Lessons in Orthopaedic Leadership: An AOA Podcast
Lessons in Orthopaedic Leadership: An AOA Podcast
Finding Your Path: Navigating Early Career Job Changes in Medicine with Antonia Chen, MD, FAOA, and Clayton Nuelle, MD
Whether you're contemplating your first practice or considering a job change, this conversation offers invaluable guidance from those who've successfully navigated multiple transitions.
AOA Emerging Leader Aaron Brandt, MD, had a discussion with Antonia Chen, MD, FAOA, and Clayton Nuelle, MD, about transitioning jobs early in your career, and how to decide what your non-negotiables are for your workplace environment.
What drives these transitions? As our guests reveal, it's often a combination of "push factors" moving you away from your current situation and "pull factors" drawing you toward new opportunities. Despite the statistic that over 50% of surgeons change their first job within three years, these transitions are rarely discussed openly, leaving many physicians feeling isolated when considering a move.
Both physicians share candid insights about creating personal lists of "negotiables" versus "non-negotiables" when evaluating both current and potential positions. Both surgeons advocate for transparency with leadership when considering opportunities and leveraging mentorship networks to find positions aligned with your evolving career goals. They also discuss practical considerations like understanding contract terms around tail insurance, signing bonuses, and trailing collections before making any move.
Welcome to the AOA podcast. My name is Dr Aaron Brandt and in this episode we're going to be discussing changing jobs in early career. I am joined by two great faculty today, both members of the AOA. Dr Antonia Chen she is a professor and chair at UT Southwestern for the orthopedic surgery department, a hip and knee surgeon by trade. Southwestern for the orthopedic surgery department, a hip and knee surgeon by trade. And Clay Nolley, sports medicine associate professor, newly associate professor at the University of Missouri, and today's podcast is focused really on changing jobs, which is not something that we talk about very often. But both of these faculty will be able to contribute their views and please feel free to introduce yourselves and tell me a little bit about your paths and kind of the process that got you to where you are now. Maybe we can start with Dr Chen.
Speaker 1:How long do we have? I'm just kidding.
Speaker 2:It's like the little brief, because we will kind of take it from there.
Speaker 1:So I started my job at Rothman Institute. I did my fellowship at Rothman Institute and stayed there as an attending and my first job transition was to Brigham and Women's Hospital in Boston. And then my second job transition, just this past September, was from Brigham and Women's Hospital down to UT, southwestern. Very different reasons for transitioning and all very different practices.
Speaker 2:Yeah, yeah, very much so.
Speaker 3:Kind of similarly.
Speaker 3:I did my fellowship at Mizzou University of Missouri in sports medicine and stayed on as faculty, but in an interesting kind of setup where I was not straight academic faculty, I actually operated and saw patients primarily at an affiliate community hospital.
Speaker 3:So it was almost more like a hospital employed position in terms of like kind of makeup of the practice and like kind of how the situation was for a couple of years. And then we moved to Texas and I was actually in private practice. I'm in a very big, well-run physician owned private practice with physician ownership of surgery centers and all that goes into that for four years. And then we moved back to Missouri and now I am very academic and strictly at academic institution and the mothership, so to speak, if you want to call it that at an academic practice and a sports medicine practice affiliated with high level team coverage and all of that sort of thing and we can get into some of those types of things. But then so I've kind of gone back and forth from almost really community kind of hospital employed, so to speak to big private practice. Now it's like straight academic practice.
Speaker 2:Yeah, I mean that's a lot. Yeah, as someone who's kind of just getting going and I did just go through my own job transition it's a lot to process to see that both of you can have been moving around. But I guess start from Dr Chen. Maybe what led to kind of some of those transitions? Was it typically just career advancement? Was it anything in particular?
Speaker 1:I think it's a combination of things. I think, when it comes to job transitions, you have to look at a few things One, you have to look at yourself. Two, you have to look at what you want in your life. And three, you have to look at what your surroundings are.
Speaker 1:I remember starting off at the Rothman Institute and it was great because I was a fellow there. But it was also I was a fellow there, and so one of the things I learned quickly is that because you're a fellow at a location and you transition to an attending doesn't mean everyone treats you like an attending. And that's one of those hard transitions to make, because you know you're familiar with the people. That's really nice. You know exactly where everything is, you know where the bathrooms are, you know you know the research team, you know the clinical team and I learned a lot from being at Rothman Institute, obviously being a privademic place. I learned the business of medicine, I learned what I would like to open up almost like a surgery center that they did and they started operating out of. So a lot of the important life lessons that I learned about running a practice becoming busy.
