Aloha, everyone. Thank you so much for coming. Feel free to come on up. We're doing it a little bit of a fireside chat because we are very, very fortunate to have incredibly a diverse field of talents being represented today. So I am trying to realize my long-time dream of being a taco chef and trying to have a facilitated discussion on the different career paths that folks have taken and what are some of the advice, recommendation, thoughts, reflections that they may have as they have navigated their individual paths. Very, very divergent and unique paths and how can we learn from it and see if there are ways that we can integrate that into our current space, whatever field or industry that you're currently in. So it is, for folks, there's a couple of chairs up front if you're looking for spaces. This session is The Road's Not Taken, Non-Traditional Careers and Opportunities Beyond Academic Medicine Paths. So our focus is really trying to be as expansive and as we're having these conversations, feel free to come up to the mic up front here. They asked that the session is currently being recorded. So in order for the audio to pick up, you just need to use the front mic there. So it is my pleasure to introduce our esteemed guest today. My name is Jacques Ambrose. I'm the senior medical director and chief clinical integration officer at Columbia University Medical Center. It is a mouthful. And I have to my right here Dr. Mike Metzner, who is a general surgeon and producer at ABC Studios for Grey's Anatomy and Station 19. So if you've seen the latest season, you have him to thank for it or blame Next, we have Dr. Katie Brewster, who is the director of the Columbia Geriatric Psychiatry Fellowship. And then next is we have Dr. Louisa Steinberg, who is the senior director of CNS drug development for Icon PLC. And last but certainly not least, we have Dr. Rob Accadino, who is the CMO of Able Inc. And we'll have each of the guest panelists share a little bit about their journey. And there are some facilitated questions. But feel free, if you have any particular questions during the course of conversation, feel free to come up and share them with us. So we'll start at this corner. Mike, you are up. Great. Hello, everyone. My name is Michael Metzner. It's funny when I told everyone at Grey's that I was coming to the APA, they're like, Why are you doing that? And I'm like, well, I have to talk about all the pathology that I see on a daily basis in Hollywood. But for real, I actually started in TV and film as a child actor. When I was 12, I said I was going to be a surgeon, fired my agent. And then actually ended up getting a double major in biological chemistry and art. I always called myself an artist before physician was on stage from kindergarten, writing plays in medical school, absolutely loved the arts. That was my outlet. It was my passion, but I also love surgery. So went to medical school at UCF. There I created the organization arts and medicine and art literary journal, acapella groups that went around to pediatric hospitals, really tried to figure out how I was going to do both within my career. I was always told you're going to have to choose one. And I always said, No, I'm not. And, you know, fast forward, I then started general surgery residency in San Antonio. I was a general surgeon doing a lot of trauma in San Antonio. I was on my research sabbatical when my own program said, you know, you're really weird. And they're looking for someone in the writers room of Grey's Anatomy for three months as a fellowship, which I was like, Oh, that's I am like, that's fits my weird background. And so I went out to LA, not knowing anyone, well, actually applied to the fellowship was hired during my interview, because they're like, Yeah, you're weird, like us, came out to LA, and that three months turned into six months, which then turned into a year. Then I became a medical advisor on the show, then an associate producer, producer, now supervising producer going into our 21st season of Grey's Anatomy, and also was a producer on station 19. So it is true, you can marry your passions, despite what all the people told me that it was impossible, because I actually didn't know that this job existed. And it is literally my favorite thing in the entire world, and very happy to talk about it today. Hello, everyone. I'm Katie Brewster. I'm assistant professor of psychiatry at Columbia University, and I'm a geriatric psychiatrist. So maybe on the second, I'll tell you kind of a little bit about my path to kind of how I got how I got here. But maybe first, I'll tell you a little bit about some of the roles that I hold now. So first and foremost, I am co-director of our geriatric psychiatry fellowship at Columbia, so I do a lot of teaching and training, supervising of the residents, of the fellows, the medical center. I also do clinical research, and my research focuses on the effects of hearing loss or hearing impairment on depression, on brain and cognition in people who are older. And I also kind of, for fun, I do a bit of community education. You know, for example, just next week, I'm going to a naturally occurring retirement community in my neighborhood, and kind of talking to seniors in a kind of informal discussion about sleeping well. And I do a lot of that just kind of for fun. I think it's something that I really enjoy. And then, yeah, and then in addition, so I also have a private practice. My private practice is on the Upper West Side. I see patients with depression, anxiety, cognitive issues, dementia, and people who are older. So yeah, so right now, I get paid for two of my jobs. So some of them are unpaid, but I get paid for two of them. So I have a 50% line. I have a .5 FTE, full-time effort, at Columbia, at New York State Psychiatric Institute, and the rest of my effort is in my private practice. And yeah, and I think so maybe I'll tell you a little bit about how I got here. So I sort of fell into the world, I fell into the field of geriatric psychiatry. I did not see myself becoming a geriatric psychiatrist when I first started training. And I remember, you know, so I did medical school at Columbia, and I remember sitting in biochemistry class, and I was like looking at protein structures, and I was like, I really, I need to see a patient. So instead of on a whim, I decided I walked into a nursing home in the neighborhood, and I just decided, sure, like, I'll volunteer. Let me spend some time working here. And I really started volunteering, working, you know, playing bingo, and dancing salsa, and learning some Spanish, and I really, really enjoyed it. And I thought, you know, this could be, this could be a career for me. And I did my, you know, I did my clerkship, and I really enjoyed kind of looking at sort of the, how aging processes affect mental health. Looking at, you know, vision impairment, hearing impairment, blood pressure, all these things can affect treatment, prognosis, and kind of pharmacology in mental health. And I thought that that was really interesting. And so I think that, you know, then I started residency, and I was an intern, and I was on medicine, and what a mentor who was a clinical researcher, geriatric psychiatrist, just emailed me randomly, and he said, hey Katie, I hear you're here. I have a bunch of different projects that I'm working on, a bunch of different clinical studies that I'm working on. Are you interested in hearing more? And I was thinking, you know, I'm a clinician, like I have no idea. I don't have a PhD. I have no idea about the world of research. And I said, sure. And I started working with him, and kind of getting involved in some of his studies, and I really, really enjoyed it, and really opened my eyes to the world of clinical research. And then lastly, you know, I did, I did a chief residency year during my fourth year, and I really, really liked teaching. I really liked admin work, and I thought maybe this could be part of, part of my career too. So I think, you know, my main message, I know, I think for the, for the trainees here, is to really, you know, be open-minded about career. That you never know what you're gonna like. You're never gonna know what opportunities will, you know, fall into your lap. And I think that, for me, that was something that I really, I, you know, I think, I think, you know, I really did not think I would be here when I first started training, first started medical school. And so, I have to put in a plug for geriatric psychiatrists. I know there are a couple geriatric psychiatrists in the room. I've seen a couple already. But there are so few of us. You know, there