Rohit Marawar M.D. 🧠
@rohitmarawar
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Sharing practical knowledge & wisdom not taught in academia | Neurology | Epilepsy | Asso Professor | Physician-Creator | #AcademicPhysicianLife | IMG Journey |
Wayne State University Detroit
Joined November 2008
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A Doctor’s Financial Reflections on Residency
If I could hop in a time machine, here's how I would fine-tune my financial decisions during my residency years to build a stronger foundation for the future:
📉Keep housing costs low
Aim to spend less than 25% of my gross income
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12 Principles for rounding and case presentations for medical students,
residents, and attendings who are forever residents at heart
#medtwitter
#neurotwitter
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Pathway to Green Card via J-1 Waiver Job
#medtwittter
#neurotwitter
#IMG
These are the steps in chronological order 👇🏼
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ChatGPT could be of enormous benefit to physicians.
However, there are serious ethical considerations.
A 🧵 with examples of AI-generated:
• Letter to insurance
• Personal statement
• Letter of recommendation
• Patient educational letter
• Review article
& much more
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The best thing about being an attending?
You can ask medical students and residents only those questions you know the answers to. 😅
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#Match2022
is done.
Now, what if you did not match?
First recommendation: Take a break.
No, seriously!
(Note: this thread is not about unfairness, doctor shortage, etc. Enough people are talking about it)
🧵
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Not all seizures with staring are absence.
In fact, it’s highly unlikely that an adult with new onsets staring seizures has absence seiziures.
They are likely having focal seizures with impaired awareness (complex partial).
It’s ok to just describe the seizure.
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A note to trainees:
Please don’t say “Sorry to bother you” when you call/text/page/email an attending with a patient-related concern.
It is your right, your job, your responsibility and good for patient care. Don’t apologize for it.
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Let's talk about the "Arrival Fallacy."
Many of us feel it, acknowledge it but don't know what to call it.
A common phenomenon seen in high achieving professionals - physicians, scientists, PhDs, and even athletes.
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@VibhaNarayanan
@AcademicChatter
@OpenAcademics
It’s called arrival fallacy. We expect to feel a sense of accomplishment but does not happen.
It’s a common phenomenon.
I felt the same when I started practicing medicine after being in training for 14 years.
To rephrase - Is this it?
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The Unwritten Rules of Mentor-Mentee Relationship
There's no rulebook 📗for mentor-mentee relationships.
I have been a mentee and a mentor.
These are the lessons I have learned over the last 15 years:
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If you are a resident / fellow on J1 visa, this is a great resource for finding J1 waiver jobs
3rnet(dot)org
It has a large repository of rural and underserved area jobs.
They send you daily emails with job postings.
I found my waiver job on it many years ago.
#IMGs
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Match Day is one of the most important days in a physician's life
As we approach
#Matchday2022
, I tell the story of my experience of this fateful day
My most personal essay for
#ship30for30
20/30
#medtwitter
#neurotwitter
#proudimg
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First day of medical school: This is it!
First day of residency: This is it!
First day of independent practice: This is it!
Hundreth day of independent practice: Is this it?
Not a cynical tweet, but a reality for some.
#academicphysicianlife
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Feb 14 is International
#epilepsy
day
65 million people on 🌍 have epilepsy
We have come a long way in epilepsy care but still have a long way to go
Major developments in clinical epilepsy in the last 10 years & aspirations for the next 10
#EpilepsyAwareness
A thread 🧵
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2021 marked the first change in 20 years in how we billed for OUTPATIENT visits
7 major changes in the new OUTPATIENT BILLING guidelines follow.
A
#tweetorial
that literally makes you money 💵
#medtwitter
#neurotwitter
1/
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A friendly reminder to residents and fellows that if you are starting a J1-WAIVER job in Jul 2024, NOW is the time to start looking for those jobs.
The goal should be to have the final contract signed and in hand a year before (Jul 2023) the start date.
#MedTwitter
#IMG
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Start to finish in 15 min. I would call that a win!
12/30
#ship30for30
#academicphysicianlife
#AcademicChatter
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A note about first-opinion and second-opinion physicians:
Physicians who provide the first medical opinion aren't acknowledged as much as they should be.
