Podcasts about what fred

Fred Bazzoli is a skilled reporter who has written for respected publications such as Modern Healthcare, MedTech Publishing and Health Data Management. Unfortunately, Health Data Management's publisher shuttered the property in February 2020. Through a set of unexpected events, Health Data Management has been revived and will now operate as a not-for-profit publication called HDMgroup, where Fred will serve as the chief content officer and editor-in-chief. Look Left's Davida Dinerman talked to Fred Bazzoli about the new venture, what readers should expect, and his thoughts on some pressing healthcare data topics. Conversation highlights include:01:11 - On the demise of the original Health Data Management and its rebirth as a not-for-profit publication in 2021.02:37 - HDM will be more forward-looking than the original publication. 04:31 - The new HDM will feature writers well known in the healthcare industry and contributed content.05:17 - HDM will explore topics that will affect the healthcare industry in the years to come, like electronic health records (EHR).07:53 - HDM will also explore the impact of cybersecurity on healthcare.08:49 - Fred shares his thoughts on organizations having an impact on healthcare data processes.11:08 - As with all new regulations, Fred believes compliance to the 21st Century Cures Act will take time. 11:36 - Tech giants can impact healthcare today, but what the future holds is still undefined. 12:43 - The pandemic has resulted in the acceleration of certain kinds of patient care, specifically telehealth.16:50 - What Fred would be doing if he weren't in journalism.  

For the last 20 years, Fred been lecturing on strategic thinking and complex problem solving; with an audience that has included the CEOs and management teams of major corporations and consulting firms around the world. Today he's here to talk to us about his book. And share some tips with us on how we can be better problem solvers and more strategic. FIND FRED ONLINE Website: https://www.fredpelard.com/ LinkedIn: https://www.linkedin.com/in/fredpelard/ Twitter: https://twitter.com/fredpelard QUOTES [00:11:10] "When you're solving problems, you're starting point pretty much every time is going to be complexity. If it's not complex, it doesn't need solving" [00:14:05] "When your chest is puffed out, you know the answer. You're in expert mode." [00:17:58] "A lot of what these profession share is one similarity, which is a lot of the essence of their work is in the past. Lawyers solve past problems. Investigative journalists reveal past crimes. Engineersing actions build things in the present. But you see a theme emerging. None of these people really focus on the future. And so when you focus on the future, the data runs out of road and you have to use a different method." [00:20:29] "You don't need real Data to have real options. You need real Data to have real solutions. And that's one of the slight drawbacks of a lot of the people I work with who tend to be analytical in their mindset." [00:23:57] "I want to know which of my ideas is wrong early so I can reallocate my scarce time and resources towards the ones that work. And then once you've done that, now you feel very confident in your ideas." [00:25:17] "It's creative first and analytical second. So first, have lots of ideas about a problem in the future and then bring the cavalry of the data to sort of whittled them down to one." SHOW NOTES [00:01:35] Guest introduction [00:02:10] Where Fred grew up and what it was like there [00:03:15] What Fred was like in high school [00:03:45] The transition from rocket science to the business world [00:05:09] The inspiration for the book: How to Be Strategic [00:07:59] Being strategic is a mindset [00:10:47] Complexity, completion, clarity, certainty, and conviction. [00:13:43] The expert mode of problem solving [00:15:33] The analytical mode of problem solving [00:17:34] The creative mode of problem solving [00:20:29] Solutions versus options [00:21:29] And moving on now to the strategic method. Talk to us about that and maybe give us the example and some benefits like you're just doing. [00:27:51] The difference between qualitative and quantitative problems [00:30:28] Qualitative problems have a unique set of challenges [00:37:26] The power of positive framing [00:40:59] A twist on The Lean Startup Philosophy [00:49:10] Sell your ideas with impactful words [00:53:42] Memorable metrics [00:58:02] Road test your metrics [00:58:59] How to create a compelling story [01:02:30] It's 100 years in the future, what do you want to be remembered for? [01:04:17] The Random Round Special Guest: Fred Pelard.

