I am going to transition this to Michaela and some of the stuff about being in, you know, once you have your job, but I'm going to do that with a question that was in the chat and I can tell you can even start with answering that and then bringing in our panelists. But, um, this is wrapping up what Dr Lombardi had said or it says after Lombardi stated the job market is very focused on hiring a general cardiologist with interventional skills. And are you are academic and hybrid positions, the only way to navigate out of this and I thought Michaela you're a good person to start us off, given where you're working and what you may have seen and then you can kind of transition, I think, to the next part of our discussion. So I'm curious to hear what the panelists think about this, but at least for when I was looking for a job that I really wanted a busy busy practice so it's interesting to know that in the academic environment, it's a little bit harder to to find that and I'm curious to hear what what you what what's your experience right now I'm super super busy and I'm very happy with where I am so I really want to underline the fact that it's important to know beforehand. What do you want, and you put it out there clearly your interview process. And then kind of asking, why, why was I being hired. Right, I think that that sheds a lot of light on that sort of issue, you know, isn't did another interventionalist leave. And so there's like a hole in the practice that needs to be filled, or is it just kind of, well we don't want to take as much call, or, or require another hospital so I think one of the ways that I tried to get at that question in a bunch of different settings was trying to understand why exactly that group was hiring right now. I think the dedicated lab time also kind of explains as to what your opportunities are. It's again a personal decision you know as of now I have three days in the lab and two days in clinic. I have built my practice in such a way that I also see general cardiology patients because I enjoy that and I want to continue. But my partner does not see any general cardiology patients, he sees all interventional patients. So it is, again, personal preference as to how you want to, how you want to design your own practice but I think it is fairly hard nowadays in private practice to have a job where you're just a pure interventionalist. All of you had said that you didn't really have any gender specific issues while finding a job which I am so excited to hear. That's the goal. I do think there are some people that still do have those issues and the question now is gone I think Bill answered it maybe but it was about, you know, asking about, you know, backup and mentors during the, during the process so you're, you're going to a new job and you're, you're going to be busy but like everyone has said you want to have backup. And in that process, I'm feeling like the person thinks you're just not capable enough. It's like a fine line there right. And so I didn't know if any of you guys had any thoughts there where you're asking for backup you want someone who would be there and scrub with you potentially that makes them know that you still are fully capable of doing the job was that ever an issue and how did you deal with that. I'll take the, I'll take the old person discussion on this. So, first of all, there are not many good mentors in our profession because most people have never been mentored themselves. I think academic medicine, basically is about crushing people. It's not about making people better than you it's about using them to engender your own fame and fortune. And I think it's a, it's a very bad culture of of our profession is very few people's goal is to actually develop others who are stronger and better. The second piece is to expect someone coming out of fellowship, doing high risk things to be perfect is ridiculous because they're really still on their learning curve. You know, there's a, there's a thing called the Dunning Kruger curve. And, you know, the people with the highest confidence they can do something, or the people with the least amount of experience. And there's this thing called the valley of despair that as you, as you have all these bad experiences, you, your expertise gets better but you get worse. And then to get true expertise, you have to get through the valley of despair and most of us just jump off the train because it's, you're tired of going to medical staff you're tired of old people telling you that you're doing the wrong thing. You're tired of all this stuff and again it goes back to a lot of medical staff, medical education, M&M is not about improving skill and about excellence. It's about Monday morning quarterbacking and making you feel like crap and preventing you from doing what you were trained to do. And so I think everybody on this call has to build up a lot of confidence. I highly recommend Brene Brown's TED talks on shame and vulnerability and the book, The Gift of Imperfection. You need to develop confidence, you're doing the right thing for the right reason so make the indications solid. When bad happens, bad stuff happens. And one of the discussions when you come into the job is, hey, I'm coming right out of fellowship, guess what, bad stuff's going to happen. You know what bad stuff happens to you. And if bad