AYAM Pediatrics Specialty Mentorship Meeting November 2023

December 04, 2023

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Career-planning webinars organized by the Association of Yale Alumni in Medicine (AYAM) connecting Yale medical students with alumni in specialties across medicine and surgery.

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00:04My name is Paul Leong and I am
00:07the Vice President of the AY AM,
00:10which is the Association
00:11for Yale Alumni in Medicine,
00:13and welcome to the second
00:18AY AM mentorship panels.
00:21We are working through each of the specialty
00:26areas that that Yale medical students
00:28may be interested in in going into.
00:31And we felt it would be a
00:33service to medical students.
00:35And I think we also have some Yale College
00:37students who are also tuned into this,
00:40who are interested in medicine and wanted
00:41to learn about what their options are early.
00:43They're getting, getting,
00:45getting on the bandwagon early.
00:47We wanted to provide this forum
00:49where we would have some alumni.
00:51We reached out to alumni
00:52all over the country.
00:53That's alumni of Yale Medical School who
00:56are interested in the field of Pediatrics,
00:58not interested.
00:59They are practicing in
01:00the field of Pediatrics.
01:02And so our objective for this
01:04is to is to provide a little bit
01:07of an insight into their lives.
01:09We have, we have pediatricians
01:11who are in the academic setting.
01:13We have pediatricians in the
01:15private practice setting.
01:16We have,
01:17we have a graduate who's in Medpedes.
01:20I know many of my friends when I
01:21was at Yale Medical School who were
01:22thinking OK maybe I should be a pediatrician.
01:24It also entered their mind,
01:26well what about Medpedes,
01:27which is which is a very viable
01:30option We have,
01:31we have also we have a pediatrician
01:33who's retired now and has but has
01:35had a tremendous sort of breadth
01:37of experience in academics and in,
01:39in in in, in, in private practice.
01:42And so we're looking forward to
01:43hearing from all these people after
01:45we're here for all these people.
01:47The real meat of this thing is,
01:49is to is to really to field questions
01:52from the students who are listening to this.
01:55We're really here for your questions.
01:57And so please don't be shy,
01:59don't hold back,
02:00ask whatever question comes to mind.
02:02I also have a list of certain questions
02:04that were submitted previously and I and I,
02:06I can also go through some of these.
02:08I'd like to introduce at this point,
02:10Anne Arthur.
02:11Anne is is a graduate of Yale Medical School
02:15and she's also involved in Pediatrics.
02:18She's a pediatric ophthalmologist
02:19and she's got a very,
02:21very responsible position in
02:23terms of in terms of representing
02:25the alumni and integrating the
02:27alumni in the medical school.
02:29So,
02:29and could you please introduce
02:30yourself a little bit?
02:31Hi, Well, good evening,
02:32everybody. I'm actually, thank you, Paul.
02:35I'm actually here working part time in
02:38Brooklyn as a pediatric ophthalmologist.
02:40And I also just joined Yale in June
02:43as Director of Alumni Engagement.
02:46And so for the students who are
02:48joining us this evening,
02:49I want to emphasize that we have a
02:51really vibrant alumni community.
02:52I'm here to help you partner with our alumni.
02:55So if you're looking for someone in
02:57Pediatrics to maybe talk to one-on-one
02:59or looking for a mentor or how to
03:02arrange a research experience,
03:04you can reach out to me. I'll try
03:05to put my contact information in
03:07the chat for those of you
03:09who may want to talk later,
03:10but thanks for coming tonight.
03:17All right, Fantastic.
03:18So what I'd like to do now is
03:23what I'd like to do now,
03:25somebody's texting me.
03:26What I'd like to do now is start to
03:28have each of the panelists introduce
03:32themselves and then and then go
03:34into sort of their own background.
03:37And so we have a list here.
03:38I'd like to start with Doctor Clifford Bogue.
03:42He is the Chairman of Pediatrics
03:44at at Yale Medical School and
03:47the Yale New Haven Hospital.
03:49Doctor Bogue, can you,
03:50can you take us away and give us about
03:527-8 minutes on your life experience?
03:57Yes. Can you hear me?
03:58I sure can. All right. Good.
04:01Well, it's welcome everybody and I'm
04:04looking forward to this discussion and
04:06I can give you a little bit about my
04:09background and what I do currently.
04:11So I as Paul mentioned,
04:16I'm I'm not AYSM graduate,
04:19but I I am a graduate of the one
04:23of the training programs that is
04:26Pediatric Critical Care Fellowship.
04:28And so I started my my career as an
04:33undergrad at the University of Virginia
04:36and then stayed there for medical school.
04:39So eight years in Charlottesville which
04:42is not a bad place to spend 8 years.
04:46And then I knew all early on that
04:50I wanted to go into Pediatrics.
04:53I'd actually shadowed A pediatrician
04:55when I was in high school.
04:58I grew up in Tampa,
04:58FL and and just loved the interaction
05:04with kids and sort of seeing what he did.
05:06And so that really turned me on to medicine,
05:09in particular thinking about Pediatrics.
05:14So I went through Med school and my
05:17experiences in Med school pretty much
05:20confirmed my interest in Pediatrics,
05:23which is really based on one I
05:26just loved working with kids.
05:28It's fun, They're resilient,
05:30they rarely hold grudges and it's,
05:34it's very interesting.
05:36And two, you know,
05:37I thought they had interesting diseases,
05:40lots of infectious diseases,
05:41lots of congenital problems.
05:43And so that both the kinds of
05:47problems that we typically deal
05:50with as pediatricians along with
05:53having a great
05:56group to work with especially both
05:58children and their families really
06:00cemented my interest in in Pediatrics.
06:03So I went after graduating from UVA,
06:07went to Vanderbilt where I did a
06:09residency and then served for a year
06:12as Chief resident of Pediatrics.
06:14During that time I I had,
06:17I thought I was going to be a
06:18general pediatrician in practice.
06:19I thought I was going to go back to Tampa,
06:21FL, which is especially what my
06:24mother wanted me to do and and be a
06:28pediatrician in in private practice
06:29caring for patients over many,
06:31many years.
06:32But as I did my various rotations,
06:35I was really drawn to the acutely I'll child,
06:39the critically I'll child and the
06:41Physiology and action that you see,
06:43you know working at working in
06:45the ICU and caring for patients.
06:47And so I decided to do a fellowship
06:51in pediatric critical care after
06:54my residency at Vanderbilt.
06:57And I also was exposed to some
07:00mentors there at Vanderbilt that
07:02were both inpatient pediatricians
07:05and neonatologists for for example,
07:08and physician scientists and did bench
07:10work and did research looking at lung
07:13injury and lung lung development.
07:15I thought that was really interesting.
07:17I did a little bit of research as a resident.
07:20I'd never done that much prior to residency,
07:25and so I looked,
07:28looked around and really found the the
07:31place that I thought was going to give
07:33me the best opportunity to really explore,
07:36research,
07:36and learn critical care,
07:38which was at Yale.
07:40So in 1989 I drove from
07:44Vanderbilt to from Nashville,
07:46TN to New Haven with my wife and
07:49dog and we settled in for what was
07:52planned to be a three-year fellowship
07:54and then moved back to the Southeast.
07:57And I loved what I did.
07:59I worked incredibly hard,
08:01learned a lot and began working in
08:04the lab and really caught the bug of
08:07of discovery science and and really
08:09trying to to learn some basic science.
08:11And I started out focusing on lung injury,
08:16got interested in in transcription factors
08:18and the role they play in in lung function,
08:23specifically homeobox genes.
08:26So then started my own lab after
08:28working with folks from the department
08:30of biology and the department of
08:32Pediatrics and had you know over
08:34a 25 year career running a basic
08:38research lab looking at the early
08:41embryogenesis of the lung and liver
08:46and it was an incredibly rewarding
08:49career from the research side.
08:52And then also taking care of
08:53patients which I,
08:54which was really very interesting
08:56and and love doing.
08:59And I stayed at Yale all these years
09:02because of the great resources available,
09:06the intellectual resources as well
09:09as the resources of, you know,
09:13a place that really understands
09:14the life of a physician, scientist.
09:17And so I have made it my career and
09:22and I've sort of shifted now from physician,
09:27scientist and and working in the
09:30ICU to running a department.
09:32I've been chair for six years
09:35and had a wonderful time.
09:38A steep learning curve because it's a whole
09:40different set of skills and challenges.
09:43But being able to build a Children's
09:45Hospital, expand what we're doing and
09:48build meaning I didn't we didn't build a
09:51new Children's Hospital but expand and
09:54expand our services across the state
09:56and really grow some exciting programs.
09:58And so that's what I spend my my day
10:00doing now is recruiting faculty and
10:03thinking about building new programs
10:05and recruiting researchers and building
10:07a research portfolio for the department
10:10and and and really excited about
10:17trainees who really are the what I view
10:19is the future of our our department.
10:22I always like to you know go and talk
10:24to our resident applicants because I
10:26tell them I'm already starting faculty
10:29recruitment when they're residents
10:31because it's it's such an opportunity
10:33to to get plugged in and stay.
10:36So that's,
10:37that's my story and I'm happy to
10:40answer later after everyone else.
10:42Any questions?
10:50Thank you Doctor Bogue.
10:51I appreciate that.
10:52That was a fantastic overview.
10:56The Next up is, is Tanya Froelich.
10:59Tanya graduated from Yale Medical
11:02School in 1999, the same year I did.
11:06And so I I know Tanya and and
11:09so she's a terrific person.
11:11And so, Tanya, tell us about yourself,
11:13your time at Yale and what you're up to.
11:15Oh, OK All right.
11:17Well, I am originally from rural
11:21northwestern Pennsylvania,
11:22which is really the Alabama
11:24part of Pennsylvania.
