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Join Kim Downey, a physical therapist, David Fessell, a radiologist, and Todd R. Otten, a family physician, as they share their journeys and expertise. Discover their unique perspectives on well-being, health care transformation, and strategies for achieving balance in demanding medical careers.

Kim Downey is a physical therapist. David Fessell is a radiologist. Todd R. Otten is a family physician.

They discuss the KevinMD article, “Pivot from clinical work? Sometimes the answer is yes, and that’s OK.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, get CME for this episode by clicking on the CME link in the show notes. Today we welcome Kim Downey, she’s a physical therapist and physician advocate, David Fessell, he’s a radiologist, and Todd R. Otten, he’s a family physician. We’re going to talk about their KevinMD article, “Pivot from clinical work? Sometimes the answer is yes, and that’s OK.” Kim, David, and Todd, welcome to the show.

Kim Downey: Thank you, Kevin, great to be here.

Kevin Pho: All right, so Kim, I’m going to always start with you. You found David and Todd, so what is it about their stories that resonated with you?

Kim Downey: Well, Todd, when we connected, I think I just sent him a message saying that we share some mutual connections, and he got right back to me and told me, this is back on June 28th, about his book. And then we just started communicating back and forth, and that really resonated with me, our quadruple aim, which he’ll touch on himself. And then we had a Zoom, and we took it from there.

And David, I think we just clicked connect, I must have clicked connect, and then I think I just started seeing his posts, and he always shares such thoughtful and inspirational posts and responses. And at one point I had said, oh, I would like to chat with you sometime, so he sent me a message on June 1st saying that he’d be happy to do that, and then we had a phone call. And now he tags me pretty much every day in his positive psychology posts, so we communicate regularly. So I’m thrilled to introduce them to each other, and them to you.

Kevin Pho: Perfect. And I know Kim’s brought together so many physicians, and one of the things that I like to say on this podcast is that we are so much more than our degrees, and it’s so interesting to hear stories about what we do outside of the hospital and outside of the exam room. So David, you’re a radiologist. Just briefly share your story and journey.

David Fessell: Sure, sure. It’s really been a journey from the head to the heart, been a journey to joy. About 10 or 12 years ago, started doing all kinds of fun things, like Kim mentioned, positive psychology conferences, communication conferences, teaching about leadership and emotional intelligence, doing improv with Second City. And then when COVID came along I said, wow, I have all these tools in my toolbox, it’s time to use them.

And I wanted to use them to help people, especially humor. Just simple things, stopping by the MR techs during COVID to say good morning and share a joke with them, and that was a bright spot. It’s a bright spot for all of us. So it’s really been that journey from the head to the heart. And a couple years ago now I decided it’s time to do it full-time. I want to help especially physicians, help people with burnout, help people with wellness, and it’s been a joy.

Kevin Pho: So David, tell us some of the things that you do. You mentioned things like improv, and you actually do a lot of things outside of that reading room that radiologists often find themselves in. Tell us a little bit more about that.

David Fessell: Yes, the improv has been such fun. I did that about 10 or 12 years ago when I was relatively new as an academic radiologist, and I knew public speaking was a big part of my work and I was really anxious on stage, and I thought, I need to get better at this. Somebody suggested improv, so I tried it. Instantly I could tell it was exactly what I needed. I wasn’t good at it, but it was helping me be more comfortable on stage, be a better speaker.

And then I found it was helping with patients. You walk into an exam room to do a procedure on a patient, injection or biopsy or something, they’ve never met you, you’ve never met them. Put them at ease, roll with whatever comes along, maybe add a little humor if it’s appropriate. So improv has been a wonderful thing. We started sharing it with our medical students, doing workshops with them. I just did a workshop with our business school students here at University of Michigan a couple months ago.

So humor has been a big one. Positive psychology has been another one, things we can do to feel better, to spread positive emotions. Kim is wonderful at that, she’s a dynamo of positive emotions, and it’s contagious, you feel it. And that’s why you keep having her on your show, I’m sure, because you feel it. And when we can do that for other people, whether it’s our technologists, our colleagues, our friends, our family, it’s a wonderful thing, and it lifts us up.

Kevin Pho: All right. Todd, you’re a family physician. Just briefly share your story and journey.

Todd R. Otten: Absolutely. So I went through pretty horrendous burnout in 2019, came back from it, and was in a really wonderful situation supervising three nurse practitioners. And in the book I call it the office utopia, because we pretty much lived the quadruple aim despite some amazing limitations from on high, if you will. Six exam rooms for four providers, being one of them, I mean, that’s like an instant bottleneck for sure.

So things were going pretty good, and then some additional horrendous decisions were made, and frankly I decided I was going to take a stand. I was going to take a stand for myself, take a stand for my colleagues, and take a stand for others. And literally I resigned the next morning after the decision was made. I stayed on for about five months, and at the end of last year I stepped away, and published the book in May of this year.

