General Updates | Navigating life as an early-career physician: relocation, career transitions, burnout, & parenthood

Naveen Pemmaraju:

Hey everyone. Welcome to this very special edition of VJHemOnc. I’m really proud to moderate this exciting discussion. I’m Naveen Pemmaraju, Professor of Leukemia at MD Anderson. I’m going to introduce each of my three panelists, but I also want each of them to introduce themselves too. So, here’s my lovely wife, Aditi Pemmaraju, who is a superstar physician, relocation expert and specialist. Dr. Jen Marvin-Peek, one of our chief hem onc fellows and leukemia faculty to be at MD Anderson. And then Dr. Sankalp Aurora, leukemia expert, finishing up our leukemia hem onc fellowship and about to be a leukemia specialist at Utah Huntsman Cancer Center. Welcome, everyone. How are you?

Aditi Pemmaraju:

Good. Thank you for having us.

Jennifer Marvin-Peek:

Great. Thank you so much for that introduction.

Naveen Pemmaraju:

This is great, guys. So, guys, I’m going to go around and kind of introduce each of you. I want you kind of to mention who you are and kind of we’re going to talk about a few issues just to give this some flavor. We want to talk about early career investigator. What is it like to manage, if you don’t mind, family, personal stress, burnout, and then relocation, whether it’s geographic relocation, as in Dr. Aurora’s case, or mindset relocation, in Dr. Marvin-Peek’s case, from fellow to faculty. And then Aditi has specialized in all this, both as my spouse through all of this, and then now also in your calling and your profession. But let’s start with Dr. Jen Marvin Peek. Jen, if you just want to introduce yourself to everyone and kind of what’s your program right now? And I’ll ask you a few questions.

Jennifer Marvin-Peek:

Of course. So as Dr. Pemmaraju said, I’m Jen Marvin-Peek. I am currently finishing up my last year of fellowship. And I will be joining as faculty here at MD Anderson in July. And I actually recently just had a baby, which is kind of the big news of my life. So, my husband is also in medicine and is currently a resident about to be a fellow. And I have a three and a half month old at home named Miles, first baby, and, you know, trying to kind of navigate what life looks like afterwards. And that includes both, you know, both at home and at work with a lot of big transitions this year.

Naveen Pemmaraju:

Perfect. And we’re going to ask you about those. Thank you, Dr. Marvin-Peek. Dr. Aurora, it’s been so lovely to get to know you, work with you closely in our MPN work. Why don’t you introduce yourself to everyone out there?

Sankalp Arora:

Yeah. Thank you, Dr. Pemmaraju, for the kind introduction. I’m Sankalp Arora. I’m a third-year fellow in hem onc at MD Anderson, and I’ll be moving to Huntsman Cancer Institute in Salt Lake City for a faculty position starting July 1st. So, I think my big contribution to this panel today would be my experience trying to navigate changing cities because we will be ending fellowship at the end of June and beginning my job starting July 1st. So, trying to get all of those things straight, trying to wrap up existing work at MD Anderson and also make my mental transition, you know, make sense, changing from a fellow to a faculty, changing that mindset. So, I’ll be going over those topics.

Naveen Pemmaraju:

Okay. And Aditi, do you want to introduce yourself?

Aditi Pemmaraju:

Hi, everyone. I’m Aditi Pemmaraju. I am Naveen’s wife. I’m also a mom of two daughters. One is in college, one is in high school. Before I became a physician relocation specialist, I was an attorney and took a break and found my calling really to serve the medical community and finding not just their home, but their community here in Houston. That is very, very important to me. Having moved around various places for Naveen’s training, having to start over, figuring it out all by myself. So if I can help you guys just avoid the mistakes that I made, then I will have done my job.

Naveen Pemmaraju:

Amazing. This is a, this is already a fun panel. I think a lot of our viewers are going to get a lot of this. So we’ll start with Dr. JMP, Dr. Marvin-Peek. You know, how do you do it? I mean, you, I’ve gotten to know you so well over three years, new mom, as you just told us, chief fellow, what’s going through your mind now as you start faculty in a very rigorous profession or leukemia profession, what is your reflections and what’s your tips for people who are watching this out there? Maybe med students, maybe residents, JMP, maybe fellows like you.

Aditi Pemmaraju:

Maybe even me. I’m sitting here watching. I am in awe. Seriously, you’re my hero. Let me learn.