Speaker 1:Building a practice was really good at Rothman Institute and you know, when I was at Rothman Institute, it's one of those things where I think most of us don't expect to leave your first job. I didn't expect to leave my first job. To be perfectly honest, I was like I'm not going to become a statistic they say what 50% of people leave within the first three years and I became a statistic. So it's just one of those things where my interests were to grow more clinically and I didn't have that opportunity there. I also wanted to grow more independently in a research fashion and I didn't have that opportunity there.
Speaker 1:Right, like I. You know learn how to run an efficient practice, run. You know multiple rooms, you know staggering, doing a good job with that and able to take those skills to a different location. But I realized that after three years that it wasn't a good fit for me in the long term. But realizing that is a really hard one. You have to be honest with yourself, honest with your surroundings and also people that you work with I mean, these are mentors of mine, right that I had gone through fellowship with and to say, hey, I think I should go somewhere else was a tough decision to make. Easier to talk about it now than it was at that time. But everything happens for a reason.
Speaker 2:Yeah, I like that. It seems like there's a challenge with that. I think you clearly would have put in plenty of effort to keep those relationships and build that structure at your location. So I think that was probably very tough. I totally get that. Felt the same way about that, dr Nolley, we had talked about just briefly before. How are these jobs coming about, or how are these opportunities coming about? And I think that's also something that everyone wants to kind of figure out. If it's not working, or is there something that's supposed to be better for me out there, even if I'm not looking? What are your thoughts on that? Or how did how did that happen for you?
Speaker 3:Yeah, I mean I think you know you start talking about job changing or people changing jobs and stuff. There's really probably kind of two kind of scenarios in general. There's a lot of scenarios, obviously, but two kind of main scenarios. One is I'm not happy where I'm at, or this is not a good situation for me, or I need to do something different. And then another one is maybe OK, maybe I'm OK here, or maybe I am happy here, but maybe there's potentially a better situation, or maybe I'm even getting recruited to somewhere else and I could, you know, as Dr Chin said, maybe I can rise clinically or maybe I can rise professionally or, you know, in leadership capacities or things like that, and those can be similar, but they can also be two very separate things.
Speaker 3:I think the first one is probably encountered a lot more in very early career surgeons. I mean, I think you know, I think we've all seen the statistics from AAOS, you know I think it's over 50% of you know, early career surgeons change their for after their first jobs, right? You know Dr Chin mentioned I don't want to be a statistic, that's the statistics he's referring to right? And so I think those reasons are probably most commonly because either the people aren't real happy in that first job that they chose, for whatever reason that may be, or they think that there's definitely, once they get into practice, they realize their practice is maybe different than what they thought it was going to be and they realize that there may be a situation that's better for them or better suited for them or just gives them different opportunity. I think more, once you get to mid-career, oftentimes people are pretty established and pretty comfortable in their practice but there may be an opportunity that launches their career to the next level or a leadership position elsewhere, or just a general situation where they're being recruited to another institution. So I think those are two separate scenarios, but certainly for the early career surgeon or the early career job, I think people choose their first job out of practice for a ton of different reasons, right, and sometimes those reasons are good ones and sometimes those reasons may not be as good ones. You know, certainly we hear when we talk to our residents and fellows and we kind of try and coach them and educate them. We try to educate them. That number one, first and foremost.
Speaker 3:It's not always just all about the money, you know. I think that sometimes the you know the elephant in the room, but it needs to be said sometimes because certainly we all understand people have debt and people have financial issues and things. But sometimes people choose jobs based on solely financial scenarios and they don't think about their actual practice, life, their home life, all of those things that go into that and the actual clinical practice. And then sometimes they get in a situation where maybe it's not super tenable or their clinical practice isn't what they want and that's why they changed. But sometimes it's just a scenario where people take the first job that they feel like they can get and then it doesn't end up being exactly what they thought it was going to be or going to be promised to them. So I think you know there's a lot of different reasons that people change jobs, probably somewhat based on where they are in their career or where they accept a job or what the location looks like. But those are a lot of different types of scenarios for sure.
