Pearls and Pitfalls for Early Career Physiatrists

By Chris Cherian, MD

Dena Abdelshahed, M.D. is a an Assistant Attending Physiatrist at the Hospital for Special Surgery (HSS) in New York, NY and Assistant Professor of Clinical Rehabilitation Medicine at Weill Cornell Medical College. At HSS, she is Associate Director of Education for the physiatry department. Prior to pursuing her fellowship, Dr. Abdelshahed was a resident at Rutgers New Jersey Medical School/Kessler Institute for Rehabilitation, including serving as the Academic Chief Resident in her final year. Dr. Abdelshahed completed the Spine and Sports Medicine fellowship at HSS this past July of 2018. I sat down with her to discuss her transition from fellowship to attending, including pearls and pitfalls for early career physiatrists.

Dr. Abdelshahed, thank you for taking the time out of your busy schedule to answer a few questions about your recent transition from fellow to an attending. How has your first few months been as a new attending?

“It’s definitely my pleasure to talk about my experience. It has been at a lot of fun and challenging in different ways. At the end of fellowship, you feel relatively prepared in terms of your medical knowledge, but the real world it is just a little bit different so it definitely took some getting used to it. While training, I had an attending physician in the room with me when I was doing a procedure or to turn to when I had a tough case and had to figure out the diagnosis. However, now as a practicing attending, you have to learn to trust your clinical acumen. But probably the aspect that you have to get used to the most is the behind the scenes work that you’re sort of spared from in all of your medical training in residency and fellowship. There is so much that goes on from coordinating care for your patients, getting them in to see a specialist, or getting an MRI authorized, or even figuring out the type of procedure and scheduling, all those aspects of practice just take a little bit of getting used to. However, once you do you kind of hit your stride, it starts to feel like everything that we already know how to do.”

What are some unique aspects of the transition that you did not expect?

“Sometimes the most challenging aspect can be knowing what the right course of action is for a patient, but having some sort of obstacle in your way, such as getting insurance to approve the treatment you propose that you believe will benefit the patient.

“For example, I recently had a patient that had history and physical exam findings such as weakness and a diminished reflex consistent with a lumbar radiculopathy which I documented in my notes. I ordered an MRI of the lumbar spine and it was rejected. I called the insurance company and eventually completed a peer to peer to advocate on the behalf of my patient. The person representing the insurance company explained that because I didn’t document a change in sensation, it didn’t meet their arbitrary criteria to approve the MRI. I then had to explain to the individual what my clinical reasoning was and why the lack of changes in sensation didn’t mean it wasn’t a radiculopathy, especially when all these other signs point in the direction of that diagnosis. So from my perspective, coming to a diagnosis that was so clear and obvious to me, but having to explain that and sort of go that extra step helped me realize that sometimes even simple things can become difficult and they just take extra time or extra effort.”

During your training, were you provided with any lectures or guidance to help with the transition?

“Definitely. I think some of the most important things I learned aside from all the medical knowledge is learning to find the correct mentors and also learning how to be a good mentor. One important part to realize is it’s not as perhaps intuitive as you might think. Especially if you’re someone interested in working in academics and being involved in residency or fellowship training, learning to be a good mentor is a skill. I had some lectures on that and luckily in my fellowship, we had some sort of formal and informal lectures on that topic. It really is an part of transitioning from a trainee to a full-fledged attending. Also, during my fellowship training, I was exposed to formal didactics aimed at learning about coding and billing, about starting a practice, contrasting academics versus private practice, and various medical legal topics those are very important aspects of medicine that you sometimes forget about but can be just as important as the medical knowledge that you gain during your training.”

What advice would you offer to a person finishing up fellowship or residency, that in retrospect, would’ve helped with the transition?

“Probably the biggest advice is identifying good mentors that will give you honest advice whether that’s about what job you should take, what’s fair compensation, or somebody that you can text/call/email with a clinical question when you just need that sort of back up. So I’ve been very lucky in having those are sort of mentors. Also, something that can be helpful is to identify someone that you’ve come across in training that you can also serve as a mentor for. Someone that you know their work from your interactions, that you can provide that sort of real world and clinical advice. I also feel that one thing that we may not have so much experience with until you transition is negotiating a contract. It’s sort of nerve wracking and certainly for me it was the first job contract that I had negotiated; it can be awkward as well as challenging. I realized that you should not be afraid to ask for certain perks or equipment you may be interested in. Really the worst that can happen is they say no and that’s okay! So identifying the things that are important to you and not being afraid to advocate for yourself is really important. No job will be perfect, but you should strive to be happy and I definitely am very happy where I am now. However, you never know where you’ll be in five or ten years so you should really think about what’s important to you, what your goals are, where you see yourself in the future, and then be your own advocate.”

Chris Cherian, M.D. is a PGY-4, Chief Resident in the Department of Physical Medicine and Rehabilitation at Rutgers New Jersey Medical School/Kessler as well as the Advancement Representative on the AAP’s Resident-Fellow Council.