Evo Terra (Host): This is the Obstetrics Podcast, brought to you by OB Hospitalist Group. I am Evo Terra. Today we're diving into life after residency. Specifically what it looks like to launch your career as an OB Hospitalist.

We're joined today by Dr. Aaron Rosen and Dr. Ayita Verna. I'll ask them about what drew them to this path, how the day-to-day compares to residency, and what advice they have for others considering this career track.

If you've ever wondered whether the OB Hospitalist life is for you, this episode is packed with real talk, insights and takeaways you won't want to miss.

Dr. Verna, Dr. Rosen, thank you very much for joining me today,

Aaron Rosen, MD: Thank you for having us.

Ayita Verna, MD: Thank you for having me.

Host: Dr. Verna, I'll start with you. What drew you to the OB Hospitalist path after residency?

Ayita Verna, MD: Well, I think for me, or I think a lot of OB Hospitalists can say the same thing. It's, it was the flexibility that this allowed. I have two beautiful daughters and my first daughter I had, when I was a third year resident. And, I remember during that time it was extremely hard for me to try to raise her and be in residency.

And I remember trying to figure out what I wanted to do after. And I really am passionate about global health. So two things I wanted to was global health and basically be present with my children. At the time I had one child and I knew I wanted to get pregnant and have a second child. And so I spoke to someone in my residency program who she started a hospitalist.

And when she told me about the position, I was like, this literally sounds like a dream. And so I was immediately attracted to that and I thought that sounds like something I want to do.

Aaron Rosen, MD: Dr. Verna, do you mind if I ask, did you go into hospitalist right out of residency?

Ayita Verna, MD: Yes, it was my first big girl job.

Aaron Rosen, MD: So, I had a slightly, I guess different and more traditional path. So when I was finishing up residency, I took a job in private practice actually in my hometown. So I was recruited to a small group practice, that was run basically as a group of solo practitioners and just sharing office space.

So when I came out, I was doing the traditional OBGYN private practice gig. So I was in the office five days a week. I was going to the hospital almost every day. I was doing 10 to 15 deliveries a month, and I realized that the lifestyle sucked and the money sucked, and the responsibility sucked. And I kind of reached this point where I was getting really frustrated.

 And it was right around the time that I had my son and he was at the time getting to be about a year old and I was missing a lot of stuff and I got this recruiting email and I was like, if this job is half as good as I think it's going to be, I'm going to run with this. And at that point it just kind of the stars aligned and I decided to make a change for myself and for my family. And I've never looked back.

Host: Sounds like it was a good decision for you. Tell me, Dr. Rosen, actually, walk me through what's a typical shift like for you now that you're an OB Hospitalist?

Aaron Rosen, MD: So I think the typical shift definitely varies location to location based on where you are working as a hospitalist. There are certainly some locations that are busier than others, and all of those you kind of get a feel for when you're interviewing. But the hospital that I work at is a community-based hospital that's still fairly busy as far as community hospitals go for labor and delivery. I walk in at seven in the morning, I get sign out from the previous physician about what patients we're taking care of, who we have to worry about, what things to be aware of for the day.

I go out and check on the nurses and get a feel for the schedule for the day and run through the patients that are on labor and delivery during multidisciplinary board rounds. And after that, I'll complete whatever rounding we have to do and I just deal with whatever's there. We, if there's patients for me to deliver, I deliver them.

If there's surgeries for me to assist on, that's what I do. And obviously a lot of what we do is managing labor and delivery and triage, and consults from the ER, but the cool thing about hospitalist work is no matter what you get, you're done at the end of your shift and there are some shifts that are crazy and busy and you're running all over the place and there are some shifts that are pretty chill and you get to hang out in labor and delivery, maybe catch a baby and watch TV.

Host: I like that idea. Dr. Verna, I know that you went straight into the hospitalist role after residency, but let's talk about the pace and the pressure that you're under now and how does that compare to what you went through during your residency?

Ayita Verna, MD: For me, I think the biggest thing is, and I don't even know if it's just about being an OB hospitalist, it's just your imposter syndrome. I mean, I go from having an attending telling me what to do or being a backup, if anything were to happen to now making all the decisions. Thankfully I think I had a pretty great training at the hospital I trained that. And so in seeing more patients, I just became a lot more confident and I realized that, I know everything that I need to know and I just had to like do a couple of shifts and then realize that I do think that the pace and pressure is a little bit less now, definitely more in the beginning because I was just more nervous.

But if I compare to a residency shift, I think it is less because as a resident you have a lot of pressure on you. You have to take care of so many things, whereas here, the nurses are extremely helpful and so a lot of times I think that decreases the load of what I have to do. And we also have two physician in our hospital.

