Here is some unsolicited #TipsForNewDocs advice on the job search

#medtwitter #livertwitter #GITwitter
Wrong: You'll have "all the resources you need"
What are these? Stats, research cores, coordinator pools...
These are...people!
You cant promise a person!

Right: Meet X, 25% of their effort will be directed towards your work if you gel. Or here is $$$ to hire Y.
Wrong: we expect you to do research, quality, etc
Right: we will support your research for X years

The week is 10 1/2 day sessions. Anything not clinical needs protection. 7 sessions is 30% protected. I was protected 3 years by the dept
Then I needed a grant for protection
Integrate time and $ when comparing jobs
Wrong: Job X offered me $100 and job Y offered me $90
Job X expects me to be 80% clinical (8 sessions), valuing my time at $100/0.80 = $125
Job Y expects me to be 60% clinical, valuing my time at $90/0.60 = $150

Wrong: Something super weird (or uncomfortable) happened during the interview process but it wasnt with someone I will work with directly so it is no prob
Right: Interviews hide dysfunction. If they couldnt do that, it needs to be considered seriously
"Institutions Don’t Love You Back"
Read this:…
Then read it again

Wrong: They want me to come in as a lecturer instead of assistant professor to keep the 7 year 'tenure clock' from starting
Right: All your accomplishments as lecturer will not be applicable when you go from assistant to associate. You are an assistant professor, my friend

Wrong: They say I dont need extra startup money because my mentor has money they will use to help me
Right: Mentors come and go. Mentor grants come and go. If you need start up, it goes to you and is specified in your contract

Wrong: Their offer is fixed and cannot be negotiated
Right: Everything is negotiable.

Wrong: They will be upset if I ask for more
Right: Everyone negotiates. If you dont ask, you cannot receive
How do you negotiate? Let me summarize that book you bought: you need multiple offers. Call it "BATNA" or call it rational thought.

1⃣Ask for the anything but unless you can get it (or something close) at job y, job x wont budge
2⃣Multiple offers help you know your market value

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More from @ebtapper

20 Apr

WHY is there a BABOON in my room?

A #tweetorial about the outcomes of hepatic coma, how far we have come, and how wild things got along the way

Up first: the lingo

Hepatic encephalopathy (HE) presents as a spectrum with subtle cognitive/motor deficits at one end (AKA "Covert HE") and coma at the other

HE/Coma can be caused by #cirrhosis (Type C, more common) and acute liver failure (Type A)

What used to (1950s/60s) happen to patients with coma due to hepatic encephalopathy ("HE coma")?

1⃣Gabuzda said everyone died
2⃣Sherlock said it was 68% mortality, Stormont 63%
3⃣Prytz said it was 80% mortality at 6-months
Read 22 tweets
31 Mar

WHAT the heck is GGT?

#tweetorial #livertwitter #medtwitter

GGT = gamma-glutamyl transpeptidase

It’s an enzyme that transfers amino acids to proteins. It's found anywhere things need transferring (liver cells, bile ducts, kidneys, heart....)

No big deal, right?


It did not take long to figure out that while lots of conditions raised the GGT, liver disease and biliary obstruction were the best at making high GGT
Read 13 tweets
28 Mar

HOW long do you live with #cirrhosis?
WHERE did MELD Score come from?
WHAT is a "TIPS"?
ARE you ready for re-#tweetorial

#livertwitter #medtwitter #meded

Imagine you are a patient with variceal bleed in 1940


Then came portosystemic shunt surgery. A treatment!

The catch?

Lots of people still died after surgery

What do we want to know so we can select the patients who will benefit from shunt surgery?

🤔Liver function?
🤔Do they look & feel well?
🎉Why not both!?

Wantz & Payne developed an A-B-C score using
5⃣Muscle wasting
Read 14 tweets
16 Mar

WHY does #cirrhosis cause palmar erythema?
HOW is estrogen involved?
WHO is ready for a #tweetorial?

Let's talk hormones, the liver, the impact of imbalanced testosterone/estrogen, & the history of spironolactone
#livertwitter #medtwitter #MedEd

Palmar erythema is:
1⃣Common (3 in 4 with #cirrhosis)
2⃣variably distributed on palm surface
3⃣caused by dilated capillaries

In 1942, Perrera showed the dilated vessels were not present on autopsy. A circulating factor must cause it.

What could it be?

Enter William Bean.
He knew that:
1⃣Palmar erythema happens in🤰
2⃣A 1940 paper showed that estrogen causes capillary dilation (in🐇🐇)

So, of course, he...
injected estrogen into men w/#cirrhosis & controls without.
Those w/#cirrhosis developed palmar erythema.
Read 16 tweets
4 Feb
I would like to thank everyone for their kind texts and tweets and thank the @AmerGastroAssn for the Young Investigator award.

It is a dream. As I cannot wait for @DDWMeeting, I would like to call out my appreciation for a few people and say a couple of things
First, I have mentors to thank. Dr Michelle Lai who gave me my start and launched me. @SenguptaNeil who taught me everything I know. And the reason I moved my family from Boston to a suburb of Detroit known away from good food, Dr Lok, the greatest mentor I will ever know
Second, I have advice. Find a place where you are surrounded by greatness and absorb it. It has been the great fortune of my life to work alongside and learn from people like JMellinger, @AkbarWaljee, and above all @NDP1001
Read 5 tweets
18 Jan
Most fun study I have ever done:

We asked clinicians why they tested NH3, their pre-test prob of HE, and what they planned to do while they were blinded to the result

tl/dr: Clinicians are good at diagnosing HE in the ED, so no need for Nh3…
We find that a clinicians' pre-test probability of HE is the same as the post-test probability. But! not only does Nh3 add nothing diagnostically, when high it leads to excess lactulose use even when tested in people without #cirrhosis

Now we need to design the QI intervention
I have always wanted to do this study. Huge thanks to @juanjgonMD 4 doing it. Even if u dont care about Nh3, we are very proud of our design, which allowed us to assess the value of a test using the clinician's real-time reasons for testing and prior probability
Read 4 tweets

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