Rachel Marek
1. Somewhere between 60-70% of pediatric hospitalists practice in community hospital settings and not in university/children’s hospitals? What is unique about the skill set needed to work in, manage, and succeed in community hospital PHM practices? A strong professional ADHD and great flexibility because you never know what you might be doing next – going to a problem delivery, running to a code in the ED, caring for a 6 month old with bronchiolitis on pediatrics, or simply examining a well newborn. It is like the weather in Montana – just wait 5 minutes and it will be different. You will wear a variety of hats throughout the day requiring a wide range of clinical expertise.
A successful community hospitalist is comfortable working independently, but also collaboratively with nursing, ancillary services, and their adult medicine colleagues. However, it is also important to know when to ask for help, because while there may be no other pediatricians in house, you have other resources both within and outside the four walls of the hospital to help you care for your patients. To succeed, I would recommend a great deal of self-motivation to continue learning, improving, and expanding your skill set beyond the clinical.
2. You’ve given lectures in the past on networking and having an elevator talk to give on job interviews. Can you expand on ways for junior faculty to network and what IS an elevator talk and how do you create one?
Even if you are not a social butterfly, or you would rather be reading a book than attending the social hour at PHM, you can network. You just have to put a smile on your face, extend a hand, and introduce yourself. This might be to someone sitting next to you at the PHM conference, or the speaker after a particularly intriguing lecture, or someone you meet at a poster session, in line at lunch, or in a small group meeting. The opportunities are endless, and honestly, everyone is hoping to network, so take the first step and make it happen.
I have been hired and have hired others whom I met through networking, so you never know where it might take you. Just like dating, you aren’t going to connect with everyone you meet – that’s fine. Collect and give out cards at a conference, and then follow-up with an email – hey, it was so wonderful to meet you at PHM/PAS/NCE. These people may become someone you collaborate with on a research project, a mentor, or even a friend. Because we are overall such a young field (please don’t examine the number of gray hairs on my head!!!), these are folks whom you will likely know for decades to come. One of the greatest, yet unexpected, joys of my career are all the tremendous PHM colleagues I have met over the years (most of whom I have never worked in the same hospital with) who are now part of my professional support network some of whom I have now known for 10+ years and look to for advice, support, and sometimes just to commiserate. The first step is hard, but the joy on the backend is endless.
An elevator talk -- well, if you haven’t already noticed, I have a tremendous amount of professional ADHD, so I have lots of elevator talks – for my section chief (Ricardo, yes, that’s you!), executive VPs of the hospital, the CMO, leaders in faculty development, nursing directors, and the like. The elevator talk is something that you can have with someone during an elevator ride (i.e. in a few minutes) without completely overwhelming them by speaking like an auctioneer. In my first years of my career, my talks revolved more about who I was, what I was doing at the hospital, and what I was hoping to accomplish. Now my talks have evolved, and I usually have a project, a goal, an idea that I would like initial buy-in on.
As with all things in life, approach your elevator talk with enthusiasm – it is palpable. These folks to whom you are talking have conversations with dozens of people a day. Why should they remember you? What are you bringing to the table? You can practice with a friend or a colleague and develop your repertoire of elevator talks.
3. You joined Texas Children’s Hospital the Woodlands as the Director of Pediatric Hospital Medicine in July 2016 after working for 10 years as a community hospitalist at Santa Rosa Memorial hospital. What advice do you give to those individuals who change programs and start in a leadership position for smoothing out that transition?
My recommendation is to listen (which you might imagine is difficult for me!). You have two ears and one mouth for reason… Remember you are joining an organization with a culture, a history, and established traditions – see how you fit in, what works, what could be better, and what changes you can initiate while respecting that culture and history. Humility is key -- the group you are joining has been doing GREAT work long before you arrived – you are simply a positive addition to that amazingness.
For my overall leadership strategy, I endorse having a vision, a goal for your ideal workplace. What would it have? How would we interact with one another? With nurses? With ancillary services? With administration? How do we promote academic success? How do we build resiliency and encourage wellness? See that vision by understanding your values and move forward with a plan. Nurture those values by your everyday actions and words (both big and small), support that within your group, and understand the why.
