. It may take time to start hearing our true inner voice and what we need and want. When we start to listen, we might be confused by the presence of two voices, one coming from fear-based thinking (The False Self) and the other coming from trust-based thinking (The True Self). Here are some identifying characteristics to distinguish the two:

The False Self – fear-based and self-doubting

  • Sees problems rather than possibility
  • Jumps to the “What if’s” – what could go wrong
  • Is accompanied by anxiety
  • Sells your abilities short
  • Has to see all the steps before starting

The True Self – confident and trusting

  • Focuses on possibilities rather than problems
  • Is able to imagine success
  • Creates a sense of calm internally
  • Does not over or underestimate your abilities
  • Is comfortable taking steps without having all the answers

How do we turn up the volume on the True Self and mute the False self?

1. Start noticing anxious, fear-based thoughts. Write these down and note the frequency.
2. Look at the fears objectively and see if they make rational sense.
3. Take stock of all you have already accomplished and the challenges you have met.
4. Give yourself permission to accept whatever feelings you are having. Get curious about their origin, rather than judging them.
5. Practice mindfulness or meditation techniques to help quiet and train the mind so it is not so reactive.
6. Do things you enjoy and love. This will awaken the heart, which is part of the internal GPS
7. Believe in the value of your individual uniqueness. Embrace your path and don’t worry if it doesn’t look like anyone else’s.

Our Internal GPS = an awakened heart + rational, non fear-based thinking

To get started on your career transformation, you don’t need to enter a specific destination into your GPS. You can start with a commitment you make to yourself. It can be a simple statement such as:

“I want to enjoy my work.”

“I want my work to be fulfilling.”

“I want to have quality family time.”

“I want to make a difference in a way that is meaningful.”

“I want to use my creativity.”

“I want to use my brain more and be challenged.”

Your internal GPS will start to work on the initial steps, and as you gain more clarity, keep refining the destination. Staircase or no staircase, it’s OK to “recalculate” so you end up in the right place – for you.

Dear Hippocrates: I want a divorce

LS Lara Photo

Dear Hippocrates,

I want a divorce.

Let’s face it, you and I were young, idealistic, and naive when we met. Everyone said we were “perfect for each other”, valedictorian and humanitarian. We thought we could change the world, one sacrifice at a time. Sleep deprivation, grueling academic hurdles, delayed gratification. We proudly wore those badges as a testament to our commitment together when we started our board certified family medicine profession in 2003.

I should’ve signed a pre-nup.

Slowly, the tendrils of distrust curled around our world. Insurance didn’t trust our decision-making, so formularies became a paradoxical, rigid moving target. Patients wouldn’t trust our recommendations, certain that their latest Google search was far more medically sound. Hospital administration stopped trusting. Our world became a time and date-stamped arena, visible to all, helpful to none. Once a pillar of scientific benevolence, doctors were now stripped of power and treated with public skepticism.

To rein in this metastatic distrust, you suggested we collect and curate data. Surely, this would “improve” our nation’s floundering healthcare system, right?! Never mind the suicidal grandfather in room 3….but did he agree to get his colonoscopy and tetanus updated?! Who cares if the basal cell skin cancer was recognized and treated on Mrs. Jones, did she sign up for a mammogram?!   My resentment grew with each step into this minefield of check boxes.

This wasn’t the life I planned for us. The inequality felt oppressive. I gazed longingly at our neighbors: The Specialists. Their grassy-green lives appeared unfettered by regulations because they could just advise, “Follow up with your primary care doctor. They’ll take care of it all.”

But I couldn’t.

Your expectations of our relationship had morphed into something unrecognizable. Gone were the moments I hoped to bask in the glow of empathy, caring, and healing. Do you recall the vows we took, Hippocrates? “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”

A far cry from your modern version. Today’s words are icily brisk as we shiver past each other in the crowded hallways. You speak in modifiers, ICD-10 codes, and triplicate forms. My Love Languages are Touch and Words. Yours is EMR. Your eyes practically glow brighter than the screen when a new data collection feature is unveiled, lengthening the nurse’s duties from 15 to 20 minutes for each patient check-in. It’s obvious you love to flirt with inefficiency.

You shift the boundaries of our relationship on a daily basis, expecting me to jump through unnecessary hoops against the backdrop of “more patient access.” How can I detect the insidious hemochromatosis, or educate the infertile polycystic patient when I’m interrupted with your ridiculous demands to answer every message or refill with neck-breaking speed?

First, do no harm….correct?

