Wed., Jan. 11, 2017
AltaPointe's Bayview Clinic
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Faculty Advisors to Senior Students
Dr. W. Bogan Brooks, Clerkship Director firstname.lastname@example.org
University of South Alabama School of Medicine Faculty Available for mentoring:
Dr. W. Bogan Brooks, Clerkship Director email@example.com
Dr. Ronald Franks, Chair firstname.lastname@example.org
Dr. Sandra Parker, Vice Chair email@example.com
Dr. Luke Engeriser, Residency Training Director firstname.lastname@example.org
Dr. Edgar Finn, Child & Adolescent Psychiatry Fellowship Director email@example.com
Informal Description of the Clinical Discipline
Adapted from Wright State University School of Medicine
WSU Contributing Members: Brenda Roman, M.D., David Bienenfeld, M.D., Jerald Kay, M.D., Terry Correll, D.O., David Hart, M.D., William Klykylo, M.D., David Bienenfeld, M.D., Jerome Schulte, M.D., Ann Morrison, M.D., Julie Gentile, M.D., Douglas Lehrer, M.D., Nancy Smith, D.O., Paulette Gillig, M.D., PhD,
The field of psychiatry is rich with possibilities, and many rewards for a fulfilling career. General adult psychiatry residency is four years long; with an internship that includes a minimum of 3 months in internal medicine and 2 months in neurology. Sub-specialization options for psychiatry include: child and adolescent psychiatry, forensic psychiatry, geriatric psychiatry, addiction psychiatry, and consultation/liaison psychiatry. Psychiatrists have a wide variety of practice opportunities including, but not limited to the following: inpatient psychiatry, outpatient private practice psychiatry with a focus on psychotherapy, community psychiatry, dual diagnoses of mental illness and addiction or mental illness and developmental disabilities, psychopharmacology and the emerging field of tele-psychiatry. Other psychiatrists may focus on an academic career, whether in undergraduate medical education, residency education or research. Research opportunities include both basic science research and clinical research. More specific information about sub-specialties follows at the end of this document.
The Department of Psychiatry is willing to assist you in any way possible regarding your interest in psychiatry, whether you plan to remain in the area or look at programs elsewhere. As you plan for a career in psychiatry, here are some tips and other resources as you explore psychiatry.
While it is important to do as well as possible on your clinical rotation in psychiatry as well as the other core rotations, it is not essential to receive the top grades. Work hard, read the literature, ask to spend time with residents and faculty, and remain professional in all of your interactions. If you are interested in academic opportunities such as writing an article to be considered for publication or to do some research, please contact your Director of Medical Student Education or Clerkship Director for ideas.
If you are uncertain about your interest, or want to see a side of psychiatry that you did not see during your clerkship, like child and adolescent psychiatry, by all means sign up for an elective. You will likely want to do your elective rather early in your 4th year to solidify your career choice, and possibly to secure a letter of recommendation. Unless you are planning to pursue a very competitive residency program, “audition” electives are not necessary in psychiatry. You will find it helpful to schedule a meeting at the beginning of your 4th year with the residency training director and/or chair of the Department of Psychiatry at your medical school to discuss your interests, including geographical locations of programs that you wish to explore. The national psychiatry interest group, PsychSIGN, also has resources available on their website: http://www.psychsign.org/
You should also join the American Psychiatric Association, which is free to medical students, and has information about careers in psychiatry and applying to residency programs. See: http://www.psychiatry.org/medical-students
Applying to Residency
Once you have decided, with the help of your faculty and academic advisors, which training programs are most likely to be a good fit for you, application out of the senior year of medical school is through the Electronic Residency Application Service (ERAS). In filling out the application, emphasize your accomplishments and activities, including extracurricular involvement. Note any research or publications, of course.
It is best to request at least one of your recommendation letters from a psychiatrist, better to have two. While the application is fairly straightforward, the Personal Statement is truly a blank slate. Use it to define yourself around some standard that makes you stand out from the crowd. It need not be exhaustive; leave the reader wanting to invite you for an interview and discuss your ideas further.
