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Conversations in Pulmonary, Critical Care and Sleep Medicine by the American Thoracic Society
ATS_BEP_059_Mid-Careers_Pt1_First_Edit
Speaker: [00:00:00] You are listening to the A TS Breathe Easy podcast brought to you by the American Thoracic Society.
Speaker 2: Hello, and welcome to the A TS Breathe Easy podcast. I'm your host, Dr. Ugo esma. You may know me from the Last Zebra podcast, and I'm excited to be hosting this episode for Breathe Easy Today, we're tackling something that doesn't get nearly enough attention navigating your career when you're past those early years, but still have decades of impact ahead of you.
If you are a mid-career medical professional physician, you know what I'm talking about. You've built expertise, you've proven yourself, but now you're facing new questions. How do you stay energized? Where do you go from here? And how do you balance leadership with continued growth? To explore these questions, I'm joined by two [00:01:00] fantastic guests, Dr.
Christina Monte Maur, and Dr. Josh Denson, my former attending at Tulane. Welcome to the show guys.
Speaker 4: Great to see you both, and thank you Ugo and, uh, ATS organization for having Josh and I both on today, uh, to talk about this important topic. I'm Christina Manor. I'm an adult pulmonary and critical care physician at Johns Hopkins.
As far as, uh, leadership roles, um, pertinent to today's discussions, I'm our, uh, fellowship program director for our pulmonary and critical care. Uh, fellowship, also senior a PD for the Osler Medical Residency. Um, and then the director of Education for, um, our entire division, which is exciting to also work with faculty.
Um, and on the side, um, I the day for far and I co-founded P Peeps, uh, where we also try to bring you some pulmonary and critical care content, um, when we can. Uh, but Josh, looking forward to hearing a little bit about you. I'm sorry, I'm, I'm the only person that's not Tulane affiliated today. Um, so I feel [00:02:00] like a little bit of an outsider, but excited to to hear you, uh, tell us all the fantastic things that you do.
Yeah.
Speaker 3: No, that's great. I was listening to some Palm pee the other day and I just, I do love that, love that podcast. I'm not a big podcaster admittedly, but every now and then I'll jump onto either UGOs or I listen to that one the other on the other day. Um, my name's Josh Denson. I'm also adult Pulmonary Critical Care.
Um, I have worked a few places around the country, but I've been at Tula for the past, almost eight years now in New Orleans. Um, I have a role kind of in education. From at all levels, from medical student to resident to fellow and faculty, um, as the associate chair of EDU of education for the Department of Medicine.
Um, but I have a special interest in mid-career education, particularly in the a TS, um, when I got started in it. So I'm happy to, and excited to talk about some of the opportunities that we have in the upcoming conference.
Speaker 2: Wonderful. Um, thank you all so much for those very, very, uh, [00:03:00] insightful intros to yourselves, uh, about mid-career, uh, in, in, in, in conversation about what we're talking, what we're here for today.
When you think of mid-career medicine, what, what do you. Believe defines that phase. In my little intro, I, I, I kind of excluded myself. I'm five years in, I, I feel like I'm, I'm still early career. What, what's the timeline that makes someone mid-career? Dr. Malmo, we'll start with you. I.
Speaker 4: Hug, you're right at the cusp.
Um, oh. Uh, I feel right. You're right at the cusp for, from mid, from early to mid-career transition. Uh, but I think when you're thinking of mid-career in medicine, as you said, Hugo, right, there's some formal definitions. You know, some organizations either for grant purposes or award purposes, define early careers a first five years after training.
Uh, while others I know extend that to 10. But I think in reality it's really, you know, the timelines don't always capture, capture people's actual experiences. So I think for [00:04:00] me, thinking about mid-career, when did I first think about that? Probably when Lauren Lynch sent the email and asked if I would consider talking about mid-career.
Uh, but. Yeah, it wasn't like a single moment. Um, it was, you know, where maybe like your early career faculty, at some institutions you're promoted from instructor to assistant and, uh, professor of medicine. It's, um, kind of this, um, celebratory day. I think for me it was more of a gradual process. Um, you know, I think I looked at it, people weren't necessarily asking me to do things anymore, um, but they were asking me to decide and lead.
So, you know, starting to lead programs, navigate complex issues, manage conflict, and really kind of mentoring others through some uncertainty. So I, that's how I see it as, you know, career paths in medicine. I'm, I'm sure Josh can also talk about this aren't necessarily linear. Um, so personal circumstances, leadership opportunities, and in institutional roles, um, really help change, um, and help us transition from the early career to mid-career stage.