Speaker 2:Yeah, yeah, and this is exactly kind of what the conversations tend to be, just with everybody is the why that first job is always hard, and so this is kind of the follow up to the one that we did with the emerging leaders, based on starting practice and doing that, I guess from your perspectives, having changed multiple times, what opportunities or how do you advise kind of the emerging leaders and those early surgeons to optimize their current situation, to try not to be that our departments, but sometimes it doesn't work, but is anything you take from your prior experience that would help people kind of optimize, advocate for themselves, things like that.
Speaker 1:I think there's two sects of thought when we're going through this decision-making. One, you're talking about emerging leaders who are looking for a job, and then emerging leaders who are currently in their first job, and I mean we can tackle both of them. If you're looking for a job, clay really hit it on nail on the head, right. You have to understand why you're taking a job and then the expectations of the job. You know, one of the things I tell people to do when you're applying for a residency or applying for fellowship is make a list of all the things that you say are non-negotiable, that you have to have in a program, and then those things that are negotiable but are nice to have. I say the same thing is true for a job right Now. The hard part is we don't always know what we want when we first start out, right Like when I first started out, I thought I really wanted to do a lot of research. So when they offered me a contract of two days clinical and three days research, I was like okay, I can work with, do a lot of clinical, I want to operate, I want to be in, I want to be in that setting. So you know, I took as much call as possible. I was doing cases on nights and weekends, you know, I was able to not get out of the park, but I had to work at really odd hours to get that Cause I didn't have dedicated OR time and I picked up more clinic time, those sorts of things. Right, but I had to claw, I have to admit, right, people like to be, you know, given that time and you can build it and things like that. And so when I went to my next job, I made sure that I had a lot more clinical time. Right, it was almost all clinical time, but that was my personal choice and I didn't know that about myself, right? So if, when you're starting a job, know thyself as much as possible, make a list of what are negotiables, non-negotiable. If location is non-negotiable, put that on the list, because that will potentially restrict how many places you can go to Academic versus private, all those sorts of things like that. But there's other things that are non-tangibles, that people don't necessarily think about, things like mentorship or having senior partners, you know, or being on an island by yourself versus having other people around. But on the flip side of things, having 20 arthroplasty partners versus you know two. Those are things that you know I don't really think that I thought of through when I was going through the process and then in the process of itself I think, when it comes to switching jobs, once you're in that place, how to make it better Again, go back to that list of negotiables non-negotiables.
Speaker 1:Are things changeable, right? Am I able to get mentorship from another attending in the same hospital, even if they're not part of my practice? And if that helps me, then that's good, right? Or you know, I actually want more research time, I want more admin time or something like that. Can I negotiate that with my practice and get that compensated, right? Is it a work-life balance thing? You're like, well, I'm working on nights and weekends but I don't have OR time. You know how can I leverage that and get OR time so that I have dedicated time? So look at your situation and say what would make me content Nothing's going to make us happy, but what will make me content in this job and what can I get feasibly in that? And then what are, again, the non-negotiables that I can attain that are actually really important? And if that's unattainable in your current practice, then maybe you start looking at another practice.
Speaker 2:I love that and, Tony, like content is such a good word Like we want to be optimists and we want to walk in and just have these rose colored glasses. But I think that in this process and in this career, it's that's not how it works and there's always going to be good, there's always going to be bad, and just kind of weighing those options and I love like your list. I wrote them down like tips and I would recommend that to everybody all the early surgeons, really anybody at any stage. Have your list, revisit it, decide what's actually contributing to the challenges that you're doing. Is this a me or is this something that can't be changed? So I love that and I think content is. We want to be happy, but content is a great goal. But Clay, I guess follow up on that, yeah, I mean she hit the nail perfectly on the head.
