1 00:00:04,663 --> 00:00:05,623 Sara Dong: Hi everyone. 2 00:00:05,623 --> 00:00:10,213 Welcome to Febrile, a cultured podcast about all things infectious disease. 3 00:00:10,336 --> 00:00:14,566 We dive into ID clinical reasoning diagnostics, antimicrobial management. 4 00:00:15,046 --> 00:00:19,426 I'm Sara Dong, your host, and today I'm quite thrilled to have two guests here 5 00:00:19,426 --> 00:00:25,526 so we can talk about working towards improved consult fitness, but before we 6 00:00:25,526 --> 00:00:29,786 get into the topic, I'll have our guests say hello and introduce themselves. 7 00:00:30,043 --> 00:00:30,553 Priya Nori: Hi. 8 00:00:30,613 --> 00:00:31,613 Great to be here, Sara. 9 00:00:31,663 --> 00:00:33,163 Thank you for the invitation. 10 00:00:33,223 --> 00:00:33,973 We're thrilled. 11 00:00:33,973 --> 00:00:35,413 We're huge fans of the pod. 12 00:00:35,843 --> 00:00:37,553 So I am Priya Nori. 13 00:00:37,703 --> 00:00:42,443 I am an adult infectious diseases doc at the Albert Einstein College 14 00:00:42,443 --> 00:00:44,723 of Medicine in the Bronx, New York. 15 00:00:45,153 --> 00:00:47,393 Here I do stewardship. 16 00:00:47,393 --> 00:00:48,503 I do OPAT. 17 00:00:48,973 --> 00:00:53,653 Um, sort of very random in the mix with lots of different things, but I 18 00:00:53,983 --> 00:01:00,783 am close collaborators with our other guest today on multiple writing projects, 19 00:01:00,783 --> 00:01:07,126 but also our academic journal, which is Antimicrobial Stewardship and Healthcare 20 00:01:07,236 --> 00:01:10,176 Epidemiology, which is a SHEA (Society of Healthcare Epidemiology of America) 21 00:01:10,176 --> 00:01:12,256 journal that we both work on together. 22 00:01:12,676 --> 00:01:15,326 And I'm gonna kick it over to my co-guest. 23 00:01:16,403 --> 00:01:18,173 Gonzalo Bearman: Thanks, and thanks for those kind words, Priya. 24 00:01:18,560 --> 00:01:19,230 I'm Gonzalo Bearman. 25 00:01:20,030 --> 00:01:23,810 I'm an infectious disease specialist at the Virginia Commonwealth University, also 26 00:01:23,810 --> 00:01:24,955 known as the Medical College of Virginia. 27 00:01:25,875 --> 00:01:28,665 And I've been the division chair here for about 12 years. 28 00:01:28,995 --> 00:01:32,205 I'm also a healthcare epidemiologist by training, and as Priya said, 29 00:01:32,475 --> 00:01:33,915 uh, we work, uh, I'm the editor. 30 00:01:33,915 --> 00:01:37,755 She's the deputy editor of the Antimicrobial Stewardship Healthcare 31 00:01:37,755 --> 00:01:39,525 Epidemiology Journal from SHEA. 32 00:01:39,825 --> 00:01:40,635 So it's a pleasure to be with you. 33 00:01:40,725 --> 00:01:41,385 Thank you so much. 34 00:01:41,755 --> 00:01:42,225 Sara Dong: Perfect. 35 00:01:42,225 --> 00:01:45,495 And you guys have a podcast for the journal too that you host. 36 00:01:45,495 --> 00:01:45,825 So 37 00:01:46,125 --> 00:01:46,455 Gonzalo Bearman: Yeah, 38 00:01:46,545 --> 00:01:47,475 Sara Dong: we'll plug that and link to it. 39 00:01:47,625 --> 00:01:48,135 So folks, 40 00:01:48,225 --> 00:01:48,705 Gonzalo Bearman: nice. 41 00:01:48,875 --> 00:01:49,935 Sara Dong: are hopefully already listening, but just in case. 42 00:01:50,265 --> 00:01:50,625 Gonzalo Bearman: Thank you. 43 00:01:50,965 --> 00:01:54,235 Sara Dong: So as everyone's favorite cultured podcast, we always like 44 00:01:54,235 --> 00:01:57,325 to kick it off by asking if you wouldn't mind sharing a little piece 45 00:01:57,325 --> 00:02:01,405 of culture, just something fun, um, things that bring you happiness. 46 00:02:01,828 --> 00:02:02,878 Priya, maybe I'll start with you. 47 00:02:03,713 --> 00:02:03,953 Priya Nori: Sure. 48 00:02:04,213 --> 00:02:06,961 So I was thinking about this a lot yesterday, Sara. 49 00:02:07,566 --> 00:02:10,206 And I, there's a, there's a lot of things I do. 50 00:02:10,236 --> 00:02:15,516 I mean, I have a low key like skincare obsession. 51 00:02:16,566 --> 00:02:18,006 I shop a lot. 52 00:02:19,236 --> 00:02:24,186 I'm a, I'm a stage mom, but you know, separate from all of that. 53 00:02:24,186 --> 00:02:29,946 I did wanna plug that we have an interest group called South Asians in ID, which 54 00:02:30,116 --> 00:02:32,586 is an official IDSA interest group. 55 00:02:33,006 --> 00:02:36,726 And something cool that we do is we have a book club where 56 00:02:36,801 --> 00:02:37,281 Sara Dong: Nice. 57 00:02:37,326 --> 00:02:42,606 Priya Nori: try to read works by like South Asian diaspora writers. 58 00:02:42,871 --> 00:02:44,731 Or anyone adjacent. 59 00:02:45,601 --> 00:02:51,811 we recently read the latest book by Kiran Desai, which is the Loneliness of Sonia 60 00:02:51,811 --> 00:02:53,931 and Sunny, which is a, a great read. 61 00:02:53,991 --> 00:02:55,191 Um, highly recommend. 62 00:02:55,641 --> 00:02:59,215 And, yeah, I wanted to plug that group and say what's up to them all. 63 00:02:59,215 --> 00:03:01,645 I know that they will be listening at some point. 64 00:03:02,490 --> 00:03:02,910 Sara Dong: Love it. 65 00:03:03,760 --> 00:03:06,140 Gonzalo Bearman: So I like that book club Priya, you gotta invite me one day. 66 00:03:06,360 --> 00:03:07,880 How many years do we need to work 67 00:03:08,025 --> 00:03:08,535 Priya Nori: adjacent. 68 00:03:09,795 --> 00:03:13,095 You certainly spend enough time with me to be a brown adjacent. 69 00:03:13,260 --> 00:03:17,130 Gonzalo Bearman: Okay, well, uh, in terms of the culture, I guess 70 00:03:17,130 --> 00:03:20,810 I should say that I'm Argentine born, you know, Argentine American. 71 00:03:20,810 --> 00:03:22,970 I have two passports, Argentina, USA. 72 00:03:23,210 --> 00:03:26,600 So naturally I'm obsessed with soccer, with being from Argentina, playing 73 00:03:26,600 --> 00:03:28,130 or watching, more watching now. 74 00:03:28,400 --> 00:03:31,340 So I spent a lot of time doing that and uh, I've been playing 75 00:03:31,340 --> 00:03:32,270 the drum since I was a boy. 76 00:03:32,270 --> 00:03:35,270 So I spent a lot of time on the drum set and playing with my cover band. 77 00:03:35,270 --> 00:03:36,890 So that, do a little something outside of work. 78 00:03:36,890 --> 00:03:38,090 It's not all work and no play. 79 00:03:38,570 --> 00:03:39,590 Sara Dong: Very nice. 80 00:03:39,916 --> 00:03:43,440 Well, I'll start by thanking you guys for creating this article, so 81 00:03:43,440 --> 00:03:47,390 I want to point listeners to, from Clinical Infectious Diseases, CID. 82 00:03:47,390 --> 00:03:51,800 There was a viewpoint entitled H.U.S.T.L.E., a consult fitness guide 83 00:03:51,800 --> 00:03:53,530 for infectious disease providers. 84 00:03:54,020 --> 00:03:59,195 And so, I'll start by asking, I mentioned that idea of consult fitness, which 85 00:03:59,195 --> 00:04:01,325 you guys explore in this viewpoint. 86 00:04:01,325 --> 00:04:03,755 So can you give us an intro? 87 00:04:03,755 --> 00:04:04,985 What do you mean by that? 88 00:04:05,171 --> 00:04:06,191 Consult fitness. 89 00:04:06,461 --> 00:04:08,821 Gonzalo Bearman: So a while ago, a couple years back, I read 90 00:04:08,821 --> 00:04:10,166 an article, which wasn't new. 91 00:04:10,546 --> 00:04:13,006 It was talking about excellence or clinical excellence. 92 00:04:13,921 --> 00:04:17,101 You hear that term a lot, but, I was actually wondering, like, 93 00:04:17,101 --> 00:04:18,721 has anyone ever defined that? 94 00:04:19,351 --> 00:04:22,591 And it's been defined, it defined both for just general clinical 95 00:04:22,591 --> 00:04:24,961 medicine and also infectious disease. 96 00:04:24,961 --> 00:04:29,371 And it comes down to a, a component of not only having an understanding, 97 00:04:29,371 --> 00:04:32,731 the knowledge and the ability to practice medicine, but really also 98 00:04:32,731 --> 00:04:35,201 having a scholarship component to it. 99 00:04:35,501 --> 00:04:38,321 And it was really very academic medicine focused, if you know what I mean. 100 00:04:38,891 --> 00:04:42,101 And it kind of led to the next step, which is consult fitness, which is. 101 00:04:43,031 --> 00:04:45,851 Yeah, there's maybe a component of being somewhat physically fit 102 00:04:45,851 --> 00:04:48,431 that was inspiring from that, but that's not really the inspiration. 