Okay, good morning. I am going to talk to you a little bit, shifting gears towards academic medicine. I actually will talk about three things this morning. One, what it is like to be in an academic environment. You're all familiar with it, but I'll give you the highlights from the staff end. But also, I surveyed four graduating classes of fellows and asked them what you, as fellows who will graduate in six months, need to know before you graduate. What helped them, something they needed to know for you for the transition period. So we'll talk about that a little bit. And then I will touch also on work and industry, because this was part of the original program. Unfortunately, Dr. Reddy was not able to make it. He had to leave the country for an emergency. So his slides are on your syllabus. His contact information are there. But I will mention that briefly from what he was going to present. Before I start, who already has a job lined up for July 2020? Okay. Who has not started the process of looking for a job yet? Okay. Good. And then another question, if you'd like to answer, who here is on a non-immigrant visa and needs some processing to help them with the next transition? Okay. Good. So I have something for every one of you. I hope you'll get something out of that. But first, let me tell you about me. Just so you know why I'm up here talking to you, why am I a good person to ask these questions to? So I did my medical school back home in Lebanon, in the American University of Beirut. And then I stayed there for two years after med school, did the clinical research, and then moved to the U.S. I did my residency at Lincoln Medical Center, which is just outside of Philadelphia. And then I moved here to Mayo. I did a fellowship in endocrinology, and then another fellowship in geriatric medicine. And this is my first year being here on staff at Mayo with a dual appointment in the division of endocrine and division of geriatric medicine. My work is bone metabolism. I do research in bone metabolism and aging. And this is the reason why I combined these two fellowships. I interviewed in a few places before I decided to stay here at Mayo. It was not a default for me, but rather a choice. I looked at other academic practices in terms of endocrinology, and I have some idea about what's out there. So hopefully I can give you some insight into that. Academia looks like this. You have many components. There are many hats that you have to wear. Of course, when we think academia, the first thing that comes to mind could be research, to many of us. And research has its own challenges. Research could be clinical research, could be bench research, translational research, depending on where your career goals are. But it has its challenges, including funding. A lot of academic institutions rely on federal or external or what we call extramural grants to be able to sustain salaries of researchers and do the research work. So funding becomes a major part of research career. If you're doing bench research, you need to join a lab or set up a lab if you're there in your career. There are many challenges that come to data analysis. Is the statistics available in the institution where you're looking to start work with? Do they have a statistics group that is free of charge to you, that is paid for by the division or the department? Or do you have to provide funding so that these statistics happen? Or do you have your own background in master's or some statistics background that you will need to use? The softwares, who's going to buy these softwares? Money is very important. So all this needs to be, you need to consider this when you're looking at a research position. Publishing, in order to progress in academic ranking. Most of the academic criteria are related to how many publications you have in addition to how many grants and so on and so forth. So these are the challenges of research. Clinical practice, of course, when you're in an academic center, you're combining clinic but also hospital service, which is the inpatient consult service. Some institutions, less and less so, but some ask you to do some general medicine work for a week or a month with residents on a general medicine ward. I know at least two that still do that. Hospitalists have taken this part mostly, so subspecialists are not doing it anymore. But at the end of the day, you're hired under the Department of Medicine, even though that's the Division of Endocrinology, so they might ask you that. And you need to know that when you're looking at that institution, whether you want to treat with antibiotics or not. So that's a choice you want to make. So you want to know about that. And then scholarly activities, because those not necessarily count towards your research time, if you're expected to supervise QI projects or come up with QI projects, supervise fellows in doing some scholarly activities too, that will be considered part of your time. The clinics could be also supervising fellows in these clinics, and that goes into teaching. So teaching, rarely do academic centers give you time for teaching. It's going to come out of your own time. Some of them do, some of them have, because they're affiliated with the medical school, so the medical school provides some funding for you, but it might be that you need to be part of the physiology course in the medical school or a program director to get that time covered, and otherwise you're just doing it on your own time. And you need to know that. When you're supervising a fellow in the clinic, is that clinic closed for you? When you're on hospital service, do they close your clinic day so you can supervise the fellow, or is that going to happen 6, 7 p.m. after you're done with your clinic? You're going to have to go back and then round with the fellow. So these are important to know when you're looking. Invariably, you're going to be asked to serve on some committees, education committees, but then this takes us into service too. There are a lot of committees in every single institution, so you're going to be asked to be on some committees, and as a junior faculty, I said yes to everything. Now I have no time to do anything else, because I'm on all these committees, because I want to be involved. I have leadership skills, I have leadership experience, let me do it. So now every other day I have a committee meeting here or there, so this also takes up your time. Sitting on a committee takes work to prepare to that committee, because you also want your integrity to be respected. So that's very important to gauge how much service you will be doing. When you're in academia and doing research, your name will start popping up into reviewing or serving on editorial boards of some journals, so that also takes up service. When you get those emails to review, you have two weeks to review this article, so this is