Jennifer Marvin-Peek:

You guys are too kind. And I really, I don’t think it’s, it’s definitely not easy. I think I, in the last three and a half months, have had so much respect, honestly, for anyone who has been a mom and tried to navigate it with having a career like yourself, Aditi. And it’s a difficult thing. And what I’ve found myself really doing a lot in the last three and a half months is figuring out how to prioritize time. And I think time is really truly our most limited resource that we have. And I think you really have to look within yourself and figure out what is most important to you and how are you going to divide up your time that reflects those things that matter to you. And so there is, you know, a certain amount of time that I want to spend at work, working on things at work, but it’s also then prioritizing saying, hey, when I get home from 5 p.m. to 7 p.m., this is the time that I am spending with my son. And that, you know, I want to make sure that I’m the one giving him that bottle before bed, that I get to read that book to him before bed and just saying, look, I’m not working from this period of time. And then at the same time, setting aside time for myself. So I like to run outside of doing work and outside of being a mom. And the only time that I can run is at 4:30 in the morning. And so it’s really just saying, look, that’s how I want to spend my time and setting an alarm and really doing it. And I think each person has to really look internally and say, look, I have a limited amount of time, a finite amount. How do I want to spend it? And then you kind of make that decision or, you know, for yourself and your happiness. And it can change over time, too. I think that’s the other important thing. You know, you set your priorities at some point in time. And a couple of years later, you could have another kid or you could have another grant or something coming up. And you have to kind of reprioritize things and make sure that your time reflects your wishes and your goals in life.

Aditi Pemmaraju:

That’s so powerful. What you referred to just now as the different seasons of life as not only a career professional, but having a family, having your own personal priorities. Yes, absolutely. That is going to change. And I think just being open to that change is, is what’s going to set you apart.

Naveen Pemmaraju:

Wow, guys. Sankalp as you joined the conversation, you know, you and I’ve talked about this before, how to, how to prevent burnout, maybe to have parallel pursuit. You and I were at a meeting conference together recently where that was the topic. You kind of impressed me and everybody else. Maybe if you want to share that, I feel like you have this great overall perspective on life. Maybe if you want to share with folks, what are things you do, exercise, other activities, not just to prevent burnout, but as you guys are saying, to manage your time so that you can thrive. Sankalp, what are your thoughts there?

Sankalp Arora:

Yeah, thank you, Dr. Pemmaraju. So yeah, agreeing with Jen, I think we are all very ambitious to be here. And especially in academia, we all have goals. There are things we want to be achieving. And of course, we should go after those. But I think we should not set everything. We should not give meaning to only our work and only our research or only our clinical duties. We have to set time aside for other things that we enjoy so that there are other things that you enjoy apart from just doing work. And I think that’s very important because, you know, as you know, a lot of times projects may not pan out. You might have depressing days in the clinic or some sad encounters in the clinic. You need something else to regenerate you and so that you can come back the next day and go back to work with the same energy that you had before. And for me personally, I got into exercising and going to the gym and I set goals for myself there as well. But those are different goals and those are different things to aspire to. And I think that helps create a balance and helps distract me when I need to be distracted from bad days at work or things that didn’t go right so that you always have something else that you’re focusing on. And as Jen pointed out, these things can change. You have different priorities for different times. Like right now when I’m finishing fellowship, my focus is purely, you know, to wrap up the existing projects and focus on my move and make sure that my transition over to a new job in a new city goes on peacefully. Right now, the other things that I have are in the backseat of my mind. So, you can always fluctuate in terms of what your priorities are, but always take time for yourself and other activities apart from just work. Do not let your work and your research, however accomplished you are, do not let that define you. Always have something else that you love and enjoy doing apart from work.

Naveen Pemmaraju:

Wow, guys. I hope we got all that on the recording because I myself got a lot out of what both of them said. And, you know, so in addition to your comments on burnout, as Dr. Aurora mentioned, he’s going to be moving soon. And so, Aditi, of course, for you, this is a calling of yours, which is to help physicians of any age, but particularly our younger colleagues. I personally was so stressed out during at least two of our moves that Aditi got us a place, what we call sight unseen. I never saw the place. I never saw the place because I was rounding. I was whatever. And so, it sounds crazy to tell anyone, but I don’t think anyone on this call was shocked to hear that, that the spouse scouted out the place and said, trust me, you’re going to like it. You don’t have time anyway. And we didn’t have money, by the way, to be traveling. So, what is your take? You can take Sankalp’s case, someone in front of you right now. But what are some tips that you think us as busy, stressed out, tired doctors, we missed all of these modules in medical school. Oh, by the way, there weren’t modules, as you know. Yeah. Give us three to five tips on physician relocation. What do you think people should be looking up for?