Speaker 3: You know, as, as Christina said, like mid-career is [00:05:00] not, I don't know that there's an exact definition, right? And that's part of the good and the bad about it. And, um. I started thinking about this, it's probably been, I don't know, four, three years, four years now. You know, we, uh, I, I've involved with at s since I was probably a resident, and, um, so I had a lot of different roles there.
And, and at one, one of the committees I was on, they asked me to think about, Hey, do we have, we need, we'd like some content on mid-career. This, we feel like this is a, a cohort of people that maybe we're not giving enough attention to. I was actually, I would argue still junior career just a few years ago.
Um, I'm now settling into what I think is mid-career slash getting old. And, um, uh, but at the time I, I, I, I didn't know how to define this, right? Like I wasn't quite, I felt like in that stage and I was trying to figure out, well, what do people that are mid-career want? You know, what, what do, what is mid-career?
How do you define it? And again, I don't think there's a [00:06:00] straightforward answer, but. In my opinion and, and in discussion with others, a lot of it has to do, I think with, you're in this period where we're, we're used to having four to five year blocks through our medical education, if you're a physician or really even in other professions as well, where you have like a couple years of startup, a couple years of comfort, and then four to five after that, you're like, well, what's the next spot?
And so I do find it's, it's a time of transition, um, or at least the feeling for transition. You may not need to transition, but a lot of people feel that they have this. Urge what's next? And I think that's rather relevant, whether you're in academics, whether you're in pure clinical practice, private practice, uh, or have something, an industry, uh, whatever that role may be.
And I think that's what, um, I found. So to get to the point I was, I guess I was trying to say is we started this, uh, session called a TS storytelling and uh, we can talk more about that later as. As, uh, Hugo's, uh, spoken about before, um, it's a session at the [00:07:00] networking Supercenter at a TS, where we have people with different life experiences come and tell their story.
Some are, usually it's people more senior career, but the goal is to target people at early, mid, and senior career just to hear how different people have had non-linear pathways to their life.
Speaker 2: Absolutely. And um, I think growing up, not think, definitely growing up, I remember one of the first lessons my dad had taught me was to name things.
So that way you know how to approach them. So in the case of problems, name the problem. So you can, you, you can identify the, it kind of acts as a north star as to how to find the solution.
Speaker 5: Mm-hmm.
Speaker 2: Why do you feel it's important to identify that you're, that someone is, you know, as a physician or you know, a provider, how, why is it important?
Important to, to recognize and identify that you're. Approaching or transitioning from early to mid-career. [00:08:00] Why is that? Why is that an important, um, thing to recognize?
Speaker 3: You know, I think that you are, I think it is important to recognize because you're gonna behave differently and you're gonna seek out different opportunities.
You're gonna elevate your level of. Attitude. You know, it's, um, some people can say, we'll, say a growth mindset, or some people will say whatever term they want to put to it, but you start to approach problems differently, as Christina was alluding to in that you're now serving more either as a mentor or as a leader in your institution or in your practice.
Um, you know, I do think sometimes I, I, I'm in academics, but I tend to, I un my, both my father and brother in, in more clinical, private practice, uh, or, or hospital practice base. And, um, so I kind of always am thinking about how these different careers can, um. Approach their day to day, which is very different than my day to day and different than your day to day and then what your personal life is going through your family life.
There's, there's so many different [00:09:00] facets, and that's what I love about this whole discussion in that it doesn't need to be on how do I get better at my job? It's really how do I make my life as good as it can be? And to me, that adds some definition to it. But Christina, what do you think?
Speaker 4: Yeah, Josh, I mean, completely agree.
It kind of just how we transition our mindset, right? I think early career, you know, really rewards saying yes to everything, right? Like, yes to the committee, yes to this opportunity. Yes, I'll lead this paper or review. Um, I think transition to mid-career, you have to have a little bit more discernment, you know?
So I felt like for me personally, uh, really within this past year had to be just more intentional about where I'm putting time and energy. Uh, 'cause really when that cost, the cost of misalignment, I'll say is, is higher now. Right? Because you're, you know, balancing things at work, you're balancing things at home, which I'm sure we'll get into, uh, but it's just, you have to, uh, I've had to reset a little bit.
I'll, I'll say, um, in the last year in.
