Mother, doctor, CEO: one woman’s journey to reshape health care [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

We dive into the powerful story of a physician-mother whose world changed with the onset of COVID-19. Our guest, Arian Nachat, a palliative and emergency medicine physician, shares her journey through the pandemic, balancing the demanding roles of mother and doctor. From navigating childcare crises and homeschooling to reimagining her career beyond the confines of traditional health care, she sheds light on the struggles faced by frontline workers. Listen as she reveals how these challenges inspired her to reshape her path, create a health care company addressing critical system gaps, and advocate for a patient-centered, physician-led approach to medicine.

Arian Nachat is a palliative and emergency medicine physician.

She discusses the KevinMD article, “Mostly miserables: a physician-mother’s struggle during COVID-19.”

Our presenting sponsor is DAX Copilot by Microsoft.

Do you spend more time on administrative tasks like clinical documentation than you do with patients? You’re not alone. Clinicians report spending up to two hours on administrative tasks for each hour of patient care. Microsoft is committed to helping clinicians restore the balance with DAX Copilot, an AI-powered, voice-enabled solution that automates clinical documentation and workflows.

70 percent of physicians who use DAX Copilot say it improves their work-life balance while reducing feelings of burnout and fatigue. Patients love it too! 93 percent of patients say their physician is more personable and conversational, and 75 percent of physicians say it improves patient experiences.

Help restore your work-life balance with DAX Copilot, your AI assistant for automated clinical documentation and workflows.

VISIT SPONSOR → https://aka.ms/kevinmd

SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://www.kevinmd.com/cme

I’m partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://www.kevinmd.com/learnerplus

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Arian Nachat. She’s an emergency medicine and palliative care physician. Today’s KevinMD article is “Mostly miserables: a physician-mother’s struggle during COVID-19.” Arian, welcome to the show.

Arian Nachat: Thank you for having me, Kevin.

Kevin Pho: So let’s start by briefly sharing your story and journey.

Arian Nachat: Sure. So I started out as an emergency medicine physician and became a patient, unfortunately, early in my career, and then studied Chinese medicine, traditional Chinese medicine. Then I boarded in hospice and palliative medicine and then also became pain-trained, so a somewhat eclectic route within medicine.

During the course of COVID, obviously, we were all encountering very different challenges and experiences, and as a single mom, that brought a whole slew of other challenges that normally I had pretty well juggled. And so I decided that I was going to address that in this article that I wrote for you and for our readers, to sort of talk about what that experience felt like.

Kevin Pho: All right, so let’s jump straight into that article. For those who didn’t get a chance to read it, tell us what it’s about.

Arian Nachat: So during COVID, obviously, being a single mom, I needed to figure out how to work full time, homeschool my kids, because I was in a state where all the schools shut down for about thirteen months, and also still pay the mortgage, which became very, very difficult to do. And as you can imagine, as a frontline emergency medicine physician, there were not a whole lot of people really jumping to volunteer to come to my house prior to the vaccine to watch my children. So I had to pivot and make a lot of adjustments.

In doing that, I discovered that I really wanted to solve a problem that became apparent during COVID, which was the fact that we as a nation really struggled to talk about death and dying. COVID-19 had opened a door in terms of people realizing even young people can die unexpectedly, and maybe this is a conversation we need to have and talk about more. And so I started a company called Pallity that attempted to address the space here, where we could talk about it, where we could educate other clinicians and other patients on how to talk about death and dying, how to prepare for death and dying, and really to empower people to understand that talking about it doesn’t make it happen. But what it does is it alleviates a lot of burden when someone is challenged with a serious illness or diagnosis.

Kevin Pho: So you had so much going on during that time of COVID, and like you said, it sounds like an overwhelming amount of responsibilities, and you also decided to start a company to further address the conversation of palliative care. How did you have the bandwidth and energy just to add that on?

Arian Nachat: I think the phrase “necessity is the mother of invention” is really applicable here. I wound up having to leave my full-time job. They were not able to accommodate my home responsibilities, so to speak. And so I took a position working for the Department of Defense, and I started working primarily as an emergency medicine physician down in San Diego. I was living in Portland, Oregon, originally and started working for the Navy and for the VA doing emergency medicine COVID relief. And so they were happy to give me blocked shifts, and so I started flying down to San Diego working seven to nine 12-hour shifts, and then I’d fly home and homeschool my kids for three weeks.

And so during those three-week blocks, I had a lot of downtime between homeschooling a four-and-a-half and a seven-year-old, obviously not an 8-hour day of education, a lot of periods of time where they were just playing or watching a movie, etc., etc. So I had time to really think and contemplate: What am I seeing that I can fix? What is within my purview of expertise and knowledge where I can make a difference during a period of time where people were really struggling?