They're the ones compiling extensive patient information, interpreting it, ordering the initial tests, and starting the
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I first became a dad during the (relatively) cushy life of an attending.
Now I have all the respect and admiration in the world for physicians (& their significant others) who have kids during residency and fellowship, especially women.
I don’t how you folks do it. You rock!
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Just because you are in academic medicine doesn’t mean that you should provide every service for free.
If you don’t value your work, no one else will.
Undervaluing yourself is a recipe for burnout.
#academicphysicianlife
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Non-compliance ❌
Non-adherence ✅
I saw a young adult with epilepsy in clinic for first visit.
The seizure frequency was once every 2-3 months. It always occurred when he missed medications. He was labeled “non-compliant”
The dose missed was always the night time dose
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What can International Medical Graduates on J-1 visas do for a smooth transition to the first job and beyond
Super niche thread for
#ship30for30
15/30
#proudIMG
@ECFMG_IMG
@AANMember
@DetroitNeurons
I have experienced the convoluted pathway of J-1 waiver. Some tips 👇🏼🧵
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@VnVrinda
@PhDVoice
@ThePhDPlace
@PhD_Genie
@OpenAcademics
This is great, especially the roadmap.
I also like to do something I call "Abolish the Thank you slide".
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Programs that don’t take IMGs:
This is what you are missing out on! 😂
#Match2024
This incredibly sincere white guy trying Indian food for the very first time and having his mind blown is so wholesome
4K
20K
274K
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Dunning-Kruger Effect in Medicine
All of us have experienced this in medicine and in life.
Confidence and knowledge are not a straight line but rather sinusoidal.
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Hot take:
The term “IMG friendly” program suggests a unidirectional benefit.
The fact is “IMG friendly” programs are as much dependent on IMGs to function and survive as the IMGs on them.
So maybe a better term is
“IMG Co-dependent” program 🎤 🫳
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40% of neurology residency is recommending to treat altered mental status by repleting electrolytes 😁
#neurotwitter
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Altered mental status is the commonest consult reason in Neurology
I cannot stress how often the cause is Iatrogenic
Specifically, medications
Check:
• Outpatient meds
• Inpatient standing meds
• PRN meds
Every. Single. Time.
#medtwitter
#neurotwitter
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I am doing a grand rounds on “Leveraging social media for professional growth”
Twitter has had an enormous positive impact on me
I would love to include real-life examples in my talk
#Medtwitter
- How has Twitter (or other social media) impacted your professional growth?
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1/ 🎉 Excited to be attending AAN2023
#AANAM
! 🧠
As a conference-goer since 2009, I've picked up a few tricks for using Twitter effectively during these events.
Want in? Here's a thread to make your conference tweeting game 💯🔥.
@AANmember
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As we approach the half-way mark of the academic year, it is a good time to remind ourselves of the Dunning-Krueger effect.
#academicphysicianlife
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14 pieces of advice for a New Attending
OR
What I wish I knew when I first became an attending
#medtwitter
#neurotwitter
#academicphysicianlife
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What do you call a community of insecure overachievers?
Academia
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6 years ago, I transitioned from private to academic practice.
It was a different world.
Teaching & mentoring residents was gratifying.
However, professionally, I was lost.
This is the advice no one gives when you start your academic career:
#academicphysicianlife
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@pnatarajanmd
Agree 💯
@pnatarajanmd
. Unfortunately not something that is taught to us. I explored the unwritten rule of mentor-mentee relationship in a recent post and was very similar. Great minds 😊
I explore the Unwritten Rules of Mentor-Mentee Relationship.
#ship30for30
19/30
#medtwitter
#neurotwitter
#academicphysicianlife
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I have spent the last ten years taking care of people with
#epilepsy
These are my ten random honest thoughts about
#epilepsy
and
#seizures
@AANmember
@AmEpilepsySoc
@EpilepsyFdn
@MIEpilepsy
@epilepsysociety
@epilepsyaction
#endepilepsy
#epilepsyawarenes
#ship30for30
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What is a common clinical practice that drives you crazy?