Aditi Pemmaraju:

Yeah, that’s such a great question. So, yeah, there were no modules. This is all learned through the school of hard knocks and experience. I would say, you know, just ask for help and find somebody who has lived this. You know, there are many wonderful professionals out there who can help you find a place to stay. But I think there’s something to be said to work with a person who has gone through this experience, who knows what it’s like to work with physician timelines, who can manage your search on a remote basis. I’ve done, I don’t even know how many, you know, FaceTime tours. Um, I’ve had several, several clients who have bought remotely, um, and thankfully they’re all happy with their place. So, I would say, you know, take the time to find that person that’s, that’s gone through this. And then also know that where you end up right after you’re done with training, that doesn’t have to be your dream home. Give yourself some time to find a place. Maybe you’re there for three to five years. Build equity, see how the job is, if it’s the right fit. And then, you know, decide if you’re going to set down roots or if you’re going to find the next opportunity. So don’t rush into buying because I think we have in medicine this feeling of delayed gratification. Like everybody else that isn’t in medicine, they’ve already bought their homes. Everybody’s done this, that, and the other. So, but we’re in a different timeline and that’s okay.

Naveen Pemmaraju:

Yeah. And you mentioned something also I wanted to make sure to highlight is community. That’s something that you’re passionate about. You’re not just trying to find a house for people. You’re trying to find a home and a community. I think that’s very important. So, if we can wrap in those two things, prevention of burnout, thriving, time management, and finding a community and finding an activity or a hobby or a group of people outside of cancer and cancer medicine, this is about sustainability. That’s what we’re talking about. We want to be able to help people at their most difficult times. As they say on every airplane you board, put the thing on you first so that you can help the person next to you. Okay. I just came up with that. So hopefully the VJHemOnc team will like that.

Aditi Pemmaraju:

I think community is part of that. Community and then your parallel pursuit.

Naveen Pemmaraju:

And now to tie into our third topic, back to JMP, it’s about career. So we talked about burnout. We talked about relocation. Now we’ve got to talk about career. Both of you, because you’re both too modest. For the viewers out there, two of our superstar fellows over the past 20 years that I’ve been here at the MD Anderson, both choosing academic professions. Jen, first to you, what are some things that you want to offer, both from your chief fellow perspective and also finalizing on the academic job? If you want to riff a little bit on that, what was your thought process? Private practice, community hybrid versus academic, staying in Houston versus moving, and maybe subspecializing versus something else. What are your tips out there for folks, Jen?

Jennifer Marvin-Peek:

Yeah. You know, I think for me, a lot of it comes down to what I enjoy spending my time doing. And some of it is I love almost everything that I do. Right. And I feel like that’s somewhat what an academic position kind of ends up being. You still get the ability to have your own patients, see your own patients, but I also really enjoy being able to, you know, get involved in research and be able to potentially, you know, lead my own clinical trials, hopefully going forward. And for me, you know, I think I never really considered private practice just because I loved that inquiry and that research ability too much. And that’s where I think academia has that benefit because you really get the best of both worlds in some sort of way. And I want a job that I look forward to every day and that challenges me and that is different every day that I’m there. And so I think for me, I always wanted a job in academia. And in terms of kind of, you know, relocating and staying in Houston, I knew very early on that I wanted to stay. Some of that is my husband and I have loved Houston. And some of that is, you know, my husband’s also still in training. But I think regardless of that, the leukemia department has been very warm and very welcoming. It is, you know, one of the best places to train. And I am honored that I am able to be faculty and still get to learn from, from everyone in the department. And so I just, I just feel very lucky with it, and I wouldn’t have wanted anything else. So.

Naveen Pemmaraju:

And then, as we turn to Sankalp, you know, you just, both of you actually gave beautiful presentations in a recent meeting that we were in, oral presentations. Sankalp, how do you balance doing RUX-AZA for MPN with the stress of relocating to Salt Lake City, Utah, a place that I don’t think that you had a chance to spend much time in? It’s a dream place for a job. With Aditi here, what are the kind of two, three, four questions, stresses that you have as a busy physician researcher about to start a busy job? Let’s put it out there and let’s, let’s get some free advice from her right now. So, what are, what are three or four questions? Cause you, you and I know what the questions you have, what every doctor person has, what are things you wish we knew that we don’t know? What should we ask her, Sankalp?

Sankalp Arora:

