Drs. Manuel Rodriguez and Manuel Castro-Borobio join Febrile from Georgia to chat about a day in the life of an ID physician in private practice and questions and considerations for new fellows consulting on the job search!

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Febrile is produced with support from the Infectious Diseases Society of America (IDSA)

Hi, everyone.

Welcome to Febrile, a cultured podcast about all things infectious disease.

We use consult questions to dive into ID clinical reasoning, diagnostics,

and antimicrobial management.

I'm Sara Dong, your host and a Med-Peds ID doc.

I know I have left you hanging for a bit of time, but please know

I'm working hard to get episodes out to you as soon as I can.

Today, I'm joined by two guests to take a slightly different approach

to Febrile and think a little bit more about careers in ID.

Our first guest is Dr. Manuel Castro Borobio.

He is a board-certified physician in infectious diseases and internal

medicine practicing in Georgia.

He is a partner at the Infectious Diseases Services of Georgia and serves

as Vice Chair of Internal Medicine, as well as the Infection Prevention

and Antimicrobial Stewardship Lead at WellStar North Fulton Hospital.

Manuel Castro Borobio: Hello, I'm Manuel Castro.

Happy to be here.

We are also joined by Manny Rodriguez He is a

board-certified ID physician.

He practices at Northside Hospital Forsyth in Cumming, Georgia, where

he serves as the infection prevention director and was nominated to take part

of the CTI Healthcare Institute program and participates on multiple hospital

committees focused on ID and patient care.

He's also a fellow of the American College of Physicians and serves as

an abstract reviewer and participates in their leadership network.

He is an active member of IDSA and has previously served as delegate and vice

chair of the Council of Young Physicians of the Medical Association of Georgia.

Hi, I'm Manny Rodriguez.

Big fan of Febrile.

Glad to be here

As everyone's favorite culture podcast, we always start off

by asking, um, if you could share a little piece of culture, basically

just something outside of work and medicine that brings you happiness.

I had a hard time thinking about this actually.

So, um, I went back and I was actually picked up a book, non-medical

book that I hadn't in a while, and that was a book on Cuban history.

My parents are originally from Cuba, and my sister and I are

first generation Cuban Americans.

And, it was just a history about Cuba and America and how the ties.

And it turns out that Franklin Pierce's vice president who

was William Rufus DeVane King, was actually sworn in in Cuba.

He's the only vice president ever to do that or, you know, president to do that.

And the reason why is 'cause he was, he was dying of tuberculosis, of all things.

So I found that's interesting tying into infectious disease.

So he went from Cuba being sworn in as the thirteenth vice president back to Alabama,

where he died forty-five days later.

So I thought that was kinda cool

That's like a perfect ID history nugget.

Manuel Castro Borobio: That's awesome.

I, I don't have anything as interesting.

I, I can say most of my, uh, fun time is definitely with my daughters.

Um, big fans of soccer in my family, including my daughters.

So I know you've had guests, because I've been listening to Febrile a lot,

um, that shared soccer and the World Cup going on, which is going on now.

And, we're one of the host cities, being in Atlanta, so excited to, to

watch the World Cup and enjoy more and more soccer with the family

I love it.

Yeah.

The World Cup is just so exciting.

It's like a, such a fun atmosphere.

Manuel Castro Borobio: Yeah

Well, I'm very excited.

We have a, a, you know, slightly different direction or consult question today.

So I'll, I'll get us started.

So you have an early, maybe in their 30s-ish-year-old, no prior

professional employment experience, and they've come to you for advice.

They are embarking on the job search in their last year of ID fellowship

training, and they really just would like to know how you went about

the process and, we're gonna talk a little bit about experiences that you

guys have had in practice as well.

So maybe I'll start there with, how do you approach this conversation?

What things do you prioritize first in that conversation?

I think it's interesting, and I went into medicine

not thinking I'd be in private practice.

Actually, I was thinking I would be a clinical educator, you know, life

obviously has different plans for you.

And, when I was looking for work as I was finishing my fellowship, I asked my

wife where she wanted to move, and it was Georgia because her mother was there.

