Drs. Priya Nori and Gonzalo Bearman teach us how to do the H.U.S.T.L.E. - to improve our consult fitness!

Journal article link: https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciaf672/8369005

From Clinical Infectious Diseases

Episodes | Consult Notes | Subscribe | Twitter | Merch | febrilepodcast@gmail.com

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 dive into ID clinical reasoning diagnostics, antimicrobial management.

I'm Sara Dong, your host, and today I'm quite thrilled to have two guests here

so we can talk about working towards improved consult fitness, but before we

get into the topic, I'll have our guests say hello and introduce themselves.

Hi.

Great to be here, Sara.

Thank you for the invitation.

We're thrilled.

We're huge fans of the pod.

So I am Priya Nori.

I am an adult infectious diseases doc at the Albert Einstein College

of Medicine in the Bronx, New York.

Here I do stewardship.

I do OPAT.

Um, sort of very random in the mix with lots of different things, but I

am close collaborators with our other guest today on multiple writing projects,

but also our academic journal, which is Antimicrobial Stewardship and Healthcare

Epidemiology, which is a SHEA (Society of Healthcare Epidemiology of America)

journal that we both work on together.

And I'm gonna kick it over to my co-guest.

Thanks, and thanks for those kind words, Priya.

I'm Gonzalo Bearman.

I'm an infectious disease specialist at the Virginia Commonwealth University, also

known as the Medical College of Virginia.

And I've been the division chair here for about 12 years.

I'm also a healthcare epidemiologist by training, and as Priya said,

uh, we work, uh, I'm the editor.

She's the deputy editor of the Antimicrobial Stewardship Healthcare

Epidemiology Journal from SHEA.

So it's a pleasure to be with you.

Thank you so much.

Perfect.

And you guys have a podcast for the journal too that you host.

So

Yeah,

we'll plug that and link to it.

So folks,

nice.

are hopefully already listening, but just in case.

Thank you.

So as everyone's favorite cultured podcast, we always like

to kick it off by asking if you wouldn't mind sharing a little piece

of culture, just something fun, um, things that bring you happiness.

Priya, maybe I'll start with you.

Sure.

So I was thinking about this a lot yesterday, Sara.

And I, there's a, there's a lot of things I do.

I mean, I have a low key like skincare obsession.

I shop a lot.

I'm a, I'm a stage mom, but you know, separate from all of that.

I did wanna plug that we have an interest group called South Asians in ID, which

is an official IDSA interest group.

And something cool that we do is we have a book club where

Nice.

try to read works by like South Asian diaspora writers.

Or anyone adjacent.

we recently read the latest book by Kiran Desai, which is the Loneliness of Sonia

and Sunny, which is a, a great read.

Um, highly recommend.

And, yeah, I wanted to plug that group and say what's up to them all.

I know that they will be listening at some point.

Love it.

So I like that book club Priya, you gotta invite me one day.

How many years do we need to work

adjacent.

You certainly spend enough time with me to be a brown adjacent.

Okay, well, uh, in terms of the culture, I guess

I should say that I'm Argentine born, you know, Argentine American.

I have two passports, Argentina, USA.

So naturally I'm obsessed with soccer, with being from Argentina, playing

or watching, more watching now.

So I spent a lot of time doing that and uh, I've been playing

the drum since I was a boy.

So I spent a lot of time on the drum set and playing with my cover band.

So that, do a little something outside of work.

It's not all work and no play.

Very nice.

Well, I'll start by thanking you guys for creating this article, so

I want to point listeners to, from Clinical Infectious Diseases, CID.

There was a viewpoint entitled H.U.S.T.L.E., a consult fitness guide

for infectious disease providers.

And so, I'll start by asking, I mentioned that idea of consult fitness, which

you guys explore in this viewpoint.

So can you give us an intro?

What do you mean by that?

Consult fitness.

So a while ago, a couple years back, I read

an article, which wasn't new.

It was talking about excellence or clinical excellence.

You hear that term a lot, but, I was actually wondering, like,

has anyone ever defined that?