are only 1,500 geriatric psychiatrists in this country. And I don't need to tell you this, but we have an aging population, that our country, our world, is getting older. And we really do not have enough specialists who have training in geriatric psychiatry. And only, for example, 40, there are only 40 to 50 geriatric psychiatry fellows who graduate from fellowship per year. And so, I think that, but, you know, I think that because there are so few of us, I, geriatric, there are so many opportunities out there for geriatric psychiatrists. I can't tell you how many emails I get, you know, how many emails I get per day, per week, about job opportunities for geriatric psychiatrists. And I think as a geriatric psychiatrist, you know, the world really is your oyster. And, I mean, I'm relatively early on in my career. I'm 36. And, you know, despite, and, you know, and despite, you know, being early on in my career, I've just been given and provided a lot of really exceptional opportunities that I think is relatively unique for people who are in my stage through, I'm just, you know, a few years out of fellowship now. And so, I think that, you know, and I think as geriatric psychiatrists, because there are so few of us, a lot of us end up doing admin, teaching, supervising, clinical work, research, and many of us kind of try to do all of those things really at once. And so, I think that if you like teaching, if you like admin, if you like that world, you know, of that geriatric psychiatry could be a really, really good feel for you. And if you want to do just clinical work, you'll have a lot of patients just clamoring to get into your office. So, that will be no problem. But anyway, I'll pass on the mic. All right. Thanks, Katie. I'm not going to disclose my age. Hi, I'm Louisa Steinberg. As Jacques had mentioned, I am a psychiatrist, and I am a senior director of clinical drug development and consulting services at ICON, which is one of the world's largest CROs. CRO stands for clinical research organization. And I'll explain in a little bit more what exactly clinical research organization is, because before I started this job, I didn't really know either. So, but let's just say it's in the pharmaceutical industry at large. I graduated from residency Columbia in 2017. And I have a PhD, and research was always a big part of my career plans. So, after residency, I did a research fellowship also at Columbia, focused on depression and suicidality and worked with John Mann at Columbia. That was a three-year fellowship. And after that, I, you know, landed a great dream job, which was a faculty position at NYU. That was halftime research at the Nathan Klein Institute and halftime working inpatient at the Rockland State Psychiatric Institute. I love patient care. I also have a private practice, which I started during my fellowship. So, patient care was also always really important to me. Unfortunately, one of my family members fell ill at the end of 2020, and I need to take a leave of absence to help care for them. And during that time, it became clear that I really needed a job, you know, that would provide more flexibility. So, I looked into various options. And I'd always gotten, you know, emails from recruiters through LinkedIn or something like that, you know, usually the typical locums things. But during this time, I got an email from a recruiter for a medical director position at ICON. And it had a little bit of a description. I thought it sounded hot, kind of interesting clinical trials, maybe I can still be using my research skills in some degree, that sounds like it might be interesting, and as a fully remote position. So, it fit the bill of flexibility very well, because I could do it from anywhere. So, I could travel and, you know, do other things I needed to do. So, I transitioned to that job at ICON in early 2021. And I started as a medical director in their medical affairs department. Let me backtrack a little bit and explain a little bit about the, you know, very broad structure of the pharmaceutical industry. So, the way I think about it, and others may have other opinions, but I generally categorize it into three big troughs. One, there's the pharmaceutical companies that you'll know of, you know, and this could be large pharmaceutical companies, small pharmaceutical companies, biotechs, but they're generally the companies that are developing the investigational medical products. So, those may be devices or medications or anything else, really. And they're generally doing the development, they hold the intellectual property and so forth, and they have, you know, do the fundraising as well. Then we have CROs, clinical research organizations, which are basically companies that have grown a lot more in prominence over the last 20, 30 years or so. And they're in charge of actually executing clinical research or clinical trials. So, pharmaceutical companies develop the products, they used to run a lot of their trials in-house, but it's so complex, and so, you need so much infrastructure to run a good clinical trial, it takes a lot of expertise, that really what's happened is that more and more clinical development is outsourced to clinical research organizations. So, clinical research organizations will work with many, many different pharmaceutical companies running their clinical trials. Now, ICON is one of the largest in the world. So, ICON does international clinical trials, first of all. Second of all, we also do clinical trials that span from phase one to phase four, and also even some marketing stuff. And ICON provides other services as well to pharmaceutical companies. So, really, you know, there's a lot of breadth there. And then the third bucket that I'll say is in the pharmaceutical industry are the research sites that actually execute the clinical trials with patients, you know, on boots on the ground. So, there are large networks of research sites, you know, that you could think of this like a system or a clinic system almost, but for research specifically, there are also little mom and pop shops where it's just like one person, one little group in one place. So, there are lots of these, but they are the people who get hired to actually execute the clinical trials with the participants. All right. So, I entered ICON as a medical director in the medical affairs department, and medical affairs and clinical research organizations are generally in charge of medical oversight for clinical trials, for the entire clinical trial. So, at sites there will be MDs that are responsible for the participants at that site, but if you're working at the CRO as the medical director, then you're overseeing the whole trial. And usually you're working on somewhere around 10 to 12 trials or so, you know, sometimes less. It depends really. And I was fortunate because in my company, you know, there are not that many psychiatrists, so I was able to focus exclusively on psychiatric clinical trials, which is great. Depending on the company, that might not be the case. They might ask you to do neurology or other trials as well, but it's very fortunate if you can stay within your area. Let's see. After about doing that for a little bit over a year, I transitioned and was promoted into the senior director role that I'm in now, which is senior director of drug development and consulting services. It's a separate group within ICON that has MDs and PhDs, and people who are in this group, like myself, generally function as what we call therapeutic experts or subject matter experts and provide consulting services directly to pharmaceutical companies. So we assist with protocol development. You know, if they don't have therapeutic expertise in-house, we can provide that and consult with them. But there are a variety of other functions we do as well. But in any case, if they ever need a psychiatrist, essentially somebody with subject matter expertise in psychiatry, that's when I'm called to assist. Yeah. And I think that's pretty much where we are, so I'll hand it over to Robert. Before that, I see that there are several folks who are waiting in the back. There's a couple of seats up in front. Feel free to sit down. I want to be mindful of your comfort. There's about 120 people who are watching virtually. There's also an outflow room if it's more comfortable for folks. I want to be mindful of everyone's mobility status as well. So please feel free to join us in the front. Dr. Accordino. Hi, everyone. Thank you, Jacques, and it's a privilege to be a part of this diverse and distinguished panel. So thank you. Thank you all, and thank you for your interest. So I'm Robert