I think, first off to Aditi’s advice, I think that it was spot on. I think initially the first time when I was looking up places in Salt Lake City, people were like, oh, are you buying? What house are you buying? When are you buying? And that was the big thing that, you know, I think which I’ve heard from some other people as well is that, no, you don’t have to rush into buying stuff in a new city when you don’t know much about the good neighborhoods. You don’t know what kind of neighborhood you would like to stay in. You have to be there for some time to see where your community is and where you would actually. And at the same time, you will get a sense of how the market is and then buy it accordingly. So I think that was spot on advice. And that’s why we have decided to rent essentially an apartment initially. And similar to Aditi’s point again, we graciously, there was one of the coordinators at the leukemia department there who is actually going to apartment tours on our behalf and sending us photos and giving us like live updates. And that’s again, very helpful to have someone do the legwork for you that really helps you figure out what do you like, what you don’t like. But I think there are still some questions in terms of, you know, is the neighborhood going to be too loud? Will we have, you know, a chance to, you know, like it needs to be in a good neighborhood where you can explore the city, but at the same time, it should not be full of college students where you can’t sleep and get to work tomorrow in time. So, a lot of these things, but I feel like I have initially when I came from India, when I moved to Birmingham at UAB at that time, I didn’t even have a chance to look at the apartment complex inside. Like I literally was sitting in India. I looked up apartments around UAB. I saw the ratings were decent enough and I just booked, we signed lease and we were there for a year before moving somewhere else. So, this is a much better chance compared to before that at least I can know what I’m like, what I’m looking into and what I’m getting. And I think as we said, you know, it’s your first job is not your last job, and your first department is not your last department similarly. So, I think doing that and just adapting to whatever we experienced there.

Aditi Pemmaraju:

Exactly. I think that’s a great point. And a year, as you all know, in training, a year goes by very fast. So, I wouldn’t rush to unpack those boxes in your rental. We actually still have boxes.

Naveen Pemmaraju:

We still have boxes. That’s really funny. And so, you know, to both of your points, both of them, I know this is speaking to your heart. So, as you both know, and both of you have supported Aditi in this, you started Homes for Healers exactly for this reason, which is how many moves have we done? Do we count five, seven moves?

Aditi Pemmaraju:

Yeah, I don’t know a lot. Several cross country and then a few within Houston.

Naveen Pemmaraju:

All of those moves Aditi did on her own. Obviously at that point, she was not yet a real estate agent. So, she felt called into doing it. But what I admire about this Homes for Healers, if you want to talk about it is you’re within a, you’re within a traditional real estate practice, as one would expect, but you have your own trademark, your own LLC. Why don’t you tell the viewers, how did you come up with that name, motto? What does it mean for early career people? How should they find you? What is that about?

Aditi Pemmaraju:

Yeah, so really just from helping Naveen and managing those moves. And like I said, got a few things right. I made a few boneheaded errors along the way. And so really it’s just my way of giving back to the medical community that has given our family so much. And also supporting any partners or spouses that are, and other family members that are along for the ride, if you will. Because I know what it’s like to be in a new city, not know anybody, to figure it all out. And so, if I can connect an incoming family, whether it’s a mom or a dad or, you know, a single person with, if they need preschools, if they need a connection to a parent at the school, if it’s a connection to other professionals in their fields. That’s the kind of legwork that I want to do, because I experienced not knowing anybody and having or I should say, struggling to find my footing in my career. And I don’t want anyone to ever go through that.

Naveen Pemmaraju:

Excellent. And as we go back to JMP, you know, as a chief fellow, I remember you guys hosted Aditi for a lecture, essentially, in the Academic Tuesday. This was considered to be revolutionary. And I think a lot of people will be copying it. So, Jen, if you want to comment on that, what was that like to host her in the academic Tuesday modules for fellows education to finally get some learning about this stuff? What’d you think about that?

Jennifer Marvin-Peek:

I mean, I think it was something that was needed because kind of, as you mentioned before, you know, we’re, we’re so used to this delayed gratification. Most of us haven’t bought houses. You know, we’ve never had to look for houses. We have no idea what we’re doing. A lot of people, a lot of us are getting ready to leave and move to new places, not myself, but you know, Sankalp and others. And it’s so, there’s so many things that you just don’t know about it. You don’t know when you go to a new house, like what things am I supposed to be looking for? Am I supposed to turn on every faucet? Am I supposed to like, do I have to do an inspection? They’re just, you know, all the whole process of buying a house is just, you know, mortgage. How does that work? There are just so many things we don’t know. And I think what’s so particularly wonderful about Homes for Healers is it’s geared towards people like us who have never done it before, perhaps at an age where people might have thought that we would have done it before and known these things. And then also just so understanding to the fact that we don’t have the time to spend learning how to do it properly. We don’t have the time to necessarily look through the house on our own five times. And we were in a circumstance that a lot of people just don’t understand. And so, your experience Aditi is just so invaluable to us. And so it was, I thought it was a wonderful kind of talk and just introduction to, to the world of real estate. And we would obviously love to have you back again.

Aditi Pemmaraju:

And I was very grateful for the opportunity. So, thank you for inviting me to be a part of that.

Naveen Pemmaraju:

That’s awesome. And Sankalp, as we think about it, it should extend into other things too. Now that you guys are mentioning it, it’s within the scope of this interview. Why don’t we learn about things like basic finances? So, stocks 101, retirement 101, you know, so all of these things, these life skills, and you’re right. I have friends and people may be seeing this, you know, who are in the business world. All of our friends who are in the non-medical fields in their early to mid-20s are already solidifying that. We don’t even start the attending career until the mid-thirties for many of us or even older. So Sankalp, I don’t know, I just wanted to get you to brainstorm. What else would you like to see in a medical curriculum, whether it’s in the medical school or I actually think residency and fellowship when you’re about to, you’re starting to make money for the first time. What else are like life practical skills? What else?