And it's been defined, it defined both for just general clinical

medicine and also infectious disease.

And it comes down to a, a component of not only having an understanding,

the knowledge and the ability to practice medicine, but really also

having a scholarship component to it.

And it was really very academic medicine focused, if you know what I mean.

And it kind of led to the next step, which is consult fitness, which is.

Yeah, there's maybe a component of being somewhat physically fit

that was inspiring from that, but that's not really the inspiration.

The idea is that if you have consult fitness, not only are you knowledgeable

and skillful as a consultant, but you can navigate the system and you know how to

navigate the system effectively to triage.

You know, manage things, uh, back burner things, prioritize things, manage a

team, et cetera, et cetera, all during the course of a day to day while

maintaining that academic scholarly edge also in the background, I dunno, Priya,

did I, did I cover most of it there?

Yeah.

Yeah, absolutely.

And I will say that you walk this walk.

I don't necessarily.

Which is why it's really beneficial for me to partner with someone like

Gonzalo who can keep me on track and say, why are you doing that?

That's absurd.

You need to stop doing that.

I'm better now.

But I started as a very unfit ID consultant in the sense that, you know,

I would write these really illustrative, beautiful notes, but they weren't really

impressing anyone, but, but me and my ID colleagues and, I probably spend

too much time in chats just engaging people and wasting a lot of time.

And so, I needed this, I needed to go through the exercise of working on this

with Gonzalo as much as I needed to share some of these ideas with, with

the people that I work with every day.

Yeah, you guys propose this framework HUSTLE.

We're gonna go through the letters, but before we do, I thought it might

be nice what you were thinking about when you started collaborating on

writing this, the goals that you were thinking about as you were crafting

the different letters of the acronym.

Well, I mean, the underlying goal for me was to put into

words and hopefully the publication that the ID community would read

on how do we reclaim or claim our workflow, maintain our focus, regulate

and manage our energies and really set the agenda in infectious disease.

Because one thing we've learned, I think with the pandemic in the rearview

mirror is like if we don't set the agenda, someone will set it for us.

You, you heard about all these experts popping up.

It had nothing to do with infectious disease and epidemiologists.

So we are the experts in this field and we're the ones who should be

saying what we will and will not do and when we'll do it, so to speak.

And that's really kind of one of the primary drivers.

Now, the acronym itself.

I'd probably have to give more kudos to, to Priya on that.

Um, I'll turn it over to her 'cause she had a good idea with that.

Take it away.

Okay.

So, and I can't even really remember the moment that we stumbled

upon the title, but we do in our regular conversations often speak

about boots on the ground issues.

So Gonzalo, uh, leads his division, but he is a rare type of division

chief that spends a lot of time in the clinic and on the consult service.

He is going through a lot of the same challenges that me as a

just kind of middle manager type faces on the wards every day.

And so we have these really robust conversations about, Hey,

can you believe this happened?

Um, what should we do about this?

Why do we allow ourselves to undergo, you know, a certain kind

of, um, martyrdom or whatever.

And so that's where these ideas and this is how the whole thing came together

basically is our lived experience coming from two different perspectives.

Um, so HUSTLE, uh, probably comes from my long time love and being a connoisseur

of hip hop, and I happened to work in the Bronx, which is the birthplace of hip hop.

I trained here.

I was a med student here too.

I've been here for a long time, so it's always like rap culture's kind

of always on the front of my mind.

and, uh, I listened to a lot of, uh, early 1990s or 2000s rappers who

used to talk about the hustle a lot.

And I think there's a lot there for us that, um, it's about the work

ethic and the elbow grease and we wanted to bring some of that in here.

Yeah, definitely.

Priya is more hip hop and I'm more rock and roll, but had been left,

left to my devices, we probably had a rock and roll quote like Tom Petty

or something like that saying, using one of his famous, famous lyrics.

Even the losers get lucky sometimes.

You know, we don't wanna be losers and we wanna be lucky all the time, you

know, so we wanna set the agenda, so,

Yeah, love.

not in a DJ T sense, right?

