I'm a urogynecologist in Rochester, Minnesota at Mayo Clinic, and we have an amazing panel for everybody tonight. Three different recent graduates to talk a little bit about themselves, their practice and hopefully make this interactive. So utilize, I believe, the Q&A box to ask any questions, and we'll try and get to those. And it may be a question that all three of the panelists answer. And yeah, we'll go from there. So Caroline, were you going to go first in your introduction? Sure. Hi, everyone. So I'm Caroline Cox. I graduated from fellowship in 2020, so I've only been in practice just over a year. I was at University of Michigan for a fellowship, and now I'm in an academic practice at University of Pennsylvania. And I am a clinical and teaching position, not a research position. Great. And Anne, yeah? So my name is Anne Tran. I am here at Mount Sinai in New York City. I am the assistant program director of the fellowship here of SQMRS. I graduated in 2019 at Northwell, which is in Long Island. And I joined the practice here in September of 2019. So I've been out for about like two and a half years now. I would say my practice is more hybrid because the compensation is like private practice, but I play a big role in academics as well with the fellowship program. Great. And Eric? Yeah, my name is Eric Hockenstead. I graduated from fellowship in 2019 from Mayo Clinic in Rochester with Dr. Okino. I am practicing at the Billings Clinic in Billings, Montana. My practice, you could kind of consider it private in a way in the sense that we don't have any academic affiliation. We're a big multi-specialty hospital. It's the biggest health system in Montana. And I do have some teaching medical students, PA students, but no residents or fellows or anything like that. Well, great. And I want to thank Dr. Cox, Dr. Tran, and Dr. Hockenstead for their time tonight. I know it's very generous of you guys to give up a little bit of time from your family, and we appreciate you doing that for these young fellows, and hopefully they'll get some knowledge imparted to them. So, you know, I think my first question to start is everybody's been in the same job since they finished fellowship. Is that correct? Nobody has gone to a different place from one or the other. Great. And since we don't have any specific questions and anyone can just fire in a question whenever they want, I'd say let's start, again, maybe in that same order with Dr. Cox talking a little bit about, so tell me about kind of your day-to-day, week-to-week practice. What are you doing? How are you educating? Kind of what's your day-to-day clinic? How many times you know are kind of those types of things the nuts and bolts of your practice? Yeah. So I have a kind of job that you're all probably most familiar with because you're all training in, you know, some kind of academic setting. But since my job is heavily on the clinical and teaching track, I do have a lot of clinical time, more than maybe some of your research faculty that you're used to. So I practice at two different outpatient sites in Philadelphia and I operate at one site. So on Mondays, I'm in clinic all day in the city in Philadelphia. So I have a very diverse patient population. On Tuesdays, I practice out in Cherry Hill, New Jersey, which is a more suburban population and see patients all day out there. In all my clinics, I incorporate procedures into my clinic day. On Wednesdays, I operate all day in the city in Philadelphia at one of the Penn hospitals. Thursdays, every other Thursday, I'm in clinic all day. And every other Thursday, I have admin time where I can do, you know, whatever I want with my time. And then on Fridays, for us at the Penn Fellowship, every Friday morning is didactic time. So we're all together all Friday morning for that time. And then Friday afternoon, I again, see patients out of my Cherry Hill site. Great. And, you know, what type of, and I'd ask all you other panelists as well, what type of like support structure do you have? Is there a nurse that works with you? Do you have nurses in the clinic? Do you have, you know, advanced practice providers that you work alongside with? Like how, kind of what's the setup and support structure from that end of things? Yeah, I'll just continue on mine and then let everybody talk back and forth. Yeah, I'll just continue on mine and then let everybody talk. But I think this is great that you brought this up. This is something you should be asking about when you're looking for jobs, because it's going to make a huge difference in your life, the support that you have. I felt really lucky to come into this system that's really well established and have nurses that know exactly what they're doing, answer the patient phone calls. They know exactly how to answer all of them. They know how to do urodynamics. They know how to do PTNS. Like I didn't have to do any of this training as a brand new grad when I'm trying to figure out my own practice. So I thought that was a plus for me. We also have one nurse practitioner who we actually just hired a new one this year. So we're kind of defining her role now, but she's going to be seeing a lot of our return patients, which is helpful for us to be able, as the MDs, to be able to see a lot of the new patients. But I know that varies a lot in different practices, so I'll hear what everybody else has to say. Great. Thank you, Dr. Cox. And Dr. Tran, tell us a little bit about what your day to day is and what kind of support structure you have around you. It's very similar to Caroline's. I think like two to three days out of the week I'm in clinic and then I have one day of block time for surgery. For me, it's Wednesday. I operate actually out of like six to seven different institutions, depending on where they need me. But my main block time is