Sankalp Arora:

I think money management is essentially something that needs to be taught more. I think all of us, as you pointed out, residency and fellowship is essentially a stipend. So, we just don’t think about, you know, investing beyond like retirement, maybe some 401k, that’s it. And we kept on pushing it. Like my mom does a lot. She’s a doctor back home in India, but she also does a lot of financial stuff. And she every time I call her, she’s like, oh, have you thought of financial investments? And I’m like, I don’t have money to invest right now. But she’s like, what about after six months? Like, what are you going to do with the attending money? Have you thought about it? You need to save, you need to invest. And I’m like, I don’t know, we’ll figure it out when we get there. So, I feel like a lot of us at this new attending, new faculty stage struggle with that unless, you know, there are family members who are very savvy in the financial setting where we don’t know initially what to do with the increased money that comes in once you start faculty. And I think having lectures, especially geared towards that to make sure that one, we invest wisely and two, we don’t fall into like the hands of scammers or the wrong people who might just try to take advantage of them.

Naveen Pemmaraju:

Yeah, I wanted to carry that discussion a bit further. You know, as I think about medical education and curriculum, we’ve had to innovate a few times. COVID-19 was one time we had to innovate. Even an interview like this, we were not using Zoom before the pandemic readily. So, I think as medical education innovates, and as you guys know, I have some stake in the game with med ed, which I care about as I know both of you do. Maybe on this interview, let’s put it out there. Why not have modules on AI? So artificial intelligence, not just at the high level. Yes, we need to be doing alpha-fold protein technology for the next molecule and research data sets, but just practical things like, should I do Claude or should I do Claude Pro? And if I do Claude Pro, I’m going to spend $200 a year. What exactly am I doing with that in my day-to-day? Is it because I’m planning national park trip for my family, which we’ve done before? Very nice. Or is it that I can do something practical? And someone to actually show people another passionary of mine, social media, what Sankalp just said is important, not just how to use it, but what are the pitfalls? Hey, if I post something incorrect on social media that could have repercussions, how do I retract it? How do I take it back? How do I do all these things? So artificial intelligence, social media, investing in stocks, one-on-one retirement, one-on-one. Guys, if you don’t mind me putting out there partner or spousal relationship advice, you know, some of these kinds of things, like what is it like to be a medical spouse? These are things that I wonder, maybe this is too revolutionary for what I’m talking about, but as we evolve in our medical education, we have so much time where we’re in front of computers. I just wanted to put out there, Dr. Jen, I don’t know, what are your thoughts? I just wonder, can we extend med ed curriculum into the real life practical as we’re learning about all these other things.

Jennifer Marvin-Peek:

Yeah, I think we absolutely should and I also love that you know some of these things you know there tends to be a delay in between new things coming and then us actually adopting them in medicine and I think one of the nice things is we really should just, we should start doing that earlier, right? And so, if we start talking about AI now, how can we integrate AI into not only our work lives, but also our home lives? How can we use that to help us? How should we today and now be thinking about investing, you know, before we actually get to the point where we have the money to do it? How should we be thinking about disability insurance before all of those rates go up? And I think these are the things that we need to do earlier rather than later and incorporating them before we’re kind of doing it too late on the back end. So I think these are all things that we should be talking about and talking about how to how to help our lives be easier because you know we have busy difficult lives and anything we could do to make that a little easier a little more efficient will help all of us.

Naveen Pemmaraju:

That’s awesome and let’s put a plea in and a call out there you know to normalize talking about difficult and stressful issues mental health issues previously has been a great stigma in our own medical profession. Even us bringing it up here is a difficult thing for many people to hear. But maybe thinking of doctors as people too, as people in marriages and relationships. And if we can aim to try to sustain each hem onc provider as a person who’s a member of their community, a member of their family, a member of their relationships, a member of their friendships, rather than it being this lonely quest where you leave all those behind, can we start to integrate that? Sankalp, I wanted to hear your kind of thoughts on that. How does one make sure to maintain their friendships and relationships despite, and you said it so beautifully earlier, some difficult days that we have as oncologists. What is your take on that, Sankalp?

