If you’re an early career physician, then chances are good that I don’t have to convince you social media is important. But, you might not realize just how important it has become as a tool–actually a toolbox filled with a number of great tools—that will help you fast-track building your professional reputation. In this new series of short articles, I’ll focus on helping you to build or enhance your professional social media toolbox. Along the way, I’d very much appreciate you virtually connecting with me and teaching me a few tricks of the trade! Therein lies the beauty of belonging to virtual communities where you can exchange ideas with a lot of colleagues who you might not physically see on a regular basis or who might not fall into your usual peer group. I’ve learned so much from early career physicians, and I appreciate how many of them are committed to social justice, focused on diversity and inclusion, excited about innovation and new technology and sophisticated in their knowledge of social media.

An interesting article titled “Build a Reputation” in the prestigious journal Nature, explained a bit about how scientists and researchers have changed the way they are developing their reputations, and you probably won’t be surprised that social media is playing a role. Indeed, academicians, including but not limited to physicians, have opportunities to widely disseminate their new research and other work within minutes. Even if you aren’t publishing research, the strategic use of social media may help you to build your professional reputation and become a thought leader much faster.

In future articles, I’ll talk about various social media channels, but the one thing that is constant throughout all channels is that if you want to build your professional reputation then you should ensure that you have a professional looking profile. For examples, on Twitter it’s best to use a professional handle (@JulieSilverMD) and to include institutional affiliations (@SpauldingRehab and @HarvardMed). Your name and credentials are critically important in academic medicine, so be clear who you are and identify your credentials and institutional affiliations. Remember that people make snap decisions about whether to friend, follow or connect with you. Your profile can significantly impact your ability to join or participate in virtual communities and build your online network, so spend the time to make yourself stand out as a professional in the specialty of PM&R.

Julie Silver, MD is an Associate Professor and Associate Chair for the Department of Physical Medicine and Rehabilitation at Harvard Medical School and Spaulding Rehabilitation Network. Follow her on Twitter @JulieSilverMD or reach out to her on LinkedIn or Facebook.

Mentoring in medicine

By Laurie Dabaghian, MD

“I took the road less traveled, and that made all the difference.” This line from a Robert Frost poem implies that taking the unexpected path leads to greater accomplishments, but I believe it does not depict the entire picture. The strength, courage and ability to take the road less traveled, while being successful doing it, does not develop by chance. It develops due to a combination of factors including hard work, training, building resources, and most importantly, reminding yourself the core reasons as to why you chose that path. These factors all stem from one base—a mentor.

A mentor is someone who has taken their own road and shares the experiences along their path with others (the mentees). This honest exchange of experiences and learnings provides the mentee insight on the journey ahead and the ability and strength to split off and build a new, untraveled path. In medicine this relationship is typically between an experienced physician and a junior physician.

Lakhani defines mentoring as “the activity that is based on ‘learning relationships, which help people to take charge of their own development, to release their potential and to achieve results which they value (1.)” It is clear that the major focus of the mentor-mentee relationship is the growth and development of the mentee, with the mentor acting as a catalyst to facilitate change and provide resources. This relationship needs to be built on trust, open-communication and the frank exchange of ideas and opinions on professional, academic, research, and personal issues, in a safe setting.

Let’s explore the components of a successful mentoring relationship. There are three parties—mentor, mentee and host organization. The mentor needs to have the ability to identify and assess the mentee’s needs and respond to them in a respectable and timely manner. The mentee has to be open to feedback and adaptable to change. Both mentor and mentee need to be able to engage in active communication and be willing to discuss issues. The host organization should be able to provide administrative and financial support, mentor training and protected time to carry out this mentoring work. Compatibility between mentor and mentee is also very important and there needs to be an understanding that this is an ever-evolving and growing relationship(2).

I have personally found that having a good mentor is key in the medical field. Most recently, while struggling to decide on fellowship training, the honest opinions of respected senior clinicians who I have developed an open and honest relationship with over the years, helped guide me through this important decision. My mentors helped me realize my strengths, the pros and cons of each path I was contemplating and the opportunities each would lead to. They were truly invaluable.