4. Having heard a few of your conference presentations, I notice a recurring theme of thank-you notes. You stress the importance of writing them – why do you think this is important and how can it help junior faculty?
The thank you note – your mom told you it was important, and yet again, your mom was right. I don’t think mine was ever wrong! In an age of instant gratification, social media updates every two minutes, and emails flying into your inbox at every hour of the day and night, the thank you card brings you back to the days of old where we all paused and took a moment to appreciate those around us. It is so important to express gratitude for all the good work happening around you. Your job would be so much harder if it wasn’t.
So, yes, I do keep a stack of thank you cards in my desk at work and order them in a 50 pack from Amazon. Because it is a lost art, I find those cards in the offices of folks to whom I sent a thank you note months and months later. It is a daily visual reminder of their great work, service, and contributions. And they remember who sent it, so when I am next at my breaking point with the fax machine (yes, they still exist), or need to find a meeting space at the last minute, or would like someone to cover for an hour while I have a meeting, I find the significance of those thank you notes go well beyond the paper and ink.
So write a thank you note today! Plus, where else do you get to show off that fabulous doctor penmanship???!!!???
5. What was the most important lesion you learned as your time as medical director at Santa Rosa Memorial Hospital acting as medical director for 8 years until you transitioned in July 2016 to Texas Children’s?
Pediatric hospital medicine is the voice for pediatrics in community hospitals. Be that squeaky wheel – advocate for the services, the equipment, and the resources you need to care for the children in the community. You have lots of support outside of the four walls of your hospital for the tremendous work you are doing, so leverage that when you need to with the hospital administration, but also work with the C-suite leaders, too, on shared goals for pediatric care.
6. You co-chaired the AAP SOHM Community Hospital Sub-Committee with Dr. Jeff Brown from April 2012 – July 2016. If you could create a bumper sticker with a slogan to inform/educate people more about community hospital/hospitalists, what would it say? What are the misconceptions?
"The Pediatric Every –Ologist"
One of the first calls I received from the ED as an attending was about a two week old critically ill infant who was presenting with likely undiagnosed cyanotic congenital heart disease. And my initial thought was why are you calling me? Wouldn’t you call the pediatric cardiologist? Oh, right, I am the only pediatrician here. I am the cardiologist right now. Okay, let’s sort this out, as the pediatric every –ologist. For a child in DKA, you are the endocrinologist. For the baby in status epilepticus, you are the neurologist. While you certainly can call the specialists for advice from your local children’s hospital, as a frontline provider, community PHM is the every –ologist.
I think some of the misconceptions that I have heard over the years is that community pediatric hospitalists are not academic. In fact, in the community, you need to be much more proactive than at a major university/children’s hospital – things certainly don’t fall into your lap, and there isn’t an entire infra-structure to support pediatric care.
At Texas Children’s Hospital in my inbox every week, I receive a list of 20+ CME-approved lectures that I can attend. At a community hospital, you are lucky if a few of the grands rounds per year include pediatric topics. Self-motivated learning is key as is a dedication to advancing pediatric quality care. Community PHMers do research, run PDSA cycles, read, advance in hospital-wide leadership roles, teach, advocate for quality care with local boards and agencies, publish, sort out staffing, chair P&T – the list goes on and on. They usually do all this with little to no protected time.
7. You are a member of the AAP SOHM Executive Committee and serve as a member of the leadership team on PHM certification. What advice do you give junior faculty/residents regarding the changing certification status of PHM?
We are at such an exciting period in the evolution of pediatric hospital medicine. Residency training and our field has changed (hurrah!) in the nearly 13 years since I finished residency. My advice is that if you qualify for the practice pathway, please take the exam during your period of eligibility. Do fellowship if you are graduating resident who sees your career as a pediatric hospitalist in a major center, but there are far fewer fellowship positions each year than there are pediatricians going into PHM. Fellowship does not currently (and likely will not for many years to come) meet the workforce demands. There will be positions in PHM for decades to come for those who are or are not board certified in PHM. Might major university/children’s hospitals in the future only hire folks who are board certified? Yes, they might, but 60-70% of the PHM jobs are in the community, and the community needs great pediatric hospitalists to care for children!
8. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Be the leader that you would like to have. Find your voice, communicate your message, take care of those around you, and remember to take care of yourself.
A successful community hospitalist is comfortable working independently, but also collaboratively with nursing, ancillary services, and their adult medicine colleagues. However, it is also important to know when to ask for help, because while there may be no other pediatricians in house, you have other resources both within and outside the four walls of the hospital to help you care for your patients. To succeed, I would recommend a great deal of self-motivation to continue learning, improving, and expanding your skill set beyond the clinical.
2. You’ve given lectures in the past on networking and having an elevator talk to give on job interviews. Can you expand on ways for junior faculty to network and what IS an elevator talk and how do you create one?
Even if you are not a social butterfly, or you would rather be reading a book than attending the social hour at PHM, you can network. You just have to put a smile on your face, extend a hand, and introduce yourself. This might be to someone sitting next to you at the PHM conference, or the speaker after a particularly intriguing lecture, or someone you meet at a poster session, in line at lunch, or in a small group meeting. The opportunities are endless, and honestly, everyone is hoping to network, so take the first step and make it happen.
I have been hired and have hired others whom I met through networking, so you never know where it might take you. Just like dating, you aren’t going to connect with everyone you meet – that’s fine. Collect and give out cards at a conference, and then follow-up with an email – hey, it was so wonderful to meet you at PHM/PAS/NCE. These people may become someone you collaborate with on a research project, a mentor, or even a friend. Because we are overall such a young field (please don’t examine the number of gray hairs on my head!!!), these are folks whom you will likely know for decades to come. One of the greatest, yet unexpected, joys of my career are all the tremendous PHM colleagues I have met over the years (most of whom I have never worked in the same hospital with) who are now part of my professional support network some of whom I have now known for 10+ years and look to for advice, support, and sometimes just to commiserate. The first step is hard, but the joy on the backend is endless.
An elevator talk -- well, if you haven’t already noticed, I have a tremendous amount of professional ADHD, so I have lots of elevator talks – for my section chief (Ricardo, yes, that’s you!), executive VPs of the hospital, the CMO, leaders in faculty development, nursing directors, and the like. The elevator talk is something that you can have with someone during an elevator ride (i.e. in a few minutes) without completely overwhelming them by speaking like an auctioneer. In my first years of my career, my talks revolved more about who I was, what I was doing at the hospital, and what I was hoping to accomplish. Now my talks have evolved, and I usually have a project, a goal, an idea that I would like initial buy-in on.
As with all things in life, approach your elevator talk with enthusiasm – it is palpable. These folks to whom you are talking have conversations with dozens of people a day. Why should they remember you? What are you bringing to the table? You can practice with a friend or a colleague and develop your repertoire of elevator talks.
3. You joined Texas Children’s Hospital the Woodlands as the Director of Pediatric Hospital Medicine in July 2016 after working for 10 years as a community hospitalist at Santa Rosa Memorial hospital. What advice do you give to those individuals who change programs and start in a leadership position for smoothing out that transition?
My recommendation is to listen (which you might imagine is difficult for me!). You have two ears and one mouth for reason… Remember you are joining an organization with a culture, a history, and established traditions – see how you fit in, what works, what could be better, and what changes you can initiate while respecting that culture and history. Humility is key -- the group you are joining has been doing GREAT work long before you arrived – you are simply a positive addition to that amazingness.
For my overall leadership strategy, I endorse having a vision, a goal for your ideal workplace. What would it have? How would we interact with one another? With nurses? With ancillary services? With administration? How do we promote academic success? How do we build resiliency and encourage wellness? See that vision by understanding your values and move forward with a plan. Nurture those values by your everyday actions and words (both big and small), support that within your group, and understand the why.
4. Having heard a few of your conference presentations, I notice a recurring theme of thank-you notes. You stress the importance of writing them – why do you think this is important and how can it help junior faculty?