stuff isn't happening to you, that just shows you have risk aversion, and you haven't actually learned much other than to not do stuff. So stand up for your patients, stand up for yourself. We spent a lot of time talking about something called excellence, not perfection, and I'll just make this about me because you know of course it's about me, which is, I've had a lot of people in the profession say, I want to be Bill Lombardi. I want to be as good as he is. And I would tell you that's the dumbest thing on earth. It isn't about who's better. It's about, are you better. And the way you get better is you find a coach, and you critically look at what you need to learn to improve and it's not to do an epicardial, you know, like I had Kate today, Kate went did an epicardial and put a two five balloon retrograde to an epicardial. That's good. She's picked up a new trick. Catherine may need to work on something else you know maybe she's got issues with proximal cap ambiguity, I don't know, don't care. But she's not going to learn that unless she has someone come in and coach her. So it's not necessarily that you want to mentor you want to get a good coach, and sometimes that coach isn't in your program. The other is, if you're in a toxic environment, you will never win the battle. What you need to do is find someone that has more reputation more ability meaner bigger a volunteer myself I love to take people on. Let them come in and fight the fight. Because, you know, we've heard all this stuff we've seen all this stuff we have a different perspective so realize that you start your new job make sure you have a collection of people not just in your group, but outside of your group that you can use as a resource to talk through when bad things happen, and to get coaching. And when people attack you that are old in your practice you can look at them and says, what are you doing better this year than last year. And if their answer is nothing. That's the whole discussion. So, not sure that's a perfect answer I'd love to hear what other people have to say but that's the way I would tell you to look at it. And I would attach to this comment another question because during the interview process you might be a little tricky to ask for mentorship, and attaching to a question that is also pending there. If we ask for mentorship. This. Whoever interview is interviewing us and they're going to think that we are not able to do things on our own. Now, we do actually identify an environment that for growth instead of doubts. Yeah, I mean there's a line right. There's a lot because like I love Renee Brown. I love vulnerability and like the most true version of myself is like, you know, the walking around totally vulnerable spilling my guts at all times. You can't do that all the time, especially in your first job. You know, especially when you're starting it's like finding a line, it's like, you know, you know it's it's you're doing all these things on your own for the first time it's okay to be a little scared, like it's okay to be not 100% sure if you want to do this last You know these small decisions that felt so easy as a fellow really feel a lot harder now. And that's okay but in, you know, I you know I've kind of given myself benchmarks like kind of first three months carte blanche. If I wanted help I'm asking for help. Who cares. You know now I'm six months in, you know, I need to start forcing myself to make some hard decisions without, you know, anyone else and learning to trust myself. And so, you know, I do think you touched upon an important thing with this question with the balance between, you know, vulnerability versus weakness. And I think kind of giving yourself some permission to be where you are in that journey, but making sure you're progressing through that journey is really important. It also depends on who you're sharing it with. I mean, you have to have your community right i mean i didn't get better at CTOs talk to the people in Bellingham I got better because Aaron grant them and Craig Thompson were my friends and when we had bad stuff happen. We were vulnerable to each other because we were the only people that understood. You've got to find your own community to share and it may not be in your practice. I think the second piece I would tell you Catherine and for all of you is to give yourself some grace. You too many people in our profession train you that this is right, that's wrong. And I would tell you that's bullshit. It's you're making a decision. There are good things about that decision and bad things about that decision and give yourself some grace, you're making the best educated guess you can. And over time, your guesses will get better. And if you get coaching, your guesses will get better. But don't, don't get too buried in this right and wrong. If you kiss it out. Great. If you don't kiss it out. Great. It's, it's not that much life and death that I think too many people have focused on. So I would just tell you is all of you out there. I mean this is something I'm working on this year for myself is to allow myself some grace, because I'm way too critical upon myself so I would just encourage you all give yourself some grace that this isn't right and wrong. This is about getting better.

job market

cardiology

interventional skills

navigating job market

gender-specific issues