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Welcome to a special episode of the podcast where we turn the tables on Kevin Pho, the founder of KevinMD. In this episode, pediatrician Lisa Sieczkowski interviews Kevin, delving into his motivations behind creating KevinMD. They discuss the transformative power of reflective reading and writing, as well as the benefits of writing for physicians. Kevin also shares advice for health care professionals looking to incorporate writing into their daily routines and reflects on the feedback he’s received from contributors to KevinMD. Plus, don’t miss Kevin’s insights for those contemplating a career in medicine.

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Transcript

Lisa Sieczkowski: Thanks for agreeing to chat with me today. I know that generally you’re probably in the interviewer seat, but today I was hoping to take the opportunity to ask you a few questions as part of a master’s program that I’m in right now.

Kevin Pho: Perfect. Well, thank you so much for asking me.

Lisa Sieczkowski: Of course. Well, first of all, I have come across KevinMD for many years now. I am a pediatric hospitalist, so I’m a physician, and it has popped up in my social media. And then I’ve been fortunate enough to submit some essays over the years that you have been kind enough to publish on your website.

And I think it’s just a wonderful place for physicians and patients and humans and other people in the medical profession to talk about what it’s like. And, you know, as somebody who’s been a physician for more than 20 years, it has changed. I don’t know if you feel that as well, but our jobs have gotten a lot harder, I think. So it’s great to have a place for physicians to be able to talk about that, and also to see what our patients are saying, see what nurses are saying.

How and when did you start KevinMD?

Kevin Pho: Yeah, like you said, I’ve been practicing for over 20 years now. I think my first job was back in 2002, so that was like 22 years ago, and I started KevinMD way back then. And certainly I didn’t realize that it was going to be the platform that it is now.

I wanted it to be a resource, really, for patients, because patients would often come to my exam room and they would read studies in the newspaper and they would want to answer that question, what does this mean to me? And at that time blogs were just in their infancy, and it really provided a way to give that instantaneous feedback, where I can share my thoughts about whatever was going on in the news and patients can get that information without having to see me in the exam room, without having to call me, without having to make an appointment to see me.

So if there was a study in the news, or if there was a change in the guidelines that patients had questions about, I could simply write it on my blog and they would read it. And then sure enough, they would come to my exam room and ask me about, hey, I read this on your blog the other day. So that was the real genesis.

And of course it has evolved since then, because of all the reasons that you said, because practicing medicine today there are so many obstacles that really impede us from giving the best care that we possibly could to patients. And it’s blossomed into a platform where we could share these stories, where not only can we continue to interpret medical news and what it means for patients, but now it’s become an avenue where anyone within the health care spectrum can write, can share their stories, can share their frustrations, and talk about how we could improve the health care system.

Just so many stories that need to be told, and there are very few, if any, platforms where primarily clinicians and mainly physicians can have that proverbial safe space to share their stories and hopefully move the needle. Because in the end we all want the same thing, we all want better care for patients, and in order to do so we do need to tell these stories and really communicate and have these shared experiences with each other.

Lisa Sieczkowski: Thank you. This is maybe a little more of a granular question, but how much time do you spend per week, per month, per day, keeping KevinMD going? I know you started your podcast series maybe a few years ago now.

Kevin Pho: Yeah, so I still see patients. I’m an internal medicine primary care physician, I practice here in Nashua, New Hampshire. So I still see patients Mondays, Tuesdays, and Wednesdays, and I do my podcast on Thursdays and Fridays. I do anywhere from 7 to 10 episodes a week, it’s a daily podcast, and we started it about four years ago, so it’s close to 1,500 daily episodes.

And it is a lot of work, technically and logistically, but I love it, because I have the opportunity to learn so much. There are very few opportunities where I can get experts from across the country, I talk to physicians across the country, health care leaders, and I have about 20 minutes of their dedicated time and I could ask them anything I want. So I come to it from a place of education, and it’s really given me perspectives that otherwise I wouldn’t have thought of, and I’ve just learned so much.

So in terms of actual hours, I could probably say, if I were just to guess, like 20 to 50 hours a week. It’s a lot. So I do that in conjunction with, of course, my family time and seeing patients.

But rather than just counting it in pure hours, I do think that it gives me that opportunity to use my medical degree in a non-traditional way, and having that contrast has ironically kept me going in primary care. Because we talk to a lot of doctors, and I’m sure we’ll talk about physician burnout and moral injury, a lot of doctors who only see patients however many hours a week, 60 hours a week, and they have to see 30 patients a day, those are the ones that tend to get burnt out.