Yet, I continued to adapt my workflow to be more efficient, clinging to the knowledge that if I didn’t care, who would? I work harder, you pay me less. (Even less as a female physician). And now all we do is fight over money, when we really should be fighting over the real downfall of us: your adultery. When you stepped out and had an affair with Press Ganey, you changed the tapestry of our relationship forever.

In your short-sighted effort to measure value based on antiquated patient satisfaction scores, you adeptly placed my vitality and compassion in hospice. How can my worth be stripped down to a number, when I’m pressured to see more volume, squeezing as much as I can in 15 minutes? I feel under appreciated, and I deserve better.

It’s not about the money, Hippocrates. It never was. No matter how many miles I run, sun salutations I cycle through, or glasses of wine I sip, I decided:

We have become incompatible.

Our core values have diverged so far apart, it’s impossible to reconcile our differences. Despite the tone of this letter, I am not angry, I’m disappointed. However, I’m filled more with gratitude for our chapter together. Relationships aren’t measured in time, but rather the amount of growth and meaning. Because of you, I have an amazing skill set, memories to fill my heart, and a clear foundation to pursue my next passion….customizable to my definitions.

“In the end, only three things matter: how much you loved, how gently you lived, and how gracefully you let go of things not meant for you.” -Buddha

Best wishes,

Your American Family Doctor

P.S.— you can keep my stethoscope, but please return my boxed set of “The Walking Dead”. The moment those zombies hit, I’ll volunteer to be everyone’s Hershel.

This guest blog first appeared on KevinMD and was written by my client Dr. Lara Salyer.  After working things out with Hippocrates, Dr. Lara is opening her own Functional Medicine practice in Wisconsin in 2017.  Thank you, Dr. Lara, for sharing your wonderfully clever and timely post with us.

ER Physician Career Transition: Dr. Dale Ray

Dale Ray, MD

Before his career transition, you were likely to find Dr. Dale Ray intubating a patient, running a meeting, or mentoring a resident. Now, in his new role working for the ACGME (American College of Graduate Medical Education), odds are you will find him on an airplane. Dr. Ray worked for many years as an emergency medicine attending, oversaw graduate medical education, and had several different roles in hospital administration. Now he travels all over the country on a weekly basis to offer feedback to the hospitals and medical centers that train the nation’s residents and fellows.

In this interview, Dr. Ray talks about his non-clinical career as Field Representative for the ACGME. He has been in this position for almost 3 years, and in spite of the heavy travel, is very happy with his choice. He would like to let other physicians know that for the right individual with a background in graduate medical education, there are opportunities in this area.

HF: What kind of work are you doing for the ACGME? (Accreditation Council for Graduate Medical Education)
Dr. Ray: I work as a field representative for the Clinical Learning Environment Review (CLER) program. Our team visits teaching hospitals and provides formative observational feedback on the learning environment. We provide the assessment through six focus areas, including patient safety. Through a series of group and individual meetings, including with members of the C-suite, we seek answers regarding the infrastructure of the clinical learning environment, the integration of Graduate Medical Education (GME) within the hospital and its activities, and the engagement of residents and fellows. With these efforts we hope to assist the individual sites to improve patient care and GME, as well as help move forward patient care and GME on a national level.

HF: Can you describe a typical week for you?
Dr. Ray: Monday is a travel and prep day. We visit a hospital or medical center Tuesday and Wednesday (and sometimes Thursday), then return home either Wednesday evening or Thursday late afternoon. Thursday and Friday we are writing up our visit report and preparing for any upcoming visits, as well as participating with any team meetings.

HF: How do you do your site assessments?
Dr. Ray: We initially have separate group interviews with the GME leadership, the senior leadership team, and the patient safety and quality improvement teams. We have a series of group interviews with residents and fellows, faculty members, and program directors. We also make walking rounds where we talk to nurses and residents on the floors and units about the clinical learning environment and patient care.

Depending on the size of the institution, we may have a second series of interviews with the physician groups. We provide a report to senior leadership based on what we have learned in six focus areas: patient safety, quality improvement, transitions of care, supervision, fatigue management, and professionalism. Our approach is unique in that our feedback is not tied to standards or citations. Rather it is observational and formative, allowing the site to process and adopt the information provided. It is our desire that the site find components of the report valuable to help them on their patient care and graduate medical education endeavors. Although some may interpret what we do as consultants, we are different in that we are not there to give advice or recommendations. In many ways, reflective feedback to an organization may be seen as more powerful. I think it is safe to say that my teammates and I look at this as a collaborative effort between the CLER program and the sites we visit.