11:25And my mom was a Chinese,
11:29Jamaican immigrant. And so, you know,
11:32and there aren't too many of those hanging
11:34around rural northwestern Pennsylvania.
11:36So I wanted to go to college,
11:38the biggest place that I could find.
11:40So I I headed off to Columbia
11:43University but after loved it there
11:47but really wanted a place that was
11:51a little bit smaller and ended up
11:53you know New Haven ended up being
11:56that blend of my kind of small town
12:00with a green in the New Haven,
12:02green in the in the center.
12:04But also some of those that that big
12:09city culture and you know the just the
12:12the intellectual and academic richness.
12:15And I was also just really
12:18excited about the Yale's,
12:19Yale's idea of of doing research that was
12:23a huge draw for me to to choose Yale.
12:27And then also that we should develop our
12:30our skills and our interests outside
12:33of of medicine and that just makes us
12:36richer and individuals and that we
12:38would have more to give to our patients.
12:41So had a fantastic time at
12:45Yale along with Paul.
12:47Originally when I was in medical
12:49school I thought that I may go
12:52into geriatrics and in fact for my
12:54my Med school thesis I developed
12:57a screening test for dementia and
13:01that was a a fantastic experience.
13:04But in the end I'm just I was
13:07just really drawn to Pediatrics.
13:09I mean Pediatrics is just frankly
13:13more fun and the the idea of of hope
13:18and being able to impact child's life
13:21for for long term just really you know,
13:26I think I think that there's
13:28there's really nothing better.
13:30So I chose to go into Pediatrics and
13:34I went off to Children's Hospital
13:37of Philadelphia.
13:38And along the way, during my time at CHOP,
13:42I've learned about the field of
13:45developmental behavioral Pediatrics.
13:46And for me,
13:48developmental behavioral Pediatrics
13:49just just really felt right.
13:52My mom was a teacher and my dad
13:55was a social worker.
13:57So, you know,
13:59developmental behavioral Pediatrics is all
14:01about how how children learn and also about,
14:06you know,
14:07the the social environment and
14:09how kids can function and reach
14:12their full potentials within the
14:14environment and within the family.
14:17A lot of people wonder, you know,
14:18what kind of conditions we see for
14:21developmental behavioral Pediatrics.
14:22So we see kids with developmental delays,
14:27autism spectrum disorder,
14:29intellectual disability, learning disorders,
14:34ADHD, neuro genetic disorders.
14:36And we are really focused on,
14:39you know, that fact that every,
14:41every child, every individual has,
14:45you know,
14:46a different different cognitive
14:48abilities and cognitive styles and
14:51how can we help each individual,
14:53each child reach their full potential
14:56and live their fullest life.
14:59So it's it's an amazing field.
15:03I have my husband is in orthopedics and
15:05so I have a friend in developmental
15:08behavioral pediatrician friend
15:09who says
15:10you know orthopaedics they can heal your leg.
15:13But you know in developmental
15:15behavioral Pediatrics,
15:16you know we heal your soul.
15:18You know we heal you know your
15:20heart and again how you're going
15:23to to live that fullest life.
15:26So at Cincinnati Children's, I, you know,
15:30got my clinical training for my fellowship.
15:33And then I also still from my time at
15:37Yale had that that that research bug.
15:40So during my second year of my clinical
15:43fellowship I decided to do a National
15:45Research Service Award fellowship at
15:48at Cincinnati Children's in addition,
15:50so I could get a Masters of Science
15:52in epidemiology and biostats that
15:55would really give me that that
15:58strong foundation for research.
16:01And so during that time,
16:03that dual fellowship time,
16:05I ended up writing a NIH Career
16:09Development award K23 to look at ADHD.
16:14That's my kind of in my area of
16:18specialty and and to look at
16:20predictors of ADHD medication response.
16:23And I really love this particular kind
16:27of research because it's it allows me
16:31to see patients and to see how our
16:35interventions really work for the
16:38patients and to to study that and to look,
16:42I'm looking at predictors and and
16:45correlates of response not just in
16:47typically developing children but also
16:49in in kids with who have Down syndrome,
16:53how our treatments work and how we
16:56diagnose ADHD in kids who have you
16:59know different cognitive profiles.
17:01So it's I I think it's a fantastic
17:06field to get involved in.
17:08I've been able to work also on clinical
17:12practice guidelines I developed.
17:14It's on the the panel that co-authored
17:17the most recent American County
17:20Pediatrics clinical practice guideline
17:22for diagnosing and treating ADHD and
17:24then I'm on the the vice chair for the,
17:27we're updating that that guideline right now.
17:31And then I also for the Society of
17:34Developmental Behavioral Pediatrics
17:37co-authored the guideline for diagnosis
17:39and treatment of complex ADHD which
17:43is ADHD in the setting of coexisting
17:46developmental or or mental health conditions.
17:49So that's also really exciting to me
17:51because you know it's not just what you
17:54know I'm doing in the clinical setting,
17:56but being able to really dig into the
18:00evidence base and to share you know,
18:03with clinicians all across the
18:06country what are best practices.
18:09I've also been really involved in
18:12teaching and training at Cincinnati
18:14Children's with our fellowship program
18:17and in particular with the research
18:20training in our fellowship program.
18:23And then this July stepped up
18:25as Director for our Division of
18:28Developmental Behavioral Pediatrics
18:29which at Cincinnati Children's which
18:33is another just great opportunity
18:35for me because it's it's also being
18:38able to think about our our region
18:40and how we're going to improve care
18:43for our entire region.
18:45How we're going to train general
18:47pediatricians in our region to to
18:50be to partner with us and taking
18:52care of our patient population.
18:55And you know there's the aspect of how
18:57we're going to partner with schools.
18:59How we're going to partner
19:01with community agencies.
19:03And then, you know,
19:04one of my favorite things to do is,
19:06is, is mentorship,
19:08just mentoring the fellowships,
19:11the fellows for research,
19:13but also other faculty members and
19:16thinking about how the other faculty
19:19members can grow in their careers and,
19:22you know, reach their fullest
19:24potential as a clinician or as a
19:27clinical educator or as a researcher.
19:30So I I feel really blessed that
19:33I've been able to have all of these
19:35different aspects in my career.
19:38And I'm also happy, you know,
19:40when it's time to answer any questions.
19:43Thank you, Tanya. That's fantastic.
19:45And you know, I remember when I
19:47was doing my Pediatrics rotation
19:48at Yale New Haven Hospital.
19:50I think one of the attendees told me that,
19:52you know, all of us,
19:53you know in medicine we like to,
19:55you know, contribute to human health.
19:57I think the way this,
19:59this attending said is that
20:00you know you when you win as a
20:03cardiothoracic surgeon, you win.
20:04I mean you extend somebody's
20:05life and their quality of life,
20:07but I mean perhaps he was thinking
20:09of population health as well.
20:10His comment was when you win in Pediatrics,
20:13you win big because you win over the
20:15entire and and your your inspiring list
20:18of activities and accomplishments.
20:20You win big because you're impacting
20:22the whole arc of a human life and the
20:24full potential, you know, not just,
20:26you know, you know, whatever.
20:27The last 15 years,
20:28while somebody gets to walk a bit better,
20:30'cause their,
20:30their hip has been replaced by by,
20:33by an orthopedist. So thank you.
20:34Throw shade at the orthopedics,
20:36you know, orthopedist.
20:38Yeah, they're amazing. They're
20:39great guys. They're great guys.
20:40They're great guys. We really
20:41get a a lot of bang for our buck with what
20:43we got. There you go.
20:45So, all right, up next we have Doctor
20:48Denise Kung at in Saint Louis.
20:51Denise, we've heard from
20:52a couple of academicians,
20:54which is terrific, but Denise,
20:56like myself, is in private practice.
20:58So Denise, tell me about your
20:59experience and and what you're up to.
21:03So thank you. It is a pleasure
21:04to be able to participate today.
21:07So my career arc is very different
21:10than our first two speakers.
21:12I started out planning
21:14to do academic medicine.
21:16I grew up in Central Missouri, Columbia.
21:19My dad was a professor at Mizzou.
21:23I always tell my patients as they are
21:25looking at their careers that their
21:28life experiences will definitely
21:29direct where they end up career wise.
21:32My life experience that affected me was
21:35the fact that I had a sister who died at
21:39birth and brother who is much younger,
21:41so he's eight years younger.
21:43So I had the pleasure or the pain,
21:45depending on what my mood is at the time,
21:47but of helping to raise him.
21:52And that really got me interested in
21:56Pediatrics and working with kids.
21:58So before I knew I wanted to be a physician,
22:01I knew I wanted to work with kids.
22:03When I was at the University of
22:06Missouri in the honors program,
22:08we did research.
22:09I ended up doing research in
22:11pediatric rheumatology,
22:12and that's when I decided to enter medicine.
22:15So my original plan was to be
22:18a pediatric rheumatologist.
22:19I graduated College in 1986,
22:23and at that time there was less
22:25than half a dozen pediatric
22:27rheumatologists and there was not a
22:29pediatric board in rheumatology yet.
22:32So my original plan was to go out
22:34there to be on the cutting edge,
22:36to help start a field,
22:39and that's how I ended up at Yale.
22:41That was my plan when I got to Yale,
22:44had to do the research program,
22:46could not identify a pediatric
22:48rheumatology research program.
22:50There just wasn't a project out
22:52there that would fit in with the
22:54schedule that was manageable.
22:56So my original research,
22:57my first summer at Yale was an HIV,
23:01pediatric HIV.
23:01So at that time,
23:03HIV had just been identified
23:06as the virus that caused AIDS,
23:08and there's a lot of research in that area,
23:10and that's where I started.
23:12So if there are any students listening
23:14to this very frustrated that their
23:16first project isn't working out,
23:17take heart, it's OK.