part of that volunteer service that no one's covering for that time for you. And then you're going to be asked to present on a Sunday morning, to present at national, local, or international venues, so this is all part of that. So you need to take all these into consideration. Now this pie chart, I put these four equally, but of course different institutions, different divisions have more or less of one of these, so it will take over the time that you do the other ones of these four, but to some extent you will have something of these four. Right now, for example, for me, I'm mostly doing research, I barely do any clinical time for the next year and a half, so my time is protected, but I still have to do service and teaching, so these also take up my research time. But at the center of all of that is you and your mentor. I think it's very important when you're looking at an academic institution is for you to know the people there, find a good mentor for you, and then know what you want. You and your mentor can decide on these. These are not always written in contracts, these are things that you discuss, you negotiate, you can talk about, so it really depends on your career goals, which one of these do you want to prioritize, and then discuss it with your mentor in order for you to decide how you want to do it. I stayed at my home institution, it has its pros and cons. Many of you may be considering that if you're getting an offer from your home institution. Of course, the pros of staying is that you're in a nurturing environment, they already have been involved with you. For me, they knew me for four years, I already have my mentorship team, so it was very easy for me to continue with them. You don't spend time in activation energy, in the sense that you need to learn the new system, who's who in research, in the clinic, which nurse does what, where are the buildings, so it takes time to start these. I did not need to do that. You can hit the ground running with your research or your clinic. Of course, you will not get a sign-in bonus, for example, or a startup package. There is less room to negotiate things because you're already part of the team, part of the system. If you're staying in your home institution, you already know the faculty. Whether they've treated other faculty as a super-fellow or a super-resident, rather than an actual new faculty. For me, it helped that I went to geriatric medicine and I came back to endocrinology because I spent the time away from them, so that helps a little bit. Sorry, they spent time away from me, but that might help. You need to see what happened to previous young junior faculty in your institution. That can give you an idea and whether it's worth it for you to do that or not. When you're looking for a place, you want to know, as I mentioned to you, your interests. You want to write them down. You want to put down what are my priorities. My priority for me was to do bone metabolism research, to have research time protected. This is how I started my negotiation. Do you have additional training? Do you plan to or are you required to? You need to factor that in. If you have ACNO, highlight that. If you have clinical densitometry certification, highlight that. If this is needed and you never plan on doing it, then also you need to know that because if you don't want to do it, you don't want to do it. Practical things, geography, minority groups, diversity is very important. You don't want to be the quota in an institution. You want to be in your own and in a nurturing environment where you, as if you belong to a minority group, you feel comfortable there, not they hired you because you're different. Finances are very important. Never be afraid to ask about money, even if you're an academic institution. When you're negotiating contract or when you're talking about interview and contracts, ask about salaries. Ask about what are the financial burden and then what other startup packages you can have. Nothing is set in stone. Many things can be negotiated and you'll learn about contract negotiation in the next hour, but that's very important. How to prepare for your interview. This is not the match where you submit one personal statement. Make a cover letter for your CV that's institution specific, depending on where you're applying, where this letter is going to, and always be prepared to talk about for one sentence or three minutes about your career goals, your research goals, your research interests because you will be asked about that. You will start with a phone interview first for those of you who haven't done that yet. You might decide based on the phone interview not to go to a physical interview because this is taking up your time, your fellowship time, whether vacation days or you're allowed to take this personal time off or not. You want to make sure that it's worth it to go to that interview. Ask the questions. If money is important for you, ask it over the phone. Don't be afraid. If this is a deal breaker for you, that's it. We don't go to interview because I cannot survive on a 120K salary, for example. Don't be afraid to ask the questions that you need to know to triage these places. Then consider your experience and your strengths as facts. Highlight what you're bringing to the table, why the institution needs you. Highlight that. Don't be shy. Be very confident about what you've achieved so far, about everything that's down there on your CV. But don't brag about it. Don't make the institution feel that it will be an honor for them to hire you because you want to find a balance between the two. Then what you need to learn today, you heard a little bit about that from Dr. Litchfield. Learning about compensation and billing is very important. If the RVU system is what the institution you're going to use, you need to know about that before you get there. So meet today with your program directors now before you finish fellowship. Ask them, how am I billing? Am I billing correctly? You can ask. You can get feedback as a fellow, as a trainee. That will be very helpful for you. Satisfaction survey from patients, even in academic institutions, we still get that. These are somehow a metric that's very important because the Google reviews are more important than other things. So it's very important. As fellows, you do get patient satisfaction surveys. If you haven't seen them yet, ask your program director for them. Review them now because they will become important because they're not going to change. It's just your attitude towards them is going to change. I accepted many things on my satisfaction surveys that I'm just fine with now. So you just need to know what's on there and how you want to handle that. Network. Network a lot. This is the best place to network. I made a lot of friends in these places, in Endocrine University, in annual meetings, in