”Academia vs. Private Practice with Dr. Lenore Bacek, DVM, DACVECC”

Dr. Bacek talks about her decision to pursue a position in academia and then leave academia after 7 years.  She also shares some insights she gained while mentoring emergency critical care residents.

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Episode Transcription

Laura: Today, I'm speaking with Dr. Lenore Bacek who is presently a Clinical Programs Manager at Blue Pearl Veterinary Partners. Dr. Bacek- graduated from veterinary school at Ross' University, then went on to an internship at Louisiana State University. She completed her residency in Emergency Critical Care at Auburn University and then became a member of faculty for over seven years. Thank you so much, Dr. Bacek, for speaking with me today.

Dr Bacek: Yeah. Thank you for having me. I'm excited.

Laura: Great, great. So I guess I just kind of wanted to ask you to take a step back when you were in the third year of your residency and considering your your next move, were you always geared toward academia or were you considering both academia and private practice physicians?

Dr Bacek: I was considered and both had actually interviewed in both. I think what really made me decide to stay in academics was that the teaching aspect, you know, obviously there is some teaching in private practice depending on the clinic you're at. And there's always, you know, technician training, a new doctor training. But I really like the hands on clinical training that we get to do with the fourth year students, with the interns and then with other residents.

Laura: So that's why you decided to go that route. The teaching was the primary?

Dr Bacek: Yeah, primarily for teaching. I also like research. I was a clinical track person, meaning most of my time was spent on clinics. But I still had research, commitment and an obligation to to do research. It was more clinical based, but I really enjoyed doing that. And the ability to collaborate across specialties, to collaborate across clinics and publish and hopefully make a difference in the literature.

Laura: Uh-huh. What was your research focused on?

Dr Bacek: So a little bit of everything. So when I was a resident, I did some research on coagulation disorders with different fluid types. And then when I became faculty, I worked a lot with the residents on their projects. So we did a lot of different things. We did some stuff with coagulation disorders, but also we did some electron microscopy stuff with central lines. We did some stuff with drug pharmacokinetic. So really, you know, it was whatever they were interested in. We just help them with that.

Laura: Ok. Got it. So how much of your time was spent on research versus clinical practice versus teaching?

Dr Bacek: So my teaching component was about 80% and that included clinics and teaching. So I was on clinics for about two thirds of the year. And then the rest of the time I was on research. And during that time, I would also work on lectures and teaching material for the residents. And then, you know, write manuscripts if something needed to be done. And then, like I said, that teaching component included both clinical teaching and didactic teaching. So lectures to the undergrads as well as the clinic floor.

Laura: And how many residents were in the program. When I was a resident, when I was a faculty, when you were faculty, we have five residents. And right before I left, we actually got a sixth resident.

Laura: Got it. What were the biggest challenges that you faced as a professor? Was it managing your time or.

Dr Bacek: Yeah. It's hard at academics because you do wear a lot of different hats. You know, you are a clinician and still a huge part of my job was patient care. But you're also training residents, training interns, training students and then doing research. And another part of academics that often gets forgotten as the administrative side. So as you kind of move up the food chain, you get more committee duties assigned to which take up a lot of time, unfortunately. So there becomes a lot of administrative stuff that goes along with it. So I think just really, you know, balancing all about stuff in and trying to still do what I enjoy, which was clinics and teaching, and not sort of get carried away with the administrative side as much as I could.

Laura: How long were your work days?

Dr Bacek: It depends. So definitely on clinics. They were longer. I mean, as faculty. I usually came in around 7:30 and then we tried to wrap up the day by 5:30 or 6, but certainly there were nights I was there with the residents helping with critical cases till 9 or 10 o'clock. On research my time was a lot more flexible. I usually worked more of the 9 to 5 schedule, you know, just because I didn't have any clinic oversight during that time.

Laura: Did you have on call responsibility? I did, yes. So there were three faculties, so myself and two others, and we would split on call. So usually I'd be on call for a week or two in a row at night and on the weekends. And then our residents were really good. We would go in if they had a case that they couldn't get stable or something like a ventilator case. They called frequently, but I really didn't have to go in super frequently, which was good for my schedule.

