I started my career in “comanagement” when I was 12 years old and had to babysit my two younger siblings (my brother is an orthopedic surgeon and my sister is an ophthalmologist). I had to learn to be responsible by making sure they were served lunch and did not hurt themselves before my parents got home.
Fast forward 15 years. I was headed to the University of Iowa to start my first faculty position. My division director, Gary Rosenthal, MD, gave me my first opportunity for teaching and comanagement at the University of Iowa. I did not have any comanagement or medicine consultation training during residency, but I was eager for the opportunity. I learned on the job, through textbooks and references, such as Perioperative Medicine: Managing for Outcome, 1st edition by Mark F. Newman, MD, Lee A Fleisher, MD, and Mitchell P. Fink, MD, and UpToDate (UpToDate.com). My most important training was “on the job” by interacting with surgeons, anesthesiologists, hospitalists, and cardiologists. I enjoyed having a role in optimizing patients in the preoperative clinic and being a part of the important decision-making process such as whether there are contraindications to surgery. I was also fortunate to be able to work with senior medicine residents on the medicine consultation rotation. Even though the medicine consult rotation had already been established, I wanted to make sure that there was educational value to the rotation. I worked with the Internal Medicine residency program and Department of Medicine to develop a medicine consult curriculum with handouts and core lectures and made the case to hire an advanced practitioner to help with the preoperative clinic volume. I learned that I had to advocate for my beliefs, and this advocacy led to improvements in resident satisfaction and educational value to the rotation.1
Kurt Pfeifer, MD, who served as the SGIM Perioperative Medicine/Medical Consultation interest group leader, asked me to take over the SGIM Perioperative Medicine interest group a few years later. I had attended a few SGIM meetings in the past, but I did not see myself as a leader in the field of comanagement. However, it gave me confidence that he entrusted me with the leadership role and served as my mentor during the transition by helping me with timetables, abstract drafts, and guidance with the first “Updates in Perioperative Medicine” at SGIM. I remember presenting at my first “Updates in Perioperative Medicine” at SGIM and feeling very nervous, but excited to share the articles that we had researched. Dr. Pfeifer also introduced me to many leaders of perioperative medicine at SGIM and encouraged me to develop a national curriculum for perioperative medicine based on advice from the SGIM Perioperative Medicine/Medical Consultation interest group.2 My work with the perioperative medicine interest group encouraged me to attend the ACLGIM LEAD program and be active in regional SGIM leadership. With my expertise in perioperative medicine and surgical comanagement and the skills I obtained from ACLGIM LEAD program, I have had the opportunity for scholarship and academic promotion. I presently serve as the Director of Surgical Comanagement at the University of Pennsylvania.
I feel very fortunate to have found a niche in Internal Medicine in which I have been able to thrive. Perioperative Medicine and Surgical Comanagement is much like taking care of siblings, making sure that everyone is focused on the best outcomes for the patients among sometimes vastly different opinions. It was not a planned career path, but one that I fell into, and I have been fortunate enough to seize the many opportunities that have come my way to improve patient care and improve resident education in General Internal Medicine.