What Fred achieved from working with me goes much deeper than just numbers The way this woman has transformed her life is incredible, this is a truly inspirational story Please remember to hit subscribe and leave me a rating and review if you enjoy this episode ;) Also screen shot and share it on your stories and social profiles as this really helps me reach and help more Type 1 Diabetics. If you'd like to see how I can help you have better control of your Diabetes Book your FREE Strategy call here You can reach out to me at ... INSTAGRAM: @type1_tom FACEBOOK: Type1Tom Email: Tom@type1tom.co.uk Download my FREE ebook: https://tafitness.activehosted.com/f/13 Join my FREE FB community: https://www.facebook.com/groups/505161143554884/?ref=share

Welcome to Xchange Revolution. Saving money and getting the best deal is in the forefront of everyone's mind right now. So In this episode Ludwina Dautovic, Founder and CEO of The Room Xchange, is talking to Fred Schebesta, CEO and co-founder of Finder.com. Fred is an entrepreneur with a vision to compare everything and empower people to improve their lives. So much so that he co-founded Finder.com in 2009, a platform that enables you to compare prices on products and services. We hope this episodes inspires you to compare and save a little more and help you to change the way you live.Subscribe, rate and review showPlease subscribe to the show on your favourite podcast directory and we appreciate you leaving a rating and review. We read all reviews on future episodes!In this episode we discuss:2.30 - How Finder got started2.50 - Fred Schebesta made the AFR 2019 Young Rich List3.50 - Core purpose of Finder.com5.44 - Only a small percentage of Australian's look closely at their finances7.48 - Covid has motivated people to look more closely at the finances9.50 - Covid will bring innovation and change the working economy13.17 - How Finder.com can save you money17.22 - Finder's new e-commerce feature20.13 - What Fred is doing to change the way he livesAbout Fred SchebestaFred Schebesta is an award-winning business leader, best known for co-founding one of the world’s leading comparison websites, Finder.com. He is a serial entrepreneur, author, media commentator, mentor and active member of the startup, crypto and small business communities. Fred ranks 22nd on the 2019 Australian Financial Review Young Rich List, worth $193 million.Fred is now leading Finder’s venture capital arm, Finder Ventures, which launched in 2018 and with it, launching HiveEx.com, a cryptocurrency brokerage.His entrepreneurial journey started well before Finder.com. At just 22 – while still at university – Fred, together with his business partner and school friend Frank Restuccia, created Freestyle Media. They grew the business into a successful digital marketing agency that sold to a publicly listed company in 2007. Their next venture was finder.com in Australia, which exploded into the comparison market in 2009 – one of the most highly competitive internet categories. Finder.com was born out of a simple concept: to educate people and directly compare student credit cards. The magic sauce was leveraging all the proven and best practice digital marketing strategies they used to sell to their clients.You can find Fred Schebesta on Linkedin.You can find Ludwina Dautovic on Linked.You can find Finder.com - Website, Linkedin and Facebook.You can connect with The Room Xchange on Facebook, Twitter, Instagram and Linkedin.

Fred owns and operates Nashua Video Tours, a real estate video and photography company. David: ”Tell us about your company.” Fred has been doing this for 15 years, starting with putting video online. Because the internet didn't support video very well, realtors didn't have computers, or didn't know what the internet was—it didn’t work out too well. When he was just about to quit, the real estate market tanked and people needed ways to sell properties. At that point, flash became the de facto way of delivering video but there were three or four different types of platforms and none of them were compatible with each other. When broadband came into play and the internet became predominant, Fred realized he could do it. Fred had started doing realtor websites. He jokes, “I've never wanted to be in this world, I just fell into it and I haven't been able to climb out yet.” He says back then, you’d buy a template so websites all looked exactly the same—nothing stood out. What became popular were 360-degree tours that were not well put together; that was when Fred thought that a video walk-through of the house made sense because then you could see the layout and the flow. “I just had this bright idea that it would be a way to do something different—but nobody was doing it because they couldn't. I really got started out of frustration trying to differentiate these people.” David: “Let’s start from when the internet was working, you could put video on the internet, and you had a drone. How did using a drone change things for you— if it did?” Fred says he’d been in the video real estate video space by himself for years but as more people got into it, he needed to differentiate himself again. Back then, you could fly drone for commercial purposes with no licensing, and everything was still very fuzzy. For Fred, the real estate market has been an odd place to be. Some realtors think they can get their nephew to buy a drone and let him take pictures, or they don't see that you need to have a license. We  know there’s a difference between having