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We discuss the striking similarities between the Kentucky Derby and the challenges of medical training. Our guest, Corinne Sundar Rao, an internal medicine physician, shares valuable insights based on her expertise. We explore the shared traits of speed, stamina, skill, training, and positioning, while also addressing the pressing issue of physician burnout. Join us as we uncover the parallel narratives and discuss ways to support the well-being of physicians.

Corinne Sundar Rao is a board-certified internal medicine physician and founder, Legacy Physicians, which helps hospitals find well-qualified physicians at a much lower overhead than they would pay staffing agencies. She can be reached on LinkedIn and Facebook.

She discusses her KevinMD article, “The Kentucky Derby: factors that contribute to winning the most prestigious horse race in the world, and what medical training can learn from them.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Corinne Sundar Rao. She’s an internal medicine physician, and her KevinMD article is titled “The Kentucky Derby: factors that contribute to winning the most prestigious horse race in the world, and what medical training can learn from them.” Corinne, welcome back to the show.

Corinne Sundar Rao: Thank you for having me, Kevin. I’m excited to be back.

Kevin Pho: So for those who didn’t listen to our first episode together, just briefly share your story and journey to where you are today.

Corinne Sundar Rao: I’ve practiced pretty much the entire breadth, inpatient and outpatient. The last few years I’ve been a hospitalist, and over the last couple of years I’ve been independently contracting, and I’m not employed. To that end, I also have my own startup that helps other physicians to do the same. So that, in a nutshell, is my story.

Kevin Pho: All right, excellent. And you wrote about parallels between the Kentucky Derby and medical training. So let’s talk about this article a little bit, but before you do, just what got you thinking about that?

Corinne Sundar Rao: Yeah, it seems unlikely, you know, like, what would that have to do with medicine? But for one thing, I’ve always been fascinated by the Kentucky Derby. Don’t ask me why. I don’t really know a whole lot about horses, but I always kind of tune in to see what’s going on every year. And I was thinking about this for even a couple of months prior to the Derby, that, you know what, we can actually find some parallels with medicine and the way medicine is going.

And then the week leading up to the Derby, it was kind of a sad week, out of the usual, at Churchill Downs. Seven horses died in those seven days, including two on the Saturday. I was working a shift, and I remember coming home, and the article had been on my mind. I had kind of started it, but I couldn’t quite complete it, and that night I finished off the rest of it and sent it to you, I think close to midnight, and you accepted it. So here we are.

Kevin Pho: All right, so let’s talk more about that article. So what can medical training learn from the Kentucky Derby?

Corinne Sundar Rao: So I think, well, what we don’t want, Kevin, is a similar fate. Not to oversimplify things, but, you know, these horses that race there go through very extensive, long training. All kinds of factors go into it in order for them to get there to run the race. And, you know, that’s what we do in medicine. Medical training is long. It’s often, you know, brutal. I don’t know that we’ve done much to change that in any way, and the end result for us is that our profession is facing a staggering amount of moral injury and burnout, physicians who feel like they love medicine but just can’t practice anymore.

And that, to me, is the main point of the whole article. What can we do? Are we on a road where, you know, this is inevitable and there’s nothing that we can do, or are there things that can be brought to light?

Kevin Pho: So during that week of the Kentucky Derby when seven horses died, what were some of the reasons behind that? Was it because they were overworked? Was it because they were overtrained? What were some of the underlying reasons why these horses died?

Corinne Sundar Rao: I believe that those were a couple of the factors. And as you know, Kevin, animal rights activists are against these kinds of races because they feel it’s unnatural, and it’s something where the horse has to participate and doesn’t have a choice. So there are all kinds of those factors, but definitely they’re pushed, usually, you know, a lot beyond maybe their capacity, because the end result is you want your horse to win the race. You want the fastest, the strongest, and the one that has the most stamina. And I think that’s kind of the bottom line. Is the training too brutal?

The horses that died, I believe, had a number of different factors, but when a horse injures their foot or something, that’s kind of the end of the road for them, because those fractures don’t heal, and the most humane thing at that point is to actually put them down.

Kevin Pho: So you mentioned the word stamina, so let’s talk about that when it comes to medical training. For those who aren’t familiar with what it takes to become a practicing physician, how does stamina play a role in medical education?

Corinne Sundar Rao: Stamina plays a huge role. It starts from before you even apply or get into medical school, because you kind of have to keep up your stamina to study those long hours to get into medical school. And, you know, I’m just going to throw this out there: 7 percent of people who apply actually get into medical school. So it’s highly competitive.

After that, you know, there are four years of medical school, and in some cases there are six-year programs as well. Those years are packed with didactics, lectures, clinical training, and studying. Like, you’re studying constantly. After that, you have to do residency, and that can be anywhere from three to five years, depending on your chosen specialty, and it just doesn’t end there either. So you need a lot of stamina to get through these years of training, of studying, and there are no breaks in between. You just have to keep going. If you take a break, that has to be explained. So it really isn’t something that most med students or physicians want to do.

Kevin Pho: Now, I know that you go to a variety of settings. Tell us what you’re seeing from your fellow physician colleagues at these various settings, in terms of what they are telling you and what you are seeing when it comes to things like burnout and moral injury. What are you seeing?

