Career Spotlight: Ryan Nelson

Ryan Nelson
Ryan Nelson, MD

This is the first in a series of interviews with hospitalists connected to the Society of Hospital Medicine (SHM) to share insights, knowledge, and expertise about career opportunities, growth, and development. Today we hear from Ryan Nelson, MD.

Dr. Nelson is an early career academic hospitalist in his fourth year of practice. He is currently an attending physician in the section of hospital medicine at Beth Israel Deaconess Medical Center (BIDMC) in Boston and an instructor in medicine at Harvard Medical School. In his first two years of practice, he was an attending physician with the department of hospital medicine at Ochsner Medical Center in New Orleans, and was awarded Faculty of the Year – Hospital Medicine, 2019-2020 from the Ochsner Internal Medicine Residency for excellence in clinical teaching.

At BIDMC, he is the director of the “Immersion in Hospital Medicine” elective for the medicine residency program. Additionally, he has been selected for the Shapiro Institute Medical Education Scholars Program 2021-2022 as well as the Rabkin Fellowship in Medical Education for 2022-2023.

Dr. Nelson has served on the Society of Hospital Medicine’s Physicians in Training (PIT) committee for the past three years. He is the co-chair for the PIT academic workgroup and the primary investigator of a PIT-sponsored, nationwide survey of hospital medicine-focused education rotations in graduate medical education. Through the PIT committee, he also spearheaded a mentorship initiative that pairs hospitalist mentors with mentees from the SHM Resident and Student Special Interest Group. This initiative was selected as an innovation finalist for the 2021 SHM annual meeting, and they are working to transform it into a national mentorship platform.

Dr. Nelson has lectured at SHM and American College of Physicians local, regional, and national meetings. His research interests include academic mentorship, whiteboard-based teaching, wellness and professional development, and the intersections of cognitive psychology with medical education.

1. What made you decide to choose hospital medicine as a career path, and specifically your specialty?

As a resident, I gravitated toward inpatient medicine. More than anything, I loved the challenge of leading a team of interns and medical students and creating daily plans of care for complex patients. My wards experiences also kindled my interest in medical education. I saw hospital medicine as the subspecialty that would allow me to continue doing what I love — caring for patients, often in their moment of greatest need — while coaching and educating groups of highly-motivated learners.

2. What does a typical workday look like for you?

My workday varies depending on whether I’m on staff (private) service or teaching service.

When I’m on staff service, I arrive at work around 7:00 a.m. and receive sign out on my patient list. I then begin looking up my new admissions, chart checking my existing patients, sending pages to consultants, and creating my daily to-do list. I typically start rounds at 8:30 a.m., prioritizing my sickest patients and discharges. As I round, I enter time-sensitive orders and check in with each patient’s nurse to receive an update on their care (always ask “what does my patient need from a nursing perspective”)! Then, I attend interdisciplinary rounds to discuss discharge planning. I usually finish rounds at 11:30 a.m. at which point I return to my desk and review my to-do list to ensure I have completed all important tasks.

After I grab lunch, I start working on my documentation for the day. As I finish each note, I call the patient’s family member or health care proxy to provide an update. I find that the note-writing process helps me consolidate the message for each day.

Lastly, I complete my billing and sign-outs. I’m usually prepared for sign-out between 4:30 p.m.-5:00 p.m. If I am the “late” person for our group, I will stay until 7:00 p.m., handling cross-coverage until our nocturnist team arrives.

When I’m on a teaching service, I arrive at work around 7:30 a.m. I spend 30-45 minutes chart-checking and then preparing teaching points for team rounds. Team rounds typically start around 8:45 a.m. I encourage my residents to create a rounding list beforehand that prioritizes the “3 Ds” (Dire, Discharge, Diagnostics) and denotes how we will round on each patient (bedside rounding versus walk rounding versus card flip rounding). At some point on team rounds, I deliver my five-minute prepared teaching points (usually at the beginning). I also teach and give feedback on-the-fly between patient encounters. We end team rounds at 12:00 p.m. so everyone can attend the noon conference.

In the afternoons, I love to teach at the whiteboard, or coach a resident on creating their own whiteboard mini lecture. Following afternoon teaching, we “run the list” to prepare the team for sign-out. My workday usually ends between 4:30 p.m.–5:00 p.m.

