Podcasts about med peds

We all want to see behind the curtain right? Today we go there with Dr. Tommy Martin, a Med-PEDS physician with over 3 million TikTok followers. We discuss the integration of social media within the medical field, the responsibilities of being a healthcare influencer, combating misinformation, and sharing personal experiences. Dr. Martin explains his journey from content creation in 2014 to becoming an influential online presence. The conversation also covers common health concerns addressed by pediatricians, challenges faced by doctors in the digital age, and the importance of authenticity and vulnerability in building trust with an audience. Please sign up for our SUBSTACK For more episodes, limited edition merch, to send us direct messages, and more, follow this link!  Connect with us: Website: https://yourdoctorfriendspodcast.com/ Email us at yourdoctorfriendspodcast@gmail.com @your_doctor_friends on  Instagram, TikTok, and YouTube - Send/DM us a voice memo or question and we might play it/answer it on the show or on socials! 00:00 Introduction and Exciting Announcements 01:27 Meet Dr. Tommy Martin 04:01 Journey into Social Media Influencing 05:25 The Importance of Doctors on Social Media 12:57 Common Doctor Friend Questions 15:59 Creating Content and Staying Authentic 20:40 Final Thoughts and Farewell

During the first year of the COVID-19 pandemic, the phrase “Healthcare Heroes” echoed through hospital walls and city streets. For many people, this felt like an overdue acknowledgment of the difficult and important work that healthcare professionals carried out during the most devastating healthcare crisis the world had seen in a century. But this phrase can also be problematic, romanticizing the sacrifices of individual clinicians without addressing the systemic failures that put them at risk, overlooking the mental health struggles they experienced, and undermining healthcare environments that encourage reflection about respect and duty. Our guest on this episode is Dhaval Desai, MD, a hospitalist at Emory Healthcare in Georgia and the author of the book Burning Out on the Covid Front Lines: A Doctor's Memoir of Fatherhood, Race, and Perseverance in the Pandemic (2023), in which he details his personal narrative as a healthcare leader and frontline physician fighting to hold his hospital together. Over the course of our conversation, Dr. Desai shares why he decided to train in both internal medicine and pediatrics, how his experiences caring for his ailing father revealed the flaws of our healthcare systems, the nerve-wracking first few months of the COVID-19 pandemic, his own struggles as a leader, healer, father, and husband during a time of deep uncertainty, how we can all better connect with patients through even a few moments of shared humanity amid our busy days, and more.In this episode, you'll hear about: 2:36 - Dr. Desai's path to medicine5:05 - How a Med-Peds residency differs from other medical residency tracks 8:06 - How Dr. Desai's personal experiences have shaped his approach to patient advocacy 11:53 - Dr. Desai's personal and professional life leading up to the COVID-19 pandemic18:46 - Dr. Desai's opinion on why it is important for leaders to be able to express emotion 24:53 - How Dr. Desai used his leadership role to help his staff navigate the emotional turmoil of the pandemic experience 28:32 - Moments when Dr. Desai suffered heavily from burnout34:47 - Stories of the isolating effects of COVID-19 in the ER 39:53 - Our society's support of healthcare workers46:19 - Advice for young clinicians on ensuring humanity stays central to their work Dr. Dhaval Desai can be found on Instagram at @doctordesaimd and on X/Twitter @DrDesaiMDx.In this episode, we discussed the New York Times article “I Couldn't Do Anything: The Virus and an E.R. Doctor's Suicide” Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.Copyright The Doctor's Art Podcast 2024

Dr. Paul Sue is an associate professor of pediatrics at the Columbia University and Director of the Pediatric Transplant and Immunocompromised Host or “PITCH” Infectious Diseases Program at the Morgan Stanley Children's Hospital in NY.  He completed his pediatric residency at Jacobi Medical Center at the Albert Einstein College of Medicine in the Bronx, and his fellowship in pediatric infectious diseases at Johns Hopkins University in Baltimore. He then moved to UT Southwestern in Dallas TX, where he served as director of Pediatric ICH ID service for the next 8 years, prior to his recent move back to NY.  His research interests include the impact of invasive fungal and viral infections in the immunocompromised host,  leveraging measures of functional immunity to improve infectious disease outcomes in high-risk patients,  and the emergence of community acquired multidrug resistant (MDR) bacterial infections in immunocompromised children. Sara Dong, MD is an adult and pediatric infectious disease physician at Emory University School of Medicine & Children's Healthcare of Atlanta, where her clinical focus is transplant and immunocompromised host ID.  She earned her MD from the Medical University of South Carolina.  She completed her internal medicine and pediatrics (Med-Peds) residency and chief residency years at Ohio State University Wexner Medical Center and Nationwide Children's Hospital, followed by Med-Peds ID and Medical Education fellowships at Beth Israel Deaconess Medical Center and Boston Children's Hospital.  She is the creator and host of Febrile podcast and learning platform, co-host of the ID Puscast podcast, and the program director for the ID Digital Institute.Learning ObjectivesAfter listening to this episode on invasive candidemia, learners should be able to discuss:Treatment of candidemia in a critically-ill immunocompromised patient.Management of indwelling central catheters in critically-ill patients with candidemia.The role of immune adjuncts (e.g. G-CSF or granulocyte transfusions) in the management of persistent candidemia in an immunocompromised patient.References:https://febrilepodcast.com/ Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update bQuestions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the Show.How to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

Dr. Paul Sue is an associate professor of pediatrics at the Columbia University and Director of the Pediatric Transplant and Immunocompromised Host at the Morgan Stanley Children's Hospital in NY.  He completed his pediatric residency at Jacobi Medical Center at the Albert Einstein College of Medicine in the Bronx, and his fellowship in pediatric infectious diseases at Johns Hopkins University in Baltimore. He then moved to UT Southwestern in Dallas TX, where he served as director of Pediatric ICH ID service for the next 8 years, prior to his recent move back to NY.  His research interests include the impact of invasive fungal and viral infections in the immunocompromised host,  leveraging measures of functional immunity to improve infectious disease outcomes in high-risk patients,  and the emergence of community acquired multidrug resistant (MDR) bacterial infections in immunocompromised children. Sara Dong, MD is an adult and pediatric infectious disease physician at Emory University School of Medicine & Children's Healthcare of Atlanta, where her clinical focus is transplant and immunocompromised host ID.  She earned her MD from the Medical University of South Carolina.  She completed her internal medicine and pediatrics (Med-Peds) residency and chief residency years at Ohio State University Wexner Medical Center and Nationwide Children's Hospital, followed by Med-Peds ID and Medical Education fellowships at Beth Israel Deaconess Medical Center and Boston Children's Hospital.  She is the creator and host of Febrile podcast and learning platform, co-host of the ID Puscast podcast, and the program director for the ID Digital Institute.Learning ObjectivesAfter listening to this episode on invasive candidemia, learners should be able to discuss:Risk factors associated with invasive fungal infections in critically-ill immunocompromised patients.Common pathogens associated with invasive fungal infections in critically-ill immunocompromised patients.Principles guiding selection of empiric antifungal agents for critically-ill patients at risk of invasive fungal infections.References:https://febrilepodcast.com/ Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the InfQuestions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the Show.How to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show. Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.

The Curbsiders and Cribsiders are back with a very special Med-Peds collaboration on RSV immunizations! Dr. Buddy Creech, Pediatric Infectious Disease at Vanderbilt, walks us through these breakthrough “vaccines" for both adults and kids. He teaches us about their mechanisms of action, eligibility criteria, and why it's been so challenging to find doses this season. Get ready for your next shot of fun!

The Curbsiders and Cribsiders are back with a very special Med-Peds collaboration on RSV immunizations! Dr. Buddy Creech, Pediatric Infectious Disease at Vanderbilt, walks us through these breakthrough “vaccines" for both adults and kids. He teaches us about their mechanisms of action, eligibility criteria, and why it's been so challenging to find doses this season. Get ready for your next shot of fun!

Think about the last time you made a mistake. Now, imagine this happened at work, with a patient, and that your clinical setting is a punitive place where people are shamed for their mistakes. Would you want to tell anyone about this error?  What if, instead, you worked somewhere that embraced open conversation about errors, and looked without judgment at all the factors that might lead to mistakes?  This is at the heart of Just Culture - a philosophy and process that looks at both the individual and the system in a non-punitive way to figure out where something went wrong, and how we can all learn from it and make changes so it doesn't happen again. Our guest for this episode is Dr. Nidhi Goel - UMSOM alum, Med Peds physician, a leader in quality and safety for both the medicine and pediatrics departments at our hospital, and Director of the Medicine Clerkship - for a practical conversation on exactly what Just Culture is and how it impacts our students. Spoiler alert: she shares a real-world example of the Just Culture process that our team will never forget.  Resources: AHRQ's Just Culture Guide IHI courses Patient Safety and Quality Improvement elective from the UMSOM Course Catalog  

Internal Medicine and Pediatrics Dr. Tommy Martin, joins the Glaucomfleckens to talk about his work schedule of bouncing back and forth between internal medicine and pediatrics, how he finds time for fitness and social media, and plays a game of meds or peds. — Want to Learn About Tommy Martin?  TikTok/YouTube/IG: @dr.tommymartin — We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! – www.patreon.com/glaucomflecken  -- We have a special offer for our audience here in the U.S. Learn more at http://www.ekohealth.com/KKH and use code [KNOCK50] for a 75-Day Risk Free Trial + Free Case + Free Shipping to the continental US (to get your CORE 500 Stethoscope). Independent Practice Partners is led by physicians with a proven track record of building successful practices from the ground up. And now, they want to help you do the same. If you're thinking about starting your own Independent practice and don't know where to start go to http://www.IPracticePartners.com. Independent Practice Partners ensures your practice doesn't just survive, but thrives!  Today's episode is brought to you by the Nuance Dragon Ambient Experience (DAX). It's like having a virtual Jonathan in your pocket. If you would like to learn more about DAX, check out http://nuance.com/discoverDAX and ask your provider for the DAX experience. Produced by Human Content Learn more about your ad choices. Visit megaphone.fm/adchoices

We are honored for the opportunity to speak with Benjamin R. Kinnear, MD, MEd, this week on the Faculty Factory Podcast. Dr. Kinnear joins us for an important discussion about changing the way we approach medical education. He advocates for a competency-based time-variable model. “At its core, competency-based education is just a philosophy of training that orients itself toward outcomes,” he told us. Dr. Kinnear is an Internal Medicine-Pediatrics (Med-Peds) hospitalist. He serves as Associate Professor of Pediatrics and Associate Program Director for the Med-Peds program with Cincinnati Children's Hospital Medical Center/University of Cincinnati Medical Center. This conversation explores the essence of competency-based education, a philosophy of training that is fundamentally outcome-oriented. Dr. Kinnear enlightens us on this crucial matter, highlighting how reshaping medical education through such an approach can revolutionize learning paradigms and ultimately shape more effective and capable medical professionals. Understanding the principles and implications of this philosophy can potentially lead to transformative advancements in our field. We also want to thank our friend Rachel Salas, MD, MEd, who recommended Dr. Kinnear to us as a guest! If you have a guest, that you'd like to sponsor to join our show, please send us a message: https://facultyfactory.org/contact-us/

For those who are a little too bubbly for internal medicine but a little too dark for pediatrics, we welcome you to the specialty of Med-Peds. In this episode, we sit with Mariam Ghattas and Abel De Castro; two recently graduated medical students who have started their Med-Peds residency. We explore their journey and experiences throughout medical school and how it has led to their field of choice, as well as tips and resources for students interested in pursuing Med-Peds.Music: https://pixabay.com/music/id-112777/  Episode Team:  Guest - Mariam Ghattas, MD (Alumni, CUSM), Abel De Castro, MD (Alumni, UOACOM-P)Hosts - Sarah Kim (MS2), Veronica Rasmusen (MS2)Script Writers - Sarah Kim (MS2), Veronica Rasmusen (MS2)Audio - Theresa Dinh (MS2), Anthony Mamaril (MS2)Producers - Sarah Kim (MS2), Hijab Gulwani (MS2)Supervising Producer - Yuu Ohno (MS2)  Director - Vy Han, MD

Listen as double board-certified physician Dr. Au shares about growing up in Hawai'i as the daughter of a Native Hawaiian dad and Maori Danish mom, how her uncle with ALS motivated her to help people, majoring in mathematics at BYU-Hawai'i, confronting racial microaggressions, finding supportive networks during college and medical school, working as a pediatric hospitalist, and now helping young adults at a university health center. She also shares her best advice for current premeds.