Speaker 3:It sounds like we're going to be very similar, antonia and I, in all of this discussion, but that makes sense with people who have changed multiple jobs and experienced a lot of things now, right, and so I mean, I mean, I think the main tenet is exactly what she said and what you reiterated, aaron there is no perfect job, right? I mean, we all like to think there is, but obviously we've all changed jobs a couple of times now, so we can all pretend to that and, truthfully, if somebody at a job that's recruiting you or where you're going to, tells you that it is a perfect job or there's nothing wrong with it, honestly that could be a little bit of a red flag, right, because everybody knows that nothing is perfect. There's great things about every place. There's not so great things about every place, and every place has its warts. Regardless of this or that, it's just a matter of deciding what works best for each person and deciding whether or not those warts are really big and really difficult to deal with, or they're really small and they're just things that happen at every hospital, right, and so there's no perfect job. It's a matter of just trying to find the job that is the best fit overall and the best way that you possibly can and you used a great word with content, and Antonio made a great point that we tell our fellows in residence too we call it a Franklin T. That's kind of like the old school method of what it is right, but it's the exact same thing Pertinent positives, pertinent negatives we're all used to that in medical lexicon.
Speaker 3:And so what are the things that you and I even tell our folks to even stratify at another level even more? So? It's things that you absolutely have to have, things that you would like to have, things that you absolutely do not want, no matter what, and then things that you think you probably don't want but you could probably deal with. So it's actually even kind of stratified into four categories and the absolute must-ves and the absolute don't wants. Those are absolutes, right, and she mentioned one. Maybe one is location for one or the other in either of those categories, right, Whether you want to live in a big city or you don't want to live in a big city, for example, or something like that, or your family does or doesn't, and then there's a whole lot of the like I would like to have and then I don't think I want or I don't think I would like to have, and she mentioned one for herself in terms of research starting out and then that changing and the ones in the middle, the likes and don't likes, those usually can change over time or those may change as you get into practice.
Speaker 3:Or as you get into a practice the absolutes usually don't change or don't change or don't move one way or another a whole lot. So you can start with those and that narrows your scope down quite a bit potentially for some people from the start. And then you start getting into the likes and wants and don't wants and don't likes and then you can really kind of start to tease things out and narrow things down even more based on those individual factors.
Speaker 3:I love that.
Speaker 2:Yeah, and I think that and those factors all change. I think that's the other thing that just be flexible, because there are things that you think that you want and need that can change as you work through things. So that's part of kind of growing and developing. I tell people that with even residency applications that like if you're seeing smoke get out the fan, you know like you got to start asking the questions and pushing those buttons because it's not perfect.
Speaker 3:So I like that. I like that term. I'm going to start using that, Aaron. So I like that. I like that term.
Speaker 1:I'm going to start using that, aaron, I like it.
Speaker 2:I'm full of them, awesome. Well, the other things that kind of come up with these conversations is kind of like how do I find opportunities if I am starting to look? Did either of you have that like to where you were, saw the writing on the wall and just were looking for this next layer? Or I think both of your situations sounded a lot of kind of progression and good reasons, but any of the not so good reasons.
Speaker 1:When I say leaving a job, I would look at the push and the pull, you know. Are you being pushed to something or are you being pulled to something else? Right, in an ideal world, everything's a pull, right? Oh, this next opportunity is great, this is where I want it. But in reality a lot of time is push or a combination of the push and the pull.
Speaker 1:I was fortunate in that when I was at my first job, someone had reached out to me at Brigham and said are you interested in a position here? And at the beginning I was like no, I'm actually pretty happy here. But it depends what you quantify as happiness. I think from a push perspective it was one of those things where I was one of many different arthroplasty surgeons and where I was pretty saturated with arthroplasty surgeons, so that made it not the greatest in the world. It also was an opportunities where, again, I had envisioned myself doing more of the clinical work and more of the research work in that realm and it didn't feel like I could achieve what I wanted to achieve. I said, for lack of a better term. So from a push perspective, it was one of those things where I was not necessarily getting the same support that I thought I would be getting and versus where I was getting a pull from somewhere else. They're like, hey, why don't you come up here and run our arthroplasty research, for example? And again, from an academic standpoint, that was a really cool opportunity. Now it's because no one wanted to do it, but that said, it was something that was neat that I could make it my own.
Speaker 1:So the first time I was asked to go interview at this at the Brigham, where I ended up going to, I was like I'll check it out. And so I checked it out and I didn't end up going there. And the second time I checked it out, the question I got asked was this is like a guy asking a girl out for a prom date Like, are you gonna say no to me? Twice? I was like, well, the timing wasn't right. You know and that's the first time I checked was a year and a half into practice and at that point in time, like the boards collection timeframe, that's, like, you know, one of those things where it just wasn't a good time to move. And so the one thing I do recommend for anyone is it can't hurt to check out other job opportunities Right, even if you're not necessarily interested in it at that time, it can't hurt to look at them. So there's, you know, some not positive things and there are some you know from being in the push. And then there's positive things from the pool.