a drone and pushing a button to take a picture or video—and being a photographer with a drone. “If you don't know how to use your camera, you're not a photographer, you don't have the right eye or the right equipment and you don't know how to do it, so it's not going to look very good. The drone is the least important part of the equation.” Fred says it’s nice to show how a property sits on a big piece of land, but flying around, looking at the roof and gutters, then left and right and up and down for three minutes isn’t all it’s about. A simple top down picture of the roof of a ranch with an ugly front yard and an ugly backyard with dead grass is horrible; it’s more of a detriment than a help. If you're trying to promote a real property, you don't want to show the crap in the neighbor's yard or graffiti on the driveway or bad shingles. Fred advises that you should be truthful, but also show people the highlights. They'll realize that the roof needs replacing or that there's a highway back there, but you don't want to promote that right up front. When Fred shoots a house he does the video, interior, exterior stills, floor plans, all of it—he has about five different cameras for different things, including a camera he can stick out of the top of his car to show the neighborhood—and, of courses, he has a drone. He doesn’t use all of those for every property but chooses what he thinks makes sense. Driving through the neighborhood, for example, his goal is to show whether it’s an older or newer neighborhood, if houses are setback from the street or are right on the street with the trees. His goal is to present the property in the best light. “I treat the drone as just another tool. When I get to a property, I either choose to use it or I don't. It's my choice. I don't want someone saying I need to.” Also, Fred sees a lot of video from new drone pilots that’s too high because the pilot is thinking about max altitude when it’s more important to think about what they’re looking at. Sometimes, Fred doesn’t even know what he’s looking at. David: “The thing people struggle a lot with is wanting to get into this—whether it's real estate marketing, promo videos or photography—but don't really have good methods or know how to get a first client. What advice would you give someone? How would you go about starting fresh?” Fred teamed up with a friend who is a realtor and did all of his first stuff for free. He was able to practice, but also able to get stuff out there for other people to see. “What I did then, I still do now. I make it very easy for someone to find me. It's not a secret. I put my name, phone number, and website at the end of every video. I've done a lot of these and I've never had anybody tell me to take my name off. The biggest thing is if nobody knows how to find you, how are they going to know how to find you?” Fred says the real estate business is a lot of repeat business. He doesn’t even want new business because his regular customers keep him really busy. He says clients want to use you for everything—for every listing. The smart realtors understand you have to spend money to make money but they’re busy too; they don't want to call a photographer, then a videographer, then a drone guy, then a floor plan guy. They call Fred and he goes to house, spends 2-3 hours at the property and does all of it. David: What do you typically charge for a job when you do everything—photos, some video, and some drone. What does your full package include? What's a typical price you would charge for that?” For under 4,000 ft2 and just video, he charges $300-$400. For a full package with drone, floor plans, etc, Fred charges $800. He says that realtors want to pay $300-$500 but if you're spending the same amount of time, it’s not worth it to not make enough money. Fred sees people either charging too much and complaining because they're only shooting one house a month or charging too little that are going to burn out. When someone calls him, Fred tells them to look at his YouTube channel, plug in their house to any video, and that's what theirs will look like. It all doesn't take very long, and you don’t have people wanting to change stuff because expectations are set at the beginning. He does charge $100 if someone wants to change anything. “What I give my clients is very fast turnaround at a fair price. What people don't understand about realtors is they care that you're accessible and affordable (which doesn't mean cheap) and that you turn it around fast and are dependable. That's all that matters.” Fred says that the most valuable part of the video is getting the listing. It's not about selling the house, the house will sell by itself. It's about getting the listing. If you're a listing agent, you're competing with two or three other brokers. The reality is if you're out there at a listing presentation with a seller and you're offering video and the other two aren't, then you have an advantage. Not many use video. Sellers want it...buyers love it. He says it’s funny cause you think if everybody wanted it, more people would do it. But because it's so difficult to do, a lot of people stay away from it because they can't figure out how to price it. It’s really all about workflow—shooting as best you can to get what you need, shooting it so your editing time is minimal, and having the right equipment so you can process it quickly and get it out the door. David: “I've heard from other people that are also really successful that they focused on knowing one thing and