One of our newest alums of the podcast, Dr. Alex Gillotte, sits down to reflect on her last four years at UCCOM before she heads to University of Colorado for her Med-Peds residency. Tune in to hear her pearls on what to look for in a residency program, how you can transform rounds into a more patient-centered experience, and what playlists got her through the longest days of medical school!Contact: gillotac@mail.uc.eduAlex's Lofi Study Playlists:1. https://open.spotify.com/playlist/37i9dQZF1DZ06evO3HyQFc?si=AhaaU11nRGqTt4iKKFpKNQ2. https://open.spotify.com/playlist/59OrkYvGv0oM1KgPABU7nw?si=hr149IGhRWmeycItb9SkaQ3. https://open.spotify.com/album/4lBMa9JEuCSIs3NkPEIwvN?si=ywUr2-BaRFKKlzGkycmzvQ

National Breastfeeding Month – August 2022Dr. Allison Stiles, Chair of the Shelby County Breastfeeding CoalitionAugust is National Breastfeeding month and on this episode, my guest and I explore the health benefits to both mom and baby as well as the barriers to breastfeeding. Dr. Allison Stiles is a physician and advocate for breastfeeding and an advocate for underserved populations. Join us for this informative conversation. More About Dr. Stiles:Dr. Allison Stiles has been practicing Internal Medicine and Pediatrics, “Med-Peds” in Midtown Memphis since 2003 when she moved back to be closer to family. She had lived in Memphis from the age of 5 through high school at Central High. She attended the University of Missouri-Columbia where she received a BS in Biochemical Engineering in 1985. She worked for Procter and Gamble as an Engineer in Cape Girardeau, Missouri, Cincinnati, Ohio, Italy, and England. In 1995 she retired after 10 years and went to Medical School at the University of Cincinnati. Dr. Stiles did her Med-Peds (Internal Medicine and Pediatrics) residency at the University of Illinois- Chicago. She is double board certified in Pediatrics and Internal Medicine.Practicing in Pediatrics and her experience with her own children led to her interest in Breastfeeding and “Lactivism”. She is Chair of the Shelby County Breastfeeding Coalition and a TN AAP Chapter Breastfeeding Coordinator. She received her certification as a Lactation Consultant in 2016. She has lectured on Breastfeeding for UT Medical students, Family Practice Residents, Pediatric Residents, and Midwives. She was a lecturer for the TN Breastfeeding Symposium 3 times and has taught a class for new Parents every month for over 5 years. She is a contributing author of the article, “Breastfeeding Sisters that are Receiving Support: Community-Based Peer Support Program Created for and by Women of Color, published in the Journal of Breastfeeding Medicine on 2/21.Dr. Stiles has partnered with and supported OutMemphis, Friends for Life, and the Metamorphosis Center. She treats Transgender and Non-binary people to help them with their healthcare needs and to be their Primary Care doctor. She is one of the few Memphis providers of PrEP, to prevent HIV. She has been treating HIV for over 15 years.Dr. Stiles is a fellow of the American Academy of Pediatrics (AAP) and the American College of Physicians (ACP). She is a member of the Academy of Breastfeeding Medicine, the AAP Section on Breastfeeding Medicine, the US Lactation Consultant Association, the International Lactation Consultant Association, the Memphis Pediatric Society, and the Memphis Medical Society. She is a member of the WPATH – the World Professional Association for Transgender Health, and the Academy of Pediatrics –Section on LGBTQ.Her Midtown practice, called “Memphis Internal Medicine and Pediatrics” is nearly 20 years old. She takes care of people of all ages, from newborns to Geriatrics. Dr. Stiles believes in science and compassionate care for all people without boundaries.Resources:www.shelbycountybreastfeeding.orgwww.memphis-medpeds.com

Rebecca, a recent graduate and Med-Peds resident at Albany Medical Center, discusses her experience at TCOM.The highlights:- The new campus facilities (brand new anatomy lab, treadmills for studying in the library, a free campus gym, and simulation labs).- Organized systems-based approach to the curriculum.- Rotation sites- The many fun things to do in the Fort Worth area.- More affordable tuition! - Pathway programs for rural medicine, Ph.D., and MPH degrees.

Episode 73: Dr. Belen Amat (She/Her) of Direct Primary Care of West Michigan - Grand Rapids, MI.Dr. Amat is a Med/Peds physician. She comes to the podcast to talk about how her practice grew from a dream into a reality. She shares about how she served the Hispanic community in Grand Rapids under the fee for service model and how she assumed moving to DPC would cause her to lose her Hispanic patients. Now, her practice is thriving and is continuing to serve the Hispanic community in ways she never thought possible. And, Dr. Amat still has time to enjoy life!1,000+ DPC clinics trust Hint to securely handle member enrollment, employer plan administration, eligibility management, billing, invoicing, collections, and more. Learn more @ Hint.com todaySupport the show (https://www.paypal.com/donate?hosted_button_id=U8K8HM52SPQ38)

Nobody wants to be hospitalized or plans for it to happen. Especially with the pandemic, we have seen incredibly high numbers of hospitalizations. In many cases, you get discharged and leave the hospital. But what happens afterward? Does life just go on as usual? Well, it depends! Joining us today to tackle some of these difficult questions is Dr. Vignesh Doraiswamy, an Internal Medicine and Pediatric hospitalist at Ohio State University and Nationwide Children's Hospital. He talks about the importance of post-acute care/rehab and inpatient therapy evaluations. He dives into how patients want to go home as soon as they're ready for discharge, but this can inevitably prolong their recovery. He also discusses the lived experiences of physicians in hospitals who handle care. Finally he touches on the inequities in receiving the vaccine, the booster shot, and projections for the future. *Please note that this episode was recorded before the rise in cases of Omicron, so while certain numbers may be different at the moment, the general concepts are largely the same.  Dr. Doraiswamy is an assistant professor at The Ohio State College of Medicine where he works with medical students as a Portfolio Coach and Applied Health Systems Science Coach. At The OSU James Cancer Center, he is the Quality and Patient Safety Lead for the James Hospitalist service lines and he is an Associate Medical director at OSU's University Hospital. He completed a combined Internal Medicine and Pediatrics residency and was the Med-Peds chief resident at Penn State Health. Dr. Doraiswamy is actively involved in medical student and resident education with interests in health equity and advocacy, health systems science, curriculum design and clinical reasoning. Connect with him:IG: @vigneshdTwitter: @DoctorVig

AD BREAK: The internet provider who works for your satisfaction. Are you looking for an internet service provider? Best fitful internet packages for your needs. Compare our internet packages and home internet plans at Transat Telecom with the best telecom internet packages. Start connecting with your loved ones today. In today's episode, we are enlightened to be with Ijeoma Opera who is a Physician, Med-Peds focused on Global Health, Joy, Justice, Health Equity, AntiRacism, Decolonization as a Liberation Speaker, Consultant & Problem Solver. (Instagram - @innodim) About Ijeoma Opara: "My name is Dr. Ijeoma Nnodim Opara, assistant professor, Internal Medicine-Pediatrics, Wayne State University (WSU) School of Medicine and attending physician, Wayne Health. I'm a woman of purpose and passion. I describe my purpose in the modified words of President Barack Obama regarding the late congressman John Lewis, “I'm a woman of pure joy and an unbreakable commitment to justice.” My ability to keep up with my commitments is grounded in my strong sense of purpose, as I try to ensure that my commitments are purpose-aligned and passion-driven. It also helps that I have a supportive spouse, three amazing little girls, a loving family who live close to me, and awesome colleagues, trainees, and mentees who help make all this possible. My faith tradition is also a great source of strength." Listen to this power-packed episode to learn how to optimize your digital media in today's ever-changing technological world. Learn more about Ijeoma Opara in her recent article published here: https://provost.wayne.edu/news/faculty-impact-combining-social-justice-with-clinical-practice-46362. Feel free to also follow her on her Instagram account here: https://www.instagram.com/innodim/ Connect with Favour here: https://znap.link/flaevbeatz Join the Pinterest & SEO Marketing club on Clubhouse today using this link here. Join the Pinterest & SEO Marketing Facebook Group to join the LIVE! sessions here. Listen to Favour Obasi-ike on the Wisdom App Rate this Podcast: https://ratethispodcast.com/wedontplay --- Send in a voice message: https://anchor.fm/wedontplay/message Support this podcast: https://anchor.fm/wedontplay/support

Dr. Nirupa Raghunathan is a Med/Peds physician, and the director of Pediatric Integrative Medicine at MSKCC. She has a background in pediatrics and adult medicine, which allows her to follow patients from adolescence to young adulthood. We discuss the role of integrative oncology in pediatrics, modalities that can be used, specific issues that AYA patients have, and how it can be advanced worldwide.

Our guest for this episode is Aisha Suara, a fourth year medical student at Vanderbilt Medical School, fellow A2O team member, and Habeeb's younger sister; listen to her talk about her journey to medicine, and what health equity and primary care mean to her.  Habeeb & Aisha also trade embarrassing stories from growing up and going to school together; you don't want to miss it! Interview:  IntroductionWho is Aisha Suara?How did you get to where you are sitting right now?Upbringing (Ethnic Background, Values, Influences/Role Models, etc.)High School (Challenges, Formative Experiences, etc.)College/Pre-Med (Motivations for pursuing medical school, challenges, etc.)Medical SchoolInterview Topic #1: The Health Equity LensWhat does health equity mean to you?How do you think your upbringing in rural Tennessee impacted your view of health equity and your goals as a physician?Interview Topic #2: Primary Care:  Med-Peds vs. Family MedicineHow did you choose med-peds as your medical specialty? How would you compare/contrast med-peds to family medicine? What about med-peds you to choose it as your way of providing primary care to patients instead of family medicine?What do you think about the perception of primary care as “easy” or “boring”?How do you plan to embody the principles of health equity into your career as a PCP?ConclusionWhere do you see yourself in 10 years? Where can we find you?Where can we follow you?

Today, Adam talks to Junaid Niazi, MD. Junaid is a dad, husband, Med/Peds physician, and coach. He helps physicians take back their time in and out of the clinic by completing their charts more efficiently.  Charting Conquered:https://www.chartingconquered.com/If you want to learn more about Junaid or read his blog that is about coaching, burnout, productivity, and whatever else floats his fancy, then visit: https://prosperouslifemd.com/Alpha Coaching Experiencehttps://coaching.thephysicianphilosopher.com/ACE-waitlistGET IN TOUCH!Website: www.dadsbeforedoctors.comFacebook: www.facebook.com/dadsbeforedoctorsInstagram: www.instagram.com/dadsbeforedoctors

Everything you always wanted to know, but were afraid to ask about the residency application process from a Med-Peds Program Director (Dr. Thomas Davis). Completing Residency Applications and doing interviews can be full of unexpected twists and turns. Short and helpful tips while you're taking a study break. Acid Trumpet Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/by/3.0/

Dr. Kim Tartaglia is a licensed pediatrician + internist working at The Ohio State University in Columbus, OH. She additionally serves as Director of Part 2/Year 3 Curriculum at The Ohio State University (OSU) College of Medicine and is thus very involved in setting students up for success during some of the most critical years of their training with setting up wards + rotations. Dr. Tartaglia earned her M.D. at Rush Medical College of Rush University (Chicago, IL) and went on to complete her med-peds residency + fellowship trainings at the University of Chicago Hospital system. She is passionate about medical education, has run multiple marathons, and is the proud mother of three children. She was a joy to have on the podcast and I am so excited for you all to hear our conversation! Have any feedback or want to help connect us with a future potential guest? Reach out via email to Gregory.Friedberg@osumc.edu. Music Credits Track: Odessa — LiQWYD & Scandinavianz [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/jNy-Dp3lgcg Free Download / Stream: https://alplus.io/odessa

Career Path to become a Med-Peds Physician The Best combination of bringing two different populations (adult and peds) into one profession. Internal Medicine-Pediatrics is a medical specialty in which doctors train to be board certified in both Internal medicine and pediatrics. The residency program for Med-Peds Physicians is a total of four years in length, compared to three years for internal medicine or pediatric alone. Upon completion of a Med-Peds program, a doctor practice in the areas of Internal Medicine and Pediatrics. Be ready to get inspired and start to Dream Bigger!!! GUEST: Dr. Amaka Ofodu IG: @ILoveMaka Subscribe to my YouTube Channel and Support the Podcast by becoming a Listener Supporter or purchasing merchandise. Bio.fm/wbartou

New Episode OUT NOW!!! Click the link in bio to check it out!!! Pill Talk Podcast w/ Dr. Amaka Ofodu, Med-Peds Physician Resident Physician PGY2

We sit down with Dr. Will Brundidge to discuss financial education from the lens of a resident. Will is a PGY-4 Med/Peds senior at Loyola University Hospital Systems. Outside of spending time with his family, Will has interests in financial independence and real estate. Currently, Will and his wife own and rent out properties in both the California and Chicagoland areas. Through a process known as “House Hacking”, he serves as both a tenant/landlord in a triplex unit to obtain supplemental streams of income to offset his monthly mortgage. We also discuss certain principles of financial education every healthcare-professional-in-training should be aware of, including student loan management, contract negotiations, and financial mentorship. This podcast is for information purposes only; no member of this podcast is a licensed financial advisor. Recommended resources from Will: https://www.studentloanplanner.com/ https://www.whitecoatinvestor.com/ https://financialresidency.com Episode produced by: Alek Druck Episode recording date:3/30/21 www.medicuspodcast.com | medicuspodcast@gmail.com | Donate: http://bit.ly/MedicusDonate --- Send in a voice message: https://anchor.fm/medicus/message

Stefanie R. Brown, MD is the Internal Medicine Residency Program Director at the University of Miami Miller School of Medicine and Section Chief for the Med-Peds and Pediatric Hospital Medicine. Dr. Brown completed her medical school from the University of Cincinnati, pursued a residency in Med-Peds from Rutgers New Jersey followed by a chief resident year. Prior to this role, Dr. Brown has been the program director of the Med-Peds Residency at the University of Miami as well as the Assistant Dean for Diversity and Multicultural Affairs. She is the recipient of a number of awards including the Women in Academic Medicine Excellence in Mentorship Award. Today, Dr. Stefanie Brown shares an analogy that a past mentor taught her about achieving excellence: In medicine, there are two pies that define your life.  The first contains the things you are responsible for. The slices are made up of your job and your responsibilities, whether it be clinical, administrative, research, or teaching. But the second pie is full of the things you really like to do: The slices in this pie contain all the things you are passionate about. The key to success—and excellence—is getting these two pies to intersect as much as possible. The more these pies overlap, the more we will accomplish with less stress and effort. Pearls of Wisdom: 1. Moving from good to great is about knowing where your strengths are, and knowing what you need to improve on. From good to great, comes greatness to excellence, then excellence to amazing. And when you are able to pay it forward to others…that is when you move from amazing to inspiring. 2. If you're not at the table, you're on the menu. As residents, we have the opportunity to be in the environments where decisions are made, we can sit in on committees, and learn from the best so that we will be more prepared in the future to hold our own seats at the table. 3. In medicine, there are two pies. The first one contains your job responsibilities. And the second one is about what you are passionate about. The goal is to get these two pies to intersect: The better it will be for us, and the less effort it takes to achieve excellence.