23:19Many of us ended up doing a second project,
23:22which is what I did with my research here.
23:24So I did a fifth year at Yale,
23:26and my research was in child abuse.
23:29So I did a project trying to identify
23:33which factors in a new mom's life would
23:39predict her odds of abusing her child.
23:45Because I knew I wanted to do rheumatology,
23:47I knew I needed to do some
23:49research in the field.
23:50One of the great things about the Yale
23:53system is it allows you to do rotations away.
23:55So I did a month at the DuPont Institute
23:59in Delaware and did a research project,
24:02and I did get that small
24:04PUP project published.
24:05So don't despair if you're doing
24:07a project where you're like, OK,
24:09it's not going where you want to go.
24:10There are a lot of options to do research
24:13away, and it can be very successful.
24:16One of my lasting experiences from Yale,
24:20one of the things that had the
24:22most profound impact on my life,
24:24actually had nothing to do,
24:26though, with the actual academic
24:28part of being at Yale.
24:30My research in child abuse required that
24:32I visit the hospital wards every day,
24:35try and get all the nurses to fill
24:37out our survey on the new moms.
24:38And there was a nurse on the
24:40floor who was my age.
24:42She'd come to Yale because her
24:44boyfriend was a Yale medical student,
24:46and to be honest,
24:47she was one of the few nurses who would
24:49really talk to me and fill out my survey.
24:52We actually ended up getting married
24:55to our spouses within a few weeks of
24:58each other when I was in Saint Louis.
25:02A few years later, about five years later,
25:03I get a phone call from someone said hey,
25:05do you Remember Me?
25:06From Yale? New Haven Hospital.
25:08We've just moved to Saint Louis.
25:10Turned out that they were doing
25:11their residency in Saint Louis.
25:13We ended up being good friends and have
25:16been good friends now for 30 years,
25:18raised our kids together and at
25:20this point are visiting each other
25:22when our kids are getting married.
25:23So the the relationships you make at Yale,
25:26they will be long lasting.
25:28They just may come to you in a
25:32very unexpected way. But I digress.
25:34So after I graduated from Yale,
25:36I did a couples match,
25:37ended up back in Missouri at Washoe,
25:41did my pediatric residency at
25:44Saint Louis Children's Hospital,
25:45and at the time still was intending to
25:48do pediatric rheumatology and finished
25:52and headed into Pete's Room here,
25:55excuse me, I wash U at the time.
25:58I also had a young child,
26:00so I had my first child at the
26:02end of residency
26:06in the early 90s.
26:07We thought we were all very progressive.
26:09We were all going to have
26:10our career and our families.
26:12We were going to do it all.
26:15I made it about six months into
26:17a fellowship and realized, OK,
26:18I wasn't going to do it all.
26:21Not having family in town,
26:23that was a challenge.
26:24And so I made the decision to leave
26:27fellowship and go into private practice.
26:30So I have been in a large group pediatric
26:32practice in West Saint Louis County.
26:34Now I'm in my 29th year.
26:38We are independent,
26:39which is kind of an interesting
26:41position to be in.
26:42These days When I entered practice,
26:45most practices were independent,
26:48independently owned.
26:49I think that as you all start your career,
26:51you're going to find fewer of
26:53those out there.
26:54But one of the things I realized was
26:56that I knew nothing about business.
26:58Trying to run a practice when
27:00you don't know anything about
27:01business is not a great idea.
27:03So I went back to Business School
27:05and while I was still in practice,
27:07did the evening professional
27:09MBA program through Wash U.
27:12Graduated with that degree,
27:13found that it was very helpful.
27:15I find the whole business
27:17aspect very interesting,
27:18something I never would have thought
27:20of when I was in undergraduate.
27:23One of the things I've really liked about
27:26private practice first was the flexibility.
27:28It let me work part time
27:30while my kids were young.
27:32I found that being a mom was a really
27:36useful tool for being a pediatrician,
27:38but also being a pediatrician was a
27:41really useful tool for being a mom.
27:43So for me,
27:45the first several years my kids were young,
27:47it was great.
27:48It gave me the flexibility I needed
27:51to do what I needed with my kids.
27:54The other thing that you can
27:55do in private practice is you
27:56can still do a lot of training.
27:58So our practice is affiliated with Wash U.
28:01We have the pediatric residents doing
28:04their weekly continuity clinic with us.
28:06Wash U does not have a program where
28:08they do their clinics at the hospital.
28:11They go into private practices so we've
28:13had the chance to train the residents.
28:15We we will have them for the whole
28:17three years of their residency.
28:19I've had PA students from Butler
28:21come through.
28:22We can also do volunteering with the
28:25different programs I currently do.
28:27Not only volunteering with
28:28the School of Medicine here,
28:30also with Slough and the Board of Pediatrics.
28:33You can also do research.
28:34So Wash U has a program where they
28:38affiliate with the private practice
28:40doctors to recruit patients,
28:42but also you can conduct clinical
28:44research in your practice if you want.
28:46So there is that flexibility.
28:49As someone said earlier,
28:51Pediatrics is a really important field.
28:53I always tell people, you know,
28:56we don't just wipe noses and change diapers.
28:59If you don't have good pediatric care,
29:02you're not getting your patients
29:04to adulthood.
29:05So what we do is important.
29:07The other thing about Pediatrics,
29:08besides the fact that kids are fine and
29:10we get a dress up for Halloween every
29:12year and not feel stupid about it,
29:14is you really develop lifelong relationships.
29:17So the kids that I first saw when I first
29:20went into practice have now gotten married,
29:24had kids and have come back.
29:25So I am now seeing the second
29:28generation of kids and families.
29:30And that's really cool that
29:31people let you in their lives,
29:33that they trust you and they
29:35come back with their own kids.
29:37And I don't think there are very many
29:39specialties where you get to do that.
29:41So really in many ways you're part of
29:43their family and that's a privilege.
29:45It's also a lot of fun,
29:47especially when you're sitting
29:48in second generations and you
29:49can look at the kid and go,
29:50OK,
29:51you're just like your parent was at this age.
29:54So it's Pediatrics.
29:55Private practice has been a really
29:58good work life balance for me.
30:02I think the moral of the story for
30:04my life is you just never quite
30:06know where you're going to end up.
30:08So I ended up someplace different.
30:10But I think it's worked out.
30:12Thank you Doctor Kong.
30:13And then that's, you know,
30:15there's there's there's more than one
30:17stairway to heaven or something like that.
30:19You know as they say,
30:21I think all of us even if you've sort
30:24of followed sort of the prescribed path,
30:26there's little left turns and right
30:28turns that all of us have had to
30:31incorporate into our lives professionally.
30:32Personally and I think you touched
30:34a lot of that and I think you've
30:36really you know emphasized that
30:37you you you're participating in a
30:39huge spectrum off of the specialty,
30:41not necessarily as a full time
30:43faculty at some place like Wash U
30:45or Slough or Yale or something.
30:47So that's great.
30:48Now Next up we have,
30:50we have Doctor James Reed.
30:53He is only a wee bit ahead of you know,
30:56many of the medical students will
30:58be listening to this.
30:59He's presently at a teaching
31:01Hospital in Boston.
31:02So, James,
31:02why don't you tell us what's
31:03going on right now?
31:05Oh, thank you.
31:05Thank you so much.
31:06I hope everyone can hear me.
31:07Thank you, Doctor. Long as well.
31:10And sorry that I was a little late.
31:11I somehow got put into a register,
31:14but it gave me a different zoom link.
31:15So I was sitting there.
31:16Again, I apologize for being late,
31:18but everyone, I'm a pgy six or
31:21third year pediatric fellow.
31:22I'm in pediatric gastroenterology
31:24at the Massachusetts General
31:26Hospital in downtown Boston.
31:28I'm six months away from completing
31:30my training and pretty excited
31:32about transitioning from being a,
31:34you know, a trainee which has
31:35been kind of a a long path.
31:37I think five years at Yale then three
31:39years of presidency at Sinai 3 in New
31:42York City during the pandemic and
31:43then three years of fellowship at MGH.
31:46This will be kind of like 11 years
31:47since I first put on a short white
31:49coat a note MGH they still give you
31:51a short white coat that you're a
31:53resident fellow or attending one of the
31:56few places that that still does that.
31:58But I think you know my my
32:01journey what I'm I'm sorry if
32:04if some people can't hear me.
32:05I think, you know,
32:06my my journey into medicine
32:08was was motivated by,
32:09you know some personal experiences as a as
32:12a young kid and I really enjoyed you know,
32:16training so far.
32:17I really loved my five years at Yale.
32:20I came in having done a
32:22little bit of research.
32:23I grew really love research.
32:24I was fortunate to work with a
32:26gentleman by the name of Kevin Harold
32:28who I think the medical students might
32:30recognize from some of their lectures.
32:33I was able to participate kind
32:34of in a one year program.
32:36I think many,
32:37many have probably heard of
32:39or tried the MHS program.
32:40I was enrolled in that and also
32:42part of the Howard Hughes Medical
32:44Institute research fellow program,
32:46which unfortunately no longer
32:48exists but used to exist back then
32:50and paid a nice stipend for us
32:52to travel and also to to conduct
32:55some intense bench research.
32:56Mine focused on something called
32:58the receptor for the advanced
32:59location and product,
33:00which was a marker of
33:02complications in diabetes,
33:03both type one and type 2.
33:05And we were looking at ways which may
33:07be removing that gene and its product
33:10could alleviate some of the immune
33:12stress that one sees in both conditions.
33:15So I had a great experience at Yale
33:16and helped springboard me into a
33:18pediatric research residency at Mount Sinai,
33:20which got a little interesting
33:21due to the pandemic.
33:22I had gone in and hoped to
33:24actually work on influenza vaccine,
33:27but the influenza really wasn't
33:28a big problem.