how to repeat it easily. They can set a reasonable price and then scale it. It's easy for them to knock out projects because they know exactly what to do. Would you agree with that?” What Fred is seeing now with new people getting into the real estate video space is they think it's boring. They’re neglecting to create video for the intended viewer—a potential buyer or a seller who's going to be using that for their house. According to Fred, people want to see the layout and flow of the house. “I'm a creative person who would love to do something different, but at the end of the day, this is what they want and this is why they keep buying what I’m selling. My videos are all 3-7 minutes long and people are commenting on different things that they're seeing so you know they're watching the whole thing.” David: “What’s your main piece of parting wisdom to someone new to the drone space?” Fred says you've got to sell something people want, not what YOU want. You have to put your feelings aside. Give your customer what they want, and they’ll be willing to pay you for it. He says you really have to understand the intended demographic that you're shooting for. If you're filming a $2 million house, you don’t make it look like a music video. That's not what people want to see or hear. Real estate video is boring to everyone except the person that's wanting to buy the house. That's the reality. People have this false idea that it has to be a minute and a half or nobody's going to watch the video, so they try to take this great big house and shorten it to fit it in 1:30’. That's not gonna work. Connect with Fred: Website: Nashua Video Tours Facebook: @nashuavideotours YouTube: @nashuavideotours Have a Drone Business? Want to be Interviewed for Season 3? Complete this questionnaire: Drone to 1K Business Owner Application Training from Drone Launch Academy Part 107 Exam Prep Course ($50 off) Aerial Photo Pro Course ($50 off) Aerial Video A to Z Course ($100 off) Aerial Roof Inspection Pro Course ($100 off) Drones 101 Course ($20 off) Other Places to Listen iTunes Stitcher Google Play Spotify TuneIn

(Photograph courtesy of Dr. Frederick Uy, and used with permission.) When was the last time you had fun in math class? The California STEAM Symposium says that needs to happen more often.  And so does Steering Committee member Dr. Fred Uy. When the seventh annual California STEAM Symposium happens, December 9th and 10th in Anaheim, educators will get to see all kinds of ways this could happen. Fred, as he prefers to be called, is the Director of Educator Preparation at California State University's Office of the Chancellor.   His specialty: math.  He has taught math, both at the K-12  level and, for more than 18 years, at the college level, preparing future math instructors to teach in more innovative ways.  Meanwhile, CSU trains the majority of teachers credentialed in California. 2019 marks Fred's first year on the  California STEAM Symposium's Steering Committee.  He has also attended the symposium many times in the past. Not surprisingly, Fred is all about exploring nontraditional ways to bring math to life for students.   He will be leading two sessions at the California STEAM Symposium, which the Californians Dedicated to Education Foundation, the California Commission on the Status of Women and Girls and the California Department of Education are producing in partnership. Fred talked about mathematics instruction, some of the ways he himself introduced "out-of-the-box" thinking into his classes and the ways he sees the California STEAM Symposium serving both future students and the next generation of STEAM teachers. On this edition of Over Coffee®, you will hear: How a different approach led Fred to his career in mathematics; Fred's first lesson for the next generation of math teachers; Some of the ways Fred captured the imagination of his own students in his math classes; A geometry lesson which Fred taught, which incorporated art; Fred's experiences in his work on the California STEAM Symposium Steering Committee; An inside preview of the California STEAM Symposium; Specific STEAM Symposium features which Fred considers to have a major "wow factor"; A look at what will be happening in the makerspaces (which will be in operation throughout both days of the symposium); A preview of the sessions Fred will be leading; One innovative CSU program for training teachers, of which a number of people may not be aware; One misconception about math, which both CSU and the California STEAM Symposium are debunking; A mini-math lesson which incorporates art!; What Fred has found most rewarding, in his first year on the Steering Committee; The changes he's seen, in the way math is taught, over his career in education; His perspective on the ways mathematics instruction needs to evolve, over the next few years. The "magic element" he recommends, to get student comfortable with math; What he's most looking forward to, as the 2019 California STEAM Symposium approaches; What he himself has learned, in the past year, that he would like to share with fellow education professionals.     And--here is our previous episode, featuring a conversation with CDEF STEAM Program Director Glennon Stratton, about the California STEAM Symposium!  The California STEAM Symposium begins at 7:00 am, Monday, December 9th, and runs through Tuesday afternoon, December 10th.  This is a symposium for anyone interested in STEAM education; here's the link for information. n!   Here's the link for information.