at the main campus, what we call the Mount Sinai Hospital. So that's the great thing about, I think, working at an institution that has a lot of branches, because then you get to see the variability in terms of our staff and how some places do it differently. And you can bring the positives back to where you typically are at. In terms of my clinic days, I have two days where I'm seeing patients in what we call a private setting. These are my private patients. And then one of the days I proctor the resident panel. We have like a Eurovine panel, which is run by the fellows and the residents, followed by like an afternoon of procedures, taking these residents and fellows through procedures such as cystoscopy and like, you know, urodynamics. And then I would say in the OR, it mimics more of an academic setting versus a private setting, because, you know, the residents and fellows are always there. So I'm, you know, letting, teaching them and mentoring them through cases. Very rarely do I get to do cases on my own, but like on my birthday, my fellow let me do it. So that was really fun for me. Then, you know, my academic time. It's, I would say, like one day out of the week, I have like a true academic time, but it's really more so like, like following up on patient, like phone calls and results and discussing. It's more like clinical than true academic time. And so it's mainly like on the nights or the weekends that I'm like trying to fit in some of that academic, you know, like research and like setting up the curriculum and didactics and stuff like that. So I feel like the hybrid situation is you get the best of both worlds, but you also have to work a little bit more. So at least that's my, you know, like when I when I have my coworkers or my co-residents, like they're, you know, living the life and they're like, what, you're still at work at like seven o'clock, you know, like I kind of pay my head and say like, yes, but I do love what I do. So that's really important. Oh, in terms of ancillary staff. So in my private practice setting, I do have VA's who, you know, try to do most of like the, you know, what Caroline said, like, like a lot of the procedures they do, and then a lot of like patient callback. Great. And Dr. Hagedsted. So in my practice, I have one partner, Dr. Craig Meyer. He's my partner here. He was, he got here about three years before I did. And when I joined the practice, there was him, a PA and his nurse. So when I joined, we quickly found that we needed more people and more support. So we quickly hired another nurse. So I have my, basically I have my team and he has his team. So I have my nurse and then we hired another PA. So I have basically my PA, my nurse and me, and then we share a medical assistant between both teams. We all function pretty well together. My typical week is, oh, I have basically one OR day a week. And that changes based on the week because Euroguide shares our block time with the Department of OBGYN. And so our block time allotment, it goes along with the generalists in the group, along with REI and us. And so I get about a day a week or so in the main OR. And then we have an ambulatory surgery center where I get about a day and a half a month in the surgery center. So three half days. And that's on average about what I do. As far as clinic goes, anywhere between three and four days of clinic a week. And I have a pretty flexible schedule. And that's the really nice thing about where I joined is I basically have the ability to create my schedule. So if I want a Friday off here or a Monday there, I can do that as long as I'm not taking too much time off and seeing enough patients. And so I do definitely have flexibility from that perspective. And then as far as admin time, I think technically I get half a day a week. But you kind of use that as you need it. I mean, I don't have a whole heck of a lot of admin time. I'm not doing anything in the way of research right now. But I do have leadership roles in the department from a quality perspective. So I'm in charge of our quality and whatnot for our department. And then I'll be taking some more of that on from a hospital-wide basis here in a little bit. But there's definitely a lot of opportunities to pick that kind of stuff up in this role outside of academics. Go ahead. My question to both Caroline and Eric is, I'm curious to know, did you know that you were looking for that particular type of job when you were looking for jobs? Or did you just happen to say, oh, there's a job in Montana and I'm going to take it and it's a private setting? Or were you actually like, I don't want academics and this is what I want? Caroline, go ahead. You go first. Sure. I knew from, I guess, way back that I wanted to be an academic. So I was pretty focused in my job search in that manner. I just, yeah, I knew that I really wanted to be involved in teaching and in a wide variety of activities. So my wife is a gynecologic oncologist. We knew going into looking for jobs that we both had, we had to find a place or an institution that could accommodate both of us. So when we sat down, we went out for a drink one afternoon and brought out a, I think I pulled up a map of the US on my phone and we started crossing out states we didn't want to live in. And so we narrowed it down to about half the country and started kind of figuring out where our game plan was going to be. And we were really open to both the private, the academic, like I would have been happy kind of going in any direction. And Billings kind of fell into our lap. We had a lot of people recommend it to us. We're both from North Dakota. So we ended up moving to a place that was closer to home than we were before in Rochester, Minnesota. So it ended up being kind of a nice thing and a blessing in disguise, being able to go to a