And so people were getting very creative. Health care systems were getting creative, Mount Sinai being one of the ones that actually led the way on doing palliative care via iPad. And so we realized that this is a form of health care delivery that works in this space. And so I was able to carve out some time to really take something and figure out a systems-wide solution for it. It was really empowering, and also, frankly, it was really enjoyable. It was fun to have a problem that was sort of like a Rubik’s Cube that I could put my skill set to and help solve.

Kevin Pho: So you mentioned earlier, of course, before the pandemic, and perhaps even now, we’re having difficulty broaching that topic of palliative care. How do you think the pandemic has changed those conversations?

Arian Nachat: Well, I think a lot of young people didn’t think it was a conversation they ever needed to have, right? Suddenly we had twenty-year-olds who were dying of COVID. And so I think that Pandora’s box inadvertently was opened, and people had to come to terms with the fact that people that they cared about and loved were dying unexpectedly. And so suddenly that conversation became front and center. I think that as that happened, people started realizing that there’s something called a good death and a bad death. If we start to talk about it, and people get to actually have a say in what their dying journey looks like, it’s more comforting both to the patient and to their family members.

It’s extremely stressful for a family. My worst day at work is when I’m sitting in an ICU with a family of ten people around the table and no one knows what grandma wanted, and suddenly people have to guess. That’s a huge responsibility to put on a family member. And so, realizing that these are conversations you can have at any juncture and really, ideally, anytime. I tell people I have an advance directive. I’ve had one since I was twenty-three because I was jumping out of airplanes with a parachute. I figured people should probably know what I want to do.

And so I’ve shared that with my patients and their families, to say, “This is not about dying. This is actually about living and how you want to live and what’s important to you.” Those are really important conversations to have at any juncture of life where your life impacts other people. So you’re getting married, you’re having children, there’s a change in your family status, there’s a change in your health status: These are all appropriate times to have a conversation and review, “Well, what’s important to me?” What was important to me at twenty is very different from what’s important to me at fifty. And so I think that the pandemic really showed people that talking about what is essentially their line in the sand, of what’s important to them versus what’s not, and sharing that with the people they love, suddenly was an OK conversation to have.

Kevin Pho: So you’re right at that intersection of palliative care and emergency medicine. That scenario that you described, where people can have a sudden confrontation with death and they may not know what their loved one’s wishes were, did that happen more often than not in the emergency department, especially during the pandemic?

Arian Nachat: Absolutely. And I think that especially on the East Coast, which is where I trained but not where I currently work, they were hit extremely hard, and they were having to have these conversations in one or two minutes with families. Early on in the pandemic, we didn’t know what the best management was, for example, and people were getting intubated, and so patients didn’t have an opportunity to have those conversations with their family members.

So I think the emergency department and emergency medicine physicians in particular are very savvy and know how to have conversations in sort of short, quick, abridged CliffsNotes versions. This is not the ICU version of “Let’s all sit down and have an hour-and-a-half-long conversation and explore this.” But it’s really essential for emergency medicine physicians, and frankly, any clinician who is working with patients with serious illness, to know how to approach the conversation in a kind, gentle, empathic way that opens the door to say, “Hey, we really want to make sure that we’re doing the right thing here. Has your loved one shared with you what’s important to them? Have they ever had an experience where they’ve had to talk about this because their spouse passed away or another family member was struggling?” It’s an incredible opportunity at a very stark moment in time for us to intervene.

Kevin Pho: You mentioned that in your article, physicians during the pandemic were viewed as necessary and expendable. So how did that realization affect your career trajectory, and did it influence your transition into, of course, starting your company, into a more CEO role?

Arian Nachat: Absolutely. Having young kids during the pandemic and realizing that we were health care heroes for a while, and then suddenly it didn’t matter that we didn’t have PPE or that we were putting ourselves at risk. Unfortunately, I did wind up ultimately contracting COVID not once but actually three times, all within a ten-month period, and have struggled with some issues related to long COVID as a result of that. The fact that there are people who don’t seem to understand the really critical role we played, and that we put ourselves at risk, was very heartbreaking.

I think that it’s unfortunate that nowadays there’s this very sort of passé approach that COVID isn’t an issue. COVID is still very much an issue. COVID is a disease we’ve never seen before. We’re going to be writing textbooks about COVID for the next ten to twenty years. We don’t know the implications of long COVID, but we’re learning a lot more about it.

