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Pediatrician and certified coach Jessie Mahoney discusses her article, “Physician wellness is a strategic imperative—not a moral crusade.” The conversation focuses on why physicians must shift their advocacy for well-being from a reactive, moral argument to a strategic one that aligns with institutional priorities. Jessie explains that effective change comes not from complaining, but from understanding two key things: how physicians’ own training contributes to the culture of unwellness, and what leadership truly values. She provides a framework for physicians to step out of victimhood and into leadership, learning to “speak the language” of executives by framing wellness as a necessity for retention, financial sustainability, and quality patient care. This episode is a guide for doctors who want to stop just enduring the system and start strategically shaping it from within.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jessie Mahoney, pediatrician and certified coach. Today’s KevinMD article is “Physician wellness is a strategic imperative, not a moral crusade.” Jessie, welcome back to the show.

Jessie Mahoney: Thank you so much for having me again.

Kevin Pho: All right, so what’s this article about?

Jessie Mahoney: So this article is about the way we approach physician wellness, and while I will say it is a moral issue and there is a ton of moral injury, that approach doesn’t get us very far and hasn’t gotten us very far. This article came about actually in an Uber ride with a friend who is a CMO in one of the Henry Ford Hospital Systems.

And we were having this conversation about how we’ve approached it. We have this sort of mismatch between: we want leadership and administration to do certain things, and yet we don’t speak their language. The way we’re advocating as physicians isn’t helping us get what we need and what the patients need and what the system needs.

This idea that it takes strategy and it takes an approach kind of like we do when we try to influence our patients, right? We’re actually very thoughtful about that, and we’re not sort of reactive and we don’t put in necessarily the emotional plea, and we often have much more efficacy.

So, we had this conversation and that got me thinking, well, what if more people understood that the way we are advocating and being strategic and thoughtful and deliberate and intentional about it could make a big difference?

Kevin Pho: So what would that look like if we approach burnout more strategically or tactically?

Jessie Mahoney: Well, so if we’re being tactical, it really looks at what do leaders and hospital systems care about and how can we speak the same language. It’s not that we actually care about different things, because in the end we actually do care about a sustainable system and they do care about quality of care and they do care about having physicians be able to work because they need physicians.

But it’s speaking their language. So their language is retention, their language is quality of care, their language is cost of care, their language is patient satisfaction. And all of those things are improved when physicians are healthy and have sustainable practices.

And so often in coaching we talk about, well, how are they just like me? And we are alike in so many ways, but we focus on how we’re different in so many ways.

Kevin Pho: So sometimes that language that administrators speak, like you mentioned, patient satisfaction, revenue, cutting costs, sometimes those goals directly lead to burnout. So how can just speaking their language address the problem of burnout?

Jessie Mahoney: Well, it’s offering a different creative solution so that helping them to see and understand how healthier physicians and well physicians who are potentially present and more mindful and not depleted and reactive. We actually do have more satisfied patients. We actually do practice care that is less expensive. We make different decisions which are higher quality in the end, and there are many studies to show that. But very often we get in this tug of war as we’re the victims and they’re the villains and they are not understanding. And it isn’t that we don’t have the exact same agenda, but to figure out where we are aligned and to figure out the language that helps them understand where we have similar things because it isn’t burnout versus, you know, patient satisfaction. It isn’t that we have to be burnt out to have patient satisfaction. It’s how can we actually work together to grow both.

It’s going to take time and I think that, you know, you also have to find people in the systems that are willing to listen. But as this conversation that I had with this friend, she is in leadership and is listening. And so very often when we pause and we show up with this different energy and I’m going to offer, it’s not the moral crusade energy, even though we’re hurt and angry and it absolutely should be different. It’s really how can we make a difference? And when we change our tone and energy and when we change the words that we use literally and find alignment, we actually can get organizations to pay attention.

And I’ll say, actually even this week, I had a request from a big health care organization who said, “Well, we actually want to talk to you. How can we do something that’s actually going to make a difference? Because we do want to retain our physicians.” And it isn’t that what they really want is faster, more productive physicians. They want people who are going to stay and provide good care because ultimately that’s what they need to have a sustainable system as well.

Kevin Pho: So just to be clear, when you say that moral crusade energy, what exactly do you mean by that?

Jessie Mahoney: Well, I think it’s often that it’s wrong and that we are being taken advantage of and that the system isn’t caring about good care or us, and I’ll say that what it looks like as an outcome is potentially that because the system is failing. But if we stay in the victimhood energy of we’re being wronged, even though a hundred percent there’s moral injury in health care, it isn’t the energy that leads us to a solution.

And I don’t say this lightly because I think the cost to physicians is tremendous, but if what we really want—and I think most of us as physicians went into medicine because we like medicine and we care about patients—and so we actually are the people who have the solutions. We work in the system, we understand it. And when we’re in the moral injury, moral crusade energy, our voices aren’t being heard as effectively. And the change, I’ll just offer, hasn’t happened yet. And so it’s that quote where if you keep doing the same thing, you’re going to get the same results. And so we haven’t been getting the results that we as physicians want and that we want for our patients and that we want for the system.