And so that's why I focused on Georgia for the most part.

And it was challenging because, I originally didn't know where

to start for-- to look other than like-- other than looking for,

classifieds in the New England Journal of Medicine or Google searching.

I ended up actually applying for a hospitalist position in Roswell,

where the practice I eventually joined found out and then actually,

um, reached out to me because they were looking for an ID doctor.

So I would kinda start asking them, saying, "Hey, you know, wh-what

about ID interests you, and why you wanna do private practice?"

Definitely.

I think that when we look into jobs after fellowship, many of us think we're

gonna go into academics, and then we start looking at private practice when

we realize that, you know, the, the place where we wanna move, uh, doesn't have any

academic program close by and we wanna be close to family, or there is a place

where we really want to be in because our spouses have a job there or opportunities.

And, we start looking into private practice after that.

Also there is a, there is a salary gap between academics

and private practice as well.

So it all depends on where you wanna be in the country, what region, what

is your salary aspiration and your family situation, and if you think, that

also offers other opportunities like, know, concomitantly doing teaching,

mentoring, research, for example.

So I, I think you have to take all of that into consideration when we

are gonna pick the place where we go.

But there are plenty of opportunities, I have to say, everywhere.

It just depends on what your goals are, uh, five to 10 years

after you finish fellowship.

Yeah.

And I think as everyone is going to already be able to tell, our goal is to

talk a bit about private practice today and, you know, Febrile has unintentionally

is a bit biased to the academic setting.

We, we tend to have fellows who come on, and that's kind of the life that they see.

But I think maybe starting with asking you about a day in the life of

someone who is practicing ID, outside of that setting, in private practice.

And, it may not be that every day is the same.

I'm guessing your answer will not be that.

Um, but I think maybe just reflecting on experiences that you guys have had

and what that job could look like.

I think for me personally, it, it was definitely a

change from fellowship and training in general because when you're in

your program, you have, in my opinion, a variety of things you're doing.

So one month you're on inpatient service, next month maybe you're in TB clinic,

next month you're in research, where every day in private practice you're

really doing essentially the same thing.

You're seeing different patients and, um, interactions may be different, but

essentially doing the same thing month to month to month to month to month.

Um, so that is, I think, a challenge to find other avenues, like Castro

was saying, for example, you know, maybe you have interest in mentoring.

Even in private practice that is available, or maybe you like to

do lecturing, or maybe you wanna do some work in the, um, you know,

space of pharma, things like that.

I think that is still available.

Um, but understanding that really this is a day-to-day job and that y- what

you're gonna be doing is not gonna really change from month to month too much.

I that was a big change for me.

Manuel Castro Borobio: Definitely.

To give you an idea about the day in the life of an ID in private practice.

In my case, I, I go to the hospital around seven, seven thirty AM, round on patients.

Usually start with the ICU.

That's where I'm more fresh, and I can, you know, be a little smarter.

Uh, and then around ten AM, go to the office to twelve, uh, on a full clinic

day, which is about three times a week, and then I have two half days.

And then, see there about eight to ten patients in the morning, then

go back to the hospital, try to see consults and finish my rounds.

Then in the afternoon, in a full day of clinic, I have

another six, seven patients.

And then if there is something else, I go back to the hospital.

My, my office is fortunately close to the hospital.

So we do about a fifty/fifty inpatient/outpatient or forty/sixty.

Some other groups have different schedules and different distribution.

Some do more inpatient, like seventy/thirty, eighty/twenty.

Or some are only outpatient, depending on what you do.

If you go into a HIV clinic, for example, you do mainly outpatient, or in some cases

you do like ID hospitalist, um, and you do only inpatient one hundred percent, right?

There is a mix, uh, and there is many opportunities depending on what you like.

I'm sure Manny has similar experiences, based on, you know, the day-to-day life.

Mm-hmm.

Absolutely.

And, you know, just like in fellowship when you're, when you're

doing your inpatient rotations, you're, you're there late.

You know, I, I start like Castro does.

I'm in the hospital by 7:00, 7:30, and then I'm rounding on

my patients, getting to clinic.