Editor's note: This article was published on February 22, 2021. COVID-19 information and recommendations are subject to change. For the most up-to-date information, visit the Centers for Disease Control and Prevention (CDC) website or view our most recent COVID-19 blog posts. The COVID-19 vaccine has been available for select groups for some time now, but many are asking why there is such a long wait. On this episode of The Rounds, Dr. Kori Krueger and Tammy Simon join us. They are helping lead the COVID-19 vaccine rollout for Marshfield Clinic Health System. Dr. Krueger is a Med/Peds provider and chief quality officer for the Health System. Tammy Simon is a registered nurse and Vice President of the Institute for Quality, Innovation and Patient Safety at the Health System. Listen to podcast below:

Tune in for a lovely conversation about coaching women through significant life transitions. I learned a ton from Pam during the interview and I am certain you will be blessed by her as well!Pamela Ludmer, MD MMEL, is a Med/Peds and Adolescent Medicine Physician and now Associate Dean for Curriculum Integration.  After completing medical school at Rutgers New Jersey Medical School, she did both her residency and fellowship at Mount Sinai in NY.She is also a divorced mom of two amazing teen boys in Westchester, NY.   After her divorce, she became a Certified Divorce Coach® in the hopes of helping other physician women navigate the challenges of divorce.  She can be found at www.alignitycoaching.com.  You can email her at pam@alignitycoaching.com.___________________________Follow Pivot & Bloom on:FB: Pivot & BloomIG: @pivotandbloompodcasthttps://pivotandbloom.buzzsprout.com

The DEI Shift, Diversity, Equity and Inclusion, is a podcast whose mission is to focus on those issues in medicine, spark discussion and provide practice-changing data, stories and useful information to help healthcare practitioners to improve their practices and environments, gain empathy, cultural competency, and humility, and to learn more about emerging D.E.I. concepts. They discuss issues related to gender, race, sexuality, religion, ability, socioeconomics, and so much more. There are many professionals responsible for producing their informative and engaging content and on today’s show, we were honored to have Dr. Maggie Kozman, a Med-Peds hospitalist and Senior Producer and Cohost, Dr. Brittäne Parker, an academic hospitalist, Producer and Cohost; Deepti Yechuri, a recent graduate of UCSD undergrad and currently applying to medical school and Assistant Producer and Sarahy Martinez, a UCSD undergrad and Production Assistant. We discuss why it is necessary to create their show and some interest and disturbing statistics behind the lack of diversity in medicine. We also discuss some of the consequences to our patients of that lack of diversity. Each member of the DEI shift then goes through a personal experience with the healthcare system that demonstrates an untoward effect of lack of diversity and the highlights a positive experience because of the presence of it.  Find this and all episodes on your favorite podcast platform at PhysiciansGuidetoDoctoring.com Please be sure to leave a five-star review, a nice comment and SHARE!!! A proud member of the Doctor Podcast Network!

Dr. Como is a Medicine and Pediatrics hospitalist physician who practices in rural Montana. She is also developing an innovative Rural Training Track for Med-Peds residents. How does she approach patient education and care in this setting? What are the benefits to trainees of training and rotating at rural clinical sites? How is Dr. Como and her team designing a unique rural residency track? Check out this fascinating discussion with Dr. Como as we celebrate Utah Rural Health Week (Nov 16-20) and National Rural Health Day (Nov 19)!

Chadwick Flowers, MD, is an Assistant Professor of at the University of Miami as well as an Associate Director of the Internal Medicine Residency Program at Jackson Memorial Hospital—University of Miami. Dr. Flowers completed his medical school from Indiana University and a Med-Peds Residency from the University of Miami where he stayed on to become a Chief Resident. He is a Med-Peds hospitalist providing inpatient care to adults and children at the University of Miami, Jackson Memorial Hospital and Holtz Children's Hospital. His academic interests include medical education, inpatient quality Improvement, and bedside procedure/diagnostics. In medicine, our top priority should always be the patient. But in order to provide the highest quality of care for patients, we cannot forget about our own well-being. Today, Dr. Chadwick Flowers explains the importance of self-care and the prevention of burnout in medicine. We'll learn a few mindfulness techniques (and what box-breathing is), and he reassures us that if we need to take a break—we are entitled to that. Aside from self-care alone, he shares the best habits of successful residents: The ones who are willing to dive into residency with an open-mind, and who aren't afraid to put themselves out there, even when rejection is inevitable. Pearls of Wisdom: 1. We cannot leave behind our own mental health. Develop and practice mindfulness techniques, breathwork throughout the day and in moments of stress, and know when to take a break. 2. We need mentorship for every aspect of our life. Find someone who is doing what we want to do, and reach out to them. Often, our mentors are what guide us toward our true passions. 3. Be willing to face rejection. Still, have the ability to put yourself out there. If we are persistent in our goals, and finding good mentors, we will eventually find the people who invest in us.

The inside scoop on Med-Peds from one of the best in Cincinnati.In the era of COVID-19, we are saddened that opportunities to shadow in the hospital may be limited. In light of this, we wanted to bring the specialties to you! In this installment of the Virtual Shadowing series, we chat with Dr. Danielle Weber about all things Med-Peds. Dr. Weber (@DEWeber_MDMEd), Assistant Professor of Pediatrics at CCHMC & Assistant Professor of Internal Medicine at the University of Cincinnati, is a new Co-Director in Clinical Skills course at UCCOM. We loved getting to chat with her about her journey in Med-Peds and we know you will love what she has to say.

What inspired Dr. Gonsette to pursue a combined med-peds residency? Join me to find out what she finds so exhilarating about being a hospitalist in Alaska. Links: Full Episode Blog Post Meded Media medpeds.org

Sometimes it can seem like every other child we see has a food allergy. How prevalent are food allergies in the general population, and how can we best diagnose and manage them? To shed light on these questions, as well as recent guideline changes in the allergy community and novel therapies on the horizon, PC RAP welcomes back Torie Grant, MD MHS a Med/Peds allergist and immunologist at Johns Hopkins. She sits down with Neda Frayha, MD to share the full scoop on food allergies. To hear Part Two of this conversation and to view the show notes as well as detailed references click here

Dr. Madeline McCrary and Dr. Bob Centor present a clinical unknown to Dr. Joel Topf. Schema #1 Schema #2 Download CPSolvers App here Patreon website Dr. Joel Topf Joel Topf went to medical school at Wayne state University School of Medicine and did Med-Peds at Indiana University. He completed an adult fellowship in nephrology at… Read More »Episode 73: Clinical unknown with Dr. Joel Topf – Polyuria

Connect with Dr. Topf on Twitter @kidney_boy and check out his blog http://www.saltwhisperer.me/ .Joel Topf went to medical school at Wayne state University School of Medicine and did Med-Peds at Indiana University. He completed an adult fellowship in nephrology at the University of Chicago. He is currently a clinical nephrologist in Detroit at Oakland University William Beaumont School of Medicine. Joel’s passion is using social media and new media to teach nephrology. He started his blog, PBFluids in 2008. He developed NephMadness and NephJC to leverage the power of community, digital scholarship and creativity to teach nephrology. He is the founder and program director of the Nephrology Social Media Collective internship which trains medical professionals to use social media for medical education. He was recognized by the American Society of Nephrology with the Robert Narins award for innovations in Teaching in 2017.