Dr. Oh-Park, Vice Chair of Education and Research Professor at Kessler Institute of Rehabilitation has served as a mentor to many residents. She believes, “Mentoring is a process that brings out the best in mentees. Good mentors can see the talent, more importantly, the passion buried deep inside someone that even he or she can’t see. This requires for mentors to spend time, energy, and be open-minded with mentees. Mentors have enormous interest in the personal and career development of mentees and want to share the professional journey with mentees- Mentoring is all about bringing others in the journey you are passionate about.”

Laurie Dabaghian, MD is a fourth year resident in the Department of Physical Medicine and Rehabilitation at the Kessler Institute for Rehabilitation/ Rutgers New Jersey Medical School and the 2017–2018 AAP Advancement Representative.

This article features input from Dr. Oh-Park, Vice Chair of Education and Research Professor at Kessler Institute of Rehabilitation.

1. Lakhani M. When I say … mentoring. Medical Education 2015;49:757–8.
2. Sng JH, Pei Y, Toh YP, Peh TY, Neo SH, Krishna LKR. Mentoring relationships between senior physicians and junior doctors and/or medical students: A thematic review. Medical teacher 2017:1–10.

Bringing adaptive sports to the Bronx

By Agnieszka Cain, MBA

Before medical school, I used to volunteer at the Achilles Track Club, an organization that brings together able-bodied volunteers and disabled runners through athletic training and competitions. I found it exciting to share my passion for sports with adaptive athletes as we ran, walked or cycled laps around Central Park. Through our conversations, I learned more about rehabilitation, the journey to recovery, and the role of sports in helping to overcome physical obstacles. The experience was meaningful and inspiring. It also left me with lasting friendships and a desire to pursue a career in PM&R.

For these reasons, I was especially eager to become involved in the adaptive sports event organized by the Montefiore Medical Center in collaboration with the NYC Parks Department and the Wheelchair Sports Federation. I leapt at the chance to combine my interests in sports medicine and rehabilitation by assisting physically-impaired Bronx residents.

April 1st was a cold, windy day, but this did not deter nearly forty volunteers from several medical and physical therapy programs from showing up to lend a hand. Most of us were ill-prepared for the cold weather, but that just motivated us to move more and keep ourselves busy. Though at times the set-up was chaotic, it all came together before we welcomed our first registrant. The event gathered approximately 30 participants, including Montefiore Medical Center’s patients, AXIS project’s basketball participants, Bronx VA patients, and local Bronx community residents, all of whom were eager to learn more about adaptive sports.

Over several hours spent together, I had the opportunity to speak with many of the participants. It was both rewarding to hear their words of appreciation and humbling to learn about the challenges they face on a daily basis. Many of them have never had exposure to adaptive sports and had limited knowledge of the local options available to them. One woman spoke about her financial struggle and mentioned that she would much rather walk with a cane than use a wheelchair, but is currently unable to spare $30 to purchase one. Another participant discussed how much he enjoyed playing wheelchair basketball. Unfortunately, he would never be able to afford the sports-adapted wheelchair, which was not covered by his health insurance. These barriers to physical activity differed considerably from those of the adaptive athletes I ran with in Central Park years before.

This experience made me realize how important such events are to the local community. The resources and guidance provided are imperative to helping the physically disabled become more active. Additionally, these individuals are further empowered towards independence.

The event was a success and News 12, a local cable news network, provided coverage of the day. We are hopeful that Montefiore will continue to organize similar events in the future.

Agnieszka Cain, MBA, is a third year medical student at Albert Einstein College of Medicine.

The power of positive self-talk: Mind over matter

By Natasha Mehta, MD

Mind over me.