Sometimes I'm getting home 8:00, 9 o'clock at night despite starting

so early in the morning, depending on the number of consults.

Because, you know, as you all know, we're, we're not-- there's no time clock.

You know, you're finished when you're finished, and

the patients need to be seen.

Manuel Castro Borobio: In private practice, a day in the life of ID

is fairly busy because, most of our reimbursement comes from volume.

the more you see is the more you potentially will be able to bill.

Yeah, and, and I think that in, in the hospital setting

also, we get a lot of consults.

ID is probably as, as you might know, of course, uh, ID is one of the

services that gets most of the consults.

I would say 10-15%

Yeah

Manuel Castro Borobio: of the census of the hospital, at least.

Because when they don't know exactly what to do or they think

they have any type of infection, we're gonna be consulted, right?

Even if it's a simple UTI or simple cellulitis, we're gonna be consulted.

Or if some-someone doesn't know what's going on, they have white count or a low

grade temp, they're gonna call ID, right?

And more in, in community hospitals, it happens even more frequently.

So I think that is important to potentially throw out there.

Yeah.

Do you feel like your relationship with the other teams in the hospitals

has been different in private practice versus when you were in fellowship or

other prior experiences that you've had?

I think there's a big customer service component,

unfortunately, when it comes to private practice because you don't want them

necessarily calling another group per se.

You want them to rely on you.

Mm-hmm.

Um, know that some, some cases you may be the only

private practice in that hospital.

Our practice currently has three different hospitals and, for example,

where Castro is at, he's by himself.

Uh, him and partner, and so it's just our group.

So all the ID consults come to us.

But where I'm at, there's another group, and they generally prefer one group over

the other because of their accessibility and knowledge base, et cetera, the way,

you know, the way the patients respond.

Yeah

Um, so I think some of that is important.

Whereas, whereas when you're in training, a lot of it's academic.

You tell the, you know, the whole surgeon, "Hey, you know, we recommend this because

of this most recent study." You know, sometimes you have to sort of walk that

fine line between, yes, this is academic, but this is sort of, you know, what the

patient needs right now and, and kind of keep your surgeon happy at the same time.

Manuel Castro Borobio: And following up on that as, as well, I feel like ID,

when you come to community hospitals, is a very important specialty.

Um, you know, we're consulted by many different departments, and many of

the surgical departments too, end up consulting ID because there is a

real infection or because they just wanna make sure everything is going

in the right direction and there is nothing else that we need to do.

So I think you understand the importance of ID as well, in the

community setting, and how much work we have and how many consults we get.

Even if it's not something that we really ne-need to be involved in, but, but we're

consulted either in, in the outpatient setting or the inpatient setting

Yeah.

Yeah.

So now this person who came to you to ask these questions is curious,

like, "Yeah, I'm interested in private practice, but I don't really know

how to start as far as looking at jobs or thinking about contracts.

It feels really overwhelming.

What advice do you have for me about navigating this process of the job

search and, and thinking about contracts?

I think like, uh, Castro said earlier, I think knowing the

location you wanna be in is important.

And then if you really wanna do private practice as opposed to be

employed, I th-- I actually think it's okay to cold call practices.

You know, pick up the phone, call them and say, "Hey, you

know, I'm, I'm Dr. So-and-so.

I'm about to finish fellowship.

I'm interested in moving to this area.

Do you have any openings or know of someone who does?" because, you know, I

think as ID physicians, we're all, we're pretty kind and good people, you know?

We wanna help each other out.

I think that people are going to talk to you regardless if

they have an opening or not.

Manuel Castro Borobio: Following with what Manny was saying, uh, knowing

the, the area is gonna be important.

More rural areas will potentially pay higher salaries.

You might have more workload potentially.

You might be the only ID in many miles.

If it's more of a bigger city, they might pay you a little less, for example,

but you might have more opportunities.

And if you have families, potentially better school districts, better places

to live or different places to live, depending on what you're looking for.

Um, when you're gonna review the contract too, might wanna get an

attorney to review all the wording, make sure everything is, is clear.

So in regards to the contract, potentially getting an attorney

to help would be, would be great.