Laura: Mentoring critical care residents. What did you see them struggle with the most?

Dr Bacek: I think work life balance is really hard. I mean, I think across the veterinary medicine field right now, work life balance is hard, but certainly for a specialty like ecc, where you emergency is sort of the catchall service, you know, if cases can't get in or needs to get in sooner. They come through emergency and then certainly critical care cases. The residents, you know, they get called a lot. They get called in a lot. And I think just the personality that ECC. Attracts is usually more of a type A personality sometimes has trouble sort of letting go and moving a case onto the next person. So just trying to help them remind them that they are people and they need to remember what they enjoy doing outside of work, hobbies and if they like musical instruments or if they like reading and still trying to find time to do those things and not just become a resident for three years.

Laura: Mental health right now is such a hot topic. And in your field, it's you know, it's so tough because most of your clients are your patients are extremely sick. So you get an extreme sick patient and an owner who's really scared, right?

Dr Bacek: Exactly. It's a hard combination sometimes, I think, unfortunately. ECC. There's a lot of really sad cases. I mean, there's definitely really great wins. And I usually tell the residents to try to focus on the cases that we helped and not necessarily things that were out of our control.

Laura: So what else would you say to critical care residents right now? They're just starting their residency. What advice would you give them?

Dr Bacek: I think it's helpful. You know, it's hard because when you start a residency, you don't necessarily know if you want to do academics or private practice. But I do think having an idea going in could be helpful just to decide, you know, do you want to see more emergency or critical care? Do you want to not see primary cases trying to have an idea of what they want their job to be when they finish can help you decide, a, where they choose to do a residency and b, sort of how they get their training. A lot of hospitals use critical lists and a lot of different ways. So just trying to figure out what they enjoyed doing more. You know, the emergency side or the critical care side or both, which again, can be a challenge at the onset of a residency, but trying to figure that out as they go along.

Laura: You're looking at long hours and how to manage that. And so when you're looking back, what was the most rewarding aspect of your academic career?

Dr Bacek: I think there's a lot of different you know, I really like teaching and I love seeing old students who've graduated when they come back, you know, when they came back into town for conferences or I ran into them at conferences. And, you know, they realized that what we're teaching them was a very practical emergency medicine and it was was helpful in their career. So that's very rewarding. I really enjoy talking to owners. So, you know, having owners that reach out and let us know how their pets are doing. And then certainly it's really I have a lot of pride for our residents. You know, we have a really good past rated Auburn. So when the residents complete their residency and passports, that always made me very happy just to see them succeed. Finishing and finally sort of seeing that light at the end of the tunnel.

Laura: What is the pass rate now for..

Dr Bacek: It varies year to year.. Yeah, and it's probably about 60 - 65%. Yeah. Some years it's worse. So I believe last year it was closer to 45 or 50%, but some years it's closer to 70. So it's variable.

Laura: Ok. So you kind of made a career shift and are now at Blue Pearl. What made you decide to leave.

Dr Bacek: So I think you know it's it's hard. I think academics is challenging for a lot of reasons. I mean, I think one of the things I mentioned was there's a lot of administrative duty, which if you don't really enjoy that, it can be overwhelming. And I think, you know, again, you are wearing a lot of different hats. So sometimes it's hard to focus on one thing or really be good at one thing. And I think luckily, you know, I think for me, I was really lucky because I recognized that I was becoming burnt out and I was able to step away and find another path you know, before it became critical. I think, again, academics. It's just it's hard sometimes it's just, you know, it's a lot of work and, you know, pay is usually lower than private practice. And a lot of times I feel like it's a lot of different jobs sort of rolled into one. So I was just ready for a change. So this fell into my lap at exactly the right time.

Laura: And what is your what are your primary responsibilities now?