The reports we put together are confidential, as they deal with the institution’s priorities and patient safety issues. They are generally about 17-20 pages, and most sites acknowledge the thoroughness of our work. Many say that the reports provide value for their own work and internal assessment. Receiving this type of feedback is a significant component to my job satisfaction.

Lastly, as I mentioned, our work serves to help inform on a national level, both with data collection and by affecting patient care and physician training

HF: How much do you work in a week?
Dr. Ray
: I have never sat down and counted, and some of the work hours are travel related. I would estimate 50 plus hours per week. One of the positives is that I do not have unending piles of work. The work is pretty well defined. I do not have 80 emails to answer every day nor never-ending projects to complete. I know when my work is done. There is some work on the weekend, but generally not a lot. I will probably work an hour today (it was Sunday).

HF: What were you doing before you transitioned?
Dr. Ray: I was practicing emergency medicine. I was 20% clinical before I transitioned to this position, as I had increasing administrative responsibility inside the health system where I was employed. I was Medical Director and Operations Director for a transfer center, Medical Director over our healthcare disparities unit, and had GME responsibilities. I had some other roles working with the Chief Strategy Officer.

HF: Did you have prior experience in Graduate Medical Education (GME) before your current position?
Dr. Ray
: I was a core faculty member, followed by being the Associate Program Director, and then was Program Director. I was then recruited and assumed other roles outside of the residency program. Soon after I left GME (Graduate Medical Education), I realized how much I liked GME and the people, both at the local as well as national level. As educators, we want to work together and have helper personality traits. I liked the atmosphere in GME. I like the teaching aspects and helping residents evolve. I would have stayed in the Program Director role longer, but I was recruited to other roles, which I accepted as I thought it was a career step.

HF: What other areas did you consider before you took this job with the ACGME?
Dr. Ray
. When I considered what I wanted to do next in my career, I was open to a wide variety of opportunities. To be honest, I was quite uncertain as to my path. My search started organically, looking into different roles in hospital systems, both in my institution and elsewhere where I had conversations about leadership and physician executive roles. However, I did not identify the right fit. For me, that included considering the management component of the job, and the individuals I may be managing. The wrong mix can be very challenging. I was also looking for something unique, as well as meaningful, where I can have an impact on healthcare. Ultimately, I was uncertain and was not finding the right fit in this leadership direction. There was no reason for me to foolishly rush into a position, so I kept looking.

HF: Were you burned out when you started looking?
Dr. Ray
: I wound not say that I was burned out, but circumstances left me open for a change. I could have stayed where I was for the near to mid-range future, but life circumstances made me think that if I was ever going to make a change, this was the right time period. I could have returned to practicing clinically full time, but balancing clinical with other activities had always been important to me.

The topic of burnout is very important to the ACGME, the CLER program and our individual team members. It is prevalent amongst physicians. It is an issue the CLER program is investigating, and hopefully we can provide information to help address burnout. It is one thing if one pursues non-clinical options because of personal interests; it is another if individuals, who are good clinicians, leave clinical medicine because of being burned out. We need to do what we can to preserve their careers.

HF: What do you enjoy about your work for the ACGME?
Dr. Ray
: I think we are making a difference in patient care. I also hope I am helping to improve physician training. I enjoy the people within GME; they are collaborative and want to do the right thing. In nearly all circumstances, we receive feedback from the site that they think our activities will positively influence the work they perform. In addition, I have frequent moments to do some teaching with the residents and fellows, and it is especially gratifying when you see a light bulb go off with regard to patient safety and concepts and ways they can improve their care. Perhaps we have inspired a few to consider work in patient safety and quality improvement as their professional focus. I meet many great people, and it has been reinvigorating.

It is also a learning adventure for me. Even though I was fairly well versed in medicine, I have made tremendous knowledge gains in areas of medicine I knew nothing about. This has been intellectually satisfying. Lastly, I enjoy my team members and our staff at the ACGME; they all have levels of expertise, competence, reliability, and emotional intelligence.

HF: What is challenging about your job?
Dr. Ray
: One challenging consideration for people is the travel. You have to be at a point in your life where those in your life understand and accept that you will be gone two to four days most weeks. You have to be practical and thoughtful (before considering this position) that you can do the travel. You can live anywhere you want, as long as you can get to an airport. Between site visits and other activities, I travel about forty-five times a year.

Beyond the travel, one needs to be flexible and adaptable to potential changes in circumstances. On nearly every visit, some unpredictable event occurs, and one needs to roll with it.