I know it's not like that everywhere, so that is a huge, huge advantage because they take care of the triage while I can do consults, ER and inpatient. So I think that's really helpful.

Host: Dr. Rosen, I know that you did spend some time in private practice before you became a hospitalist. What was that transition like and maybe the transition from residency to your private practice and then now this transition to the OB hospitalist role?

Aaron Rosen, MD: Well, I think first and foremost I want to agree with Dr. Verna. The impostor syndrome thing is very real, and I think we all feel that coming out because you go from, even if you're the best resident in your residency program and you are just a gangster roaming in the halls and you know everything and you can deal with everything and you think you can do the crash C-section and you can do the ectopic and like everything is just butter.

The second you finish residency and you don't have that security blanket of like, even if you didn't like your attending, even if they're not a particularly good attending in residency, they're still your security blanket and they're still the one that really bears the brunt of the responsibility. And when I was doing my first delivery in private practice, I'll never forget this patient.

 We ended up pushing for five hours and you're just so pot committed to this delivery and you're so emotionally invested in it that, you know, this is like right after I got my hospital privileges and like the family's in the room and just emotions are running high. And you realize, oh my God, this is just me.

Like if I call the C-section, this is on me. And that feeling was I had so much bravado and confidence in residency, and it took a little while for me to get that back when I was in private practice. And then, I think the transition from, you know, obviously I got used to that and private practice was fine.

You know, I took great care of my patients. I had a good time, but the life pressure wasn't really what I was looking for. And the transition to hospitalist was very different. You know, you go from being in the office every single day and really only going to the hospital to take care of your patients.

To being in the hospital and suddenly all the stuff that the residents would call me about and say, Hey, we've got a patient who's got X, Y, and Z going on, what do you want to do with her? I'm the one who's like just there dealing with all of that in the hospital. So there was a bit of a transitional period there.

But I feel like what we do in the hospital is very similar to like the work of a senior resident, but the pressure feels different and I guess, because you're the attending, there is more responsibility, but I feel like you deal with less of the logistical BS of being a resident, which is a relief to be honest.

Host: Yeah, I'm sure that's some of the least best jobs of any job is that red tape, that bureaucracy that we all have to deal with. Dr. Verna, I want to go back to you and ask about that imposter syndrome again, coming out of residency, mentorship, training that helps some of that. So how did that help you when you were early in your career?

Ayita Verna, MD: So, I still consider myself pretty early. I'm like a year and a half out, but to be quite honest, and that was like the most shocking part because one thing about residency, it's very like, team-based. You always have a senior, a younger, and you're always with people.

You're never like really alone. That was the biggest thing that was different for me because I was in the hospital and like. Like, who's my friend? Like, no one is with you, or no one is telling you what to do or things like that. So for me, I really just had to be confident with what I was taught and just apply to the patients.

But that was definitely different. You don't really have like, you have orientation for the hospital, but you don't have training to be a OB Hospitalist. They give you a kind of like a little document about the things that we do and how the hospital runs, but they don't really train you.

I had to learn a lot from like the nurses and then the people that the second doctor that would come, I would ask, so what do you do for this and that? I kind of like worked my way up like that to be becoming more comfortable around the hospital, knowing what they do and how they work. But that's definitely different because in residency, I mean, you're trained for so long and you always have somebody teaching you, like if you have a question, you just always have somebody to go back to.

I do feel like I could talk to people, but at the beginning I just didn't even know where to go. But I do feel like my Site Director was always there. She always was present for me. She even told me like she would come to the hospital if I needed, so she made me feel more comfortable with that.

Host: Very good. Very good information. Dr. Rosen, you've spoken at length about the work life balance. What you are feeling now? You are much happier, I believe, from your prior role. Yes. Um, I think

Aaron Rosen, MD: Yes, understatement.

Host: Yeah. So that's great. Obviously you had private practice before, and so now we've got Dr.Verna who just came straight outta residency. How do you feel, Dr. Verna, and I'll let you fill in with this too, Dr. Rosen, how do you feel your about your work life balance and also your career satisfaction, knowing you've only been at this for a year and a half, but how do you feel?

Ayita Verna, MD: Honestly, so good. And I am so, it's interesting because going into OB Hospitalist, I thought maybe that's going to be my short term until I figure out what I want to do. And the more I'm doing this, the more I want to do this. And I'm like, I mean, the flexibility is like no other, like you can't compare the amount of time I have with my kids.

