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The AOFAS Orthopod-Cast
Changing Jobs
00:20:39
Host Dr. Natalie Danna chats with Drs. Casey Humbyrd, Cesar de Cesar Netto, and Kelly Hynes. They provide pearls on managing career changes in this episode from the AOFAS Young Physicians Committee. For additional educational resources, visit
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- [00:01]
A
Welcome to AOFAS Ortho Podcast, where leaders in foot and ankle orthopedic surgery discuss the issues that affect you and your practice. Please note that the views expressed on this podcast do not necessarily represent the views of the AOFAS or its members.
- [00:27]
B
Welcome to the AOFAS Young Physicians Committee Podcast series. Today's episode is on changing jobs. I'd like to welcome our guests. Dr. Casey Humbert, Chief of the Foot and Ankle Division and Associate professor at Penn, Dr. Cesar de Cesar Neto, Associate professor at Duke, and Dr. Kelly Hines, Assistant professor at WashU. To get us started, can each of you share with us how long you had been at your former position and how you came to find your new role?
- [00:55]
C
So I began my career at Johns Hopkins. I had been a resident there and I returned as faculty in 2014. I moved to the University of Pennsylvania in January of 2021amidst a world ending pandemic. I had been in discussions about the opportunity at Penn to become their division chief prior to March of 2020. And then throughout the process they came back for a second round. And due to a lot of circumstances that had changed because of the pandemic, it was the right time and the right move for me and my family. So I had been at my first job for seven years and then counting residency, I'd been there for 12 years.
- [01:45]
D
So I had four years at University of Iowa in Iowa City, had four great years, was not planning to leave at all, especially because I had moved several times before by doing fellowships throughout the United States. I think you, most of the time you don't plan what's going to happen. And I was approached by the Duke Food and ankle team, Dr. Easley particularly. And then there was a lot of conversations. Initially told him that not gonna happen, cause you know, there was not a real reason for moving and things were going well. And then he said, let's just keep talking. And then the conversation kept going. And then in May, after a lot of difficulties and thinking about family and all that involves a move, we decided that again, like Casey mentioned, it would be the best for our families and we decided to move and we moved to Durham in May 2023.
- [02:55]
E
Yeah, I was at the University of Chicago for almost eight years. I went there straight from fellowship, which was in Vancouver in Canada. I was pretty unfamiliar with the American healthcare system, but we took that leap. My significant other, Jason, is also an orthopedic surgeon. And we were really happy in Chicago for a long time. And last fall we had very random serendipitous calls from two of our friends and colleagues at Wash u. So Doct McCormick reached out to me and one of the hand surgeons had reached out to Jason without even knowing they were reaching out to us at the same time, which was an interesting sign. We weren't really looking to move, but it was just a really great opportunity for us to grow in our non clinical careers. We both have interests in research and administration work and it was really a good fit for both of us. I started work there two and a half weeks ago in August of 2024. So it's all knew.
- [03:54]
A
Wonderful.
- [03:55]
B
Thanks for sharing that. At what point in the process did you tell your former colleagues, your chair that you were considering another opportunity and leaving the position?
- [04:06]
C
I told my chair when I had an offer in hand and I was flattered. They then tried to counter and did a retention package and actually I was being recruited by Scott Levin at Penn and he is friends with my chair. So he asked for permission to reach out just to make sure all feelings were respected and nothing became too uncomfortable. And so that that was how that process played out. And I think it was really important for me that it played out in an above board way because due to kids schools and my kids were in a school that was open during COVID so we kept them in Baltimore. When I started my job, I didn't start for almost six months after I'd announced that I was leaving.
- [04:59]
D
Yeah, I'm not sure there's a formula. Right. But I try to be as direct you can be. So when I was approached I wasn't considering for real. I had in my mind not going to happen, not going to consider. But Dr. Easley came to town so people knew about it and so I felt that it was appropriate to let my chair know and my partner. And at that point I tell them not considering for real. And I try to keep them aware of the communications that continue to happen. And when I after a long time, I think it took probably eight months or nine months, kind of like a baby. And when I made my decision, I communicated to them. They were kind of at that point already expensive process, but we're kind of already expecting. There was not a lot of discussion because I made up my mind and I said look, I think it's the best. And they ended up understanding. And I think it was a way to do it. Not the right way. I'm not sure there's right or wrong, but that's the way it went for me.
- [06:07]
E
Pretty similar. I told my previous chair when we were strongly Considering it, not before. Because again, it was kind of like Caesar. It wasn't like the plan. It was probably about a month before we accepted the offer and we truly didn't decide until the day we accepted the offer. So a lot of agonizing, a lot of difficult decision making for sure. Absolutely.
- [06:29]
B
It can be kind of tough to navigate those conversations. What did you do differently in terms of shaping your new position from how you might have approached your first position, having a better understanding of what you needed for your Practice to succeed, etc.