As someone, let's say, they're starting to have conversations with

a practice and everyone always asks, "What questions do you have?" So that's,

they've come to you and asked, like, what are things that they should be asking

about job structure or call schedules or other things that are unique to private

practice that a fellow or someone who's looking for a new position should know?

Manuel Castro Borobio: Sure.

Um, so when you, when you ask about, questions to ask the

practice, I ask usually how is, you know, your regular day.

So I get a feel of what the workload is, how many patients do you normally see.

I ask about call schedules.

How frequent are your night calls?

Um, which fortunately for ID is usually handled over the phone.

We don't normally have to go in.

But still you wanna know that and you wanna know the weekend calls.

Most of groups are gonna have weekend calls.

You wanna ask about benefits, and this is something that we don't get in, you

know, fellowship with not many, fellows come out knowing what to ask for in

regards to health insurance, malpractice insurance, tail coverage, um, which is

the insurance or the malpractice insurance once you leave a practice that will cover

you for a few years, that has a cost.

Retirement plans, 401Ks, matching 401Ks from the group that you're gonna join

or the hospital you're gonna join.

You wanna know the type of reimbursement, the base salary, potentially bonuses

depending on productivity or, RVUs that many hospital systems use.

You wanna know how many doctors they have that will distribute better the workload.

A lot of things to that, that you can potentially ask

Yeah

Manuel Castro Borobio: but we don't know that when we come out of

fellowship and we're looking for a job.

I'm sure Manny has other questions potentially as well

No, sure.

Like, If you're interested in becoming a partner, what is

their partnership track like?

how many years?

You know, do the partners take equal call, or as a partner, do you take less call?

I think that's important to know, uh, because it does vary group to group.

I think Castro highlighted a lot of the really important questions to ask

Manuel Castro Borobio: Yeah, in regards to partnership also, the buy-in, there

is, uh, usually a fee that you have to pay when you wanna become a partner.

We've encountered multiple amounts, uh, throughout the, uh, interviewing process.

So it, it, it's interesting.

That's something you also can use AI or internet to, to ask,

or friends, you know, to ask.

Like what do you get for being a partner?

Like what is the pros and cons of being a partner?

We won't spend a ton of time I think on compensation and salary, but,

we do talk about how do you find out what is sort of a ballpark for the area

you're in, and I feel like there are, you know, those one or two resources

that we use for academic practice.

Is there anything that you can refer folks to that you think is

helpful, or has it been really asking around for folks who know more

about the practices in that area?

Any other advice that you would give for a fellow trying to figure

out, you know, hey, is this salary average, below average, above average?

I, I personally, I mean, I-- or in my case, I, when I, I

actually interviewed in s- in a couple different places and got a feel for

what the salary was gonna be like.

Really just a couple places too, but, um, that gave me a sort of

idea of like where the offers were.

As, as you said, Sara, and I think like the salary.coms, those kind

of places, it's, it's so variable

I know.

I think it's really hard to use that

Yeah

guide, um, for unfortunately.

Manuel Castro Borobio: There, there is also a, a yearly survey that

Medscape, um, comes up with, and that gives you an idea nationwide.

But you'll have to potentially refine your search with ChatGPT or Gemini if you

wanna learn about the, the specific area where you're gonna, where you're gonna

Yeah.

Yeah

I think part of that's also bonus-driven too, 'cause they, you

know, get a base salary, but yet your bonuses could vary quite significantly

depending on the practice models.

We're talking about a lot of things that we don't necessarily

pick up in fellowship or, or maybe we can, we have to seek it out.

So I think that's a good transition to ask, what are things that you wish you

knew during fellowship or kind of right before the end that would help you as

far as working in private practice, things that you wish you could have

spent some time on in fellowship, skills that you might have tried to build out?

I think one of the things I would tell a fellow is actually

for the application process, you know, once you join a private practice or

even a hospital system, you're gonna need all your paperwork, all your

diplomas, all your resume up to date.

I think that's super important.

I don't think I can emphasize that enough.

Just having it one place, one file

Yeah yeah.

And you just double-click and download it, and

Yeah.