Speaker 1:And I had to start from scratch. Right, I had to develop a name again. I had to. No one knew me right. And so to work and take that process. I warn people that takes, depending on the practice you walk into. If something's not well established for you ahead of time let's say someone's retiring and giving it to you that's three to five years, you know. So you can't expect to walk in and say like, hey, I'm going to have exactly what I had before, my OS flash practice and my new practice now. So there are some downsides to it. But just recognizing which draws you more. Is it the pull that's driving you more, or is the push or the combination? Either way, then it's a sign I'd say.
Speaker 2:Yeah, I like that my thoughts.
Speaker 3:Yeah, I mean, I think you know antonio mentioned something earlier that I think is really vital and can help when it comes to, like, changing jobs or looking into change jobs, and that's mentorship and leaning on mentors. You know, obviously that's one thing that I think the aoa does a great job of is developing these mentorship programs, and I would encourage everyone in the aoa to get involved in some sort of the mentorship programs or the different types of things. Or, if you attend the aoa meeting, attend some of the you know some of the mentorship programs or the different types of things. Or, if you attend the AOA meeting, attend some of the you know some of the talks or some of the symposiums that the AOA does on mentorship, because it's huge and it can benefit you in so many different ways, one of which is what we're talking about with connections, or having people that have connections that can help you, and so just a brief example for me.
Speaker 3:So the reason we moved to Texas is because my wife was military, and so she had a service commitment to the United States Air Force, where she's going to be a hand and microvascular surgeon for four years in the United States Air Force in San Antonio Texas and I was going with her. I wasn't staying behind with, you know, with a family and everything else but that meant I had to find a job in San Antonio Texas. And so and I, we knew nothing about San Antonio Texas, never even been there before. So I reached out to a couple of my mentors, one of which was one of my fellowship directors, and I said, hey, you know, anybody in San Antonio that, like, would be willing to maybe hire a guy, and sure enough, he was really good friends with Steve Burkhart, which is a name that anybody that's done shoulder surgery probably knows pretty well or read the books and stuff. And he linked me up with him and said this guy's a great guy.
Speaker 3:Guy, you got to interview him, you got to talk to him, you know, you got to take him all this kind of stuff you know that mentors do for you. And then, sure enough, you know, after meeting with him a couple of times, it worked out really well, and so I was fortunate to link up that way, but it really went. It really went. That simply is that you know, one of my mentors talked to one of his good friends, who then kind of linked us all up together and made it all work and it ended up being a great opportunity in a private practice in Texas. And so I would just say, you know, leaning on mentors or trying to develop those relationships or utilize your mentors or your connections that you have through organizations like AOA and things like that could really help you. You know, guide the job search or guide, you know, to certain positions that people, trusted people, can give you better information about.
Speaker 2:Yeah, yeah, and that's something that I've noticed through the process is and I'm going to throw out what may seem like random comments through this conversation but authentic authenticity and being authentic as a person throughout this process, no matter what you're doing, is huge, because that's when the opportunities really do come. So those mentors, those sponsors, those people are going to be able to advocate for you better or help you find those spots If you know at least a little bit of what you want and who you are. And so that's why I've enjoyed kind of hearing your guys' paths, because it seems like, regardless of whether it was a push or a pull, these opportunities came or these changes came because of those things as well, and that's that for me. I just made that change myself. It wasn't that I was necessarily looking, it wasn't quite the right situation, but I have been very lucky to have great, wonderful sponsors and people who have advocated and pulled, which has been helpful for me, because I'm going to be the first to admit I don't know what I want.
Speaker 2:I know a little bit of what I don't want, and so that's kind of how I've made decisions. So that's part of the process. I want to kind of work into the process of leaving. And these are the hard conversations. And, antonio, you're now chair. I'm sure you've had to have these conversations and we've had them a few times now. But how do we have these conversations and do it without hurting our situation where we're at, and doing it the right way? I guess, if there is a right way.