This is a fun and insightful interview with Gary’s long time friend, Fred Joyal. In this interview Gary and Fred discuss; What Fred has learned from spending over $500 Million in advertising to encourage patients to go to the Dentist, …  

Fred Hubler founded CCWMG with the goal of providing exceptional client service and allowing the clients access to institutional strategies, programs and platforms typically reserved for ultra-high network individuals. By using wealth accumulation strategies and a variety of diverse financial and insurance instruments, he strives to help clients reduce the risk of investing in these uncertain times. All these and more on today’s Grab Life Big Podcast! In this episode, you will learn: Fred’s brief background. What Fred does today. What percentager Fred is. Fred’s net worth. Where Fred’s investments are. Fred’s life happiness index. Fred’s life’s past and future greatest hits. Fred’s best and lowest pillar. What Fred’s diet looks like. Plus so much more! Fred Hubler Frederick E. Hubler, Jr. is the President and Chief Wealth strategist for Creative Capital Wealth Management group. He has a M.B.A and is a certified wealth strategist. He is also a registered principal. Fred created one of the first retainer-based wealth management firms that offers high quality virtual meetings through the use of technology. "Changing the way financial advice is given- from virtually anywhere". Fred is a multi-year NABCAP Premier Advisor and one of Main Line Today’s Top Advisors. He has also been featured in the Wall Street Journal, Christian Science Monitor, Kiplinger's, MainLine CEO, Philadelphia Magazine, the Philadelphia Business Journal, American Banker, and Chester County Life. Fred is a current board of the Andy Talley Bone Marrow Foundation, and the West Chester University School of Business Advisory Board. He is a past Chairman of the Phoenixville Area Chamber of Commerce, a past President of the Kiwanis Club of Phoenixville and previously served on the Board of Directors for the Phoenixville Senior Center as Vice-President. He is married to Elizabeth, has six year old twins James and Abigail, and loves Eagles football. His hobbies include technology, cigars, and cars.

Humans have been producing food using the same paradigm for 10,000 years. But the burden of a growing population and the impacts of an industrial approach to farming threaten the entire enterprise. The Land Institute is working on a solution. In this episode, we talk with Fred Lutzi, President of The Land Institute, about their unique approach to transforming current destructive agricultural practices. The Land Institute is a science-based research organization based in Kansas, US, that is developing perennial crops as an alternative to current unsustainable practices in agriculture. Instead of relying on and tweaking extractive industrial systems, the institute focuses on perennial grains grown using regenerative agricultural practices. “Agriculture must understand and mimic sustaining natural systems if we hope to feed a growing world population”.   In the episode we discuss: What Fred thinks are the major problems of agriculture today What the Land Institute means by transforming agriculture by developing a ‘Natural Systems Agriculture’ What perennial crops are, what they promise, and how they differ from annual crops The Land Institute’s Kernza® wheatgrass crop and the road to commercialization Why perennial crops are currently not the norm: what’s holding us back? What Fred thinks we can all do as consumers to work towards a common goal A pilgrimage to the beer of the future: Long Root Ale – a Kernza®-based beer by Patagonia Provisions Links The Land Institute website More about Perennial plants Great video about Long Root Ale - A Kernza®-based beer by Patagonia Provisions The Land Institute's global research partners  

Session 17 Dr. Fred Weiss is a Radiologist by training who did a Fellowship in Pain Medicine. However, he's going to share with us today what he likes least about the specialty, part of the reason he's not currently practicing Pain Medicine. Let's jump right in and learn about Pain Medicine! [01:38] Residency and Fellowship Fred is currently an emergency radiologist at Geisinger Health System in Danville although he previously practiced as a Pain Medicine physician in Florida. Finishing his last fellowship in 2014, he's been practicing as an attending for about two years now. He actually did two fellowships, one was a half and half fellowship in Neuroradiology and Musculoskeletal Radiology, and the second was in Pain Medicine in University of Pennsylvania. Prior to medical school, Fred was a physical therapist and he really enjoyed the musculoskeletal system and the nervous system, finding those were the easiest for him to understand, digest, and put into practice. During rotations, Fred enjoyed all the subspecialties affiliated with pain but didn't actually see himself as a surgeon although he liked interventional radiology-type procedures. So it was a matter of choosing a base specialty for going into Pain, doing neuro and musculoskeletal procedures the most. [03:45] Traits of a Good Pain Doctor Fred underscores patience as a major key to becoming a good Pain Medicine physician, along with compassion since you mostly see patients with chronic pain as a Pain doctor. Although right now, Fred admits that the best trait to have is patience with a political system and medical system we're currently in with all the