I don't wanna be losers.

Uh, well, okay, so we wanna take on the HUSTLE mindset.

So, uh, we're gonna walk through the letters.

I'll introduce the letters and have you give a little insight

into, um, what you were thinking.

So we're starting with H, Hone your skills, set

boundaries, manage expectations.

Alright, Priya, do you want me to take that?

Yes, this is, anyone that knows you and reads this paper.

It is like you screaming off the page.

So I think you should start.

Okay, well maybe I'll try not to scream, but alright.

So hone your skills, set limits, and and manage expectations.

Really honing your skills of consult management or managing your service.

Setting limits.

And I think this is really important because I've learned this by being a

division chair for 12 years and seeing the other 11 or 10 division chairs around

me, how they set limits with their teams.

Like, we don't do these consults, we're not available unless you have

tissue, tissue, uh, uh, histopathology.

We as oncologists, were not interested.

You know, you've heard these things before

Yeah.

and it's like we seem to drop everything when we get a call.

Forget a call, an epic chat.

Like that's

Hmm.

of a sudden all, uh, unbelievably important.

So we need to set limits and we don't work shifts, like let's take hospital

medicine, and, and then we may never work shifts 'cause we're never gonna

have an ID team with 85 people on it that would come in eight hour shifts in 24 7.

But we can set limits on what we think is a reasonable workday.

And this is referenced in the paper.

I'm saying now more than ever, that no one should work beyond 6:00 PM.

Now, what time do you start?

Well, that's up to you, but generally you should never

work more than 10 hours a day.

And the truth in my opinion is that the majority of ID consults, you may disagree,

Sara, Priya may disagree at times also are important, but they're not urgent.

They're important, but not urgent.

So we can say, you know, we will see x number of cases up until four o'clock and

then the last hour and a half or so are charting, and then we're out the door.

The next day starts, whatever's left over, it gets carried over.

And this is worth saying that expectation with the team is important because,

it should be an expectation across the team.

If, if I'm coming off service or I'm coming on service and someone

else is on service, they can kick over two to three cases to me.

It's no problem 'cause that's how we function.

Set limits, you know, so that we don't burn ourselves out.

So that, that's really kind of the, the underlying tone.

And we'll get back to the team at ethos shortly.

Yeah.

No, I, I have no disagreement so far.

I like that.

And important, not urgent.

Yeah.

All right, so for U, we have upgrade your toolbox.

So what kinds of things can we work on here?

This one might also be Gonzalo, but, he's a lot more tech savvy

than I am, and he's an early adopter of some of these AI based tools and stuff.

I'm sort of a slow adopter, but, um.

I'll let him talk more about that.

I think

So you.

it's working out well for you, right?

I think mostly, I mean, AI it's not a savior.

It's neither a saboteur.

So I think you have to use it deliberately.

And the two examples that come to mind, I'll give you really three examples

that come to mind, that would be in kind of updating your tools, we use Epic.

I, I, I use Epic because that's the only option I have.

Maybe you have Cerner, who knows, but, uh, one is to, uh, when

you have an opportunity to do AI generated note taking, learn it.

Learn how to do that.

You can usually even modify your speech and the way you summarize things, so

the AI note generation actually picks up your differential diagnosis and

action plan quite easily, and it saves you so much time in documentation.

I've gotten so much better the last three months on that.

That's number one.

Number two, within Epic, for example, we have Up to Date embedded.

I think everyone else does.

Uh, if you're not aware of, UpToDate has an AI generated assistant within it

now that uses UpToDate exclusively, or the data within UpToDate to answer your

specific questions or queries by ai.

And sometimes instead of doing a long winded literature search, when you

have one really simple question, you type in your question to UpToDate

and you can generally, I would say trust the source because the authors

of UpToDate are peer reviewed, referenced, et cetera, et cetera.

So that'd be another example.

The third is, and this is hit or miss, but I think it's going only

going to get better even when you do a consult and you open up a new,

a new note or a note in, in Epic.