Session 90 Dr. Philip Chan is an academic Infectious Diseases physician at Brown University in Rhode Island. He has been out of training now for about 8 years. He talks about his typical day, why he chose this specialty, the training path, and an inside look into this field. Meanwhile, be sure to check out all our other podcasts on MedEd Media Network. [01:22] Interest in Infectious Disease Philip recalls being interested in Infectious Diseases (ID) back during undergrad. With a Major in Microbiology, he was basically interested in bacteria, viruses, infections, and how to solve such problems. Although Philip's dad is a cardiologist, he was already interested in fixing things at an early age. So he went to college majoring in Engineering. Then he realized he wanted to go to medical school so he shifted to Biology. However, he thought it was too generic so he then changed to Microbiology, specifically focusing on genetic engineering. [02:40] Traits that Lead to Becoming a Good Infectious Diseases Physician Philip says you've got to have the ability to think through a problem from top to bottom. You also have to have a particular attention to details. He advises medical students, especially early in their career, is to think about a problem in a timeline. You have to be able to put things together in a timely fashion and think through the different problems and problem-solving critically. He initially got into the field of HIV early on in his career mainly due to the research aspect of it. But as he progressed, he had gotten so much interested in the intersection of HIV, social justice, and health disparities. A lot of his work is presently focused on public health at the community level and engaging populations across their state. [04:20] Other Specialties of Interest During medical school, Philip found everything to be interesting. He loved his surgical rotations as well as OB-GYN, Medicine, Pediatrics, and Oncology. But when he got to residency, he felt he was fully committed to Infectious Diseases. He did consider Oncology due to the genetic research he did at that time. But he eventually landed on his current specialty and he's happy he did. What he likes about ID is that it touches every part of the body. There's a broad overlap of lots of other fields and disciplines. You can actually cure a lot of infection. A lot of medicine now is managing chronic diseases. That's fine. But one thing that appealed to him about infections is that you can cure a majority of them. You can make people 100% back to normal. "A lot of medicine now is managing chronic diseases... but one thing that appealed to me about infections is that you can cure a majority of them." [06:00] Types of Patients Philip categorizes patient care in two types. He does consult in the hospital where he'd be dealing with "bread and butter infectious diseases" These include endocarditis, osteomyelitis, diabetic skin, and tissue infections. They also treat a spectrum of all other infections from malaria to TB and to many other sorts. Moreover, the outpatient side has become more of his "bread and butter." This includes HIV care. He started the prep/prophylaxis clinic at their site. He also runs their STD clinic. He didn't receive enough training in these through fellowship and residency. But the outpatient ID care has taken a lot of his time now. About a third of the time, there are clear culture data to help guide the decisions. Then a third of the time, they don't have culture data. Cultures may not be accurate, negative, or they're not drawn correctly. Then there are also lots of bugs that don't grow. Philip believes that about a quarter of the time, they're shooting dark and making their best guess. Then they're just guided by other aspects of the clinical patients. The other third of their time, they deal with random things that they get called for. Majority of the cases would be fever. For instance, there's a rising blood count. Others would be taking random questions that may be unclear to the primary care team. 10% of the time would be people getting diseases from other countries like malaria, TB, etc. And a small percent of that time, they're able to nail the diagnosis of some really random diseases. They give them the appropriate antibiotics and cure them. "You've given the appropriate antibiotics and you cure them. That's one of the greatest feelings in ID." [09:40] Is His Job Just Like the TV Show House? Funny how Philip thinks that none of it does look anything like his job. 1 out of every 10 patients, he sees the complete mystery and you try to piece things together. One thing they really love to do as ID doctors is to dive into the social history. This includes the person's demographics and how you frame them epidemiologic-wise. And just to be clear, there is no housebreaking involved. "For many parts of medicine, the social history doesn't necessarily matter quite as much. But in ID, the social history can really be everything." [10:45] Academic vs. Community Setting Philip believes there are pros and cons to each. Basically, it's about what you like to do. In private practice, there's incredible flexibility especially if you work for yourself. You can make much more in the private world depending on what you do. He describes his career as being very academic and research-oriented. He's also the PI of several NIH grants and other grants, which you can't do in the private world. For academic ID careers, you can get involved in research and public health. You have the chance to get involved in lots of other different committees and leadership roles and stewardship. You can work for the Department of Health. "There's a lot of other opportunities in the career of ID to really spread out." [11:50] Doing Research without a PhD Philip is doing a ton of research at a major Ivy League institution, yet he doesn't have a PhD. This is concrete proof that it is possible to do research without that PhD. After his undergrad, he got a masters in Genetics. So he has some research experience that he has built on. What he recommends to students is that if you're really interested in research, really collaborate. One of the keys to successfully writing NIH grant is he always leads the grant with a PhD person. The NIH loves this as there are two different complementary skill set – one a clinically oriented researcher and the other a PhD-driven researcher. [13:00] Typical Week Philip holds clinics on Thursday and Friday afternoons. For about 4-8 weeks of the year, he does inpatient service time where he sees most of the bread and butter disease cases. Then the rest of this time is spread out running various research and the programmatic aspects of what they do. He's spread across various institutions, pushing different agendas related to HIV and other STDs. [14:00] Doing Procedures and Taking Calls Compared to other fields, ID is a less procedure-driven field. But there are a lot of things you can do, which are quite parallel to what an internist does. For instance, they do lumbar punctures, thoracentesis, and other procedures. There are other physicians who feel comfortable doing biopsies.  Nevertheless, they routinely take cultures. "Compared to other fields, ID is a less procedure-driven field." According to Philip, the beauty of this field is that there's not many emergencies where you have to go into the hospital ever. Hence, this gives them a very good quality of life in terms of taking calls. He personally takes calls a couple of months where he has to answer phones through the night. However, for academic institutions, there's a fellow who takes all the calls. And if there's something they can't answer, they then refer it to the attending. And this happens to him only about 1-2x  a year. For a lot of the calls, they'd usually give the patient antibiotics and see them in the morning for evaluation. Philip says he has a good work-life balance. His wife works full-time so he actually does a lot of the childcare in their household especially in the evenings. Although you have flexible time, you have to put in the time to be successful. But you can be flexible in terms of how time is managed. He makes sure he exercises everyday. "As an academic ID physician, you have the flexibility of your time." [16:55] The Training Path and Competitiveness Infectious Diseases is a fellowship after internal medicine residency. You go through the traditional 3-year internal medicine residency. In general, you go through a two-year clinical fellowship after that. There are numerous variations such as research-oriented fellowships combined clinical research fellowships for 3+ years. Given that ID is an especially research-driven field, there are lots of places that combine clinical and research together. The typical pathway is two years of ID fellowship. A number of his colleagues come from Med-Peds residencies to do Adult ID and Pediatric ID fellowship over 3-4 years as well. Pediatric ID is a specialty so you can go from a pediatric residency into a pediatric ID fellowship. The top programs in ID tend to be competitive but there is not as competitive per se as Cardiology or GI. To be competitive, you should do well in residency as a rule of thumb. Be involved in something that really demonstrates your interest. ID is very diverse as there are a lot of people from various backgrounds and experiences that are interested in the field. For instance, there are people interested in infection control, antibiotic management, international health, HIV/STD pathway, etc. So try to explore these through residency. Do research or other projects with a mentor to really show and demonstrate your interest. Or to find out if this is really something you're interested in and that you want to continue this pathway. Just do something outside of your normal residency duties. If you're interested in academic medicine, you can get involved in some grants or publications. [20:45] Subspecialty Opportunities There are various routes to become certified in HIV care. One is to do a fellowship in Infectious Diseases. As an internal medicine doctor, there are certification programs where you can become a certified medicine physician in HIV care. This is generally a one-year fellowship. Once you've become specialized, there isn't any "next step" in terms of specialty. Those that really take the next level are research experts. These are people who have developed research expertise in drug resistance, for instance or a neurological complication-related to HIV/AIDS. Usually, these are people who have done research on a specific topic of HIV. These are world-renowned experts in a specific aspect of HIV. Within your typical ID fellowship program, there are usually no specific tracks where you can get certified in. Usually, it's based on where you spend your time on. There are elective months as well as clinical care. A lot of these are self-directed and self-driven. There are programs, workshops, and courses being offered at academic institutions where you can start to develop specific interest and focus within aspects of infectious diseases. "Most of what happens in how one develops one's interest and expertise, within infectious diseases, is based on where you spend your time." Alternatively, the people that develop expertise in meningitis or fungal inspection or STDs are people who have developed programs and research portfolios around those different topics. [24:15] Bias Against DOs One of Philip's mentors is a DO who runs infectious control at Rhode Island Hospital. He routinely calls him for pieces of advice. He knows other fantastic mentors who are DOs. "It's less about the degree after your name and more about what you make of yourself and how your career transpires." [25:10] Working with Primary Care and Other Specialties Philip also provides primary care himself to his HIV positive patients. The way medicine has gone, as he puts it, is that everything is subspecialized that it's so impossible to be good at everything. You can't just keep up with every single aspect of literature or every single disease. He found that through the years, he has become less comfortable managing aspects of diabetes and primary prevention related to cardiovascular disease. Moreover, there are some diseases like HIV that if you engage all primary care physicians, we would all have the potential to make huge strides in addressing the HIV epidemic. So they're trying to engage the primary care community in assisting patients with HIV testing and STD testing. Other specialties ID physicians work the closest with include internists/primary care and hospitalist internists. [27:22] Special Opportunities Outside of Clinical Medicine There are tons of opportunities for ID physicians to get involved. He has colleagues across the world who work internationally. There are people who provide care at international sites and those who consult with NGOs and the WHO. Nationally and locally, there are many health departments across the country that have consulting physicians. Some even have full-time physicians for infectious diseases within public health. Personally, Philip consults part-time for the Department of Health aspects related to HIV and STD. There are also opportunities at other outpatient health centers. Some of his colleagues provide consulting services related to Hepatitis C treatment, HIV care, and other aspects of ID care to community health centers, NGOs, etc. A lot of community-based organizations have medical director roles related to substances treatment, AIDS service organizations, STD clinics, etc. [28:45] What They Don't Teach in Medical School For Philip, leadership was something he had to learn on the fly. He currently manages a team of over a dozen people. The business aspect is something they don't teach you in medical school, as well as how to manage people and how to be a leader. They train you very well throughout medical school and residency to be a clinician. But for basic business/leadership/managing skill was something he had to learn on the fly. This was something he had to do everyday. That being said, it was something he wished he had formal training with given his current positions. What he has done though was to find key mentors or people who have been through this time and time again. He'd lean on them heavily and ask them questions about how to navigate different situations. "Seek out a couple of key trusted people that you can ask confidentially some tricky situations if you ever find yourself in them." [30:50] The Most and Least Liked Things Philip has gravitated more into the preventative side of infection, which was something he didn't anticipate through his training. He started their HIV preexposure prophylaxis program. He sees a lot of people that are at risk of HIV and one of his jobs is to keep them negative. He enjoys interacting with young HIV positive people. Preventative care wasn't something he saw doing 10-15 years ago. But he has now found this to be the most enjoyable aspect. "I feel like I do a lot of education, counseling, teaching, and mentorship to my patients – guide them through difficult situations, mostly, but not all related to their health." On the flip side, what he likes the least about his practice is the administrative aspect that can become sometimes overwhelming. At some point, the administrative side of medicine may start to weigh heavily on your career. So just set some clear boundaries and structures to help manage that time. In fact, Philip just sat on a panel for physician burnout and found that the EMR is one of the number of causes for physician burnout. [33:10] Major Changes in the Future Philip says that for those considering careers in HIV specifically, is to consider places where HIV is affecting people most, including the deep south. A lot of money and resources are now being redirected to such places where HIV is hit the hardest. In terms of HIV cure, Philip sees an optimistic future in the fact that it can be done. a couple of patients now have received bone marrow transplants with HIV mutations to make them resistant to HIV infections. And when implanted with a bone marrow transplant, these people can now be cleared of HIV. There could still be remnants of HIV but people in the field are considering this as functional care. However, this is not something really applicable to the general HIV population. Reason being is that in order to get a bone marrow transplant, you have to destroy one's immune system. Bone marrow transplant is for those with leukemia and other blood-borne cancers. Also, there's a 25% mortality rate with bone marrow transplants. And you wouldn't want to risk that percentage for putting HIV medication that can keep you controlled for life. All this being said, it has the potential to cure HIV. Ultimately, Philip would still have chosen to be an ID doctor if he had to do it all over again 110%. His advice to students is to do it early. It's a fantastic career and he's 100% glad he did it. There are tons of opportunities with some overlaps with international careers, public health, and public policies. "Try to explore a career in ID especially if you're interested in public health, social determinants of health, addressing health disparities." Links: MedEd Media Network

Session 83 Dr. Renee Rodriguez is a community-based Pediatric Cardiologist. She shares why she loves children’s hearts, a typical day, and whether she has balance in her life. Meanwhile, be sure to check out MedEd Media Network for more helpful resources. [01:25] Interest in Pediatric Cardiology The first time she realized she wanted to do pediatric cardiology was the second she started residency being her first rotation as a pediatric resident. For her, residency was the best thing that ever happened since she wasn't in school anymore. She did another rotation but it wasn't as fun as cardiology. From a physiology standpoint, Renee finds congenital heart disease super interesting. It's like a puzzle where you have to figure out where the blood flows based off of what the anatomy is. So she fell in love with congenital heart disease, to begin with. She also fell in love with the patients. For most kids with heart disease, they're neurologically intact. So Renee got to bond with each of the patients Renee would describe pediatric cardiologists as having a unique personality of being able to not only communicate with kids, but also surgical in nature, are cut to the chase, and have high expectations. And she felt she resonated with it as she wants things to be more hardcore. [05:08] Traits that Lead to Being a Good Pediatric Cardiologist Renee describes a good pediatric cardiologist as being constantly questioning what is happening and trying to evaluate things in multiple different ways. Try to understand how to use those different modalities to answer a good question. You could order all of those tests on every patient but that would not be good care. So you have to be thinking about what you're trying to answer and how you can best answer it in a non-invasive way to get the results you need. And if you need to have invasive testing, what is it going to gain, the timing of it. So you need to be able to decipher how you're going to work a problem up. You have to be able to be collaborative. In pediatric cardiology, you're working with surgeons, EP doctors, transplant, heart failure, pulmonary hypertension -- there's a lot of little subspecs when your patient is getting a little bit more complicated. As a pediatric cardiologist, you're needing to be the conductor in all of this between all of the different specialties when it gets pretty complicated. So be collaborative and be able to deduce how you need to work a patient up and what each test is going to give you. "Be a calming collective presence for families. Patients who come to see a pediatric cardiologist are petrified, even if it's just an innocent murmur or the kid has chest pain." Moreover, you have to be calm to the patients and their families as parents are walking in the door, worried and freaked out that their kids are going to die. Most of the time, the kids are totally fine. It's not going to be anything major. But if it is, it's going to be something they're going to live with. You're going to have to be able to dance that wine and speak with parents as you're trying to give them that information and guide them through it while not totally having them walk out of your office in shambles. [07:35] Types of Patients As an outpatient community pediatric cardiologist, she sees a lot of murmurs that are typically benign, like a small hole or small valve defects, nothing major, that typically doesn't require any procedures or intervention. One of the common ones that present later in life is a large atrial septal defect. You don't necessarily pick up murmurs unless there's a significant blood flow across the hole on top of the heart that it causes some rumbling across the pulmonary valve. A lot of those kids present a little later when you hear that murmur and it can be mistaken a lot for a typical murmur so physicians don't necessarily send them until later. This would be one of the things that would require some intervention like surgery or cath procedure based off of the defect size. She also sees chest pain which is rarely ever cardiac. In kids, it's typically musculoskeletal or lung-related. If it has something to do with exercise, Renee gets those referrals. She also does preventative cardiology, a large portion of her practice is cases with high cholesterol, obesity, pre-diabetes, family history of early coronary artery disease or hypercholesterolemia. She also does a fetal echo. That's a whole different realm of primary indications that a pregnant woman would need. [09:45] Diagnosing Patients The large majority of her patients come to her undiagnosed and then she sees them. She built up the fetal echo practice because of the way pediatric cardiology is today where we rarely pick things up post-natally. "Because of our imaging abilities now and good prenatal care, we tend to pick up most significant congenital heart defects in utero." If you're a pediatric cardiologist scanning a patient, they're doing a fetal echo and identify a defect or a patient needs to deliver, you become that patient's pediatric cardiologist once they're born. Meanwhile, general pediatricians will pick up as an outpatient such as murmur, chest pain, family history, etc. They may do an EKG before they see you but usually, it's the pediatric cardiologist that does the diagnosing, if anything needs to be diagnosed. [10:52] Typical Day and Taking Calls Renee comes in two and a half days a week. She comes in the morning. She basically categorizes her patients. Her heart-healthy lifestyle patients are her more preventative cardiology patients like high cholesterol or obesity patients. It's more about lifestyle counseling, nutritional, exercise, etc. For cardiology patients, she will have them get an EKG before they come in. She will review it and walk in the door and decide if they need any further testing. She starts at about 8 am with an hour-long patient slot for new patients. Return patients will have half an hour usually. She sees patients from 8 to 5 on Thursdays and Fridays, doing echoes, and doing EKGs in the clinic room, answering in-basket messages from patients or answering phone calls. Then she's done by about 5:30 pm after she has closed her charts. "I do a lot of pre-charting. I pre-chart on all my patients beforehand so that by the time I get to see them, obviously I will have reviewed the chart in its entirety and then I can just add in what I need to add in quickly. In terms of taking calls, she doesn't take any in-house calls. She's actually surrounded by two major universities with very robust surgical and inpatient hospitalization with certain pediatric cardiology patients. So if they need advanced care, they can go to the two children's hospital near her. She also has some privileges at a couple of local hospitals where she can just get called anytime. And she has the option to take it or not depending on her availability. For her group, she's on call probably once every 6-8 weeks. She can just get called by any of the pediatricians in the urgent care or in their clinics, usually reading EKGs or answering questions for them. If there's anything very dramatic where a kid needs to be evaluated immediately, she can have them go to the hospital she's privileged at and she can evaluate them there. Or if she knows the children need some advanced care then she could just send them to the children's hospital. In terms of work-life balance, Renee considers having great balance. She built her outpatient practice to make sure it's a 100% possibility, reason that she took the decision to be part-time. That being said, she's able to balance her outside creative interest, her family, and her own self-care very well. [14:44] Community vs. Academic Setting Renee felt she received excellent training in evidence-based, high-quality, very well-thought out pediatric care. Sometimes, when you keep that only in an academic setting, you don't get to disseminate that kind of care outside. It's important to bring that kind of care to a community-based setting to be able to provide that same type of care people who wouldn't be able to travel always to Stanford or UCSF, where they're located. She thinks this kind of care should be disseminated everywhere. These are the things that led her to be in the community. "Sometimes, when you keep that only in an academic setting, you don't get to disseminate that kind of care outside." [16:35] Training Path to Become a Pediatric Cardiologist After undergrad and four years of medical school, you do a pediatric cardiology residency followed by a pediatric cardiology fellowship. There are selective programs now where you can match in a path from medical school, you become a resident for 2-3 years and then automatically go to your cardiology fellowship, you're guaranteed a spot. But typically, it's a three-year residency in peds and 3-year fellowship in cardiology, and then a couple of years after that if you want to subspecialize. There is a hugely growing field in pediatric cardiology called adult congenital heart disease. There are people who do adult medicine first and then spend time rotating through pediatric cardiology to get a better sense of congenital heart disease. They clearly understand the adult onset issues, but they need to understand the pathophysiology and surgical management of the pediatric realm. This is what ends up happening from the adult side and then they treat adult patients more than peds patients. Renee thinks that people who do Med/Peds could do that. As to competitiveness, Renee describes pediatric cardiology as one of the more competitive specialties of peds. That being said, most people she knew ended up matching into some programs. To be competitive, a resident has to be hardworking in everything they do regardless of what kind of rotation you do. So work hard and make great connections. Be a good learner and be open to opportunities. People talk to each other so never burn bridges. So working hard is always the right answer. "Go the extra mile when you're on the pediatric cardiology rotation, but you really should do that across the board because you have no idea who knows who and who could say what about what." [20:55] Special Opportunities for Subspecialization After cardiology fellowship, other areas for you to subspecialize include electrophysiology or interventional cardiology, pulmonary hypertension. There's also CVICU, which you can do from PICU or you go and do additional training in cardiology. Or if you're a cardiology fellow, you can go from cardiology and do additional year in pediatric ICU. Or you can just do an ICU year. There are also some preventative programs coming up where you can do an additional year of preventative cardiology. And adult congenital disease as mentioned above, which you can do from the peds side. There's also advanced imaging. [23:15] Message for the Osteopathic Students Renee never saw any DO students getting any different treatment or thought process. She believes that if you work really hard, there's no such thing as luck. Be there, be present. Work hard. Take opportunities where you can. Show off as your best self every time and you can get typically what an MD student would get. "If you work really hard, opportunities present themselves from the hard work that you do." [24:05] Working with Primary Care, Other Specialties, and Opportunities Outside of Clinical Medicine "Pediatricians should feel comfortable developing a relationship with a pediatric cardiologist." Congenital heart disease, for instance, is a hard thing to understand unless you do a deep fellowship in it. That being said, feel comfortable calling somebody, even just asking what the pediatric cardiologist thinks. At the end of the day, it's about having a team-based care. A lot of what pediatricians see in the clinic would be really taking family history. So anytime you're seeing a kid complaining about chest pain, really take a detailed family history. And not just cardiac disease but general heart disease, like if anyone in the family has this certain disease or not. Renee advises primary care physicians that if at any time you worry about a heart problem, take a very detailed cardiac family history. "Lots of things are genetic diseases that are passed down." Other specialties they tend to work the closest with include those from the subspecialized cardiology field, interventionalists, EP doctors, sometimes surgeons, neurologists. In terms of special opportunities outside of clinical medicine, you can get involved teams doing heart screening. There would be a lot more opportunities in the future as with technology and monitoring. [28:30] The Most and Least Liked; and Major Changes in the Future Renee really thinks pediatric cardiology is a very interesting field. What she thinks is cool is that you still get to see the people who you only read about on textbooks. "It is a super interesting fast-paced, highly evolving field with a lot of really amazingly smart, fun people." What she likes the most about this field is the way she's connecting with the patients and their parents. They are terrified the moment they walk into the clinic. But she's able to tell them that they're going to be totally fine. Of if there is something wrong, Renee is the person who can lead through this whole thing. Being able to take their hand through it all is something humbling. Conversely, what she likes the least is feeling like no matter how much you do, you can never tell with 100% certainty that everything is okay. In terms of the major changes she sees coming into the future of this field, she mentions the power of the smartwatch where you can pick up certain things. Ultimately, if she had to do it all over again, she would definitely do it. Her message for medical students and residents is that don't discount anything along your path. Really check all over again even if you think you've found what you really want. Don't get tunnel-visioned and think like you have to do well it a certain rotation only. Instead, work hard because everybody talks and pediatric cardiology is a super small field and everyone knows everyone. So you've got to put on your best face always. Always be showing up with your best self! Links: Follow Dr. Rodriguez on Instagram @reneeparo. MedEd Media Network