Sankalp Arora:

Yeah, I think to your point about mental health in general, it’s very important to normalize that not just mental health issues, but even just day-to-day sadness or disappointments in things that is common and it happens and it should be normalized that this is something that’s expected sometimes, especially the kind of jobs that we do and everybody should have a support system to lean on and share things with. It can be a partner, it can be a parent, it can be a colleague, but everybody I feel like should identify a group of people who they feel comfortable sharing everything with, who they know would be a safe space and they would not be judged to do that. I think that’s, and that basically plugs you into having, maintaining your relationships with everybody, with your friends, with, you know, your partners, with everyone, so that you always have something to, you know, fall back on. You know, it can just be a simple thing like a pickleball group every weekend where, you know, just you play pickleball and talk about things. So, it doesn’t have to always be in a mental health therapist’s office, which is great. Like, you know, if you need it, it’s an excellent thing. And just being a doctor should not discourage you from that but it doesn’t always just have to be directly with a psychiatrist even with your friends you know sharing things that you feel and they normalizing your feelings you normalizing their feelings that can make the society much more like mentally healthy than the way it is currently is.

Naveen Pemmaraju:

Amazing and speaking my support system I have mine right here that all of you know. And as Sankalp said, some of the folks who follow me on social media know that I have a basketball game that everyone’s invited to every Saturday, which has resulted in me making lifelong friends and camaraderie. So, Aditi, to you, so speaking of support system and community, again, this is a theme of today’s very novel kind of interesting discussion that we’re having. You know, one thing that you have helped me and our family on the most is what I call the practical tragedies of life. They happen to everybody. They happen anytime. And you have just been a wizard at that. With your new calling, with physician relocation, finding people homes, one of those that is the bane of almost every doctor’s existence is that of home repairs, home maintenance, setting aside money for said AC, which will always cost $10,000 in the middle of summer. In July. In July. Car breaking.

Jennifer Marvin-Peek:

Happened twice to me.

Naveen Pemmaraju:

See, there you go, right? So, for everyone out there, none of these things are theoretical. In Houston, New Orleans, places where we’ve lived most of our lives, flood, flood insurance. I don’t know how you’re going to do this in one minute, but you’ve done this for our family for 25 years. What are some just practical tips? I know you have these tips. Walk us through. You have like, that’s part of your thing where you, I don’t know. I don’t know how you want to comment on this, but basically there’s a recipe of things that you should be planning, setting aside money, maintenance and repairs. As you remind me, that’s part of life. What, what does a busy doctor do? Who’s in the start of a 12-hour call and gets that call that a pipe is burst at their house?

Aditi Pemmaraju:

Yeah. Well, okay. In that specific case, know where your water shut off is, for sure. So, I would say, you know, when you guys decide to take the leap and, and have a home of your own, walk through it with your inspector, have them show you, okay, where is your water shut off? Where is your circuit breaker? Just basic things like that. Then as far as you already alluded to the, you know, home maintenance fund, it’s not fun. Nobody wants to do it. Nobody wants to, you know, repair their windows and their wires, but you guys are all in the medical profession and you know, we’re preventative care, how important that is. Home maintenance is your preventative care.

Naveen Pemmaraju:

Wow. That’s a new one. And you, what do you call it? Adulting. She calls it adulting. When I complain about, wow, we got to fix the air conditioner or the house. So, do you recommend for early career folks, maybe even setting aside money once a month, like as a home maintenance fund?

Aditi Pemmaraju:

Even just starting off with a hundred dollars a month, just so that when that bill comes, it’s not, you’re not freaking out about how you’re going to pay for it. And then automate that.

Naveen Pemmaraju:

Another tactic you’ve had, and maybe both of you guys can comment, it’s when you move to a different location, it’s good to start figuring out having a team, right? This is something you name in. So obviously, having a plumber, having a go-to handy person, having all of those things. Now, by the way, that can take years. And then in Sankalp’s case, you’re moving. But I think that’s something that you believe in. I don’t know if you want to comment on that. Some of it’s word of mouth.

Aditi Pemmaraju:

Yeah. Yeah. So, I mean, hopefully the person that’s helping you find your place. Well, if you’re in an apartment, you won’t need to worry about that. But, you know, just having that list for, you know, your realtor. That’s something I try to provide my incoming clients is a handyman and referrals from relationships that I’ve built over the years. I have met these people. And if they don’t do a good job, then they’re out. So yeah, just going from word of mouth, that really helps.

Naveen Pemmaraju:

Yeah, a lot of stress for us as physicians, guys, and correct me if I’m wrong, it is what we’re talking about here. It is that, as Jen said, we have sort of this delayed life experience where we’re not experiencing basic stuff until our mid-30s. So, there’s a little bit of a stress that, oh, so you’re a doctor, you’re good at xyz, but you’re telling me you don’t know how to call a plumber. Yes, that’s exactly what I’m telling you. Then you call said person and the said activity doesn’t go the way it wants to, or the bill is way higher than you want to. We don’t have a reference range for if that’s real or not so Sankalp as you mentioned I don’t know if I’m getting scammed or not and then finally we just don’t even know who to call like even if you look up on online, yelp, google okay I don’t actually know there’s all these choices so I thought that was important what you said and then maybe as we go back to Jen as we think about this, so we are good at assembling teams in the hospital, right? Inpatient rounds, clinic team, research team, systemic mastocytosis team. But why are we not so good at what I call practical teams? So, for example, now the next thing we’re going to talk about is food. What are we, what are we doing as physicians? We’re giving advice to people all day, how to be healthy, presumably cancer. But then when we get home at six, six 30, seven, now we’re ordering takeout fast food.