place where that was a nice fit for both of us, allowed us to really kind of spread our wings and kind of hit the ground running in a practice, and then also be closer to family, which has been nice for both of us. And I guess same for you, Anne. What about you answering the same question? For me, I think it was a little bit more limited in the sense that I wanted to stay in the New York City region. And so based on that, it's just whatever was available. So same thing, like Eric said, it was just like it fell into my lap, this job. And again, I mean, this is my personality too. I just go with the flow. And so I didn't sign this contract here until I think pretty much like May or June. So for a lot of people, that's really late in the game. A lot of people want contracts by January already. And I think I was fortunate in the sense that I have support from my family, like my husband, and just being able to have that luxury of just going with the flow, so to speak. Awesome. I'm going to go to a couple of the Q&A questions. So question, again, each of you give a couple answer. Do you work with other urogynecologists? Are you the only surgeon in your practice? How did that affect your practice kind of when you started? And I guess I'd say probably when you were looking for a job, is that something that you substantially took into account? That wasn't the specific question, but I think we get that quite a bit as a question, is I want a partner or I want to start on my own. So yeah, start with Dr. Cox, maybe. I'm one of five urogynes at Penn, and I did prefer a larger group because I like working in a team environment. That's just more fun for me. Just thinking about some of my friends who started practice at the same time who are one of two, who joined someone who was previously solo, it's a really different dynamic. And I feel like me joining as the fifth, people are more flexible about someone coming in with maybe different training. I had really different training than my partners, and they were all really accepting of it. Whereas if you're joining someone who's been in practice themselves for a really long time, it just might take a little more time for them to get used to someone who's different. And even someone who's having another person in the office. So that's just something to think about. I didn't really think about this question until you just asked it. But if I had to say, I think I was only looking for places that had other urogynecologists there. I think that was the unconscious desire that I wanted. Otherwise, I probably would have reached out to a lot of private practices and said, hey, I can offer you my services as a urogynecologist. And that actually has opened up a lot of opportunities for past fellows that I've seen. They just cold called hospitals or private practices and said, hey, are you looking for somebody? And actually, our most recent graduate found her job in San Diego that way. And she's the only urogynecologist. To me, I don't think I was very interested in setting up a new urogynecology practice, doing that business side of it, like looking for like the best urodynamic machine and all, you know, like all of that, like nitty gritty stuff I don't think I was interested in. So I definitely wanted to join a practice that was already there. Oh, and I guess at Sinai, because we're such a large institution, there are probably like 11 urogynecologists, but in each location has like different numbers. So let's say where I'm working at, there's one, I have one partner who's a urogynecologist, Dr. Asher Walsh, and then like, but you know, literally a 10 minute walk down the road I'm at Mount Sinai West, and there's like two other urogynecologists there, you know, so there is a large volume of urogynecologists at the institution, I would say. Yeah, for me, I was really open to kind of either one, kind of like, you know, I was more than happy to start my own thing somewhere. And I made a handful of cold calls to places where my wife and I were both interested in practicing, you know, and I would encourage people to do that if there's a place you want to be or an area you want to be in, I'd say, make calls, call random groups, see if they're interested. You're gonna get rejection, but you know, you never know until you start asking around. And you also get a lay of the land doing that, I think that that's a nice thing. You know, certainly, I think joining the practice I did, it was really nice for me in that Craig got here, I think, what, two or three years before I did, so he kind of laid the groundwork and did all the heavy lifting before I got here, so people were used to having urogynes around, you know, the way our practice works in the clinic is I don't have to compete with the urologists for, you know, overactive bladder and stress incontinence or prolapse for that matter, the generalists don't deal with prolapse or incontinence, so he kind of got everyone used to having a urogyne around, so from that perspective, it was really nice. But yeah, I mean, I think, you know, certainly something to keep in mind is the logistical things that you're gonna have to piece together if you go into a place without urogyne is making those good relationships and, you know, thinking about equipment and support staff and all that. I think some of the advice I got before the job search was, you know, was talking to just anybody you can, whether it's networking with other fellows or other attendings, other places, or even talking to a lot of the reps, device and medication reps. They know the lay of the land pretty well, and they can give you advice on different hospitals, different groups where there might be job openings, things like that to kind of give you a good idea of where to look and kind of what to look for. Awesome, yeah, I'd second that for