33:29So the influenza research was put
33:30on pause as we were all deployed.
33:33The little adult ICU time at Mount Sinai,
33:36which I can tell you from an
33:38experience being forced into
33:39kind of an adult medicine setting
33:41really did reinforce that yes,
33:42I do like to take care of children more.
33:44I do like changing diapers on smaller,
33:47smaller kids unless the
33:49diaper has pale stool.
33:51And in that case, I panic because I'm
33:53a pediatric gastroenterologist because
33:54we need to do a colostasis workup,
33:56which is something that hopefully all
33:58the medical students have heard of
33:59and something not to be taken lightly.
34:01And of course always done very
34:02promptly because there are some
34:04time sensitive diagnosis in there.
34:05But you know,
34:06did my time at Sinai actually the
34:08pandemic was kind of a unique experience.
34:11It exposed me to some patients with
34:13immuno deficiencies where COVID
34:15either took longer or didn't seem
34:16to have the same classic course.
34:19So I was able to do some research
34:20with a woman named Doctor Charlotte
34:22Cunningham bundles at Sinai in
34:24immuno deficiencies and how patients
34:26with those responded to COVID-19.
34:28And then still when the pandemic
34:29was kind of at its sight in 2020,
34:31I matched MGH and I had, you know,
34:34was able to match the pediatric
34:36gastro that was, you know,
34:38for me kind of a summative,
34:39you know,
34:40a summation of a bunch of interests.
34:41I had met different patients with
34:43gastrointestinal and hepatic conditions
34:45throughout my medical school at Yale.
34:47I had a great introduction
34:49actually as a third year medical
34:52student into pediatric GI Lena.
34:54Our body was a wonderful fellow.
34:55Dr.
34:56Beau probably remembers her
34:57from a few years ago.
34:58She later moved out to UCSF and I think
35:00works at Stanford and I ran into her
35:02at a conference about a few weeks ago.
35:05So really great connections you
35:06can make as a medical student
35:08that that will carry you forward.
35:09And then you know,
35:11similar exposure to liver and GI disease
35:13at Sinai which is a large center,
35:16you know, got me interested.
35:16And then I was you know fortunate
35:19to to move to MGH for training.
35:21So I'm right now kind of,
35:23you know,
35:23both a little farther from where you
35:25guys might be sitting as medical
35:27students and and some undergrads.
35:28I don't know if any of any any
35:29of the undergrads are out there,
35:31but I'm happy to take questions,
35:32you know,
35:33provide my perspectives and and thoughts.
35:35And I'm also, you know,
35:36very eager to hear what the rest of
35:37the panel has to say because I'm,
35:38you know,
35:39still a trainee for a few more months.
35:45James, that was fantastic.
35:49So Next up we have Doctor Carol Smart
35:53who's a long standing member of the AYA
35:56AM and has done all kinds of fantastic
35:59roles with with our organization.
36:01She had completed Medpedes training and
36:04like I said at the beginning of this,
36:07this panel, I I had a number of friends
36:11myself as a medical student who were
36:14interested in Pediatrics but they very
36:16much reflected on the notion of Medpedes.
36:18There's an attractiveness I understand too.
36:20You know, you can follow your patients
36:22over the whole arc of their life.
36:23It seemed that that what how do you
36:25beat continuity of care with that?
36:27But Carol, can you can you tell us
36:30about your own experience and and
36:32tell us about your present activity?
36:34Absolutely.
36:36Thank you. I'm happy to be
36:38here and chat with everybody.
36:41So again, my name is Carol Smarth.
36:45I grew up in New York City,
36:48a child of Haitian immigrants,
36:52and my parents had a lot to do with my
36:55interest in medicine and also interest
36:58in what kind of medicine I had to do.
37:00So growing up always heard about Haiti and,
37:04you know, medicine in underserved areas.
37:06So that really fueled my desire
37:09to be interested in international
37:12medicine and medicine in general.
37:14So I am a graduate of Yale
37:18College class of 92.
37:20So for your undergrads,
37:21I was Saybrook and and then
37:25stayed for medical school,
37:27which was not anticipated.
37:29But Yale Med offered an incredible
37:32chance at education and incredible
37:35philosophy on how to learn,
37:36which I think has affected
37:39all of us positively.
37:41And so I graduated from Yale Med
37:45in 1997 after taking an extra year.
37:49But one of the most sort of,
37:51I think,
37:52critical moments in my education
37:54at Yale Med is actually I applied
37:56for a Downs Fellowship,
37:58which is a public health fellowship
38:00to do international travel at the
38:02summer of our after our first year.
38:04And I don't know if that still is
38:07available and an opportunity now,
38:10but it was an incredible opportunity.
38:11Many of my my friends at that
38:15time went abroad.
38:16I unfortunately did not
38:17get a Downs fellowship,
38:19but was able to connect with some
38:22folks in Haiti and spent the summer
38:26at the General Hospital in Haiti.
38:29And there I was working at the
38:34UNICEF rehydration clinic.
38:35So my project was how to sort of pick up
38:38cholera from normal infectious diarrheas.
38:41And unfortunately that project
38:44was became very relevant later
38:46because since then Haiti has
38:49had many cholera outbreaks.
38:51But working there really illuminated
38:56my interest in in infectious diseases,
39:00Pediatrics.
39:00But I also worked with adults and
39:03worked with a lot of infectious
39:06diseases including HIV and TB.
39:08So that combination really whet my
39:12appetite for what I would do later.
39:16So I completed medical school
39:20and took a year,
39:21an extra year to do some extra research
39:24because when it came down to choosing,
39:27I really loved Pediatrics like,
39:30you know these my fellow panelists.
39:33But I really felt the need and to be
39:36able to provide adult care because
39:39of underserved areas and the need to
39:42be able to provide for the whole,
39:45you know, spectrum of life.
39:46So I really had a hard time
39:48choosing and took a year off to
39:51sort of think about it and decide.
39:53During that year I did a fellowship in
39:56violence prevention at the CDC and it
39:59focused on Pediatrics and gun violence.
40:01Again, you know,
40:03nurturing my love in Pediatrics,
40:06but I also went to.
40:08Gabon,
40:08Africa and worked for about four or
40:12five months there doing infectious
40:15diseases and a lot of adult medicine
40:17as part of the Schweitzer fellowship
40:20and again leaving that to that.
40:23Those experiences couldn't
40:25decide between and at that time.
40:27Yale did not have a Med Peach program,
40:30did not have a family medicine program.
40:32So I started looking around and there
40:35were very few Med Pete's program.
40:37Mount Sinai had one,
40:39but Harvard had one as well.
40:42And so when I went up to Harvard,
40:46I fell in love with their concept.
40:49I also was greatly interested
40:52in Paul Farmer's work,
40:54the late Paul Farmer who was on faculty
40:57there and did a lot of work in Haiti.
40:59So I chose to go ahead and
41:03complete residency there.
41:05So a residency in Med
41:07PEDs is very interesting.
41:10It really does juxtapose the
41:13differences between medicine and
41:15PEDs and people will definitely
41:18appreciate the very differences
41:19in the culture and mentality.
41:21So in the Med Peeds program at Harvard,
41:24you either do your medicine at MGH or
41:26at the Brigham and you do all your
41:29peeds at the Children's Hospital.
41:31So all renowned hospitals and every
41:34and every three months I would
41:36switch back and again very different
41:40cultures and and experiences.
41:44But so helpful and I think just really
41:49added to my ability to connect to people,
41:53understand differences and really
41:55appreciate life in in all its stages
41:59and health in all its stages.
42:00So after I completed my Medpede's fellowship,
42:07which takes four years,
42:10I went ahead and worked for
42:12a year because my husband,
42:14also an orthopedist,
42:15had just finished his fellowship
42:17and was actually finishing up
42:19his fellowship in New York.
42:20So I worked as an attending
42:21in medicine for a year because
42:23it was hard to find Med peeds
42:26after doing adult medicine attending
42:29teaching in in in New York City for a year,
42:33I went and pursued my interest
42:36in ID and infectious diseases.
42:38And so again I had a very wide
42:42breadth of interest which you know
42:45many people were like narrowed down.
42:48But I I really couldn't.
42:50So along with Med PEDs,
42:52I then did an infectious disease fellowship
42:57at Hopkins and I I couldn't decide
43:00between whether I would do peas and adults,
43:02but decided to do adults and try to
43:04finagle doing a little bit of both.
43:05But Hopkins made me choose one.
43:08And this is a little bit the
43:09conundrum of of riding the line.
43:11But again, when you practice
43:13international medicine and you,
43:14you have to be able to do
43:16everything and and all ages.
43:18And I think that was like the drive for
43:20me wanting to do a little bit of both.
43:22But nonetheless,
43:24I did ID adult ID while I was at
43:27Hopkins and also completed a Robert
43:30Wood Johnson Clinical Scholar
43:32Fellowship because I was interested
43:34in clinical research and did some HIV
43:38work and HIV work and socioeconomic
43:42status while in Baltimore.
43:44And so and so I think that that
43:48that really was the fruition of
43:51of Med PEDs and ID for me.
43:54And after finishing that,
43:57my husband who was also again an
44:00orthopedist at Hopkins for that time,
44:02decided to join private practice with
44:05his brother here in Virginia Leesburg,
44:07VA, where I currently AM.
44:10And And so I had a big decision to
44:12make whether I was going to leave
44:14and then do more private practice.
44:16And after having options to work
44:19in more community health setting
44:21versus a private practice,
44:23I did join a family practice that where
44:26I was able to do a little bit of everything.
44:29So you know,
44:31at this time I do
44:35pretty much PEDs and adults.
44:37I would say I do a third PEDs,
44:402/3 adults in a day.
44:41I may see a newborn and I might
44:44see a A a patient. That's 101.