- [06:46]
C
When you're taking your first job, even, you know, though I returned somewhere where I had trained, you're still an unknown quantity. And I think it's really hard in your first job to ask for lots of things and get them because you're going to be in the red for them for a while because you have to build a practice. As someone who was coming in, you know, having been board certified, like there isn't that stress for the new job. Knowing that I know how to have a practice, knowing I hadn't yet been sued, knock on wood, still haven't been sued. Knowing the reputation that I developed in different work. You then get to ask for a lot of stuff and not just financial things, but looking for your next step in leadership and growth. And so I negotiated for a lot of non financial things in addition to negotiating for the financial components. And so I think that was, you know, when I was first applying for my first job, I was not asking for them to pay for a coach and I was not asking to have control of supply side of, you know, our resource chain. I was not asking for certain leadership roles and defined components that like put a lot of particular language into my contract to make sure it met my needs. I also am married to an attorney who negotiates for a living. And so he worked real hard on my contract, which it's always a process, but it's a process that he's super comfortable with. And the whole time I'm like, I'm just going to sign. And he's like, absolutely not. This isn't, we're not there yet. And so it was really good to have someone, someone who knows just that process because you're talking with the chair, but ultimately you're negotiating with an administrator whether you know it or not, because they're the ones who control the finances and they know what is and isn't possible. And eventually when you ask for a lot, they'll go to the chair and say, hey, which fund can we tap? What thing can we do to make this happen. But for most of it, you're negotiating with someone who does this all day and has lots of time to spend. And their whole goal is to get the most productive person as cheaply as possible because that helps their books. So just having that framing and understanding and then having an advocate that I lived with were really helpful in things that were nowhere on my radar. My first job where I was just like, I want to get a job. I'm pregnant. I'm going to have to get. Let me get a job before I look pregnant. I have to pass boards, I have to build a practice, I have to operate alone. You know what you're thinking year one versus year eight, really different.
- [09:48]
D
I let Casey go first because I knew the story was good, so. Well, I'm not first. My wife is a physician, so she's not an attorney. So we were not in a very good spot in that regard. But I agree, I agree what she said. I think it's. It's more comfortable in the second time. Not that we have to. Not everybody needs to change their jobs, but if you're changing, I think the second job, I agree with Casey that it's much more comfortable because, I mean, we're blessed to be in good positions. And if you're trying to. If they're trying to recruit you, they know they're going to have to, you know, you want more. It's not about money. It's about academic opportunities, leadership, and some other stuff. So I think they're more prone to give you what you want to make the move. So I made sure that I, and then some of my mentors said they will give you what is in the contract. They're not going to give you what they tell you they're going to give. So make sure that everything is on paper, otherwise you're going to get there.
- [10:49]
C
It's not written down. It never happened.
- [10:51]
D
Exactly.
- [10:52]
C
And it's not going to happen.
- [10:53]
D
Exactly. So I try to. I'm not very good with this type of negotiations. I think you mentioned before that we're very straightforward. Like you're just gonna sign this and get it, get it done. But I try to ask for the things that I thought was important for my priorities in terms of research, leadership, academic, but also clinical, surgical. It was much more. More comfortable to negotiate the second one than was to negotiate the first one.
- [11:21]
E
For sure, I would agree. Not a lot more to add. But for me, it was leadership in informatics, which is a super weird thing that nobody in orthopedics knows anything about. So for me it was even tailoring the interview process to meet people outside of orthopedics in the new job, which I never would have known or even thought of the first time around. But yeah, I'm a pretty easy person to negotiate with. I don't think I played a very hard game, but it was more about making sure my interests were going to be satisfied because that was our main change.
- [11:54]
B
Sure, it's got to be worth making.
- [11:55]
C
The move and I think it's worth just kind of the reality that when you're looking for your first job, you don't have a job. And the negotiating term is batna, your best alternative to negotiated agreement. My bat now the whole process was staying in a job that I loved. So I'm going to ask for all the things or at least my husband's going to ask for all the things. And throughout the process he was like, if they haven't said no, we haven't asked for enough. And you have to figure out where their nos are and then you compromise from there. But if you ask for things or ask for salary and they say sure, you, you lowballed yourself. And so trying to get as much data as you can when you're changing jobs, talking to people, figuring out where everyone else is. Cesar's outnumbered today. But like especially as women, where in general you're going to get low balled and knowing what the culture is of a place, do they have a structure to ensure that everyone, at least when they come in, in their first year of practice, is there a real focus on trying to drive equity and compensation or is it just whatever you can negotiate for yourself, I think is a really big thing that we don't often focus on enough. And it's uncomfortable to ask your friends how much money they make and ask your friends how much money they make when you're negotiating for a new job.
- [13:26]
D
Yeah, very important information.