The interview is the centerpiece of the application for psychiatric residency. Be prepared to demonstrate that you have thought clearly about your career decision, and about selecting the programs to which you are applying. Come with questions about the characteristics that define the program, such as its philosophies about teaching and learning and about psychiatric practice. You will have the opportunity to find out from residents and program coordinators about call schedules and other logistical dimensions of the program; save your questions of faculty for the meaty stuff. A good reference article is: Bak et al. "Applying to Psychiatry Residency Programs." Acad Psychiatry. 2006; 30: 239-247.
Comments from a Chair regarding the application process
The application process is undoubtedly anxiety provoking for many. In some ways this process is more critical than application to medical school. Undergraduate medical education, with rare exceptions, is a rather uniform experience for students throughout the country since much of what is taught and how it is taught is mandated by accreditation regulations. What makes the psychiatry residencies unique is often reflected in a program’s philosophical approach to the patient, psychotherapy, teaching commitment, and breadth of clinical experiences. I feel passionately that this is the most exciting time ever to be entering psychiatric training. Scientific advances have brought us increasingly closer to the integration of the neurobiological with the psychosocial and our treatments are exceptionally effective. The exciting aspect of interviewing is the opportunity to meet new faculty and residents from other institutions. These encounters provide you with differing institutional and personal views about American psychiatry which are critical for you to ascertain because they form the ethos and value system of a particular training program.
Comments from a selection committee member
We are looking for individuals who are well rounded in all areas of their life. We like to see determination, focus and an ability to clear all hurdles as they are presented in achieving your academic and career goals. You don't need the highest scores or grades, but it is encouraging for us to see that you can do well enough in the “book work” to take the next step in applying that knowledge in real life clinical scenarios.
In order to maintain an optimal training environment, we seek people who “work and play well” with others knowing that a significant amount of your learning will come from your colleagues. Of course, people skills, empathy, compassion, and a desire to help others are essential.
Comments from a resident
Deciding where to do residency can be a daunting task. Having an idea of what type of program you are looking and where you want to live can be helpful prior to searching. For example, knowing if you are looking for a program strong in psychotherapy, psychopharmacology, research, fellowship opportunities, etc. will be helpful in guiding your decision. One good resource to get started with is FREIDA Online at https://www.ama-assn.org/life-career/search-ama-residency-fellowship-database
This website will allow you to search for programs based on residency and fellowship types as well as their location. In addition, there are usually links provided for each program directing you to their homepage. Other information contained on this site includes salary, benefits, vacation and contact information for each program to help answer any questions you may have.
All programs have their strengths and weaknesses, as the field is so broad that no single program can prepare you for all of the career opportunities in psychiatry. First figure out what specific strengths you want in a program. Research opportunities? Extensive psychotherapy training? Early exposure to child and adolescent psychiatry? Elective opportunities? After you decide on what you want in a program, compile a list of prospective places. Explore programs outside of your geographical interest, as sometimes you may be surprised! Even if you need to stay in a certain area due to personal reasons, it is important to look at other programs.
Interviewing can be rough both emotionally and financially. Go to those places you really are most interested in further exploring. Most people wear down after a while and end up not going to all available interviews. Much debate exists whether to schedule first, middle or last the places you are most interested in. I recommend somewhere in the middle, so you can compare the programs to those before and after.
On the interview day, it is important to meet residents. A red flag should go up if you only get to meet one or two. Attend any possible events/activities that residents are involved with during your interview day/s as this is the best way to see how they interact with each other and with you. The questions below are good to ask. Have an idea of what you want to know about a program before the interview day. My one big piece of advice here would be to ask a well balanced amount of questions. Don’t overly focus on salary or time off, at this will be what you are remembered by when you leave. Lastly, never rank a program you wouldn’t want to go to because you just might end up there.
Interested in Child and Adolescent Psychiatry?
Child and Adolescent Psychiatry (CAP) is the most underserved specialty in medicine as well as one of the most rewarding. CAPs are involved in a wide range of clinical activities with children and families, as well as consultation and administration. To be a CAP means that you have an almost unlimited choice of practice patterns, locations, and lifestyles. The scientific basis of CAP is growing as fast as any area in medicine, informed by molecular biology, imaging, pharmacology, medical epidemiology, outcome research, and advances in psychotherapy. But the most important part is the chance to make a difference in the development of children, adolescents, and their families.