44:49Often I see family members, 3 generations.
44:53I'll see, you know, grandparents,
44:56parents and their children.
44:58So that's the joy of doing family practice.
45:01You see them in all ages and all stages,
45:05and you also are their confidant.
45:07You end up being the counselor and
45:12essentially what one patient put
45:15very eloquently, the quarterback.
45:16You run the plays, you,
45:18you guide them, you direct them,
45:20you direct the the specialist they
45:23go to and the decisions you make.
45:26And that has been the most rewarding part
45:30of my job because I've started a family,
45:34which by now my kids are now in college,
45:36and I'm now an empty nester.
45:38I did continue doing some international
45:40work with Partners in Health
45:42and Paul Farmers Group and have
45:44continued to be active with them.
45:46I've gone back down there.
45:47I consult with a lot of the Haitian
45:51doctors there still regularly
45:53and and am currently now involved
45:56with a new organization,
45:57Community Coalition for Haiti,
45:59that has a clinic in Jacmel,
46:01Haiti.
46:01And we are in the process of building
46:05their clinical outreach program as well.
46:09And so being in private practice
46:12has allowed me to still continue my
46:15love for international medicine,
46:17my love for ID.
46:19And with COVID,
46:20ID now has become primary care,
46:23which you know that line has
46:25always been very, very, you know,
46:30hard to delineate anyway.
46:32So I do a little bit of everything every day,
46:35which is what I love and still am able
46:39to do international medicine as well.
46:41So I look forward to answering
46:44any questions and ensuring any any
46:48more experiences as as needed.
46:52Thank you Carol. That would that's
46:54again another incredible background.
46:56I mean everything from ID to the Robert Wood
46:58Johnson Fellowship to all of your training
47:00and and and the vast array of of what you
47:03see today that's that's pretty amazing.
47:05So our last speaker and just to the
47:09students who are listening to this,
47:11you know, be prepared with your questions
47:14because after Doctor Starr speaks,
47:15we'll again I have some questions
47:17that have been submitted,
47:18but we'd love to hear some
47:20live questions from you guys.
47:21Don't be shy.
47:22So be prepared to ask your
47:23questions after this last speaker.
47:25So Amy, tell us what you you have,
47:29you have the,
47:30the widest perspective of all of us, right?
47:32You're you're now retired,
47:34but you spent, if I recall,
47:36talking to you about half your
47:38life in a private practice setting,
47:39but half your life in a in
47:40a in an academic setting.
47:42So tell us all about it.
47:43And we do want to leave some
47:45time for students.
47:46So the other students questions,
47:47of course, so, so,
47:48so we'll,
47:49we'll hear it,
47:50but then we'll get on to the questions.
47:54All right. Well, I'm very happy to be here.
47:57I am a graduate of the class of 1974 and
48:01I always was interested in Pediatrics
48:05and I think for a very simplistic reason.
48:07I just thought it was optimistic.
48:09I liked working with people and if
48:12I helped them they had a long life
48:14in front of them so I enjoyed that.
48:17So I did the usual the residency,
48:19and I took myself to Los Angeles and I
48:24worked for Southern California Permanente,
48:26both because I like the mechanism
48:28of how they delivered healthcare,
48:31but also for myself.
48:34I felt it had a good balance of work,
48:38life balance.
48:39I already had one child and I
48:42ultimately had three children,
48:44and I liked having said hours.
48:46I didn't want to run a business of my own,
48:49and I liked being in the camaraderie of a
48:52very large hospital and medical setting.
48:55So I started practicing general
48:58Pediatrics and I enjoyed it.
49:00But I found that I really had an
49:02interest most in one group of patients,
49:05as it turned out,
49:07which was chronic illnesses.
49:09I liked seeing people long term,
49:12trying to work with them.
49:14And I discovered particularly that
49:17I like the rheumatologic diseases
49:19as one of the other doctors had.
49:21And so I became fascinated by that.
49:25I told all the people,
49:26the pediatricians around me,
49:28if you don't like that kind of patient,
49:30send them to me.
49:31And I started doing one day a week
49:34of just rheumatology patients
49:36and of course there there was no
49:39fields of pediatric rheumatology.
49:40Then I was just doing it as
49:42part of General Pee's.
49:44The other four days I did General Pee's
49:46and I took my ALE background with me.
49:50I said the only way I'm going to do
49:53this is learn it is to do it myself.
49:56So there was one Pete's room textbook.
49:59I read that.
50:00Then I read a lot of adult room textbooks.
50:02Then I went to Symposia and I
50:06started doing anything I could do to
50:09find information to do it better.
50:12And I did this for about 14 years.
50:15I was very happy and had patients I loved.
50:19And then the Academy of Pediatrics
50:21decided that they were going to now offer
50:25such specialization in Pete's room in 1992.
50:28And the question became what to
50:30do with the people who had already
50:33been doing it but never certified.
50:36And so the rule became to
50:39be grandfathered in.
50:40You would take,
50:42if you had done already,
50:44more than three years of Pete's room
50:46practice, you could take the exam,
50:49and if you passed,
50:51you would become board certified.
50:53And so I went back to my Yale mode.
50:56I asked for six weeks off,
50:58and I studied and I studied because the
51:01exam had lots of things that didn't
51:04pertain to my clinical practice.
51:06There was a lot of statistics on it.
51:08There was a lot of immunology on it,
51:11basic immunology,
51:12which I really hadn't studied back in the
51:1670s in at Yale, but I had that same
51:19concept of how to study from the Yale
51:22system because no one was watching me.
51:25I was just doing it.
51:27And so when I passed the exam,
51:30I was the first Pete's room
51:33person for Kaiser Permanente.
51:34And then I began to see all
51:37these patients from all over.
51:40And basically I wound up doing 4 days of
51:43Pete's room and a day of general Pediatrics.
51:46And my night call was general Pediatrics.
51:49And that went along for about 14 years.
51:52And then my children grew up and
51:55moved away from California and I
51:57thought I needed another challenge.
51:59So I spoke to a number of the foremost
52:03rheumatologists in the country and
52:05I said would you take me on as on
52:08a sabbatical and I'll come and see
52:10what life is like in academia.
52:13And so Columbia said yes.
52:15And I went off and I spent three months
52:18there and it was a tremendous change for me.
52:21I mean, I got involved with research,
52:23particularly clinical trials of course,
52:25teaching Med students and
52:28residents and and fellows,
52:30and it was great experience.
52:32And I went back to California and about
52:35a year later Columbia asked me if
52:37I'd like to have a full time position
52:40and transition to academic medicine.
52:43And since there was nothing really to
52:45keep me in LA anymore except my patients,
52:48I decided to go ahead and do that.
52:51And that was a a real change for me.
52:55Different system, but I I really enjoyed it.
52:59Obscure cases, odd diseases I had never seen,
53:03chikungunya, arthritis,
53:05all kinds of crazy things.
53:07And I loved it.
53:09And ultimately I ran the fellowship
53:12program there and stayed 11 years.
53:15And I retired just in 2020,
53:19about a month before COVID broke out.
53:22And so that's what I did.
53:25And I think what I would want
53:28to impart to young people,
53:30even though I'm old and and
53:33these stories are old,
53:34is that you have to be very
53:38adaptable in in life and in practice.
53:41You start out with one thing and you
53:43wind up doing something different.
53:45And all of us here have kind of
53:48said that you have an idea coming
53:50out from from medical school and
53:52you may stay in Pediatrics,
53:54but you're shifting into a
53:56different form of Pediatrics.
53:58The second thing is that Yale taught me
54:01to think for myself and to work on my own.
54:05If if it wasn't available with
54:08a person or a class,
54:10you could do it with journals and
54:12books and all of those other things,
54:15and you could make sure that
54:18you did what you want to do.
54:21So I've spent 45 years in Pediatrics
54:25and honestly, I loved all of it,
54:28absolutely all of it.
54:29And I couldn't have asked for better.
54:33And when Howard Pearson,
54:34my mentor when I was at Yale,
54:36told me, just do what you love,
54:39that's the way I did it.
54:41And it was a great a great run.
54:46Well Doctor Starr that was that was
54:49a frankly inspiring you know I mean
54:51we we all of us at Yale you know
54:53talk about the Yale system and how
54:55it encourages lifetime learning.
54:58It encourages sort of self starting
55:01and and and and and your narrative
55:03was all about that right.
55:05I mean, you, you, you,
55:05if the field didn't exist,
55:06you went and you went and got all
55:09over it yourself and and especially
55:11caught up to you 14 years later.
55:13So that's really fantastic.
55:14That's really great.
55:15So listen,
55:16I appreciate all of you who have
55:18given us your background.
55:20I let you each go a little bit
55:22longer because I think what you
55:24had to say was very valuable.
55:26But what I want to do and again
55:28I encourage the medical students
55:30to ask any questions you have.
55:31But while you're thinking of those questions,
55:33if you're storing them up,
55:35you know some of the questions that
55:37were posed to me through through
55:40the registration process and just
55:43in speaking to to some of you guys
55:46and the students, each of you.
55:48And I mean,
55:49perhaps talking to Yale medical
55:51students is a little bit, you know,
55:53of a bias sample because a lot
55:54of us are selected because,
55:56you know,
55:56we have a lot of perhaps intellectual
55:59inquiry in US and that sometimes
56:00leads to to to research, you know,
56:03but not every medical student
56:05is is into research.
56:07You know, research in an academic setting
56:10typically leads to a lot of grant writing,
56:13a lot of publications and that's fabulous.
56:17But you know, my wife is the assistant
56:19Dean of the medical school here at Pitts.
56:21She writes a lot of grants and I think,
56:24you know, when when people for instance
56:26entertain the idea of being a doctor,
56:29that's a certain activity,
56:30There's a certain kind of pace.