Corinne Sundar Rao: Kevin, I’m fortunate to get to know several physicians in different facilities, because that’s kind of what I’m doing. I’m not in any one place. What I’m seeing is the lack of autonomy. When physicians are employed, whether it be by a large corporate entity, a large health system, or a hospital, you don’t have any autonomy. I’ve seen it always comes down to that lack of autonomy, being kind of a widget or a cog in a wheel, basically being told what to do, what your productivity measures are, and what metrics you have to meet. These are the frustrating things, and an absolute lack of, you know, flexibility in your schedule.

Kevin Pho: So let’s dive deeper. When you see a lack of autonomy and a lack of flexibility in a schedule, or that we have to meet these certain productivity targets, tell us a story. What exactly does that mean?

Corinne Sundar Rao: So I’m talking, of course, from, you know, the hospitalist medicine standpoint. However, you can apply it to not just internal medicine. You can apply it to outpatient, and you can apply it to other specialties. Bottom line.

So just going back to hospitalist medicine, over the last several years it’s evolved to where a full-time job as a hospitalist is seven on, seven off. So you work seven days. Those are 12-hour shifts, and they could be a combination of, I don’t know, nights, swing shifts, day shifts, whatever you have. And then you’re off seven days. So on the surface, it sounds really enticing. “Oh, you get seven days off. Like, nobody does that.”

Well, let’s go back here. How many hours are we working here? You can’t do anything that’s normal stuff, because you’re there for 12 hours in that cycle, and your life doesn’t follow a seven-on, seven-off pattern. Birthdays, anniversaries, trips, and important dates happen, illnesses happen, and they don’t follow a seven-on, seven-off pattern. So that’s what I meant when I said lack of flexibility.

And the autonomy part, as you know, when you’re in an employed position, that’s kind of what you’re giving up. And the majority of physicians, I believe the number is somewhere around 70 percent, are currently employed in some way.

Kevin Pho: So what are some things that the Kentucky Derby is doing to help prevent these tragedies from happening? And is there anything that you could learn from the world of horse racing that is being applied to the medical field to help prevent these tragic circumstances?

Corinne Sundar Rao: Yeah, so, you know, there’s a lot of attention, of course, with this year’s race, and negative attention, the kind they didn’t want. And so I believe that the authorities, or whoever, you know, the people that are involved in running this race, have said that they’re going to step back and look at these factors and actually see what is going on, see if there are any common factors, and see what can be improved. Maybe they need to make new rules. So again, not being a horse expert by any means, but that is kind of what I read in the follow-up articles on that.

And I think, you know, there is attention being drawn to issues that are facing us. There are physician organizations and advocacy groups that are speaking out. In fact, one of them just had their summit a couple of weeks ago. Take Medicine Back started off as Take Emergency Medicine Back, because the founder, Dr. Mitchell Li, is in emergency medicine, and then it expanded to Take Medicine Back. And they’re bringing attention to these important issues. And, you know, I mean, I guess it’s going to take all of us at some point to move the needle.

Kevin Pho: Now let’s talk specifically about a lack of autonomy, because I completely agree with you. I do think that is a major reason why physicians are burned out or feel that moral injury. Now, aside from policy solutions or relying on organized medicine and other physician organizations, what can individual physicians do? What can individual hospitalists do to take back that autonomy, especially if they’re in an employed position?

Corinne Sundar Rao: Yeah, so one thing is to look at, you know, what situation you’re in. Physicians tend to follow kind of a certain path. We are less inclined to take risks and to look outside the box. So a lot of physicians feel employment is the only way to go, and that is probably not true. I would be one to say it’s not, and I was employed for many years. So I think you need to look at your situation and first ask why you are employed. Is it the benefits? Is it the location? What is it? Is it the so-called security? Because actually, I mean, employed jobs are no more secure than part-time, PRN, or locums. So I think you need to take a good, honest look at yourself and your situation and see what needs to change.

As far as, I think what you’re really asking is, what can you do when you’re already in that position? I think you need physician leaders. Your CMO or your medical director needs to be on board with having the interests of, you know, their team. If that doesn’t happen, then I don’t know that you’re going to get very far. I think physicians, you know, could get together and say, “This is what we don’t like about our program. What can we do? What can we do to make things better for all of us? Do we have to follow the schedule? Could we do it this other way?” That gives them some autonomy and some control, and it makes them feel like they have a say. Most of the time, that’s not the case.

Kevin Pho: We’re talking to Corinne Sundar Rao. She’s an internal medicine physician. Her KevinMD article is titled “The Kentucky Derby: factors that contribute to winning the most prestigious horse race in the world, and what medical training can learn from them.” Corinne, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Corinne Sundar Rao: Kevin, I’d like to tell the audience to live life on your terms. There are a lot of things that we cannot control. However, there are things that we can. So we need to start thinking outside the box, and the most important message from me is, let’s start living lives on our terms.

Kevin Pho: Corinne, thank you so much for coming back on the show and sharing your time.

Corinne Sundar Rao: It’s been a pleasure. Thank you for having me.