I think that's super important and very helpful.

But Castro, I know there are other things too

Manuel Castro Borobio: Well, uh, I was,

are probably more, more important.

And we're all having flashbacks from doing our credentialing,

so we'll give a beat for that

Manuel Castro Borobio: you know, I'm a, I'm a foreign medical graduate,

so, like, having to ask my school in, in Peru to send me certificates,

and then I have to translate them.

That process already takes, like, six weeks.

You know?

It's like, I have to ask them.

They read the emails, you know, a few days later.

Then they send them to me, you know, weeks later, and then I have to translate it.

So, yeah, documentation, licensing being up to date.

Um, yeah.

Uh, there's a lot of documentation that you have to get

But I always also say I think what very important

is some practices do wound care, and I, I don't think that's

emphasized enough in fellowship.

I mean, we see wounds, but we're kinda like, okay, wound care is doing it.

I was lucky enough in fellowship that my director allowed me to do

a one-month rotation in wound care, which was, I thought was great.

The other things are coding and billing.

still struggle with that, and I'm over 10 years in, I'm still struggling

with how to code the right consult l-level and office note, but things

like that certainly I think are very helpful and n-not emphasized enough

Manuel Castro Borobio: And just to add, uh, to that, coding and billing

is extremely important, and private practice as well, it's no, no different.

When we're in fellowship, we don't always get the exposure to the coding.

Uh, so that's something that, you know, if you can get like a webinar

or any ideas online on how to code appropriately based on the time or the

medical decision-making, that's important.

And adding to the other things you, you wanna know when you come out of

fellowship, there are many private practices, many groups that have infusion

centers where they do IV antibiotics, IV drugs, some immune therapies

for like rheumatology, neurology.

They get fed by other specialties too for infusions and, and that's very helpful.

Uh, not only because you can help the patient not have to go somewhere else for

these treatments or to the hospital or be admitted, you can take care of it there.

But also depending on how you use infusion centers, it can help the reimbursement,

because of how you can code and you can bill for the infusion centers or

for your infusion patients as well.

The other thing would be working with mid-levels.

I, I didn't have much experience in residency or fellowship , and, you

know, we, we work with them a, a lot, not just within our group, but

with other specialties and sometimes some of the surgery groups that's

all, all whom we talk to . And so it's important to learn to to work

with them and be ready for that.

Manuel Castro Borobio: If you work with hospitalists too, another thing that is

important, and I think this is mentioned in, in training but it definitely becomes

very real when you're out of training.

If you work for a hospital, you're affiliated to a hospital, they'll probably

ask you to be part of the antimicrobial stewardship team, the infection

prevention team, and there are definitely opportunities to help in leadership in

different hospital systems, and also you can grow your career that way.

Many ID doctors are CMOs.

Many ID doctors are lead in, in these different departments like antimicrobial

stewardship, infection prevention.

So that also gives you a plus for your career in general

And I, I think you, I mean, you guys have already started

to allude to it a little bit.

I think what I find maybe a little bit intimidating about thinking about private

practice is the business component of it.

I guess my question would be how involved are you in that part?

Or, uh, maybe the other way to ask that too is how did you gain those skills or

experience or learn about that component of your practice and your work now?

Just a super simple

Manuel Castro Borobio: I'll let you go, I'll let you go first, Manny.

Yeah.

Um, we go, "Oh my gosh." You know, as I mentioned, I, I, I

finished fellowship in 2013.

I've been in private practice ever since, and every day I'm learning

something about the business.

It's such a different part what I do.

What I'm doing day to day is seeing patients, and that's what I wanna do,

but the business part is so important, you know, dealing with hiring and firing,

um, dealing with, you know, oh gosh, is this product the right product for us

to purchase for the wound care center?

All those things you don't-- I didn't think about, and now it's

just a part of our day-to-day lives.

Hopefully, if you're in private practice, you have a very good practice

manager that's reaching out to you for sort of the important things.

Not so much like, "Hey, the, the light switch is working, isn't working today,"

or someone's didn't show up to work today.

Like we've experienced, it's, it's, it's intimidating in the sense of

like you're being asked questions all the time, ma-making decisions.