To become a Child and Adolescent Psychiatrist, you would complete a two-year residency (often called a fellowship), usually after three or four years of residency in General Psychiatry. Most residents take begin their training after three years, combining the first year of CAP and the last year of General Psychiatry into a five-year residency; but other arrangements are possible. A CAP residency prepares a psychiatrist for the totality of somatic, psychological, and social interventions required in direct clinical work, as well training psychiatrists to serve as consultants to schools, social agencies, the justice system, and other programs. There are also “Triple Board” programs, which prepare you to be a general psychiatrist, CAP, and pediatrician after five busy years. In any case, all CAPs presently must be board-eligible in general psychiatry. Applicants to general residencies will usually express their interest in CAP when they apply, and apply formally to a CAP program after two years. A fourth-year elective in CAP is certainly not required but may help you to discern and focus your interests. Students interested in CAP should join the American Academy of Child and Adolescent Psychiatry (www.aacap.org) and receive our highly-cited journal, JAACAP.
Interested in Forensic Psychiatry?
Forensic psychiatry is a specialty which encompasses many pursuits. Forensic psychiatrists may focus on criminal determinations such as innocence by reason of insanity, on tort (or liability) cases, on civil determinations such as competency, on issues of child custody, on care of imprisoned offenders, or any of a number of different areas in which the law and psychiatry overlap. Forensic psychiatry appeals to those who are comfortable making stark determinations and testifying to them in public settings. To be eligible for ABPN certification, one must complete a one-year fellowship. There are about forty certified fellowship in the US. Neither fellowship training nor board certification is required for practice, but in any setting involving competing experts, the trained and certified specialist is at an advantage.
Interested in Geriatric Psychiatry?
Demographic patterns guarantee that the elderly will need ever more psychiatric care for the foreseeable future. Advances in the study of dementias and mood disorders of late life make geriatric psychiatry an exciting pursuit. There are about sixty accredited fellowship programs in geriatric psychiatry. Fellowship training is intended for those aiming for academic careers in geriatric psychiatry, and is required for eligibility for ABPN certification in the specialty. Most practitioners who treat the elderly, however, are not fellowship trained and have derived their expertise form special focus in residency and in their practices. Excellent information about careers in geriatric psychiatry is available from the American Association for Geriatric Psychiatry at: http://www.aagponline.org/index.php?src=gendocs&ref=CareersGeriatricPsychiatry&category=Main
Interested in Consultation/Liaison Psychiatry?
Consultation-Liaison Psychiatry/ Psychosomatic Medicine is an exciting subspecialty of psychiatry where the psychiatrist combines knowledge of psychiatry, internal medicine and the other specialties taught in medical school to evaluate complicated patients with psychiatric symptoms in the general hospital setting. “Consults” are often seen on an emergency basis at the request of the treating physician, and are usually seen on inpatient medical and surgical wards, in the emergency room, or in outpatient medical or surgical clinics. Typically the reason for evaluation is suicidality or suicide attempt, depression, confusion, or capacity for medical decision making. Also, psychiatric consultation is performed in specialty clinics or for a special “situations.” For example, a psychiatric evaluation is usually required prior to organ transplantation or flying in outer space. Specialty areas of consultation include hematology/oncology, burn units, as well as, working for the CIA, FBI, NASA or a branch of the military such as flight evaluation for the Air Force, evaluation for submarine duty for the Navy, as well as evaluating candidates for Special Forces. Consultation psychiatrists are usually employed at major medical centers, University teaching programs, or by the government, but may also have a “private practice,” working with multiple medical groups on an outpatient basis.
To become board certified in consultation psychiatry one must successfully complete one year of ACGME-accredited fellowship training in psychosomatic medicine. A useful website for more information on Consultation-Liaison Psychiatry/ Psychosomatic Medicine is the Academy of Psychosomatic Medicine at http://www.apm.org.
Interested in Addiction Psychiatry and Co-occurring addictions/mental illness?
Through any career path, be it child or adult, you will see patients with addictions. Knowing how to recognize and manage addictions will be a valuable part of your training. As a part of the general psychiatry residency, you will be exposed to addiction psychiatry as a rotation generally within the first two years. Should you desire further training you can complete a fellowship in addiction psychiatry which is a board certified subspecialty you can complete after your adult psychiatry training. It is a one year program, and there are currently forty three programs nationwide, with two being in Ohio. Addiction psychiatrists work in many settings and can see a wide variety of patients.