You can summarize the hospitalization by hitting AI summary of the hospital stay.

Now it may not capture everything you want, but it may give you about

75 to 80% of what you need to get started and really to minimize your

time hunting and pecking and clicking within the electronic medical record.

So those are some examples.

I think that we should always be on the lookout for technologies or shortcuts that

can, you know, hedge our efficiencies that can give us a little bit bit of leverage

where we previously didn't have have that.

Yeah, and I feel like like even outside of AI folks who like lovingly

call themselves luddite, it's like just taking the time to go through and set up

shortcuts, set up your epic, so that's

Yeah,

it's in a flow that works for you.

Correct.

I feel like as a trainee, we often do that.

We have an hour in orientation where someone who's a little bit more senior

teaches folks how to set up their epic.

And I think we maybe don't do that as much for faculty or, or people

get rolling and they just don't think about, but it's so worth your time

Correct.

to just streamline it.

Agreed.

Whatever you can do to leverage your documentation time or make

it shorter and more efficient, I think is probably gonna help us.

'cause we're, we're really there to make diagnoses and decisions.

Right, Sara?

Yep.

Diagnose and decide that's it.

Not to do a bunch of charting and tapping, et cetera, et cetera.

That's not really what we're there for.

Yeah.

We have to remind, I have to remind myself frequently.

You're not just here to write notes.

But you're here to make decisions and give recommendations.

If people don't want to follow 'em, that's a different discussion.

That's forthcoming, I think.

Right?

going with that one as our next, uh, commentary.

Yeah.

Hopefully Paul Sax will go for it, uh, once again, he is been

very generous, uh, to us so far, but

Yeah.

All right.

Well, we're going on to S now, um, seeking an effective individual slash

team approach to consults and curbsides.

Hmm.

Yeah.

Who wants to take this one?

Yeah, I think so.

But probably what I would share has to do with our combination of, of strategies

for this, but um, there should be a certain expectation across the ID service

that these are the boundaries we're setting and these are the expectations

for coverage or being a team player.

If somebody suddenly falls ill or there's a, a family emergency

or something bad happens, we all need to have each other's back.

And it can't just be the same old people filling in when a need arises

and, uh, nor can one person have, um, a different set of conditions that,

that they don't necessarily pull their weight in terms of coverage, et cetera.

So, for instance, um, sometimes I've heard that, uh, it often falls on

the junior faculty or the young, younger people on faculty to cover

holes, gaps in the schedule if there's a sudden departure or something.

But you know, these are also the folks with the small children with childcare

issues and for whom there are certain constraints where they can't always just

like drop what they're doing and cover, and maybe it is the more senior attendings

who don't have those same challenges anymore, that can, um, pitch in.

Of course that's not fair.

It shouldn't always fall on on one, one group.

It should be very balanced.

So there should be a certain out loud expectation for collegiality and uh,

just having each other's back because, you know, we spend more time at work

probably with these folks, with our ID family than often with the folks at home.

Gonzalo, you have anything to add from your perspective as a chief?

I mean, I think that what I, I've learned more than ever that.

Just like football or soccer.

My favorite sport, this is a team sport.

It really is.

And team sports thrive on individual talents working within a team ethos

and a team kind of tactical plan.

And the same really holds in ID 'cause in an ID division like mine.

There's transplant specialists, musculoskeletal specialists, HIV

specialists, general infectious disease, and you get the point.

There's just a variety of different doctors.

Uh, each with their own interest, but also agreeing to work within the confines

and the expectations of the team.

And it's become really apparent to me as you, as we stress the team kind of

ethos the individuals are going to have.

Uh, what's the word I'm searching for?

There are gonna be challenges, whether it's daycare challenges, personal sick

leaves or sick, uh, issues, maybe family issues, uh, issues with spouses, et

cetera, et cetera, that we have to be available to cover them collectively and,

and there should never, ever be pushback.

Like, I can't help you today.

If you're on service, you're one of the four to five people on service.

