The 24/7 Baby Doctor

By Victoria McEvoy, M.D.

Losing the Contest but Winning the “War”

Dr. Julie Silver’s annual writing course (www.HarvardWriters.com) had me at “hello.”

Rarely do I enjoy sitting through a conference, but I was transfixed with the nuts and bolts presented about how to get a book published for all the physician-writers. The course was packed. The participants were invited to enter a contest: offer a title and a brief synopsis of the book that you would like to write. The winner gets to meet with an agent and discuss the process. I lost.

However, several months later I was contacted by a member of the Harvard Medical Book Publishing Division who had seen my entry and was intrigued. With a little encouragement I was off and running on a multi-year odyssey to write a compelling book proposal that a real publisher would actually want to underwrite. There were lots of starts and stops—the usual discouragement and shock at the amount of time this project was consuming with no obvious reward in sight. And this was just the proposal; I could only imagine what the actual book writing would entail, should I ever get to that part.

We finally reached the “fish or cut bait” point. Dr. Silver said that I needed to partner with a professional writer who knew how to write a proposal that would pass muster. Enter Florence Isaacs, a New York writer who became my alter ego for the better part of a year. Once she pulled me over the finish line, we got an agent, found a publisher, and in May 2010 my book was published—The 24/7 Baby Doctor: a Harvard Pediatrician Answers All Your Questions From Birth to One Year. The book really does exist, and people have paid real money to purchase it—what a thrill! More importantly, new parents and grandmothers have told me how helpful the book has been to them.

The journey was long, painful, and hard but worth every minute. With the help of many knowledgeable journeymen and women along the way, we now have a book that sits on bookshelves in retail outlets, hospital gift shops, and homes of new parents. You can order it on Amazon.com where the author page completes the story.

Victoria McEvoy, M.D. is an Assistant in Pediatrics at Harvard Medical School and Chief of Pediatrics at Massachusetts General West Medical Group in Waltham, MA. She is a former columnist for The Boston Globe and has written for numerous publications including The New York Times.

Should You Invest Money In Your Writing Career?

Two things happened simultaneously today that made me think about whether doctors should invest not only time but also money into their writing careers.

The first thing was that a doctor who is a pretty good writer sent me an email and said that she didn't want to pay a freelance editor to work with her on her book proposal. This doctor wrote that she was willing to spend time on becoming a better writer, but she didn't think she should have to spend any money. 

The second thing that happened was the publicist for the Harvard CME Publishing course that I direct sent me an email asking for a few bullets about why a doctor should consider coming to the course. In both instances, working with a freelance editor and/or coming to a publishing course, means that you are spending not only valuable time but real dollars. Why do that? Isn't just spending the time to write enough? 

Sometimes it is enough to just spend the time. Some doctors are able to publish their novel, non-fiction book, magazine article, etc. without ever going to a course, attending a writing workshop, hiring a freelance editor, and so on. Anyone who successfully publishes must spend a significant amount of time on the writing, but not everyone has to financially invest in a "publishing education."

But many doctors have truly brilliant ideas that are not quite executed well enough to show the world just how terrific their book is. When this happens, and the rejections pile up (or the work isn't even submitted for fear of rejection), writing becomes a really frustrating process. Busy physicians often give up and don't publish what would almost certainly be wonderful books, articles and other materials. 

So, since I need to send the publicist a few bullets, let me jot down some thoughts here and see what you think. I'd say that a few of the top reasons why doctors might want to consider coming to the Harvard publishing course include:

1. You can meet editors, literary agents, publicists and other authors who can offer invaluable advice and connections that are impossible to come by without face-to-face contact. On-line communication is terrific, but nothing beats meeting someone, shaking his/her hand, and genuinely making a connection. Just ask Greg Bledsoe, MD, who founded this website with a colleague. I met Greg at a conference and decided to fit this blog into my busy schedule, because I had met him and really liked him. We connected. He's a real person who's smile I've seen and hand I've shaken.     

2. Creativity breeds creativity. Looking for your muse? You'll often find it when you bounce ideas off of other creative individuals. Sure, your wife, boyfriend, best friend and barber might all listen and offer encouragement, but getting input from outside sources and "vetting" your ideas can make them much stronger and better defined. Plus, it's really fun to hang out with doctors who like to write and talk about creative ideas. 

3. Publishing a book is a dream that many doctors have. But, there are some really phenomenal opportunities that involve publishing intellectual property in non-book form that we'll be discussing this year at the course. I'm working on that lecture now. I've gotten lots of great ideas from past course attendees who have done some amazing things that go beyond book publishing. I'll share lots of info about what they did and how they did it.

