downloadThe final year of residency is challenging.  Your responsibilities at work increase. Exams loom. And the job or fellowship hunt begins…

This month in the MEdIC series we present the case of Jamal, a senior emergency medicine resident who is torn between the job he desires and the job that others are suggesting that he pursue. Join us as we ‘listen in’ on his conversation with his friend Cindy (a Pulmonology fellow) as they compare their adventures in new job negotiations.

The Concept

Inspired by the Harvard Business Review Cases and led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@Brent_Thoma), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the fourth Friday of the month, we will pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses will be made available for download in pdf format – feel free to use them!

If you’re a medical educator with a pedagogical problem, we want to get you a MEdIC. Send us your most difficult dilemmas (guidelines) and help the rest of us bring our teaching game to the next level.

The Case

Case written by Dr. Teresa Chan
Questions written by Dr. Matt Seidsma

“You know, Jamal,” Cindy stated casually, “This ‘growing up’ stuff is harder than I thought it!”

“Agreed.”

Jamal, a final-year resident in Emergency Medicine at A.W. Esome Hospital (an affiliate of Best University), nodded in agreement as he reached for his wine glass. He was so glad to be able to commiserate with his friend Cindy about his job decision woes. Cindy, a finishing fellow in Pulmonology, had been a good friend since medical school and they’d traveled a long road together after matching to the same institution. Now, on the precipice of their next big step, it was really nice to have a comrade-in-arms as he ventured into the wide world of job applications, interviews, and ‘big decisions’. He would be writing his boards in the fall, and now in the middle of winter, it was high time for him to start making some decisions about the year beyond June 30.

“At least the job market in Emergency Medicine isn’t so bad. It’s a bit harder in my field,” said Cindy.

“But at the same time, too much choice can be just as difficult,” Jamal sighed. “I mean, my wife’s job isn’t nearly as flexible, and she’s relatively established at her law firm. We’ve talked about it lots, and she would be up for a change if it came to that… But I just don’t know.”

“What don’t you know about?” inquired Cindy.

“Well, I just don’t know if I should stay here! It would be a nice transition. I know the nurses, I know the system. Over all, I do like it here.  But they’re really pushing me towards clinical research. They LOVE the fact that I’ve got my Masters in Clin Epi, and they really want me to fill their ‘research void’. My Academic Department Chair would really like me to apply for a PhD at Best University, and then work only 25% clinical. I really want to work more initially, but they seem to see me as a big researcher… and I’m getting a lot of pressure to develop that niche.”

“At least they seem to want you.  What’s the problem?”

“Yeah. But what they want doesn’t seem like what I want.”

“What do you want?”

“I just want to be appreciated. And not bullied, you know? I really want to do education stuff, and the whole first 4 years I’ll be chasing clinical grants. Which doesn’t help me develop my skills as an educator. I mean, you know me…”

“Education is clearly your passion. I know…  So how are you gonna handle that whole situation? Clearly their vision is different from yours.  Have you looked into a competing offer? Have you gone ‘down the street’ to see what the EM folks at University of Medical Technology & Sciences have to say?”

“Yeah, I have sent in my CV and letter of interest to UMTS, but I don’t know… I just feel like I actually want to stay at A.W. Esome Hospital. I really like the medicine, and the patient population, and the job itself is amazing.  But I also want to make sure my academic portfolio starts off in the right way too.”

“Hmmmm. It is quite a dilemma. Maybe you should talk to our old mentors at Superior Medical School? I’m sure Dr. X would give you some insights?”

You are Dr. X, an established Professor of Emergency Medicine at Superior Medical School.  You know Jamal quite well, and have followed his career from a distance since he left for residency across the continent.  What advice would you give Jamal?

Questions for Discussion

  1. How do you counsel final residents about choosing between an academic-based or private/community jobs?
  2. If a resident like Jamal aspires for an academic tract, there are still important choices to be made. Each of the following areas are respected as portfolios: research, education, or administration. Can you do a combination of these, or are you better off being a specialist in one of these three areas?
  3. How can you best negotiate for the time splits you want between your clinical time and your academic time?

We look forward to hearing your thoughts over the week (November 22-28, 2013).  Join us online for a blog-based discussion (take a look at the comments below), or tweet us (@TChanMD or @Brent_Thoma) with your thoughts.

Weekly Wrap Up

As always, we posted the expert responses and a curated commentary derived from the community responses one week after the case was published. Our respondents for this case were:

  • Dr. James Stempien, Department Head Emergency Medicine, Saskatoon Health Region, Assistant Professor University of Saskatchewan
  • Dr. Gus M. Garmel, Clinical Professor (Affiliate) of Surgery (EM), Stanford University School of Medicine, Senior Emergency Physician at Kaiser Santa Clara (TPMG)

Click here to go to the Expert Responses and Curated Community Commentary to this case (Posted on November 30, 2013).

Special thanks to Dr. Matt Siedsma (@Matt_Siedsma) for his help in developing the questions for this case.

 

All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.  Also, as always, we will generate a curated community commentary based on your participation below and on Twitter.  We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.

Teresa Chan, MD
ALiEM Associate Editor
Emergency Physician, Hamilton
Associate Professor, McMaster University
Ontario, Canada + Teresa Chan
Teresa Chan, MD

@TChanMD

ERDoc. #meded #FOAMed Own views expressed. Contributor to @ALiEMteam, @WeAreCanadiEM, ICE Blog, #FeminEM. @MedEdLIFE founder. Works @McMasterU & @HamHealthSci