I could never have this amount of time if I were in private practice. And I love that when I'm home, I'm home. I don't have to attend to my phone, I don't have to be on call. I don't have to. And that to me is everything. Being present with my children is everything to me. So that's huge. And I sometimes, I think to myself, I'm like, is everyone, are all my ex co-residents like this happy because I feel so fulfilled in life. I love that I get to be with my family. I love that I'm fulfilled with my job and my career. And like even though like you don't see your patients, but the patients tend to come to the same hospital. And so you tend to have continuity of care even if you don't have continuity of care, if you get what I'm saying.

And then another thing I want to add is, I was able to add one day of clinic a week to my schedule because it is so flexible. So I do one day of clinic in a community health center, and those patients tend to come to my hospital, which makes more continuity of care in the way that this works. And I'm even allowed to do global health work when I'm ready, because I have so much time off, so.

Host: So, Dr. Rosen, in your opinion, now that you are an OB hospitalist, right, and even for hospitalists early in their career, which somewhat early in your career, not quite as early as Dr. Verna is, but how has that helped you prevent the burnout that you would see in other practice models?

Aaron Rosen, MD: So I think it is important to address like the burnout situation when it comes to physicians, particularly high stress practices like OBGYN. And if you look at the data, the majority of the data, it supports the idea that like the control of work life balance is a key factor in determining whether or not physicians feel like they're experiencing burnout.

And I'll give a, an example of private practice versus now that really impacted my decision making. So when my son was born, I was trying to make plans to take some paternity leave. I'd like to spend time with my wife and help her recover. I want to be with the baby and my son was born, and like I said, we, I was in a group office, but we ran it like a solo practice.

So each of us was our own doctor. We had our own patients, we had our own schedule, but we would help each other as needed. And when my son was born, I had a whopping nine days out of the office after he was born. And in those nine days I did five deliveries. Because I love my partners from the office, I'm so close with them, but like I, I just feel like that really wasn't something that I could ask for them to cover my patients. So I had patients that were due around the same time as my wife. I told them I would do my best to be there for them. And you just feel so much responsibility.

And the bad side of that is you feel a lot of guilt if you're not there for them. So, I'm leaving my wife when she's postpartum with a screaming, crying baby at home to go run into the hospital. And thankfully to those patients' credit, I think we're like totally bonded over that. And we see each other at the park all the time, because yeah, I work in my hometown, and I would go into the hospital and I'm screaming at these patients to motivate them to push like, you're the only thing standing between me and my newborn child. Get this freaking baby out. And they all delivered vaginally and pushed for like 20 or 30 minutes.

Like it's, it's the OB dream. Like if my normal patients could do that on a day-to-day basis, it would be amazing. But just having that amount of responsibility and lack of flexibility in what I had pictured was going to be this incredibly beautiful, albeit stressful moment in my life was really like a reality check to me.

Like, Hey man, you gotta, maybe think about this as a thing for you. And I think comparing that to what I do now, it's night and day, you know, I can submit what days I want to work and what days I don't want to work. I am able to pursue things outside of the hospital that I am passionate about.

I have several side jobs, which I'm happy to talk about later. And I think that there is no, there's no perfect job in obstetrics and gynecology, but if you're looking for work life balance and freedom in your life and the ability to do things that actually matter to you outside of a professional setting or even professionally, but outside of the hospital, hospitalist is like a no brainer.

Host: It must be going well for you, Dr. Rosen, because you have just been promoted to Site Director, whatever that means. Can you share a little bit about that opportunity and how you got that pretty early in your career?

Aaron Rosen, MD: So, I mean, I wish I could say that it was because of my, you know, stunning clinical skills. But really, I just think when you're working as a hospitalist, the hospital expects you and the company expects you to kind of take on this role as the safety king of the hospital. You know what we do, is we're the emergency backup person. We take care of the people who come in without a doctor. If we are not going to be passionate about patient safety, who is? And from the time I started, I'm working in a hospital where some of the treatment algorithms and some of the physicians might not be as up to date as they should be.

And I felt very passionate about updating things as much as I could. So I am in the meetings with the hospital talking about how we can improve this. I'm talking to the Chief of the department about how we can improve this. And when my current Site Director stepped down, she recommended me for the role.

And I didn't get it that time. They brought somebody else in, but when, he had other things going on in his life, and he was stepping away, the company asked me to take over and I've been doing it for, it's gotta be about 10 months or so now. And, I enjoy it. It's a little bit more administrative work.

But I do get to be in a leadership position and it gives me an opportunity to have a little bit of career advancement based off of that too.

Host: So do you think that you're going to stay in this role long term? Or is this just a stepping stone for you to become something bigger and greater than you already are today?