And so for me, the realization was: What can I do to impact health care in a systemic way, and at the same time take care of myself and take care of my kids and put them front and center? And so I switched to a role where I have tighter control over my schedule. I still work clinically, but I work fewer shifts clinically than I did when I was working full-time clinical medicine. And so now I can set my meetings in such a way that I can be home and available for a kid’s event. I can take time off in a way that is a little bit more under my direct control, scheduling-wise.

It’s not to say that the role of CEO in any way is easy, because it’s not. I get phone calls at all times of day and night, but it’s still within the realm of: I can take those calls at home. I can be sitting in my house and can still do homework with my kid and step away for a few minutes if I need to take a call. So I think for me, the Eureka moment, so to speak, was realizing that our time here is limited. For me, the importance shifted to: How do I become more of a presence in my kids’ lives, and how do I control my schedule to allow for that? It’s been really a nice shift for me.

I still work clinically in the ER. I still work clinically doing palliative medicine. I don’t want to ever take my foot completely out of the clinical space. I think being a clinician entrepreneur is extremely important. I don’t think that health care is going to shift because of an MBA sitting in a boardroom making decisions about clinical bedside health care. I think that’s a terrible idea. I think that as more physicians engage in changing health care, because they’ve been at the bedside, they’ve been in those moments of time where a patient has a critical decision that needs to be made about their care, we are in a much better position to identify the problems in health care. We are much better at coming up with problem-solving solutions for it. And so for me, it’s really allowed me to shift my career, now that I’m later in my career, to being a little bit more about home life and about bigger impact, rather than the one-on-one individual patient exposures that I have.

Kevin Pho: I want to talk about that transition from clinical to business. There’s a stereotype that physicians generally aren’t well versed in business practices. So talk to me about that transition to becoming a CEO. Did you have any business background? And whether or not you did, how difficult or easy was it to transition into a CEO role?

Arian Nachat: So I think it was quite challenging. I think that the business world of medicine is not something we get any training on. Funny enough, I just watched a Dr. Glaucomflecken little video about that this morning, where it was, “How much training do you have about health care?” In med school, we get zero training about health care and how the system is designed, which I think is terrible and is a very big disservice to physicians.

So when I was building an integrative medicine service for Kaiser earlier in my career, I thankfully had allies and sponsors within Kaiser who supported me going to the Stanford Graduate School of Business to get some business training. And so I spent four months there learning about the business side of everything and applying it to health care specifically. I have to say that it was a world I was completely unfamiliar with, and that was very overwhelming initially, to realize that I didn’t have the language. I didn’t have the framework to talk about things. And so that four-month experience there was really instructive in terms of giving me those tools that I did not have going to medical school. It allowed me to build the case for why integrative medicine was important, why we should pursue using non-allopathic means to help support patients, and the work that we did there was extremely rewarding. We showed a relative risk reduction for chemo patients being hospitalized of 13.3 percent. That’s a huge impact.

And so I was able to translate that experience into Pallity and building a company where I could have those conversations with venture capital and with private equity and with insurers and all the various stakeholders who have a stake in health care. I think the thing that was most disappointing, and I still struggle with, is that while we had funding offers from private equity and venture capital, it became very clear to me that the health care aspect of it was the least of their interests. It was very much about return on investment. And so we wound up not taking funds from those groups, because I saw what happened in the hospice space. In the hospice space, three-fifths of hospices are now owned by private equity, and I’ve seen the spiral of care downward in terms of the quality of care that these patients receive, which is heartbreaking.

I’ve had patients sent to the emergency room where I’ve been consulted to see them as a palliative care clinician, and the nurse sending them in didn’t know their name, didn’t know their diagnosis. When I would ask, “What’s the diagnosis?” they’d say, “Cancer.” And I’d say, “What kind of cancer?” And they wouldn’t know the answer to very basic questions.

So I think what I have struggled with as CEO was first realizing that there are things I just don’t know coming out of medical school, and that I very much needed to learn and also hire a team of people for whom the business and finance side was something they were very savvy about. So I have a CFO who specifically does know all of that, but I felt, in order for me to be in the room and be able to intelligently understand the conversations, I had to get some training on the business side of it as well, so that I understood what they were talking about and could engage in those conversations in an intelligent fashion.

I don’t mean to hold the finance hat myself. I think it’s really important to understand that you can’t be all things for all people at all times, and that applies to being a mom and an entrepreneur and a clinician. But also, as a CEO of a company, you need to have a team around you of people who can actually support the other functions of your company that are not your wheelhouse, and recognizing which ones are and which ones are not. So for me, handing off the business side to my CFO, but being able to intelligently converse with him, was really important.

