Burnout follows from physician to wellness director [PODCAST]

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“Over the years, trainees poured their hearts out. I began developing wellness electives and curriculum. I ultimately became a founding co-chair of faculty wellness at one institution and the director of wellness at another. This “’final” evasive strategy, working on physician wellness and resilience. Over the years, I have increased the number of disclaimers in my talks: “I know that the system must change, and until it does, here are tips for your own individual resilience.” I have tried to impress upon administrators the need to improve staffing, workflow, and documentation requirements. I understand the constraints. There are statewide and nationwide policies. There are requirements set by payors. I am certain that the impact of policy decisions is often not understood by those creating them. I feel that the fundamental structural flaws must be addressed: a daunting task.”

Claudia Finkelstein is an internal medicine physician.

She shares her story and discusses her KevinMD article, “Burnout follows from physician to wellness director.”

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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. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. On today’s show, we have Claudia Finkelstein. She is an internal medicine physician. She wrote the KevinMD article “Burnout follows from physician to wellness director.” Claudia, welcome to the show.

Claudia Finkelstein: Thanks so much for having me.

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

Claudia Finkelstein: Absolutely. So I trained in the Dark Ages at McGill University in Montreal, where I met and married an American, so I found myself practicing for most of my career in the U.S. health care system. So, a bit of a jarring difference there. I was working at a county hospital affiliated with the University of Washington and loved it: primary care, ambulatory and inpatient, always teaching residents and students. So I had the world’s greatest job, until I didn’t.

I just sort of started noticing hints of corporate creep and corporate speak around the same time that these trainees, and I think I’m a kind of friendly and maternal sort, started pouring their hearts out about their lives in addition to their patient stories. And so I started getting interested in physician wellness sort of before it was cool, and I was focused on a lot of the individual aspects of it, and then that grew into a huge interest in the system-level things.

And so I sort of crept around, trying to get out of the way of the changes going on, as I describe in the article. I was lucky enough to be wellness director at two institutions, and again, I loved it until I didn’t. The obstacles felt huge, and I felt like I needed to take a step away.

Kevin Pho: So when you talked about the corporate speak and the corporate creep that was interfering with your practice as a physician, what are examples of that?

Claudia Finkelstein: Well, one example that really comes to mind: The institution I was at had “[name of institution], healing with the heart” as the sign outside. And one day I was walking into work, and the sign was coming down, being replaced by “University of Washington X campus,” right? So everything was getting very standard. It seemed small, but I just felt like, “Wow, they removed the heart.”

And we started spending time, and I was in a room with an international expert on cardiovascular disease prevention, another expert on the accuracy of screening mammography, a group of people, and we were getting lectured at by a billing compliance person telling us, “Oh, your notes are just wrong. They should include this and this and this.” And I just thought, “Wow, that is quite a reversal of fortune.” So these are two small examples that come to mind.

Kevin Pho: And when you said trainees came to you with some of their individual issues, what are some examples of those?

Claudia Finkelstein: Well, it’s really hard to be a really wonderful spouse or wonderful parent when you’re also in the middle of an internal medicine residency. Not that it’s impossible to do, but sometimes, particularly the women would come and ask about balancing things. And also, they’re very young, people in their early 20s who have seen more death than most other people in their early 20s, right? And so sometimes they wonder, “Well, why are my emotions a little mixed up?” And so we would just talk about and normalize the fact that their life experience compared to their developmental stage is a little bit off. So those are just a couple of examples.

Kevin Pho: All right, let’s talk about your KevinMD article titled “Burnout follows from physician to wellness director.” Now, for those of you who get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Claudia Finkelstein: Sure, absolutely. So I’ve sort of hinted at it during our chat so far, but it describes the sudden realization at the podium one day, when I was lecturing a group of medical students, that my heart just wasn’t in it anymore. So then in the article, I go through the evasive maneuvers that I took through my medical career to stay engaged and loving it. And it was just so interesting how sometimes you’re really in the moment, noticing, “Hmm, this just isn’t working,” right? And so despite the evasive maneuvers, even up to becoming wellness director, I realized that that was it.

Maybe you can tell from just this interview that I’m a ham and I love to do public speaking, and that day, I just didn’t have it in me. But then the interesting thing in writing the article was that I started to connect with the fact that, hmm, maybe it’s not that I’m just not good enough, but what I was feeling really superimposed itself so well on the three spheres of burnout. And it’s like, “Ah, that’s what’s going on.” And so it can happen to anyone.

Kevin Pho: So when you talk about these evasive maneuvers that you did to try to avoid burnout, what are some examples of those?