Aaron Rosen, MD: So I think, I didn't go into medical, I didn't go into, I didn't go to medical school. I didn't go into residency to, to sit at a desk. That's not why I do this. You know, I want to continue taking care of patients. I don't have aspirations of being a hospital CMO, that's just not something I've ever had any interest in.

So I do want to continue work as a hospitalist. I like being the site director. So there are some opportunities for advancement from there where I can still continue to work shifts and I would obviously entertain those should they present themselves. That being said, hospitalist work particularly, when you're doing 24 hour shifts is a very physical job.

I think I'm going to be doing this when I'm 70 years old? I don't think so, but I'm hoping the combination of my three jobs will allow me a little bit more freedom when I get to that age. So, um, I don't think I really need to worry about that.

Host: Yeah. That makes sense. So Dr. Verna, I'll go back to you for a moment. And Dr. Rosen spoke about this a little bit, but how do you think your role as the OB hospitalist is helping with the quality improvement or even patient safety where you work?

Ayita Verna, MD: I mean, for me, I think, just being in the hospital, it's so crucial for just the safety of the patients. A lot of times I've had to deliver a patient because the private physician, was on their way and didn't make it. I've had code orange in front of the hospital and I think that's really important that we're here and we can attend to the patients and in case of emergency, we're always there. And I think really important.

Host: Sticking with you for a moment, Dr. Verna, what would you tell other OBGYN residents who are thinking that they, maybe they need to have years and years and years of practice before becoming an OB hospitalist? Is that true? What should they do?

Ayita Verna, MD: No, I actually don't think so at all. I mean, coming right out of residency, I think Dr. Rosen kind of alluded to that at the beginning. It's very much similar to being a senior resident, except you don't have a safety net, the attending. And so, I think you're very well prepared and, you know, you just have to learn how to attend to emergencies, which we do in residency all the time.

And so to me, I feel like after a couple of months, just doing this job, I, became very comfortable and I think about all the time, how good my training was, but even every time I get scared and I'm like, oh, I've seen this, I've seen this before. I've seen and I know what to do. And I remember one of my first shifts, was a 26 weeker, she was in labor, and I had to say, I'm like 26 weeks. I'm like, oh my gosh, okay. But we've done that so much in residency. I was like, okay, I just have to make the call. I mean, she's literally eight centimeter dilated, and she was breech, so she had to go for a C-section. I had to make the call.

So that was scary. But I was trained for this. And so everything went well in the end, but I think that you don't have to go through private practice to become an OB Hospitalist. I think, I've learned from my mentors that they have gone through private practice and a lot of them said they would never go back.

I've talked to so many people and at this point in my life, I don't know if I see myself leaving OB Hospitalist. So we'll see.

Host: Dr. Rosen, I've saved the final question for you. What should young residents know about this career that they might not learn during their training?

Aaron Rosen, MD: I think, and I don't want to just like keep beating a dead horse with a work-life balance thing, but I think that if you look from the inception of the idea of residencies, like you, I don't know if you guys have ever read the research on this. You know the stories of the first surgical residency coming out of John Johns Hopkins, like a hundred years ago, was basically just a cocaine stimulant driven maniac, making people work 72 hours straight and telling them that this is how you're going to learn things. You have to go through what I'm going through. You have to do this grind, and you have to live this life, or you're not going to learn, you're not going to be able to take care of patients.

And I, I think that obviously residency has evolved a little bit since then, but this idea that like OBGYN is this, like, I'm going to sacrifice my life in service of others, that persists. So I think if you talk to people in private practice, that's how they feel. It's like, yes, I leave my friend's birthday party.

You know, I skipped that vacation for this and, and that's normal and every opportunity I have to buck that trend, I try to, and I tell people like, that's not normal. Like, that's not sustainable. You will not be happy living that life, especially in this day and age where like there are other opportunities available to you.

So, you don't have to go into private practice and sacrifice everything that makes you happy in service of your patients. We just had a corporate event and we had to like write why we're doing this job on our paper and hold it up in front of us and smile and look like a doofus in front of the camera. And I thought for a long time about like, what am I going to write on this paper? Because I hate this stuff. So I wrote, do the job I love, and still have time to be with the people I love, and I think that that really sums up why I do this. The best part about private practice is the long-term relationships you have with patients.

You're taking care of people for years. You're with them through abortions, you're with them through miscarriages, you're with them through the birth of their child, through cancer diagnoses, all these really intense emotional periods in their life and the problem with that is the guilt you feel if you miss something that you're supposed to be there for.