“I can do anything for 5 more minutes…Don’t let your mind get in your body’s way…I am strong…I will get up this hill.”—me to me

Considerable emphasis has been placed on the study of how what we say to ourselves can improve our performance. Self-talk has been explored in many different domains, and in sports and exercise psychology it has been described as an effective strategy to facilitate learning and enhance performance. Narrative reviews have supported three types of self-talk—positive, instructional, and motivational self-talk. Positive self-talk is largely more supported then negative self-talk. Instructional self-talk is usually better for precision-based tasks with technical or kinesthetic aspects to the movement. This is in contrast to motivational self-talk which is better for tasks involving strength, endurance, and conditioning. Its use has also been associated with persistence and continued execution of a challenging task.

Task oriented thoughts have been shown to improve confidence and motivation when compared to an outcome-oriented mindset. Studies on youth English football players found that overemphasis on results of a match led to a “climate of fear,” and those who perceived the outcome of the match as the fundamental measure of success had a “fear of failure”. These athletes were more apt to self-blaming, attacking, and neglecting statements with heightened levels of pre-performance anxiety. In another study, tennis players had improved serving accuracy in the two groups that focused on positive imagery or self-instruction versus the control “serve-as-usual” group.

It is tough to empirically evaluate self-talk as it relates to outcomes. As language is not universal, and studies depend on what is going on in a participant’s mind, a variable that cannot be measured, or very easily controlled. Many people describe their minds as spinning, or continuously switching tasks. This is why mindfulness, the meditative technique of being focused and aware of the moment and associated feelings, has become so popular. It enhances our perception of control, improves confidence, and spiritual well-being.

Senay et al used a meditative technique to compare interrogative versus declarative self-talk for one minute before completing anagrams. The interrogative group would focus on the task while priming with self-formed phrases that start with “Will I”, while the declarative group would start with “I will”. Interestingly, there was better task performance in the interrogative group. The hypothesis was that less directive influence on a future behavior allowed for autonomy and individualized intentions, which tapped into intrinsic motivations to pursue the goal.

I used motivational and positive self-talk to help improve my half marathon time, AND it worked! The training processes became meaningful when I focused on each run as a task, not a means to an end. I found when I focused on the outcome (i.e., final minute mile), I was easily drained with a worse time. So is this something I can apply to medical training? This process is long and grueling, with countless hours spent towards various different career goals and a smaller number of hours spent thinking about how to be a better significant other, daughter, friend, and person. I like this idea of interrogative self-talk; it not only creates a challenge and taps into my will to succeed, but it also opens up the opportunity for chance occurrences, for mishaps, and for barriers. It allows the opportunity to be gentle with my sensitive ego, to try again and say it’s ok: “Will I next time?”

Natasha Mehta, MD is a fourth year resident in the Department of Physical Medicine and Rehabilitation at the Kessler Institute for Rehabilitation/ Rutgers New Jersey Medical School.

1. Chiu, S., & Alexander, P.A. (2000). The motivational function of preschoolers’ private speech. Discourse Processes, 30, 133–152.
2. Conroy, D. (2004). The unique psychological meanings of multidimensional fears of failing. Journal of Sport & Exercise Psychology, 26, 484–491.
3. Hardy, J. (2006). Speaking clearly: A critical review of the self-talk literature. Psychology of Sport and Exercise, 7(1), 81–97. DOI: 10.1016/j. psychsport.2005.04.002
4. Hatzigeorgiadis, A., Zourbanos, N., Galanis, E., & Theodorakis, Y. (2011). Self-talk and sports performance: A meta-analysis. Perspectives on Psychological Science 6(4) 348–356
5. Malgorzata M Puchalska-Wasyl (2014). When Interrogative Self-talk Improves Task Performance: The Role of Answers to Self-posed Questions. Applied Cognitive Psychology, Appl. Cognit. Psychol. 28: 374–381. Published online 19 February 2014 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/acp.3007
6. Malouff J, McGee J, Halford H, Rooke, S. Effects of Pre-Competition Positive Imagery and Self-Instructions on Accuracy of Serving in Tennis. Journal of Sport Behavior. Sep2008, Vol. 31 Issue 3, p264–275. 12p.
7. Pitt T, Woflson S, Moss M. (2014). Research Note: The relationship between fear of failure and self-talk in winning and losing situations. Sport & Exercise Psychology Review. March 1, 2014.
8. Senay, I., Albarracin, D., & Noguchi, K. (2010). Motivating goal-directed behavior through introspective self-talk: The role of the interrogative form of simple future tense. Psychological Science, 21(4), 499–504. DOI: 10.1177/0956797610364751
9. Tod, D., Hardy, J., & Oliver, E. (2011). Effects of self-talk: A systematic review. Journal of Sport & Exercise Psychology, 33(5), 666–687.

