So if I can add one thing, and I wonder what Bill's going to say about this too, is I've counseled about 10 years of interventional fellows going to find jobs, and one of the things I make sure that they know is, or that they make sure is defined, is how much volume they're going to get, how many days in the cath lab, how can they increase their volume if they needed to, because that is my concern. And I will say, I think it's more of a concern with a lot of the women coming up than men, where they want a general cardiologist, and they'll be like, yeah, we'll give you a half day in the lab. And that's not the first job that you want, and so that should, in your mind, be a deal-breaker, because to be an interventionalist, you need to get your volume early and then decide what you want to focus on in that. So that's one thing I would say, because I think all of you all have very high-volume jobs, but those are a little bit far and few between, and just having seen it from the other side, helping fellows, but also just recently getting a job after changing jobs after 10 years and seeing what's actually out there. So that should be a deal-breaker. Bill, do you have any thoughts on that? Unfortunately, most jobs actually are a general cardiologist that gets to do intervention, and I think you have to be an advocate that you want to be an interventionalist. I sort of tongue-in-cheek and say, if you're in clinic more than you're in a cath lab, you're actually a general cardiologist, not an interventional cardiologist. And so it's a problem across the board. I don't think it's a gender-specific issue. Again, it goes back to being an advocate for yourself and making sure that essentially contractually you guarantee some of these things. I think at times you're like, oh yeah, you're going to be okay, the volume's going to grow, you're going to get this, and then you get there, and it's not necessarily the truth. So one of the things I tell people, for me, one of the big-ticket items is Rampart, is being able to have no lead in the cath lab, and so is that something that you can advocate for? Can you advocate, I wish I'd built into my contract having a fellow. I didn't do that, and I wish I had, because coming up with funding for the CHIP fellow has been a bit of a pain. The other thing I would tell you, and I think Vivian was bringing this up, but I'll change the narrative to it a little bit, is too many people, and I've counseled a few fellows recently about this, it's the, well, is this the right job, or is this the right job? And they get very focused on, is it right? Is it right? The reality is you don't know, and that's okay. First of all, you have to have great faith in your ability that you're going to make it right, that when you get there, you can collaborate, you can engage people, that you're dynamic, that you know how to understand things, and so that therefore you can make the job what you want it to be. I think the second piece in that is, again, if you don't like it, quit. There are other jobs. So, you know, and it's just because that other job isn't there, doesn't mean you can't find another one, maybe even better. You know, if you'd have told me when I came out of my fellowship that I'd be a full professor of medicine at an academic center in Seattle, I'd have laughed at you. I would have never dreamed I'd been here. So I think, you know, be open to that this is a process. It's not right or wrong. You weigh sort of the benefits, you weigh the risks, and you take your best shot. But if you make a mistake, it's okay. Let it go. Don't live with it. Just move on and learn from that mistake and get what you want. Yeah, one thing I wanted to add, especially from my standpoint coming out of fellowship where I was trying in one year to put together structural coronary complex intervention and peripheral, is that when you decide you're going to practice, private practice especially, make sure there is someone that can mentor you and sort of help you out in starting complex cases on your own, because it's always hard. In fellowship, we're all strong and very self-confident, but then when you're on your own, you want to make sure that you want to build your numbers lowly. You can have someone around that can protect you. So personally, I chose a practice where there were three interventionalists so that we could have sort of double days scrubbed together in more complex cases, and I could develop my own confidence and independence. So I want to, we want to switch gears, I think, to kind of starting your first job and things you should know there. But before then, I want to say a few things. One was just summing up, like when Bill was talking, I always, you know, the whole like just quit and find something else, it's hard. Easier said than done, but just kind of in your head, just bet on yourself. That's what I, you know, when I switched jobs, it was I knew I was going to find what I wanted. Just bet on yourself and just, you know, keep that in mind. It's so hard, I know, but that's part of it, just kind of advocating for yourself and just know that you have it. And if you've come this far, you definitely can figure out a way to get the job that you want. There is no perfect job. But before that, before switching to how to change into the changing job, I just want to ask the panelists, barriers to interviewing, to kind of advocating for yourself, and I will put out there, you know, anything gender specific. And I'll just give one example where I was just at a fellows course and the fellow came up to me and said, you know, I want to figure out what is their maternity leave. And when I bring it up, people seem to kind of shudder. My advice to her was, first of all, I've decided it should not be maternity leave. It's parental leave. And that's just what the word we should be using. And number two is you don't have to ask because hospitalists and states all have their laws and you don't have to, you know, that shouldn't be something that you have to bring up if you felt like you needed to. But I'm bringing that up because I wanted to hear from each of you. If there was any barriers that you felt you had to overcome and any advice there. Yeah, I guess I didn't feel like I had any gender specific barriers in the process. I think, you know, going on interviews, you always hear the classic line, there are three things, right? Money, location and job description. And you can pick two. I hate to tell you guys as an interventional cardiologist, you can pick one. And so, you know, I think being honest with yourself about what that is, like, maybe it's location, like, that's okay. You know, for me, it was job description. And so I was, you know, super upfront with that as I traveled around. The other thing that I was saying, you know, what sort of things have I was I trying to figure out when I was interviewing for jobs, like your first job, it's hard to be an interventional