On this episode of Medicus, Dr. Nate Derhammer joins us to talk about medical education and how it has changed since when he was a student. He also discusses his role as the residency program director of Med-Peds at Loyola and offers his perspective on how students can do well in their clinical years of medical school, as well as match into Med-Peds for residency. You won't want to miss this!

Dr Bustillo discusses the specialty of Primary care internal medicine today, the choice of Medicine-pediatrics and the rewards of being an associate program director amongst other things

Dr Bustillo discusses the specialty of Primary care internal medicine today, the choice of Medicine-pediatrics and the rewards of being an associate program director amongst other things

Latest episode of The Medical School Podcast --- Support this podcast: https://anchor.fm/themedicalschoolpodcast/support

Session 64 Dr. Lauren Kuwik is a Med-Peds specialist in upper New York. She shares with us her desire to go into Med-Peds vs other specialty and so much more. Check out all our other podcasts on MedEd Media Network. We are constantly looking for people to guest here on our podcast. If you know a physician whom you think would be a great guest, reach out to them and give them my email address ryan@medicalschoolhq.net and have them contact me and we will get them on the show. Today's guest is a private practice Med-Peds doctor. Med-Peds is internal medicine and pediatrics combine specialty. Lauren is now practicing for five years in Buffalo, New York area. And she talks all about her journey with us today. [01:50] An Interest in Med-Peds Lauren grew up knowing a doctor who was a family friend who ended up being her internist when she transitioned from her pedia rotation and she was Med-Peds. Having always wanted to be an archaeologist and a teacher, she feels that Med-Peds allows her to be both. With internal medicine, in terms of the archeology part of it, you're always putting together clues to figure out what's going on with the patient. She loves the mental tenacity involved in internal medicine. While for the peds part, she loves children and thinks they're fun. She loves taking care of kids. And as with the teaching aspect, she loves educating patients on a daily basis. So she gets to do all the things she wanted to do together in one specialty. "You're always putting together clues to figure out what's going on with the patient." [03:08] Is Med-Peds Going Away Soon? And How It's Different from Family Medicine With the generality of it with both internal medicine and pediatrics, she doesn't really see any risk of the Med-Peds going away over time. There's a need for primary care doctors and specializing in both really gives you the opportunity to be a better pediatrician and a better internist. People really like to have someone that they can see themselves and their kids. They're both the doctor to the mothers and kids. So Lauren thinks this specialty is really here to stay. "Specializing in both really gives you the opportunity to be a better pediatrician and a better internist." How is the specialty different from family medicine then? Lauren explains it's similar to family medicine or family practice where they take care of the whole spectrum from babies all the way to patients in their 90s or 100s. But they don't do OB, so they don't deliver babies. They take care of pregnant patients but they're not involved in their prenatal and delivery care. They do very little surgery. And while family medicine may do a couple of months in pediatric training, Med-Peds would have to do a full residency in pediatrics and they're board-certified in pediatrics. They can subspecialize if they want to. So any specialty comes out of internal medicine, out of pediatrics. You can either subspecialize in the pediatrics and adults subspecialty or you can specialize in both. There are those that may want to take care of patients with compact heart disease as a kid. They're then repaired and now they're in their 30s. So there are people who will do a longer fellowship and combined internal medicine and pediatrics, cardiology and then they can take care of those people throughout their whole life. It's longer. If each fellowship in internal medicine or pediatrics three years, that's usually about a five-year fellowship. Other people just do adult cardiology but because they're pediatric certified, they feel very comfortable with those cases. There are other ways to do that without doing it for five years. Nevertheless, it's a lot of training. [06:00] Traits that Lead to Being a Great Med-Peds Doc Lauren explains that you have to be willing to talk to people. You have to be willing to build relationships and be comfortable speaking with specialists. This will help your patients out in the future. Additionally, you have to be able to apply knowledge to things that don't seem very straightforward. Some people like to have one specialty where they get a lot of deep knowledge in a very narrow pocket. You have to know a little about everything and be really willing to work hard. Alternately, if you're someone that doesn't like to do a lot of procedures or like to be in an operating room, this is where you can do minor procedures that are not heavy. So this is a good fit as well. "You have to know a little about everything and be really willing to work hard." Aside from Med-Peds, another specialty that actually drew her was Emergency Medicine. In fact, she thinks most people in Med-Peds, at some point, considered a career in Emergency Medicine. For her, a couple of things impacted her decision. First being was that her mother was an emergency medicine nurse practitioner. She spent a lot of time volunteering in the emergency department. She found it to be so much fun with a lot of variety. But ultimately, she likes controlling her time. She doesn't mind an emergency every once in a while or dropping everything to take care of it. But she doesn't lots of emergencies going on at the same time. She doesn't like feeling flustered.  She really likes having control over her schedule in deciding the hours she wants to work without someone assigning those to her so she gets more time with her family. [08:05] Types of Patients and Typical Day Lauren sees a mix of patients from a one-day old baby to a 91-year old patient. She sees a mix of well visits or annuals. She sees people who are getting ready to go for surgery or those who come in for chest pain or for fever. It's just a variety of things. A typical day for Lauren is getting to the office 30 minutes before she starts her day.  She'd do a lot of things between seeing patients like talking to her nurses, answering calls, checking labs, reviewing many documents, images, and sometimes prepping her notes in the morning. She sees patients in the morning for about three to four hours. And then she also sees patients in the afternoon. She has a late day where she's in the office until 7 at night, but she comes in at noon when this happens. So it's basically the same day just pushed forward. Lauren explains that where she lives, she does more of outpatient care. But for most outpatient primary care doctors, are having their patients taken care of in hospital by hospitalists. So she only goes to the hospital for babies born to her practice at the newborn nursery. Most pediatricians have their hospitalists and the nursery sees their patients. That said, she reckons it at 95% out patient for her. [10:22] Taking Calls and Work-Life Balance Lauren takes calls one day a week. She might get one phone call usually. In fact, one time, she went almost three months with no phone calls on that day. Sometimes, she gets two or three. And every fifth weekend, she's on call. She gets an average of ten phone calls. She doesn't necessarily have to be somewhere. She just has to be available by phone. If patients hear her kids talking, they know she's living her life. But it's not as time-consuming. Lauren has three kids and two of them, she had during residency. However, with the kind of schedule she has, she feels like she has a lot of time with her kids. "Anything after having two kids back to back in residency seems like a ton of time." [12:05] The Training Path As a Med-Peds doctor, you're taking a three-year pediatric residency and a three-year internal medicine residency. Then you're mushing them together into four years. Because of that, there's a lot of overlap especially in the first year about learning how to be an intern. A lot of the things that you learn are not really specific to one specialty or another. There's not a lot of time for electives or research months. They have a lot of inpatient and intensive care unit months compared to a traditional pediatric or traditional internal medicine residency. "There's a lot of overlap especially in the first year about learning how to be an intern and a lot of the things that you learn are not really specific to one specialty or another." For Med-Peds, there's a national guideline that you have to hit to both finish your pediatric requirements and finish your internal medicine requirements. And Lauren doesn't think this is a modifiable thing. She feels lucky though because her clinic "assignment" was at a private practice and a community where the other doctors are really happy in primary care. It gave her a great introduction to life as outpatient primary care doctor and talked her into that role. Lauren goes on to explain that Med-Peds programs are usually pretty small. She's from the east coast and most programs were 2-4 residents per year. Most people who graduate from her program would be one in the primary care. They only did dev specialty in internal medicine or pediatrics. And sometimes, they overlap stuff such as sickle cell care or cystic fibrosis care. She has seen people do both although she has no knowledge of the actual data. But speaking of her program, most people went into primary care. Lauren doesn't think Med-Peds is competitive. She went to state school and interviewed at top programs but she didn't think it was particularly competitive. Primary care in general, she thinks, is not as competitive too. Although she wished it was more competitive, but she assumes it has more to do with salary. "I wish they were more competitive. It probably has a lot to do with salary. I think they're the greatest field in the world, but not as competitive." [16:30] Bias Towards DOs, Special Subspecialties, and Working With Other Specialties Lauren doesn't really see any bias towards DOs. A lot of times, she forgets when she thinks about her colleagues that she did training with as to who went to DO school and who went to MD school. As to what's not available to a Med-Peds doc to do a fellowship in, there might be people who do a Med-Peds residency and then do a fellowship that is just within one sphere, for instance, pediatric ICU. But the practice both in the pediatric and adult realm, she does see this happen. But there's not anything that's cut out. When she was rotating in pediatrics and internal medicine, most of the attendings are happy to have Med-Peds on their teams knowing they're pretty academic and they work hard. Other specialties they work very closely with Cardiology, Oncology, Surgery, and sometimes Nephrology. Outside of clinical medicine, special opportunities would be telemedicine, college health, reviewers on different journals, etc. [18:55] What She Wished She Knew that She Knows Now Although not specific to Med-Peds, Lauren wished she knew so much more of how the business in medicine. Being a private practice owner and actively learning, she wished they taught this in medical school. She wished she got a wiser advice about her student loans before entering attending shift, although it's coming around and she plans on them being gone in a couple of years. "I wish I knew so much more of how the business in medicine because I'm a private practice owner and I'm actively learning but I wish that they taught this in medical school." What she likes the most about being a Med-Peds doctor is being someone's doctor. She likes taking care of families and she loves taking care of older adults in their 80s and 90s. She thinks there's so much to learn from them and she loves taking care of first time babies of families and guiding them through the process. On the flip side, what she likes the least is the reimbursement compared to specialists. Although there's not a lot to complain about, it seems like it's a fact that they pay more for procedural specialties than they do for those people who hold their patient's hands and talk to them when something's going on. And she really thinks the reimbursement playing field must be evened out. [20:15] Private Practice versus Academics The reason she chose private practice over academics is having control over her own schedule and over how things run where she is. Additionally, you get paid more, you get to have a better schedule, and so you get a better quality of life. You get to have more say over how your practice runs and you're not having an administration telling you what to do. Lauren recalls that in her particular practice for five years, the first four years, she was an employed physician. And then she became a Partner last year. And she basically realized she would never work for someone else for the rest of her life. [21:35] Major Future Changes in the Field Lauren mentions this thing called, capitation. It doesn't impact students but there's a change in the way that they're paying private practice. This is on a regional level, but a lot of insurance companies are interested in incentivizing in order to provide really good care to their patients. But then they pay you per month to be someone's doctor and they pay for sick visits when patients come in. "There's changes in the payment structure for private insurance right now." Overall, with the Affordable Care Act, this has not affected her practice in a negative way. So she's interested to see what happens in the new healthcare plans. Moreover, the one population she loves taking care of which are 80-year-old patients are on Medicare. They've worked so hard so you would want those to be available to those patients. [22:55] Final Words of Wisdom If she had to do it all over again, she'd still choose the same specialty 100%. Lastly, Lauren would like to impart to students that it's important to network and connect with attending physicians. Shadow them to see if this is something you're interested in. Most of them are really excited to share their specialty with people. So if you know someone that's a family friend or your pediatrician, or someone you met at a networking event for premeds, really take them up on the offer if they offer for you to shadow. Or reach out to them. Because they want to share that with other people who may be interested. Links: MedEd Media ryan@medicalschoolhq.net