Speaker 1:So everyone has a different path. I would actually add something to the whole mentorship and people idea. This is a topic that people don't talk about. I remember when I was looking for a new job and leaving I felt like a pariah. I feel like there was no one opened up about it Again. Where I was coming from, everyone was like, well, no one leaves the Rothman Institute and you're like, wait a second, but if I leave then, am I weird? What's wrong with me? Things like that.
Speaker 2:So I hope you find what you're looking for is what I kept hearing.
Speaker 1:I'm like find yourself. It's a millennial topic, that's one of the things. But the discussions are hard, so there's a few ways to look at this. So I think it depends on the reason why you're leaving, right? So before leaving my first job, it was a discussion of the people that are saying, hey, these are the things that I'd want. Is it possible to achieve these? More clinical time or whatever. And if they can't deliver that, then when you look for another opportunity to present another opportunity to them, it's not a surprise, right? You've been asking this for a period of time. They can't fulfill it, and you know, for whatever variety of reasons, and if they can't fulfill it, then you have to seek somewhere else to accomplish that.
Speaker 1:On the flip side, when I was leaving Brigham, I had some job interviews and all the job opportunities. I was very upfront with my chair very early on. I was like, hey, I'm interviewing at these other places, this is what I'm looking for. Are these things that I can achieve here? So, for example, I wanted to be chief of arthroplasty just to really get the leadership opportunities there, to understand what it's like and to really help change the needle of what we did in arthroplasty at Brigham and after some time my chair, to his credit, gave it to me, which is really nice, and you go. You know, what can we do to keep you here? Or what can we do to? You know, advance your career here. And every time I brought up something. Sometimes they could do it, sometimes they couldn't right, and I had to ask myself is this enough of a needle to move me to move somewhere else or not move somewhere else? But I think the worst thing to do is to be clandestine and not be upfront with your leadership and interview at jobs. Then all of a sudden spring a job at them or say, oh, I'm going to this job opportunity because I couldn't have that here, and they're like well, I didn't know you had all these concerns or questions and things like that.
Speaker 1:So communicating early, I think, is one thing and then communicating with their patients is another thing. That's always a tough one. After establishing a practice for a period of time. It's always tough to leave them, tough to leave the people that you've worked with. But again, as long as you're upfront as to why you're doing it and what you're going to. So here was a big pool. Right, I was. I got to be a chair of a department which is a pretty cool pool. So less of a push, really, not much of a push there, but much more of a pool here. But again some. And then there's some things that I did say to my chair. I'm like, well, you know, here's the few things that I would want to be able to change, and some things are not changeable, as we know, from a systems perspective. So, no matter, as much as my chair would love to be able to do so, that's not necessarily a feasible thing. So being honest with people you work with, so that nothing's a surprise, is a nice thing, I think.
Speaker 3:I love that you gave your first you know your first spot at Rothman the opportunity to meet you at your goals and expectations, or at least you set those expectations and you gave them things that you were looking for to further your career and at least you gave them the opportunity to do that. At least it sounds like it and that sometimes that may be feasible and sometimes may not, and that's okay, right If certain places that you just said can't meet you at those things, but you at least gave them that opportunity Cause then when those opportunities did arise for you elsewhere, like you said, they couldn't be surprised when you went to then go take those opportunities. I love that.
Speaker 1:Yeah, it makes sense, but one of those things for you to be honest with yourself and then honest with them, you know, and that's not a fun conversation either.
Speaker 3:How about for you, clay? So if I could, I think the first thing I always say is if you're thinking about leaving or even looking into leaving number one and we say it all the time and it seems basic, but it's so true and obviously we've all heard the horror stories Don't burn any bridges anywhere, anytime. Like it's easy to say, it's a lot harder to do, especially if you're going to take a new job or if you know you're going to go somewhere else, or if you even really don't like where you're at. Like don't burn bridges. Like this is a small world, it's a small community, no matter what special subspecialty you're in, whatever. Like just don't burn bridges anywhere you are, even if somebody wronged you. Like just take the high road a hundred percent of the time. It's a lot easier said than done for all of us, of course, but like just try and keep repeating that mantra to yourself before, during and after a job search or a job leave.