Speaker 2: I love that, um, that quote, the cost of [00:10:00] misalignment is a lot higher and I, I can personally, personally, um, attest to saying yes to all the things because I, part of, I I think at least for me, part of being, um, transitioning to being an attending I'm, I'm only five years out of fellowship, was there's a sense of, am I ready?
Even though you are confident in your training. You still have that sense of Am am I ready? And part of our training up to this point was to kind of get as much exposure as possible, right? So you want to go and do the lines you want to go, and that's kind of the way to do it. And so out of, out of, out of training, that that is, that also informs the way you say yes.
'cause the answer is yes in training. So naturally you're going to say yes. Um, phasing into your, into your career. Uh, as, as you start working as an attending, so this now becomes a different kind [00:11:00] of saying yes. You're now being more, it sounds like you're being more introspective and saying yes to things are more aligned to your own person as opposed to your career.
Is, does that sound about about right?
Speaker 4: Yes. It goes and say, I think, I think that's really fair to say and really, you know, a good way to think about about it. I do also think that this, you know, transitioning to and being mid-career really kind of affords. To really kind of work on mentorship and sponsorship, though, right?
Like those opportunities that you may have said yes to three, three or four years ago may not be the best choice for you. But this is where you can really start to think of others in your field, um, either at your own institution or external institutions, and really start to elevate others just to kind of keep the process and the cycle going.
Speaker 2: Dr. Denson, what, what particularly stood out to you as something that was challenging in that transition, going from early to mid-career?
Speaker 3: That's a good question. You know, I think I'm still in it. I, you know, I think I'm, I'm solidly in Midcareer [00:12:00] now. I, I, I'm, you know, I wasn't sure a couple years ago. I'm about eight years out and then, you know, associate professor in terms of the academic timeline.
But, um, you know, I've done a lot of different stuff. I've trained a lot of different people and, uh, so I feel like I, you know, the, the, the struggles are, you've done all these things and then I. Firstly, I feel like, all right, well I'm here. Like, what's next? You know? And I feel like if I had looked back, you know, 10 years ago and said, Hey, what was your 10 year plan?
I probably would've already been there, been there. Mm-hmm. I've already been there and done that, you know? And so, you know, when you're going in through, at least through medicine, you know, you're go trying to get into medical school and then residency and then fellowship and you have you like, you know, your 10 year plan and I'm, that's something that I think good mentors obvious often give that advice to people, but.
Having that tenure plan is, is hard for a lot of people and I think that in mid-career, like it's, you need to kind of reset that and so to me, I think that is a, a, it's not as clear cut what your [00:13:00] tenure plan should be as when you're junior to early faculty, you know, even earlier than your early faculty.
Like you kind of know you have a 10 year plan and it should be in this pathway in general, once your mid-career. To me, the hardest part is, well, what is my next 10 year plan? I'm a little bit focused on, you know, little kids and things like that. So it's, that's to me the most important thing. So it's hard to really aside 10 year plans to my career when I have these other obligations.
Speaker 4: Yeah. I think, um, maybe just building off what, what Josh was saying, um. We each have, I think, different, um, different competing interests. Um, and I, I feel like mid-career is when kinda like your life outside of medicine becomes more complex really, and like less optional, right? There's things that you have to put into focus that maybe you didn't for your initial stages.
Um, and. As a faculty member. So, you know, caregiving, uh, for many, um, Josh mentioned, mentioned parenting. I'm not a parent, but you know, my wife and I have, you know, [00:14:00] we're, we're a little family. Um, but, you know, relationships, you know, your nuclear family. Um, I, I live, you know. My parents are in Texas. I'm still here, um, in Baltimore.
So kind of that disconnect as you're thinking of aging parents, like just new things that you didn't really think about, uh, before. Um, so I feel like you're almost like holding, I see it as like holding multiple identities at once. You're, you're a physician, a leader in your field, a partner, a parent for many, caregiver for many as well.
Um, and how, how do you get to, to balance all of this? Still thinking about, you know, what your 10 year plan is. Um, I know it becomes harder. It's a, it's an easy question for us to ask applicants. Um, for sure. Like, what's your five plan? But like, when we get asked that now, it's like, oh, like what is my five, 10 year plan?
I'm not really sure.
Speaker 3: Yeah. I, I, I was, I, you made a big point on that. I, I feel like I asked applicants that and then I'm telling them I don't really know what I wanna do. You know, I thought I did, but I don't, you know, and, um. But I did touch on, uh, you [00:15:00] know, uh, your aging parents is another issue. I think that is part of life.