Accordino. I'm a pediatric and adult psychiatrist. I still have the privilege of caring for patients, and I'm on faculty at Mass General and Harvard Med School. And I am chief medical officer of a health care, a tech-enabled health care company called Able2. Able2, on my, just to give you a sense of what we do, and then I'll tell you how I got here. It was an accidental interest in technology, really, as a vehicle of democratizing access to mental health care. I don't need to tell any of you in the room that there's a huge mismatch in terms of those who need care and those who are providing the care, all of us. So thinking about ways to use technology to better leverage the scarce resource of clinicians, providing that care is something that's become central to my professional work and my interests. Able2 is a 16-year-old health care technology company where we, so there's, we have scaled. We are beyond startup stage. We have scaled to provide care to those who need it in all 50 states. There's 1,500 clinicians on my team. These are mostly therapists of different flavors, so licensed clinical social workers, psychologists, marriage and family therapists, which is very common of therapists in California in particular. And we provide timely access to insurance accepting care. The care is all different flavors of cognitive behavioral therapy. So there is flexibility and clinical consideration, but it's highly protocolized care in terms of what's delivered. And we rigorously track outcomes to ensure patients are getting better. The care is time limited, which is the secret to getting patients into care in a timely fashion. So, and we accept insurance, and we have partnerships with 40 different insurance companies. So a patient, to simplify things, there's a few different ways they get to us. But if a patient says, I'm interested in therapy, we essentially do a triage process to understand what they're looking for, and if they're appropriate for our programs. We don't treat all conditions. We mostly treat mild to moderate anxiety, depression, and stress. And, but we have different pathways of what may be causing that depression, anxiety related to medical conditions, related to life transitions, and so on and so forth. And again, it's with therapists who are trained specifically working off of sort of an iterative protocol. But the care is time limited. So we're tracking outcomes, and patients typically get two months of treatment, and then we see how they're doing, and then we reassess, which allows us to free up the capacity of those clinicians so that people can get access to care in days that's insurance accepting, which is pretty unique in this space. And this started prior to the COVID in particular, just the extraordinary growth in this space for better or for worse with varying degrees of quality. And I'll get back to that in a moment. But this was an area where, we have been very, very focused on quality. I've been the chief medical officer for almost two years now, and my predecessor handed me this extraordinary gift of a real focus on quality, which makes us very, very unique, I feel. And this is sort of one of the take homes, I think that's most important for those of you who are considering going into private industry to understand that there's all different perverse incentives when you're at something that is venture backed, and where there's investors involved. And you need to ensure that the work you're doing aligns to your standards as a physician and just in terms of thinking about quality. So back to my path, and then I'll zoom out for a moment again. So when I finished training, this is why I sort of accidentally stumbled across technology. I had the privilege of serving in the federal government through a program called the White House Fellowship, and served in the Secretary of Defense's office. And the military has a $50 billion health affairs budget for innovation and research, those who have received grants from the DOD, but also for delivery of healthcare to 1.5 million service members and their families across the world. So it actually is a fully integrated payer and provider system. And in that capacity, I was in the Secretary of Defense's office, I was in Ash Carter's office, and was tasked with sort of helping issues of access to mental health services, to integrating physical and mental health care, to value-based payments and population health in general. And with that mandate learned a tremendous amount and became really fascinated by technology, not to replace us, but technology is a vehicle again of democratizing access to care when it's thoughtfully deployed in terms of focusing on quality and patient safety. So when I completed the White House Fellowship, so I've been at Able2 for two years, and I led the clinical team at another venture-backed healthcare technology company, and also the chief medical officer at a similarly innovative publicly traded company. So I've had different chapters, and part of this has to do with sort of aligning, as I mentioned, being true to aligning your incentives with that of the CEO and ensuring and desires in term focusing on quality and having, you're oftentimes sort of the foot on the brakes in terms of quality of like, CEOs will get these ideas of what might be possible and the role of the chief medical officer sort of reign in, in terms of thinking about the patient and the clinicians providing care. And it's a delicate role, and you need to ensure that you're working for a CEO with aligned incentives and aligned motivations in terms of quality. So that's how I became interested in this space, and I think I otherwise would have done full-time academic medicine for a period of time and then thought about sort of pivoting in terms of broader abilities to influence how people receive care, but I've loved the mix of continuing to practice, I've protected time, and then also being able to do work day in and day out that helps lots of people get care. I'll just zoom out for one second to say, and many of you may know this, since 2017, there's been $10 billion of venture money invested in mental health care to improve access with all sorts of varying degrees of success and failure and misaligned incentives of quality not being the focus and patients getting hurt in the process. This is a real sort of mixed bag of what's happened, and I'm not gonna name names, but there's companies I'm sure you know about that sort of took some missteps where there was this rampant pursuit of profit in spite of patients, and patients were hurt in the process, so this is a very mixed bag of what's happened with these financial commitments, but I will say that there are good companies out there, it's really important to do a lot of diligence, that are really interested in actually doing good and doing right in the process, so they need to sort of balance the desires of their investors to have a successful investment, but also ensuring that patients are helped in the process, and I think with technology, we've done a lot in terms of accessing care, but the next wave of this is really focusing on the quality of that care that's delivered, and it's been a privilege to be a part of that discussion and thinking about it, and I look forward to talking about this more with all of you, so thank you for having me. Thank you, Dr. Harris. All right, just to get a better sense, for folks who just joined us later, I've spoke about I've always wanted to be a talk host, so we're gonna do a little bit of a wake you up activity, so by round of applause, let me know how many of you are trainees, so medical students, resident fellows. Okay, so like about a third. How many are healthcare providers right now, graduated? They're like so tired from patient care. Any folks from industry here? There's no folks from industry? They don't wanna out them, so that's fine, that's fine. I can't think of any other categories. Oh, yeah, thank you. Any folks, did you say residency directors specifically? Oh, yeah, residency training directors. Woo! So there's two of you guys. So resident, just find them afterwards. So one of the most common questions that we get from trainees in particular is like if I'm interested in this, nothing about residency really prepare me for any of the diverse career that our panelists are talking about. So the most common question is like if I'm interested in your particular field, what would you recommend as like the first opening the door, foot in the door step, opportunities, tactics? So we'll go down the line, but reverse order, so starting with Rob. You have to pay attention, Rob. There you go. I'm getting