Attention mid-career physicians: Let’s find our ikigai [PODCAST]

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“Mid-career colleagues: it’s time to go back to the future.

Time to learn again. Time to build professional and social networks at work. Take a lunch break. Bring home a few fewer RVUs.

I recently started a monthly journal club for our small section of gastroenterologists as a way to recreate some of what I loved about residency. A case conference to discuss difficult cases is next.

While the rewards of these diversions are not quantifiable, they are still valuable.

I hope my colleagues feel the same way. Maybe I’ll throw in some free movie tickets, as well.”

Anish Sheth is a gastroenterologist.

He shares his story and discusses his KevinMD article, “Attention mid-career physicians: Let’s find our ikigai.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Anish Sheth. He is a gastroenterologist, and he wrote the KevinMD article “Attention mid-career physicians: Let’s find our ikigai.” Anish, welcome to the show.

Anish Sheth: Thanks, Kevin. Great to be here.

Kevin Pho: So we’ll get into your article a little bit, but first off, can you share your story and journey to where you are today?

Anish Sheth: Yeah, so I’m a gastroenterologist. I finished training about 12 years ago and do all aspects of gastroenterology here in Princeton, New Jersey, as part of a hospital-based digestive disease center. And I love what I do. I feel blessed to have chosen a field that still, 12 years in, excites me and interests me.

On the side, I also do work with the hospital that I work for dealing with physician wellness. And so we started about a year and a half, two years ago, prior to the pandemic, administering a nine-question validated wellness survey to our physicians. I was responsible for the outreach, the launching of that, and then also data analysis and action steps on the back end based on what the data shows us. And honestly, as I looked at that data and thought about my own career, that’s what really prompted me to get involved and to write the blog that I did.

Kevin Pho: So when it comes to wellness and hospital-based initiatives, was that interest from you, from the physicians, or was it from administration?

Anish Sheth: Yeah, it was from the physicians. So I had been talking to some physicians about this. I sit on the medical executive committee, and it was something that was clearly lacking. We have medical staff dues, and we have funds in the coffer, and I said, “You know what better way to really figure out what we can do to help our medical staff? Let’s start with gathering some data.”

So we use the Well-Being Index, which is a Mayo Clinic-designed, nine-question validated survey that can be completed in about a minute to two minutes on someone’s smartphone. And it’s also a longitudinal survey, right? So it actually helped us through the pandemic to understand what our physicians were feeling, what they needed more of. But it was really a physician-led initiative, and still to this day, it is actually physician-driven here.

Kevin Pho: So from the data from your institution, what were the scores on some of these wellness studies?

Anish Sheth: Yeah, so the higher the score, the higher the level of distress. The Mayo Clinic has done studies looking at this and saying if you have a score greater than three, that is correlated with higher physician burnout, higher levels of dissatisfaction, job dissatisfaction. There’s some correlation, as you get higher on the scale, with things like substance abuse and suicidal ideation, things that get really serious. And so we had some consistent findings from our studies that we use to actually put some measures in place.

One thing we found, which is a trend nationally, is that our OB/GYNs had the highest distress scores. They were actually the only subspecialty that actually averaged above that level of three. And so we formed a task group to look at what that is. Is this something that’s inherent to the specialty? Was there something that the hospital could do, that the medical staff could do, to help improve their quality of life and work-life balance?

But the other thing that really kept popping out from these surveys was the mid-career physician, right? So that’s where I sit. These are folks that graduated medical school between 15 and 24 years ago. This group of physicians consistently had higher levels of distress than our younger colleagues or our sort of later-career colleagues. And to me, that just really never made a lot of sense. And so that’s kind of where I dug in a little bit and thought about my own experience.

Kevin Pho: So you’re describing me as well. I’m about 20 years out of residency. I do primary care internal medicine, so I’m certainly interested in hearing more about your findings and solutions. And you wrote about that in the KevinMD article “Attention mid-career physicians: Let’s find our ikigai.” Now, for those who didn’t get a chance to read that article, can you just walk my audience through it and share the story of why you decided to share it?