It's, it's a part that you may not see coming until you're there, you know? Um, you know, my mom's the best person in the world and, uh, you know, she has a medical problem that we've been dealing with the new cancer diagnosis this past year. So everyone's got something going on and that's, um, that to me is why the only way that I was able to develop this storytelling thing was there's no way to say what you should or shouldn't be doing as a mid career.
You just gotta hear other people's life events and problems and understand what other people are going through so that. You know when you come across, if you learn from it, hopefully, and, and or not, and you, and you and you're, you're pushing forward
Speaker: early bird registration for a TS 2026 in Orlando is now open.
Register now and save members get a discount, so become an a TS member or renew your membership to take advantage of the savings. Visit conference.thoracic.org Today, [00:16:00]
Speaker 2: I'm, I'm reflecting on and, and just hearing you both talk and. Um, it, it's not lost on me that as medical students, residents, fellowships and early into early or like early attending shift, eating, easing into mid-career.
What I'm sensing is there is, I have a theory that I've been, I've been conning in the back of my mind that we as physicians have delayed adulthood. And by that I mean you start, you start in college four years, four years of medical school, um, three or however long years of residency, however long years of fellowship.
And I would count your first few years of being attending, still a part of training. In fact, I mean, we would all agree that medicine is a forever training, but certainly in those first few years and. Because you're saying yes to everything, you're still neglecting other parts of yourselves that make you whole.[00:17:00]
And maybe it's now that you're, you're now settled into your career, that you're now being more aware of all of the other things that are important. And maybe that is, is what's happening here. And I don't know what you guys think about that.
Speaker 4: I could, could not agree with you more. And I'm sure Josh is gonna have similar sentiments as well, but I, uh, yeah, I, it's a, it's a, a grounded theory, so I think you can, you should be, be able to run with that.
I actually, in my career too, I actually did, uh, I had a nursing career before medicine, so I spent eight years as a bedside nurse, um, before I transitioned to medical school. Um, you know, so it was a little, my path, definitely not linear. So I think even adding on, you know, additional years to that. So like, I remember my first year of faculty, my wife was so excited.
She was like, I'm really excited for you, you finally get your, your real job now. Um, she's like, but I've been in education for 20 years. Like, when are you gonna catch up? So, like, thinking about that, like, we're in, we were in such different, um. [00:18:00] Such different atmospheres, uh, of work collectively. Like, I'm excited, I wanna do everything.
I wanna say yes. And she's like, I've done that. Like, I want, I want the beach condo. Like, that's what I'm thinking about. So like, our perspectives were different. So I think, you know, for us, you know, in this mid career de definitely what our partners and spouses are doing, um, may be a little bit misaligned from where we are.
Um, so I, I. Thank you for pointing that out, Hugo, and I think that's so real and such a valid, um, point to make and, and talk about more, but I'm interested to hear if, if Josh has anything to add to that.
Speaker 3: Well, Christina, I was interested, so you did eight years as nursing before and then that, and then you would argue you were kind of mid career in nursing in a transition at that point, which, which is awesome.
You know, I think that like, that's the whole fun of it is like, I've been thinking about that recently, kinda like Hugo's been pontificating on things. I, I do it in the car when I'm driving around and, you know, you could do a whole, I could do a whole new career, you know, at any point in your life you could do a [00:19:00] whole new pathway in life.
And I think that is fun and exciting. I think it's, it's less stable. Like if I, when I think about that or I bring these ideas up, my wife tries to shut me up. You know, like keep, keep it calm. But it's exciting, I think, to think about those things. To think about new pathways. Or how can you make your current path?
What, what do you want to focus on? So as we've talked about, I think people can take either direction, they can open up change path or narrow in on something, and that's kind of the fun part of it.
Speaker 2: What, what are some pressures, um, financial or other pressures that tend to increase? At, at the mid-career stage, you guys kind of hinted at it.
You, you mentioned leadership expectations. You're now, uh, focusing a lot on family needs. Uh, we often talk about in medical, in medical professional, uh, careers, the, the, the burden of student loans and medical school loans, et cetera. What other kind of, what kind of pressures in that, in that [00:20:00] vein is much more prevalent, uh, easing into your mid-career and, you know, you guys being in it.
Right now,
Speaker 3: I think, you know, most recently I've been thinking about, you know, kids are always talked about as being expensive. And actually when I little kids, I personally did not find them to be exceedingly expensive. It just depends on what, what's going on in their life, in your life. Obviously I felt more pressure of loans in the beginning and kind of just getting things started and moving in the right direction.