good morning texts from my nine-year-old nephew on the West Coast. So I would say, and I touched on this already, well, first of all, mentorship is the most important thing and sort of thinking about people you know and alums of your training program and doing outreach if non-traditional opportunities are of interest or just sort of so much of this is networking and thinking, and I think you've heard this in all of our journeys, and just sort of thinking through whose path may be of interest and then reaching out and asking for advice and feedback of how to make the pivot. And you can sort of stick your toe in with these things by doing some consulting. I did this during residency just to sort of have a sense of what's out there and there's a lot of interest sometimes in having like a few hours of your time, and if you can make that work, that's a way to sort of figure this out and also just be very thoughtful, as I mentioned about diligence-ing these places where you might work and sort of being very thoughtful about the, and this you know, this is where your clinical skills are so important. If something doesn't pass a sniff test for you of what clinically makes sense, that's a problem. So you are the clinical expert. This is where you have training that's so important for the success of any of these initiatives. So don't short shrift that and really honor it. And I would say also when I, so I get outreach from trainees all the time and one of the things I emphasize when people are asking about what to do in training, I think the answer will come as no surprise. It's actually for any of these things where you're going to be a clinician first and clinical content subject matter expert, it's ensuring that you're making the most of training and not short shrifting that. It's just such an invaluable time that will then set the foundation for everything that comes next. Program directors are so happy to hear that. Yeah, I'll agree with Rob on this. You know, really making sure that you have a breadth of exposure to, you know, different conditions in your training. I would say, you know, your strongest, most important asset when entering, you know, the pharma industry is, you know, your clinical knowledge, your clinical skillset. That's really, you know, your expertise. Nobody else has that. So in that sense, having some time seeing patients after training would be helpful. So a couple of years, whether that be private practice or, you know, in some more structured setting, but that will be helpful rather than coming directly out of residency. And I think, you know, generally getting some exposure to research during residency, ideally clinical research will also be helpful or human subjects research, just because, you know, how that is run, you know, having some familiarity with what's a protocol, you know, what are adverse events, you know, all of these things, you know, what are sort of basic regulatory, you know, considerations that you have to keep in mind on a clinical trial. So these are just things that it's helpful if you have some familiarity. That being said, it's not absolutely necessary because there are plenty of MDs who go into the career via various paths that have no previous exposure to clinical trials, so. Thank you. I think that, you know, my advice as a, you know, thinking about career is really about advocacy. Like you really have to be an advocate. And I think that particularly if you're a resident, you know, there may be room for, you know, electives, for example, if your residency program doesn't have something that you really wanna do, ask. You know, for example, when I was a fellow, I wanted to do some research and it was not part of the curriculum. I asked and I got one day off a week to do research and it wouldn't have happened unless I asked. And I think that that's my main advice to all of you. There are a lot of different opportunities. People love working with trainees. And if we can make it work with your training director, if we can make it work, even as an early career psychiatrist, there are lots of opportunities to ask, to get different experiences that you may not be having already. So I would agree, definitely training is very important. You can't really consult in entertainment without having clinical knowledge. I do get a lot of emails and DMs and smoke signals. How in the world do you get into the entertainment industry as a medical consultant? And, you know, of course there's the networking way and there are a couple of organizations, Hollywood Health and Society is one. It's actually affiliated with USC where they have created an amazing organization that provides free consulting to writers around Hollywood and actually around internationally, just to make sure that any of the information that's being put on television shows, it's as accurate as possible. Sometimes that works, sometimes they don't listen. But I actually, I'm a co-founder of a consulting agency, Real Medical Consulting, R-E-E-L, where because I've had so many people on both sides, actually from productions who are like, oh my gosh, you know, we need a cruise doctor who has all this clinical experiences on cruises. I know very niche kind of things. You trust me, I have, I could, the memoir is being written. But Real Medical Consulting actually connects physicians around the world with productions. So if you, you know, as a psychiatrist, we definitely need you in entertainment in many different ways. But it's actually, you know, we definitely need you in entertainment in many different ways. But it's actually a device that connects. So if they need a physician in the UK who actually is actively practicing or anywhere the production's happening, we actually link those professionals with the different productions around the world, which has been actually pretty amazing. It's a big jump. The beauty is though, there's a spectrum of medical consultants within the industry. Those who might read a script, take a couple hours out of their week in order to comment. Probably the hardest thing about television specifically is it's so fast paced. We do one episode of Grey's Anatomy in nine days. And that's 12 to 16 hour days. And I'm on a set from 5.45 in the morning to sometimes 10 o'clock at night. Especially on a show that is surgery almost every single day. So again, you have to also kind of choose how much you want to invest into being a consultant because you can take that couple hours a week or you live and breathe and dream pitches and the show. So I think that's one great thing about this industry. And I actually also practice still. I see patients on weekends. I work seven days a week. Which I, you know. Yeah, let's talk about burnout. What's your Instagram handle, Michael? Well, first round of applause for our speakers. So there are the other side of your individual fields because it's a little bit different from the traditional track of academic medicines where you graduate and you join a work often with an AMC is all the different pitfalls that you have to navigate and the instability question mark about am I going to be able to navigate this field? So the other common questions that we have across the board for folks is what are some of the downside of this particular field that I should be mindful of? We'll start back on this side. Okay, so I think instability is number one, 100%. In entertainment, as I'm sure some of you have heard in the past year, we had a five month strike. So that's five months of not working. Which I mean, again, we're all physicians so we have a great backup plan. But it is something that as a physician, you're in medical school, you're like you have that goal. You are always told you have the stability of always having a job. It's the opposite within the entertainment industry. Shows get canceled all the time. I was a producer on Station 19 that was just canceled this year. That happens, that show was around for seven years which is actually crazy to think of that it was on for that long. But there is an inherent instability and talking to all the people that I work with, I'm one of three physicians who are at the producer level or higher. There are some war stories. It is a very different world and you kind of have to retrain your brain in order to kind of thrive in it. But the other thing is the respect in entertainment. So that was also something that was really actually difficult because in an OR, I was making the decisions and yeah, and in your clinics, you make your decisions. In entertainment, you give your suggestions and at the end of the day, I always make this joke, but it's not really a joke. If we