I will start -
😠 Ordering "routine" antiepileptic drug levels without a clear reason
😡 Making unwarranted changes to doses based on these unwarranted levels
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The J1 visa and two year home requirement is much more complex than I thought.
Here’s a flowchart that might be useful to some.
Two major things I did not know -
1. It is subject to home country
2. Even research/scholar J1 visas can have the 2 year rule
(Source: visalaw)
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@TessaRDavis
This is great advice. Agree 💯. I am a big proponent of planning the ending. I call it “Abolish the Thank you slide”
@VnVrinda
@PhDVoice
@ThePhDPlace
@PhD_Genie
@OpenAcademics
This is great, especially the roadmap.
I also like to do something I call "Abolish the Thank you slide".
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#ChatGPT
can be an excellent "Teaching Assistant" for educators.
But most are not aware of its true potential.
Here's how to use it correctly in your teaching plans and unlock its true potential.
#MedTwitter
#AcademicTwitter
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#Match2024
Applicants, sometimes it might seem like Program Directors and others reviewing your applications are on opposite sides of the battlefield.
But that is not true. Everyone involved only has one aim: a bright future for you and the program.
We're all on the same side,
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@MohitHarshMD
Love it!
Double love that there were neurological symptoms in all. History still rules in neurology.
Triple love that you canceled the MRI. I could give you a hug 😀
Plugging my history thread here
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Created this neurologist GPT on ChatGPT
Name: Doc Cortex
Goal: Educate with a humorous twist
Go ahead...ask it any neurology question.
Let me know what you think.
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It has been heartbreaking to see on
#medtwitter
the stories of scores of people going unmatched.
But it does not have to be this way
But hardly anyone is offering solutions
Simple changes to the medical education system can help our doctors & our patients.
An op-ed thread
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A careful curation of the best tweets from July 2022 embracing the different aspects of
#academicphysicianlife
Clinical Work
Teaching
Research
Admin
Life
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#Match2023
When requesting a letter of recommendation, make every effort to send your personal statement to the letter writer in addition to the CV.
The writer may only know you professionally and for a short period of time.
They need to know your story.
1/
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Resident continuity clinic frequently takes a backseat to inpatient acute medicine.
Outpatient clinic can occasionally be frustrating but is vital for training.
Some thoughts to make the outpatient experience more meaningful for the residents (& the attending)
🧵
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Medieval artifacts we still use in healthcare:
Fax
Pagers
Paper charts
Internet Explorer
What are others?
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Who is a good mentor?
• provides honest advice based on available information
• has your best interest in mind
• gives your perspective that your blind followers won't
• has your back but also knows when to admonish you
A mentor is also human; they are allowed to be wrong.
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@neurogenicpoet
This is a great framework and speaks to the truth that we all experience as we move further in our career.
I also like this somewhat similar framework
Dunning-Kruger Effect in Medicine
All of us have experienced this in medicine and in life.
Confidence and knowledge are not a straight line but rather sinusoidal.
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12 Essential Non-Medical Books for Medical Students, Residents, and Faculty for Thriving Professionally and Personally. A thread 👇🏽
18/30
#ship30for30
Comment below what you would consider an essential non-medical book
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Oct 1 marks my 6 years of being in academia.
These years have had many memorable moments punctuated by frustrations and failures.
Knowing these 6 concepts of academia earlier would have saved me a lot of frustration.
#medtwitter
#academictwitter
#academicphysicianlife
🧵
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7 of my absolute favorite 🎙️ podcast 🎙️episodes from 2022.
Staying true to my purpose here, these provide valuable knowledge about the "soft skills" of
#academicphysicianlife
.
Plus, they are just nerdy fun
I hope you find them enjoyable and learn as much as I did
#medtwitter
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There are many ways to “hack” looking at the camera:
1. Put a sticky note near the camera reminding yourself
If this is not enough…(for me it’s not)
2. Move the window of your own video as close to the camera as possible without blocking the other person’s face. This helps if
#Match2024
virtual interview tip:
Look 👏🏽 at 👏🏽 the 👏🏽 camera👏🏽. Not the screen when talking.