One of the things that I’ve learned talking to thousands of physicians and reading thousands of articles on my site is that those physicians who use their degrees to follow their passion, and not just do only one thing, and be more than their degrees, are the ones that tend not to burn out. So even though, if you look at it from an absolute hour standpoint, it sounds like a lot, but I think that doing what I do in contrast to seeing patients, and having those parallel pathways, has kept me going longer than I would have otherwise.

Lisa Sieczkowski: That’s really interesting to hear. I would agree with you 100 percent. I have been fortunate, I guess, to have been handed an opportunity to become involved in residency program leadership 13 or 14 years ago, so pretty much the entire time I’ve been at my current location. And although that role comes with a whole unique set of challenges and stresses, it is different than, I guess you could say, seeing however many patients a day you’re told that you have to see. And so yeah, I definitely agree that a physician who can diversify your assets, in a sense, is probably going to be able to have a more healthy, long-lasting career.

Kevin Pho: Absolutely. And I think that one of the themes that I have on my site and on my podcast is that physicians are more than our degrees. And like you said, we have so many doctors that I’ve talked to that have careers outside of seeing patients, and I think having that contrast is what keeps them in medicine longer.

Lisa Sieczkowski: Yeah. Are you personally the one who reads every essay that gets submitted and selects which ones will be published on your website? Are you doing all of that work as well?

Kevin Pho: The answer is yes. I am the only person that chooses which articles go on my website, and chooses my guests. I do have a team that helps me with some of the technical aspects of my site and keeps the site up, sometimes when there’s a lot of traffic to the site it’s a challenge to keep the site up sometimes, and I do have a team for that. But in terms of all the editorial decisions, I am the only one who makes those choices.

Lisa Sieczkowski: Wow, that’s really impressive, because it’s been 20 some years now, you said, that you’ve been.

Kevin Pho: Yeah, so I would say about 22 years, yes.

Lisa Sieczkowski: Wow. I know we talked a little bit offline about, as you have become busier and busier creating the content and editing the content, that you are not writing as many blog posts yourself. But I am really interested in hearing, both from your personal experience as well as from the people that you talk with and hear from, what is it about writing and sharing what you write that does seem to be so bucket filling for a lot of physicians? Not all, but a lot, I think.

Kevin Pho: So I think that in general, when it comes to training physicians, the medical education system is really good at the academic part. It’s good at teaching doctors the knowledge they need to be physicians. But I don’t think it’s very good in teaching physicians what a life in medicine is like. And when they go out and graduate and get their first job, oftentimes I hear from a lot of my guests, it’s not quite what they expected during medical school and residency.

There’s a lot of business aspects in today’s health care. There’s a term that I recently heard from Paula Muto, I just interviewed her earlier, and she talks about the financialization of health today. And that’s just a fact of life in American health care. And physicians by nature, they don’t have a great background of business, otherwise they wouldn’t be going into medicine if they did. They don’t gravitate towards those business aspects.

But the sad truth is that whenever they go out and get their first jobs, and it could be in a hospital or a clinic, if they don’t have those business aspects, I think it’s going to be very difficult for them to adjust. And that leads to the disempowerment of physicians. And the disempowerment of physicians is a major cause why the burnout statistics are about 50 percent. 50 percent of doctors are indeed burnt out.

So I think it’s tremendously important for physicians to have that outlet and get back to what medicine is about. And medicine is about stories. It’s about sharing stories, it’s about hearing patient stories, it’s about telling your own stories. And on my site and on my podcast, a lot of physicians, that’s what I encourage them to do. They share their stories about what it’s like to have a difficult patient encounter, to talk about an outcome that they didn’t want, to talk about some of the difficulties they have in practicing medicine, or if simply physicians have a bad day.

Because these types of outlets aren’t encouraged during medical training, and they certainly aren’t encouraged on the job today. So being able to write and share these stories, it gives physicians a sense of community, to make them think that, hey, I’m not the only one going through this. And if enough people hear our stories, hopefully that’s going to lead to lasting change in our health care system, if those decision makers hear the stories and hear about how difficult it is to provide the patient care that we all want to. We wouldn’t be able to influence our decision makers without sharing our stories and having them hear it.

Lisa Sieczkowski: Excellent, I totally agree with that. One of the most impactful posts or essays on your site that I read was a number of years ago now, and I remember sitting in my kids’ bathroom, when they were younger and they still let me come in the bathroom when they were taking baths, I wouldn’t want to anymore, and I was scrolling through, multitasking, and I read an article entitled, and I’m probably misquoting it a little bit, but “Dear physician peer,” or “Dear insurance reviewer, you are not my peer.”

And it was, I think, written by an oncologist who was unable to get the appropriate test approved by the insurance company for his patient to rule out cancer for her effectively, and just going through that whole process.