actually were to show what our daily lives were in a hospital, you probably wouldn't watch it on television. It would be 80% admin work. Like two hours of writing notes. It's true. You have to have a balance of entertainment, wanting to show these stories that are very compelling and the accuracy. So it's trying to find that balance. That is truly one of the hardest things. And realizing that you aren't on the top of the totem pole anymore. I have a director who can make any, or Ryan Murphy, who will just want to say, oh, I want to do it this way. I'm like, well, but that's not medically correct. Who cares? And so, you know, there's a lot of that. So you have to be a easygoing person and pivot, know how to pivot, so. Really quickly, clap if you are at the top of your food chain in your corporation. They're like nervous. There's like, I saw a couple of people started clapping when no one else was clapping. They're just like, slow down and dissipate it. You should say clap if you're at the bottom. Yeah, clap if you're at the bottom of the food chain. We're pro-bottom here. Katie. See how I can answer this question? I think that, you know, the question is like, if you do have a nontraditional path, like how are you gonna get paid for what you love? I think that's always a challenge. And I actually do a lot of work that I'm not paid for. And I sort of make it up in other ways. And I think that that's kind of where balance comes into here, to your, you know, thinking about how you can figure out to do what you love and also figure out how to support yourself. And I think that's a very personal decision and it's something I'm working on still too. So there are no downsides to my job whatsoever. I love it and I have no comments. No, I mean, I think, you know, something can be a downside for somebody or an upside. So I think, you know, so what distinguishes this particular career from, you know, other sort of more traditional careers that might be a downside for somebody? So as an academic researcher, you are, you know, as Mike mentioned, you're sort of, you're the boss, you're in control of your research project or your grants or whatever, and you're wearing a million different hats, but you're sort of the start and the finish of it. In the pharmaceutical industry in general, you are one of a highly, highly diverse multidisciplinary team. And, you know, as a physician, as an MD, you often do sit somewhat higher up in the hierarchy just because you have that subject matter expertise and training and so forth, and that is very well respected, so that's good. But again, you know, depending on where you sit in the pharmaceutical industry, again, you know, you're not the one making necessarily the final decision on every, you know, definitely not on everything. On some things, yes, maybe, but, you know, there's always going to be a collaborative, you know, multidisciplinary approach. You know, this is highly matrixed environments, you know, with lots of specialists and experts, so you're going to, so, you know, some people thrive in that. I happen to really like that, but, you know, for some who would like to say, I want to be in control of everything, that might be a downside. I think, you know, but otherwise, that's mainly the main thing I can come up with. Maybe I can come up with something else. I'll think about it, but please ask away, so. Yeah. So I think part of the richness of what I do is that I get to work cross-functionally with people with all sorts of different backgrounds, and you've heard this in varying degrees from all of us, I think. So I work with engineers on the technology side and folks on product teams, marketing teams, operations teams, all of whom could be doing a lot of different things. They could be working at Google or Meta, and they're choosing to try to improve healthcare, specifically mental healthcare, and that is really special, I think. So I agree with a lot of what's been said. I think there are factors that you have to accept that are outside of your control, and I think this is true of all careers, but maybe more so in the private sector where I already mentioned that very important relationship with the CEO, and there may be a situation where the CEO leaves or the investors in the company decide to change the CEO, and then your function dramatically changes. It may be a time to move on. There's a lot outside of your control, and just continually making sure that your values align with that of the company for which you work where you are not solely responsible for the values and priorities of the company. So it's really important to continue to keep that front and center with all sorts of different incentives around you, and as I mentioned before, folks who are interested in different things, but the sweet spot is when you can align, you find a lot of overlap with what everyone wants, that the investors want a return on their investment, that you want clinical quality in the care that you're delivering, and that both what you're doing on behalf of patients and as a business are successful simultaneously, and that can be very challenging. Thank you, everyone. All right, we're gonna have a couple of questions that's very specific to the sector and the industry itself, so just getting a little bit of audience participation. Where do you want, we'll cover all four different sector, but where do you want to go first? Choose your adventure. Yell it out. Pharma, private practice, academia. Tech? All right, tech, you are up first. So, ooh, this is a good one. What are the potential financial rewards for medical professionals in startups? And follow up, how do you navigate the regulatory hurdles and compliance issues? So let's start with the regulatory hurdles and compliance issues. I think in any medical role within a company, you're aligned to the legal team that everyone needs to wear a risk management hat and think through the ramifications of what may sound like a very good idea in terms of company growth, but doesn't make sense in terms of delivery of high quality care. So that's the first thing. So this is, I sort of painted this picture before that you're often the brake on the accelerating gas pedal of saying, wait, wait, wait, wait, we gotta think about this, this. And you will have other allies, particularly the legal team, the general counsel on an executive team to assist in advocating for that. And that's what makes for a good leadership team. You wanna have people who are dissenting and have thoughtful debate about how to move something forward. And ultimately it will be the decision of the CEO. And that's why it's important to be very aligned in terms of the CEO. So that's the risk management piece and compliance. I will then go to the, so to the compensation piece, I think is the. Carrot and the stick. So anything in private industry, so the way your compensation works is a combination of, and it's interesting, these are such, it's like the podcast, death, sex and money, the things we think about a lot but don't talk about enough. So I think particularly as physicians, we often don't talk about this. So, but a high level sketch of how this works and whenever you're taking something, it's important obviously to speak to an employment lawyer and to get perspective on what's standard in a field and speak to colleagues who are in similar sort of non-traditional paths to understand what this is like, as would be the case for any job. The way that compensation works is that typically there's a mix of both your cash component, like what you're being paid and what's called equity, which can take the form of a lot of different things. With a public company, that equity is, can be sort of restricted stock units of the public company or what's called options, the ability to purchase stock that vests over a period of time and it's incentive for you to stay at a certain strike price that is typically lower or hopefully lower than the price per share. So you, so this is sort of the equity component which rewards longevity in a company and making a commitment to that company's growth. In startups where these are privately funded companies, you get these equity packages that vest similarly and there's a projected worth and this is when you hear about startups getting acquired or startups going public. This is when there's some sort of liquidity event that that is actually turns into like real money. But when you're at a startup, you can't really view it as such. You need to sort of think about what you need to live on with the real cash that you're earning and not the equity which you should sort of, I think the right way