Next stop--the real world

By Julian Willoughby, MD, MPH

After 10 years of post-college education and training, I have finally completed all the requirements and gained the experience I need to start my career as an attending physician. We, as physicians-in-training, often refer to this as entering the “real world." I am looking back and would like to share just a few of my thoughts and experiences with all of you who are racing to this same point.

I am now just 2 months from starting my career as an attending physician, and life has never been crazier. By the end of the summer I will have completed a competitive sports and spine fellowship, moved halfway across the country, purchased my first home, witnessed the birth of my first child, and started my first “real world” job.

I remember sitting down with my fellowship director at the beginning of the academic year last summer when he outlined the year to come, and stated that I should start looking for a job in September. I was somewhat shocked, thinking: “ok, I need to study for written boards coming up in August, then start looking for a job in September, all while trying to actually train for said job somewhere in-between.” How was I supposed to know what job to look for when I hadn’t even gotten a grasp on my sub-specialty?

My philosophy regarding my career-path has always been: ‘Don’t look too far forward for risk of stumbling on what’s right under your feet.’ While this statement could also be re-branded as the “procrastinator’s motto”—it worked well for me up to a point. That point came last fall at the AAPM&R career fair. I had gone to the career fair the year before for practice, and came away with lots of interviews and calls and opportunities. However, now it was real. Whether I was more nervous or much more selective, the fair did not seem nearly the success as my practice run the year before. Although I was not panicking yet, I was getting worried about my options and the time left to explore them.

Fast forward to the spring, and although I did not have anything nailed down, I did have a few options I was closely considering. None of these came from a job fair or a wanted ad. This brings me to point #1—you will most likely find your job through someone you already know. Networking at conferences and fairs is important, but you will find that your most meaningful and exciting opportunities will come from those individuals and organizations that have already seen what you’re made of and what you can do. Certainly make sure you start going to as many relevant conferences as possible and meet people, but more importantly, in everything you do, do it well. Show up and be interested. Get a mentor. Reach out to prominent figures in your field. If possible, set up an elective month with them, or anyone that does what excites you. Get involved with organizations on the local and national level. You will find that each opportunity you take gives you a platform to excel and creates more opportunities. For me, these came through a few simple places: a rotation where I made a particularly good impression, an elective I set up where the attending became a mentor and a personal friend, or an organization where I volunteered and went above and beyond. Doing similar things throughout your residency will be far more valuable than frequently searching the job boards.

While great career opportunities are likely to present themselves—sometimes it can be really difficult to sort out what actually is great opportunity, what is not, and in what ways can you shape it to your goals. This, of course is the matter of contract negotiation. I will not discuss the job interview process, as most of us are quite proficient at this point in our careers after college, med school, and residency interviews. However, one area most of us have never had to experience is the negotiation of a contract. We are so used to just accepting what is offered that we have never had the chance to shape our own workday. This brings me to point #2—get a lawyer. Regardless of how simple you think your contract is, or how good a deal you think you are getting, it will be worth it to get a lawyer for simple contract review. They will typically cost between $500-$1,500 and be worth every penny. I recommend getting a lawyer located in the geographic area of where you will be working, as laws will vary state-to- state and you want someone who is experienced in working with physicians and healthcare institutions in that area. While each of these topics could be an article unto themselves, some things you should review with the lawyer include: signing bonuses, restrictive covenants, period of guaranteed pay, and tail insurance.