There should be a just, it is an agreement, you will help out.

Or if you're not on service, you're next up, so to speak.

Yeah.

So for T, Take action and Lead, maybe I'll lump those, uh, together,

kind of like you did in the paper.

I think this is one of my favorites.

Um, so the taking action part has to do with this kind of renewed and

urgent sense of advocacy that I think falls in the ID wheelhouse, generally

speaking, but sort of now more than ever.

Advocacy is one of the ways that we're gonna improve our day-to-day

circumstances and that we're gonna leverage and remind people what

our value is in hospital systems.

So, while we are not necessarily folks who thought a lot about

advocacy, let's say before 2024, 25.

Um, suddenly we found ourselves, really thinking and talking about it a lot.

I've been involved with a lot of IDSA related advocacy, um, causes

around workforce and around billing.

I think one of their true successes has been the modifier codes.

Um, I know Gonzalo, uh, works a lot with IDSA as pertains.

Um,

Hmm.

compensation and work standards, et cetera.

Let 'em talk about that.

Yeah, it was kind of our call to action that you have to

like step up to the plate.

This is urgent.

Gloves are off.

Um, if not now, then when, and so that's where the, those

two letters come into play.

Yeah.

We'll put them together.

And you mentioned, uh, Priya compensation, and, uh,

things I'm doing still with the IDSA.

The bottom line is, you know, people wanna feel that they're being

compensated fairly and appropriately.

Uh, it, it may be unrealistic, Sara to say, Hey, I'm a first year ID doctor.

I wanna make a million dollars a year.

You know, that's kind of unrealistic.

Uh, but we can be aggressive in our negotiations with our

respective compensation plans.

And the way to do that is to understand the market and also to understand

what academic medicine is doing, not only nationwide, but around you.

Particularly if you're in, in an area that has multiple academic medical centers

that you can, or your competitors, and.

Really that, that get leads to the point of, getting to more creative FTE models.

Mm-hmm.

I guess I'm the inaugural chair of the IDSA Division

Chairs Community of Practice.

Now go into my third year, and I tell you that because when we took over

that project or started their project, launched it two years ago, there was no

agreed upon standard as what does a 1.0 clinical FTE do in academic medicine?

Now we're almost there.

We've done a nationwide survey of division chiefs.

Manuscript and process gonna be submitted this year and published in

CID or OFID, we hope, uh, sanctioned by the IDSA and supported by them.

That gives us parameters.

If you're a 1.0 FTE, you do x number of weeks.

Here's the range on service.

Here are the number of days in clinics you typically do.

This is your kind of admin time, and, and how does that equate to

the number of hours per year and general, the number of RVs generated.

And we need those leverage points to really advocate for our teams.

Otherwise, you're going up against compensation plans or compensation

boards and say, industry standard is such, and like, where's that?

You know, it was published in some, some industry magazine, which

really got no input from that.

So that's been very helpful for us at VCU advocating for our work standards.

The number of sessions or number of hours that we work and also kind of

the compensation model, uh, in terms of academic rank, assistant, associate,

and full professor based on national compensation, uh, parameters for

people in an ID and at that level.

And very helpful actually.

You have to be proactive.

Very excited about that, um, publication, I know

that had been a work in progress.

All right, so we're wrapping up towards the end of hustle.

So E emphasizing our role in efficiency.

So how can we pitch ourselves best?

So,

I think the underlying theme, and this is gonna sound a little, I don't

know if it sounds boastful or slightly crass, and I don't mean to be that way.

It's like you wanna be so good that you can't be ignored.

Mm.

So we as ID wanna be so good that we can't be ignored.

How do you do that?

Well, you not only do we take care of patients, high quality,

et cetera, et cetera, but that's not what the hospital sees.

You wanna have steady revenues, so you'd always want your revenues to be

steady, if not climbing, that helps.

But the important thing is to also emphasize what we're doing

to further the hospital mission.

This is how we've increased your access.

This is how we decrease your length of stay.

This is how we decrease your cost in the pharmacy with a stewardship program.