4. Finally, there's nothing that beats hearing from the pros what's really going on in publishing. It's a dynamic and fascinating world. The faculty tell it like it is.  They are encouraging and can save you a lot of aggravation and time. They can help pave the way for you to get where you want to go more quickly and effectively. 

I could certainly add more bullets, but what I'll end with is that I've taken my own advice. I've hired editors to work with me. I've gone to writing courses and workshops. Sure, I could have done it all alone, but I'm not sure I would have been able to do with my writing what I wanted to do.  My theme when I write is very focused on healing. If you want to see some of my publishing on healing, check out my website at www.JulieSilverMD.com. I didn't learn to become an award-winning writer in medical school. I earned my "writing degree" by working with pros who have taught me a lot. I am continually learning from publishing experts—I won't ever be "done." 

Whatever you want to do with your writing, consider whether a small financial investment will help you to be more successful more quickly. It just might...

Physicians & Lifestyle Design

In the last couple of posts we've discussed the idea of taking responsibility for yourself and "building your own ship" and we've also gone through a few common reasons why physicians aren't the best at career modification.

In this post, I'd like to spend a little time introducing you to the idea of "lifestyle design," something that has become a bit of a buzz-phrase in the business world but as far as I can tell hasn't penetrated the world of medicine just yet (for a lot of reasons).

I'll begin with a personal story...

When I jumped off the academic track in 2006, I wasn't exactly sure what I wanted to do as a career but I knew I wanted something unique.  My idea was to design a career that was flexible, fun, adventurous, and meaningful, all the while paying my bills and being a responsible spouse and parent.  Simple, huh?

I spent months thinking about how to do this as a physician.  I searched websites and blogs.  I spoke with mentors and colleagues.  I read the literature, all to no avail.  There seemed to be no conversation about a career like this in medicine.  I mean, there were a few articles about volunteer opportunities or non-traditional careers, but nothing really like what I was trying to create.  

What I found, though, was that while the medical community was silent about how to develop a very non-traditional and interesting career, the business world had already awakened to the idea.  Within the world of business, the idea of becoming a "free agent" and overhauling your career through "lifestyle design" was beginning to pick up steam. 

Around this time I picked up a copy of the book Free Agent Nation by Daniel Pink.  I'm not sure how I found this book, but it became a sort of manifesto for me.  In this book, Dan explains how more and more individuals were escaping their cubicles to become independent free-lancers and living their lives with increasing flexibility and empowerment.  It was a great read and it hit me at a very important time.  Through this book I realized that I was not alone in my desire for more autonomy, and that a lot of workers who had already yanked themselves off the grid were thriving.  I was hooked.

The second book I read was a book that has become a bit of a cult classic already, Timothy Ferriss' text, The 4-Hour Workweek .  This book is a basic introduction to how Tim built a stream of residual income and then used his extra time and money to explore his interests and live a more interesting life.  It was Tim's book that introduced me to the term "lifestyle design," and while the phrase might seem a bit hokey, it's a very powerful concept.  Basically, what Tim discusses in his book is the idea that it is possible to live an incredible life if you prioritize correctly, live frugally, and develop your entrepreneurial side.  Some have criticized the book recently, explaining that no productive person-- not even Tim Ferriss himself-- really only works four hours a week-- but I would argue that that's not really the point.  The catchy title sells books, but it's the mindset Tim describes that is the reason why the book is an important introduction for individuals who feel helplessly caught in a hamster wheel at work.  Tim's point is that you can-- through ingenuity and hard work-- leap off the hamster wheel and into something much better.

So how does all this apply to physicians?

Well, when you have a career discussion with most physicians, it often boils down to whether or not that individual wants to continue practicing clinical medicine or go into a nonclinical job.  There's nothing wrong with either, mind you, and I have friends who have great careers in each; however, for me and for many other physicians, I suspect, this approach is just too simplistic.

The fact is, I like clinical medicine.  I've spent a of of time getting good at what I do and I'd like to continue to be able to help people by providing good clinical care to patients who need it.  I also like many aspects of the nonclinical opportunities available to physicians-- things like consulting, writing, medical device development, and many other niches really appeal to me.