Dr Bacek: Yeah. So I'm running... Blue Pearl has what's called the Emerge program. And essentially it was designed about a year and a half ago, a year and a half or so. It's an accelerated emergency training program. And really, I'm sure you know better than anybody. There's a huge shortage of emergency vets right now. I think part of it is emergency medicine is very scary for new graduates. And people either don't feel comfortable with knowledge and skills or they don't feel like they get the mentorship they need. So this program is really designed to give those new graduates the skillset and the mentorship they need. So it's a three year commitment to Blue Pearl with the first year being the training aspect of it. So I took over that program. So I'm in charge for that program, development, recruiting, sort of all the details. I do some university recruiting as well. So we split up all the universities and I visit about eight or so a year to talk to them about, you know, not just emerge, but other post-graduate things like internships or just general work work that they could do. And then I work a little bit with the scientific committee and I still get to review grants. So that lets me still do some research, even in private practice. Yeah.

Laura: So I'm sorry, but I don't quite understand the difference between the EMERGE program and an internship is. An internship at a specific hospital.

Dr Bacek: And that's a great question. And I think that's something we have to explain to people. So an internship is really going to be rotating through all different specialties and it's mostly for people, you know, if they want extra experience or if they want to do a residency. The Emerge program is really designed for people that know they want to do emergency, but feel like they want a little extra support before they start. So the EMERGE program is they are not rotating through other specialties. They're really spending their time on E.R. They spend the first month with us here in Tampa for boot camp. And basically, it's four weeks of lectures and labs. We do a lot of different topics, you know, including soft skills like communication and wellness, you know, with them during that boot camp. And then after four weeks, they go to their home hospital and that's where they'll spend the next three years. And it's a more graduated program. So there's different phases where they sort of ramp up to being an autonomous E.R. doctor where they get less and less mentorship, essentially. So it's very, very heavy mentorship in the beginning. And the mentor backs off slowly. And then, you know, there there are seen cases by themselves with someone else in the building, but they're functioning as an E.R. doctor. So this program was really developed for people that that have that career path in mind that they want to do emergency. They don't want to do an internship. The pay is better. So it goes up to market pay within the year. So, you know, internships obviously are paid a lot lower as a training program. So it's just a different set of people that usually choose the EMERGE program.

Laura: Okay, I got it. And is it any location or is that location chosen by Blue Pearl or its annual location?

Dr Bacek: So they interview at the clinic of their choice, just like they would if they were interviewing for regular emergency clinician job. So it has to be mutual on the associates end, but also the clinics end. And then the clinic has to feel that they have the support, that they have quality senior emergency clinicians that can provide appropriate mentorship and that they have the support staff to do that. So right now we have associates all over the country. There's about thirty five associates spread out over probably about 20 hospitals.

Laura: That are in the Emerge program?

Dr Bacek: Yes at different stages.

Laura: And they stay at the same hospital for three years. I believe that's what they do.

Dr Bacek: So they you know, after the first year, they solve a mentor, but really they're only checking in with a mentor if they need to. And at that point, they are a fully functioning E.R. doctor being paid market rate for those two. So the second and third year.

Laura: Got it. And how long has Blue Pearl had this program?

Dr Bacek: So the first class was in January of twenty eighteen. So it's not super old, but it's growing very, very quickly. And I think, again, it's just filled a need that's out there. You know, a lot of new grads don't want to do internships if they're not going to do a residency, but they do want that extra training. So it really just fills a spot that wasn't there before.

Laura: And what about mental health? Is there a component of the boot camp that addresses that and helps them get ready for the challenges of emergency medicine?

Dr Bacek: There is some resilience and wellness structured in there. One of the things that we do is at this during the second phase, which starts about week 16, we start doing weekly webinars with the group. And again, and a lot of them are medical topics. But we do have some wellness and resilience built in there as well to hopefully give them the tools to at least recognize if they're having a hard time and be able to reach out if they need to. And then again, they have their mentor that they're checking in with fairly frequently. So hopefully issues can be identified early if they're struggling or if there are problems.

Laura: Was that part of the residency program at Auburn? Were they offered resources in case they were really struggling?

Dr Bacek: I mean, there really wasn't a structured part of the residency that was wellness. But with the university, they there are resources available to the residents for free. So, you know, there were a lot of, you know, main campus people that would come and talk to the residents as a group about the resources available and recognizing warning signs in themselves and in the students just to sort of know what to look out for.