This is the number of infections we've averted with the healthcare

infection prevention programs.

You know, they've expanded orthopedics.

Now we're seeing more than ever number of cases.

We have a musculoskeletal service.

This is the expansion of people in referrals we're getting from the

community to, you know, move that forward.

And the number of people we're now monitoring on OPAT.

So you wanna be very explicit.

It really comes down to being able to speak and what's in it for them.

You've gotta be able to speak that.

And if we don't speak that language clearly, coherently, persuasively, I

think we are doing ourselves a disfavor.

Priya.

I will add, and we talk about this a lot, which is understand what

the priorities of your employer are.

Yeah.

And who do you report to and what is the org chart?

While a lot of us in academic ID have appointment at medical schools

who may have formalized roles, don't think for a second that the suits

in charge of hospital pay lines and budgets and ROIs and such give,

you know, a fill in the blank about your travel to ID week to present an

oral abstract or this paper that you wrote or that paper that you wrote.

When they hear those things, what they actually hear is,

oh, when are they doing this?

Is it on my time and my dime?

Therefore, put all of that aside, put it in a separate bucket and focus

on what you're accountable to, to show the ROI on the the dollars and

cents that they're investing in you.

So if you can truly reorient yourself around successes related

to readmissions, length of stay reductions, some of these CMS metrics

and leapfrog scores and all that.

Um, not to say that should be all that we're about, but we do have to

play that game to a certain extent.

It, it is when you meet those metrics and you show that their

investment in you and your team has really paid off and paid off extra.

That's when you have the freedom to explore some of these other

things that you want to do or these other academic projects and such.

But remember, first and foremost, especially if you're a hospital based

employee like me to stewardship, infection prevention, you know what

have you, that essentially it's a business, it's a corporation.

You have to align your metrics and your successes with that kind of structure.

Right.

And it takes a knowledge of, as Priya alluded to, is understanding what

their priorities are at any given time.

And those priorities can shift, so you have to be aware of that too.

Uh, an example that recently comes to mind for us is, you know, we have

like, like many other institutions, VCU has gone and purchased a couple

community hospitals that are far away.

They're in the radius, the satellite now of VCU Health.

Obviously they don't have infectious disease doctors in the

countryside in rural Virginia.

So now we're their go-to people and we're now negotiating a contract with

telehealth services, et cetera, et cetera.

But the real thing that drives this interest is they don't want to have to

transfer people with just to VCU Health mothership, I wanna say, because they

have an ID prom that could be managed with just ID expertise via telehealth,

because transfers are a big problem here.

The place is always on diversion and always packed.

So, you know, negotiating or leveraging those things like we're

here to provide these services.

This is why we think we're owed this amount of money or

coverage or FTE support, 'cause it falls into that mission too.

You have to be very clear with these things.

The other thing I was gonna ask you both is I really appreciated how you

ended this with maintaining positivity.

Um, I mean, I try, I'm not gonna say it always happens, but I try to do that,

you know, personally at work and, and through things like Febrile, but, uh,

maybe thought, you could share, you know, any tips that you have on keeping

that ratio of positive to negative high, and particularly, you know, you

guys both wear a lot of different hats.

You're leaders, you know, how do you help create an environment where we

achieve that for everyone on the team?

Priya, do you wanna start with your team or your group?

Well, I can, um, but actually I was gonna ask you to

first explain what that principle is.

The, the

Oh, the positivity principle.

Yes.

It's so, it's referenced in the paper and the psychology.

Organizational psychology would suggest that we have a negativity

bias, all of us, myself included, that you need generally three positive

emotions to overcome a negative one.

So you're kind of going up the hill on this one, and the, so how do you do that?

You can't necessarily erase negative feelings.

You can't tell people don't be negative.

But you can try to build an environment and you have to be a role model in this,

in which you anchor on the positive things, the accomplishments, where

we're going, what's important to you.

If you're able to do that, what wins we've had to keep, uh, the momentum

and keep the focus more positive.