In regards to signing bonuses—your lawyer, if they have worked with that employer before, will often know if they are willing to provide a signing bonus, and what may be a reasonable range. Even if they don’t, do not be afraid to ask for one. While certainly a potential employer can revoke an offer at any time, typically the worst reaction you would get to a request for a signing bonus would be “no.” There really is no risk to asking, and potentially lots to lose. A friend of mine told me their lawyer helped them secure a very significant signing bonus that he would never have thought to even ask for. This will be useful for you as you are likely relocating and starting a new chapter in your life. Speaking of relocating—relocation allowances are separate of the signing bonus and can also be negotiated. Typically they should easily cover your expenses for a full service relocation, but you could also use this as bargaining in a signing bonus, especially if you do not have to relocate or have minimal expenses. Bottom-line, discuss with your lawyer and ask for a reasonable signing bonus.

Restrictive covenants (or “non-compete” clauses) are very commonplace and often unavoidable. A restrictive covenant is essentially a clause in a contract that defines a restriction in an employee’s post-employment activities should that employee separate from the organization. Typically, for physicians, this is a geographic limit to where you can practice medicine in relation to your employer after you leave the company. Although we can only imagine why this would not be beneficial for us,it is understandable that the organization would want to protect itself. You can imagine how difficult it might be for a hospital system that invested in your early career, helped you build a solid patient base, then you leave and take 80% of your patients with you to a clinic you open right across the street. Since you used the organization’s resources, facilities, and advertising while building your practice, it would be unfair to leave and take a subset of patients you built with you. Whether or not a restrictive covenant is “enforceable” varies state-to- state and court-to- court. Typically states that do enforce these covenants only do so if the covenant is reasonable in scope, duration, and geographic area. The covenant also cannot unduly burden the general public or the individual physician.1 The important thing to remember is to review the covenant with your lawyer and if there are parts that seem too burdensome or concerning, you can often modify it. Courts often also make a distinction between soliciting former patients and treating former patients—so just remember to not worry if you find yourself separated from your employer, They cannot take away your right to use your hard-earned skills to make a living for you and your family. Just realize you may have to start over in terms of building a patient-base.

In regards to period of guaranteed pay—remember that this is important as often you will be starting from “zero” and needing to build your own patient base for your practice. If you are working in a place that is primarily productivity-based pay, you would really struggle without a cushion-period where your pay is guaranteed. Typically, the time frame for a guaranteed salary is 2 years. From my discussions with other young attendings, this time will fly, and it may still be difficult to get quite to where you need to be production-wise. So be sure that you work towards getting this important income safe-guard as you are getting started.

Briefly, in regards to tail insurance, make sure your institution provides it. This is basically malpractice insurance that will cover you for a certain time after you leave the practice, for any lawsuit or issue that occurred during your time there. This is crucial, as any future employer will not want to cover a lawsuit that occurred at a prior institution, and it could be financially disasterous to face a lawsuit on your own without insurance.

Most importantly of all regarding employment negotiations: GET IT IN WRITING. Do not trust any promises, statements, assurances, or other discussions with anyone in the company or practice unless it is written out in your contract. I personally ran into issues myself where details were discussed verbally and even in emails, but in the last moments, things were changed or altered. If your potential future employer is unwilling to put something you discussed and agreed upon in writing, this should give you pause. So, when comparing opportunities, you should only compare what is put before you in black and white. Assume everything else is subject to change.

Although I feel lucky that my procrastination did not degrade my job opportunities, and my lack of knowledge in negotiations did not prevent me from making some beneficial adjustments, there are certainly some things I wish I had known and done differently. The time to enter the real world is right around the corner for all of us, and hopefully these thoughts will help you enter it with just a little more confidence!

Julian Willoughby, MD, MPH, recently completed his Sports Medicine fellowship at the Shirley Ryan AbilityLab and Northwestern University. He also serves as the ACGME PM&R Representative for the Resident and Fellow Council of the AAP.

1. Breitenbach. (July 2013). “What physicians need to know about restrictive covenants.” Medical Economics. Retrieved July 20, 2017 from http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/financial-strategies/what-physicians-need-know-about-restrictive-cove