- [13:28]
B
Great advice. Specific for Kelly. Back to the informatics topic. Can you talk about some of the logistical issues of wanting to maybe move your templates you've worked hard on in your EMR or you know, bring some of things you've set up for yourself in your prior practice? Can you move any of those with you? How can you make your transition easier?
- [13:52]
E
Yeah, you can download all your smart phrases, which is helpful, which I did because I have hundreds, which is unusual obviously, but I'm on one spectrum. You cannot take other things like preferred orders and lists and different kind of more technical things from epic. So creating a document of that Yourself is super helpful because I didn't do everything, which I thought I had done, and starting over. It's very time consuming to build all that again, but you can just export a PDF document of all the smartphrases, which is a huge chunk of what is already saved in epic. So I would definitely recommend that. And I got all the or preference cards and things as well, which I would recommend. If you don't think about it, it's easy for those to disappear right after you leave.
- [14:43]
B
Good advice. If they were correct in the first place.
- [14:46]
E
If they were correct.
- [14:47]
C
Yes.
- [14:48]
D
I brought my Dragon commands as well. You can export the Dragon commands and automatically upload to the new Dragon. That helps Dragon and accent from international people. They help a lot.
- [15:04]
B
From a research perspective, you probably have to leave most of your Phi behind, but any tips on X rays, bringing images, or bringing any of your clinical patient information?
- [15:19]
D
Well, that is complicated. Right. Because you have to check. Each institution has different rules. I had a lot going on, as I'm assuming you guys also had. And then so I try to speed up and try to finalize everything that I could and try to, you know, have the data ready to be assessed and not to harvest more data out of electronic medical records or imaging. And so we did a lot of that in the final. My final days in Iowa. And so spreadsheets like that, yes, without patient identification, but everything. Everything else stay behind. And then imaging from some cadaver studies that, you know, for cadavers is different. And then I did keep some of the images that I have for cadavers, but everything else stayed behind. And then still some studies going on with different investigators. And then you have to collaborate and get things done.
- [16:30]
C
And I'm just gonna. It's probably not that relevant for most orthopedic surgeons, but I had NIH funding. And so it's interesting because it's miserable when you have funding to flip institutions. And it was the end of a grant, so it wasn't that much. And so they literally just said, we're not going to deal with the hassle of moving 10,000 or $15,000 from one institution to another. Wasn't worth it. But if you do have funding, you have to talk to the grants manager because there's a lot of rules around that. And you certainly don't want to be on the bad side of the federal government.
- [17:10]
B
What has been the most surprising part about the change for each of you? Any hurdles or perks that you didn't anticipate?
- [17:18]
E
I'm right in the middle of it. So I don't have a lot to add, but it is kind of nice to start fresh. You learned a lot in your first job. You built your systems, and so much easier to come in when you know how you want to do things rather than learning as you go. So it's been refreshingly okay so far.
- [17:38]
D
I think the more, you know, the more you try to make things as easy, as perfect as possible, as direct and as clear as possible. There's always, you know, there's always some stresses. Unfortunately, it's part of the. Part of the process. Right. And I think that's good because it means that at the end of the day, you don't want to leave, and also they don't want you to leave. But, you know, the. I would say the separation is always more traumatic than you would imagine. Even if you try to do things as good as possible, it's not easy for any of the sides, but not a good idea to keep moving. That would be my takeaway of changing jobs.
- [18:31]
C
For me, it was very different than where I'd been because I went back to where I had trained. And so my faculty partners, it's really hard for them to not view you as a resident. And the nurses and the staff all knew you as a resident, and it's very hard for that transition because they kind of treat you like a baby attending. And then when I came in to Penn, everyone's like, oh, this is the chief. This is the chief. And I had actually been the division chief at Hopkins, but it was very different framing. They're like, oh, you have to meet with the hospital presidents. You have to meet with these people. They're like senior leadership. We have to have you meet with all of these folks. And so it was just a very different feeling because I hadn't trained there, and one of my research buddies says, how do you define an expert? It's anyone who lives more than 20 miles from here. And so it's one of those grasses always greener. So you come in and everyone's really impressed with you, and then you just try and maintain that and try and keep that first impression going. And it's way easier to do when you're not having the anxiety of, oh, this is my first solo calc fracture. Oh, this is my first total ankle. When you already have your bearings surgically, it's easier to impress the staff or at least not lose the you're the boss feeling.
- [20:01]
B
Well, thank you all. This concludes our discussion on this very interesting topic. So thank you to my esteemed guests. Thank you to the AOFAs, the young physicians Committee, and of course to all of our listeners.
- [20:15]
A
Thank you for listening to the AOFAS Ortho Podcast, a Convey Med production. To learn more about joining our dynamic community of highly skilled orthopedic specialists, visit aofas.org.
- [20:32]
E
SAM.