My main question is not whether I want to practice clinical medicine or jump into a nonclinical career, it's how do I design my life to be able to practice medicine, participate in the nonclinical activities I enjoy, and still have the flexibility to pursue life outside of medicine?  Discussions about clinical versus nonclinical are at their core too reductionistic for most modern physicians.  What most modern physicians really need to be having are overarching discussions about how to design a lifestyle that incorporates the multiple facets of their career interests and also does not overlook the ultimate (and most likely unspoken) goals they have for their lives. This is a much deeper conversation, but one that is desperately needed today in this time of significant upheaval in our healthcare system.

So where do you begin if you're a physician and you are interested in exploring this idea of "lifestyle design?"

Well, don't go to the career advice section of your specialty journal and certainly don't go to the HR person at your hospital or academic institution.  

In my opinion, you should begin by checking out the conversations going on in other fields.  There are some incredible websites built around some really creative and interesting people who are living fascinating lives and teaching others how to do the same.  Check out the following as a starting point:

• The Blog of Tim Ferriss: Experiments in Lifestyle Design
• The Art of Non-Conformity Blog
• Thrilling Heroics with Cody McKibben
• The Blog of Corbett Barr

Once you immerse yourself in this culture you begin to see possibilities that you never would have realized before.  What's more, as a physician there are even more possibilities available to you than for the typical person, if only you'll step out and take a little risk.

Over the last few years this idea of lifestyle design has been a focal point of my thinking when it comes to career moves and ultimate goals.  I've invested a lot of time, cash, and sweat into learning how to build a unique career, and my hope with Freelance MD is that we can use this website as a vehicle to help other physicians, just like you, succeed in designing a lifestyle and career they truly enjoy. 

Consumer Healthcare Is Getting Clearer All the Time

We're getting closer to the end of the yellow brick road.

The opaque veil over the US healthcare system is being drawn aside, and, like the Wizard of Oz at the end of the yellow brick road, reality appears.

Take cost transparency, for example. I serve on the Colorado All Payor Claims Data Advisory Commission (http://www.civhc.org) The idea is to create a data set of all health claims and make them public in an effort to provide pricing transparency to markets. 13 states have them, and several more, like Colorado, are in the process of forming them. http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2010/Sep/1439_Love_allpayer_claims_databases_ib_v2.pdf

Then check http://www.wipricepoint.org/ for a place to compare costs at Wisconsin provider locations. Want to  know how much you'll be charged for an ER visit in one place compared to another ?. No problem. Do you want it as a iPad application? No big deal.

OK. Now we have price information. What about quality comparisons? The US government is here and they are your friend. For quality comparisons, check www.healthcare.gov . Are you starting to see the pattern?

Finally, let's take healthcare information exchanges, combine quality data with cost data and , voila, we have a value equation. The final piece de resistance is to add international healthcare cost comparisons, like we do at www.medvoy.com , and there you have a picture that is becoming clearer and clearer with each and every day.

The new reality is that every bill you send and every thing you do will be sliced, diced, compared and parsed. Get used to it. It is never easy when you discover the Wizard of Oz is some dumpy short guy with glasses.

Physician Leadership In Industry

Physicians in industry must be strong leaders and team players.

Do you consider yourself a leader or a team player or both? To succeed in industry, physicians will need to be strong leaders—but also team players.

Physicians looking for non-clinical careers may find a good fit in the medical device or pharmaceutical industries.  Some will readily adapt to the technical aspects of their new role. Others may be thought leaders in their field—but could fail if they cannot work effectively in teams. Still others may not fit, if they can’t or won’t follow leaders with less clinical knowledge or experience.

The culture of a company will vary depending on what is valued. For instance, some companies are science-based. Applying the scientific method in all parts of the organization is expected and highly valued. Other companies are very competitive. They compete intensely against time, past performance and industry rivals to rapidly achieve quality results. While companies may differ in their core values, most get things done by working in teams. Teams move scientific breakthroughs from the lab through the clinic to the marketplace—and support other aspects of the business. 

Most companies believe diverse teams working together generate the best decisions for their patients, staff, and shareholders. Their team structure provides opportunities for staff to impact the direction of the organization, gain broader perspective about other functions within the company, and reach their full potential. 

So, what does this mean to a physician who is considering a career move to the medical device or pharmaceutical industries?  t means the physician must be able to demonstrate strong leadership skills—but also work effectively in teams. It means that they will not always be the leader, even if they are experts in the area. It means they will need to flexible, adaptive to change. 

Leading companies in the medical device and pharmaceutical industries continuously evaluate staff on their performance.  But this is not just about getting things done or getting results. Staff members are also evaluated on (1) how they achieve results in line with company values and (2) how effectively they demonstrate the company’s leadership attributes. 