to think about this is assume it's not gonna be worth anything and then if the company's successful, it could be worth something. But you wanna be very thoughtful about that. So that's sort of a high level sketch but there's a lot and I think sometimes as physicians also, I've had colleagues sort of ask like, oh, do you know an employment lawyer? Can I just sort of add, do you mind just running something by them? And I think the most important point if I could instill in everyone in this room for any job is it's so important to talk to an employee and to hire an employment lawyer. This is not just like to have someone who like you ask a curbside to. This is money well spent because it's important to understand what industry standards are even for academic medicine physicians for any job that you would take that's so important. And we didn't go to law school and you need to understand the fine print of what you're signing up for and you need to understand the ramifications of signing up for something, be it what happens after you leave this job? Are you subject to a non-compete? Is there a non, like what happens after? And you need to understand all of that and it's really, really, really important. There's been a lot of changing landscape around non-competes and non-competes affect physicians in all sorts of different ways. I've seen a lot of colleagues on LinkedIn post about this. So it's just really, really important to understand and I would say that's true for any, for the most traditional path, it's true to understand what you are signing up to. So that is a really, really important point. Do not be penny wise and pound foolish when it comes to signing a contract and do not be shy. I mean, after residency, you have to be thoughtful and look out for yourself. You put all this investment of time and money and resources and brainpower in this very long path of training. So it's important to be very thoughtful about protecting yourself in the context of work. Thank you, Rob. Rob does all my negotiation. All right, we can pivot a little bit to private practice because I think that's another very common question. This is for you, Katie and Luisa, if you want to take on part of it, is one of the most common questions from trainees graduating from residency is how does one, asking for a friend, how does one go about establishing a private practice as like a junior person? And then the second corollary is for people who are already working in academic medical centers and faculty positions, how do you then transition that into a private practice similar to Rob's comment about some of the non-competes? And I think different markets will have, different cities will have different regulations and different institutions may have different rules surrounding that. So big caveat, Amtor. I'll try my best. I think in engaging an employment lawyer, I completely agree with you that that is a really, really important part of any contract you sign. And when you form a private practice, it's very helpful to look through your contract and look through kind of, and when you're thinking about kind of setting up a private practice on your own. So quite literally, it's the overhead of forming a private practice is pretty easy. If you want, you have to get an office and if you end up wanting to do in-person care, you need an electronic medical record, you need malpractice insurance, you need an individual DEA, you need a way to, you know, for payment, you need a way to figure out how you're gonna bill, you need to figure out kind of what insurances you're gonna take, if any, and kind of think through that about how to make that work in your practice. I think that when you're, so when you're forming a private practice, you know, everyone always worries, how am I gonna find patients? I think that's the main question that everyone has. How am I gonna find patients? Like, I'm just starting up out of training, how am I gonna do this? And I think that, you know, my main advice is, I mean, the network can be, networking, of course, can be really helpful for this. You know, let people know. I mean, that's a basic, let people know you're forming a practice. Let people know that you're starting out. Tell your supervisors, tell colleagues. You know, one thing that I did that I actually found very helpful when I started at a private practice, and again, I take care of a lot of kind of medically complicated patients, I actually just reached out to several primary care doctors, some internists, that I worked with and really liked, and I said, I'm forming a practice, here's my information. And I got a ton of referrals from there. And I think that, you know, if coming out of training, I also think, you know, what's gonna set you apart from other providers, other psychiatrists, is finding a niche for yourself. And I think that this doesn't mean you have to do a fellowship. You know, I remember one of, a colleague of ours from residency actually developed a relationship with an OB-GYN who specialized in pelvic pain, and like quite suddenly, overnight, became like a pelvic pain psychiatrist, and he didn't, you know, he was, that was not his background. He didn't have a huge interest in this, but this kind of became what his specialty was, and I think that can be a really helpful way to kind of set yourself apart, and kind of a way to get referrals. Like, you're known, this is what you, this is the type of patients, and I think that kind of requires some thinking on your part. Like, who do you wanna work with? Are there certain patient populations you like, some patients you don't like? And kind of think about what kind of practice you want. So, I'll let you, I'll let Lisa speak. Yeah, 100% agree with what you said. I think, you know, Katie's a geriatric psychiatrist, so a lot more specialized. I, you know, in my private practice see all general adult psychiatry. And, you know, in my experience, you know, I think this probably geographically varies a little bit. New York City obviously is psychiatry central, right? And particularly the Upper West Side where we are, so maybe there's, you know, some things that won't translate. But often I'll say, I think the patients really do find you, and even if you're just out of training, you know, there is such a need for mental health care and psychiatrists that actually I think getting patients is not a huge hurdle. You do have to put yourself out there in some form. I personally do it on Psychology Today. I have a profile there, and I probably get 80% of my patients from Psychology Today. They find me, you know, and, you know, there is an element there where patients end up picking you. So, I'll say, you know, 75% of my practice is younger women, you know? So, and that's fine. You know, that works for me. You know, there are different ways to go about finding patients. You know, I've seen colleagues, you know, who, you know, have a big Instagram, you know, thing where they do a lot of, you know, sort of mental health education via Instagram and build up a following that way, you know, or are posting on LinkedIn, or they write blog entries for Psychology Today. So, there are many, many ways to get, you know, a little bit of visibility, and the patients will find you. And I think if you open a practice and you accept an insurance or a couple of insurance rosters, then you would fill your practice very quickly. Everyone's gonna start a private practice now. All right, Michael, a question for you is how do you integrate in some of the artistic elements that you're interested in, in the medical consulting that you do in the entertainment business? Is it usually encouraged? Do you find that there's space where you can infuse some of the elements that you find aesthetically pleasing and influence not just the medical side, but also the arts of the entertainment industry? Yeah, I'm very fortunate because my job, I'm in the writer's room actually pitching on story, both medical and character. I get to see what we wrote and actually be on set and work with all the directors, actors, make sure that they look like they know what they're doing or teach them and all that kind of stuff. And then I actually do all post-production for the show as well, which means every single cut of the show, I've probably watched it seven or eight times before you see it on television, always giving notes. So- Is that typical? No, no, it isn't just because there aren't many shows that put such an emphasis on the public health aspects of medical. Edutainment, I like to say, because I'm sure you've, how many of you have watched a medical show and it could even be Grey's and you're