Aditi Pemmaraju:

That might just be us.

Naveen Pemmaraju:

This is a very personal, we’re putting it all out there here. So now as we go to Jen and Sankalp, our younger colleagues, I want to talk about why are we not teaching people how to do three things? Fine, cooking is one thing. Food assembly is another. Why are we not subsidizing as hospital systems food delivery or at least the ingredients to that? Why aren’t we talking about nutrition for the doctors? Jen, what I’m asking you is who heals the healer?

Jennifer Marvin-Peek:

Well, I think definitely a question that’s for people higher up than me as to why the hospital does not give us food when we are at home. I would love that, of course. But, you know, getting to the question, you know, who heals the healer and, you know, how do we take care of ourselves, both physically as well as emotionally, you know, with our jobs. I think for me, it’s really, as you guys mentioned earlier, it’s really the community of people that support you. You need to surround yourself with people that you know are going to support you through your worst days and also celebrate your wins as well. You know, not every day. I do not come home every day bright and cheery. And I can definitely absolutely say that, but you need someone at home who, if you’re super tired, you don’t want to make food. It’s going to be, you’re like, I really want a home cooked meal. You know, maybe, maybe they’ll make you food that day. You just need someone who is going to listen to you, support you, you know, still love you, even if you’re grouchy that day. Um, and I think that’s, that’s the most important is just asking for help when you need it, surrounding yourself by people that love you and support you. And they’re, they’re the ones who get us through it.

Naveen Pemmaraju:

It resonated with me, Sankalp, as we go back to you, as you guys all know, everyone who knows me, I’m what they call 30 out of 30 extrovert. As you all know, I love people. It’s real. It’s not fake. But when I have those days, I call it an oncologist day at our house. You know, you have this decision-making fatigue where yes, I just made 177 mainly life and death decisions for folks. I just don’t want to decide where we’re going to order from. And I don’t necessarily want to talk to anyone. And maybe I just want to put on an old episode of West Wing and have some ice cream and call it a day. At first, I felt guilty about it, or I even made fun of it. Now I realize that’s my body’s way of asking for, let’s just take some rest here and let’s reset. Sankalp, you said, because now I need to help the next folks the next day. And it’s been one of the great sources of my success, if I may give it away, that after a long, busy, difficult day for hem onc, allow yourself space for recovery. LeBron James, Tom Brady, they do this. After a grueling playoff game, the first thing they do is ice bath, trainer, massage, whatever. It’s called recovery time. We never talk about it. But maybe a difficult inpatient day Sankalp, maybe a long clinic day, maybe a difficult research outcome. So maybe if people feel comfortable sharing, Sankalp what’s recovery time for you? Is it yoga? Is it meditation? Is it an extra gym session? What do you think about that?

Sankalp Arora:

Yeah, I think recovery time, as you said, it’s absolutely important. And I think in the long run, that’s what helps prevent burnout is when you’ve reset your mind and you’ve been able to actually do something. I think key thing for us is when we talk about recovery time it should truly be recovery time and it should not because I often was guilty of you know say I have done a full day of clinic and then I want to take a break but then oh I just got some drafts or a paper back from one of my attendings and okay let me just work on this this is not clinical work so it’s technically recovery, it’s not because you’re still stressing your brain out. You’re still doing this and you might not feel this in the short run, but in the long run, you will start seeing those effects and you would not, you need to be able to, as I said, wake up every morning, excited about the rest of your day. And for that, it’s important to rest. So, I think sleeping, I feel like can make a profound effect. Growing up and while studying for entrance exams, we were always told that six hours a night is enough. But I realized as I age, it is not. And sometimes I feel like it doesn’t always have to be going to the gym for an extra session, just taking a nap or watching a comfort TV show or a sitcom. I think that can help. Whatever recharges you, whatever lets your mind relax and not always be on that high internet mode, you should do that. And each person may have a different activity that helps them do that.

Naveen Pemmaraju:

What a great discussion. So, as we wrap up, I’m going to go to each of you for kind of your final closing thoughts. So Aditi, for you, you know, as you’ve helped guide our family and now others through your Homes for Healers, what are some, maybe some final closing thoughts that you want, maybe I’ll frame it, that you wish we had known about the house moving and relocation process? What are some tips you want to give to folks out there? What have you learned and what do you want people to know about?