And when it's more than just you, it's even harder because, you and your

partners may not always agree with path that you want the practice to go.

Manuel Castro Borobio: That's, that's the most difficult part and the part

you're not prepared to actually, work on.

As Manny was saying, we are ready to see patients, and we

wanna see patients that we enjoy.

But there are different angles to the business part that you don't know,

and you learn as you go pretty much, or you learn from senior partners.

As Manny was saying, you don't always agree on things, and you have to

vote, and sometimes it doesn't go the way you want, sometimes it does.

And there are different aspects to running a business, the overhead cost, which

is the money you have to get to pay the employees, medical assistants, nurses,

nurse practitioners, OIC, infusion center nurses, wound care nurses, front desk.

And sometimes the reimbursement, you know, how you gonna be paid and pay

everyone, changes because of insurance.

We constantly see changes in Medicare reimbursement, and then

the private insurance follows that.

The day-to-day operation and how patients can complain about something or employees,

you know, there's potentially drama among employees, and you have to deal with that.

It's really important to have good managers in each department.

Sometimes you get great managers, and you don't have to deal with that

directly, and you just give an opinion.

Um, and sometimes you have to deal with it yourself if, if the

managers are too busy or they are not as involved as you would like.

So it's tough.

You learn day by day . It's always something new.

Yeah.

Excellent.

So not surprisingly, the running a business question wasn't easy and simple.

But any other pearls, advice that you wanna include

Manuel Castro Borobio: We can talk about the, the investment part and then

I-- and, and then we can touch on how to leave a practice because I think

it's important for fellows to know.

Yeah

Manuel Castro Borobio: in regards to investment, or how to generate

more income, if you will, as an ID.

There are different avenues.

You can diversify like, in real estate if you have that kind of money, if you

were able to save that kind of money.

You can also try to do extra jobs like expert witness, where you help attorneys

with medical practice cases more commonly.

You can do telehealth for example, or consulting.

And you can always try to use for that, um, investment advice for

example from White Coat Investor.

Many I know you might have experience also with financial advisors or

accountants that can help save some money or, or generate more income

Yeah, my two points or two senses.

I think it's important.

I mean, I, I dislike running a business.

I think my, uh, forte, my fortitude, my, my, my thing is seeing patients.

I'm not sure how to… I hate to say this, I'm not sure how

to manage my money, you know?

So it's, I think it's important to have someone who knows better than I do.

Just like if you consult someone in the hospital for a problem, I think I

gotta consult a financial advisor to make sure I'm doing the right thing,

saving enough money for retirement.

I have two children.

I wanna make sure I'm able to have enough money to pay it for them for college.

I have medical school loan debt still

Mm-hmm.

still.

Um, and so all those things are important to look at.

And it's expensive being an attending.

I mean, yes, you're making money, but someone's always asking for something?

Um, whether it's getting your DEA renewed, your memberships

renewed, it's adds up very quickly.

It goes very far.

what you make goes, it goes away very quickly.

It's

Yeah, yeah

Um, and as far as how to leave a practice, I, it

goes back to, like, the contracting and speaking to your lawyer.

Find out what the non-compete clause is

You know, how long is it?

What's the mileage from the location?

Do you have a non-solicitation agreement as well?

Is there an indemnity clause if something happens to the practice after you leave?

Can they come and, and, and ask you to do something or pay a fine afterwards?

I think those are important questions to have.

I mean, hope that the practice you find is someplace you're

gonna stay for a very long time.

But if things don't work out, you do wanna understand, you know,

these are the things I have to do to

Manuel Castro Borobio: And if, if you're a partner, usually there is a

buyout and, and you can recover some of the money you pay for the buy-in.

Sometimes in, in those clauses, like the non-compete clauses,

they also have the tail coverage.

So sometimes depending on your partnership, the company can

pay for your tail coverage or sometimes you have to pay it again.

The tail coverage is paying for malpractice.

You know, if something happened, if there was a, an investigation or a

claim against you once you left the practice, that tail coverage will

cover it for a few years after.