like, oh my God, that is the worst thing I've ever seen. That never happens. It happens all the time. And it even happens on our show. I admit that we do not get everything right. But again, there's that balance that we always have to kind of think about. But Grey's Anatomy really is a unique show in the fact that whether it's correct or not, a lot of people actually use our show to learn about medicine. Now, yes, a lot of our cases are one in a million and they don't happen very often, but it is amazing how our show inspires people to go into medicine. We get letters all the time. I mean, I remember growing up, I was in high school when Grey's Anatomy started and House, Grey's Anatomy, Scrubs. I mean these were, I don't know how many, anyone watch these? Going like before training and just. Clap if you're in your 30s. ER. For the elder millennials and Gen X. Yes, ER. MASH. I'm not saying that you watch MASH. So old. But I'm just going back. I mean there's you know there's a lot of different medical shows. But yeah, no. But yeah, no. I feel very fortunate because I get to have a lot of creative expression. And you know it'll be from the theme of an episode is unhinged. And I'm like well let's do a wandering spleen because it's unhinged from the abdominal wall. And then they're like alright let's make it more dramatic. Oh well it actually happens in pregnant women more than anyone else in the population. So she's pregnant. The patient's pregnant. Let's make it even worse. And then I'm like well I mean you can have torsion you know splenic torsion and then you have an infarct. Then the spleen ruptures and then are we saving mom or baby? Which of course creates these really compelling hard gripping stories. Other times it's my own patients or inspired by my own patients of things that I've seen in trauma. And yeah it's for me actually talking about being at the APA right now for me in training and I'm sure a lot of us can agree we see some pretty horrific things. And at least where I trained there wasn't a lot of time for reflection. And I have been in mass shootings where I get 12 kids who were shot with an AK-47 and really awful awful things that are very difficult to deal with. And so now being on a television show where we talk about it's all you know no one actually dies which is so nice but it's really given me a sense to look back and think of oh my gosh I actually experienced that in real life but now I'm in this scene and we're running a code and it's horrific but it's actually cathartic for me and I found that it's been a great way to reflect on all the tragedy and all the patients that I personally had and then kind of use that as you know the passion to show it to other people and hopefully inspire others to help and go into medicine. So it's pretty fun. That's awesome. Last but not least, Dr. Steinberg with how popular and viral the drugs like Ozempic has been. Can you talk a little bit more about the drug creation process? Does it typically gear towards there's an end goal in mind and then we're going to try to source the agent and what's your particular role in shaping that and developing the medication? So this is, developing drugs is a very, very complicated and very, very lengthy process. I don't know the stats off of my top of my head but I think probably 95%, 98% of molecules that are discovered never make it anywhere. You know, they fail even if that's in pre-clinical work or in first in human phase one trials. So the majority of things that are discovered and trialed, you never see the light of day. I can't speak exactly to the very early process because I'm not involved in that. That is on the pharmaceutical company side and it's also the purview of specifically trained people for that. Pharmacologists usually are involved in that and basic scientists and this is, if you were interested in that, I think there's actually really a separate training pathway for that where you would probably do a PhD and biological science and then start very soon after your PhD working directly for a pharmaceutical company or a lab company that does this kind of work. There are also lots of startups that are doing this kind of work. They have special computing platforms and things like that where they are modeling and developing different compounds. So there is an entire subset of the industry that looks just at that. But at some point you have a molecule through animal work. It's been determined that it has a certain effect and then that gets followed up now and then you start with your animal model work and generally it's a little bit more general then and then you get to where we as MDs may have our first real role is in the translational side where you go from the basic science animal work to, okay, how do we translate this to humans? Where is this useful? There are people who specialize in the pharmaceutical industry specifically working at that intersection where you're working with the scientists and saying, okay, it does this and this. Who would this be useful for? What would be our population? And what makes sense? So that's one. And then it sort of keeps going down the line. So once you have in animal work there's a lot of steps not just what does it do but is it safe? Is it safe in animals? Is there teratogenicity of the product? So a lot of animal work has to happen before it can even go into humans. Then phase one which is first in human studies is sort of its own little complex field, subfield within the industry where it's the first healthy volunteer human subjects where you see, okay, is this tolerable? Is it safe? What are the pharmacokinetics? What are the pharmacodynamics of this drug? And so forth. And then if that is all safe and can go and it looks promising, then you can go to patients. So that's when you enter your it could be phase 1B, it could be phase 2A. There are different ways to call this depending on who exactly you're looking at. But in any case you'll then move to patients and then see, okay, proof of concept does this drug or for that matter this device actually work in the intended patient population as we think it would? This is very important. A lot of drugs fail here. Even if you make it through the it's safe, it's tolerable, it's nothing terrible is happening, a lot of drugs and devices will fail right there. But if you can get through that, you move to a slightly larger cohort, phase 2B and then you'll move eventually to phase 3. All throughout all of this whichever company or so forth that you're working for, there's constant interplay with the FDA. That's another aspect when you think about pharmaceutical industry which I've neglected to mention, there's the other side which is regulatory FDA side which interfaces with that as well, which is also a very interesting career path we've seen a lot of people go into. There's a constant conversation with the FDA between the pharmaceutical companies and the regulatory agencies to make sure that everything is in line and that this all makes sense and that it is what the FDA deems appropriate. That's amazing. Please give our panelists a round of applause for their expertise. And then please give yourself an applause for sitting still for almost an hour and a half. At this point we'll open things up for open Q&A. If folks have any particular questions, please feel free to go to the front mic. Please. Hello. Thank you. My name is Gabriella. I'm a third year resident at University of Colorado. Nice to meet you all. This may be regional specific but this is a question for the doctors in private practice. I do find that as I think they're all have private practice. Okay, so everyone then. I guess just insights into navigating the space as they're growing different types of providers such as psychiatric mental health nurse practitioners, how to distinguish your services from those. I mean I think MDs kind of know what the distinguishment is but I don't know if that always translates to patients or like kind of clients that are potentially coming in. And then also like what you see that future role becoming. I think at least in my state it seems like there's a little bit of a what word am I looking for? A stratification of services depending on economics and how people pay for things. Just curious what your insights are for that. Who wants to take the first crack? Go for it. Well, I think you know the first question you have to ask yourself is how do you want to practice, right? Because if you're going into private practice you could envision sort of two different maybe more models. One would be a private practice, solo private practice where you are the only