103 00:04:48,851 --> 00:04:52,941 The idea is that if you have consult fitness, not only are you knowledgeable 104 00:04:53,091 --> 00:04:57,891 and skillful as a consultant, but you can navigate the system and you know how to 105 00:04:57,891 --> 00:05:00,471 navigate the system effectively to triage. 106 00:05:00,906 --> 00:05:05,016 You know, manage things, uh, back burner things, prioritize things, manage a 107 00:05:05,016 --> 00:05:08,586 team, et cetera, et cetera, all during the course of a day to day while 108 00:05:08,586 --> 00:05:12,186 maintaining that academic scholarly edge also in the background, I dunno, Priya, 109 00:05:12,186 --> 00:05:13,656 did I, did I cover most of it there? 110 00:05:13,656 --> 00:05:13,716 Yeah. 111 00:05:13,951 --> 00:05:15,391 Priya Nori: Yeah, absolutely. 112 00:05:15,391 --> 00:05:19,141 And I will say that you walk this walk. 113 00:05:19,461 --> 00:05:21,116 I don't necessarily. 114 00:05:22,421 --> 00:05:27,131 Which is why it's really beneficial for me to partner with someone like 115 00:05:27,131 --> 00:05:31,091 Gonzalo who can keep me on track and say, why are you doing that? 116 00:05:31,181 --> 00:05:32,711 That's absurd. 117 00:05:32,711 --> 00:05:34,121 You need to stop doing that. 118 00:05:34,521 --> 00:05:35,631 I'm better now. 119 00:05:35,901 --> 00:05:43,971 But I started as a very unfit ID consultant in the sense that, you know, 120 00:05:43,971 --> 00:05:49,511 I would write these really illustrative, beautiful notes, but they weren't really 121 00:05:49,511 --> 00:05:54,291 impressing anyone, but, but me and my ID colleagues and, I probably spend 122 00:05:54,291 --> 00:05:58,251 too much time in chats just engaging people and wasting a lot of time. 123 00:05:58,341 --> 00:06:04,135 And so, I needed this, I needed to go through the exercise of working on this 124 00:06:04,135 --> 00:06:08,935 with Gonzalo as much as I needed to share some of these ideas with, with 125 00:06:08,935 --> 00:06:10,465 the people that I work with every day. 126 00:06:11,605 --> 00:06:15,305 Sara Dong: Yeah, you guys propose this framework HUSTLE. 127 00:06:15,305 --> 00:06:19,175 We're gonna go through the letters, but before we do, I thought it might 128 00:06:19,175 --> 00:06:22,755 be nice what you were thinking about when you started collaborating on 129 00:06:22,755 --> 00:06:26,665 writing this, the goals that you were thinking about as you were crafting 130 00:06:26,795 --> 00:06:28,325 the different letters of the acronym. 131 00:06:28,490 --> 00:06:32,165 Gonzalo Bearman: Well, I mean, the underlying goal for me was to put into 132 00:06:32,795 --> 00:06:36,245 words and hopefully the publication that the ID community would read 133 00:06:36,605 --> 00:06:44,073 on how do we reclaim or claim our workflow, maintain our focus, regulate 134 00:06:44,073 --> 00:06:48,033 and manage our energies and really set the agenda in infectious disease. 135 00:06:48,213 --> 00:06:51,183 Because one thing we've learned, I think with the pandemic in the rearview 136 00:06:51,183 --> 00:06:54,543 mirror is like if we don't set the agenda, someone will set it for us. 137 00:06:55,278 --> 00:06:57,183 You, you heard about all these experts popping up. 138 00:06:57,183 --> 00:06:59,343 It had nothing to do with infectious disease and epidemiologists. 139 00:06:59,523 --> 00:07:02,943 So we are the experts in this field and we're the ones who should be 140 00:07:02,943 --> 00:07:06,453 saying what we will and will not do and when we'll do it, so to speak. 141 00:07:06,573 --> 00:07:08,403 And that's really kind of one of the primary drivers. 142 00:07:08,403 --> 00:07:09,723 Now, the acronym itself. 143 00:07:10,248 --> 00:07:13,728 I'd probably have to give more kudos to, to Priya on that. 144 00:07:14,028 --> 00:07:16,398 Um, I'll turn it over to her 'cause she had a good idea with that. 145 00:07:16,398 --> 00:07:16,938 Take it away. 146 00:07:19,308 --> 00:07:19,728 Priya Nori: Okay. 147 00:07:19,728 --> 00:07:24,590 So, and I can't even really remember the moment that we stumbled 148 00:07:24,590 --> 00:07:31,961 upon the title, but we do in our regular conversations often speak 149 00:07:31,991 --> 00:07:34,421 about boots on the ground issues. 150 00:07:34,938 --> 00:07:41,163 So Gonzalo, uh, leads his division, but he is a rare type of division 151 00:07:41,163 --> 00:07:45,273 chief that spends a lot of time in the clinic and on the consult service. 152 00:07:46,113 --> 00:07:49,713 He is going through a lot of the same challenges that me as a 153 00:07:49,803 --> 00:07:54,403 just kind of middle manager type faces on the wards every day. 154 00:07:54,733 --> 00:07:58,033 And so we have these really robust conversations about, Hey, 155 00:07:58,033 --> 00:07:59,143 can you believe this happened? 156 00:07:59,563 --> 00:08:01,213 Um, what should we do about this? 157 00:08:01,218 --> 00:08:05,193 Why do we allow ourselves to undergo, you know, a certain kind 158 00:08:05,193 --> 00:08:07,803 of, um, martyrdom or whatever. 159 00:08:08,733 --> 00:08:13,583 And so that's where these ideas and this is how the whole thing came together 160 00:08:13,583 --> 00:08:17,763 basically is our lived experience coming from two different perspectives. 161 00:08:18,383 --> 00:08:28,523 Um, so HUSTLE, uh, probably comes from my long time love and being a connoisseur 162 00:08:28,613 --> 00:08:34,958 of hip hop, and I happened to work in the Bronx, which is the birthplace of hip hop. 163 00:08:35,018 --> 00:08:35,828 I trained here. 164 00:08:35,828 --> 00:08:36,938 I was a med student here too. 165 00:08:36,938 --> 00:08:41,018 I've been here for a long time, so it's always like rap culture's kind 166 00:08:41,018 --> 00:08:43,598 of always on the front of my mind. 167 00:08:45,038 --> 00:08:53,378 and, uh, I listened to a lot of, uh, early 1990s or 2000s rappers who 168 00:08:53,378 --> 00:08:55,688 used to talk about the hustle a lot. 169 00:08:55,808 --> 00:09:00,608 And I think there's a lot there for us that, um, it's about the work 170 00:09:00,608 --> 00:09:05,018 ethic and the elbow grease and we wanted to bring some of that in here. 171 00:09:05,303 --> 00:09:05,933 Gonzalo Bearman: Yeah, definitely. 172 00:09:05,933 --> 00:09:09,683 Priya is more hip hop and I'm more rock and roll, but had been left, 173 00:09:09,773 --> 00:09:12,953 left to my devices, we probably had a rock and roll quote like Tom Petty 174 00:09:13,133 --> 00:09:16,853 or something like that saying, using one of his famous, famous lyrics. 175 00:09:16,853 --> 00:09:18,713 Even the losers get lucky sometimes. 176 00:09:19,958 --> 00:09:23,183 You know, we don't wanna be losers and we wanna be lucky all the time, you 177 00:09:23,183 --> 00:09:24,983 know, so we wanna set the agenda, so, 178 00:09:25,073 --> 00:09:25,973 Sara Dong: Yeah, love. 179 00:09:26,348 --> 00:09:28,358 Priya Nori: not in a DJ T sense, right? 180 00:09:29,828 --> 00:09:30,818 I don't wanna be losers. 181 00:09:32,003 --> 00:09:37,193 Sara Dong: Uh, well, okay, so we wanna take on the HUSTLE mindset. 182 00:09:37,193 --> 00:09:40,073 So, uh, we're gonna walk through the letters. 183 00:09:40,256 --> 00:09:43,226 I'll introduce the letters and have you give a little insight 184 00:09:43,226 --> 00:09:45,206 into, um, what you were thinking. 185 00:09:45,206 --> 00:09:48,686 So we're starting with H, Hone your skills, set 186 00:09:48,686 --> 00:09:50,966 boundaries, manage expectations. 187 00:09:51,241 --> 00:09:53,396 Gonzalo Bearman: Alright, Priya, do you want me to take that? 188 00:09:53,741 --> 00:09:58,331 Priya Nori: Yes, this is, anyone that knows you and reads this paper. 189 00:09:58,331 --> 00:10:00,761 It is like you screaming off the page. 190 00:10:00,851 --> 00:10:02,501 So I think you should start. 