3. What do you consider one of your career successes? How did you achieve it?

At my first hospitalist appointment at Ochsner Medical Center in New Orleans, I was selected as “Teacher of the Year – Hospital Medicine” for excellence in teaching. I was honored by this award because more than anything, I love to teach. I believe that I achieved this award by saying “yes” to most teaching opportunities very early in my career. I taught clinical reasoning to medical students, prepared whiteboard mini-lectures for my wards teams, and coached medical students and residents to create clinical vignette abstracts for regional and national conferences.

4. What do you consider a challenge you’ve faced in your career? How did you overcome it?

In 2020, my wife and I were offered jobs at Beth Israel Deaconess Medical Center in Boston. This was an amazing opportunity for our careers, but it meant moving across the country from New Orleans to Boston at the height of the COVID-19 pandemic. In a matter of months, we had to pack up our lives, move into a new apartment, navigate a new city, and adjust to new jobs and hospital systems. Now that we’re settled into our new home, we often talk about this challenge together and agree — we overcame it because we had each other’s support.

5. How did the global pandemic affect your day-to-day working life?

At the beginning of the pandemic, like so many other hospitalists, my work-life rapidly transitioned from teaching service rotations caring for patients with a multitude of medical issues to direct care service rotations caring solely for patients hospitalized with COVID-19. I retired my professional dress in favor of scrubs and adjusted to wearing an N95 for 80% of my workday. I am so thankful for vaccinations which have gradually allowed the return of basic social events that I once took for granted, such as a shared meal with colleagues.

6. Where would you like to see your career path going next?

In the coming years, I hope to become more involved in medical education leadership both at my institution and nationally through SHM. I love mentoring medical students, residents, and early-career hospitalists, and I hope to turn this passion into a major part of my job description.

7. What membership benefits offered by the Society of Hospital Medicine have helped you in your career?

SHM membership has offered me tremendous benefits. Discounted rates on conference attendance and access to The Journal of Hospital Medicine and The Hospitalist have made it easy for me to network with colleagues and stay up to date on hospital medicine literature, respectively.

8. Do you belong to any SHM SIGs (special interest groups), chapters, or committees? If so, which ones and why?

Yes, I have served on the SHM Physicians in Training (PIT) committee for the past four years. I applied and reapplied to this committee because I love coaching, mentoring, and fostering the career development of medical students, residents, and early career physicians. I am also a hospitalist liaison through the PIT committee for the Resident and Student SIG.

9. What impact has SHM had in shaping your career?

SHM has been truly transformative to my career! My involvement and engagement in the PIT committee have introduced me to incredible colleagues from around the country. I met my career mentor, Dan Ricotta through SHM as well as fantastic research mentors including Shannon Martin and Emily Mallin. SHM has afforded me tremendous professional networking opportunities that have resulted in publications, lectures, and workshops.

10. What is a piece of advice you would share with job seekers or offer a new hospitalist just beginning their career?

Use the mnemonic FIND as a guiding framework for your first year as a hospitalist:

Familiarity — become familiar with independent practice and with your hospital’s infrastructure and support system.

Identity — perform self-reflection and counterbalance your clinical duties with your passions outside of work.

Network — engage your support system, meet your colleagues, learn names, and use them often!

Direction — toward the end of your first year, begin to visualize your unique path as a hospitalist. Find a mentor to guide you through this process.

I contributed to an article about this framework for The Hospitalist with three fantastic colleagues (Drs. Alison Ashford, Teela Crecelius, and Rachna Rawal). Check it out to learn more!

Lastly, if you have an interest in academic hospital medicine, attend SHM’s Academic Hospitalist Academy. I attended in 2019, and it was one of the best decisions I have made in my early hospitalist career!

11. Is there a particular area of specialty medicine you enjoy working with, such as clinical care, teaching, or research? Why?

As mentioned above, I love to teach, so I am my happiest when attending on a teaching service. But I also learn the most on teaching services from the talented and inspiring residents and medical students at my institution. I enjoy serving as the team mentor and taking a back seat so the resident can function as the team leader and build confidence through autonomy.

12. Finally, what is something unique about your career, or career path?

I am passionate about whiteboard-based education. Throughout my early hospitalist career, I have endeavored to transform this passion into a scholarly niche. I developed a framework for elevating whiteboard mini-lecture design, delivery, and refinement, and I have shared this approach through lectures, publications, and most recently a #MedEd Tweetorial. To further develop my academic niche, I am pursuing a medical education fellowship at Beth Israel Deaconess Medical Center.

Learn more about SHM and the benefits of membership.

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