56:32There's a certain cognitive
56:33exercise that's going on.
56:35It's a bit distinct.
56:36Then the act of like, oh great,
56:38there's a, there's a, you know,
56:40request for application for
56:41an R1 or something, you know,
56:43something like that.
56:43Let's get all over that
56:45writing that that big,
56:46thick impressive tome of a of of
56:49of a grant application to the NIH.
56:52You know,
56:52one of the questions in in in short was if
56:55I'm not particularly taken with research,
56:58you know is you know what, what?
57:01What should be, how should that affect
57:03my choices in terms of Pediatrics?
57:05Obviously not every pediatrician
57:07is doing research, most aren't.
57:09But, but if you're a Yale medical
57:11student and you're thinking, geez,
57:13I don't know if I like writing
57:14grants and I love seeing patients,
57:16but you know,
57:17how should that,
57:18how should that sort of mold your decisions?
57:22Does anybody want to take a swing at that,
57:24that question?
57:31Well, if nobody will take a swing at that
57:32question, Doctor Bogue, let me ask you,
57:34you're in a position where you, you know,
57:37you're looking at young hopefuls.
57:38Let's be honest, your institution,
57:40your, your department is
57:41legendary for the research.
57:43What if somebody comes up to
57:44you guys and just sort of says,
57:45I just want to be a really good pediatrician?
57:48What's the honest answer to that?
57:49Is that like, listen,
57:50there are many great training programs
57:51that are a little less research intensive.
57:53Maybe you should look there Or is
57:55there is there a spot for them at Yale,
57:57New Haven Hospital?
57:57If they're like, you know, I'm,
57:59I'm just going to really take
58:00great care of kids.
58:02Thanks for the question.
58:05I would say it's fine.
58:07If you want to take care of kids,
58:08that's great.
58:11And we do have residents that every
58:13year that that's what they want to do.
58:16They're not interested in
58:18some specialty training,
58:19they're not interested in research.
58:22They just want to take great care of
58:25kids and that's the career they pick.
58:27So I would say out of our of
58:30our residency somewhere between
58:3240 and 50% end up going into
58:36general Pediatrics in some form
58:37or another and then the other half
58:39are going to subspecialty where
58:41you're more likely to do research.
58:43So you know in our selection
58:47process that that doesn't really,
58:50it's not a big factor whether you do or not.
58:53It's just overall what what's your interest,
58:56how do you come across and you know are
58:59you going to be a good member of the team?
59:03Great. Tanya, you had your hand up I believe,
59:06Did you want to add something to that?
59:07Yeah, I mean I I would say that
59:10even pediatric subspecialties,
59:12I think the stat in the the NASA
59:17National Academies of Science,
59:19Engineering and Medicine
59:20report that recently came out,
59:21I think only about half of pediatric
59:24sub specialists actually do research.
59:27And the truth is that there's a dearth
59:30of pediatric sub specialists across
59:33the nation to to care for all all of
59:35the kids who need sub specialty care.
59:38So, you know,
59:39for me as a Division Director in
59:41developmental behavioral Pediatrics, yes,
59:43I'm, I'm really excited if someone comes to,
59:47you know, apply for a faculty position
59:49and they want to do research.
59:50But I am equally as excited if they
59:53want to be that amazing clinician that
59:56takes care of of all the needs that
01:00:00are out there for our patients, right.
01:00:03And and I would just add that there are
01:00:06a lot of ways to be involved in research
01:00:08without being the one that's writing the
01:00:10RO one grants and having that stress.
01:00:13We have a lot of faculty that you know,
01:00:15participate in clinical trials and they,
01:00:18they help, you know,
01:00:19they're on a team and they're contributors,
01:00:22but they do it in a way that
01:00:25feels comfortable for them and
01:00:26fits with their their,
01:00:29their clinical activities.
01:00:31Yeah, I mean it's really
01:00:33all about team science.
01:00:34You know everybody has unique skills
01:00:36and interests to to contribute.
01:00:39Absolutely. You know,
01:00:40I wanna I wanna loop together one of
01:00:44the questions that was anonymously
01:00:46submitted to me which and and maybe
01:00:49relate something to what you're saying Tanya,
01:00:52in that there's a bit of a dearth
01:00:54of pediatric sub specialists.
01:00:55I bet there's communities where you know
01:00:59there's the children are being underserved.
01:01:01You know they don't have a pediatric
01:01:03rheumatologist who's either gone
01:01:05through the fellowship or whatever
01:01:06or has taken enormous efforts to
01:01:08self educate themselves on that.
01:01:10And you know nobody goes into medicine
01:01:12you'd like to think and and I don't
01:01:15think anybody goes into Pediatrics
01:01:17because of you know earning a living.
01:01:19You know when you say there's a
01:01:21dearth of Pediatrics sub specialist
01:01:22and I listen to Doctor Reed say
01:01:24that well he's you know he's you
01:01:25know six years of training that's
01:01:26as long as training an orthopaedist.
01:01:28I think is this a factor you know say
01:01:33I'm say I'm I I remember a personal
01:01:36account I was talking to one of one
01:01:39of my child's special needs and was
01:01:41in in need of the services of the
01:01:45pediatric endocrinologist got growth
01:01:47hormone for the better part of a decade.
01:01:50And I remember talking kind of offline
01:01:52with one of the pediatric endocrinologists
01:01:55here at the University of Pittsburgh
01:01:57and was leaving the University of
01:02:00Pittsburgh at the UPMC system.
01:02:02And part of the reason perfectly
01:02:05candidly was financial.
01:02:06The you know when you ask somebody
01:02:08to to train for six years when you
01:02:11ask somebody to pass through an
01:02:13education at at at Yale Medical School.
01:02:16I'm quite involved with you know in
01:02:18terms of improving the financial
01:02:20circumstances for our students coming
01:02:22through with debt and I think we we're
01:02:25we're doing better at Yale Medical School.
01:02:27But the reality is that you don't
01:02:30have to be making too much.
01:02:31We can help quite a bit at Yale
01:02:34Medical School in terms of, you know,
01:02:35reducing your tuition burden.
01:02:37If if if your income is is is pretty
01:02:40low but the threshold is not that high.
01:02:43You can be a pretty middle income
01:02:45person in the United States.
01:02:46And when you go to Yale Medical School,
01:02:48they're going to say that's sufficient
01:02:50that we'd like you to pay the full load.
01:02:53You know you know 95 a year or
01:02:55something if you put somebody into
01:02:57$400,000 of debt and then you ask
01:02:59them to do six years of training and
01:03:02and you and you and then you kind
01:03:04of you you you you pay em.
01:03:06What this very talented pediatric
01:03:08endocrinologist did for a couple
01:03:10years taking care of my child.
01:03:12I was I was a little unsettled to
01:03:14hear that she was leaving the academic
01:03:16world partially for for that reason.
01:03:19Am I am I off base has has has the
01:03:22circumstances improved since I've
01:03:23spoken that Lady are are is this is
01:03:25this a deterrent in any fashion is
01:03:27this part of the reason for the the
01:03:29dearth of of pediatric subspecial
01:03:31or or is there
01:03:32something else who likes
01:03:33to take a swing at that.
01:03:37I would I think that the the
01:03:38idea is out there you know that
01:03:41that that's absolutely a factor.
01:03:43I mean the people do need to make a
01:03:45living and pay for their family and and
01:03:47you know if they if they have loans.
01:03:49So there's an increasing awareness
01:03:51of this problem and you know if
01:03:54you do research there's pediatric
01:03:56research loan repayment that I,
01:03:58you know I actually have that which
01:04:00was extraordinarily helpful for
01:04:02me for for paying off my loans.
01:04:05But there's also increasing movement
01:04:09to offer loan repayment for people
01:04:13who do pediatric clinical care.
01:04:15And there's a, you know, there's a,
01:04:18there's a huge movement again that
01:04:20needs some report about the pediatric
01:04:22subspecialty workforce with just a huge
01:04:25proponent of these loan repayment programs.
01:04:28And I think there is movement on that.
01:04:32There's also a movement
01:04:34to improve the payment.
01:04:35Again,
01:04:36the nascent report talks a lot about
01:04:38the need to increase reimbursement
01:04:41for pediatric sub specialists.
01:04:44Good. James Reed are you you're
01:04:48you're finishing your training
01:04:50do you give any thought?
01:04:51I think previous to your time at
01:04:53Yale medical School you you know
01:04:54you worked in the world of finance.
01:04:56You understand dollars and cents.
01:04:57Is this the slightest consideration
01:04:59or you you're just enraptured with
01:05:01with the with the children and the
01:05:03cognitive challenge of your work.
01:05:05I think Doctor Long thanks for
01:05:07the the question directing me.
01:05:08I I I am indeed enraptured with with
01:05:10caring for children especially with
01:05:11GI and liver disease and and the work
01:05:13I do I actually do bench work in
01:05:16fibrosis with Ray Chung and MGH but
01:05:19and that's an interesting perspective.
01:05:20So I work in a laboratory that's part
01:05:22of the Department of Medicine and we're
01:05:25we're talking about conversations
01:05:26in terms of people looking for a
01:05:28job right out of the paediatrics of
01:05:29specialty training versus an adult
01:05:31subspecialty training for example.
01:05:33And there is a noticeable difference.
01:05:35I can say this because I have gotten
01:05:38mailers oddly for an adult GI job
01:05:40and they'll put a salary on the the
01:05:44postcard and then when you look at
01:05:46the ones for Pediatrics it's it's
01:05:48not you know not in that ballpark.
01:05:51So I think and then of course these
01:05:52are salary for for private practice
01:05:54not for for academic centers.