A nice resource for more information can be found at www.aaap.org. This is the website for the American Academy of Addiction Psychiatry (AAAP). This website contains a wealth of knowledge including knowledge specific to medical students and residents. There are national meetings and other educational opportunities available as well.
Interested in Community Psychiatry?
Imagine being able to help people survive a life-threatening illness which strikes them just as they are becoming independent young adults, shaping their own their lives. People living with schizophrenia and other severe mental illnesses in our communities face daily challenges both in periods of crises and stability. Psychiatrists with an in depth understanding of these diseases and willingness to work with individuals with severe mental disorders and their families can help make the difference between hope and demoralization.
The life-long nature of many of these illnesses provides an opportunity to work with patients and families for years and sometimes decades. The challenge of being able to use all of ones skills including the therapeutic alliance, pharmacologic knowledge, community resources and even common sense make community psychiatry rewarding. Additionally, the complex nature of these illnesses and the individuals’ needs to be able to successfully live in their homes involves many other professionals. This allows the psychiatrist the bonus of being able to work with a team, to not feel isolated or unduly burdened with all of the problems that can arise. While the work day may be busy and full it is virtually never dull. In short, community psychiatry, changes lives—yours and your patients and their families!
Interested in developmental disorders/mental illness?
Individuals with intellectual and developmental disabilities (DD) comprise ~1-3 % of the U.S. population, and so patients with co-occurring mental illness and developmental disabilities will be integrated into nearly every mental health care delivery system. Patients with dual diagnosis (mental illness/intellectual disabilities) often present with communication difficulties and behavioral issues; this specialized patient population also commonly has undiagnosed and untreated medical conditions which can be screened for by psychiatrists. The psychiatrist plays a vital role in the medical care of dual diagnosis patients since they will frequently be referred for mental health assessment for these behavioral presentations of medical issues. The Wright State University Department of Psychiatry offers a Dual Diagnosis curriculum including didactics and clinical practice sites where residents in training can gain exposure to this patient population. There are only a handful of residency training programs in the U.S. who can offer this experience, and it continues to grow and be a popular site for resident training.
Interested in a research career?
The National Institutes of Health (NIH) spent over $30 Billion during the last fiscal year with almost 10% of those funds going to psychiatric, psychological, and addiction-related research through the National Institute(s) of Mental Health (NIMH), Drug Abuse (NIDA), and Alcohol Abuse and Alcoholism (NIAAA). Additional funding from the states, National Science Foundation (NSF), American Psychiatric Association and other professional societies, private foundations, and other sources add millions of dollars each year to the struggle to solve the dilemma and tragedy of mental suffering. A substantial proportion of these funds (for example, ~10% of the NIMH budget) directly supports training -- including research career development.
Several WSU Department of Psychiatry faculty are involved in clinical psychiatry research and welcome interested trainees. Time and scope of participation is generally flexible depending on the trainee’s interests and career goals. For residents with an interest in making research an integral part of a career, we have had success in obtaining external funding to help the individual get started. Each resident’s chosen mentor can help the resident focus interests, design a small pilot study (or get involved in a larger existing project), achieve the study objectives and move the results to a publication and/or meeting presentation. Such opportunities during training can help the resident decide whether they want to make research part of their future, either as a principle career direction or as a gratifying addition to a clinical career.
Interested in college mental health?
College mental health offers outstanding opportunities to help students during one of the most pivotal times in their lives. Today's college students are increasingly diverse and presenting with a myriad of needs to include multicultural and gender issues, career and developmental issues, life transitions, stress, substance abuse, suicidal behavior, violence, and serious psychological problems. Clearly, there is a shift towards more severe presentations in college mental health centers than ever before. Many students are coming to college with an extensive prior psychiatric history and already taking psychiatric medications. This makes for an exciting place to practice psychiatry with students who are motivated to learn and grow in all aspects of life.
Free public information about mental health issues for college students and others is available on APA's consumer Web site at http://apahealthyminds.blogspot.com/.
Interested in advanced psychotherapy training/psychoanalysis?