cardiologist. Like, you're very brave standing next to your mentor going to like 28 atmospheres on that 50 balloon. It is very different when you're standing there by yourself, and there's no one else in the lab, and you've seen things rupture. And you're like, Hmm, if this ruptures, it's just me, me and these two hands and that person's life. So, you know, having, you know, and I thought maybe I would be immune for this because I did three interventional fellowships. Nope. It's hard. So having partners that you can be vulnerable in front of and be like, Yep, wish I would have done that differently. Or what do you think? Or, hey, do you know what, I'm about to do something crazy. I'm pretty sure this is the right thing to do. But I would feel better if I could say it out loud to someone. And then go like, Yep, sounds crazy. Go for it. It's the right thing to do. So I was I was really looking when I was interviewing for like those sorts of people. So I didn't face anything gender specific, I think, similar to my prior statement, you know, this is the first time where you're interviewing for something where you need to identify what you want, right. And so it can be intimidating on your first interviews to kind of ask those questions that you're not used to asking, right? Things about salary, things about, like you said, how many days in the lab, you're not used to asking those types of specific questions, because we're so used to just, you know, usual format, right? You're used to this is what fellowship is going to be, this is what residency is going to be. And I think getting over that is a little bit difficult and intimidating at first, because you don't want to be like, well, I feel like I'm being so demanding on these interviews, like, you need to understand what those jobs actually entail. And the only way you're going to find out is by asking those questions during the interview. Also, you know, I think talking to my other friends and colleagues that were also going through the interview process, or who had recently done it is also very helpful, because there are certain things that you don't realize that you should be asking, or that are okay to ask until you kind of talk with some of your friends and colleagues, and they're asking those same questions. So I think that's also helpful, like that support system while you're going through the interview process. I really didn't have any gender specific limitations. But like Bill said before, you know, when you go to do a job, it's it is you had to make sure that you had to see if it's going to work for you. And as we go into practice, we are going to spend more time with our partners more than we spend with our own families. So to me, it was important that I had colleagues who could be like friends and partners, and not folk who are like looking over to make sure that you know, I'm like not sizing the stent right, but people who would actually be on your team. And speaking of to Catherine's point, you know, about salary, when you're a fellow, you know, nowadays, I think a fellow earns about 75k. And then you see these salaries, salary offers, and you're like, oh, my gosh, it's like 450 at one place and 550 at another. That's like my whole salary is extra. It really doesn't matter. You know, 100,000 after tax and everything, it turns out to be actually not so much in the long run. If you're in a very unhappy practice, it doesn't mean anything at all. I would say having like a good happy practice where you know you can do what you want to do with great partners. Just add another 100,000 to that in your mind. That's how much it would value. I'll say two things. One, you're all going to make a lot of money. You know, I took a pay cut to come to the U. And, you know, I could argue, but one, jobs that pay you a lot of money, you're going to work to earn it. And, you know, it's about widgets. It's not about being excellent at your job. You're going to be a lot happier if you're just trying to be excellent at your job. And I think the theme that everybody has just said is when we talk a lot about with our high risk PCI fellows, because this is the challenge. The most important thing of the job we're going to join is culture. It's not necessarily having a senior partner because some of the senior partners are going to stick their foot on your neck and try to get you in trouble with medical staff because you're not like them and you don't do what they do. You can be in a cath lab where the cath lab staff, you know, I like to talk to the cath lab staff because you can find out if all the doctors are bickering about each other to the cath lab staff, that's potentially not a culture you want to work in. And again, I think depending on the specialty or what you want to do, what you want is a culture that is going to engender you developing excellence. If the culture is making widgets, great. You're going to make a lot of money and nobody cares. Just make widgets. But then realize when you get there and you want to do X, Y, and Z, that may not happen because they're more focused on widgets. Do they have a medical staff environment such that like if you have a perforation from going up to 28, are you going to get in big trouble for it? You know, Catherine works with Kanzari and Anna Kalinic. She's got a nice, nice little net to work with, you know, but that may not be if she were at Piedmont South or whatever. So I think those are important things for the people, for the participants is look at the culture. And when you look at culture, that's how do they treat their receptionist? How do they treat the nurse? Talk to the cath lab staff and how do they respond? Are they timid and afraid of the doctors or are they people who are engendered and engaged and they want to learn? Are they happy? Are they sad? All of those things can give you some insight into the culture you're joining, which is actually the most important piece. Money, location, and thing is less important than if you're in a, I've been in a practice with a bunch of bad people. It is no fun. It's one of the reasons I left. I had three partners repetitively sending me to the medical staff office and then having these long conversations to explain why they weren't right. That's no fun to go to work. So really important to find good culture. And, and the other piece I would say to say, you're right. It is hard to find a new job after you've got a job, but the issue is you have a job. So you have all the time in the world because you don't have to leave till you find the one that's going to fit your needs. So that does give you some ability. When you have a job and you're looking for another, even if you're happy where you are, kind of look, I will say that just because you want to know your worth and know how to negotiate even while you're there.

interventional cardiologist

job search

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transitional challenges

job satisfaction