Um, but I'm starting to, at least where I am at the moment and my kids are. Around, uh, like 11 and seven and, um, but like, you know, getting towards high school and college expenses and braces and things like that, that are adding, starting to build the cost, I'm, I'm definitely realizing more, um. Kid expenses.
Um, but that's at the same time as trying to figure out the rest of my, like your parents, are they prepared for either retirement or living outliving their [00:21:00] wealth, um, siblings, um, or close friends that need help. You know, things like that. And so I do think there, at least in my world, there's different pressures that are now competing that as a mid-career.
I didn't, I didn't even think about these things as a early career. You know, I was really focused on kind of just getting loans paid off. Trying to find a house, that sort of thing. But I'm curious, Christina, you're a definite, I think, at a different stage than I am too. I'm curious what pressures you've, you've felt more of.
Speaker 4: My wife and I were both fortunate to have, um, I think we're in the, we were in the last cohort that got our loans forgiven, um, as Biden transitioned out, um, which I could not be more thankful for. I mean, I, I think about it now and I'm like, what would I, what would we do day to day in order to. Make sure that we were making our loan payment and, you know, yeah.
Affording a house, um, without, without any children. Uh, so that was, um, I think something that I'm very fortunate about. And I know not everyone has that opportunity though, so I know that many people, um, are going through that. Um, and I think, [00:22:00] um, as Josh you were saying. Right. It, it is kind of thinking about that next step, right?
Are our parents gonna be okay? Um, are, you know who, who's gonna take care of them if we don't live in the same city as them? What is that gonna look like for, for our parents? And then, you know, starting to think about myself, um, what am I gonna do? Um, you know, I hopefully still have some, some time before I have to think about that.
But, uh, we were joking the other day. Uh, with some friends that, uh, was like, my wife's gonna be at the assisted living, going to all the social things. And then she's like, she's like, Christina, I think I am gonna forecast. She's like, you're gonna be like in the memory unit. And I was like, why don't you be in the memory unit?
I don't think that's fair. Uh, but then it just, it prompted a discussion about like, oh wow, like this is real. Like, it, it may, you know, even if it's like 15, 20, 25 years, um, away, when you start to think about that transition, um, it's. It's something that you need to start thinking about now. And I, and I really think, right, like for some people, if you think about like, what would I wish I had known [00:23:00] earlier, kind of with finances, just really learning more like financial literacy at a, at a much earlier stage.
I shouldn't be thinking about it for the very first time as a mid-career. Um, faculty in person, like, what is it? What does this look like? What should I be doing? Um, starting those conversations much earlier, you know, residency, fellowship, early career faculty, um, which I know that, you know, a TS um, definitely is an organization has these talks about these topics, um, in certain programming.
Um, I know that Josh mentioned the, the networking supercenter. So there is a place to talk about it and people need to hear about it and think people wanna hear about it. Um, so hopefully, hopefully that answers a little bit of the question.
Speaker 2: Absolutely. I think especially going, you, you, you kind of transitioning into what my next question was with regards to financial conversations that we should be, um, having before becoming mid-career, um, or transitioning to mid career.
Speaker 5: As we wrap up this first part of the conversation, what really stands out [00:24:00] to me is this idea that mid-career doesn't just happen overnight. It's not a title, it's not a promotion. It's not even a number of years. It's a shift in responsibility, a shift in identity, and often a shift in pressure from leadership expectations to family responsibilities, to the quiet weight of financial decisions that maybe we wish we had started thinking about much earlier.
Dr. Meyer just highlighted something really powerful. These conversations about financial literacy need to start sooner. Not when you're already juggling everything, and certainly not when the stakes feel so high. We should probably start earlier during training in residency and fellowship and maybe even before.
So in part two, we're going to dig a little deeper into that. Should financial literacy be built directly into medical education? What are we not taking our trainees about life [00:25:00] outside the hospital? And how might that change the trajectory of burnout, stability, and long-term fulfilled?
This is the A TS Breathe Easy podcast.
I am your host, Hugo Esma, and I'm looking forward to catching up with you guys in part two of our conversation.
Speaker: Thank you for joining us today. To learn more, visit our website@thoracic.org. Find more a TS Breathe Easy Podcasts on transistor, YouTube, apple podcasts and Spotify. Don't forget to like, comment, and subscribe, so you never miss a show.
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