sure. I do think, you know, pounding the pavement and utilizing any resource you can, and device reps are certainly a great resource because they know, you know, where things are and about the community and was it a caustic environment? And that's why the person left and those types of things. So that's great. So next question, we'll try it. So we've got some questions coming in. We got maybe a half hour left. So basically about salary compensation. Are you RVU based, you know, and how are you compensated? And, you know, a tougher question is how do you ensure that you'll have the patient volume to meet RVU requirements? And I don't know that there's an easy answer for that, but so go and we'll go back to Dr. Cox on kind of salary compensation. And I'd say, are you bonus? Do you have bonus options? Are you strict salary? Does everyone in your department make the same or your division make the same? Are you making different amounts? You know, those types of things. So my, I have a base salary and then the way Penn does it for all the faculty is everyone has an incentive plan that allows you to make above your base salary. And there are different categories on that plan. And then there are different amounts of fulfillment that you can get depending on what metrics you meet. You can get part of that incentive or the full incentive or anywhere in between. And I'm on a guaranteed salary for two, my first two years. And I think that's really, really important to ask for no matter where you start out is a guaranteed salary for the first couple of years because of that issue of building up the patient base. Everyone takes time to build up their patients. Was your base salary negotiable? Yeah, so I was able to negotiate that base salary. And then each year we essentially work out our incentive plan and what is weighted differently. We, you know, work with our division chair. She works with the ultimate chair on that. Great, Dr. Tran. So I also am in salary. My contract is for three years and my salary was, my base salary is not negotiable. They're very strict about like salary at Sinai. And part of it is paid by the actual medical school, like a certain portion. And then the rest is, I have to, once I'm off contract, I have to make up the RVU for that. So in terms of, again, getting referrals from other, I actually think that it helped that I trained here at Mount Sinai. And so I knew a lot of people already. So when they see me again, they're like, oh, why are you here again? And they know that I'm the urogynecologist. So now they start referring a lot of patients to me. And so that referral base is always helpful, which is, not everyone has the luxury of training where they're gonna end up. So I definitely benefited from that. I would say in terms of bonuses, I don't get any bonuses. I think it's up for renegotiation at the end of my three years. So just know that, definitely I agree with Caroline, like at least, like the best is like two, average is like two years contract, like salary-wise. And if you can get three, that's even better. And then what you can do is like renegotiate at the end of two years, if you're seeing that you're making more than what your salary is, you can just say, hey, can I get off of contract? If that's possible. Yeah, I mean, similar to the other two here, I started off on salary and that was negotiable. So I was able to, I think it was about a 10% ask, I think is what I went back with them, at them with, and they accepted that. So I had my base salary plus a student loan repayment bonus that I get every year for eight years, I think. Because you're again is considered under the Department of OB-GYN, which is considered primary care. So I get a primary care bonus, so who knew? But every state differs in what they're allowed to give and the same thing with institutions. So being a nonprofit institution, these institutions have to be careful in how much they give you. So there's other creative ways for compensation. And so ask whoever, you wanna know when you're applying for a job, what kind of institution it is, because that also will allow you to negotiate or not negotiate. And so I think when negotiating, and I encourage everyone to negotiate when you get your first contract, because again, all I can say is no. And so, but be reasonable. I think that's the biggest thing is just being reasonable with your ask. And know your numbers. One of the things that helped me the most with negotiating is that OGS payment or the OGS salary report, it's a survey that goes out to OGS members every year. And so I took those numbers of physician with less than five years experience and made that my starting point. And I do one of the percentiles off of that. And I sent them, they actually asked for the data. So I sent them the data and they said, okay, sounds reasonable. And so use those numbers to your advantage because they can really help you out in terms of negotiating. So use those numbers to your advantage because they can really help you out. Now that I'm two years out, I am on an RVU production model. And so I have a base salary. And as long as I hit certain thresholds that I get my salary, and certainly if I over-perform that, then I get bonused on top of that. And that bonus is paid out quarterly. And so at the end of the quarter, if I've exceeded my expectations, I get paid out quarterly. So you can see how much that is. And they also allow you to be creative too. So now that I've gone to production, they allow you to, as a group, pool and split RVUs. So as a group, like my partner and I could pool our RVUs and split them. So my wife's group, the Gynon group does that. So they pool all their RVUs and split them because that way everyone's kind of working hard and splitting the pot evenly. And there are certainly ways to do that. Hospitals