Session 61 Dr. Catherine Mcilhany is a community-based General Pediatrician. She joined us to talk about her position and her path and what you need to know. We're constantly looking for guests that we can feature here in the podcast. It has been a challenge for us. Please shoot me an email at ryan@medicalschoolhq.net if you know any specialists that you would like to have on the show. Back to today's episode, Catherine has been in practice now for 15 years. Several weeks ago, I talked with a rural General Pediatrician. So you get to hear some differences between rural medicine and a community-based, urban center general pediatrics. [02:15] Interest in Pediatrics It was during her third pediatric rotation that she realized she wanted to do pediatrics. She just had so much fun with the kids and that's what she liked about it. She admires the resilience of kids despite what they're going through. "If you can have some fun almost everyday in some part of your job, it's totally worth it." She did consider doing OB/GYN but then she got into rotations and realized she didn't want to be a surgeon of any type. She also thought about doing Med-Peds but she found the scope of family medicine was so broad that she was worried there would be so much to have to know all the time. She was looking for something narrower. And after doing her adult medicine rotations, she realized she wanted to stick with the kids. That said, Catherine likes working with the parents. A big part of what they do is educating parents and sometimes, crisis management. She describes it as a little intimidating thinking that you're taking care of the most important person in most people's lives. Hence, you have to interact with adults as well. [05:35] What Is Med-Peds? Med-Peds is a combined specialty of internal medicine and pediatrics training so you would be fully qualified to do the full scope of adult internal medicine plus pediatrics care. So it's like Family Medicine except that you're not doing GYN procedures like Family Medicine might do. So you don't have the OB and some of the more specific GYN type. [06:20] Types of Patients In a day, he will see everything from a 3-day-old to a 19-year-old. She had seen a 19-year-old having some schizophrenic break to a diagnosed cancer. She does see a lot of healthy children. She works in a population of a fair number of kids who are really struggling in school. She sees a lot of behavior issues in her office. She also sees a fair amount of contraception counseling, sexually transmitted disease testing in teenagers. So it's an interesting scope of diseases that they see in pediatrics, which is quite opposite to what most people probably think that they're only seeing cold cases. "The hard thing about pediatrics is that you'll see a lot of kids with the same chief complaint, but you have to be able to find the one that has something that's unusual." Although children may have a chief complaint, the hard thing about it is that you have to be able to find the one that's unusual. Hence, you need to be well-trained in seeing a high volume of kids and always thinking who's going to be the "zebra out of all these horses." [08:12] Community versus Academic Setting Catherine admits having worked in an academic setting. But she knew she didn't want to do academic general pediatrics, which involves doing research since it wasn't really her interest. Then when she went into general pediatrics to be a regular primary care pediatrician, she thought getting her feet wet and figure out doing it before she'd teach the residents. Although now, she's in the position where she has been doing it for four years now so she feels more comfortable. [09:50] Typical Day and Procedures Catherine doesn't do any inpatient or nursery-rounding. Her typical day starts at 07:55 am with her first patient. At her clinic, their schedules are about 24 patients a day. So she's doing any number of well visits or sick visits. But most weeks, she sends a couple of kids to the ER, or at least once a month. In terms of doing procedures, Catherine explains the biggest opportunity is when you're working in a little bit of a smaller area where those doctors do a lot. In her office though, they don't do so much suturing just because of how their schedules are set up. So they don't have as much time to do those. "If you're working in a little bit of a smaller area, those docs do tons." But doctors in smaller areas do a lot. They do their own admissions. And if a kid needs a spinal tap, they'd do it. They'd do the inpatient side of things and go to deliveries. They stabilize infants how are newborns. So there's that big chance of doing procedures if you're willing to live in slightly small area. Whereas in large metro areas, it's a little harder mostly just because of the way practice is set up. Nowadays, there a lot more hospitalists around, which is a big change compared to back when she was still training. [12:45] Taking Calls and Work-Life Balance Catherine only take calls a couple weeks the whole year, which means she has a very nice setup. But this may vary from place to place. As in her case, she works for a larger group. It also depends on what size of community you're in. Catherine says she has enough time for her family. She doesn't work five days a week, specifically that she has a couple of kids and one of them has a lot of medical needs. So she tries to balance those things. But for most pediatricians, they're pretty aware that they have lives outside of medicine and they're pretty balanced. Primary care, just in general, sometimes is tough because you will have to figure things out. And if the specialist you send someone to hasn't been able to figure it out, the patients go back to see you. That said, she likes primary care also because it's challenging. But the people that go into pediatrics are pretty much looking out for each other. "Everyone knows that people have lives outside of medicine and they generally want to preserve those for themselves and for their colleagues." [15:05] Choosing Where to Do Your Training Catherine wanted to train at a setting with a charity-type hospital or public safety net hospital where she got to take calls and have a lot of responsibility since she badly wanted the experience. And that's where she ended up going. Also, because where she went to medical school had a large county hospital system, for which she went through a lot of those for her rotations. "If you really don't know what you want to do and you're not sure if you'd want to go into some kind of subspecialty or not, go somewhere that has a strong program." Additionally, go to a school that has a really good primary care focus and that the clinic structure is good. Sometimes, things can change so you want to make sure that you go somewhere that's a well-rounded, strong program. Catherine adds that you should go to where it's going to make you happy. Think about where you're going to be happy and where you're going to fit in well because it's a long three years. It's a lot of calls and a lot of hours. Also, try not to go too far from your support network. [17:05] Bias Against DOs and Common Pediatric Subspecialties Catherine says she hasn't seen any bias against DOs. And coming originally from Oklahoma which has a very large osteopathic presence and she's from Tulsa, which has a very well-regarded osteopathic medical school, she's not seeing it. If this was a question 25 years ago, she would have said there was a difference. But where she trained, she really doesn't see it as an issue. The other more common subspecialties for pediatrics are hematology, oncology, cardiology, and gastroenterology. Catherine stresses how there's a much larger academic emphasis in pediatric specialties that in the adult world. There's a lot fewer jobs in pediatric subspecialties that are non-academic. "There's a much larger academic emphasis in pediatric specialties that in the adult world." If you want to do hematology-oncology in pediatrics, you're virtually 100% looking at the academic curve. So there's just not enough population that support that kind of complicated work that needs a huge amount of technological subspecialty support like hematology-oncology which needs ICU and al these other subspecialists with it. So if you don't want to do academics and you desperately want to do hematology-oncology, pediatrics may not be the right choice. [19:55] Her Message to the Future Specialists to Help Them Take Care of Patients Better First, Catherine says that if it sounds like a really stupid referral, it may be that the parent would literally not take no for an answer. Conversely, if they're puzzled by something or there's a hole in the story that they can't figure out, understand that sometimes that they know a little more. And sometimes, as primary care doctors, they can fill in some of those gaps.. Or they can sort out why this family is so anxious about x, y, or z and they can't figure out why. So she wishes specialists to know that they can just call them. Especially that everything is on electronic medical records now. "Sometimes we have some context that they may not have." [21:20] Working with Other Specialties The people she works with the most are ICUs, cardiology, infectious disease, dermatology, and GI. She doesn't use hematology too often which is good but she uses pulmonology a ton due to asthma cases. That said, they use a whole variety of specialties. But the one they need more of is developmental behavior pediatrics and mental health support. This is one part of pediatrics that Catherine thinks that they as general pediatricians end up trying to manage a lot more than they feel comfortable managing. Luckily, she gets great support from where she works but there's a lot of people out there that don't. "We are seeing a lot of mental health issues too now on kids and teenagers and it has gone up a lot in the last 15-20 years." Outside of clinical work, you can do MD/PhD Peds Hema/Onc, which was what her friend did and now does drug development. [22:33] What She Wished She Knew Catherine wished she had known how much better she would be once she became a parent. Again, she says it's an incredible responsibility and privilege to take care of someone's kid. "It is an incredible privilege for someone to trust me with their child's health." It's a tough job, but at the end of the day, pediatrics is great. At times, you may have to tell some bad news and it can be difficult. And she sort of knew this but she didn't really know this until she had her own kid. What she likes most about being a pediatrician would be her patients and her colleagues. She considers them as being each other's tribe. Everyone she works with is very committed to population health of the children in the U.S. On the flip side, what she likes the least is wrestling a one-year-old to see their ears. ON a serious note, she says the hardest thing is people who don't want to vaccinate their kids. She knows they care for their child and they think they're making the right decision. [27:05] Major Changes in Pediatrics and Final Words of Wisdom Catherine points out that telemedicine is a big issue right now. And she thinks some pediatricians get the "primadonna" type reputation but it's not true. The irony is they're the least interventionist with their own patients. So she really doesn't see how telemedicine for pediatrics is going to work. If she had to do it all over again, Catherine would still have chosen to become a pediatrician. Ultimately, for premeds or med students interested in getting into pediatrics, Catherine's advice is to realize that it's the parents and not just the kid. Also, remember that it's always about what you're going to be happy doing. Compare yourself to other people going into it and when you do rotations. Think about could you work with these people. You want to make sure you could sign your patients out or trust your colleagues. Or if you feel like you could enjoy working with them. "You really want to be in a field that not only do you really love the patients but your colleagues and you have similar and tuned personalities." So don't just look at the work hours, the prestige, the money, etc. But long term happiness. You need to feel like you fit. Don't try to put a square peg in your round hole all the time even if you thought you're only going to do one thing. Be flexible and think about where do you really fit since you're going to work with them for a long time. Links: ryan@medicalschoolhq.net