So those are important points and, and as Manny was saying touching base

with an attorney that can guide you through the process is important.

It's, it's more complex than you think than

Yeah

Manuel Castro Borobio: your notice and getting out, you know, in,

in a number of days they require.

So

Yeah

touch base with an attorney.

Well, the next thing I was gonna ask a little bit about is, we're so

used to in fellowship and many academic settings constantly being at conferences

and seeing folks around campus and in private practice, how do you feel as

far as how often you're seeing your… Well, I guess it depends if your other

partners or folks that you're working with, how do you think about professional

development and staying up to date?

Are there things that you help to do to stay connected to your local ID community,

but also the larger ID community?

I think speaking personally again, in my experience has

been, it's been very challenging to go to conferences and keep up in that sense.

Most of it's just done by reading, looking at things online as I'm seeing

the patient or trying to keep up with my recertification or things of that nature.

And that goes to like when I said earlier on as far as like the

day-to-day, kind of like you're in that hamster wheel of seeing the

patients and not doing much of else.

Luckily, here in Atlanta we have an ID society that meets every so often, but

it's hard to get there because if you're leaving early in the morning to go to

work and coming late at night, that doesn't leave much time for your family.

And, I think that's important to find that work-life balance.

You wanna meet your colleagues and, you know, and the latest information, but at

the same time you wanna go, you know, see your kids and spend time with your spouse.

Um, so that's definitely been difficult.

To be perfectly honest, this past IDSA meeting was the first one I've

attended since I finished fellowship.

Um, so that's, that's-- I think that says a lot about, um, sometimes,

again, we're just a very busy practice.

Other pri- practices may not be as busy and, and it depends

on what your priorities are.

But it's been very challenging to, to keep up with that.

Manuel Castro Borobio: Yeah, you learn that, um, reading articles,

online articles, New England Journals of Medicine, JAMA, and definitely

UpToDate on a frequent basis, um, is, is probably where you catch up of the time.

Sometimes going to different conferences is hard because of, as you said, Sara,

and, and Manny as well, coverage.

You know, either you take vacation time or you, you take time to go there

Yep.

Manuel Castro Borobio: partners have to cover, right?

Um, so that can be, that can be tricky.

And that, when you go back to reviewing the contract, you wanna have at least

protected time to go to CME activities.

Uh, because when you recertify, then you realize that you, you don't

have the CMEs you need and you have to, you know, get like 50 CMEs in

the next two weeks to recertify.

So it's like, yeah, that's tricky.

That's tricky as well

Yeah

Yeah, and I, I would just, uh, shout out to, you know, uh,

IDSA and a, and a few other organizations that do the comprehensive reviews.

I think that's extraordinarily helpful

Yeah, definitely.

And I think that's a really nice segue just to ask about job satisfaction.

We talk a lot about work-life integration is probably the better

word, but, um, you know, tell me a little bit about that and how your

experience has been in private practice

Manuel Castro Borobio: This is getting dark.

Well, I would say a plug for private practice is that

because, especially as a partner, you can set your own schedule.

I mean, if you're not working, you're not seeing patients, you're

not really generating income.

But if I wanna leave work a little early, you know, I call my partner and say, "Hey,

my daughter's having XYZ event. Can I step out for, you know, an hour early t-today?"

And, you know, we do that for each other.

So in that sense, you have more control over your schedule.

But there is a, you know, there, there is a cost to that.

I think that's the-- one of the nice things about being in private practice

is that you have that freedom to do that.

Um, you know, like Castro was saying, you're changing your, your clinic

schedule rather than having to wor-worry about talking to an administrator about

it and going through all those hoops.

I think that's really helpful as well.

Um, but it is private practice, so the job doesn't leave

just because it's after 5:00.

I mean, my phone's always going off.

Sometimes they don't know that you're not on call, and so the ER's calling you at

eight, nine o'clock at night even though you're not listed to be on call, you know?

Mm-hmm.

pick up the phone, politely say, "How, you

know, how can I help you?" You know, "What, what can I do?"

Um, and then, you know, relay it to the other, the person who's on call.

So it, it's-- that is challenging.

Manuel Castro Borobio: Yeah, definitely just adding to what Manny said.

You, you are your own boss.

You're a partner.

You can distribute your schedule a little differently if you needed to.

Um, but there is definitely a burnout, uh, as Manny was saying.

More patients you see, the more volume, the more reimbursement,

but also the more burnout, right?

I mean, doing notes late at night, seeing a large amount of patients

is gonna create some burnout.

So one of my recommendations is also try to schedule vacation

every three, three to four months.

Try to get at least, you know, a week if you can with your family or sometimes

even if it's a staycation, right?

What we call a staycation, staying home and enjoying, your kids, your

family, your activities in the city, that helps you decompress, so you

don't get burnt out so quickly.

Um, yeah, and that, that's probably the best you can do to kind of get out of

what you… every day, um, and, and try to, to decompress and have some better

mindset going back to, going back to work

I think having a very supportive partner

is, is extremely important.

Understanding that, you do work long hours and it's not because you don't

wanna be home, but that, you know, you're doing this because it's your job.

I f- I have found that to be exceedingly important in my life at least.

Um, the only other thing I mentioned, I'm not sure how, where th- where

this fits, is trying to find new providers to join your practice.

Again, you know, not everybody wants to move to a rural part of a state,

but even where we are in Atlanta or the outskirts of Atlanta, it's, it's hard to

find ID physicians that wanna come in.

So I, so I mean, any, any ideas anyone has for recruiting, we're all, we're all ears.

Manuel Castro Borobio: Uh, I, I do wanna say because it seems like when

we talk about burnout, it's hard, you know, because of the amount of

patients we see or how late we work.

But it's important to say that-- and I think many and, and you,

Sara, see the same thing, what we do is very rewarding, right?

What we do finally is, is extremely rewarding.

Um, the detective work, trying to get to the right diagnosis, being able as an

ID to, in many cases, heal the infection and, and not like other potential chronic

conditions in other specialties, uh, being able to heal and treat appropriately.

Um, I think the patients really appreciate what you do, and other

s-specialists also appreciate what you do, and the hospital as well.

Um, so the work-life balance sometimes is hard, but there is a great

rewarding component to, to what we do, and I-ID is a fantastic specialty

I agree.

100%, you know, echo what Castro says.

I mean, w- w- I, I don't… I mean, we work this late, we work

these hours in because we love it.

We really do love the ID.

Well, you guys beat me to it.

You beat me to it.

My last question was gonna be, you know, what do you love about ID?

Um, but maybe I'll just kind of open it up for any additional final comments or

pearls, things you wish you knew that you feel like we didn't cover so far

I would just say re-- if, if there's a-- truly a fellow out there

interested in private practice, reach out.

Reach out.

I mean, we'll leave obviously our information for Sara.

Reach out to one of us.

Um, we don't have all the answers certainly, but, we can help talk to you

and, and s- see what your interests are and hopefully help so that you don't make

the same mistakes we did, um, and find the right place for you, whatever that may be.

I think ID is a special calling.

you know, not, not thinking everybody can do it or do it well for that matter

Manuel Castro Borobio: And I think it's important that you have your goals well

established, you and, and your family, if you have family, you know, where you

wanna be, what area you wanna move to.

And don't be afraid to ask for what you want.

Talk to mentors or other fellows that have already, taken other jobs and

see what's important to them, what, what was important to them, and don't

be afraid to ask for what you want.

Um, you might not get everything, but you, you can get some of the things

you want and, and the group or the hospital can accommodate for your needs.

Thanks so much to Castro and Manny for joining today and

sharing a little bit about their experiences in private practice.

Hopefully, we'll talk about other career-oriented episodes in the future.

You can check out the website, febrilepodcast.com, where we

keep the Consult Notes, which are written show notes for the

episodes with links to references, our library of ID infographics,

and a link to our merch store.

Febrile is produced with support from the Infectious Diseases

Society of America, IDSA.

Please reach out if you have any suggestions for future shows or want

to be more involved with Febrile.

Please reach out if you have any suggestions for future shows.

Thanks for listening.

Stay safe, and we'll see you next time