Claudia Finkelstein: Well, one was actually moving into working in long-term care, so in post-acute care facilities. As opposed to having a waiting room filling up with people if I was taking too long, I could really sit down at the patient bedside, speak to the family, speak to the patients, and speak to the staff. So it felt really wonderful to be doing that, and so that was one evasive maneuver.

Another, which I absolutely loved, was becoming one of a core group of clinical teachers. We got to spend tons of time with small groups of medical students, teaching them to do sort of benchmark-driven physical exams and beautiful narrative interviews of the patients, et cetera. So that bought some time out of clinic. I think part of it is I’m a terrible typist, and I was just finding ways that I could minimize the number of things that I had to type. So these were two of the evasive maneuvers that I took, and taking on more administrative stuff, like the faculty wellness, et cetera.

Kevin Pho: So you also made a transition to wellness director several times. So tell me about that transition. What exactly does a wellness director do?

Claudia Finkelstein: That’s a really good question, and one that I’ve grappled with myself. I think it is currently becoming much more of a thing. There’s actually a course at Stanford for chief wellness officer development, so it’s a burgeoning field. In Seattle, at the University of Washington, I was informally doing a lot of the wellness stuff already, and then thanks to the chair of radiology at the time, who had our dean’s ear, we formed the founding faculty wellness program.

So part of it was faculty development type of things, bringing in people to talk about managing your priorities and paperwork, in addition to sponsoring mindfulness classes, in addition to developing and training a group of peer supporters, and giving so many presentations where people would just sort of sigh and feel validated, I think: “Oh, it’s not just me. This is actually a thing,” right? And this was in the earlier days.

So then I was recruited out to Michigan State University, which has a bit of a different structure in terms of the clinical to educator to et cetera. And so here again, a lot of individual support, a lot of group presentations, and a lot of pushing uphill, trying to say, “Let’s look at the workflows, let’s look at the scheduling, let’s look at et cetera.” So I think, at least the way that I practiced it, being the wellness director was being the eternal pebble in somebody’s shoe.

Kevin Pho: And as wellness director, how did you move the needle for the other clinicians who may have been suffering from symptoms of burnout?

Claudia Finkelstein: That’s a great question. I think different clinicians start with a different needle point, right? And so I think number one was just feeling seen and recognized, and knowing that this is not an individual deficiency, right? I have pointed people towards coaches, towards therapy. So really, I feel both sad and delighted that I helped a lot with individual-level resilience. However, where I was not able to move the needle to my own satisfaction was on systems-level stuff, which I think is where the money is, really.

Kevin Pho: And you also mentioned that as wellness director, you also had burnout from that role. So talk more about that.

Claudia Finkelstein: Well, I think it comes from feeling like you’re getting nowhere, right? And so I was delighted to be providing support, but also feeling disingenuous, because every talk that I gave was like, “The system has to change, and for now I can help you individually.” And I think I felt that I was not able to effect system-level change, and so that set up a little bit of cognitive dissonance for me. So I’m speaking wellness and advocating for something that I am not actually succeeding in to my satisfaction.

Kevin Pho: So going forward, because you’re obviously an expert on burnout, you were a wellness director, and the fact that someone with your level of expertise isn’t able to change the system that causes a lot of the burnout, I guess, to put it bluntly, what hope do we have going forward?

Claudia Finkelstein: I think we have tons of hope. Stay tuned; I’m submitting another blog. But I think there’s a lot of hope, because things need to reach a point where the price of not doing something exceeds the price of doing something. And I think the great news is we have been accepting and attracting into medical school very idealistic, socially conscious kids who are truly coming from an ethical perspective, not an “I want to support my family” perspective. So I think there’s some degree of actuarial change in the works.

I think also we need to look at the system that our system is operating within, our society. And so, it may be my Canadian bias, but I really believe that health care as a for-profit industry is a really flawed model, and we need to really reexamine our priorities, even in terms of deployment of workforce, right? The ratio of social workers, case managers, and APPs to vascular surgeons may not be exactly in the way that favors optimum population health.

Kevin Pho: We’re talking to Claudia Finkelstein. She’s an internal medicine physician. She wrote the KevinMD article “Burnout follows from physician to wellness director.” Claudia, what are some of your take-home messages that you want to leave with the KevinMD audience?

Claudia Finkelstein: My take-home messages are that it’s not you, and it is you, right? So we have intrinsic personality characteristics that cause us to work too hard and suppress our emotions. So I think in the “it is you” vein of things, it’s always great to look for support and social connection. And the “it’s not you” is like, yeah, we need to advocate and really make strides so that we can get back to medicine as a vocation, as opposed to an industry.

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

Claudia Finkelstein: Thank you.

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