Speaker 3:If I could get slightly more granular, I won't dive too far into the weeds, but I think one of the things that is important is before you even sign a contract, whether it even be your first contract or when you're looking for a next contract is to. You do have to ask some of the hard questions ahead of time, and some of the things as simple as like if I were to leave, what is my tail insurance look like? Who pays for it? Do I have to pay for it? Does the department or the institution or the group pay for it? What about a signing bonus that I may or may not have received? What about some of the compensation? What about some of the trailing collections? Who gets that or does it still come?
Speaker 3:And so those are maybe a little bit more granular things that may be beyond the scope of this particular general conversation, but those are hard questions to ask when you're negotiating with a new job or a new place, right, because you don't want to give the idea of I'm already looking for my out before I even sign or before I even join the place.
Speaker 3:But they're important things because, again, as we've stated, the statistics half of people are going to leave, and so, like you need to plan ahead for the, just in case. It's just like getting life insurance or disability insurance, right, we all hope that none of us ever have to use or need any of that. But somebody's going to, some of us are going to, someone's going to need to, so you got to have it right and so you really got to like, get down, fine tune all those granular details of some of those specific things ahead of time to prepare yourself, if and when you do leave or you do need to leave, that all those things are lined out and written and in contract form well ahead of time. Yeah, yeah.
Speaker 2:Yeah, that's not completely part of the part of this, but it is. I mean, these are part of having the conversations, is being prepared to have these conversations and you don't want to go into it with looking for the out, but this is, it's part of the job, it's something that I, like I felt awful trying to go and have these conversations with my chair. It was someone that I still, to this day, consider a game changer for me, not just mentor, but kind of that next level, if you will. So, like you said, I was very upfront with him from the start. I got mixed information on kind of how to approach that.
Speaker 2:Some people were like you don't have to talk to anybody, you can just kind of explore and see, but to me it just didn't feel truthful and so, again, just going back to just not burning bridges in the way that I wanted to be perceived Like, is it me to kind of go behind back and look for jobs or do I want to kind of be upfront and go through the process with them? It also gave me the opportunity to talk about the things that I was having trouble with, and that conversation needs to be ongoing. It's part of optimizing that first job and optimizing your situation and I'm not the best at that and we're still working on it, but learned a lot from the first process, so I love that. Yeah, I think that's important. That first contract or that second contract, whatever contract you're in being comfortable and safe in your job is great. It takes a lot of pressure off of you too as far as just kind of focusing on the work.
Speaker 1:How do you like what? Something that Clay said, and I really do like to emphasize, like don't burn bridges and don't burn bridges from residency, don't burn bridges from med school, don't burn bridges from fellowship. I ended up my job at Brigham because my chair was my residency attending. You know, and that's crazy how small of a world we had. Right, clay's. Back to you know, it's all right, like it's. There's reasons that things happen and if you had burn bridges then it'd be a very different discussion. Orthopedics is a very small world. Private, academic, doesn't matter what it is. It's a small world. So don't piss people off, you know, and there's obviously reasons and when to you know, obviously not to burn bridges but to bring things to light that are wrong, but to have you know things that I didn't like in my last practice but I wasn't just like this is dumb, this is stupid, you guys stink for having it this way or making me do this for the last four years.
Speaker 3:I said, hey, like this is a situation, this is something that's kind of difficult.
Speaker 3:This is not why I'm leaving I'm leaving for different reasons but this is something you guys may want to look at as a group moving forward, or this is something that could, you know, potentially be an opportunity to improve. And they took that to heart, like they took what I said. You know, I had an exit interview with a bunch of the folks in the group and I said this is all the things that I love about this place. You guys are doing awesome in so many ways. Here's a few things that you know were difficult for me while I was here and that could be better, and they since changed almost every single one of those things for the new partners that they've added, and it's made it a better opportunity for the surgeons that have come behind me, and so and I still have great relationships with all those people. I think, at least in part because of that, because they feel like they've gotten better in some respects just from learning and from some of those constructive parameters that you know that I gave them before even leaving Awesome.
