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Non-Pharmacological and Natural Treatments for Nerve Pain, Part 1

Can lifestyle changes help with nerve pain? Yes. There is scientific evidence out there showing diet and exercise can lead to a decrease in neuropathy symptoms from diabetes (diabetic neuropathy). 

REJECTED! Why I'm Glad No One Wanted to Hire Me (as an Integrative Medicine Physician).

Through multiple rejections and dead-ends, I finally got on right career path. No one wanted to hire me as an integrative medicine physician, and I'm glad!

No One Said It Would be Easy...

My tablet, laptop, and cell phone were open all at the same time in a desperate online search for a job as an "integrative medicine physician" in early 2015. A diplomate from the now disbanded, American Board of Integrative Holistic Medicine, I had just started my fellowship in Integrative Medicine at the University of Arizona in an effort to legitimize myself as a true integrative medicine practitioner. Naively, I believed back then that if I proved myself to be worthy enough, I could finally land my dream job. 

But, there was only one big problem...I am a SPECIALIST, a specialist in Physical Medicine & Rehabilitation... (known as a Physiatrist)


(Someone please cue the audience of confused looks and the awkward background soundtrack of crickets chirping!)


My search revealed that 80% of the "Integrative Medicine" jobs required board certification in Internal Medicine or Family Medicine. The other 20% wanted additional training in functional medicine or acupuncture. I applied to these jobs anyway, hoping someone would make an exception. No such luck! My cover letters all said the same thing: I was willing to practice primary care, as long as I provided integrative care. Most of the time, I received no response. Sometimes, I received a polite rejection letter. Other times, I received e-mails like this:


"Hi Dr. Zelnik,

I have been asked to find out if you are aware that the position is for an integrative medicine physician with a broad focus rather than as an integrative chronic pain specialist..."

I replied, stating that I was aware of this, and looking forward to discussing more details about the job. 

I never heard from them again.





What exactly is the deal with no jobs out there for integrative specialists? 

My colleagues gave me these answers.


  • Most Integrative Medicine departments and practices are solely dedicated to primary care, and a specialist looking to practice primary care is highly unusual.
  • Academic Integrative Medicine centers were almost all funded through primary care departments, so a physiatrist would simply be out of place. 
  • Private practice physicians looking to go into academics are heavily scrutinized, no matter what position or department they are applying for. 
  • There were departments and practices with integrative specialists, but these connections arose because the specialist was already affiliated with the healthcare institution and had made valuable connections and in-roads to be included within integrative medicine.
  • Integrative medicine departments are already struggling to sustain themselves and adding specialists just puts another big strain on the budget.
After finding out which integrative medicine centers were NOT primary care funded, I set out to work e-mailing the department heads and applying for whatever positions were available. They either weren't hiring or I never heard back from them after submitting the application.

After endless rejection, I really had to manage my feelings of anger to accept that none of this was personal. None of these places I had applied to had even reached out to contact, meet, or interview me. Their whole picture of me was narrow and based on a CV resume that likely never even it made it to a physician's desk. 

Have any other integrative specialists had this experience of feeling shut out? Has anyone felt like they had to jump through infinite obstacles and hoops to get a job doing what they love?



Revelation, Desperation, and Failure

For the rest of 2015, I searched three times weekly for integrative medicine jobs and contacted multiple recruiters. When two jobs came up willing to hire a physiatrist, and I jumped (no, I LEAPED) at the chance to interview. 

The first job was at an established functional medicine practice in the DC metro area. The founder was a class act who was nothing but gracious and kind to me. He knew I had little functional medicine experience but wanted to give me a chance to see if I could find a role within his practice, which primarily treated chronic pain. At the end of two days with him, he and I both could tell I was not ready to let go of some elements of being a specialist. This was truly a revelation for me. After all I had been through, I wasn't ready to leave physiatry behind.

The second job was in Oklahoma. It was to join a newly established private practice integrative chronic pain program and grow it from the ground up. It allowed me to retain my identity as a specialist.  I almost immediately said "Yes!" at the opportunity without asking very many questions. My desperation, unfortunately, blinded my thoughts and actions. My friends, family, and, even my boss at that time, vehemently warned me I was jumping in too fast without getting a proper feel for the practice. But no one could change my mind, and I set out in late 2016 on my hero's (or fool's) journey.


Like a whirl wind romance, the job felt too good to be true, and it was. The integrative pain program was already being phased out, starting just months after I started working there. In the first phase, I was let go.  It was the first time I had actually lost a job. That rejection hurt worse than any past relationship heartbreaks. My spirit and soul felt shattered, empty, and defeated. 
I just moved a thousand miles away from everyone I loved and now was totally devastated and alone. 