191 00:10:02,756 --> 00:10:05,216 Gonzalo Bearman: Okay, well maybe I'll try not to scream, but alright. 192 00:10:05,216 --> 00:10:07,976 So hone your skills, set limits, and and manage expectations. 193 00:10:07,976 --> 00:10:10,931 Really honing your skills of consult management or managing your service. 194 00:10:11,921 --> 00:10:12,731 Setting limits. 195 00:10:12,731 --> 00:10:16,916 And I think this is really important because I've learned this by being a 196 00:10:16,916 --> 00:10:21,506 division chair for 12 years and seeing the other 11 or 10 division chairs around 197 00:10:21,506 --> 00:10:23,756 me, how they set limits with their teams. 198 00:10:23,756 --> 00:10:27,926 Like, we don't do these consults, we're not available unless you have 199 00:10:27,926 --> 00:10:29,966 tissue, tissue, uh, uh, histopathology. 200 00:10:30,836 --> 00:10:32,546 We as oncologists, were not interested. 201 00:10:32,786 --> 00:10:33,956 You know, you've heard these things before 202 00:10:34,121 --> 00:10:34,411 Sara Dong: Yeah. 203 00:10:34,526 --> 00:10:39,191 Gonzalo Bearman: and it's like we seem to drop everything when we get a call. 204 00:10:39,191 --> 00:10:40,631 Forget a call, an epic chat. 205 00:10:40,661 --> 00:10:41,081 Like that's 206 00:10:41,531 --> 00:10:41,611 Sara Dong: Hmm. 207 00:10:41,741 --> 00:10:44,261 Gonzalo Bearman: of a sudden all, uh, unbelievably important. 208 00:10:44,561 --> 00:10:49,011 So we need to set limits and we don't work shifts, like let's take hospital 209 00:10:49,011 --> 00:10:51,991 medicine, and, and then we may never work shifts 'cause we're never gonna 210 00:10:51,991 --> 00:10:56,341 have an ID team with 85 people on it that would come in eight hour shifts in 24 7. 211 00:10:56,821 --> 00:10:59,731 But we can set limits on what we think is a reasonable workday. 212 00:11:00,121 --> 00:11:01,411 And this is referenced in the paper. 213 00:11:01,871 --> 00:11:04,991 I'm saying now more than ever, that no one should work beyond 6:00 PM. 214 00:11:05,561 --> 00:11:06,551 Now, what time do you start? 215 00:11:06,551 --> 00:11:08,261 Well, that's up to you, but generally you should never 216 00:11:08,261 --> 00:11:09,611 work more than 10 hours a day. 217 00:11:10,181 --> 00:11:15,131 And the truth in my opinion is that the majority of ID consults, you may disagree, 218 00:11:15,131 --> 00:11:19,841 Sara, Priya may disagree at times also are important, but they're not urgent. 219 00:11:21,041 --> 00:11:22,241 They're important, but not urgent. 220 00:11:22,601 --> 00:11:27,161 So we can say, you know, we will see x number of cases up until four o'clock and 221 00:11:27,161 --> 00:11:30,071 then the last hour and a half or so are charting, and then we're out the door. 222 00:11:30,981 --> 00:11:33,981 The next day starts, whatever's left over, it gets carried over. 223 00:11:34,581 --> 00:11:37,251 And this is worth saying that expectation with the team is important because, 224 00:11:37,301 --> 00:11:38,981 it should be an expectation across the team. 225 00:11:38,981 --> 00:11:42,281 If, if I'm coming off service or I'm coming on service and someone 226 00:11:42,281 --> 00:11:45,371 else is on service, they can kick over two to three cases to me. 227 00:11:45,371 --> 00:11:47,651 It's no problem 'cause that's how we function. 228 00:11:47,981 --> 00:11:50,381 Set limits, you know, so that we don't burn ourselves out. 229 00:11:50,591 --> 00:11:53,111 So that, that's really kind of the, the underlying tone. 230 00:11:53,111 --> 00:11:55,211 And we'll get back to the team at ethos shortly. 231 00:11:56,276 --> 00:11:56,666 Sara Dong: Yeah. 232 00:11:56,996 --> 00:11:59,846 No, I, I have no disagreement so far. 233 00:12:00,656 --> 00:12:01,226 I like that. 234 00:12:01,226 --> 00:12:03,056 And important, not urgent. 235 00:12:03,131 --> 00:12:03,341 Gonzalo Bearman: Yeah. 236 00:12:03,786 --> 00:12:06,846 Sara Dong: All right, so for U, we have upgrade your toolbox. 237 00:12:06,846 --> 00:12:09,336 So what kinds of things can we work on here? 238 00:12:09,565 --> 00:12:14,005 Priya Nori: This one might also be Gonzalo, but, he's a lot more tech savvy 239 00:12:14,085 --> 00:12:20,555 than I am, and he's an early adopter of some of these AI based tools and stuff. 240 00:12:20,555 --> 00:12:22,385 I'm sort of a slow adopter, but, um. 241 00:12:22,775 --> 00:12:24,245 I'll let him talk more about that. 242 00:12:24,245 --> 00:12:24,515 I think 243 00:12:24,515 --> 00:12:24,725 Gonzalo Bearman: So you. 244 00:12:24,935 --> 00:12:25,945 Priya Nori: it's working out well for you, right? 245 00:12:26,010 --> 00:12:28,295 Gonzalo Bearman: I think mostly, I mean, AI it's not a savior. 246 00:12:28,295 --> 00:12:29,435 It's neither a saboteur. 247 00:12:30,185 --> 00:12:31,925 So I think you have to use it deliberately. 248 00:12:31,925 --> 00:12:35,415 And the two examples that come to mind, I'll give you really three examples 249 00:12:35,415 --> 00:12:38,415 that come to mind, that would be in kind of updating your tools, we use Epic. 250 00:12:38,475 --> 00:12:41,025 I, I, I use Epic because that's the only option I have. 251 00:12:41,055 --> 00:12:46,695 Maybe you have Cerner, who knows, but, uh, one is to, uh, when 252 00:12:46,695 --> 00:12:50,835 you have an opportunity to do AI generated note taking, learn it. 253 00:12:51,825 --> 00:12:52,725 Learn how to do that. 254 00:12:52,725 --> 00:12:56,865 You can usually even modify your speech and the way you summarize things, so 255 00:12:56,865 --> 00:13:00,705 the AI note generation actually picks up your differential diagnosis and 256 00:13:00,795 --> 00:13:05,225 action plan quite easily, and it saves you so much time in documentation. 257 00:13:05,315 --> 00:13:07,295 I've gotten so much better the last three months on that. 258 00:13:07,320 --> 00:13:08,405 That's number one. 259 00:13:08,675 --> 00:13:13,145 Number two, within Epic, for example, we have Up to Date embedded. 260 00:13:13,145 --> 00:13:14,075 I think everyone else does. 261 00:13:14,720 --> 00:13:19,190 Uh, if you're not aware of, UpToDate has an AI generated assistant within it 262 00:13:19,190 --> 00:13:24,560 now that uses UpToDate exclusively, or the data within UpToDate to answer your 263 00:13:24,560 --> 00:13:27,380 specific questions or queries by ai. 264 00:13:27,980 --> 00:13:31,880 And sometimes instead of doing a long winded literature search, when you 265 00:13:31,880 --> 00:13:35,450 have one really simple question, you type in your question to UpToDate 266 00:13:35,690 --> 00:13:39,370 and you can generally, I would say trust the source because the authors 267 00:13:39,580 --> 00:13:42,460 of UpToDate are peer reviewed, referenced, et cetera, et cetera. 268 00:13:42,640 --> 00:13:43,780 So that'd be another example. 269 00:13:44,440 --> 00:13:46,990 The third is, and this is hit or miss, but I think it's going only 270 00:13:46,990 --> 00:13:50,260 going to get better even when you do a consult and you open up a new, 271 00:13:50,320 --> 00:13:52,300 a new note or a note in, in Epic. 272 00:13:52,835 --> 00:13:57,065 You can summarize the hospitalization by hitting AI summary of the hospital stay. 273 00:13:57,245 --> 00:14:00,245 Now it may not capture everything you want, but it may give you about 274 00:14:00,245 --> 00:14:04,175 75 to 80% of what you need to get started and really to minimize your 275 00:14:04,175 --> 00:14:07,265 time hunting and pecking and clicking within the electronic medical record. 276 00:14:07,505 --> 00:14:08,765 So those are some examples. 277 00:14:08,765 --> 00:14:13,805 I think that we should always be on the lookout for technologies or shortcuts that 278 00:14:13,805 --> 00:14:18,135 can, you know, hedge our efficiencies that can give us a little bit bit of leverage 279 00:14:18,135 --> 00:14:20,085 where we previously didn't have have that. 280 00:14:20,441 --> 00:14:24,938 Sara Dong: Yeah, and I feel like like even outside of AI folks who like lovingly 281 00:14:24,938 --> 00:14:30,158 call themselves luddite, it's like just taking the time to go through and set up 282 00:14:30,443 --> 00:14:32,873 shortcuts, set up your epic, so that's 283 00:14:32,963 --> 00:14:33,203 Gonzalo Bearman: Yeah, 284 00:14:33,523 --> 00:14:34,293 Sara Dong: it's in a flow that works for you. 285 00:14:34,733 --> 00:14:35,033 Gonzalo Bearman: Correct. 286 00:14:35,223 --> 00:14:38,063 Sara Dong: I feel like as a trainee, we often do that. 287 00:14:38,063 --> 00:14:42,293 We have an hour in orientation where someone who's a little bit more senior 288 00:14:42,293 --> 00:14:44,123 teaches folks how to set up their epic. 289 00:14:44,123 --> 00:14:49,103 And I think we maybe don't do that as much for faculty or, or people 290 00:14:49,103 --> 00:14:51,543 get rolling and they just don't think about, but it's so worth your time 291 00:14:51,593 --> 00:14:51,773 Gonzalo Bearman: Correct. 292 00:14:52,073 --> 00:14:53,333 Sara Dong: to just streamline it. 293 00:14:53,633 --> 00:14:54,083 Gonzalo Bearman: Agreed. 294 00:14:54,083 --> 00:14:56,873 Whatever you can do to leverage your documentation time or make 295 00:14:56,873 --> 00:14:59,423 it shorter and more efficient, I think is probably gonna help us. 296 00:14:59,873 --> 00:15:02,603 'cause we're, we're really there to make diagnoses and decisions. 297 00:15:02,603 --> 00:15:03,093 Right, Sara? 298 00:15:03,578 --> 00:15:04,028 Sara Dong: Yep. 299 00:15:04,088 --> 00:15:05,648 Gonzalo Bearman: Diagnose and decide that's it. 300 00:15:06,398 --> 00:15:09,038 Not to do a bunch of charting and tapping, et cetera, et cetera. 301 00:15:09,098 --> 00:15:10,238 That's not really what we're there for. 302 00:15:10,713 --> 00:15:11,003 Sara Dong: Yeah. 303 00:15:11,063 --> 00:15:14,678 We have to remind, I have to remind myself frequently. 304 00:15:14,948 --> 00:15:16,718 You're not just here to write notes. 305 00:15:16,993 --> 00:15:19,748 Gonzalo Bearman: But you're here to make decisions and give recommendations. 306 00:15:19,748 --> 00:15:21,968 If people don't want to follow 'em, that's a different discussion. 307 00:15:23,848 --> 00:15:25,138 Priya Nori: That's forthcoming, I think. 308 00:15:25,138 --> 00:15:25,378 Right? 309 00:15:26,398 --> 00:15:29,188 going with that one as our next, uh, commentary. 310 00:15:29,318 --> 00:15:29,738 Sara Dong: Yeah. 311 00:15:30,208 --> 00:15:33,148 Priya Nori: Hopefully Paul Sax will go for it, uh, once again, he is been 312 00:15:33,148 --> 00:15:36,213 very generous, uh, to us so far, but 313 00:15:36,518 --> 00:15:37,118 Sara Dong: Yeah. 314 00:15:38,198 --> 00:15:38,708 All right. 315 00:15:38,738 --> 00:15:44,408 Well, we're going on to S now, um, seeking an effective individual slash 316 00:15:44,408 --> 00:15:47,168 team approach to consults and curbsides. 317 00:15:48,143 --> 00:15:48,653 Priya Nori: Hmm. 318 00:15:48,938 --> 00:15:49,118 Sara Dong: Yeah. 319 00:15:50,618 --> 00:15:51,713 Who wants to take this one? 320 00:15:52,583 --> 00:15:53,513 Priya Nori: Yeah, I think so. 321 00:15:53,513 --> 00:15:59,893 But probably what I would share has to do with our combination of, of strategies 322 00:16:00,503 --> 00:16:08,343 for this, but um, there should be a certain expectation across the ID service 323 00:16:08,403 --> 00:16:13,203 that these are the boundaries we're setting and these are the expectations 324 00:16:13,203 --> 00:16:15,423 for coverage or being a team player. 325 00:16:15,423 --> 00:16:19,263 If somebody suddenly falls ill or there's a, a family emergency 326 00:16:19,263 --> 00:16:23,133 or something bad happens, we all need to have each other's back. 327 00:16:23,133 --> 00:16:28,643 And it can't just be the same old people filling in when a need arises 328 00:16:29,113 --> 00:16:35,303 and, uh, nor can one person have, um, a different set of conditions that, 329 00:16:35,303 --> 00:16:39,053 that they don't necessarily pull their weight in terms of coverage, et cetera. 330 00:16:39,413 --> 00:16:45,413 So, for instance, um, sometimes I've heard that, uh, it often falls on 331 00:16:45,413 --> 00:16:49,543 the junior faculty or the young, younger people on faculty to cover 332 00:16:49,543 --> 00:16:52,723 holes, gaps in the schedule if there's a sudden departure or something. 333 00:16:53,083 --> 00:16:56,623 But you know, these are also the folks with the small children with childcare 334 00:16:56,623 --> 00:17:01,433 issues and for whom there are certain constraints where they can't always just 335 00:17:01,433 --> 00:17:06,188 like drop what they're doing and cover, and maybe it is the more senior attendings 336 00:17:06,188 --> 00:17:10,718 who don't have those same challenges anymore, that can, um, pitch in. 337 00:17:10,828 --> 00:17:11,878 Of course that's not fair. 338 00:17:11,928 --> 00:17:14,298 It shouldn't always fall on on one, one group. 339 00:17:14,298 --> 00:17:16,408 It should be very balanced. 340 00:17:16,408 --> 00:17:22,708 So there should be a certain out loud expectation for collegiality and uh, 341 00:17:22,708 --> 00:17:26,758 just having each other's back because, you know, we spend more time at work 342 00:17:26,758 --> 00:17:32,398 probably with these folks, with our ID family than often with the folks at home. 343 00:17:33,388 --> 00:17:36,838 Gonzalo, you have anything to add from your perspective as a chief? 344 00:17:37,288 --> 00:17:40,588 Gonzalo Bearman: I mean, I think that what I, I've learned more than ever that. 345 00:17:41,518 --> 00:17:42,838 Just like football or soccer. 346 00:17:42,838 --> 00:17:44,338 My favorite sport, this is a team sport. 347 00:17:44,608 --> 00:17:45,268 It really is. 348 00:17:45,698 --> 00:17:50,468 And team sports thrive on individual talents working within a team ethos 349 00:17:50,558 --> 00:17:52,118 and a team kind of tactical plan. 350 00:17:52,658 --> 00:17:55,838 And the same really holds in ID 'cause in an ID division like mine. 351 00:17:55,838 --> 00:17:59,078 There's transplant specialists, musculoskeletal specialists, HIV 352 00:17:59,078 --> 00:18:01,688 specialists, general infectious disease, and you get the point. 353 00:18:01,928 --> 00:18:03,758 There's just a variety of different doctors. 354 00:18:04,358 --> 00:18:08,918 Uh, each with their own interest, but also agreeing to work within the confines 355 00:18:08,918 --> 00:18:10,298 and the expectations of the team. 356 00:18:10,688 --> 00:18:16,058 And it's become really apparent to me as you, as we stress the team kind of 357 00:18:16,058 --> 00:18:18,398 ethos the individuals are going to have. 358 00:18:19,483 --> 00:18:20,413 Uh, what's the word I'm searching for? 359 00:18:20,473 --> 00:18:24,303 There are gonna be challenges, whether it's daycare challenges, personal sick 360 00:18:24,303 --> 00:18:29,463 leaves or sick, uh, issues, maybe family issues, uh, issues with spouses, et 361 00:18:29,463 --> 00:18:34,243 cetera, et cetera, that we have to be available to cover them collectively and, 362 00:18:34,243 --> 00:18:37,083 and there should never, ever be pushback. 363 00:18:37,333 --> 00:18:38,683 Like, I can't help you today. 364 00:18:39,203 --> 00:18:41,933 If you're on service, you're one of the four to five people on service. 365 00:18:42,203 --> 00:18:44,723 There should be a just, it is an agreement, you will help out. 366 00:18:45,023 --> 00:18:47,183 Or if you're not on service, you're next up, so to speak. 367 00:18:48,013 --> 00:18:48,283 Sara Dong: Yeah. 368 00:18:49,543 --> 00:18:55,003 So for T, Take action and Lead, maybe I'll lump those, uh, together, 369 00:18:55,003 --> 00:18:56,353 kind of like you did in the paper. 370 00:18:56,933 --> 00:18:58,673 Priya Nori: I think this is one of my favorites. 371 00:18:58,733 --> 00:19:03,923 Um, so the taking action part has to do with this kind of renewed and 372 00:19:03,953 --> 00:19:10,848 urgent sense of advocacy that I think falls in the ID wheelhouse, generally 373 00:19:10,848 --> 00:19:13,098 speaking, but sort of now more than ever. 374 00:19:13,358 --> 00:19:17,588 Advocacy is one of the ways that we're gonna improve our day-to-day 375 00:19:17,588 --> 00:19:23,408 circumstances and that we're gonna leverage and remind people what 376 00:19:23,408 --> 00:19:26,228 our value is in hospital systems. 377 00:19:27,038 --> 00:19:31,418 So, while we are not necessarily folks who thought a lot about 378 00:19:31,418 --> 00:19:35,783 advocacy, let's say before 2024, 25. 379 00:19:36,113 --> 00:19:41,113 Um, suddenly we found ourselves, really thinking and talking about it a lot. 380 00:19:41,363 --> 00:19:47,213 I've been involved with a lot of IDSA related advocacy, um, causes 381 00:19:47,243 --> 00:19:50,383 around workforce and around billing. 382 00:19:50,383 --> 00:19:54,943 I think one of their true successes has been the modifier codes. 383 00:19:55,243 --> 00:19:59,353 Um, I know Gonzalo, uh, works a lot with IDSA as pertains. 384 00:19:59,818 --> 00:20:00,088 Um, 385 00:20:00,123 --> 00:20:00,243 Sara Dong: Hmm. 386 00:20:00,688 --> 00:20:03,388 Priya Nori: compensation and work standards, et cetera. 387 00:20:03,388 --> 00:20:04,348 Let 'em talk about that. 388 00:20:04,845 --> 00:20:07,815 Yeah, it was kind of our call to action that you have to 389 00:20:07,845 --> 00:20:09,165 like step up to the plate. 390 00:20:09,165 --> 00:20:10,095 This is urgent. 391 00:20:11,085 --> 00:20:11,925 Gloves are off. 392 00:20:12,255 --> 00:20:17,025 Um, if not now, then when, and so that's where the, those 393 00:20:17,025 --> 00:20:18,235 two letters come into play. 394 00:20:18,405 --> 00:20:18,695 Gonzalo Bearman: Yeah. 395 00:20:18,735 --> 00:20:19,635 Priya Nori: We'll put them together. 396 00:20:20,190 --> 00:20:23,430 Gonzalo Bearman: And you mentioned, uh, Priya compensation, and, uh, 397 00:20:23,470 --> 00:20:25,295 things I'm doing still with the IDSA. 398 00:20:25,640 --> 00:20:28,100 The bottom line is, you know, people wanna feel that they're being 399 00:20:28,100 --> 00:20:30,020 compensated fairly and appropriately. 400 00:20:30,665 --> 00:20:34,415 Uh, it, it may be unrealistic, Sara to say, Hey, I'm a first year ID doctor. 401 00:20:34,415 --> 00:20:35,585 I wanna make a million dollars a year. 402 00:20:35,945 --> 00:20:37,085 You know, that's kind of unrealistic. 403 00:20:37,595 --> 00:20:40,295 Uh, but we can be aggressive in our negotiations with our 404 00:20:40,295 --> 00:20:41,975 respective compensation plans. 405 00:20:42,035 --> 00:20:46,475 And the way to do that is to understand the market and also to understand 406 00:20:46,595 --> 00:20:50,555 what academic medicine is doing, not only nationwide, but around you. 407 00:20:50,675 --> 00:20:54,365 Particularly if you're in, in an area that has multiple academic medical centers 408 00:20:54,515 --> 00:20:56,765 that you can, or your competitors, and. 409 00:20:57,145 --> 00:21:01,408 Really that, that get leads to the point of, getting to more creative FTE models. 410 00:21:01,808 --> 00:21:03,758 Sara Dong: Mm-hmm. 411 00:21:04,468 --> 00:21:07,228 Gonzalo Bearman: I guess I'm the inaugural chair of the IDSA Division 412 00:21:07,228 --> 00:21:08,638 Chairs Community of Practice. 413 00:21:09,208 --> 00:21:12,808 Now go into my third year, and I tell you that because when we took over 414 00:21:12,808 --> 00:21:17,488 that project or started their project, launched it two years ago, there was no 415 00:21:17,488 --> 00:21:22,078 agreed upon standard as what does a 1.0 clinical FTE do in academic medicine? 416 00:21:22,838 --> 00:21:24,248 Now we're almost there. 417 00:21:24,278 --> 00:21:26,678 We've done a nationwide survey of division chiefs. 418 00:21:26,948 --> 00:21:29,798 Manuscript and process gonna be submitted this year and published in 419 00:21:29,798 --> 00:21:34,238 CID or OFID, we hope, uh, sanctioned by the IDSA and supported by them. 420 00:21:34,478 --> 00:21:35,708 That gives us parameters. 421 00:21:35,708 --> 00:21:38,318 If you're a 1.0 FTE, you do x number of weeks. 422 00:21:38,318 --> 00:21:40,088 Here's the range on service. 423 00:21:40,088 --> 00:21:42,428 Here are the number of days in clinics you typically do. 424 00:21:42,728 --> 00:21:45,398 This is your kind of admin time, and, and how does that equate to 425 00:21:45,398 --> 00:21:49,658 the number of hours per year and general, the number of RVs generated. 426 00:21:49,838 --> 00:21:53,588 And we need those leverage points to really advocate for our teams. 427 00:21:53,708 --> 00:21:56,768 Otherwise, you're going up against compensation plans or compensation 428 00:21:56,768 --> 00:21:59,938 boards and say, industry standard is such, and like, where's that? 429 00:22:00,448 --> 00:22:03,808 You know, it was published in some, some industry magazine, which 430 00:22:03,808 --> 00:22:04,888 really got no input from that. 431 00:22:04,948 --> 00:22:10,528 So that's been very helpful for us at VCU advocating for our work standards. 432 00:22:10,843 --> 00:22:14,713 The number of sessions or number of hours that we work and also kind of 433 00:22:14,713 --> 00:22:19,063 the compensation model, uh, in terms of academic rank, assistant, associate, 434 00:22:19,183 --> 00:22:23,253 and full professor based on national compensation, uh, parameters for 435 00:22:23,463 --> 00:22:25,053 people in an ID and at that level. 436 00:22:25,233 --> 00:22:25,813 And very helpful actually. 437 00:22:26,718 --> 00:22:27,678 You have to be proactive. 438 00:22:28,623 --> 00:22:30,873 Sara Dong: Very excited about that, um, publication, I know 439 00:22:30,873 --> 00:22:32,643 that had been a work in progress. 440 00:22:33,403 --> 00:22:36,493 All right, so we're wrapping up towards the end of hustle. 441 00:22:36,493 --> 00:22:40,483 So E emphasizing our role in efficiency. 442 00:22:40,513 --> 00:22:42,893 So how can we pitch ourselves best? 443 00:22:44,513 --> 00:22:44,963 Gonzalo Bearman: So, 444 00:22:45,263 --> 00:22:48,053 I think the underlying theme, and this is gonna sound a little, I don't 445 00:22:48,053 --> 00:22:50,843 know if it sounds boastful or slightly crass, and I don't mean to be that way. 446 00:22:50,843 --> 00:22:53,153 It's like you wanna be so good that you can't be ignored. 447 00:22:54,043 --> 00:22:54,263 Sara Dong: Mm. 448 00:22:54,533 --> 00:22:56,723 Gonzalo Bearman: So we as ID wanna be so good that we can't be ignored. 449 00:22:56,783 --> 00:22:57,533 How do you do that? 450 00:22:57,863 --> 00:23:01,583 Well, you not only do we take care of patients, high quality, 451 00:23:01,583 --> 00:23:03,773 et cetera, et cetera, but that's not what the hospital sees. 452 00:23:04,373 --> 00:23:07,313 You wanna have steady revenues, so you'd always want your revenues to be 453 00:23:07,313 --> 00:23:09,323 steady, if not climbing, that helps. 454 00:23:09,683 --> 00:23:13,613 But the important thing is to also emphasize what we're doing 455 00:23:13,613 --> 00:23:15,113 to further the hospital mission. 456 00:23:15,683 --> 00:23:17,303 This is how we've increased your access. 457 00:23:17,723 --> 00:23:19,553 This is how we decrease your length of stay. 458 00:23:19,823 --> 00:23:22,943 This is how we decrease your cost in the pharmacy with a stewardship program. 459 00:23:23,153 --> 00:23:25,853 This is the number of infections we've averted with the healthcare 460 00:23:25,853 --> 00:23:27,323 infection prevention programs. 461 00:23:27,593 --> 00:23:29,333 You know, they've expanded orthopedics. 462 00:23:29,333 --> 00:23:31,073 Now we're seeing more than ever number of cases. 463 00:23:31,073 --> 00:23:32,663 We have a musculoskeletal service. 464 00:23:33,143 --> 00:23:35,573 This is the expansion of people in referrals we're getting from the 465 00:23:35,573 --> 00:23:38,063 community to, you know, move that forward. 466 00:23:38,063 --> 00:23:40,313 And the number of people we're now monitoring on OPAT. 467 00:23:40,673 --> 00:23:42,203 So you wanna be very explicit. 468 00:23:42,593 --> 00:23:46,223 It really comes down to being able to speak and what's in it for them. 469 00:23:46,973 --> 00:23:48,203 You've gotta be able to speak that. 470 00:23:48,203 --> 00:23:53,783 And if we don't speak that language clearly, coherently, persuasively, I 471 00:23:53,783 --> 00:23:55,283 think we are doing ourselves a disfavor. 472 00:23:55,913 --> 00:23:56,243 Priya. 473 00:23:57,478 --> 00:24:02,361 Priya Nori: I will add, and we talk about this a lot, which is understand what 474 00:24:02,361 --> 00:24:05,211 the priorities of your employer are. 475 00:24:05,716 --> 00:24:06,016 Gonzalo Bearman: Yeah. 476 00:24:06,466 --> 00:24:11,026 Priya Nori: And who do you report to and what is the org chart? 477 00:24:12,286 --> 00:24:18,376 While a lot of us in academic ID have appointment at medical schools 478 00:24:18,376 --> 00:24:24,766 who may have formalized roles, don't think for a second that the suits 479 00:24:24,826 --> 00:24:32,176 in charge of hospital pay lines and budgets and ROIs and such give, 480 00:24:32,356 --> 00:24:41,161 you know, a fill in the blank about your travel to ID week to present an 481 00:24:41,161 --> 00:24:44,741 oral abstract or this paper that you wrote or that paper that you wrote. 482 00:24:45,521 --> 00:24:48,121 When they hear those things, what they actually hear is, 483 00:24:48,151 --> 00:24:49,351 oh, when are they doing this? 484 00:24:49,351 --> 00:24:51,421 Is it on my time and my dime? 485 00:24:52,081 --> 00:24:56,701 Therefore, put all of that aside, put it in a separate bucket and focus 486 00:24:56,701 --> 00:25:02,371 on what you're accountable to, to show the ROI on the the dollars and 487 00:25:02,371 --> 00:25:03,661 cents that they're investing in you. 488 00:25:04,921 --> 00:25:11,011 So if you can truly reorient yourself around successes related 489 00:25:11,011 --> 00:25:16,611 to readmissions, length of stay reductions, some of these CMS metrics 490 00:25:16,611 --> 00:25:18,441 and leapfrog scores and all that. 491 00:25:18,921 --> 00:25:22,121 Um, not to say that should be all that we're about, but we do have to 492 00:25:22,121 --> 00:25:24,041 play that game to a certain extent. 493 00:25:25,091 --> 00:25:28,991 It, it is when you meet those metrics and you show that their 494 00:25:28,991 --> 00:25:34,076 investment in you and your team has really paid off and paid off extra. 495 00:25:34,526 --> 00:25:37,976 That's when you have the freedom to explore some of these other 496 00:25:37,976 --> 00:25:41,456 things that you want to do or these other academic projects and such. 497 00:25:41,756 --> 00:25:45,176 But remember, first and foremost, especially if you're a hospital based 498 00:25:45,176 --> 00:25:48,746 employee like me to stewardship, infection prevention, you know what 499 00:25:48,746 --> 00:25:52,916 have you, that essentially it's a business, it's a corporation. 500 00:25:52,916 --> 00:25:59,636 You have to align your metrics and your successes with that kind of structure. 501 00:25:59,741 --> 00:26:00,041 Gonzalo Bearman: Right. 502 00:26:00,131 --> 00:26:03,521 And it takes a knowledge of, as Priya alluded to, is understanding what 503 00:26:03,521 --> 00:26:05,411 their priorities are at any given time. 504 00:26:05,411 --> 00:26:09,191 And those priorities can shift, so you have to be aware of that too. 505 00:26:09,461 --> 00:26:13,076 Uh, an example that recently comes to mind for us is, you know, we have 506 00:26:13,106 --> 00:26:16,616 like, like many other institutions, VCU has gone and purchased a couple 507 00:26:16,616 --> 00:26:18,536 community hospitals that are far away. 508 00:26:18,896 --> 00:26:21,566 They're in the radius, the satellite now of VCU Health. 509 00:26:21,866 --> 00:26:23,846 Obviously they don't have infectious disease doctors in the 510 00:26:23,846 --> 00:26:25,376 countryside in rural Virginia. 511 00:26:25,376 --> 00:26:29,186 So now we're their go-to people and we're now negotiating a contract with 512 00:26:29,186 --> 00:26:30,926 telehealth services, et cetera, et cetera. 513 00:26:31,286 --> 00:26:35,336 But the real thing that drives this interest is they don't want to have to 514 00:26:35,336 --> 00:26:40,151 transfer people with just to VCU Health mothership, I wanna say, because they 515 00:26:40,151 --> 00:26:43,931 have an ID prom that could be managed with just ID expertise via telehealth, 516 00:26:43,931 --> 00:26:45,701 because transfers are a big problem here. 517 00:26:45,701 --> 00:26:48,701 The place is always on diversion and always packed. 518 00:26:49,091 --> 00:26:52,301 So, you know, negotiating or leveraging those things like we're 519 00:26:52,301 --> 00:26:53,651 here to provide these services. 520 00:26:53,651 --> 00:26:55,961 This is why we think we're owed this amount of money or 521 00:26:55,961 --> 00:26:59,351 coverage or FTE support, 'cause it falls into that mission too. 522 00:26:59,981 --> 00:27:01,271 You have to be very clear with these things. 523 00:27:01,575 --> 00:27:06,435 Sara Dong: The other thing I was gonna ask you both is I really appreciated how you 524 00:27:06,435 --> 00:27:09,870 ended this with maintaining positivity. 525 00:27:09,870 --> 00:27:14,460 Um, I mean, I try, I'm not gonna say it always happens, but I try to do that, 526 00:27:14,490 --> 00:27:18,930 you know, personally at work and, and through things like Febrile, but, uh, 527 00:27:18,960 --> 00:27:23,370 maybe thought, you could share, you know, any tips that you have on keeping 528 00:27:23,370 --> 00:27:28,170 that ratio of positive to negative high, and particularly, you know, you 529 00:27:28,170 --> 00:27:30,060 guys both wear a lot of different hats. 530 00:27:30,060 --> 00:27:35,460 You're leaders, you know, how do you help create an environment where we 531 00:27:35,460 --> 00:27:37,470 achieve that for everyone on the team? 532 00:27:38,010 --> 00:27:40,320 Gonzalo Bearman: Priya, do you wanna start with your team or your group? 533 00:27:40,725 --> 00:27:43,395 Priya Nori: Well, I can, um, but actually I was gonna ask you to 534 00:27:43,395 --> 00:27:46,065 first explain what that principle is. 535 00:27:46,065 --> 00:27:46,485 The, the 536 00:27:46,755 --> 00:27:47,835 Gonzalo Bearman: Oh, the positivity principle. 537 00:27:48,135 --> 00:27:48,555 Yes. 538 00:27:48,705 --> 00:27:52,365 It's so, it's referenced in the paper and the psychology. 539 00:27:52,365 --> 00:27:55,445 Organizational psychology would suggest that we have a negativity 540 00:27:55,445 --> 00:28:00,815 bias, all of us, myself included, that you need generally three positive 541 00:28:00,815 --> 00:28:02,180 emotions to overcome a negative one. 542 00:28:02,705 --> 00:28:08,225 So you're kind of going up the hill on this one, and the, so how do you do that? 543 00:28:08,325 --> 00:28:10,785 You can't necessarily erase negative feelings. 544 00:28:10,995 --> 00:28:13,125 You can't tell people don't be negative. 545 00:28:13,455 --> 00:28:17,535 But you can try to build an environment and you have to be a role model in this, 546 00:28:17,535 --> 00:28:21,330 in which you anchor on the positive things, the accomplishments, where 547 00:28:21,330 --> 00:28:23,550 we're going, what's important to you. 548 00:28:23,550 --> 00:28:28,450 If you're able to do that, what wins we've had to keep, uh, the momentum 549 00:28:28,450 --> 00:28:30,610 and keep the focus more positive. 550 00:28:30,730 --> 00:28:34,690 The other thing I'm more recently learning is as I meet with faculty 551 00:28:34,690 --> 00:28:38,800 member and staff, not just faculty and APPs, is try to explore like, 552 00:28:38,800 --> 00:28:40,270 what are your signature strengths? 553 00:28:40,540 --> 00:28:44,560 Like, what do you really like about your job, or what do you like to do? 554 00:28:45,505 --> 00:28:48,845 And play toward their signature strengths as much as possible. 555 00:28:48,905 --> 00:28:52,715 If you can give them tasks or, or things are related to their signature strengths, 556 00:28:53,345 --> 00:28:58,095 that is going towards positivity and the psychology and the psychol psychology 557 00:28:58,095 --> 00:29:01,845 literature would suggest you don't need to be doing what you want or what you 558 00:29:01,845 --> 00:29:03,135 like a hundred percent of the time. 559 00:29:04,065 --> 00:29:07,095 Basically 20% of the time, if you're doing things that you think is value, you 560 00:29:07,095 --> 00:29:09,585 think are valuable, you, you stay engaged. 561 00:29:10,065 --> 00:29:12,765 So, you know, play to those kind of principles. 562 00:29:13,130 --> 00:29:17,390 Priya Nori: Yeah, I would just add that if somebody out there, if the 563 00:29:17,390 --> 00:29:23,330 ID community right now is feeling particularly negative or morally 564 00:29:23,330 --> 00:29:28,485 injured or hopeless, that is not you. 565 00:29:29,325 --> 00:29:31,725 It is natural to feel that way right now. 566 00:29:31,725 --> 00:29:37,195 A lot has happened in the past few years and it can seem hopeless and 567 00:29:37,195 --> 00:29:44,635 that is probably a normal response to everything, the circumstances around us. 568 00:29:46,015 --> 00:29:50,650 Um, and not to mention that a lot of what we're experiencing now 569 00:29:50,650 --> 00:29:54,760 seems to have come hard and fast after the causes that we care about. 570 00:29:55,720 --> 00:30:02,530 Health equity, uh, HIV, um, funding for research and public health, and these 571 00:30:02,530 --> 00:30:07,090 are like, this is it almost shot an arrow right to the, the heart and the 572 00:30:07,090 --> 00:30:09,760 core of who we are as a profession. 573 00:30:10,180 --> 00:30:12,370 And so it's okay to feel those things right now. 574 00:30:13,120 --> 00:30:19,015 So take a look at the 20% of the things that are within your immediate 575 00:30:19,015 --> 00:30:23,305 domain or your grasp or your sphere of influence and, and see how 576 00:30:23,305 --> 00:30:24,955 those things can be made better. 577 00:30:25,390 --> 00:30:25,660 Gonzalo Bearman: Right. 578 00:30:25,705 --> 00:30:31,015 Priya Nori: So, um, finding community within interest groups or affinity groups 579 00:30:31,015 --> 00:30:39,175 or, doing some work through mentorship or some of these non medicine related, 580 00:30:39,175 --> 00:30:43,315 but still, uh, community building things like book clubs, et cetera. 581 00:30:43,795 --> 00:30:48,055 Now these are totally uncompensated and you have to build them in to your 582 00:30:48,055 --> 00:30:52,855 very busy schedule, but it's very, very worthwhile because, uh, you'll 583 00:30:52,855 --> 00:30:56,695 number one, speak to other people feeling the exact same things as you. 584 00:30:57,195 --> 00:31:02,230 Um, they will help you to have the language and the tools to understand 585 00:31:02,230 --> 00:31:06,760 what's going on and contextualize it and say, Hey, yes, that is wrong. 586 00:31:06,790 --> 00:31:07,870 That is messed up. 587 00:31:07,870 --> 00:31:10,150 I am being gaslit. 588 00:31:11,260 --> 00:31:13,780 Nod to a another one of our publications. 589 00:31:13,965 --> 00:31:14,255 Sara Dong: Yeah. 590 00:31:14,650 --> 00:31:19,690 Priya Nori: Uh, but it can be, it's often, it's the only comfort that 591 00:31:19,690 --> 00:31:25,030 we may have these days and, you know, it's its own act of resistance 592 00:31:25,350 --> 00:31:25,410 Gonzalo Bearman: Hmm. 593 00:31:25,450 --> 00:31:29,030 Priya Nori: because that little thing can become something bigger. 594 00:31:29,610 --> 00:31:33,670 Like an interest group, uh, with starting with five people 595 00:31:33,670 --> 00:31:35,620 around environmental issues. 596 00:31:36,355 --> 00:31:42,355 Like Sustainable-ID can grow into a group of 50 people with a formal recognition 597 00:31:42,355 --> 00:31:44,395 by a professional society, et cetera. 598 00:31:44,395 --> 00:31:46,585 You never know where you can go with those things. 599 00:31:47,525 --> 00:31:53,165 You never know who you may help and influence positively along the way. 600 00:31:53,165 --> 00:31:58,475 And so I say find, look internally, see what are those things for yourself 601 00:31:58,475 --> 00:31:59,530 and, and try to run with them. 602 00:32:00,215 --> 00:32:03,365 Gonzalo Bearman: Right, and don't, don't underestimate the, I guess, 603 00:32:03,365 --> 00:32:05,345 the dividends of really small things. 604 00:32:05,405 --> 00:32:09,475 Um, for example, I mean, everyone likes to have lunch every now and then, right? 605 00:32:09,475 --> 00:32:12,445 Or have a cup of coffee, or I would imagine most people do at least. 606 00:32:12,805 --> 00:32:18,065 So little acts like, you know, we'll have a, a lunch for the team, the 607 00:32:18,065 --> 00:32:20,795 faculty only every month, open mic. 608 00:32:20,795 --> 00:32:23,195 We can talk about whatever we want or talk about nothing, but there's 609 00:32:23,195 --> 00:32:25,745 pizza and salad, and everyone's welcome and we just have a good time 610 00:32:25,745 --> 00:32:27,155 eating lunch, or if you're on service. 611 00:32:27,425 --> 00:32:30,395 When I'm on service, which is frequent enough, I buy 612 00:32:30,395 --> 00:32:32,405 lunch for the team every time. 613 00:32:32,495 --> 00:32:33,545 It's usually Thursday afternoon. 614 00:32:34,335 --> 00:32:35,325 It's in the faculty lounge. 615 00:32:35,325 --> 00:32:38,985 I bring in the whole team and we have lunch and we're not discussing cases. 616 00:32:39,525 --> 00:32:40,965 It's a free flowing discussion. 617 00:32:41,775 --> 00:32:43,545 Have a cup of coffee with one of your colleagues. 618 00:32:43,545 --> 00:32:46,665 You know, let's go to the Starbucks in the hospital and just shoot the breeze. 619 00:32:46,875 --> 00:32:49,875 Talk about projects and just talk, shoot the breeze for 20 minutes. 620 00:32:50,235 --> 00:32:54,200 These are all engagement community building activities. 621 00:32:54,500 --> 00:32:58,445 Uh, kudos to one of our faculty members and associate professor who just, uh, 622 00:32:58,805 --> 00:33:02,225 who were organized an outing tomorrow night for people to go bowling. 623 00:33:02,225 --> 00:33:04,805 I think there's a lot of people going and it has nothing to do with work 624 00:33:04,805 --> 00:33:05,885 except that we all work together. 625 00:33:06,845 --> 00:33:09,365 Uh, so that's, uh, that is something I think is great. 626 00:33:09,365 --> 00:33:10,565 That's, that's community building. 627 00:33:11,225 --> 00:33:14,975 It's kinda like that scene, uh, in, I think it was the Top Gun two movie, 628 00:33:15,275 --> 00:33:18,755 which I saw, uh, when it came out a year or two ago, whenever that was 629 00:33:18,755 --> 00:33:23,075 when I think the character played by Tom Cruise has his, his team 630 00:33:23,075 --> 00:33:24,935 playing flag football on the beach. 631 00:33:25,385 --> 00:33:27,185 And then the Admiral shows up and is like, what are you doing? 632 00:33:27,575 --> 00:33:28,745 It's like you wanted a team. 633 00:33:28,745 --> 00:33:29,705 I'm building you a team. 634 00:33:30,185 --> 00:33:30,455 Yeah. 635 00:33:30,875 --> 00:33:33,455 When you build a team, you just do things that are not directly related 636 00:33:33,505 --> 00:33:35,755 to your, your immediate work tasks. 637 00:33:36,835 --> 00:33:37,495 Go bowling. 638 00:33:37,765 --> 00:33:39,145 We have a foosball table here. 639 00:33:39,145 --> 00:33:40,795 We have a dartboard and throw around the corner. 640 00:33:41,155 --> 00:33:42,535 It's there for anyone who wants to use it. 641 00:33:42,805 --> 00:33:43,465 Take a break. 642 00:33:43,615 --> 00:33:44,185 Play foosball. 643 00:33:44,860 --> 00:33:45,730 Sara Dong: Love it. 644 00:33:46,690 --> 00:33:49,790 Um, well, I'll open it up one last time. 645 00:33:49,790 --> 00:33:50,960 Any closing thoughts? 646 00:33:50,960 --> 00:33:54,580 Anything else, you know, resources and articles that you wanna 647 00:33:54,580 --> 00:33:55,930 point some of the listeners to 648 00:33:57,415 --> 00:33:59,965 Gonzalo Bearman: One article that just caught my eye, it caught my eye 649 00:33:59,965 --> 00:34:02,875 so much that I invited her to come to VCU and she's coming next month 650 00:34:03,365 --> 00:34:03,655 Sara Dong: Nice. 651 00:34:03,865 --> 00:34:07,015 Gonzalo Bearman: Darcy Wooten from Washington University of St. Louis. 652 00:34:07,015 --> 00:34:09,415 She's just published a paper in CID. 653 00:34:09,465 --> 00:34:12,255 I think it's More than a Message, death by a thousand chats. 654 00:34:12,255 --> 00:34:17,985 And I think she is like a home run, her and her team or her group really giving 655 00:34:17,985 --> 00:34:22,485 us a clarity on like, look, these things, epic chat is neither savior, no saboteur. 656 00:34:22,545 --> 00:34:27,585 That's from her paper, that there a lot of messaging. 657 00:34:27,795 --> 00:34:28,695 It's excessive. 658 00:34:29,790 --> 00:34:32,970 I think the, the number of messages per day by the ID service, at least at 659 00:34:33,000 --> 00:34:36,120 Washington University of St. Louis is astonishing the number they're getting, 660 00:34:36,120 --> 00:34:42,390 they quantified it, of which 99%, let me repeat, 99% were not urgent. 661 00:34:44,010 --> 00:34:45,900 And what a distractor it is. 662 00:34:45,900 --> 00:34:49,110 And she actually provides some solutions on what we can do about it. 663 00:34:49,110 --> 00:34:49,920 So check out the paper. 664 00:34:50,835 --> 00:34:51,885 Sara Dong: Yeah, it's really great. 665 00:34:51,885 --> 00:34:54,735 I also will second and say that it's excellent. 666 00:34:55,050 --> 00:34:56,595 Priya Nori: It is a great paper actually. 667 00:34:56,595 --> 00:34:58,635 The timing for me was perfect. 668 00:34:59,025 --> 00:35:05,055 I was at the end of a two week stretch on the teaching service at our busiest 669 00:35:05,055 --> 00:35:11,925 hospital, and um, I was definitely snarking and throwing a lot of shade 670 00:35:11,925 --> 00:35:13,875 in those epic chats by the end of it. 671 00:35:14,730 --> 00:35:18,660 And, um, wasn't my best look like it. 672 00:35:18,720 --> 00:35:23,340 There were med students involved and residents and fellows, and I definitely 673 00:35:23,340 --> 00:35:29,610 wasn't being a kind of example of setting boundaries or any of those 674 00:35:29,610 --> 00:35:32,250 things that we uphold as good qualities. 675 00:35:32,640 --> 00:35:37,050 So when, when that came out, I said, oh, wow, I wish, uh, I wish this had dropped 676 00:35:37,440 --> 00:35:41,100 maybe earlier, but I immediately sent it to my fellows, and we thought through 677 00:35:41,400 --> 00:35:44,415 some of the situations where we could have, um, maybe done things differently. 678 00:35:44,415 --> 00:35:48,465 So highly encourage your listeners to, to check that out. 679 00:35:48,805 --> 00:35:54,265 Another one was a presentation at ID week, which, probably they're working 680 00:35:54,265 --> 00:36:01,195 on the publication now is an abstract, where the study investigators from two 681 00:36:01,195 --> 00:36:07,705 institutions, uh, totally geographically separated, looked at revenues related to 682 00:36:07,735 --> 00:36:12,535 the new modifier codes, the complexity modifiers that IDSA worked on, 683 00:36:12,715 --> 00:36:12,955 Gonzalo Bearman: Right. 684 00:36:13,105 --> 00:36:16,555 Priya Nori: they found actually quite a difference across the divisions. 685 00:36:16,585 --> 00:36:17,035 Um. 686 00:36:18,015 --> 00:36:23,505 revenue generated based on these complexity add-on codes, and it's just, 687 00:36:23,505 --> 00:36:27,650 you know, another tool in our toolkit to 688 00:36:27,695 --> 00:36:27,875 Gonzalo Bearman: You. 689 00:36:29,220 --> 00:36:29,775 Priya Nori: maximize the impact 690 00:36:29,825 --> 00:36:29,885 Sara Dong: Yeah. 691 00:36:29,960 --> 00:36:32,540 Priya Nori: of the work we're doing, both for ourselves, but for the 692 00:36:32,610 --> 00:36:35,030 institutions we work for as well. 693 00:36:35,070 --> 00:36:39,500 So we're really glad to see that people are now, I mean, the 694 00:36:39,500 --> 00:36:41,180 science is super important, right? 695 00:36:41,180 --> 00:36:44,330 It drives our field, it improves patient care. 696 00:36:44,330 --> 00:36:48,800 It's extremely impactful, but it's really nice to see the community taking on 697 00:36:48,800 --> 00:36:50,600 some of these workforce issues as well. 698 00:36:51,305 --> 00:36:55,805 Because that's probably one of the biggest threats to our field going forward. 699 00:36:55,805 --> 00:36:58,685 And, um, the future is a little uncertain in that way. 700 00:36:58,685 --> 00:37:04,795 So we need to also focus the academic pursuit internally to see what kind 701 00:37:04,795 --> 00:37:09,115 of research and data we can generate about our everyday types of issues. 702 00:37:09,760 --> 00:37:13,000 Gonzalo Bearman: Yeah, Sara, so if I may add one last comment is that, and 703 00:37:13,000 --> 00:37:17,410 to kind of throw some numbers out there, uh, there's like over a million doctors 704 00:37:17,410 --> 00:37:20,980 licensed in the United States slightly, maybe 1.1 million or something like that. 705 00:37:21,490 --> 00:37:25,105 And ID is maybe 14, 15,000. 706 00:37:25,915 --> 00:37:28,615 So we're less than 1% of the physician workforce. 707 00:37:29,005 --> 00:37:31,975 Now, if this was a truly capitalistic system, then we'd be killing it, right? 708 00:37:31,975 --> 00:37:34,525 'cause we're in high demand and low low supply. 709 00:37:34,525 --> 00:37:35,845 But we know that's not the case. 710 00:37:35,845 --> 00:37:38,845 We're in high demand and low supply and things are as they are. 711 00:37:39,295 --> 00:37:44,365 But look, lining here, the silver lining is that, you know, we are in high demand. 712 00:37:44,365 --> 00:37:46,435 We're a huge value to major health systems. 713 00:37:46,555 --> 00:37:49,015 Whether it's because they need us for the hospitalists, they need 714 00:37:49,015 --> 00:37:52,135 us for the transplant programs, they need us for musculoskeletal 715 00:37:52,135 --> 00:37:53,635 infections, et cetera, et cetera. 716 00:37:54,055 --> 00:37:54,985 We're in high demand. 717 00:37:55,345 --> 00:37:58,495 So this is the time for us to say what or to be clear on 718 00:37:58,495 --> 00:38:00,055 what we will and will not do. 719 00:38:00,505 --> 00:38:01,945 We're not gonna get dismissed. 720 00:38:02,245 --> 00:38:05,785 We're not gonna get fired as long as we're clear and coherent 721 00:38:05,845 --> 00:38:07,045 and principled in our approach. 722 00:38:07,390 --> 00:38:11,500 You know, there's, if you fire ID doctors, good luck getting new ones 723 00:38:11,500 --> 00:38:13,930 because there's very few people coming outta training programs. 724 00:38:14,080 --> 00:38:18,430 So we have more leverage, I guess, is the take home message than we think, and we 725 00:38:18,430 --> 00:38:20,140 should use that leverage to our advantage. 726 00:38:20,410 --> 00:38:24,250 Kind of set the agenda, claim our focus, maintain our sanity. 727 00:38:27,221 --> 00:38:31,211 Sara Dong: Thank you so much to Priya and Gonzalo for joining the episode today. 728 00:38:31,330 --> 00:38:35,350 You can catch this viewpoint in Clinical Infectious Diseases entitled 729 00:38:35,620 --> 00:38:39,610 H.U.S.T.L.E., a Consult Fitness Guide for Infectious Diseases Providers. 730 00:38:40,379 --> 00:38:44,009 You can check out the website, febrile podcast.com to find the Consult Notes, 731 00:38:44,009 --> 00:38:47,909 which are written compliments to the episodes with links to references, 732 00:38:48,269 --> 00:38:51,149 our library of ID infographics, and a link to our merch store. 733 00:38:51,869 --> 00:38:55,799 Febrile is produced with support from the Infectious Diseases Society of America. 734 00:38:57,299 --> 00:39:00,059 Please reach out if you have any suggestions for future shows or 735 00:39:00,059 --> 00:39:01,589 wanna be more involved with Febrile. 736 00:39:02,564 --> 00:39:03,524 Thanks for listening. 737 00:39:03,914 --> 00:39:05,564 Stay safe and I'll see you next time.