Insights on Residency Training

Dr. Bhardwaj is a Chief Resident at UMMS – Baystate Medical Center in Springfield, MA

My whole life, I have always wanted to do something that will be remembered. Becoming a physician was a hard but well-thought-out choice. Toward the end of my residency, I knew I wanted to be a hematologist-oncologist, but I had no idea what type of career pathway I wanted to pursue. During the APDIM Chief Resident Annual Meeting last year, I had the opportunity to attend a session on different career paths by Dr. Gregory Kane, Chair of Medicine at Thomas Jefferson University Hospital. To make a long story short, my life changed for the better in a lot of ways after that session. In this post, I’ll attempt to lay out some pearls I took away from that session. In addition, there are snippets of my own research on a few topics.

Irrespective of what one does — be it primary care, hospital medicine, or sub-specialty training — one can pursue different paths.

Being a Clinician – Educator

In medicine, “clinician–educator” refers to a physician whose primary role is caring for patients and who has formally incorporated educational principles and scholarship into her/his job description.

In other words, these physicians usually stay on as faculty in programs that have a medical school, a residency program, or a fellowship program. They often function as your preceptor attending in the clinic or hospital setting. Their main roles involve patient care and educating medical trainees.

What kind of roles could I pursue as a clinician educator?

• Join a practice as an academic attending in the setting of your choice.
• Become a faculty member, like an assistant/associate professor or professor.
• Be a clerkship director for medical students.
• Develop curricula for trainees at all levels.
• Become an Associate Program Director or Program Director of a residency or fellowship program.

How can I hone my skills to be a Clinician-Educator?

1. Some residency programs have a Medical Education Track. This is a great steppingstone to understanding the core concepts of Medical Education Training. Enroll for it!
2. Journals, such as the Journal of Graduate Medical Education, and the MedEd Portal are great bonus resources. Most of these resources are available with free access through your institution.
3. There are specific courses that you can pursue, including:
   • Master’s in Medical Education: For example, Johns Hopkins University has a distance learning program.  Be sure to keep your clinical schedule in mind when choosing a distance-learning course.
   • Harvard Macy Program: Read my co-blogger Frances Ue’s post Reflections of an Aspiring Clinician-Educator for more information.

A Career as a Clinician-Scientist

Nearly everyone who pursues a career in medicine has the goal of improving patients’ lives. However, methods for doing that can take on different forms. Midway through residency, some residents realize that they want to spend most of their time doing research. If you are not an MD/PhD student but you want to be a researcher, you can still do it after residency! If bench research is not for you, there are plenty of opportunities for clinical research, including epidemiological research and clinical trials.

How can I hone my skills to be a researcher?

1. Several large residency programs have a clinician-scientist pathway through ABIM. This is for medical students who know early on that they are interested in research. Several, if not all, programs require some background in basic or clinical research before enrollment.
2. Take on extra courses to improve your understanding of research. This is a great way to start if you had minimal exposure to research during residency. These include:
   • Master of Science in Clinical Research: Some programs provide tuition aid if you pursue these additional courses during residency/fellowship. Hence, these degrees can be pursued in-house, if there is availability. If not, several online programs are available.
   • Master of Public Health (Epidemiology/Biostatistics focus)
   • There are additional workshops available to hone your research skills. For instance, the American Society of Clinical Oncology (ASCO) and the American Association for Cancer Research (AACR) have combined efforts to conduct a workshop on how to design clinical trials effectively. This workshop happens annually and is available for Hematology/Oncology trainees and early-career physicians.
   • Consider applying for a research fellowship after residency.

Pursuing Physician Advocacy and Public Policy

“Never doubt that a small group of thoughtful committed citizens can change the world; indeed, that’s the only thing that ever has.”- Margaret Mead

As physicians, we often find ourselves at the crossroads of a unique and sometimes intimate knowledge of patient needs. This subsequently intersects with the ability to leverage influence to change healthcare system delivery, lower social barriers, and even impact political policy. We are in a unique position to advocate for patients in their times of vulnerability. Advocacy can happen at different levels — community level, state level, federal level and national level. All of this can result in policy changes.

How can I hone my skills to be a physician advocate?

1. Several professional organizations at the state and national level have Advocacy and Health Policy committees. The members of these committees are instrumental in writing resolutions which are then proposed to legislators. There are dedicated times and opportunities to meet with legislators to lobby for your proposals. Some examples of organizations include the American Medical Association, the American College of Physicians, and individual state medical societies like the Massachusetts Medical Society. A great way to start is by joining your state chapter and finding out what work is happening at the grassroots level.
2. There are courses available, like a Master’s in Public Health (with focus on Health Policy)
3. Consider fellowship programs like the IMAP Physician Advocacy Fellowship, which seeks to make advocacy a core professional value for physicians.

Read further: Physicians as Public Advocates: Setting Achievable Goals for Every Physician

What Is a Physician-Administrator?

Given the rapidly changing healthcare environment, the need for effective healthcare leaders has never been greater. As a result, many organizations are recognizing that physicians are an asset as leaders of healthcare organizations. Their hands-on involvement in healthcare puts them in a unique position to translate their insights into successful healthcare management. Administrative Medicine” is a good fit for those who have insight into the doctor-patient relationship (the core product of healthcare) and an ability to think about operations globally.

What roles can I pursue as a Physician-Administrator?

• Physicians with administrative inclinations can become Chair of Medicine at their institutions.
• Chief Executive Officer and Chief Medical Officer of a hospital are career goals if you are looking to be an executive.
• You can become a Residency/Fellowship Program Director if you are interested in an administrative role and want to continue being a clinician.
• Medical Directors are administrators with specific spheres of influence.

How can I hone my skills to be a Physician-Administrator?

1. Apply for a Chief Resident position if you think you might be interested but are unsure what to expect. This job gives a great first glimpse at what being in administration involves.
2. Be sure to apply for any roles that would provide you with substantial leadership experience.
3. Course options to help you hone your managerial skills include:
   • Master’s in Business Administration, Master’s in Healthcare Administration
   • American College of Physician Executives (ACPE) offers several leadership and management courses for physicians, including online courses.

Read Further: Becoming a Physician Executive: Where to Look Before Making the Leap

Practicing Clinical Medicine

Many physicians very clearly know that their sole purpose for going into medicine is patient care. Therefore, they choose to focus only on clinical medicine. A vast majority of them practice in private or group settings in the community. They spend 100% of their time seeing and caring for patients.

What kind of roles involve purely clinical practice?

• Non-academic hospital medicine
• Community primary care physicians or sub-specialists working for a hospital/group that is not attached to a training program
• Private practice

This is by no means an exhaustive list of options, but is meant to be a guide for your career pathway. Plenty of physicians choose to pursue alternative careers like medical insurance, pharmaceutical company position, or medical writing. Also, physicians who stay in academia often do a combination of the above during their careers. A simple Google search will yield plenty of results.

In conclusion, there are a bucketful of career paths to choose from after you graduate. Meanwhile, my bestadvice to you would be to seek out mentors in the field(s) you want to pursue. Nobody can steer your career the way a great mentor can!

*Resources available on this blog post are not endorsements in any way. No conflict of interest to disclose.