tend to, I think, be reasonable as long as you're doing your work. Great. I mean, one thing on the farther mature end of things, but being cognizant of, one, your expectations of compensation and RVUs, because there are certainly places that'll give you a two-year salary that's astronomically high with basically no possibility to sustain that in the future. So understanding what are you gonna join? Who are you gonna join? How many RVUs are they pulling in per year? How are you gonna be able to sustain that? So if somebody's saying, we're gonna give you a guaranteed 650 for two years, and you're like, oh my gosh, that's amazing. Understanding what that's gonna turn to in 24 months is a very important concept to think about. So just keep that in mind. So in general, anything you wish you knew about before starting the job, anything you wish you had negotiated for, or things that you would have liked to ask during your job search, that's a couple of different questions sandwiched into one. But essentially, is there something or a group of things that you would set of these one particular thing, this is what I wish I would have known, or wish I could have known that I could have negotiated for those types of things. Dr. Cox. I honestly don't have anything that I wish I would have known going in. I didn't really have any big surprises personally in my job. So I'll let the other two answer. Dr. Tran. I don't think I have anything either to add to that question. You guys are pleasers. I think it's like, you know what I was getting into because I trained here. So it's very different. I knew who my partner was, I know the politics of the system. But if you are, I think, I don't, yeah, I really, I'll think about that. And if I find an answer, I'll, you know, inform the group. All right, you're putting it all on me guys. Thanks. You know, I was like, I know Eric. I will just say one thing, not from my experience, but from a friend's experience who started the same year as me, but started in private practice. And I'll say this being on maternity leave myself right now, she did not negotiate for her in maternity leave and then had to negotiate for it once she was pregnant and did not get what she wanted. And I think that's a huge issue. I would say for men and women, you know, we should really all have parental leave no matter what gender. So that would be a good thing to negotiate for if it's not like, for me, a pensive institutional thing. But if you're in a private practice, that's something you need to negotiate for. I mean, I think first and foremost, what I wish I would have known is that the COVID-19 pandemic would have happened because that wrecked my first year and a half of practice. Cause I think I was just, my practice was ramped up just to about like perfect. And then the pandemic happened and I didn't basically work for two months and we just didn't see patients. And it's mostly come back to, I think what I would consider normal. But yeah, that was tough trying to build a practice in the, you know, throughout the pandemic. I think that was real tough. I think the biggest thing I wish I had more experience with and knew more about was coding and billing and RVU and that whole business. I was kind of spoiled, you know, with Dr. Aquino at Mayo where we didn't worry a whole heck of a lot as trainees about RVUs and coding and billing. A lot of that stuff was done kind of behind the scenes. And to a great extent that's done for me here when it comes to clinic visits and things like that, that's all done by coders. So that's actually a question that you should be asking when you look for jobs is how that works because having coders do that for you is really helpful but on the same token, that can also hurt you because you could be missing out on a lot of potential revenue in the clinic and OR settings. Certainly when it comes to billing in the OR that was a steep learning curve for me. Knowing what to say, what to code for. You know, I look at, you know, the way my partner describes things and bills for things and it's like, wait, we're doing the same thing but you're calling it 10 different things and you're billing way more than I am. This is crazy. And so there's certainly a game to be played, I think from that standpoint. And I think learning it and knowing it and being comfortable with it. If you know that before you get into practice I think you're gonna be way ahead of the curve and being able to establish your practice. And then once you hit production, being ready for it and being able to, you know, be as productive as you can be. That's probably the thing I wish I'd known most about. I was lucky, I signed my contract in my second year. So I had a year, over a year to kind of prep and think about how I wanted my practice and knew, you know, what I wanted out of it, what equipment I needed, you know, those kinds of things. So if you get the opportunity to sign early, you know really think about it in advance and don't wait to the last minute because it really does take a lot of that anxiety away. Great. Next question, Eric, you kind of answered a little bit but you know, when did you guys start looking for like job opportunities, start interviewing and reaching out to places? And, you know, another question was how do you kind of put somebody on the back burner while you might be waiting to hear from somebody else? So if you were negotiating with a couple of different places how did you strategize to communicate with them? Well, I mean, I started, actually started looking for jobs before fellowship because I, you know I knew I was, what I was doing. And I knew the difficult spot that my wife and I had been being a couple in a two subspecialties that was going to probably take us longer to find a job than most. So I started that process fairly early and