HF: What makes you especially suited for this kind of work?
Dr. Ray
: I am comfortable speaking with CEO’s and other senior leadership. I have worked enough in the C-suite that I understand their perspectives. I am also pretty curious and inquisitive, and this job is a new learning experience each week. I think this improves my performance and keeps the job interesting.

HF: Is there anything you wish you’d known ahead of time?
Dr. Ray
: There was a fair amount of disclosure from the ACGME about the position and by myself about what my professional needs and goals were. It was a big professional leap for me, so they wanted me to know if I could make this commitment. I joined the team early on, so there were a few “if I had known that” type of considerations that had to be worked on as the program matured. For anyone who is considering a big transition to a different role, I would recommend they ask detailed questions about a wide variety of scenarios and the day-to-day work. I would also recommend a contingency plan – no one takes a position that they think will not work out, but it is good to have a plan B just in case.

HF: Do you still do any clinical practice?
Dr. Ray: I gave it up in July. Part of my plan B was continuing clinical practice. I practiced two years after joining the ACGME. I was the last holdout of the full-time CLER field staff to maintain clinical activity. I gave it up because my wife and I were moving to a different state, but even if we had stayed, it was not fair for me to be traveling during the week, and then to work clinically on the weekend. Primarily it was not fair for home life, but sometimes it was a long week for me personally. In addition, with the limited amount I was working clinically, it was getting increasingly difficult to keep up with the new processes, technology, EMR demands, documentation requirements, and compliance work. At the time I left I was working clinically about 16 – 24 hours a month. It seemed I was spending at least half that amount of time with all the non-clinical activities related to work. I do miss some parts of the work, especially the “great cases” and working with residents. The job I currently have fulfills a number of those needs. I required a slow wean.

HF: How has the job change impacted your personal and family life?
Dr. Ray
: Even though I have a heavy travel schedule, much of the work I do at home I can accommodate on a flexible schedule. Therefore, I can make time for my wife, my home activities, and myself. Since I can travel from most any airport, it has allowed us to relocate and try a new life adventure. If this does not work out here, we can try somewhere else.

HF: How long did your career transition take?
Dr. Ray
: Once I decided I would be willing to leave my current position and organization, it took me about two years to find the right fit.

HF: Who would be a good candidate for this kind of job – both experience and specialty wise? Are there any openings?
Dr. Ray
: GME experience is necessary, as is a knowledge of patient safety, as well as having a broad range of knowledge and experience across our six focus areas. Some visits you are in charge and some you support the lead, so you need to be able to switch back and forth from being a leader to a follower. Although gratifying, the visits are demanding and you must have a level of emotional and physical stamina. You have to have some resilience to deal with both travel challenges and if an issue were to arise at a site. In addition, understanding the challenges to and the pressures on health care systems will help you do the job effectively. With regard to clinical experience, we have a wide range of generalists and specialists. In fact, having a diversity of specialties adds to the richness of the teams.

Currently, we do have an opening and we have periodic full-time and part-time openings as the program grows. These will be posted on the ACGME website.

HF: What are the different ways one can obtain GME experience?
Dr. Ray
: It’s essential, and core to the job. Current team members have been head of GME at their institution, a program director, or Chief Medical Officer. We have not had any team members who served as only either Chief Quality or Safety Officers without a formal GME role, but I suppose there may be circumstances where that may be considered. Conversely, someone with GME experience without knowledge of patient safety or quality would probably not be a competitive candidate. It is not a job for a 31-year-old, as you need to have a breadth of experience. Most people are in their late 40’s through early 60’s.

HF: Any advice for other doctors considering a career change?
Dr. Ray
: First, magical thinking will not work. It takes time, effort, and commitment. Under any circumstances, it is important to be prepared, proactive, and patient, yet ready for an opportunity. I was in a position where I was valued and liked the people I worked with, so perhaps I had some advantages in that I wasn’t jumping out of a frying pan. Coaching helps. It helped me both with clarity and to help sort out opportunities, what the marketplace of opportunities looks like, and to provide objectivity. It also may help you from simply jumping to next thing that is offered, without taking the long view. Coaching also played an important role in quickly eliminating a myriad of possibilities for which I was ultimately not fit. Regarding the objectivity, a coach should have a client’s interests as their sole interest. Potentially free advice is worth exactly what it costs, and even though it may be given out in a well-meaning manner, I would be cautious. I would also not underestimate the need for financial preparation. If the right position for your happiness is one that requires a pay cut, golden handcuffs will make that transition challenging.

Thank for this great interview Dale!