And since then it’s kind of been this whirlwind of networking with wonderful people like Kim, and being on shows and doing podcasts and doing a lot of advocacy work. And ultimately what I’d really like to see is all these wonderful people out there break down these silos, improve the connectivity, amplify those voices, and create some really major change at the highest levels. So, double click on what David said, I love the positivity out there, and I thank all of you for what you do.

Kevin Pho: So Todd, you mentioned the quadruple aim. Now for those who aren’t familiar with that, what exactly is that?

Todd R. Otten: So let’s go back a little bit. The history of the Triple Aim, it came out in 2006 from IHI, and I tend to simplify it to patient experience, quality care, lower costs. And population health was obviously a big part of that. But in 2014, really in my opinion a landmark article from Dr. Sinsky and Dr. Bodenheimer, they suggested a fourth component, being provider wellness. And that really resonated with me, I was an immediate adopter of that, and pretty much went and shouted about it at my institution. I joke I was an army of one for six to 12 months.

But then, going forward, when I came out of burnout, I realized we’re all part of the system, we all own it, and we all need to do something to make this better. And that was really where we came up with putting the “our” in front of it, to call it our quadruple aim. Because I feel if everybody does something, we can get over some of this learned helplessness and really make a big difference. So that was kind of the evolution, from the Triple Aim to our quadruple aim.

Kevin Pho: So Todd, tell us some of the work that you’re doing in terms of advancing that. Everything you say I completely agree with, so in terms of advancing that philosophy, our quadruple aim, what are some of the things that you’re doing toward that?

Todd R. Otten: Absolutely. So I’m working closely with Medicine Forward to really consolidate and amplify the physicians’ voices, to restore that sacred bond of the patient and doctor relationship. I spend a lot of my energy there. Networking is also part of it, making these connections with other individuals. I’ve been talking with global health impact networks, there’s some other big projects that are on the horizon but I don’t want to usurp anything there.

Another cool thing that I’m working on is a keynote called The Power of One Plus One. And the reality of that is, I’m really going to focus on relationships and how you can do some amazing things. For example, Kim and I have done all kinds of cool things. So in my mind one plus one doesn’t equal two, it potentially equals 100 or a thousand or maybe a million. We’ll see where it all goes. So that’s just a few things I’m working on.

Kevin Pho: So Kim, as you hear Todd and David’s story about all the things that they’re doing outside the exam room, and talking to a lot of other physicians as you do on LinkedIn, tell me some of the themes that you’re trying to spread with my listeners, that all these other doctors are doing. Do you see any commonalities between them?

Kim Downey: Well, there’s just so many doctors doing so many interesting things, and I also know that so many doctors are struggling, and that’s what I love about LinkedIn, is that they’re talking about all of these things. So I try to speak with doctors about the things that they’re struggling with.

And then when I had the ideas for the articles, it was, there’s also doctors that are still managing to thrive even now, right? So then I wanted to spotlight some of them, and just all the different things that they’re doing, from just finding ways to take care of themselves. A lot of them found coaching or therapy, or just focused on hobbies and finding their voice outside of medicine. Some have taken to writing and art. So to just spotlight. And then others that received coaching then went on to become coaches themselves, and that’s filling their cup, is helping others, and actually David I believe coaches, right?

So just all those different things. But then my last, this was the fourth article, because this was about physicians who have pivoted from medicine. And Dr. Charity Hicks is the other physician who collaborated on this article. And sometimes if you need to step away temporarily or longer for yourself, there’s nothing more important than that. So just spotlighting all the different things that doctors are doing and can do.

Kevin Pho: So David, you are a coach yourself, and looking at your article, you specialize in coaching physicians and leaders who are transitioning into a new role or out of an old role. Talk about that transition, because one of the things I notice, doctors often feel stuck, and especially doctors who are burned out, they feel like there’s nothing else that they can do. Tell us about that transition when doctors are pulled outside their comfort zone into something new, and that something new could be something outside of medicine, it could be in a leadership role. Tell us about that transition itself and some of the challenges, and how you coach doctors through that.

David Fessell: Sure, sure, great question. A lot of times, since we put so much into our training, so many years of medical school and residency and fellowship, we think that’s all we can do, and it’s really not true. Doctors are incredibly smart people, they’re incredibly talented and driven, and there’s so many things that they could do if they see the possibilities.

That includes coaching, as Kim mentioned, that’s one of the reasons I became a coach, because I worked with a coach, found the benefits. Coaching is one of the things. Writing, speaking. I love to give keynotes around wellness, just been doing that at several institutions around the country, grand rounds. And working, writing, speaking, coaching. And yeah, doing things in the research world, in the pharma world, in the academic, bench research, the clinical research. And then you can just step away completely. I know physicians who have become entrepreneurs or solopreneurs, started a business, gotten into what’s new in technology.

I mean, smart people can do amazing things, and we get a very narrow and limited view from our training, that this is all we can do. And when you step back and you see the possibilities, what’s out there, it’s just amazing. And these are ways that we can help people. Physicians are driven to help people, we love to help people. There’s so many ways to do that, even outside of medicine.