Anish Sheth: Yeah, so let me just define ikigai, which is something that I came across in doing some other readings in terms of longevity and happiness, again, separate from medicine practice. But it’s something that the Japanese kind of refer to as the reason for getting up in the morning. It’s sort of that thing that keeps you going, that sustains you, and that keeps you going. And they looked at actually residents of Okinawa, Japan, among the longest-living groups of people in the world. And what they found, in addition to healthy lifestyle and diet, was that many of these individuals, well into their 90s, would actually have sustained and consistent reasons for living, right? So there were karate instructors in their 90s. There were people that did volunteer work.

And what I realized about us is that when you take a step back, Kevin, you look at where we are in our lives, right? So most of us are making reasonable amounts of money, right? We’re making more money, certainly, than we were when we were residents. If we had student loans, many of us have been fortunate enough to pay those off. We’re well established in our communities. Referrals and patients know about us. So it wasn’t obvious to me why our group of physicians would actually have higher levels of distress.

And so when I thought about myself and I thought about the happiest times of my medical career, I actually looked back to my internal medicine residency. Now, I love gastroenterology, but I think what I missed was two things. I missed the fact that every day I got up and I knew my main job was to learn, and that sustains us. And then the second thing was the camaraderie, right? You’re rounding with a team. You’re in conferences with a dozen other medicine residents who are at the same stage of life as you. You’re probably socializing with these people after work a lot more than you do now.

Now, when we do our work, what do we do? We’re pretty much working in isolation. We’re with our patients. We’re in the EMR. We’re meeting with our staff. But I love my colleagues, and when I get a chance to speak with them, I do, but I don’t get that same feel. And I feel like maybe for me and some of the folks I’ve spoken to here, that’s what we’re missing: that ikigai of learning something new, getting excited about trying something different, discussing cases with colleagues. I think we’re missing that part to our medical practice.

Kevin Pho: And I think that brings up a good point, because, as you said, medical practice is now much more siloed. Back when I started, I saw patients in the clinic, and then I’d go to the hospital and nursing home and see inpatients and see nursing home patients. But right now, we have separate physicians doing each of those silos. Like, I just do outpatient medicine. Of course, we have hospitalists, and we have people who just round at nursing homes. So there is definitely a decrease in that camaraderie that we all had during residency.

Anish Sheth: Yeah, and it’s interesting. I was reading an article related to this, which, if you look at what newer hospitals have done with the medical staff lounge. My dad was a physician. I remember being a kid, and he had to round on Saturday, and I’d go into the lounge, and there’d be food. It’d be a huge room. There’d be dozens of doctors sitting around talking about stuff. Most new hospitals that are constructed, the medical staff lounge is tiny. It’s minuscule because, what you just said, there are very few physicians now who go in and out of the hospital. And when they do, they’re time-crunched. So they’re going in, they’re seeing their patients, they’re running back to the office. So this notion of having a space where we can talk medicine, talk about whatever we want to do, get that camaraderie going, that’s really, I think, something we’re missing in our practices.

Kevin Pho: So now that you have the findings from your studies and you brought them to your task force, what happens next?

Anish Sheth: So I think part of it, I’ve taken my own section and said, “What can I do for my own sort of job satisfaction and my gastroenterology colleagues’?” So what I did a few months ago was I started a journal club. We’re a relatively small, community-based practice, but we do a journal club. We do it virtually. We do it one evening every month, and that’s been huge, right? It’s a way to just connect outside of the regular workday, but it’s also a way to stimulate the brain, share thoughts about articles. We’re going to start a case conference soon for our section as well.

And the other things, which I have advocated for, which I have to admit I haven’t done myself because of the RVU world we live in, but part of it is taking a lunch break, right? Not sitting in front of your EMR clicking off tasks as you wolf down your sandwich. Reaching out, getting out of your office, going to the cafeteria, making plans, heaven forbid, to actually have lunch with a colleague. I mean, when was the last time anybody’s actually ever done that?

So I think getting back to some of those things I miss from internal medicine residency, right? My internal medicine residency, we used to sit around at case conference with food for an hour with 12 colleagues, discussing interesting cases with professors. I have none of that right now. And I think trying to get elements of that back in my practice is really one big takeaway for me from this study.

Kevin Pho: Now, how much of that responsibility is on physicians, and how much of that is on the administration, who really controls a lot of the workflow structures, the RVU-based world, as you said? Because if we don’t sit in front of our EMRs during lunch, we just have to sit in front of it at night after we put our kids to bed. So how much of that onus is on individual physicians, and how much of that responsibility should be placed on administration to really change the workflows?