I think the heartbreaking part for me was realizing how hard it is to make change in health care. I think we’ve seen Amazon try to make it, JPMorgan, the whole Haven initiative. The reality is that health care has some very entrenched stakeholders, and they really have very little interest in no longer being the predominant stakeholder in that space. And so breaking in with a new way to approach patient care, or where patient care is more important than return on investment, is something that, from a business perspective, I understand that’s not what they’re there to do. They’re there to make money, which comes to a very ethical conversation of: Should health care be a for-profit entity or venture?

I think you’ll get different answers depending on who you talk to about that. But I think at the end of the day, while, yes, I expect people to make money in the health care space, we went to medical school because we believed in helping people, but we obviously want to get paid appropriately as well. So I’m not completely lost on this topic, where people should not make some money off of this. But at the same time, when it becomes more about that than doing the right thing for a patient, or providing the quality of care that you would want for your family member, that’s where I have struggled entering the business side of this space and realizing my moral compass is different from their moral compass.

Kevin Pho: So you’re one of those rare individuals that is well versed, of course, both on the clinical side and the business side. You mentioned private equity, and not only are they taking over the palliative care space, they’re also taking over many of the emergency departments that we have in the country as well. So how can we as physicians push back on the importance of patient care to private equity companies, where they just solely focus on return on investments? Where do you see this leading, and how can we as clinicians push back against that?

Arian Nachat: I think that’s a great question and a really important question for us as clinicians, human beings, and a nation, frankly. I think that we have to engage in the political process. I think we have to engage in legislative processes. I think that as a group, I know that the word “union” is a word that makes physicians exquisitely uncomfortable. There are physicians who don’t believe we should unionize; there are physicians who believe we should. The reality is that physicians have the weakest voice right now in the country when it comes to speaking up and having really the force of labor behind it.

When you look at the nursing unions and you look at other unions throughout the United States, they have a voice, and they’re able to really impact their salaries. They’re able to impact their working conditions. They’re able to do all those things because they come together as a large group and they demand better. I think as physicians, we’ve always leaned towards being altruistic, and “I’m just going to do the right thing.” And if COVID should have taught anybody anything: We were expendable, and no one was really looking out for our interest.

So I think that as a group, as a whole, physicians do need to come together. I think that we do need to raise our voice, and I think more and more that is happening. You’re seeing it on social media. You’re seeing it with more physicians running for political office. I think that’s really important. I think we need to have our own lobby, so to speak, in Washington, D.C., and I think we need to engage in all those processes. And if we need to walk out, we need to walk out.

I’m on many Facebook groups for physicians, and there was a recent post from an EM physician about an EM CMG where they told them they don’t have enough money to pay them next month. And I don’t know any other industry. Look at the pilots union, for example. Could you imagine what would happen if the pilots were suddenly told, “We’re not going to pay you for last month”? They would walk off the job. But because people’s lives are at stake, physicians hold themselves to a standard of, “Well, I can’t just walk off.” I do think we can. I think we can give plenty of notice and have them bring in PAs and NPs and locums groups and whatever they need to do. But I do think that the health care industry as a whole, and I think the country as a whole, needs to start valuing the role that we play in health care and start allowing us to have a seat at the table.

Kevin Pho: We’re talking to Arian Nachat. She’s an emergency medicine and palliative care physician. Today’s KevinMD article is “Mostly miserables: a physician-mother’s struggle during COVID-19.” Arian, we’ll end with some take-home messages to the KevinMD audience.

Arian Nachat: I would say, get engaged, number one. Find a way to get engaged with moving the needle on health care to make your personal experience as a physician better. I think we’ve lost too many physicians, both by just exiting health care and also, unfortunately, to physician suicide. We need to start taking care of ourselves.

Number two, I think talking and engaging with our patients and our colleagues on how to deliver superior care, and how to talk about serious illness and death and dying, is something we should all be comfortable doing. It doesn’t need to be scary. It doesn’t need to be me showing up with a shiv in a black cloak, but rather, it’s an opportunity to explore a patient’s goals and needs and desires and really give them an opportunity to have agency at a time where they may feel very much out of control and impotent to really affect their care.

And then I would say, lastly, we have done such a great job as clinicians supporting each other that we need to continue to do that. Whether that is “I want to exit clinical medicine and go into an entrepreneurial role,” or “I want to leave medicine altogether and just explore my passions and spend time with my family,” or “I want to be a better clinician at the bedside, and I want to do more things and impact my department,” I think we all can make different choices. I think we all have an opportunity at different stages of life to make those decisions, and that we should continue to support each other and really encourage each other to be well.

Kevin Pho: All right, and thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Arian Nachat: Thanks, Kevin. Really appreciate it.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes