SVM Communications: Finding a job after fellowship – a conversation with (gainfully employed) experts

Finding a job within vascular medicine after fellowship may seem intimidating to current trainees, but it doesn’t need to be. Being well prepared for your job search and starting the process early can help ease trainee anxiety. Members of the Society for Vascular Medicine (SVM) NextGen Committee and the Marketing and Communications Committee discussed tips for job hunting with Dr Elizabeth Ratchford of Johns Hopkins Medicine and Dr Naomi Hamburg of Boston Medical Center to gain insight into how to best navigate the current vascular medicine job market. The interviews were conducted by Drs Ahmad Hallak and Merry Ellen Barnett, associate members of the SVM. Dr Hallak is a vascular medicine fellow at Ochsner Health System. Dr Barnett is a vascular medicine fellow at the University of Virginia.

Conversation with Dr Elizabeth Ratchford (Johns Hopkins Medicine)

Dr Ratchford is an Associate Professor of Medicine who currently serves as Director of the Johns Hopkins Center for Vascular Medicine in Baltimore, Maryland. She spends most of her time in clinical vascular medicine, with special interests in peripheral artery disease and fibromuscular dysplasia. She serves on the Executive Committee of SVM as Secretary and Chair of the Membership Committee. Dr Ratchford also serves on the Editorial Board of SVM’s journal Vascular Medicine and edits the Vascular Disease Patient Information Page section.

Why are vascular medicine specialists important? What healthcare gaps do they fill?

Just as cardiology goes with cardiac surgery and neurology goes with neurosurgery, vascular medicine provides the noninvasive counterpart to vascular surgery and catheter-based vascular intervention. The vascular medicine specialist is dedicated to optimizing the care of patients with vascular disease. Owing to the diversity of available management strategies for these patients, the evaluation by a physician specialized in this disease process ensures all therapeutic options are utilized appropriately. In addition, they play an important role in several multidisciplinary teams including pulmonary embolism response teams (PERT), stroke teams, and wound care teams. Having a vascular medicine specialist on these teams who specializes in these disorders provides expert opinion and help in collaboration for problems that cross disciplines.

How does a vascular medicine specialist find a job?

Connections and networking are important, since potential positions may not be advertised and may only be found by word of mouth. At times, practices who are hiring a vascular medicine physician may not be certain how best to utilize a vascular medicine specialist or even what to pay them. Opportunities can be found in different settings, including wound care, vein clinics, reading vascular ultrasound studies, inpatient consultations, and outpatient longitudinal follow-up of vascular disease. It is reasonable to reach out to colleagues in the SVM directory as a starting point. Even if a position is not open at that time, it is helpful to get your name out to let people know you are looking for a position. The SVM Mentorship Program can provide guidance in career decisions. In some cases, programs aiming to expand their vascular department may consider a proposition of starting a vascular medicine fellowship. There may be both university/academic opportunities and hospital/clinical opportunities. Funding for the position may come from multiple sources; both the employing program/university and the hospital may contribute because they have a vested interest in improving patient outcomes. Thus, you may have to be creative in marketing yourself as a vascular medicine specialist.

What questions are important for a vascular medicine specialist to ask during an interview?

It is important to inquire about the call schedule, inpatient obligations, outpatient responsibilities, and mentorship/teaching responsibilities. You may also want to ask about protected time for calling patients back, reading ultrasound studies, research, or other work commitments. What support staff will you be working with? Will you have a nurse, advanced practice provider, medical student, resident, fellow, and/or guidance from a senior physician? Compensation for a vascular medicine specialist is not well delineated, which gives room for negotiation. The 2019 SVM Comprehensive Practice and Salary Survey (an SVM member benefit) gives guidance and expectations of compensation and can be a tool for negotiations. ¹

Any closing thoughts for vascular medicine trainees?

One of the best parts of working in vascular medicine is the variety. No day is ever the same, and a single day in clinic can bring vastly different diagnoses and learning opportunities. Take advantage of that variety when carving out your schedule. Physicians often tend to map out their lives far in advance, but keep in mind that your career in vascular medicine will evolve over time and you do not have to figure it all out right now. Five years down the road, you may have developed a completely new vascular niche based on random opportunities that pop up. Now that your training is completed, enjoy the ride and don’t forget to guide others along the way.