Hope

At my darkest moment, there immediately came an offer to continue part time work at a rural tribal community health center. I was later hired full time and spent two years practicing integrative medicine at the center, mostly in the capacity of musculoskeletal medicine and chronic pain management. I never asked for permission, approval, or acceptance to be an integrative physiatrist. In fact, most people did not even know or care what integrative medicine was, let alone physiatry (imagine even more confused looks). They just wanted to work with someone who cared about the community and wanted to make a positive impact.  

The experience allowed me to strengthen my primary care skills and pilot a chronic care management program. During that time, I joined the the Duke University Leadership Program in Integrative Healthcare. My mind expanded and thrived on learning more about business, healthcare management, and leadership. My interests strangely started drifting away from being a life-long integrative medicine clinician and more toward wanting future freedom to take on a larger role in shaping the future of healthcare. I ultimately accepted a position as medical director of an occupational health clinic in 2019. 

Last year, an associate from the Duke leadership program and I were discussing a job interview I had attended in 2018 for a prestigious academic pain management program. The interview went awry when, early in the day, I realized the program was a bad fit and felt embarrassed that I had asked too many pointed questions and openly expressed doubts about the job. However, the truth was that it never was a bad thing to ask really tough questions, especially given my horrible lack of discernment in the past! It was also the right thing to be authentic and not pretend to agree with something that was not my viewpoint, just to feel accepted by the "hot shots" in the field. I laughed, recalling some of the grueling moments of the interview, as the whole experience seemed to instantly transform into something comical, rather than humiliating.  My friend then said "why don't you ask [well-connected colleague] about getting you a REAL integrative medicine job."

I paused a moment, and said, "No, I think I want dream big, be a CEO or something like that." We laughed again at joke of that, but he knew I was serious at some level about forging my own path and being the CEO of my own life and destiny.

Why did I spill out my heart and guts today?

It certainly is not pleasant reliving or rehashing the past. I did not write this to get sympathy or put out a negative blast about the hiring culture of IM. It might be seen as unprofessional  to be so honest and open about my experiences. Writing exactly what's in my heart leaves me quite vulnerable to others' opinions and judgements. 

I ultimately put this out publicly to connect with that one discouraged integrative medicine practitioner out there who is currently struggling to find a job where they can thrive... and practice medicine on their own terms. 


We all have our own path to growing and learning. Rather than envy my colleagues who have seamlessly flowed into amazing integrative medicine positions and dream jobs, I sit still and silent within my heart to honor my experience and let go all my unfulfilled expectations. My career failures will shape but not define me. Tough life lessons were shaping my strength, knowledge, and spirit by fire. 


You will find your niche. My best advice is to be absolutely honest with yourself. What do you want from your career? Is it a way to fund your true passion to be the owner of a yoga retreat center? -OR- Is your current job your actual life's passion? The answer might change your perspective on how you view your current situation and provide a strategy for getting to finally live your passion.


If you feel like everything is going wrong, and you keep trudging uphill in your career, you may be actually be diverging from your true path to fulfillment. 


The most important lesson is to never feel a sense of desperation in your journey. Rejection does not mean that you need to try harder to be someone that you are not or compromise your viewpoint and values just to be hired. Instead, it should force you to be even more outspoken about what you believe in and unapologetic about your unique talents and authenticity. 

Through the countless rejections, I learned more about myself and what I wanted than if I actually had gotten what I had wanted from the beginning. It is tough to see out the other side when you are actually going through adversity, but trust me on this!



Why I am Glad No One Wanted to Hire Me!

On a broader level, I'm glad no one wanted to hire me at an Integrative Medicine Department. Through my studies of healthcare models and theory, I have concluded that Integrative medicine should become part of a whole system of primary care. 


Integrative medicine is primary care. 

Nevertheless, specialist involvement and input is vital in shaping the future of integrative medicine. Specifically, for Physiatry (and Pain Management), we should be at the table, right next to primary care when deciding the best integrative practices for managing disabling conditions and chronic pain. WE WANT AND NEED TO BE INVOLVED


In general, integrative specialists have in depth insight into perplexing medically complex cases, and we absolutely LOVE to share our knowledge and insight. We know the  intricacies of diagnosis and treatment of less commonly seen (and often missed) medical conditions. Our diagnostic vision and instinct allows us to see deep into our patient's stories and find patterns and the outlier clues leading us to the what is hidden underneath. We can formulate outside-the-box treatment plans customized to our patient's needs and resources. We no longer need to follow textbooks, as we are leading the advancement of our field and will write the next chapters and volumes of work for the next generation of medical practitioners. We integrative specialists are in a masterclass of our own. 

Specialists should not be forgotten, but it does not need to be all about us. The focus is on breaking down barriers to collaboration between integrative primary care physicians and specialists by truly seeing each other with a spirit of deep gratitude and professional love. We all have important ideas to improve healthcare and deserve to be heard and included! 
As a team, we can improve our patients' lives and guide them to discovering their own power.









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