small local national chapter meetings. I made a lot of connections, a lot of friends. You're going to need this when you move to your first fellowship, whether it's your co-fellows on a WhatsApp chat group or on a Facebook group or whatever. You want to ask questions because you're moving into this together. You want to ask a lot of questions when you move to the first year after fellowship. So that's very important. And then once you start, you're in a new place. You need to build your reputation. You need to build your new network. Where are the patient referrals coming from? Who am I collaborating with in research? Who's who in the Department of Surgery? We learned this morning about how important the surgeon experience is. So which surgeon has what experience. Volunteer to give lectures to the GYN fertility group, for example, if you're going to be working with them. Or volunteer to give a lecture to the surgeons or the nutritionists to collaborate with them on research or because you're going to be working together in the clinic. So these are important. We know how much lab medicine and radiology are important for our specialty. So you want to know who are these people in your new institutions. Advertising, depending on where you are or who you are, you might want to advertise on social media, on local TV stations, on local radios, because you want to get referrals because you need to work. So this might be important. And then understanding the workflow. You're very comfortable with how things work now when the nurse rooms the patient and then the nurse takes med reconciliation or I do it, blood pressure, things like that. Learn the workflow in the first few weeks when you're orienting or shadowing the practice before you start actually seeing patients because you're going to need to be efficient in practice. Even in academia, time restraints are very rigid and you need to abide by that. And then speak up for yourself. If there is something that you negotiated in the contract and it didn't happen, whether it be a standing desk, for example, or a space, a window in your room, whatever you negotiated in your contracts and did not happen, don't be shy to speak up. It's not because you're now on board that well, it's not going to happen again. The contract lasts three years. You're going to have to renegotiate the contract. You write that down. They did not commit to this on the contract. Well, I'll commit to it on the renegotiation in three years. So speak up for what you wanted to do that you already brought up during interview and contract negotiation. And then, no matter how well you prepare, there's a big learning curve that's going to happen. I put here three years, but it's actually three to five years after you move to the practice. There's a steep learning curve. And this is why it's important to do that transition along with people who are doing it with you. Young junior faculty who's done it a year or two ahead of you. Connect with these people in your new institution, the old institution, in your fellowship. Stay in touch with them on social media, for example, or wherever, because that's going to be important to ask these questions to get answers to. Even things like reimbursement for travel. I have a lot of these questions now. I need someone who's done it so I can ask them how to do it. So small things like that. So in the last few minutes, I'm going to touch about industry. This is Dr. Reddy who was supposed to be here. You have his slides. You have his contact information. But what he wanted to mention, anyone is considering, or at some point, not necessarily now, a career in industry? Anyone is thinking about that? Okay. Well, industry gets a lot of bad rep, but there are good things about industry that it's important to highlight. This is an option for you. And for those of you who are on a non-immigrant visa, this actually might be a really good option. There is the incubator concept in industry that even though you might join now, let's say, as a junior researcher in a pharmaceutical company, you might negotiate that you can go to a place, to an academic center, and to work in someone's lab in order to build expertise or learn a technique that you're going to bring it back. There are a lot of collaborations. Here we do a lot of collaborations with industry in our labs. So it's important to know about that. They can nurture you depending on your career goals. They can give you a lot of money available. No grant application process is necessary like we do for federal funding. The money is available, but you just have to follow as long as the goals are aligned with the goals of the company that you're working with. The money is available to do research. I have an example from Bone. We know that for denosumab, for example, a lot of the Rank-Ligand discovery did not come from an academic lab, but rather from Amgen. They discovered the Rank-Ligand, and eventually were able to not discover it. They discovered how important it is in the development of osteoporosis, and they were able to eventually get the monoclonal antibody denosumab for it. They did a lot of research in Amgen for that. There's a lot of good research going on there. That kind of research is more practical, more goal-oriented, if you want, in the sense that the idea is we're going to find a compound that we're going to market. That's the goal. It might be closer to satisfaction than what we do in the lab, because you have a lot of failures that might happen in academic labs. The areas of interest can change quickly. Again, another example from the bone industry. Merck had to shut down their entire bone research after spending $1.3 billion on odonacatib, which is catepsin-K inhibitor, because in the Phase III clinical trials, there was an increase in the risk of stroke. They did not want to market this product anymore. They shut down their entire bone wing. There's a change in goal. That's always a challenge when you go to industry. The failure is not necessarily a failure of the team. It's the compound that had an increased risk of stroke that was seen in Phase III clinical trials, but yet people are maybe out of job because of that. All this research is secretive because this is kept inside closed doors for the industry. You need to keep that in mind. This is not about you and your advancement, but rather advancement of the company itself. It's not your own ego that you're promoting. There are many opportunities, whether you decide to join now as an early career or later in your career, mid-career or late career, where what experience you have might land you a different position within that food chain, within the industry. You need to keep those in mind. I thank you. Feel free to reach out to me at any point. Thanks.

academic medicine

academic environment

mentorship

transition period

industry

preparation