01:05:56But I think there is you know people
01:05:58now are are you know people thinking
01:06:01of entering Pediatrics pediatric
01:06:02trainees are thinking about this and
01:06:04it's something that I've thought about
01:06:06too and I think it has to do with you
01:06:08know in the their all the attendance.
01:06:09McCall can correct me in in terms of
01:06:12how reimbursements had been structured
01:06:13in the past through private insurance
01:06:15and the differences and caring for a
01:06:18patient population that might have more
01:06:21Medicaid payers in it than Medicare
01:06:23payers and private insurance payers.
01:06:25But I'm hoping that this is something and
01:06:27certainly I've seen a lot of advocacy work.
01:06:30When you become a pediatric president,
01:06:31you get membership in the American Academy
01:06:33of Pediatrics who will send you emails
01:06:35every day which are really good to read.
01:06:37Sometimes you can't read all of
01:06:38them because there's so many.
01:06:39When you join a subspecialty,
01:06:40there's also the subspecialty organizations
01:06:42which will send you lots of emails.
01:06:43But there is a lot of work going on in
01:06:46terms of advocacy from the sub specialists,
01:06:48from the general pediatricians and from
01:06:51other parts of medicine to help increase,
01:06:53you know, compensation.
01:06:54Given the amount of work and the fact that
01:06:56you're doing something in Pediatrics,
01:06:58you know,
01:06:58you're I think Doctor Long, he said.
01:07:00You win.
01:07:00You win big because you're
01:07:01not only affecting Care now,
01:07:03but really for the rest of the
01:07:05patient's life.
01:07:07I think this is something the
01:07:09Children's Hospital Association
01:07:10is also taking on advocacy,
01:07:12legislative advocacy to
01:07:14to increase reimbursement.
01:07:16I just want to say Doctor Arthur put
01:07:18a link in the chat about the pediatric
01:07:21subspecialty loan repayment program.
01:07:22So thank you, Doctor Arthur.
01:07:25And well before I move on to
01:07:26the next question, you know, I,
01:07:27you know, reflecting what you said,
01:07:29Doctor Reed, it, you know, yeah,
01:07:31when you win in Pediatrics you win big.
01:07:33And you know you'd love to think that
01:07:36you know in in in in our health systems,
01:07:39prioritization of the public health
01:07:42and looking at you know outcomes
01:07:45as opposed to you know who's who's
01:07:47cranking out the most procedures
01:07:49in a fee for service model.
01:07:51You'd like to think society would
01:07:54Orient how people are renumerated
01:07:56in in in at least a fairway.
01:07:58When I was a little kid I I grew up
01:08:00in England till I was seven years old
01:08:01and I have no idea the answer to this
01:08:03question but I I wonder if you're a
01:08:05Pediatrics and specialist at Guy's
01:08:07Hospital in London is there a huge
01:08:09like you know in in a system that's
01:08:12largely orchestrated by the state.
01:08:13You know they do they look at
01:08:15this a bit differently.
01:08:16Do Pediatrics and specialists in in
01:08:18Europe or the UK or what have you.
01:08:20Are they like you know jeez
01:08:21what's the deal here guys?
01:08:22I'm I'm,
01:08:23I'm really you know really contributing
01:08:27greatly to the public health and and
01:08:30why Why some sort of differential.
01:08:31Hopefully that differential is
01:08:32improving and and and and and
01:08:34and and will get much better.
01:08:35So but
01:08:37we do also have to say I mean as you said,
01:08:40Paul none of us you know chose these
01:08:42fields because you know we were
01:08:43looking for the salary and you know,
01:08:45I would I I would choose you know,
01:08:47my field again you know 1000 times
01:08:50if I had to make the choice just
01:08:53for the life satisfaction. So
01:08:56here's another question I I was
01:08:59posed to me by a medical student and
01:09:02this was that there's an awareness
01:09:05maybe this is maybe this is just
01:09:07'cause we read it in the media.
01:09:09There's an awareness that that young people
01:09:13are under a great deal of stress nowadays.
01:09:15Is that, is that just sort of,
01:09:17are we just saying it to each other
01:09:19as so much that we believe it?
01:09:21But this question went something like this.
01:09:24Given that, let's assume for a
01:09:26second that young people are under
01:09:28a different kind of stress than
01:09:30maybe we were when we were children
01:09:33in this 80s or the 70s or the 60s.
01:09:35You know, does that,
01:09:37does that manifest that into the field?
01:09:39You know, are we our pediatricians,
01:09:42whether they're in general practice or,
01:09:44you know, in an academic setting?
01:09:46Are they dealing with a great deal of duress,
01:09:50emotional duress and what have you?
01:09:51And do I need to be prepared for that if,
01:09:53if I'm gonna, if I'm gonna go into that
01:09:55and there's a lot of kids in duress,
01:09:57let me ask somebody who's maybe,
01:09:59you know, in a private practice setting.
01:10:01Denise, can you, Doctor Khan,
01:10:03can you tell me,
01:10:04like in your practice in Saint Louis?
01:10:06You know listen Saint Louis is a great city.
01:10:10You know, I, I've,
01:10:11I've good friends there.
01:10:12Saint Louis also famously has
01:10:14a very high crime rate,
01:10:15extraordinary crime rate at least
01:10:17in certain areas of it.
01:10:19Is this a symptom of duress in your
01:10:21community and is that manifested
01:10:22into into the lives of children?
01:10:24Are you feeling it in your practice?
01:10:26I think absolutely so.
01:10:27I'm in my 29th year of private
01:10:29practice now my practice is
01:10:30in West Saint Louis County.
01:10:32So it is a little bit different
01:10:34than Saint Louis City whose
01:10:36statistics you hear the most about.
01:10:38But I would say especially
01:10:39coming out of the pandemic,
01:10:41it's very different now the
01:10:42lives of the teenagers than it
01:10:44was pre pandemic and definitely
01:10:46different than it was 20 years ago.
01:10:48It's really hard to be a teenager.
01:10:51Social media is a big part of it,
01:10:53pediatric practice in the
01:10:55private practice setting,
01:10:56a lot of it is psychiatry now.
01:10:58So I in the last several years,
01:11:02I now have a handout that I
01:11:04can give my patients that has
01:11:05all the crisis phone numbers,
01:11:07if you are in crisis,
01:11:09the numbers to call right
01:11:10all the psychiatric care.
01:11:12There is a psychiatric urgent care
01:11:15in Saint Louis affiliated with one
01:11:17of the non pediatric hospitals that
01:11:20if you are in crisis go get help.
01:11:23The rate of teen suicide unfortunately
01:11:26I think is extremely high.
01:11:28There have been more now in the
01:11:31last 10 years than I saw in the 1st
01:11:3420 years of my practice combined.
01:11:36It is a crisis in this country
01:11:38and as a pediatrician,
01:11:39you're definitely on the front lines.
01:11:41So I think the practice that people
01:11:46will have for those graduating now is
01:11:49very different than when I graduated.
01:11:51You need to have training in psychiatry.
01:11:54You need to be prepared not
01:11:56only for counseling but also
01:11:58prescribing psychiatric medications,
01:12:00and that's very different.
01:12:02It's a it's a crisis for the entire country.
01:12:06I think the pediatricians on the
01:12:09front line definitely feel it.
01:12:10It to be honest,
01:12:13I think it contributes to a lot
01:12:15of burnout for pediatricians
01:12:16who are on the front line.
01:12:18If you aren't prepared to be a psychiatrist
01:12:20and that's what you are, that's hard.
01:12:23You kind of affect the game.
01:12:24The rules have changed of what you're doing.
01:12:27So I I think anyone who wants to go into
01:12:29private practice needs to go in with
01:12:31their eyes open and realize that yes,
01:12:33we take care of the patient,
01:12:34we take care of the family,
01:12:36but we also take care of a
01:12:37lot of psychiatric needs.
01:12:39Now we'll be on the front line.
01:12:42You need to be prepared for
01:12:44getting back up when you need it,
01:12:46how to do it in an emergency,
01:12:47because unfortunately that's a lot of it.
01:12:49But definitely the kids are in crisis.
01:12:53You can kind of look at world events,
01:12:56you can look at events in
01:12:59the US with things socially.
01:13:03There are unfortunately a lot of aggression,
01:13:06a lot of anxiety in people that
01:13:09manifest itself in aggression to
01:13:11different people in different groups.
01:13:14And the kids feel it.
01:13:16And unfortunately,
01:13:16they all have social media.
01:13:18They're seeing everything.
01:13:19So that on the one hand they see all these
01:13:23videos of people living fabulous lives,
01:13:25and on the other hand,
01:13:26they're seeing all the videos of all
01:13:28this aggression and hate out there.
01:13:30And how you reconcile that
01:13:31when you're young is hard.
01:13:32I don't know how you successfully do that.
01:13:36But definitely it's a good question.
01:13:38It's definitely a part of Pediatrics.
01:13:40It's something as a society that
01:13:42we're still trying to figure
01:13:43out what the answer is.
01:13:44We're definitely not there.
01:13:45But I think it's important to have
01:13:48thoughtful people part of the conversation.
01:13:52Thank you. That's great.
01:13:52And I'm gonna, I'm gonna ask for a
01:13:55doctor smart to contribute next.
01:13:56But I I absolutely. I mean, I I,
01:13:59you know I have a very good friend
01:14:02who works in academic Pediatrics and
01:14:04she commented simply that you know,
01:14:06when I was compared to us is what
01:14:08she said when I was a child.
01:14:09You know, just even family
01:14:11Thanksgivings and stuff like that.
01:14:13You know, of course there's always little
01:14:14things going on in life and everything,
01:14:16but the kids seem to have tuned into the
01:14:19fact that that that even the adults are
01:14:22a little concerned about certain things.
01:14:24You know, they, you know,
01:14:25even a 11 year old understands whether
01:14:27it's the political tone of the country
01:14:29or stuff going on more widely speaking.