just again, cold calling people saying, hey, you got something open in three years and you got a lot of laughs, but, you know people do look ahead. And so the opportunity I found at Billings Clinic, you know, that started kind of showing up I think at the beginning of my second year a lot of kind of conversations happening and things kind of lining up into place so that when there was openings both in Geinach and Uruguay it worked out. What was the second part? Oh, putting someone in the background. So, yeah, we had, you know, a couple things going on at the same time we were talking to Billings Clinic and it was not a fun conversation to have because once we found where, you know at the Billings Clinic, we, it was a good fit. We knew it was, we knew we weren't going to find something that worked better for us. And so, you know, we took it. And I think, you know, if you know you want something and it's exactly what you want, I mean, take it, right? But it's a difficult, certainly difficult conversation to have, you know, tell someone, oh, hey by the way, those plane tickets you bought that hotel room you paid for, we're not gonna need it. We found another job. It certainly upsets the other parties, but, you know I think being honest and telling right away I think was the best thing to do. And even though I'm, you know, some I'm sure some feelings were hurt from the other end I think they were at least happy we did it right away and we're upfront about it. And also the other thing too is you know when we interviewed here we got asked are you looking other places and say yeah I am you know be honest I don't think you need to say oh no you're the only it's like residency fellowship of course everyone knows you're looking at other places um and just be honest and you know you don't have to give your all your secrets away but um I think honesty is probably the the best way to go. We'll reverse it. Dr. Tran how about the same question? I mean that's the honesty to me is the biggest you know like value you can bring to a program. So I actually had a lot of contracts um so I I had a a partner that I really wanted to work with except she was 77 miles away from me and I actually was willing to drive that in in New York traffic in New Jersey traffic that's horrible so um I my husband actually had to put a and no to that so then I you know like I had to tell her sorry like it's not going to work out but just being honest about it and saying like you know family-wise my dynamic it's not going to work out it's just going to eat too much time into my personal time um but I will say like if you're looking for a job like um tell I reach out for help before you're you're actually like looking because a lot of institutions have budget meetings that like actually they're looking like right now they'll in January they'll have like budget meetings for the next year like the next cycle like 2023 you know so that's like something to like um so if you can plant that seed into like wherever your ideal location is and then they can actually try to make that happen at their budget meeting you know like because every like they um I think you have to get the buy-in from the chairman or or whoever the you know whoever runs the the financial aspect of the hospital so once they buy in then it's just like you know getting down to the you know contract etc but I actually I actually was thinking about this recently and I said like like finding a job is kind of like dating you know like um you you know you have well if you have a lot of opportunities you if you just tell them honestly like you know like I am still looking like there's some reservations that I have and you can just say like these are my reservations and and you know like um but breaking up is really hard too you know so if you I would just like end it politely and honestly and say like you know it's not going to work out and then you know like that phrase of like oh I hope we can be friends like may not always work out but sometimes it does like that that my ideal you know partner like 77 miles like away like I still text her all the time you know and like we're we're friends but so I think honestly setting up um like knowing where you want to go beforehand like the earlier you are the better so then they can start you can ask for help from like all different aspects and then um you know just going with your instinct too like your intuition so yeah so I started um sending cold emails to academic um institutions in the spring of my second year of fellowship I have to say that wasn't very fruitful um it was much more fruitful to actually use connections and talk to people like I had a meeting with my chair at Michigan and she talked to people that she knew we have a small community so using your your ties is going to be really really key here reach out to everyone that you feel comfortable reaching out to um and that's how you're going to get the most um networking ability and then I was constantly looking at that Augs career site as well and that's where I ended up getting a few interviews from applying for jobs that were listed in there um and I want to say be flexible about all this you know nothing is that if somebody tells you they're going to have a job do not 100 believe them that they're going to have a job for you these things can fall through and if someone says they don't have a job don't believe that either Penn had told me at first they weren't hiring for two years and then they hired me so these things change all the time um and then the other thing on the saying no I mean I think that's really a key thing too like I I had a very early job offer that I had to delay because I haven't even finished my interviews yet and I I just asked them for an extension and they gave me an extension and it was very nice um and