The thank you note – your mom told you it was important, and yet again, your mom was right. I don’t think mine was ever wrong! In an age of instant gratification, social media updates every two minutes, and emails flying into your inbox at every hour of the day and night, the thank you card brings you back to the days of old where we all paused and took a moment to appreciate those around us. It is so important to express gratitude for all the good work happening around you. Your job would be so much harder if it wasn’t.
So, yes, I do keep a stack of thank you cards in my desk at work and order them in a 50 pack from Amazon. Because it is a lost art, I find those cards in the offices of folks to whom I sent a thank you note months and months later. It is a daily visual reminder of their great work, service, and contributions. And they remember who sent it, so when I am next at my breaking point with the fax machine (yes, they still exist), or need to find a meeting space at the last minute, or would like someone to cover for an hour while I have a meeting, I find the significance of those thank you notes go well beyond the paper and ink.
So write a thank you note today! Plus, where else do you get to show off that fabulous doctor penmanship???!!!???
5. What was the most important lesion you learned as your time as medical director at Santa Rosa Memorial Hospital acting as medical director for 8 years until you transitioned in July 2016 to Texas Children’s?
Pediatric hospital medicine is the voice for pediatrics in community hospitals. Be that squeaky wheel – advocate for the services, the equipment, and the resources you need to care for the children in the community. You have lots of support outside of the four walls of your hospital for the tremendous work you are doing, so leverage that when you need to with the hospital administration, but also work with the C-suite leaders, too, on shared goals for pediatric care.
6. You co-chaired the AAP SOHM Community Hospital Sub-Committee with Dr. Jeff Brown from April 2012 – July 2016. If you could create a bumper sticker with a slogan to inform/educate people more about community hospital/hospitalists, what would it say? What are the misconceptions?
"The Pediatric Every –Ologist"
One of the first calls I received from the ED as an attending was about a two week old critically ill infant who was presenting with likely undiagnosed cyanotic congenital heart disease. And my initial thought was why are you calling me? Wouldn’t you call the pediatric cardiologist? Oh, right, I am the only pediatrician here. I am the cardiologist right now. Okay, let’s sort this out, as the pediatric every –ologist. For a child in DKA, you are the endocrinologist. For the baby in status epilepticus, you are the neurologist. While you certainly can call the specialists for advice from your local children’s hospital, as a frontline provider, community PHM is the every –ologist.
I think some of the misconceptions that I have heard over the years is that community pediatric hospitalists are not academic. In fact, in the community, you need to be much more proactive than at a major university/children’s hospital – things certainly don’t fall into your lap, and there isn’t an entire infra-structure to support pediatric care.
At Texas Children’s Hospital in my inbox every week, I receive a list of 20+ CME-approved lectures that I can attend. At a community hospital, you are lucky if a few of the grands rounds per year include pediatric topics. Self-motivated learning is key as is a dedication to advancing pediatric quality care. Community PHMers do research, run PDSA cycles, read, advance in hospital-wide leadership roles, teach, advocate for quality care with local boards and agencies, publish, sort out staffing, chair P&T – the list goes on and on. They usually do all this with little to no protected time.
7. You are a member of the AAP SOHM Executive Committee and serve as a member of the leadership team on PHM certification. What advice do you give junior faculty/residents regarding the changing certification status of PHM?
We are at such an exciting period in the evolution of pediatric hospital medicine. Residency training and our field has changed (hurrah!) in the nearly 13 years since I finished residency. My advice is that if you qualify for the practice pathway, please take the exam during your period of eligibility. Do fellowship if you are graduating resident who sees your career as a pediatric hospitalist in a major center, but there are far fewer fellowship positions each year than there are pediatricians going into PHM. Fellowship does not currently (and likely will not for many years to come) meet the workforce demands. There will be positions in PHM for decades to come for those who are or are not board certified in PHM. Might major university/children’s hospitals in the future only hire folks who are board certified? Yes, they might, but 60-70% of the PHM jobs are in the community, and the community needs great pediatric hospitalists to care for children!
8. Jack Percelay often ends his list-serve commentary with the phrase “that’s just my 2 pennies.” What are your two cents?
Be the leader that you would like to have. Find your voice, communicate your message, take care of those around you, and remember to take care of yourself.