01:14:32They're not blind to that and they can see
01:14:33that the adults don't quite have the answers.
01:14:35And so they're it's not surprising
01:14:37at all to me that they're they're
01:14:39gonna manifest some some anxiety
01:14:40and some depression and and and
01:14:42uncertainty and and and and that's
01:14:44going to be a big part of the job.
01:14:45Carol, tell me what's on your mind.
01:14:48I was just going to echo what
01:14:51what you guys have said.
01:14:53I think there's a trickle down effect
01:14:55because parents are more stressed
01:14:57and kids are more stressed. You know,
01:15:00I think that that that relationship,
01:15:02I see it every day as I take care of
01:15:05families because those stressors inevitably
01:15:08affect your kids and and it's it's
01:15:11hard to see when you're living in it.
01:15:13But as a sort of a surveyor from afar,
01:15:18I can more easily translate it.
01:15:21So a lot of times family stressors,
01:15:23parental problems do translate to the kids.
01:15:27COVID has made mental health really
01:15:30a priority all around and so I
01:15:32don't think it's gonna, you know,
01:15:34you can escape it in any field of medicine,
01:15:37frankly, because of the degree of anxiety.
01:15:40I think social media has a lot to do with it.
01:15:43Patients have educated themselves,
01:15:44gone to Google and diagnosed themselves
01:15:47by the time you see them in whatever field
01:15:49that that that is also something about it.
01:15:52But you know right now in both
01:15:56medicine and PEDs along with vitals,
01:15:59general anxiety screen and a depression
01:16:02screen are are considered vitals
01:16:04and now Pediatrics and medicine
01:16:06for every patient that comes in.
01:16:09And that just tells you where you
01:16:11know where we are as a nation.
01:16:15Tanya,
01:16:16I was just gonna reinforce what
01:16:19what Carol said that yes, it is.
01:16:22It is a big, big issue that
01:16:23we deal in with in Pediatrics.
01:16:25But I don't think, you know,
01:16:27for any field of medicine,
01:16:28it's quite prominent the
01:16:30epidemic of loneliness, anxiety,
01:16:31depression, substance abuse.
01:16:33So if you are a responsible
01:16:36doctor no matter what age of
01:16:38patient you are taking care of,
01:16:40there are you know you're going to be
01:16:42dealing with mental health concerns.
01:16:46Fabulous. So listen, we only have a few
01:16:50minutes left and you know I think our,
01:16:53our medical students,
01:16:54I think this sort of 20,000 foot.
01:16:57Carol, did you have another question?
01:16:59No. OK, good. So the, you know,
01:17:04I think this 20,000 foot view on on on the
01:17:07specialty of Pediatrics is very, very useful.
01:17:10I think it's good, you know,
01:17:12to have the long vision.
01:17:14I do recognize though that a lot
01:17:15of our Yale medical students,
01:17:17they they're very smart and they're
01:17:18they're aware of all these fundamental
01:17:20issues and some of them just have
01:17:22more mechanical and logistical
01:17:23reasons to be tuning in tonight.
01:17:26They're like, geez,
01:17:27I'm a first year medical student.
01:17:28I'm trying to make up my mind or but maybe
01:17:31I'm a third and 4th year medical student.
01:17:33Does anybody have any pearls of wisdom?
01:17:35If you were a fourth year, 3rd year,
01:17:38second year medical student and
01:17:40you know you're becoming just
01:17:42enamored of of Pediatrics,
01:17:45there's the typical things,
01:17:48you know get some good mentorship.
01:17:49If you are involved and
01:17:51interested in research, do that.
01:17:53There's the tactical issues of you know,
01:17:56do you do sub is and, and,
01:17:58and and and wear and other kind
01:18:01of thing beyond those things.
01:18:03But I'm certainly I'm certainly
01:18:05you know those if you can comment
01:18:07on any of those things do you have
01:18:10any specific maybe more practical
01:18:12pearls of wisdom about you know what
01:18:14what what should you do if you're in
01:18:16the seat of the people that we're
01:18:18speaking to this evening and wanting
01:18:20to enter into a pediatric specialty
01:18:23What would be what would be sensible
01:18:24things to be thinking about And
01:18:26I'm going to put ask Doctor Beau
01:18:28once again because because he's.
01:18:30But anybody please contribute to
01:18:31this what would you what would
01:18:32you what would you advise.
01:18:34Well you know as a general bit of
01:18:39advice I really totally agree with what
01:18:42Amy said when she was talking about
01:18:44her story is follow your interests.
01:18:46You know the thing that is the best.
01:18:49I think one of the best Hedges against
01:18:53Burnout is really loving what you do.
01:18:57And if you love what you
01:19:00do and it's meaningful,
01:19:02then that carries you a long way
01:19:05that can carry you in a job that
01:19:07doesn't pay as high as the next one.
01:19:08It can carry you when you have to
01:19:10write grants and work weekends.
01:19:11It can carry you when things are difficult
01:19:14because you feel you're making a difference.
01:19:16And so you know I I think as
01:19:19and this corollary or the,
01:19:22the other part of that that I would say in
01:19:25my own experience is nothing is forever.
01:19:27There are so many opportunities and
01:19:30you can change and you've heard stories
01:19:32tonight of people who have changed what
01:19:34they did partway through their career,
01:19:36moved from private practice to
01:19:38academics and did this or that.
01:19:40I, you know,
01:19:41I I did all sorts of things in my
01:19:44career from research to running
01:19:46an ICU to running a fellowship
01:19:49to now running a department.
01:19:51Those are all very different experiences
01:19:53that I have fully enjoyed and have
01:19:56made my career so exciting because I
01:19:58didn't do the same thing for 40 years.
01:20:01Everything you can really follow
01:20:05your interests.
01:20:05So that would be my broad advices.
01:20:08Don't don't overthink it.
01:20:10Kind of kind of go with your gut and
01:20:14what you love to do and you know if
01:20:17you need to change you can change.
01:20:21Wonderful. Any other comments from anybody?
01:20:23I I certainly as you're thinking
01:20:26of that of of of all the comments
01:20:28and there were a lot of inspiring
01:20:30comments made this evening.
01:20:31I thought Doctor Starr's comment
01:20:33I've worked in this I'm gonna
01:20:35paraphrase you Doctor Starr.
01:20:36I've worked in this for 40 something
01:20:38years and I loved every day of it.
01:20:41You know listen you know that's
01:20:44fantastic and what a privilege and
01:20:46and I think this institution that we
01:20:48all share is a big part of launching
01:20:50us in that direction because listen,
01:20:52we we interact with you know we
01:20:54have friends and colleagues and
01:20:55all over the you know we we have
01:20:57all walked through our lives.
01:20:58You know we know quite a few people
01:21:00probably the majority of people
01:21:02who would not necessarily say boy
01:21:04I've worked in something for 40
01:21:05years and I've loved every day of
01:21:07it and so that's that's an enormous
01:21:09success and a life well lived and
01:21:11a professor well worked in.
01:21:12So I really wanted to thank
01:21:18everybody for participating.
01:21:19It was really it was really fantastic.
01:21:22Listening to your stories I,
01:21:23I, I I sincerely found them
01:21:26very inspirational I think.
01:21:28I think.
01:21:29I think I think I'm I'm going to
01:21:31go away from this more inspired
01:21:33and feeling more grateful.
01:21:35Now there's an undergraduate
01:21:36course at Yale it was the most
01:21:37subscribed course at Yale.
01:21:38How to be happy.
01:21:39I think I saw red that and they
01:21:42said they said this.
01:21:43I forget there was a lady who was
01:21:45teaching that hundreds and hundreds of
01:21:47people signing up for it and and they said,
01:21:49yeah.
01:21:49She said if you ask,
01:21:50if you tell yourself each day
01:21:52something that you're grateful
01:21:54for you'll find yourself being
01:21:55happier because it reminds you not
01:21:57just of your little pesky problems
01:21:58but but what makes you happy.
01:22:00And I think I've heard a lot this
01:22:02evening about you know what what to
01:22:04be grateful for all of you and and
01:22:07and specialists and doctors like yourself.
01:22:10Does anybody else have any closing comments.
01:22:12But I thank you.
01:22:15Well, I just want to say this
01:22:17has been a wonderful experience
01:22:18and I've really enjoyed hearing
01:22:20everybody's stories as well.
01:22:21So thank you for the opportunity,
01:22:24good stuff. And I hope our,
01:22:25I hope our students who have been
01:22:26a little bit quiet this evening,
01:22:28I hope they, I hope they derive real
01:22:30value from this because because
01:22:32it's a it's a great compendium
01:22:34of life experience here.
01:22:35OK. So thank you.
01:22:37I think our contract information is
01:22:39showing up and if you have questions,
01:22:43anything that I talked about or
01:22:45even didn't mention a questions,
01:22:47comments reach out. Yeah, I agree.
01:22:52That's absolutely the case.
01:22:53You know, there's we approached
01:22:56all living alumni who are
01:22:58connected to Pediatrics training,
01:23:00retired in practice.
01:23:01And we had quite a few responses,
01:23:04some many multiples of what's
01:23:05involved in this panel.
01:23:07And so to the students,
01:23:09undergraduates or medical students,
01:23:12these folks, most of them checked
01:23:14the box on the initial survey that
01:23:16they're OK with being contacted.
01:23:17And so we're gonna be back
01:23:19in touch with the students.
01:23:20And so to say there are these
01:23:22couple of dozen of pediatricians
01:23:24all throughout their careers that
01:23:26would be happy to receive questions
01:23:28and you know points of career
01:23:30advice or something like that.
01:23:32And so we'll make all these names,
01:23:34but then all all the other
01:23:36names that weren't able to fit
01:23:37onto the panel tonight,
01:23:38this will all be made available
01:23:39to our students.