honestly I didn't tell them a final no until I had signed my contract with Penn because I didn't want to be left in a spot with no job yep and I think you know another great opportunity is conferences right you know augs sgs you know be out there meeting people if you want to be academic you know talk to the people who you know are the head of the academic places the fellowship directors hey I'm looking you know again two years how are things going you know what's going on and so I think you know introduce yourself we're all pretty nice people typically so you know the worst you can hear is something you know like Dr. Hawkins has said like hey you know probably not looking and then you know six months later you'll see him posting something online like oh we're looking for an academic urogynecologist so just you know no doesn't mean no yes doesn't mean yes like Dr. Cox said and just you know keep pushing forward so all right let me look at Q&A here um so a little bit you know what were your strategies you used to build up your you know your patient base and what were some of the challenges and I'd say just aside from COVID I think that's been a challenge for all the kind of younger people starting out so aside from COVID but even what were your planned strategies whether they may have come to fruition or not um from that side of things so we'll start with Dr. Cox again because you're on my screen. So I was lucky that at Penn there is a marketing team and I was able to meet with them and they were able to get me virtual meetings with some potential um referring providers and then also like they put up big posters with my face um in entranceways in the clinics like big big posters in my face um and that did attract some people who were just kind of walking by like oh I kind of need a urogynecologist um and then another thing I was able to do is work with my partners on them sending me patients to which I know it's not going to happen everywhere um but like I had a partner who was stepping back from prolapse surgery and I really wanted to do prolapse surgery so she gave me those patients she likes vulvar surgery so I give her all my vulvar patients so if you can kind of work that out with your new partner or partners like what you really prefer um that's that was really nice. Dr. Tran? I was gonna say we can switch it up and have Eric go first but um no like again I think I was very fortunate like um because I knew all the um like I knew all the people my referral base already but I would say if you like you can always like reach out a lot of the urgent care centers like um you can go and like kind of reach out to the providers there talk about like recurrent UTIs because I'm sure they get like a lot of those patients and drop off cards um in terms of like I think um you can give lectures to like different um like I guess departments that could actually help get your name out there a little bit more um and then just be available like you can also I honestly think the heart of any like OBGYN department is actually the obstetrics labor floor and so like I always walk by there like on my way to my office because it's like you have to walk by there and so like um always like just you know like you can drop off business cards there and say like hey if you have somebody with a support degree or you know somebody with postpartum life incontinence like please remember me and you know like um you can get a lot of like referrals that way as well. So yeah a couple things so uh one of the you know when I first moved to town my partner and I met at a local bar and decided to hash out our practice and kind of how we wanted to set things up and um you know we and he was and I got really lucky in that you know um we decided that we would kind of just share all the referrals and kind of split things down the middle so anything that came unless they're you know he had a specific relationship with somebody that was like I need to see him only um we decided hey anything that comes in like basically you know prolapse for prolapse, incontinence for incontinence, pain for pain because you don't want anybody getting loaded up on pelvic pain and everyone else getting all prolapsed um and so you know we basically split things down the middle in terms of referrals and we have a really nice cohesive practice that way that anything that comes through just kind of gets shifted to whoever is open and works really well like that. I've done some outreach visits uh or I should say some meet and greets so um you know in little communities outside of Billings um going to meet people, meet providers, shake hands, give cards, you know get them lunch, breakfast, that kind of thing. That all stopped at the start of the pandemic um there was plans to kind of go all over the place and then that stopped um but again that's changing um I gave some lectures so I gave uh you know went to the family medicine residency and gave a gave a lecture on incontinence to the residents and the attendings uh which was really nice because they were able to kind of meet put some faces to names and then um you know get some referrals that way. I did a lecture at a kind of a women's symposium uh thing for all of Montana though so it was kind of a web webinar conference so again got to to meet people in the community that way which is really nice. Um certainly some marketing things that the clinic did um but then we also do outreach so I go um I go to uh Bozeman a couple days a month, my partner does too, going up to a couple other places um and just kind of establishing outreach other places just to make sure we keep our um you know able to give access to patients throughout the state because we're a huge state. Not a lot of people but big geographically. Great and I mean I think from an academic perspective like sell yourself