You know, oh my gosh, I was stuck in traffic and I missed that delivery. Or why did that patient go into labor the one weekend I'm in New Orleans for a wedding, you know, and when you switch to a hospitalist role, you do give up what I think is the best part of that job, which are those long-term relationships with patients. But the flip side is you get back control of your life and you still get the opportunity to form quicker, albeit still meaningful bonds with patients in the hospital.

I think there is one really important thing we need to touch on. And this is kind of the elephant in the room when it comes to what job you're going to choose when you're leaving residency, and that's the idea of completing your oral boards. And Dr. Verna, I'm going to kick it back to you, but there, there are definitely.

There's this looming thing where when you're taking your oral boards, you need your cases, you need your case list, and be very careful choosing your job and be very cognizant of the requirements for boards when you're making that decision. Because, I went into private practice with no concern in the world that I was going to be able to get my oral boards done because you're getting your office practice cases, you're getting your GYN surgical cases, and you're getting your OB cases, and that's not a problem.

But if you're taking a non-traditional job out of residency, like a hospitalist job, there may be some deficiencies that you need to be aware of unless you're in a very, very busy hospitalist position where you can check the boxes on what you would call the office practice cases. You might be able to use ER visits or triage visits for that.

And use your GYN cases from residency, or you might need to do what I imagine Dr. Verna is doing right now where you're supplementing this job with one day of a week, in the clinic. Dr. Verna, if you want to speak to that.

Ayita Verna, MD: So for me, I mean, again, I knew maybe like two hospitalists, one of my co-residents that they were going to go into fellowship. They became a hospitalist first for a year. They were able to get some of their cases. Most of these people, they will take six months of their cases from residency and then continue getting their cases in their OB hospitalist job.

To me, I plan on taking my oral boards the first year, but then I had my second daughter, so I said, I'm just going to push it to the second year. Now, when you're in the second year, you can no longer use your cases from residency so you can do the 12 months or the 18 months. And for me, I don't know, I just felt like using the ER and triage could be a little bit more complicated and I just wanted to make sure that I had my cases.

So doing this, the office outpatient, which I actually like doing just because it's a community health clinic. So I don't have to commit to any patients. I don't have to deliver them or anything like that. I do their prenatal cares and then, they go deliver in whatever hospital.

And so with that, I am able, I'm actually collecting my cases now because I'm taking my oral boards this year, and so I've had more than enough cases from the clinic just to fill up the office based practice one. So yeah, I think it's very important to think about that because I did go back and forth thinking, should I just get this job or just like do it from hospitalist and I feel like I would be more stressed out just doing it as a OB hospitalist. And so I chose to do the extra clinic job on the side.

Aaron Rosen, MD: I think that's the best piece of advice that I could give to someone who is coming out of residency and really wants a lifestyle focused job, like being a hospitalist and the work-life balance is amazing. And to be honest, the money is better than what I made in private practice, which a lot of people are surprised to hear. I make, probably 70% more money working as a hospitalist than I did when I was in private practice. And that's because you're not paying rent, you're not paying your employees, you're not paying your own malpractice insurance. You really need to tailor your job either in the first year or your second year out and focus on boards.

Because if you don't do that, you will not be board certified. It'll be very hard for you to be employed. So, I say this as strongly as I can. Use the advantages of the work-life balance and maybe think about what Dr. Verna did where you're working for a community-based health clinic, find a job at an FQHC. Call a local Planned Parenthood and see if they want somebody one day a week and these hospitalist jobs are going to be fine with that. You can have one day of clinic a week, and you don't have to commit to it long term. Do it for six months, get all the cases that you need, get your board collection done, and then take your oral boards, dominate those, and live your best life when you're done.

And you can always change your shift requirements. You can start your hospitalist position and say, Hey, I only want to work five days a month because I'm going to also do clinic. And then when you're done with clinic and you're like, look, I really like this hospitalist job, you pump up those shifts, make a little bit more money and you leave clinic behind.

But you can't ignore the requirements that exist to get those boards done. Because that's super, super important.

Host: Well, this has been a fascinating conversation. Thank you both, Dr. Rosen, Dr. Verna, for joining me on the program today.

Aaron Rosen, MD: Thank you for having us.

Ayita Verna, MD: Thank you for having us.

Host: Once again, that was Dr. Aaron Rosen and Dr. Ayita Verna. Ifferent path straight from residency? Learn more about OBHG's career opportunities and discover how you can thrive as an OBGYN hospitalist by going to OBHG.com/careers. I have been your host Evo Terra, and you have been listening to the Obstetrics Podcast from OB Hospitalist Group. Thanks for listening.