Emulates eye contact!
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Flying to and from conferences is a productivity super hack.
Best time to write/edit/revise that dreaded manuscript.
Laptop charged ✅
Noise-canceling headphones ✅
Caffeine ✅
Motivation ✅
Cramped Seat ✅
#AES2022
@AmEpilepsySoc
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I explore the Unwritten Rules of Mentor-Mentee Relationship.
#ship30for30
19/30
#medtwitter
#neurotwitter
#academicphysicianlife
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I have 1.8 million views on my tweets in 8 mon
A 3% engagement rate means 54,000 people have interacted with my tweet in some way
No matter how many talks I give or research I publish in my lifetime, I can never match this impact.
This is the power of scaling via social media
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@Brandon_Beaber
The vascular imaging clearly shows “puff of smoke” pattern of Moya-Moya.
MS is a “lazy” diagnosis for white matter changes.
I recently diagnosed 5 patients of same family with CADASIL. They had been treated for MS for 5-20 years.
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I have been coming to
#AES2022
since 2009 when I was still learning to spell levetiracetam as a PGY-3.
So many learnings along the way about how to optimize (any) conference experience.
I will be adding these tips to this thread over the next 3 days.
@AmEpilepsySoc
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Sharing a heartfelt post from my wife's Instagram
When it comes to patient-centered care, my wife is my inspiration ❤️
Happy National (All) Doctor’s Day
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Random Unsolicited Personal Finance Advice for Physicians in Training - More Bang for Buck than Medical School Loans
Tried to play around with emojis. Not sure how it turned out
11/30
#ship30for30
@WCInvestor
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@SadiqNaveed
The prevalence of neurological illnesses in neurology applicants and their family members is more than the general population.
The difference is statistically significant.
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Fact: IMGs are indecisive about contributing to retirement plans.
As an IMG, I spent many years overlooking the opportunity to contribute to employer-sponsored 401K/403b accounts.
Initially, my hesitation stemmed from the uncertainty surrounding my stay in the U.S. I wondered,
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I am a big proponent of narrative Assessment and Plan in residency.
Narrative writing clears thinking and improves reasoning.
It should include “why” and “why not” a particular diagnosis is possible.
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I don’t understand how
#psychtwitter
or any specialty can talk about “holistic” approach to applications and not give
@awsumpowers
a chance. 😡
You can create a podcast helping 1000+ trainees - highlighted on Medscape, create support groups, be a speaker on (inter)national forums, get published, complete TY residency, be a great intern, not fail any board & still end up
#unmatchedMD
in psych. Maybe tad bit bitter today.
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Summary:
1. J-1 waiver job on H1b
2. I-140
3. Complete 3 years of J1-waiver job
4. I-485 / EAD and AP
6. GC
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Now, everyone gets started on Keppra (Levetiracetam)
There is little consideration for worsening anxiety & depression, change in personality, and irritability.
A change in medications does not mean a change in risk.
Every medication has its own risk.
Choose wisely!
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10 years ago, around the same time, I started my first job.
The independence was euphoric, the money life-saving.
Next one year I learned more than the four years of residency.
Uptodate became my confidant, my advisor, my mentor.
I got few things right, some things wrong
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You know what is more challenging than starting intern year?
The transition from junior resident to senior resident!
This was my personal experience and the experience of many residents I spoke to
How to win at this challenge: (in collaboration w/
@JayKinariwala
@MihirKakara
)
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@Dr_Oubre
As you proceed to listen and present each aspect of the presentation, the number of differential diagnoses should narrow down.
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Doximity has released its version of GPT: DoximityGPT
This has potential to be helpful until GPTs are seamlessly integrated with EMRs.
Access it here:
Walkthrough with video and my impressions:
• Start writing a natural language prompt. Here I write a
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1. Visa for employment in a J1-waiver job : H1b
Sponsored by employer
3-year commitment to working in a “healthcare underserved area”
Pro tip: the physician contract should state that the employer will sponsor a green card and start the process during the 3-year employment
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@DrKentris
@DrAlrahmani
This was a major part of my talk last week 😀
Suggestions:
• We should absolutely do it. Building a social media portfolio takes time and effort, and we should be rewarded.