Conversation with Dr Naomi Hamburg (Boston Medical Center)

Dr Hamburg is a Professor of Cardiovascular Medicine who currently serves as the Chair of the Vascular Biology Section and Interim Director of the Whitaker Cardiovascular Institute at Boston Medical Center in Boston, Massachusetts. She is trained in both cardiology and vascular medicine, and currently practices in an academic setting (approximately 75% research/25% clinical). Dr Hamburg is a past Trustee of the SVM, a current member of the Vascular Medicine Editorial Board, and past Associate Editor for the journal.

How should vascular medicine fellows approach thinking about a job after fellowship?

Early in training, fellows should start thinking about what type of job they are looking for. Vascular medicine is a small community, but we are very diverse in terms of what people actually do. We have people in academic research, academic clinical practice, private practice, and folks with cardiology training. Fellows should think about what they truly enjoy doing, and then pursue that. For example, do not pursue academic research if you hate research. Early on, fellows should also think about where they want to live. There are a lot of regional differences in what a vascular medicine practice looks like, say if you are practicing in the Northeast versus the Midwest. If you are hoping to practice in a specific region that is different from where you are training, it is worth talking to people in vascular surgery, interventional radiology, and cardiology in your desired region to get a sense of what vascular care looks like in that region. Once a fellow knows what they want, then they can start looking.

Do you have any tips for finding vascular medicine job openings beyond job boards?

Vascular medicine is an unusual job market because most people do not know what vascular medicine is. If you tell someone you are an interventional cardiologist, people know what that is and generally have an idea of what it entails. This is not the case if you say you are a vascular internist or that you practice vascular medicine. There is absolutely a huge demand for practitioners of vascular medicine, but it will require more work on the candidates’ part to find a position compared to other medical fields. Networking is a huge part of this field; direct contact with field leaders is helpful because then they know who is out there looking for jobs. Often field leaders in vascular medicine will be asked ‘do you have anyone for this position?’ when a job isn’t necessarily posted (particularly in academic settings). In private practice, some fellows have had success with cold-calling to cardiology, vascular surgery, and interventional radiology practices.

Do you have tips for fellows who are going to be pioneering a vascular medicine program straight out of fellowship?

The first thing these fellows should do is have a discussion with folks who have done exactly that. People like Drs Elizabeth Ratchford (first Columbia, now Johns Hopkins) and Aditya Sharma (University of Virginia). After that, it’s really important to get information about what is needed in terms of vascular medicine at an institution, as this can vary greatly. Is the institution looking for someone to establish an independent vascular medicine practice with an outpatient practice and inpatient consult service? Are they looking for someone to strictly do perioperative management for vascular surgeons? Fellows considering an institution can go on informational interviews to determine what the institutional needs are, who the players are, and how they can meet those needs (and if they want to).

What are some points of consideration for trainees hoping to start a basic science lab as junior faculty?

The earlier in training you know that you want research to be a primary part of your career, the better. There was an era when it was easy to add on later, but in the current medical environment it can be hard (although not impossible) to add on later when you already have an established/busy clinical practice. You will need time dedicated to research during training to be mentored and gain the necessary skills to do funded research. It’s helpful if you figure this out in residency because many fellowships have the ability to do a T32 with dedicated research years.

Any closing thoughts for vascular medicine trainees?

Whatever path you pick, there will be a fair amount of pressure at work. Make sure that you are intentional about taking time outside of work to enjoy the things that you love. Also, take advantage of the fact that practically everyone in vascular medicine is friendly and approachable. People are always happy to talk; they may be busy, and you may have to ask a few times, but everyone is always happy to chat with young people who are interested in vascular medicine.

The ‘SVM Communication Page’ is a regular feature of Vascular Medicine, used to share information with members of SVM. All articles in the collection are available for free online at vascularmed.org. To learn more about SVM and become a member, visit vascularmed.org.