Speaker 2:Yeah, yeah. I think that's incredibly important and to that end, I went to medical school here in New York and did not want to stay for residency, which many people would be like, oh, like there's no way they would ever bring you back, you know. But that's kind of how this opportunity came back was mentors and sponsors who recalled that, even with me being like I really don't want to be here, coming back and asking that question. I thought was pretty, pretty cool. So just to follow up on that, those points of the not burning those bridges, keep things open and have kind of truthful conversations. But we're running a little bit low on time. I think this has been exactly what I think people need to hear and people should talk about. Hopefully it will kind of lead to more conversations and more openness about these discussions because it is a real thing, a real common thing, definitely not advocating for job change, but it's part of the career, part of the process. I guess any kind of closing words of wisdom from you guys before we sign off.
Speaker 1:Reach out anytime is what I would say. You know, we've gone through it. You'll be surprised at how many people have gone through the process of changing jobs, and if one person can't relate to the reason why you're changing a job, find someone else. You know everyone has different reasons for it, and maybe your mentor for something is not your mentor for changing your job, and that's okay. It's okay to have mentors in multiple different spots. I like what Clay said about having your mentorship leaning on people. The AOA is a great foundation for that. There's multiple different ways that you can do that, and so finding your people, to talk to it, that you can be candid with and honest with, and to get a really good assessment of whether or not you should leave, what you should leave for, if the opportunity is really the reason to leave, those are important things to have.
Speaker 3:I always tell our folks don't be afraid to ask for anything or within scope of reason, of course, but don't be afraid the worst that any place or any new place or any different place, the worst thing that can happen is they say no or no, we just can't do that here. But don't be. I think when people are looking for jobs especially their first job, but even their second job like people are afraid to ask for something or afraid to negotiate something because they're like, oh, I don't want to come across as a greedy person or I don't know if they would even be able to do it. Like the worst thing that can happen is they say we can't do that, like, right, like so, don't be afraid to ask, and if you don't ask, you may never even have the chance to get it Right. This is what I always tell our fellows and residents. Like if you really want something, or even if you think you want something but you don't ask, they're probably not just going to come out and give it to you, or just come out and say, oh, how about we give you this extra day of our time? Or how about we give you this or that Right? Or how about we give you just two academic days of paid time. You know, whatever it may be, you can name the situation. So not they may be able to accommodate you, or maybe something else may not work quite as well, but they accommodate you for what the ask is or what the ask was.
Speaker 3:And especially if you are changing jobs, it's important to know to think about the fact that, like, you're in a little bit different situation than when you're just coming out of training, right, like when you're first coming out of training, a lot of people are just hoping to get a good job. Right, once you've been in practice, especially if you've been in practice for a few years, or especially if you're board certified, or especially if you know you've established yourself in research space or academic space or clinical volume, whatever it may be. Now you hold a few more cards a little bit right, like you've established yourself as a quality surgeon, hopefully, or whatever, in different places, and so you hold a little bit more cars and a little bit more sway, and so your negotiating power is a little bit better. Not that, again, that it's all about negotiating power. It should be about finding the best opportunity and the best fit for you.
Speaker 3:But don't be afraid to ask for things, and if a place is looking at you once you've been in practice for a few years already it's probably because they have a need and because they want you, hopefully and potentially in many cases. So don't be afraid to like kind of push the envelope a little bit again, within reason. Like we've said before, you don't want to be a jerk to anybody or anything, but like don't be afraid to ask for things and push the envelope Awesome.
Speaker 2:Yeah, I mean that's perfect. You even kind of referenced back to that starting practice. You definitely have to optimize and do your best in that first job, like if it turns into your career job, wonderful, but it still is going to affect the process moving forward. So just taking advantage of that optimizing and then I love it. I think that asking those questions, utilizing programs like the AOA, is huge. It's leaders, it's people all over the country that want to help and want to be a part of that process and want to have conversations like this Like what other organization is going to breach subjects like this openly? So utilize those resources, join the AOA, become an emerging leader, kind of all these different things, because you're going to have these networks to work from.
Speaker 2:I wrote down so much stuff for myself from you guys today. This was an awesome discussion. I think it's really going to be helpful to people. So thank you both for your time. Please look out for the next recordings, the next episodes of the Emerging Leader Podcast and, if this is the first one you're kind of listening to, we have one on starting practice earlier, as well as a couple others in queue. So thank you again for your time. This was wonderful and I'll see you at the next meeting.
Speaker 1:Thanks so much for organizing this, Aaron.
Speaker 3:Oh yeah, Thank you very much, Aaron. Thanks for inviting us Appreciate it.
Speaker 1:Yeah, thank you.