Kevin Pho: So David, for those physicians, like you said, they have a narrow experience on what they think they can do, and they’re maybe a little bit hesitant to pull away from that. How can physicians take that first step outside of their comfort zone?

David Fessell: Sure, sure. It’s really helpful and wise to start where you are. Keep doing what you’re doing, maybe you can cut back on your clinical duties to 90 percent, 80 percent, 70 percent, something like that, and then start some of these other activities in that space. You have to free up some space, you don’t want to just add new things in because you’re probably already overwhelmed as it is. So if you can free up a little space, and then try something new and build from there. Start writing a little bit, start speaking a little bit, start doing workshops, whatever it is that excites you, and then grow it from there. Start small and grow.

Kevin Pho: And Todd, you have a book where you talk about your quadruple aim, Ripple of Change. One of the quotes that is in the article is that we need more clinicians at the highest levels involved in decision making. Now how can we do that? How can we have more physicians, again, break out of what they do clinically and involve themselves more into that leadership role?

Todd R. Otten: Absolutely. So I think part of this is, those that are not wanting to continue on with clinical work, there are opportunities that abound, as David said, in many arenas, including leadership roles. We are desperate for clinicians to be involved in these decisions. And if you’re going to cut back clinically, perhaps devote some of that time to leadership positions.

The institutions where I’ve seen the magic that can exist in health care are when the leadership and clinicians were rowing in the same direction, and when that happened it was a beautiful thing. And so there’s positions all over the place. Sometimes if you’re stuck, take a calculated risk and try something different. It might be a wonderful change for you. That would be my biggest suggestion in that regard.

Kevin Pho: And just to be clear, do physicians need formal training in management in order to step into these leadership roles? Do they need an MBA, for instance?

Todd R. Otten: It probably depends on who you ask, Kevin. So a lot of people would suggest that the leaders of hospitals need an MBA. I would probably be a contrarian to that, that we’re delivering health care, so we need nurses and physicians leading those roles. And frankly we have too many business people leading it and putting profits over people, and that’s a big part of the reason why we’re in this mess that we’re in. So I think I could outperform lots of CEOs out there in terms of leading hospitals, as I’m sure you and David and Kim could as well. So I’ll get off my soapbox.

Kevin Pho: All right, we’re talking to Kim Downey, she’s a physical therapist and physician advocate, David Fessell, he is a radiologist, and Todd R. Otten, he’s a family physician. We’re talking about their KevinMD article, “Pivot from clinical work? Sometimes the answer is yes, and that’s OK.” Now I’m going to ask just each of you just some of your take-home messages that you’d like to leave with the KevinMD audience. David, we’re going to start with you, then Todd, and we’ll end off with Kim. So David, why don’t you go ahead.

David Fessell: Sure. A great and quick, easy, simple exercise people can do, just take a few minutes at the end of your day to pull out a journal, five to 10 minutes, review your day. What energized me today? That’s a beautiful question to ask. And then over time notice the patterns. What’s bringing you energy, what’s bringing you down, and adjust your schedule, who you interact with, the kind of work you do, what you do.

And another quick tip, while you’re journaling, write down a couple funny things that happened that day. This is an evidence-based way to improve your well-being, and then you can share them with other people tomorrow. And sharing positive emotions is a wonderful way to help your own wellness and those around you.

Kevin Pho: Todd, what are some of your take-home messages?

Todd R. Otten: I think the power of positivity cannot be understated. It can fill you up and just turn around a horrendous day. Random acts of kindness are an amazing thing.

I’ll give one just short example. When Joshua, my co-author, was really struggling with his health, he was in a deep dark place, and frankly I was running out of ideas for him. And I told him, Joshua, I believe that you’re going to get better, but you have to believe it too. Fast forward two years, we co-authored a book together, and yes, he’s doing better, and frankly so am I. So be kind to one another. The power of positivity is an amazing thing.

Kevin Pho: And Kim, let’s end off with you, your take-home messages.

Kim Downey: Sure. And I would like to share Charity’s takeaway from the article, which was, always leave space in your life for creativity, curiosity, and play. It’s remarkable where they can take you if you let them. And I think that can’t be understated. And Todd and David have wonderful, interesting hobbies, right, and I think they realize how important, and I know Charity likes nature and flowers and art, and they fill her cup.

And that actually reminded me of something Dr. Alette Colum said when I interviewed her for my podcast, and I shared that on LinkedIn this morning. And during our podcast she said, pick up a paintbrush, pick up a guitar. And I feel like that could be a slogan, right? It could be literal or metaphorical.

And we talked about, know yourself, your needs, your values, and your identity beyond doctor. And if you think you don’t have time, seek out a coach or a therapist or anyone you can bounce your thoughts off of, particularly as it relates to setting boundaries, so you can find some time to take care of you.

Kevin Pho: Kim, David, and Todd, thank you so much for sharing your stories and journeys, and thanks again for coming on the show.