complications going on with opioids where a lot of physicians feel like they have targets on their back. More so, pain physicians feel that the most because they're prescribing opioids considering the country is going through a national opioid epidemic right now. [05:05] The National Opioid Epidemic During interviews for attending jobs, Fred sees a lot of diversity in the way people practice pain medicine. There are those that practice only interventional procedures such as injections, epidurals, facet injections, Neuro Blocks, spinal cord assimilators, etc. On the opposite end of the spectrum, there are those that only prescribe pain medications and when you only do this type, there are only a few classes of medications being prescribed including opioids. And there are those people doing things in moderate amounts of injections and pain medications. There's a lot of heterogeneity in the way people practice and there are people who abuse these medications and seek them while there are those who really need it and those who don't. Fred finds how difficult it is not just on a day-to-day basis, but also, on a patient-to-patient basis to figure out who's a good candidate for certain medications and for certain procedures, and who would respond to what. [06:46] Ways to Get into Pain Medicine In the physical therapy world, Fred's specialty was manual therapy as he enjoyed putting his hands on someone to make them feel better either for mobilization or for therapy purposes, similar to osteopathic medicine. It drew him toward that especially that he found success in those sort of techniques so he wanted to carry it over to the Pain Medicine field. To some extent, he was fairly successful in getting patients off pain medications by simply using manual therapy techniques and other modalities. Fred is not an osteopathic physician. He actually applied to nine osteopathic medical schools and got rejected from all of them. Instead, he got accepted to an allopathic school. When he was in medical school, there were a limited number of specialties eligible for Pain Medicine Fellowship such as Anesthesiology, Physical Medicine, Neurology, and Psychiatry where he has done rotations in all of those. When he did his rotation in Radiology and met an interventional radiologist who did a bit of pain management procedures, he decided to go into Radiology, then do Interventional Radiology, and do the pain part of it. But when he went into Radiology while doing interventional rotations, he found that the only part of it that he enjoyed were the pain procedures. So he wanted to do a Fellowship in Pain Medicine. Along the way, he met his mentor who is a neuroradiologist and a neuro interventional radiologist at UC San Diego, who was actually the first radiologist to become board-certified in Pain Medicine. What he actually did was apply for fellowship in UC San Diego where he was already part of the faculty, completed the fellowship, and was able to be boarded under the American Board of Psychiatry and Neurology. The institution then sponsored him for the exam to get certified. A few years later, another physician did the same thing but he was sponsored by the American Board of Physical Medicine and Rehab. However, there was a lot of political change happening in the field of pain management around the time he applied. The Anesthesiology board was simultaneously closing and opening options and required physicians to have their primary boards sponsoring the examination. Consequently, Fred appealed to the American Board of Radiology (ABR) and had multiple organizations rally around this and lobby for pain medicine to become an official subspecialty of Radiology since many of the procedures were even invented by radiologists. So he wrote an 80-page application for the ABR and then to be submitted to the American Board of Medical Specialties (ABMS) and were successful in getting Pain Medicine to become an official subspecialty for Radiology. Other boards that applied included the American Board of Emergency Medicine and the American Board of Family Medicine. As a result, pain medicine is now an official subspecialty of those skills as well. [12:12] Types of Patients Pain Medicine physicians treat patients across the board from the developmental spectrum treating patients, children and adults alike. When he was in Florida, Fred was treating mostly 80-year-old females with back pain and neck pain as the most common issues. The youngest patient he has treated was a eight-year-old for a chronic pain, biomechanical issue due to pes planus (flat feet) where he gave her a few exercises (incorporated with martial arts exercises being a black belt himself) and prescribed no medications. She was pain free after a month. [14:40] A Typical Day: Clinics and Procedures Fred's typical day depends on whether it's a clinic day or procedure day. If mixed, he would see about 15-20 patients between 8am -12pm. Then do a 10-minute follow-up on someone he did facet injections previously. Other patient are those with chronic regional pain syndrome where he would do regional blocks or ultrasound-guided like stellate ganglion block. He also treats chronic ankle pain where he injects joins with ultrasound guidance. Fred describes his typical day as similar to sports medicine clinic day. On his procedure, he would usually have epidurals, facet injections, nerve blocks that are image-guided under fluoroscopy. His nurses would then bring patients in from the waiting room to have them prepped and