In addition to the biological and pharmacological understanding and treatment of the patient, WSU Department of Psychiatry has a rich tradition of training residents in the practice of psychotherapy. Psychotherapy helps to address patients' concerns about problematic areas of their lives. These might include interpersonal conflicts, personal unhappiness, conflicts at work, difficulty in relationships, loss issues, or traumatic experiences. With treatment, patients are able to work through problems and gain a better understanding of themselves and their interactions with others in their lives. Through the Psychotherapy Clinic, residents receive training in individual, group, family and child psychotherapy. Sigmund Freud was the founder of Psychoanalysis which has evolved over time. Today there are many schools of psychotherapy theory and practice. For those who are seeking a longer and deeper experience, psychoanalysis remains a viable choice. Many of the Psychoanalytic Institutes across the country offer fully psychoanalytic training and shorter programs for certificates in advanced psychotherapy.
Learning and practicing psychotherapy is a valuable undertaking. It is a uniquely rewarding experience in which we see patients change and grow in their efforts to overcome psychological obstacles. WSU residents meet weekly with experienced psychotherapy supervisors in addition to receiving classroom didactics which emphasize history, theory and practice. Empathic listening and understanding of our patients enhance skills not only used in psychotherapy but in all areas of medicine.
Interested in rural and underserved populations in psychiatry?
A few psychiatry residencies, including Wright State, offer opportunities to work with patients who live in rural areas, or who are otherwise "underserved" (e.g. inner city populations, working-poor families, Native American persons etc.). These sites have become quite popular with our residents during the Community Psychiatry rotation and for electives, because the residents enjoy exposure to people from other cultural backgrounds, and also because the patients deeply appreciate the care they obtain from the residents. In addition, I think you can learn the most about providing evidence-based treatment when you work in an environment where resources are scarce, because you have to think very hard about what you are going to spend your money on, and in what order. There is a broad differential diagnosis (including organic causes for mental status changes) for any given patient you will see, in part because often no one else has examined the patient and figured out what is going on and also because most of these patients have many concurrent physical ailments. These facts immediately impose upon you the responsibility to order the appropriate laboratory studies and not order inappropriate studies, weigh risks and benefits of any treatment carefully, determine patient acuity at every appointment, and become aware of the training and competence of all of the other members of the treatment team. These team members will seek out and act on your advice about differential diagnosis, the interface with primary care providers, medication side effects, prognosis, and case formulations.
If you decide to work in a rural or underserved area after graduation, you will become a respected and trusted professional in that community, and you will never be forgotten by the people there (for better or worse). You sometimes can obtain student-loan repayment if you work in such an area after you finish residency, with some up to about $100,000. Please see the AAMC Financial Aid site for more details: students-residents.aamc.org/financial-aid/
Suggested Application Timeline* from Bak et al. "Applying to Psychiatry Residency Programs." Acad. Psychiatry. 2006; 30: 239-247
• Plan fourth-year schedules with faculty advisors (assuming fourth year electives start in July; some schools start earlier, requiring earlier planning)
• If considering externships at outside institutions, request applications
Start reviewing FREIDA and program websites
• Residencies: Update program’s website and brochures
• Obtain application photograph
• ERAS website opens; applicants may begin working on applications (around July 1)
• Residencies: Graduation and welcome new PGY1 residents; review externship application
• Request letters of recommendation not obtained during the third year clerkships
• Begin writing and editing personal statements
• Registration opens for NRMP (around August)
• ACGME accredited programs on ERAS begin accepting applications (around September)
• Residencies: Prepare for NRMP and ERAS; review externship applications
• Begin scheduling interviews
• Complete fourth-year psychiatry electives by November, if possible
• Residencies: Download applications from ERAS and invite a few applicants to interview; others will only be invited after the MSPE is reviewed.
• MSPEs are released (around November 1)
• Check that all application documents are available on ERAS
• Continue the interview process and maintain communication with programs of interest
• Applicant registration deadline for NRMP (around December 1) (late registration fee after deadline)
• Residencies: Review MSPEs and put applications into categories (invite for interview, wait list for invitation, and reject). Send out bulk of invitations and schedule interviews as applicants respond. Some programs will start preliminary ranking and give feedback
to applicants at some interval after the interview.
• Complete last interviews; send thank you notes to training directors and others (optional)
• Consider a ‘‘second-look’’ at top residency choices
• Consider sending follow-up communications to training directors of top interest programs
• Applicants and programs may begin entering rank list on NRMP website (around mid-January)
• Residencies: Invite back some applicants if it is felt that the applicant or the program needs more information (these are not necessarily the top applicants). Some programs will invite top applicants for a dinner to ‘‘wine and dine’’, but many programs do not subscribe to this.