As you consider career opportunities in industry, imagine how you might be evaluated against the expectations of your new role. How would others describe your performance?   What would you include in your self-assessment about team work?  Here are some statements of effective performance:

Team Leader

• Displays strong leadership in a team environment
• Builds a strong sense of teamwork and purpose
• Conveys a powerful influence in a team environment
• Promotes cooperative behavior and team efforts
• Excels in building teams for success

 Team Player

• Excels in developing team momentum, enthusiasm, and pride
• Resolves team conflicts with finesse
• Participates effectively in team efforts  
• Excels as a team player

What With All You ER Docs Starting Things?

Everywhere I look, there's another ER application.

When I'm at a cocktail party, one of the questions I get asked the most is , "What made you become an ENT doctor?" My thought is that medical students make their career decisions based on a lot of factors, but perhaps the one that stands out the most is the "personality" of the specialty they choose.  Take the following quiz by matching the word with the specialty:

A. Jock                                            A. Cardiothoracic surgeon

B. God                                            B. Psychiatrist

C. Looking for answers                  C. ENT doc

D. Geeky gadgeteer                       D. Orthopod

E. Life Styler                                   E. Emergency Medicine Specialist

One of the great things about working with SoPE (http://www.sopenet.org) is I get to hear about a lot of great innovative ideas. Lately, it seems, I've met more ER docs with great ideas than I can recall.

One , www.scribesstat.com, assigns pre-med scribes to ER docs to enter data into the EMR, thus making them more efficient.  Another, www.itriage.com, is a mobile health triage app that directs patients to the right place at the right time, and even gives you wait times in the ER or ambulatory facility you choose. Another ER doc wants to revisit an old infatuation with marine biology and commercialize products that come from the sea. As we all know by now, Bledsoe created this website and runs medical conferences looking for polar bears in Canada.

What's with these people? Can any of you out there help me understand this?

I think the rest of us can learn a lot from these life-stylers. Give yourself a present if you got that answer right.

Intelectual Property: Why you should care about Stanford vs. Roche

The Supreme Court will now decide who owns what.

The Supreme Court has agreed to hear Stanford v Roche. In this case, the federal circuit in September 2009 ruled against the university's claim of rights over an invention that measures the effectiveness of HIV treatments. Even though the inventor did research under a National Institutes of Health grant to Stanford, he also was working for a company later acquired by Roche and made an agreement assigning his rights to that company. Stanford claimed title to the invention under the Bayh-Dole Act of 1980, and in 2005 sued Roche, asserting the company was infringing its patent in its marketing of HIV detection kits. The circuit court ruled that Roche "possesses an ownership interest" and rejected Stanford's claim.

Why should you care about any of this? Here are two good reasons:

Because if you are an employee of a healthcare organization, your employer might make you sign an employment agreement assigning your intellectual property rights as a condition of employment

For example, when I started working for the Univeristy of Colorado, I did not sign an employment agreement. Under common law and case law surrounding Bayh-Dole, the 1980 act that gave univeristies the IP rights to research funded by federal grants, I was asked to assign my IP rights to the University as part of the inventions disclosure and patent process after the fact. But, forget academic faculties. In 2001, about 20% of US doctors were not self-employed. In my specialty, only about 5-6% of the approximately 9500 otolaryngologists in the US are academics.

The number of doctors working in wage and salary situations continues to increase. Physicians and surgeons held about 661,400 jobs in 2008; approximately 12 percent were self-employed. About 53 percent of wage–and-salary physicians and surgeons worked in offices of physicians, and 19 percent were employed by hospitals. Others practiced in Federal, State, and local governments, educational services, and outpatient care centers.Physicians and surgeons held about 661,400 jobs in 2008; approximately 12 percent were self-employed. About 53 percent of wage–and-salary physicians and surgeons worked in offices of physicians, and 19 percent were employed by hospitals. Others practiced in Federal, State, and local governments, educational services, and outpatient care centers. http://www.bls.gov/oco/ocos074.htm

Regardless of how the Supremes rule, the case has muddied the waters leading employers of knowledge workers to tighten the reigns.

Because now it might be harder for you to get money for your idea.

Investors, like VC's, hate uncertainty. In an amicus brief filed with the Court, the American Venture Capital Assn pointed out that the Federal Circuit’s decision would tend to discourage venture capitalists and established companies from committing the “risk capital necessary to develop [federally funded] inventions to the point of commercial application".

If you are interested in bioentrepreneurship and are an employee, whether you are in an academic or non-academic setting, keep your eyes on Stanford v Roche.