ready to go and doing procedure after procedure. Fred also adds how patients would cry and give you a hug after they've treated you and they're pain-free which is very rewarding for him. Fred performs procedures on 60%-70% of his patients since a lot of patients will respond to physical therapy. Being a physical therapist, he has a general idea of who responds well to it or who may need a little push like an injection to give them temporary relief in order to be able to tolerate more physical therapy. While there are also patients who flat-out refuse to go through physical therapy which he finds pretty challenging. He further explains that injections are only temporary for the vast majority of patients and what helps long-term is physical therapy and rehabilitation. This is reflected in the newest guidelines where physical therapy and exercise modalities are the first line of defense rather than prescribing opioids or doing injections. Fred remembers one of his deans who taught in primary care class that there is no evidence for physical therapy prescribed for back pains and now it's come to a complete 180 degrees which he thinks as much more appropriate. [19:05] The Role of Injections With a lot of theories on how injections work, Fred points out that reducing inflammation is one of them. He also adds being a radiologist poses an advantage who are able to figure out what types of patients can respond really well to steroids coming from a perspective of decreasing inflammation. However, most of the time, physicians don't see much inflammation going on but there is remodeling or irritation of bone-on-bone arthritis and those patients respond to a combination of local anesthetics and steroid since the steroid will allow the local anesthetic to last longer, where the duration of which varies from patient to patient. One of the challenges they have in pain medicine is really figuring out who is going to respond the best and the most to the procedures that we do for the best bang for their buck. Fred can actually figure things out based on what he can see on the MRI. [21:23] Taking Calls and Work-Life Balance For outpatient pain, you don't take any calls. In the practice he was in, he would take calls Mon-Fri/8-5 and no call on weekends. If patients had issues, they were instructed to call the emergency room or the primary care doctor and follow up during daytime hours with their office if the issue is really urgent. As pain doctor, your work-life balance basically depends on your practice setting. If you're just opening a private practice, you will be developing your practice so you have to put your heart, soul, gut, and time so you probably won't have any vacation. But on a typical steady state, you get to have your 3-4 weeks of vacation per year, work Mon-Fri, 8-5, and no call on weekends. [23:10] Different Pain Fellowships and Matching Fred explains that the process for fellowships is unifying more and more every year where it's the same umbrella and category of fellowships, largely housed in Anesthesiology academic programs throughout the country, with only six or seven are currently in Physical Medicine and only one or two in the Neurology department. Everyone is applying for those fellowships and depending on the department, there is some bias as to whether it's calculated or not in terms of taking a certain number of anesthesiology or PM&R residents for their program. For instance, for anesthesiology, you can apply to any program and that's fine but if you're in PM&R, only a certain of spots are allotted for some fellowships. Moreover, Fred describes matching as very competitive in that back in 2015, 65% of those who applied ended up matching which means 35% did not match, quite a large percentage of people. [25:18] How to be a Competitive Applicant If you're in Anesthesiology, Pain Medicine is already built into your program where you will be doing a couple months of it irregardless. In order to be a competitive applicant, you have to go in rotations, work hard, show some interest, and a get as much hands-on as you can. Ask for it. Sometimes you even have to beg for the fellows to give up their procedures or work directly with the attending to do some procedures. Other ways to be competitive is to get involved in research and doing a presentation for society meetings to show some initiative and to show the attending physicians that you're willing to put a little extra work in it as there is really not that much work to put in. If you're a PM&R resident, seek out pain doctors who are fellowship-trained for this process. Get to know them and get their tips. Get their connections. A lot of times, it's not necessarily what you know but who you know. So really network as much as you can. Fred gives the same advice to the Anesthesiology resident to put an extra effort to do a little bit of research and get to know the people in your department and work with them. [27:05] Pain Medicine Subspecialities and Boards As part of the training, you basically do some hospice palliative care training so you can work in that type of setting. So you can also do a subspecialty in Cancer Pain, which is a lot of opioid management but nothing to worry about patients getting chronically addicted because they really won't live that long so it's really just for palliative care. The procedures tend to be more complicated with cancer pain patients. Additionally, opioids don't have a complete effect for relieving their pain so they have to get intrathecal