Although we’re definitely different types of physicians doing different types of work, I’ve had to be in that chair as well, arguing for why the insurance company should pay for all four days of a child’s hospital stay instead of just two, or pay for an inpatient stay versus observation. And many times, as you probably know as well, you’re talking to someone whose clinical career was in a completely different field, so maybe a radiologist, and they may not know the fever guidelines for newborns.

So that was kind of my first introduction, I think, to KevinMD, and finding that commonality even though this was a different physician, someone I’d never met, practicing a different type of medicine. It really drove home the fact that some of those business aspects of medicine that you mentioned earlier are so draining, and really are, I think use the word moral, or the phrase moral injury, knowing that you’re not able to provide the best and the most appropriate test for your patient because somebody at an insurance company is making that decision.

Kevin Pho: Yeah, and physicians, we’re so siloed, right? Because we may be going through all these pre-authorization hassles, and we may think that I’m the only one going through this, and the fact is that we’re not. Physicians all around the country are dealing with the same issues. And not only could it be prior authorization, it could be all the EMR headaches and whatnot.

I think that it’s important to have that sense of community, because physicians today, we don’t have that doctors’ lounge that was there decades ago, right? We’re all practicing in our own offices, in our own silos. So having an ability to have a space where you could share your stories and get that feedback from other physicians, and let everyone know that, hey, we’re all going through the same thing, I think is tremendously valuable.

Lisa Sieczkowski: It’s worked for me, I’ll say that. I also want to express my gratitude to you for helping me get promoted. So I am not a traditional research-focused physician, and I do work at an academic facility, and although I had lived and worked here for quite a while, I felt like I contributed a lot to the organization. It wasn’t necessarily in the traditional way of publishing papers, or some of the scholarly output that seems to be very valued in an academic promotion process.

But what I did submit was some education things I’ve done, and also I wrote down the titles of every blog post that had ever been published on KevinMD and a few other places, and that seemed to be enough.

Kevin Pho: Oh, wonderful. Congratulations.

Lisa Sieczkowski: Not only has it been good for me emotionally, spiritually, as a treatment for my own anxiety to write, there was that benefit as well.

I would love to hear, you have probably, more than anyone else I can think of, had the most contact that a physician could possibly have with other physicians and health care providers and patients from all over the world, I would imagine, at least all over the country. What is your one-liner, or your synthesizing of where we’re going in medicine? Is it hopeless? Is there still hope for us? Would you advise your own children to go into medicine? Advice that you’d give for the next generation of physicians, as you and I are looking at maybe 15 more years? You’re probably more financially savvy than me and can retire earlier. But what advice do you have for those that are just out?

Kevin Pho: So I think that medicine is the best career. I have no regrets about going into medicine. And you ask if my kids, my daughter is a freshman in college and she currently is going through that premedical path.

I don’t think there’s any career where you could make as big a difference in someone else’s life. Because as difficult as we think medicine is, if you look at it from the patient’s perspective, it doesn’t even compare. I talk to physicians where they have to guide family members through our health care system whenever they get a difficult diagnosis, and even as physicians it’s very difficult for them to navigate our health care system.

So I do think that clinicians, and it could be physicians, advanced practice practitioners, everyone within the health care field, we all have a tremendous responsibility, and it’s a privilege to have that responsibility to guide patients through our health care system.

I do think that with our health care system the difficulties are only going to grow. You talk about the cost of our health care system taking up 20 percent of our GDP, and that number is only going to increase. But I think that means that the financial pressures that cause our health care system to be worse than what it should be, means that the responsibilities that we have in our health care system are only going to grow.

So my advice to those considering a career in medicine is that you have to do it for the right reasons. Don’t do it for traditional superficial reasons like money and prestige and whatnot, or if your parents tell you to do it, don’t do it for that. You have to do it for the right reasons, because it’s not an easy life. There are sacrifices that have to be made. You talk to a lot of physicians who, as I mentioned before, may not have been prepared, or may not anticipate what a life in medicine is like. You have to go through with your eyes open and do it for the right reasons. So if you go into medicine for the right reasons, I don’t think that there is any more rewarding profession.

Lisa Sieczkowski: That’s excellent advice. I don’t know that I have any other questions.

Kevin Pho: So I think it’s important for physicians to share their stories, to write, use it as an outlet, to contrast yourself from the grind of medicine every day. Because I think there are a lot of difficulties that physicians face, and I think writing is a tremendous outlet, not only to connect with other physicians, but get back to why we went into medicine in the first place. And that is to not only share our stories, but also to make the stories of our patients heard.

Lisa Sieczkowski: Thank you, Kevin.