Session 50 Dr. Kristina Lehman is a Med-Peds doc who specializes in Breastfeeding Medicine, helping new moms and new babies through the struggles of breastfeeding. Check out all our other podcasts on MedEd Media. If you're a med student and you want to be prepared for what's coming, we have a boards podcast coming up for Step 1 and probably Step 2 in the future. Back to today's episode, Breastfeeding Medicine is one of those fields that really gets down into a "super" niche which is pretty awesome. Kristina is a Med-Peds doc who has taken some further specialty training being a breastfeeding physician. While the breastfeeding side of her practice only comprises about 25%, still this is worthwhile to talk about as a stand alone podcast. This will give you the information you need if this is something you're interested in. Out of training now for about ten years, Kristina is practicing in an academic setting. [02:13] Her Initial Interest in Breastfeeding Kristina's interest in breastfeeding sparked when she had her first child. She always knew she would breastfeed and when she had her baby, she thought she had no idea what she was doing. So she began researching until she just grew more passionate about it. But the turning point for her was when she discovered the Dr.MILK group, a breastfeeding group. MILK stands for Mothers Interested in Lactation Knowledge. She realized there were people out there who actually are pediatricians and lactation consultants. Before this, her training focus was in internal medicine and pediatrics. She did a med-peds residency. Coming out of it, she wanted to do primary care and she started in an academic setting. She joined the faculty at where she trained to do Med-Peds Primary Care. [04:00] Lack of Coverage on Breastfeeding During Pediatric Rotations Kristina explains that a lot of times, experiential learning comes down from our attendings. Because doctors don't do a great job at breastfeeding, they're not likely to advise their patients well, too. To add to that, there is a lot of formula marketing in pediatric residency. A lot of the AAP stuff is sponsored by these companies. "We know that doctors don't necessarily do a great job breastfeeding themselves. And that when they don't do a great job, they don't advise their patients very well." That said, AAP now has a curriculum where they recommend breastfeeding but still it's not widespread. Also, there are a lot of issues with breastfeeding in terms of other specialties telling that infectious disease antibiotics are not compatible with breastfeeding. So when a mom has a complication, she has to stop breastfeeding or pump and dump. Kristina thinks doctors should just really go back to medical school. [05:40] Traits that Lead to Being a Good Breastfeeding Medicine Doc Kristina cites the primary things to be a good breastfeeding doc are wanting continuity of care, being a good listener, and wanting to know what's going on. Kristina says the need to integrate and see what's happening to both the baby and the mom. Think about what's going to be best for both of them. "You can sit there and talk about what's really important for the baby but then that can lead mom to the wayside." Kristina adds having good problem solving skills is helpful. More importantly, you have to be interested in women and women's health. You shouldn't be afraid of breasts since the breasts are a big part of the practice. She admits there are people that are actually scared of that a lot of times. Kristina says that are male lactation consultants. It's obviously a female-dominated field. But if you're a guy and you're super interested in helping women then it's like male OB/GYNs. There are a lot of women that see male OB/GYN and they have a good reputation. [07:37] Other Specialties that Caught Her Interest Before going to Med-Peds, Kristina was interested in OB/GYN. She loved prenatal visits and all the outpatient stuff that goes with it. She hated surgery and being up at night. So she realized quickly that it wasn't the right specialty for her. That said, she has always been interested in the women's health aspect of things. Within primary care, she was happy just to do straight up primary care. She loves the variety of seeing both kids and adults. And when she found Breastfeeding Medicine, she was happy she had the opportunity to focus on the academics. She was happy she could get to work on it with medical students and residents. She had the opportunity to work on curriculum development. [08:30] Types of Patients and Taking Calls On a daily basis, she deals with regular breastfeeding stuff. She's able to give more evidence-based information and more support for the day-to-day latch and milk supply. When she has a more specialized referral, she gets varied cases. For example, a baby that hasn't latched since birth. Or it could be a baby that was in the NICU so he/she was formula-fed so they have a hard time getting back to the breasts. Sometimes too, moms are having a hard time with milk supply so she helps them troubleshoot how to make this better. Although there are really moms that have insufficient glandular tissue which never developed from puberty so there isn't enough milk supply. She also deals with other issues like cracked and bleeding nipples or mastitis. "Most of the stuff is just the day-to-day maintenance of breastfeeding that moms just need a lot of support." Kristina doesn't do any of the inpatient stuff such as taking calls. But she wishes sometimes though that there was somebody on call. They recently had a mom that had a wound infection. She was in the hospital and got switched around in antibiotics, specifically Cipro. The doctors on the service talked to the pharmacist and the pharmacist said it wasn't okay to breastfeed with it. They told the mom that she had to pump and dump. And so for ten days, she had to pump and dump. Then the mom came to her a bit later. But they would have been able to take care of that early on. She didn't actually need to pump and dump since there was no indication for that. Moreover, mastitis would be an urgent thing but not necessarily too urgent for you to really drive to the hospital just to see it. [11:10] Erring on the Side of Safety Kristina explains there's a lot of stuff that says benefits outweighs risks. But very few places actually consider a mom's plasma level and what level gets into the breastmilk. Therefore, how much is the baby ingesting and how much of that ingested amount would the baby absorb into their bloodstream? There is the infinite risk center run by a pharmacologist that has gone through all this. But doctors prefer to err on the side of safety. But Kristina points out there is more risk of clogged ducts and mastitis if you're pumping. Throwing milk away is just heartbreaking too. There is also the risk of that formula to the baby if the baby is formula-fed. "Basically, nobody feels comfortable with the information that is out there saying it's okay to breastfeed." [12:37] Work-Life Balance Kristina describes having a good work-life balance. Her husband is also a hospitalist in internal medicine. So financially, they're in a good spot but they're also busy. They have two kids. She started full-time and as they're having kids, she has worked herself down to 50%. Currently, she's working herself back up with some nursery work. Nevertheless, this has allowed her to have some good work-life balance. Similar to primary care, you're not on call and you're not going to the hospital necessarily. It's mostly an office-based work. [13:24] What It Takes to Become an IBCLC Kristina notes that to become an International Board Certified Lactation Consultant (IBCLC), there is an international exam that anyone can take. But there are different pathways depending on your background. The nurse or a doctor has a different pathway than a lay person off the street that wants to get it. It requires some health and science background classes. As a doctor. you have to do 90 hours of lactation coursework. And you have to have a thousand clinical hours. Fortunately, those aren't supervised. So if a OB/GYN wants to become an IBCLC, they can use the time they talked for prenatal and postnatal counseling. Their hospital rounds can count too if they took care of mastitis or if they've worked with support groups. All those hours can add up. Once you have those hours, you take the exam and then you're given this gold standard of certification. You're reputable and the community is having that level of knowledge and experience. Another program is the Healthy Children Project, the certified lactation counselor. And this is how Kristina actually got her start. She did a 40-hour course. You do an exam and then do a little certification. "Technically, anybody can do it. It's just having that evidence-based information. Make sure you're learning the right stuff." There's also the Academy of Breastfeeding Medicine that has the fellowship track where you get an FABM designation. They're also working on a more clinical-based fellowship in the future. Kristina also adds getting knowledge from mentorship and working other people and getting those other certifications.When it comes to billing, Kristina bills not as a lactation consultant but as a physician. [16:20] Working with Primary Care and Other Specialties Again, Kristina recommends making sure that what you know is evidence-based. See if there's somebody in your area that is more specialized. See if they're listed on the Academy of Breastfeeding Medicine's website or there's a doctor in town that's IBCLC. This way, you know who to refer to if you're having issues. Secondly, it's nice to reach out to them and talk about it especially if you have any questions. "Search out that extra bit of training so you can be the best resource for your patients possible." Other specialties she's working with are ENT and Peds in Dentistry. Kristina says it's nice being trained both in internal medicine and pediatrics since she's self-sustaining. She can take care of the mom and the baby. But if you're a pediatrician and doing breastfeeding medicine, you'd probably be working with internal medicine or OB counterpart to help you with some of the mom stuff. Conversely if you're an OB/GYN, you'd have to work closely with pediatricians to take care of the peds stuff. Other special opportunities outside of clinical medicine would be academia and research. They sponsored fourth year medical students to do some pre-residency lactation work. She also worked on the curriculum development for the interns in the pediatric residency. She does nursery rounds so she does teaching there. Research-wise, there are a lot of opportunities in terms of curriculum and teaching development and the biochemical science behind breastfeeding. [18:55] The Most and Least Liked Things About Breastfeeding Medicine Kristina has been so enriched with the experience personally that bringing it on to other moms is helpful. She likes the fourth trimester concept when they help moms realize that those first couple of months of motherhood are really overwhelming and exhausting. So being able to support moms through that is enriching for her. She likes watching those kids grow and develop and the parents become parents and learning the parenting kinds of things. "For me, the biggest things is helping those moms meet their goals and raise cool kids." On the flip side, she finds it frustrating how little other people understand about the field. When people do or say things along with their lack of knowledge can affect how they take care of patients. [20:17] Major Changes in Breastfeeding Medicine Kristina hopes they can get a more dedicated fellowship or clinical track for this niche. We are in the day and time when breastfeeding is becoming more than the norm. So moms are initiating a lot more and are being more successful. Along with that, we see more moms struggling or having issues that need the support. Unfortunately, Kristina admits the lack of infrastructure for them at this point in time. Things have definitely been a lot better. But she hopes to continue to see more changes with that like paternity leave for instance. [21:20] Breastfeeding versus Formula-Feeding Kristina points out that it's important to let moms know that there are going to be challenges and they need that support system. So find that support system and make sure you know what your resources are. She often tells parents to never give up on their worst days. Reach out for help when you need it. "I often tell parents too, never give up on your worst day. You're going to have bad days. You're going to have bad moments." Breastfeeding also has a lot of health benefits for moms that we don't usually look at. It actually reduces the risk of breast cancer, diabetes, heart disease, hypertension, multiple sclerosis, etc. So there are lots of benefits for moms as well. So there should also be a focus not just on the baby but also on moms. [22:35] Final Words of Wisdom If this is something you're interested in, Kristina recommends checking out the Academy of Breastfeeding Medicine. They have a great website with a lot of great protocols there which are evidence-based. If you're a woman and interested in this, look up Dr.MILK group. They have over 10,000 members on Facebook. They welcome even those who are not breastfeeding but just want to learn more about breastfeeding. Lastly, be open to the fact that you may not get a lot of training about this but it's super important and there are opportunities out there to learn more. Do you have any ideas for specialties or if you know any physician whom you think would be great guest on this podcast, shoot me an email at ryan@medicalschoolhq.net. Links: MedEd Media Dr.MILK IBCLC Healthy Children Project Academy of Breastfeeding Medicine

Today we welcome another brilliant individual, Philip Verhoef, MD, PhD, FAAP, FACP. Dr. Verhoef demonstrates a significant level of dedication to medicine. Not only did he do a Med-Peds residency at University of California-Los Angeles, but he then went and completed a Fellowship in both Adult and Pediatric Critical Care Medicine at the University of Chicago (10 years of training!!). Since that time he has stayed on at the University of Chicago with an appointment in both Pulmonary/Critical Care Medicine and Pediatric Critical Care Medicine, recently rising to the level of Assistant Professor. He has also made a name for himself as a clinical expert on the REAL ramifications of the boom that is Healthcare Reform. Today he was kind enough to stop by for lunch and share a very concentrated view on the ACA, AHCA, and on the idea of Single Payer system. This talk is vital not only to the intensivist, but to everyone in the United States. I assure you, this is one lecture you will want to watch with the ENTIRE family!!

Help Ian interview all 120+ specialties! www.undifferentiatedmedicalstudent.com/suggestions/ Show notes! Dr. Tcheurekdjian is the Co-Program Director of the Allergy and Immunology Fellowship Training Program at University Hospitals of Cleveland, as well as an Associate Clinical Professor at Case Western Reserve University School of Medicine, and finally the Vice President of Allergy/Immunology Associates, Inc. Dr. Tcheurekdjian completed his undergraduate degree at Marquette University in 1995; completed his medical degree at the University of Wisconsin School of Medicine and Public Health in 2000; completed a Med/Peds residency at University Hospitals of Cleveland and Rainbow Babies and Children’s Hospital in 2004; and then completed a fellowship in Allergy and Immunology at Stanford University and University of California, San Francisco in 2006, after which he returned to Cleveland to start his practice. Dr. Tcheurekdjian also the Co-President
of Ohio Clinical Research Associates, LLC and is currently an active researcher in the realm of ethnic differences of allergies, their associated genetics, as well as the documentation of the presentation of a variety of uncommon allergies. Voted Best Doctors in America by Best Doctors, Inc. 3 times since 2013, Dr. Tcheurekdjian's clinical interests include the evaluation and treatment of primary immunodeficiencies, recurrent infections, asthma, allergic rhinitis, eczema, food allergies, and hives, and has made multiple appearances on NBC, CBS, and ABC morning and evening news to speak about allergies. Please enjoy with Dr. Haig Tcheurekdjian!

Session 16 This week's guest is Dr. Joel Topf, a private practice and academic Nephrologist who loves teaching and the small details. Back in Episode 06 of the Specialty Stories Podcast, we first covered Nephrology where I talked with Dr. Jean Robey, a private-practice Nephrologist. As you get to listen to both episodes, you will hear some differences in both of those settings. My goal for this podcast is to not just give you insights into what a certain specialty does, but also, for you to see the differences between an academic specialty and a community specialty, or a private-practice physician and be able to compare those different settings. As you go through your medical training, most of the exposure you get is the academic side of medicine and that is not the majority of medicine practiced. Hence, I wanted to give you insights into all of the different aspects of it and be able to compare a private-practice Nephrologist (back in Episode 06) and this episode which is more of an academic Nephrologist. [03:00] Choosing Nephrology Having finished his fellowship in 2003, Dr. Topf is in a hybrid setting where he works for private practice but hired by the hospital to run their fellowship program. He teaches medical students (second to fourth years and the residency program), although it's not a pure academic role since he doesn't do a lot of research. Coming out of medical school, Dr. Topf wanted to do a specialty that allowed him to subspecialize so he chose Med-Peds. It was on the third year of his four-year residency that he decided to do a fellowship and specialize in Nephrology. What led him to this decision is finding how interesting medicine gets and as you study it more, it gets even more interesting. Then before you know it, you can't escape. Dr. Topf was so delighted with Nephrology. However, he was also working on another project, writing a textbook on fluids and electrolytes. So while he was learning a lot of Nephrology, he was also learning a lot of Renal Physiology and fell in love with it. By the time he was choosing his specialty, he felt like Nephrology had picked him more than he picked the specialty and there was nothing else he would ever consider doing. Had he had a more open mind, Critical Care would have been something he considered but he's happy with Nephrology since a lot of the very interesting cases that he likes in Nephrology are shared with Critical Care. [05:35] Traits of a Good Nephrologist Dr. Topf says that the most important trait that leads to being a good nephrologist is being detail-oriented and fastidious since it involves a lot of numbers and balls to keep in the air when you take care of these patients who have a number of problems especially when it comes to dialysis or transplant cases. Most other primary care doctors and specialists want to take their hands off and leave it all up to the Nephrologist to take care of that so you end up being a generalist for a wide span of patients. So even though much time is spent focused on Nephrology, at least in training, Dr. Topf emphasized that you still need to keep your Internal Medicine skills sharp (reason that he re-certified in Internal Medicine). [06:40] A Typical Day Being a Nephrologist Dr. Topf would usually start his day at an outpatient dialysis clinic or two. They see all of their hemodialysis patients once a week and they have around 50 hemodialysis patients. So he goes to a couple of dialysis units in the morning and see a few of his first shift dialysis patients. Next stop is the hospital to see patients through the rest of the morning then have clinic patients in the afternoon. Sometimes in the middle of the day, he would also see dialysis patients on the second shift and at the end of the day, he often stops at the dialysis unit to see patients on a third shift. Hemodialysis patients need to get dialysis three days a week so people are either on a Mon-Wed-Fri schedule or Tues-Thurs-Sat schedule. Each dialysis typically runs about four hours starting somewhere between 5-6 am and the first shift will go from 5-9 am or 6-10 am. Then at 10-11 am, the second shift will go on and then at 2-3 pm, the third shift will go on. Dr. Topf has patients at multiple units on all those different shifts so he has to find a way to see them once a week. [8:20] Types of Patients and Other Procedures In the U.S., 45% of people that are on dialysis get there via diabetes while about 30% get there from hypertension. Essentially, somewhere between two-thirds and three-quarters will be diabetes and hypertension. The rest is everything else that causes kidney disease such as glomerulonephritis, severe kidney injury that never recovers, polycystic kidney disease, cancer, myeloma, etc. Dr. Topf doesn't do procedures that Interventional Nephrologists normally perform. Although during his Fellowship, he did a lot of kidney biopsies and put in a lot of temporary dialysis access. He also has partners that are more interventional who still do kidney biopsies and others put in peritoneal dialysis catheters and hemolysis catheters, but it's not something Dr. Topf likes doing. [10:10] The Academic Aspect of Being a Nephrologist Dr. Topf gives standard lectures every month where he gives a morning report to the residents at their hospital who are in the internal medicine program as well as lectures to their five Nephrology Fellows. He participates in the Fellowship in terms of interviewing and selecting the next year's fellows as well as in evaluating the current fellows. Additionally, he runs one of his outpatient clinics as a fellow clinic so he staffs that fellow in a clinic. He also has a standard role of teaching third year medical students three lecture series as a new group of internal medicine third year students rotate through the hospital for basic nephrology concepts. Another one of his responsibilities in the Fellowship Program is helping coordinate the Fellow Research Projects so these get into fruition. [11:53] Seeing the Two Sides of Nephrology What attracted Dr. Topf to the job was the opportunity to teach as this is something that he really wanted to do. He just didn't want to be locked into the bureaucracy of a traditional academic program with lots of pressure to publish and get grants. So he found this hybrid model that fits the kind of practice that he wanted to do. Basically, it was his practice that became the driving force to bring both of these things to the hospital. [13:00] Work-Life Balance Dr. Topf describes his Nephrology practice as enjoyable. It's more of a traditional physician model where he doesn't have set hours and has a call generally once a month with certain exceptions such as when a partner gets sick or death in a family so he would have to get calls twice or thrice a month, which happens rarely. But nephrology in general is more of a traditional internist model. It's not a hospitalist nor an E.R, doc so you're not punching in or out. Dr. Topf describes himself as a business owner so he works harder because he owns it and the work he puts in is delivered back to him in monetary rewards. When he gets a call, he covers all the patients in the hospital so he typically sees somewhere between 20 and 30 patients in the hospital each day that he is on call, which would be a full day. [14:55] The Path to Residency and Fellowship If you want to be a pediatric nephrologist, you need to do three years of internal medicine and then you need to get a Nephrology Fellowship, which is traditionally three years long (Commonly today, there are two years now.) In the old model, it consists of one year clinical and two years of research. For most fellowships now, it's two years of clinical experience with some clinical research in the second year. During his adult fellowship, he spent a lot of time doing Pediatric Nephrology where he did special rotations at the children's hospital and got a lot of experience. What he found out from that experience is that it really is a different specialty. There is a crossover but there isn't all that much because the diseases they see are quite a bit different. If he lived in an area that didn't have a pediatric nephrologist, he would absolutely see children but he lives in Detroit where there is a children's hospital two to four miles away from his hospital so it would be absurd for parents to take their kid to see an adult nephrologist when there is a pediatric nephrologist right next door. He did think about doing it early on in their training but as he began to appreciate what being a specialist really meant, it made less and less sense for him. If you want to be a generalist, don't sub-specialize. If you want to be a specialist well then you need to be a specialist where you need to focus on just the patients that you're going to be taking care of. Why he chose adult nephrology over pediatric nephrology is primarily because of the way higher demand for an adult nephrologist. He has heard stories of people finishing pediatric nephrology fellowships and not being able to find a job or they're not able to use that training having to spend for years waiting for a position to open up so in meantime would have to do general pediatric work so they don't get to use their training. [18:30] Competitiveness of Nephrology Fellowship and the Hospitalist Boom A nephrology fellowship is not competitive, in fact, Dr. Topf reckons it's close to two nephrology spots for every one applicant. So it's absolutely a buyer's market. Therefore, the residents are in great positions where they will definitely get offered interviews everywhere and they will be able to put a very aggressive rank list since there would still be a match system. Very few people who want to be a nephrologist are unable to become a nephrologist. What they want to see in nephrology fellowship applicants is somebody who has a strong desire to be a nephrologist rather than just someone who sees it as a fallback. They're looking for someone who really loves the specialty and wants to be a nephrologist and not just what's available to them. This is demonstrated through a research experience in nephrology or letters of recommendation from fellow Nephrologists they know or have done rotations in their institution or they've contacted them early on and shown interest to it. All these could put any applicant way higher on the rank list. Six years ago, they had 200 applicants for their two to three spots a year but the number has waned this year to just 22. The demand thereby fell off to 90% in six years. Dr. Topf’s theory is that this could be caused by the hospitalist boom, a huge new specialty that emerged from nowhere that they have to staff up every resident plus they pay excellent salaries, offer shift work, and they start getting paid the next day their residency ends. Whereas in a nephrology fellowship, you have two more years of postgraduate training to go through and then you get a job where you're going to work more than 40 hours  a week. Compared to a cardiologist or a G.I. doctor that gets a much higher salary than as a hospitalist but at the end of a nephrology rainbow, the salary may just be modestly better or the same as with a hospitalist. [22:30] Subspecialty Opportunities Subspecialties available include Transplant Certified, which happens one year after fellowship, and Interventional Nephrology, which is less regulated. Some fellowships do that, others have two or three-month courses run by dialysis access companies that give them all the training needed for those procedures (no board certification for that). Others do Hypertension subspecialties, which is just a test given by the American Society of Hypertension. You can do fellowship and get formal training for it but a lot of people just take the test and gain that certification. [23:45] Primary Care and Other Specialties Dr. Topf thinks primary care physicians are doing a good job with it but they should be more aggressive with hypertension and less aggressive with glycemic control since he sees a lot of patients suffering from over-emphasis on trying to get the A1c all the way down causing a lot of hypoglycemic spells. But these are style issues more than knowledge gaps. Among other specialties he works closest with include critical care, E.R. cardiology and endocrinology. They also get consults for the same diseases oftentimes such as hypercalcemia. [26:10] Special Opportunities Outside of Clinical Medicine A huge opportunity outside of clinical medicine is a Dialysis Medical Director. There are thousands of dialysis units around the country that cannot operate without a medical director. Medical directors need to be board-certified in Nephrology. Dr. Topf adds that this is a different type of medicine than you've ever practiced before since you will be providing population health and be looking at all the infections that happened in, say, 80 patients there that month and try to find patterns causing these infections. They also have to go over the water treatment system considering the massive amount of water used in dialysis, meaning 5,760 liters per shift and you run three shifts per day so that is close to 20,000 liters of water being treated in a dialysis unit everyday. Keeping all that equipment up-to-date and functioning is a continual exercise and you have experts that help you with it but the medical director is at the top of all those experts to make sure they're doing a good job and doing all the reports on water quality, infections, and meeting targets in hemoglobin, albumin, and phosphorus. You will also be working with a Nutritionist or a social worker. Apparently, there are a lot of different benchmarks of a dialysis quality and as a medical director, you're responsible for those. [29:30] The Best and Least Good Thing Dr. Topf finds being a nephrologist to be a rewarding career for him. His advice to a brand new nephrologist is that your first few years coming out of Fellowship are still a major learning moment. You are nowhere near the top of the mountain so there's still a lot of learning you need to do so be humble. What he loves best about being a nephrologist is the teaching side of it. He also loves having that longitudinal experience with his patients where he is able to see and take care of patients through all the different phases of their kidney disease. On the flip side, what he likes least about being a nephrologist is those four dialysis visits a month for each dialysis patient which he considers as an overkill. He thinks he didn't need to do this that much since you could do all the medically important stuff in just two visits but this is a requirement(which is also a reimbursement-driven thing) that ends up being unnecessarily burdensome for him . [32:15] The Future of Nephrology The advancements in technology and techniques taking over much of the diseases have significantly reduced the numbers of procedures needed in treating diseases related to, for example, cardiology. Nephrology is highly dependent on dialysis so if a new technology comes on, whether it would eliminate dialysis or dramatically reduce its need would be a major earthquake for the specialty. Nanotechnology creating smaller filters to create a transplantable artificial kidney is something he doesn't see being viable for a long time. It sounds cool but it doesn't really address the biggest problem with current dialysis which is access, the mere process of getting the blood in and out of the body safely. Unfortunately, this technology doesn't address that. [35:30] Final Words of Wisdom If he had to choose Nephrology again, he would still have chosen it in a second. Lastly, Dr. Topf wants students to know that if they find the kidney to be interesting but intimidating because of how difficult it is, then it's not that difficult. You will be able to learn the kidney from its very fundamentals when you go to fellowship and you will be building a model of it in your brain. Once you have that model, everything makes sense and it all falls into place. That is difficult to understand how much simpler everything will be when that happens. Once you get it, you get it and it's not very hard. If you're interested in it, pursue it because it's not that hard. [36:40] Bias Among DOs and Caribbean Graduates Dr. Topf said that they have a DO on the board in their practice and will likely be the next CEO. Their assistant program director is also a DO. So there no bias, not even close to having a bias. They also have a Caribbean graduate who is an excellent doctor as a partner. Links: Get connected with Dr. Joel Topf on Twitter @kidney_boy. Shoot me an email at ryan@medicalschoolhq.net MedEd Media Network Specialty Stories Podcast Episode 06: A Private-Practice Nephrologist Talks About Her Job American Society of Hypertension

Go to audibletrial.com/TUMS for a free 30-day trial membership and free audiobook! Help Ian interview all 120 specialties listed on the CIM website! Show notes! Dr. Elizabeth Higgins Dr. Higgins is a Hospice and Palliative Medicine fellow at Johns Hopkins, as well as an Associate Professor of both Internal Medicine and Pediatrics at Albany Medical College. Dr. Higgins completed her undergraduate degree at Siena College in 1985; her medical degree at SUNY Health Science Center – Syracuse in 1989; and then completed a combined Med/Peds residency at Albany Medical College in 1993, after which she practiced as an attending physician for 23 years before deciding to enroll in a Hospice and Palliative Medicine fellowship, which she will complete in June of 2017. Before applying for her fellowship, Dr. Higgins has held several titles, including that of Med/Peds Residency Program Director at Albany Medical College (a position she held for 10 years until 2007), as well as Associate Dean of Student Affairs, a position she at the Medical College until starting her fellowship. For her work in medical education, she is a 3 time recipient of the Golden Apple Award (most recently in 2009) bestowed by the American Medical Student Association to highlight a professor deserving of notoriety due to their improvements or advancements in medical education. In line with her commitment to medical education, Dr. Higgins is also on the Advisory Committee of the AAMC’s Careers in Medicine program, whose website is the basis for most of the interviews featured on the Undifferentiated Medical Student podcast. Please enjoy with Dr. Elizabeth Higgins!

Dr. Stehouwer the Associate Program Director of the combined internal medicine-pediatrics (med-peds) residency program as well as the founder and director of the med-peds Consult Service at University Hospitals Cleveland Medical Center in Cleveland, OH. Before becoming a physician, Dr. Stehouwer studied philosophy at Calvin College where he received his undergraduate degree in 2007. He then received his medical degree from Case Western Reserve University School of Medicine in 2011, where he developed an interest in the care of children with complex and life-long medical conditions, leading him to pursue a med-peds residency to learn how to provide care to these children who continue to combat their illnesses well into adulthood. He completed this residency at University Hospitals and Rainbow Babies and Children's Hospital (which share a campus) in 2015 after which he completed a med-peds chief resident year in 2016. During his chief year, he began the aforementioned med-peds consult service to assist physicians in managing patients who straddle the divide between adult and pediatric medicine. In addition to running the med-peds consult service and acting as associate director of the med-peds program, Dr. Stehouwer also attends on both general medicine and pediatric wards individually. Please enjoy with Dr. Nathan Stehouwer!

Med-Peds is a shortened term for “Combined Internal Medicine & Pediatrics”.A physician trained in Med-Peds can care for the newborn to the geriatric patient.Med-Peds physicians tend to the care of patients throughout their life span. Caring for multiple generations of the same family requires an understanding of family dynamics, epidemiology and the impact of acute or chronic illness at all ages, all in the context of family systems. Linda DeCesare, MD, is here to explain how Med-Peds physicians draw from the knowledge and skills of pediatricians and internists to bring breadth and flexibility in their approach to clinical medicine.