• Putting more eyes on more CVs that have social media scholarship is the only way to make P&T
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@DocDifferently
It’s clear that he did not have any real life experience or maybe something more sinister
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How to accurately bill half of your outpatient visits (without thinking).
Case-based scenarios 🧵
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Most happy and proud physicians I know have a major source of happiness outside their job.
This source will make a shitty job bearable, a bearable job great, and a great job fantastic.
I have never known any happy physician who had a fantastic job and a shitty personal life.
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#Match2023
is officially in the books! 🎉👏
But hold up...the
#ERAShow
never stops!
With only 6⃣ months until
#Match2024
interviews, the clock is ticking! ⏳
It's time to level up your application game:
Your best ROI is in:
📝 Crafting a compelling personal statement
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How a Daily Writing Habit in Academic Researchers can Improve Well-Being and Increase Productivity
Why should an academic researcher develop a daily writing habit?
A daily writing habit can be transformational.
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The personal statement is one of the hardest parts of the residency application.
But it also provides the best return on investment.
The most challenging part of writing the personal statement is the ZERO DRAFT.
How to create and grow a ZERO DRAFT for YOUR Personal Statement:
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10/10 - The goal is always seizure freedom with the least amount of side effects. Do not be satisfied by occasional seizures, and do not let your physician be satisfied by occasional seizures. You deserve better! Request a different or a higher level of care.
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Fantastic to meet this group of people
#IRL
doing great work for IMGs and residency training.
@TheNewANA1
@AMahajanMD
@drdangayach
@EricaSchuyler
Dr. Imana Naqvi
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@obstatsinc
@IshanGargMD
I don't think that is universally true. When I review residency applications, personal statements are one of the most important aspects of the application for me.
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Think 10 times before ordering that unnecessary test as an attending.
While it might seem "just "another test," remember that you are being observed and modeled.
The trainees will practice that lifelong as independent physicians.
That 1 test = thousands of unnecessary tests
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@awsumpowers
@ProjectImg
@StoriesImg
@IMG_Advocate
@ImgJourney
I was on J1 visa during residency & fellowship, did 3 years of private practice as J1 waiver job and currently in academic practice. I am happy to provide my perspective and answer any questions I can
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Navigating
#Match2024
and
#Match2025
Expenses Wisely
Recently, a post popped up about the best credit card to use for
#Match2024
applications. The original question was genuine, but the responses were alarming. People were hyping up "lounge benefits" and "Uber credits" as
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Whether you are presenting to the attending or calling in a consult,
it is your responsibility to convince
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A communication pearl.
I also see this in personal statements.
❌ epileptic patient
✅ patient with epilepsy
❌ psychotic patient
✅patient with psychosis
A patient is more than the disease they have.
#TipsForNewDocs
Might seem like a small thing, but get in the habit of referring to pts with diseases, not diseased pts.
Wrong: "the gallbladder in room 352"
Right: "pt with cholecystitis"
The pt may have a disease, but the disease does not define the pt.
#kittlesonrules
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@MohitHarshMD
Anti seizure medication levels.
The levels are a “reference range” not “therapeutic level”
The reference range is a population measure. Therapeutic level is specific to that patient
Patients can have seizure control or side effects below the “therapeutic level.”
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Dizziness has to be the most frustrating symptom.
For the patient AND for the neurologist.
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Do you know why residents are called residents?
In honor of
#ThankAResidentDay
#MedEd
#Medtwitter
A brief history of residency and major milestones:
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@joshmcgoo
As a fellowship director, IMO not much value in publishing case report for improving CV.
Reasonable to present as posters at conferences.
It’s getting difficult to publish case reports for free ( I don’t count Cureus).
A strong reason to publish: cases are really unique.
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Current adult neurology PGY2s - would love to meet you at
#AAN2023
and chat about epilepsy and CNP fellowships. Coffee is on me.
Feel free to DM via Twitter or AAN app. I will be checking regularly.
#AANAM
#neurotwitter
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1/10 - The worst thing about epilepsy is that seizures are unpredictable.
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