opioid pain pumps, another type of procedure which is very effective in cancer pain. Just like any board exam prep, you're going to have to study and work hard. But because only a few people talk about pain medicine boards in general, there's this fear about them. For those in pain fellowships right now, Fred suggests that it's almost identical to the process of taking the in-training exam. So if you did well on the in-training exam, you're going to do well on the boards. There are books available online (some for free) that you can download and do those questions. There are also question banks online that you can practice on but they are fairly expensive and Fred thinks they're only marginally useful. Overall, you can do this easily with just a free book. [30:08] Primary Care and Other Specialties What Fred wants to communicate to, not just primary care physicians, but also to all fields referring to pain medicine, that pain medicine does not equal opioids. Pain medicine equals a comprehensive management for pain that's both behavioral, procedural, medical, and rehab. Fred often encountered patients who'd say they've been referred to him by their primary care doctor because it's illegal for them to prescribe it. The truth is that it's never illegal for a primary care doctor to prescribe opioids but the bottom line is that opioid care is not good pain care. It requires procedures and rehab and other types of medications that are much better for pain. Therefore, if you're going to refer to Pain Medicine, Fred believes that patients need to have a clear expectation of what to think and what they're going to receive on the first day and it's certainly not going to be a controlled substance. Other specialties Pain Medicine works the closest with include Neurology, Neurosurgery (for nerve blocks), Orthopedics (for chronic knee pain), and Primary Care referrals. [32:30] Special Opportunities Outside of Clinical Medicine As in any field, you can do medico legal consulting as well as present for various pharmaceutical companies but there could be a lot of ethical issues involved so you want to make sure you're not only pushing the drug but that it also works for your patients. Several pain doctors also open their own surgical centers. [33:33] The Emotional Aspect of Pain Medicine Going in from radiology which is really cognitively challenging throughout the day, Fred finds pain medicine as less cognitively challenging because you have already practiced patterns for step-by-step management so the cognitive aspect is not there as much as the emotional aspect. It is very emotionally challenging throughout the day. 20% of Fred's patients do really well, while some do neutral, a chunk of them just don't get better. What Fred wished he would have known before entering this field is how emotionally taxing the practice can be throughout the day as you will be seeing a lot of patients crying and feeling hopeless. And on top of the chronic pain, patients also have financial issues and even on top of that is the absence of physical therapy practices that took Medicaid. In fact, a lot of the procedures he offered that he thought would be best for patients were not covered since the organization he worked for did not believe in free care so he was not allowed to provide those procedures. In the end, his patients were stuck taking medications they didn't want to take because that was the only option they had, some stuck with opioid medications because that was the only class of medications that their insurance company or Medicaid would cover. Sadly, a fairly large part of our country has been addicted to prescription opioid medications. This is one of the reasons Fred went back to the practice of Radiology because he didn't believe in this process that is self-feeding and defeating at the same time, making the problem worse than better. On the other hand, what Fred likes the most about Pain Medicine is seeing his patients get better especially when he's able to bring the two skill sets of Radiology and Pain Medicine together. Patient get better with the right diagnosis and the right directed targeted treatment. If he had to do it over again, Fred would still have chosen Pain Medicine despite all the political issues being that it's a fantastic and rewarding field because it challenges you on every level. [38:44] The Future of Pain Medicine What Fred sees on the horizon is more technology dedicated to things like spinal cord stimulation, a device implanted subcutaneously that create electronic bursts to block pain signals. These types of technologies would come forward in the algorithm of treating patients earlier with higher end procedural intervention rather than doing medications, steroids, and local anesthetics on a frequent basis. Stem cell therapy is another thing that he sees having a lot of potential. As more research comes out, there's going to be niche indications for certain types of stem cells to be injected into various nerves, joints, and tendons that will stimulate healing. [40:25] Final Words of Wisdom If you really want to do this despite the political climate, go for it. At the end of the day, you're going to be extremely well-rewarded for the work that you do. The patients are going to love you and get tons of Christmas cards and hugs. It's a very rewarding field but it takes a lot from you cognitively, emotionally, and physically but at the end of the day, it's well worth it. Links: ryan@medicalschoolhq.net Geisinger Health System