introduce yourself to people introduce hey I'm you know you know I'm Dr. Tom Korten you know Caroline Cox I'm one of the New York oncologists here nice to meet you you know to the colorectals to the orthos to everybody you know just introduce yourself be available if you're at a surgical center talk to them about like oh yeah hey you know get to know your urology team like get to know people who you're gonna probably eventually call for help potentially at some point in time in your life and and you know just introduce yourself and be open and collegial and I think that is helpful because there's a lot of people outside of OBGYN that don't know what a urogynecologist is right I mean so you talk to an orthopedic surgeon and they might say like what do you do like I do incontinence and prolapse you know and at least they'll know typically what incontinence is and they're like oh you know my friend has that or somebody asked me about that and then they'll start saying like oh I just talked to somebody about that let me send you to Dr. Cox you know those types of things so you know be available and that was really beneficial for me I did the same thing and meeting our the surgeons who do all the kind of the interrectal stuff here and the GI docs and letting them know that I do a sacral neuromodulation and it can help with your fecal incontinence patients and you know that's gotten me a lot of referrals from the general surgeons who are like yeah I don't want to do this here give it to Hockinstead you know so it's been really nice and then likewise you know we do combo rectal prolapse you know you know stuff like that so it's it's it goes both ways and I think they realize that too. And then one question which I know a lot of people always ask and we should hopefully fit around that out for maybe the last five minutes did you use a contract lawyer were they state specific and how did you find a lawyer when you were negotiating your you know signing your contract? Just start with Eric you're on my screen. Yep so first thing is and I tell this to everyone is read your contract like read every bit of it it's they're not that complicated but read through it so you know what's in it and then yes get a lawyer. I lucked out my one of my best friends so I was roommate of mine in college lives in Billings and it's from Billings and he's an attorney and so and he's also does a lot of contracts so it really worked out nicely for me so I'm probably the worst one to ask but yeah I would say just whoever you whenever you sign anything like that make sure someone looks at it it for mine is very boilerplate but you know it gives you some peace of mind anyway. Dr. Cox? It was very complicated and I did not understand a lot of the language in there even after obviously a lot of education. So I did not use a lawyer I used a contract expert who works with physicians and who has worked on the administrative side giving out contracts to I got his name from a fellow who was above me who had used him and it was fantastic he went through line by line on my contract with me explained everything to me and told me the exact questions to ask. He like helped me word my emails back and forth because that's kind of thing you don't really know how to correctly do. He helped me work on negotiations so probably more than just a lawyer would do this guy was able to do if anyone wants his name you could send me a message. But yeah talk to the fellows above you to see what they have done. Could you give an idea maybe what roughly what you may have paid for that service? I think I paid $800 and it was worth much more than that. Yeah for sure that's that's very inexpensive. I would get that person's email from Dr. Cox because that's a unique person you don't hear about those people very often you know just because again you're usually attorney bill in 400 an hour and they're just going over the wording and saying like I changed this so that's awesome. Ann? I wish I had that lawyer or contract negotiator email but I would I will write it down for any future you know if I change think about changing jobs but no I used a lawyer. I chose this one just because she billed per contract you know as opposed to per hour and I paid about four thousand dollars. All right well we have you know two minutes any final parting words of wisdom for our attendees tonight? I feel like I should give a Adam sit like a Billy Madison quote stay there as long as you can no but I know you'd like that one Okina. No I would say just you know enjoy your time in fellowship like you know it getting out of it's really fun I think being in practice now is a blast and I really enjoy it but soak up everything you can from your attendings like they give you a ton of advice get you really ready for things and don't be like super intimidated by it like go into it you know confident and prepared like you do for everything else and I think you're going to come out the other end happy and just remember you don't like a job you can always find another one you know and and that's you know wherever you end up isn't necessarily the place you're going to be your whole life so and I think keeping that in mind will kind of set your mind at ease hopefully a little bit. I'm still looking for this guy's email and we're all reachable by email so if anyone has any other questions or wants to like a one-on-one session with any of us please like just email us. Well I want to say we're about at our time thank you to the panelists for sharing their wealth of knowledge a little bit about this subject because it's so important and and I'm hopeful that we have something like this at least annually to keep giving back so again all reachable by email and thank everybody for listening. Thank you. Hi. Hi.

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