• NRMP late registration deadline and deadline for applicants to certify their rank order lists (around mid-February) (NRMP staff will be available to answer questions during the final deadline hours)
• Status of applicant as matched or unmatched is released (around mid-March, 3 days before Match Day)
• Scramble for unfilled positions if applicant failed to match (around mid-March, 2 days before Match Day)
• NRMP match results are available (Match Day, around mid-March)
• Residencies: Formulate and submit rank list. Program(s) may or may not choose to let some applicants know how they anticipate ranking them.
* The activities of the residencies have been added alongside the student timeline for a contrasting perspective.
Sample questions asked of applicants
• Describe your strengths and weaknesses.
• When, why, and how did you decide on going into psychiatry?
• Describe your experience during your psychiatry rotations. If you did not receive the top grade, why not?
• Describe an interesting case you have seen. What did you learn from this case?
• Describe your educational history. Are there any gaps in your education? Were there any disruptions due to sickness, family illness, academic problems, disciplinary actions, or the like?
• Explain any unusual information in your application, personal statement, Medical Student Performance Evaluation, recommendations, transcript, and test scores.
• Why did you choose the college and medical school you attended?
• What are the best methods by which you learn?
• What are the important factors you are considering in psychiatry training, and why do you think our program would be a good fit?
• How did you first learn about our program?
• Are you interested in pursuing fellowship training after residency? Do you want to leave after PGY3 for a child and adolescent psychiatry fellowship?
• What career plans do you currently envision?
• Which geographic areas are you considering?
• What questions do you have regarding our program?
Sample questions applicants ask of faculty or training directors
• What do you see as the program’s strengths and weaknesses?
• What are the qualities of the residents who thrive in this program?
• How do the residents perform on the PRITE exam and psychiatry board exams?
• What do your residents do after graduation? What percentages pursue fellowships, academics, and private practice?
• What is the evaluation process for the residents and the program?
• What is the balance between psychopharmacology and psychotherapy training?
• How many hours per week of psychotherapy supervision do residents receive, and how is this organized?
• What are the research and teaching activities for residents? Are they required?
• What is the diagnostic, socioeconomic, and ethnic mix of the patient population?
• What are the affiliated hospitals in which residents work, and how close are they?
• What is the variety of clinical settings in which residents will be exposed? How much time is spent doing inpatient versus outpatient work?
• May I have a list of the didactic seminars and elective rotations?
• Which medical schools and colleges did your residents attend?
• Do residents get an allowance for buying books and attending conferences?
• Are modifications of the program likely; will there be changes in the psychiatry department or medical center that will impact the program?
Sample questions applicants ask of residents
• What do you think are the program’s strengths and weaknesses?
• Which other programs did you seriously consider?; Why and how did you rank this program?
• Do you have any misgivings about your matching here?
• What is the culture among the residents, and what is their relationship amongst themselves and with the faculty?
• Have residents left the program? What do residents do after they graduate?
• How much autonomy and oversight do residents have when making clinical decisions?
• What are the on-call requirements, and what is that experience like?
• How do you feel about the case conferences? Grand rounds? Elective rotations? Didactics? Is didactic time protected from clinical duties?
• Do you have a resident process or support group? When is it and is this time protected?
• How diverse is your clinical work and patient mix?
• What type and how much psychotherapy exposure and supervision do you get?
• Have adjustments been made in response to residents’ complaints regarding didactics or rotations?
• Do residents engage in moonlighting jobs?
• Where do residents live, and what are typical housing costs?
• How are the accommodations (library, cafeteria, and sleeping rooms)?
• Do residents have enough free time to continue doing the things they enjoy?
Characteristics to Consider in Evaluating Training Programs
• Balance of training in psychotherapy, psychopharmacology, and social psychiatry
• Training in various clinical settings (e.g., forensic, student mental health, community) and health delivery systems (e.g., public sector, private hospital, academic, managed care)
• Quality of psychotherapy training and supervision
• Research opportunities
• Administrative and teaching opportunities
• Patient population
• Program size
• Teaching faculty quality and diversity
• Residents’ quality, diversity, and background
• Residents’ post-graduate career paths
• Residency culture, morale, and quality of life
• Residency director’s commitment to education
• Salary and other benefits
• On-call schedule
• Moonlighting opportunities
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