Laura: It sounds like a really neat program that Blue Pearl is doing. I've heard of some other smaller groups starting programs like that as well.

Dr Bacek: Yeah, it's really exciting.

Laura: Yeah, it sounds like a win win for for Blue Pearl. But yet for the doctors too, because so many of them want to be mentored. Right out of the gate. And to have a structured program.

Dr Bacek: Yeah. For sure. And I think the goal is, you know, a lot of people leave emergency medicine because they don't feel like they have the support or the skills and they burn out. They're not happy. There's a lot of different reasons. But the goal would be, you know, if we give people the tools early on, we find these hospitals that really want to invest in the ER doctors. Hopefully they'll want to stay longer than three years, hopefully after three years. They don't all decide to leave. That would be the goal that now we've trained these people. They're excellent doctors. They're happy, and then they can become the mentors for the next generation of associates.

Laura: So you're more in a management position in the Emerge program or do you actually get to do any teaching?

Dr Bacek: I get to do both. So I'm in charge of the program, but I deal with some of the lectures and labs, which is really fun. So it does still provide me with, you know, the ability to to teach the people that are in the program or, you know, they want to be here. So they're very excited. So it's fun. And I'm glad I still get to do that.

Laura: And that would happen in Tampa.

Dr Bacek: Yeah. So the bootcamp right now is in Tampa twice a year in the summer and then in January.

Laura: Is it hard to get into the program?

Dr Bacek: No. I mean, right now that basically they just apply like our regular E.R. doctor and if they're interested in the program, you know, as long as they're hired on as an E.R. doctor, they can join the program. So there's not a lot of specific application material that they have to provide or anything like that.

Laura: So, OK, so it's not competitive?

Dr Bacek: Not at this point. I mean, we're trying to you know, this year in July, we had 15 associates, which is a fairly big class. So, you know, trying to figure out what's the max number that we would want to have. We wouldn't want to turn people away. We would probably just increase the number of classes that we do per year if we needed to. But we really want people that want to be in the program to be able to join.

Laura: And taking another step back. Dr. Bacek-, when you look at your career, is there anything you would have done differently or any thoughts on that?

Dr Bacek: You know, I really love emergency critical care. I think it's a little frustrating sometimes. There are some specialties that get paid much, much better. Certainly it's not all about money. But, you know, I think we all have student loans that we worry about. I don't think I would change anything. I mean, I've been very happy and I feel lucky that I was able to move into another job that makes me happy. Maybe if I could go back in time, I would have looked at cardiology as a specialty. I mean, when I was an intern, I honestly was deciding between cardio and ECC. And I picked ECC because of the variety, because you do get to see a little bit of everything and still, do, you know, some cardio, some surgery, some neuro. And, you know, I think that's really interesting and exciting to not know exactly what your day is going to be like. So my final answer is, no, I would not change anything.

Laura: Uh-huh. It's got to be a very rewarding career.

Dr Bacek: It is. And I think, again, you know, being in academics, I really enjoyed my time there. I think teaching, you know, it's just fun to teach students that are excited to, you know, start their careers and they're excited about doing different procedures and learning things. And, you know, certainly the animals that, you know, we help save is always rewarding seeing them go home and the owner is happy. That's always great.

Laura: Well, thank you, Dr. basic-. This has been wonderful. Yeah, I'm excited to learn more about or to hear more about what you what it was like choosing academics versus private practice. And most people do say that teaching is is what takes them to academia. So it's you know, it's an interesting career path. And I think it's wonderful. The program seems so interesting that, you know, you're kind of trying to to to make a change in the industry by helping these younger doctors get a better start. Is what it seems like to me.

Dr Bacek: Right, exactly. I think it's really trying to address why do people leave emergency medicine and how can we try to help that area? You know, so giving people, again, if they don't feel comfortable with the knowledge and the skills, but also wanting the support and a mentor. I think trying to trying to do that will hopefully keep everyone happy and wanting to stay in emergency longer.

Laura: Right. And hopefully help the shortage go away. Right. Yeah, OK. Well, thank you so much for talking with me. And it was great to learn more. You've just been so gracious. Thank you.