The other thing I'm more recently learning is as I meet with faculty

member and staff, not just faculty and APPs, is try to explore like,

what are your signature strengths?

Like, what do you really like about your job, or what do you like to do?

And play toward their signature strengths as much as possible.

If you can give them tasks or, or things are related to their signature strengths,

that is going towards positivity and the psychology and the psychol psychology

literature would suggest you don't need to be doing what you want or what you

like a hundred percent of the time.

Basically 20% of the time, if you're doing things that you think is value, you

think are valuable, you, you stay engaged.

So, you know, play to those kind of principles.

Yeah, I would just add that if somebody out there, if the

ID community right now is feeling particularly negative or morally

injured or hopeless, that is not you.

It is natural to feel that way right now.

A lot has happened in the past few years and it can seem hopeless and

that is probably a normal response to everything, the circumstances around us.

Um, and not to mention that a lot of what we're experiencing now

seems to have come hard and fast after the causes that we care about.

Health equity, uh, HIV, um, funding for research and public health, and these

are like, this is it almost shot an arrow right to the, the heart and the

core of who we are as a profession.

And so it's okay to feel those things right now.

So take a look at the 20% of the things that are within your immediate

domain or your grasp or your sphere of influence and, and see how

those things can be made better.

Right.

So, um, finding community within interest groups or affinity groups

or, doing some work through mentorship or some of these non medicine related,

but still, uh, community building things like book clubs, et cetera.

Now these are totally uncompensated and you have to build them in to your

very busy schedule, but it's very, very worthwhile because, uh, you'll

number one, speak to other people feeling the exact same things as you.

Um, they will help you to have the language and the tools to understand

what's going on and contextualize it and say, Hey, yes, that is wrong.

That is messed up.

I am being gaslit.

Nod to a another one of our publications.

Yeah.

Uh, but it can be, it's often, it's the only comfort that

we may have these days and, you know, it's its own act of resistance

Hmm.

because that little thing can become something bigger.

Like an interest group, uh, with starting with five people

around environmental issues.

Like Sustainable-ID can grow into a group of 50 people with a formal recognition

by a professional society, et cetera.

You never know where you can go with those things.

You never know who you may help and influence positively along the way.

And so I say find, look internally, see what are those things for yourself

and, and try to run with them.

Right, and don't, don't underestimate the, I guess,

the dividends of really small things.

Um, for example, I mean, everyone likes to have lunch every now and then, right?

Or have a cup of coffee, or I would imagine most people do at least.

So little acts like, you know, we'll have a, a lunch for the team, the

faculty only every month, open mic.

We can talk about whatever we want or talk about nothing, but there's

pizza and salad, and everyone's welcome and we just have a good time

eating lunch, or if you're on service.

When I'm on service, which is frequent enough, I buy

lunch for the team every time.

It's usually Thursday afternoon.

It's in the faculty lounge.

I bring in the whole team and we have lunch and we're not discussing cases.

It's a free flowing discussion.

Have a cup of coffee with one of your colleagues.

You know, let's go to the Starbucks in the hospital and just shoot the breeze.

Talk about projects and just talk, shoot the breeze for 20 minutes.

These are all engagement community building activities.

Uh, kudos to one of our faculty members and associate professor who just, uh,

who were organized an outing tomorrow night for people to go bowling.

I think there's a lot of people going and it has nothing to do with work

except that we all work together.

Uh, so that's, uh, that is something I think is great.

That's, that's community building.

It's kinda like that scene, uh, in, I think it was the Top Gun two movie,

which I saw, uh, when it came out a year or two ago, whenever that was

when I think the character played by Tom Cruise has his, his team

playing flag football on the beach.

And then the Admiral shows up and is like, what are you doing?

It's like you wanted a team.

I'm building you a team.

Yeah.

When you build a team, you just do things that are not directly related

to your, your immediate work tasks.

Go bowling.

We have a foosball table here.

We have a dartboard and throw around the corner.

It's there for anyone who wants to use it.

Take a break.

Play foosball.

Love it.