person and you're just seeing your patients and that's it. But you could also have a practice where you actually hire other MDs and nurse practitioners and I have colleagues who have done that and built quite large practices doing that seeing thousands of patients. So you can go either way, right? In terms of distinguishing yourself I think as you said we know the difference and some patients do as well and so I think in a way there are patients who are looking specifically for an MD are very different from the patients who are going to go to a nurse practitioner or something. They may just have been in the system longer and just know themselves more or maybe based on regional differences in terms of providers available but I think generally patients who seek out an MD specifically that definitely does exist. I see that as well. In terms of accessibility socioeconomic factors yes, that's a huge thing and again I think the big difference is in insurance providers whether you accept insurance or not and also in terms of whether you're practicing or some people part time practice maybe in a community mental health clinic or something like that or there are other forms where you may practice interestingly some people who participate in clinical trials are using that as a way to access care as well so when you work for a research site or a research site network these networks actually also function as care providers so they will do both they'll have a research arm and a care providing arm. I haven't worked for a site so I don't know exactly how that's structured but that's not unusual and can be obviously a resource for patients but obviously it comes with its own caveat so the one thing I wanted to add was that I think we're seeing this more and more as MDs. We're doing more specialized consultations I think that's been happening. I actually have many patients who see MPs for their medication management and come see me when they want a specialist and that I think that has sort of changed even over the past few years that model of care is becoming a lot more popular and I think one of the benefits of her practice is you pick your patients, you pick your office you pick how often you want to work and you set your fees and I think that I have a whole range of fee structures. I see patients free, I see patients pro bono, I see patients for a full fee and I really it's nice that you can be flexible in that way. Rob, Michael do you guys have anything else to add? Jeff. Aloha, Jeff Akaka from Honolulu, Hawaii I have two questions one for you how do you relate to your patients who know that you're doing show business and have created all this writing and for all of the panel you're really busy if you've got kids how do you carve out time for your kids? He's at the top of the food chain. So I actually make it a point not to talk about it at all I'm sure there are a couple patients who come to me knowing and yeah I'll hear mumbles between different patients who are like oh do you know what he does but I try not to, like I do not advertise that I because you know I'm also a Grey's fan I mean you know it's an interesting thing. What I've learned is that patients are not nearly as interested in you as you think they are like if you google search me you know you can see all of my professional background nobody ever says anything or asks anything about it so I'm sure it's the same for you yeah I will have the occasional question about McDreamy but I try and delineate that because I don't you know it's out there for people if they want to see what I do but yeah I think that I try and draw a line in the sand I don't want to use that as a reason why people are coming to see me yeah I haven't really luckily had that problem and I do want kids one day I'm married five years in June to an amazing husband who has my exact same name Michael John Metzner but Australian so we were on the view yesterday and that's all they wanted to talk about you have the same exact name but yeah that is something you know working seven days a week I mean I don't get to see my husband as much as I'd like to and we want to have kids in the next couple years so I am trying to I just keep saying I'm going to work as hard as I can now because I'm young and I have the energy so that way when we do have kids I'll have to scale back at some point clap if you're in your thirties no actually I'm not I'll go I'll answer the family kids life work balance question I guess this is a plug for my job it's great because I work fully remote I work from home I travel only a couple times per year so and that was an upside actually when I transitioned into this career is that I got to be present home a lot more you know much more than I was in training or even when I was practicing so that was really special I do still have full time child care so it's not that I'm not doing that I have a four year old and an eight year old but you know I'm there and because I have some flexibility you know I can do a lot of things that like I can go pick up my daughter from school after after school you know if they have a performance or some sort of other activity I can do that I also have generous PTO on vacation so I can take that as well so that's been a real benefit yeah yeah I think that this is something we all struggle with I had two kids during training and I think that just gotta make it work that's my only advice but I think that psychiatry is flexible you know I think that you can play all these roles in a proper practice it's flexible to you set your own hours and I'm able to pick my girls up from school most days and so I think it's really about kind of setting your schedule really protecting your time in your schedule but I think it's a challenge that I think we all still I'm sure struggle with at times yeah I think you know hybrid options or remote options are really great for that so yeah always when you take a job ask about parental leave policy anything else you wanted to add Rob? I'm sorry no I would just second what's been said I don't have kids yet either but I do think that there is some flexibility that there is some matter of control that you have with these things but it's important to really be deliberate and to understand the culture of the place that you're joining and how it you know can you be offline for a family commitment and then make up the work later in the day like there's ways to sort of do things in the right environment alright last question go for it in the same vein as balance so I'm kind of on the cusp of moving a little bit beyond private practice that I'm in to some other opportunities and how do you kind of unwind yourself from some of that clinical practice and not have to be beholden to portal messages all the time and like do a small portion of patient care or your private practice with the other opportunities how you make those roles work together so when I went from academia to industry I decreased my private practice time I'd been seeing patients two evenings a week that was during my research fellowship and my faculty position and then you know knowing that you know not knowing exactly what the culture would be but I knew it was important for me that I wanted to see patients still ended up for that reason decreasing my practice time to one evening a week so and you know when you decrease that right you know that may be in different ways you know that you just don't take on new patients and people sort of you know leave organically because it's time for them to leave or you can say I'm cutting down my practice and transfer them to other providers you know so there's a number of ways you could go about that I think but I think really you have to be realistic and say okay if I have X number of patients you know how many you know email messages phone calls whatever am I going to get you know as long as you're running a private practice that is still your responsibility and you know it's important to communicate with your patients about okay you know I am available for this or for this but you know I'm not you know available for you know you when you you know let's say call on the weekend or something you know for you know coaching on the phone or something like that whatever you know they may you just have to be very clear about what you do do and what you don't do so and then enforce that boundary Anyone else? Alright thank you so much for coming you

non-traditional career paths

medicine

Jacques Ambrose

Dr. Mike Metzner

Dr. Katie Brewster

Dr. Louisa Steinberg

Dr. Rob Accordino

networking

mentorship

work-life balance

pharmaceutical industry

tech-enabled healthcare