Aditi Pemmaraju:

I think the biggest thing is that you’re not alone. There are people out there who really care. And it’s not about, it’s not about the transaction. We’re here to support you and develop a long-term relationship. I’ve become friends with some of my clients. They’ve invited me into their lives and I’m so grateful. Um, and I would say, you know, if there is a partner or a spouse, um, find that community, uh, and, and make a life of your own outside of your person in medicine. I think that’s really, really important.

Naveen Pemmaraju:

That’s awesome. And to JMP and Sankalp for your guys’ final closing thoughts, maybe if you want to focus on what we talked about here, this concept of burnout, career transition, what tips do you have, maybe each of you, as someone’s leaving their internal medicine residency and about to start hem onc Fellowship this July 1? Jen, if you want to start and then Sankalp to close.

Jennifer Marvin-Peek:

Yeah. So, I feel like we’ve spent a lot of time this episode talking about work and life. And I personally, am someone who hates the term work-life balance. I don’t think it’s a great term. And the reason that I hate it is I think it implies that one is good, like life is good and work is bad. But I think the reality is, is that there can be hard and good times in both, right? There can be times in which life is really hard. You know, you have a sick pet, you have a sick family member, you’re trying to navigate buying a new home, you’re, you know, your air conditioner breaks in the middle of July. And there can be times when work is really hard, you have a grant deadline, you’re trying to get something in, but there can also be times when both bring you a lot of joy. You know, at work, you’re super excited. You, you know, your clinical trial worked or you had a patient that you were able to help get through their terrible cancer or, you know, in life you have a baby, you know, things like that. And I think that it’s just important to make sure that you’re spending time on things that bring you joy, whether that is work, whether that is life. There are going to be times that are going to be really hard, but relying on your people to get you through it and focusing on the things that bring you happiness and allocate your time accordingly. I think that’s just the most important.

Naveen Pemmaraju:

Wonderful. And Sankalp, your closing thoughts?

Sankalp Arora:

Yeah, I think for me, I would use one sentence saying essentially give yourself grace. I think we, especially moving into a hem onc Fellowship and trying to build up a research portfolio, trying to build up an academic career, trying to do the best for our patients, we expect a lot from ourselves. And every day we wake up trying to push beyond what we’ve already been doing. But there are times where, you know, things might be bad or things, you know, might be difficult. You might have a difficult rotation. You might have a difficult patient encounter. Things might happen. And at that time, it’s okay to sit back, relax for a bit and give yourself grace that, okay, no, I’ve been doing my best. This time, you know, maybe I did not get this grant or maybe this did not work out, but it doesn’t mean that, you know, it’s not a reflection on me. It’s just one thing that I’m going to encounter a thousand such things in my career. And okay, if this did not work out, that’s fine. There’s always something else to look forward to. I think that’s very important. And knowing when it’s time to take a pause, take a break, and recharge yourself before the next challenge that you take on.

Naveen Pemmaraju:

I think it’s wonderful. And, you know, my closing thoughts are, as you guys know, I trained at Johns Hopkins for my internal medicine, and I learned quite a bit from the Oslerian teaching. And one of Osler’s most famous phrases was aequanimitas, which is what I’m thinking of in this kind of really lovely conversation we had, kind of first of its kind I’ve ever been a part of. And so aequanimitas was a watchword. He derived it from Marcus Aurelius and the Stoics, which refers to equanimity. So, equanimity under all circumstances. It’s not a detached calmness, as has sometimes been mistaken. But what he said is basically, you know, situation, space, and you. So, whether it’s a difficult patient situation, so, you know, terminal cancer case that you’re not able to turn around, a difficult situation at work, a difficult research thing, can there be a little bit of a space in between you and the situation? Because you both need to be able to feel and understand what happened here. But if you dwell on it to the point where it distracts or disturbs you from the next 20 things you need to do, then you’re not going to be effective for those next 20 people or those next 20 items. So there has to be a way to not be either detached or so invested that you can. So aequanimitas, equanimity, calmness under all circumstances, but still realizing and understanding what’s going on. So that’s what this makes me realize. I think as we close this session, we talked about some heavy topics. I think if folks get a chance to really watch this, we’d love to hear your feedback on it. But what we wanted to do here in this first of its kind session is to bring up two or three topics of great interest to the early career physician as they make the transition from training to attending. We talked about really difficult topics such as burnout and work-life, not balance, but work-life coexistence, as Dr. Jen is reminding us, career transitions, and of course with Aditi, the scary, quite frankly, difficult physician home relocation. So anyway, so I want to close by saying thank you all for your time, your energy, Take care of yourselves and each other. And we’ll see you next time. Bye, everybody.