Um, well, I'll open it up one last time.

Any closing thoughts?

Anything else, you know, resources and articles that you wanna

point some of the listeners to

One article that just caught my eye, it caught my eye

so much that I invited her to come to VCU and she's coming next month

Nice.

Darcy Wooten from Washington University of St. Louis.

She's just published a paper in CID.

I think it's More than a Message, death by a thousand chats.

And I think she is like a home run, her and her team or her group really giving

us a clarity on like, look, these things, epic chat is neither savior, no saboteur.

That's from her paper, that there a lot of messaging.

It's excessive.

I think the, the number of messages per day by the ID service, at least at

Washington University of St. Louis is astonishing the number they're getting,

they quantified it, of which 99%, let me repeat, 99% were not urgent.

And what a distractor it is.

And she actually provides some solutions on what we can do about it.

So check out the paper.

Yeah, it's really great.

I also will second and say that it's excellent.

It is a great paper actually.

The timing for me was perfect.

I was at the end of a two week stretch on the teaching service at our busiest

hospital, and um, I was definitely snarking and throwing a lot of shade

in those epic chats by the end of it.

And, um, wasn't my best look like it.

There were med students involved and residents and fellows, and I definitely

wasn't being a kind of example of setting boundaries or any of those

things that we uphold as good qualities.

So when, when that came out, I said, oh, wow, I wish, uh, I wish this had dropped

maybe earlier, but I immediately sent it to my fellows, and we thought through

some of the situations where we could have, um, maybe done things differently.

So highly encourage your listeners to, to check that out.

Another one was a presentation at ID week, which, probably they're working

on the publication now is an abstract, where the study investigators from two

institutions, uh, totally geographically separated, looked at revenues related to

the new modifier codes, the complexity modifiers that IDSA worked on,

Right.

they found actually quite a difference across the divisions.

Um.

revenue generated based on these complexity add-on codes, and it's just,

you know, another tool in our toolkit to

You.

maximize the impact

Yeah.

of the work we're doing, both for ourselves, but for the

institutions we work for as well.

So we're really glad to see that people are now, I mean, the

science is super important, right?

It drives our field, it improves patient care.

It's extremely impactful, but it's really nice to see the community taking on

some of these workforce issues as well.

Because that's probably one of the biggest threats to our field going forward.

And, um, the future is a little uncertain in that way.

So we need to also focus the academic pursuit internally to see what kind

of research and data we can generate about our everyday types of issues.

Yeah, Sara, so if I may add one last comment is that, and

to kind of throw some numbers out there, uh, there's like over a million doctors

licensed in the United States slightly, maybe 1.1 million or something like that.

And ID is maybe 14, 15,000.

So we're less than 1% of the physician workforce.

Now, if this was a truly capitalistic system, then we'd be killing it, right?

'cause we're in high demand and low low supply.

But we know that's not the case.

We're in high demand and low supply and things are as they are.

But look, lining here, the silver lining is that, you know, we are in high demand.

We're a huge value to major health systems.

Whether it's because they need us for the hospitalists, they need

us for the transplant programs, they need us for musculoskeletal

infections, et cetera, et cetera.

We're in high demand.

So this is the time for us to say what or to be clear on

what we will and will not do.

We're not gonna get dismissed.

We're not gonna get fired as long as we're clear and coherent

and principled in our approach.

You know, there's, if you fire ID doctors, good luck getting new ones

because there's very few people coming outta training programs.

So we have more leverage, I guess, is the take home message than we think, and we

should use that leverage to our advantage.

Kind of set the agenda, claim our focus, maintain our sanity.

Thank you so much to Priya and Gonzalo for joining the episode today.

You can catch this viewpoint in Clinical Infectious Diseases entitled

H.U.S.T.L.E., a Consult Fitness Guide for Infectious Diseases Providers.

You can check out the website, febrile podcast.com to find the Consult Notes,

which are written compliments to 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.

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wanna be more involved with Febrile.

Thanks for listening.

Stay safe and I'll see you next time.