Anish Sheth: That’s a great question. I think we would obviously say it should be a balance of both. In reality, I think people listening to this know that it’s up to us at the end of the day. Like, I have to make a decision about if I’m going to do this for another 20 years and I want to enjoy it and be fulfilled. Maybe I bring home a couple hundred less RVUs a year, and I just have to be willing to do that. And I think in the long run, I’ll probably never miss that, but I think I will miss opportunities to discuss things and to get to know my colleagues better, to meet new providers, to learn, to stimulate the brain. I think those things.

And it’s interesting. As we do these things, this is an ongoing survey for our medical staff. It’ll be interesting to see how well this translates into real job satisfaction and happiness.

Kevin Pho: We’re talking to Anish. He is a gastroenterologist, and he wrote the KevinMD article “Attention mid-career physicians: Let’s find our ikigai.” So you mentioned a few things that physicians can do to help redefine our purpose and maybe help us continue mid-career. But what are some other findings from the studies and from your conversations with colleagues? Any other findings that you want to bring up and solutions that you want to share with my clinician audience listening to this?

Anish Sheth: Yeah, so I think a lot of this we also found in mid-career physicians, but we really found that there’s also a 2x level of distress among our female colleagues as opposed to male physicians. And that was something that we’ve also taken a closer look at. I think part of the mid-career physician burnout, or lack of wellness, is seen on the female side, right? Which is, they have a lot of responsibilities. Let’s face it, right? We have a lot more household responsibilities, child care responsibilities, and we heard that from our medical staff.

And so we are trying to make things easier. We’re trying to supply takeaway meals for physicians who are working in the hospital, trying to provide better child care options, trying to be sensitive to call schedules, sensitive to scheduling meetings in the early mornings or in the evenings, when they may have other responsibilities at home. So I think part of the mid-career story is also better told by looking at the female physician distress scores, which were in fact higher. And this is a stage in life where, like you and I, we both have teenage kids, younger kids, and that sort of translates into greater work-life responsibilities.

Kevin Pho: Now, have you received any pushback from the administrative side when it comes to implementing so many solutions? One of the things that you said is that sometimes physicians have to accept fewer RVUs or maybe work less, and I think those aren’t the things that administrators want to hear. So when you bring up some of these solutions, have you received any pushback from administration?

Anish Sheth: Yeah, so not yet. I actually think our administration is receptive. I think everyone responds to data, and I think they realize in the long run they need to employ physicians who are happy in what they do. And so our administration has actually been very receptive, and we’re actually thinking about, as next steps, what we need to sort of institutionalize to make this something that is thought about when policies are put in place, when compensation packages and contracts are structured. We’re not there yet, but I think we have a captive audience with administration, so we can go to them and say, “Look, this is what we’re doing on our end. This is what you can do to help us.”

Kevin Pho: So you’ve given so many great tips during this conversation. If you were to summarize it as one actionable tip that mid-career physicians should follow in order to find their ikigai, what would that one tip be?

Anish Sheth: Think about the happiest you have been in the practice of your medical career, from medical school to the current day, and figure out why you were happy, and try to incorporate that as much as you can into your daily practice today.

Kevin Pho: And my final question: Do you have any take-home messages you want to leave with the KevinMD audience?

Anish Sheth: Find your ikigai. We love what we do. Just because you’re unhappy and overworked right now, it doesn’t mean that medicine wasn’t the right calling. It’s just, you got to get back to what you enjoyed about it. And like I said, let’s say most of us, thankfully, are going to be OK financially. I don’t think we’re going to look back 20, 30 years from now and say, “You know what? We made 20, 30, 40,000 less than we could have.” I think we’re going to look back and say, “You know what? I was grateful that I could practice this great career for as long as I did.”

So whatever you need to do today to make sure that you’re in it for the long haul, that you can continue to see your patients and do what you want to do, make a change. Do it small. Do it once a month, like I’m doing with journal club. Do it once a week, once a day, whatever you can do, because I think in the long run, we’ll look back and we’ll be thankful.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Anish Sheth: Thanks, Kevin.

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