And that’s where I always go back to this: when we are replete, when we have a healthy nervous system, when we are not in a reactive mode, physicians are incredible humans who can come up with these solutions. And so if we use our smart minds to be strategic. And strategic isn’t always the same. You do have to know who you’re talking to. You do have to know your system. You do have to know who to talk to. The other piece here that I think we often forget is that we do have to process that grief and frustration and anger that medicine is not what most of us thought it would be when we started out. And when we can move past that and say, “OK, well here we are. How can we have it be something that is worthwhile for us and that brings good to the world?”

Kevin Pho: So I agree with you that the ideal scenario would be finding that common ground between the administrators and the physicians. I sometimes see a more cynical perspective that views this through the lens that physicians are replaceable. They’re replaceable by nurse practitioners and physician assistants. So just from your experience, how irreplaceable are physicians really to most health care systems? And you’re probably exposed to a lot more different health care systems than I am through the clients that you see.

Jessie Mahoney: First of all, I would say that the cynicism that we’re bringing is classic to burnout. So when you’re burnt out, we are cynical. So it actually makes sense that we’re seeing things from the cynical point of view. I have seen health care systems where the clinicians and physicians or APPs or whatever language—everyone has a different language, actually—they work together, they come on retreats together, and they find a way to support one another. So when we are depleted, we really look at the other people, who’s to blame, and how can we blame them?

And these days at least, there aren’t enough physicians to go around. And so we are going to need help. It’s really, again, here advocating effectively because I don’t think the language of replaceability… if we actually said, “OK, well we have people who are trained as NPs and PAs, and we have people who are trained as MDs and DOs, and how can we divide things up to figure out where each of us can make the biggest difference? How can we work together to do something that’s better than arguing amongst ourselves?” And I do know that, you know, in some settings, particularly ER, I think there’s a real lens to “we’re going to be replaced.” But when we come at it from that energy, again, we’re coming from scarcity mindset, which we were trained to have in medicine, and we’re coming from reactivity and fear.

And so my thought would be, you have a smart brain, you can actually say, “Well, how can we work together? How can we sell this to administration and to leaders? How can they actually get more out of this by creating a system that works?” I think that people who don’t work in medicine, it’s the idea that, well, we’ll just replace these, they’re interchangeable. But if we could explain not why we’re better, but how we bring one thing and they bring one thing, and how a health care organization can actually benefit from both, that I think is actually, again, the language, it’s the strategy. Because I would say that when we’re arguing about it and worried about our replaceability, we’re not actually getting anywhere. We are being replaced in many cases.

My former health care organization has actually gone the opposite way, and they used to have more nurse practitioners and physician assistants, and now they have more physicians. And so different health care systems are trying different models and part of this is figuring out what will work and how can it work. And I think that if we are busy worrying about being replaceable, we’re not busy finding the solutions creatively. And again here, this is the strategy and the advocacy. Well, what do we bring that’s different and how maybe can we use those people to do things that—this might sound not good—but do things that we don’t want to do or that are not the best use of our time? Because there are things I think in spaces where these extenders, I think a lot of people call them, can be helpful.

There are many times as physicians, and part of this may be the problem, where we say we have too much work and we need help, and then they bring in more workers and help and, “Well, those aren’t the right ones.” And there’s that fear there. And so this is coming back to that physician mindset we’ve talked about a few times, and I really do think it’s getting us into trouble. A lot of the ways that we were trained to think are adding to the burnout crisis; they’re adding to the system’s problems. This is not at all to say it’s our fault. This is a much bigger monster, bigger than physicians. But if we want to keep doing what we love, getting creative and focusing on outside-the-box solutions and focusing on alignment and strategy is where I think we can make some inroads.

Will we be able to solve the problem? I don’t know. It’s a huge, complex problem, but I know that what we’ve been doing so far hasn’t been working particularly well. And so what if we leaned into some of this strategy? And it reminds me a bit of working with anti-vaccine patients. And there, you know, we have to get creative, we have to be strategic, we have to be thoughtful. What matters to them? Where are we aligned? And that’s the only way that as a pediatrician you can potentially help someone make more thoughtful decisions about that. And I think there are so many parallels in my mind about those two situations that when we get frustrated and when we feel like victims as pediatricians in that scenario, we don’t have the outcomes that we want either.

Kevin Pho: So tell us the steps in terms of speaking in that strategic mindset, because that doesn’t come naturally to a lot of physicians, and that’s not part of physician training. We take patient care personally, right? And sometimes that detracts from that strategic lens, right? So do we need to get business degrees? What are some first steps in terms of approaching burnout more strategically?

Jessie Mahoney: I actually think we don’t need business degrees, but I think we do need to think like a marketer and so think, “Well if this is what I want, how are we aligned?” And it’s really leaning into, again, the alignment. One way to think about it is persuasive speaking, and we’ve talked about negotiation. It’s a negotiation. And so utilizing a lot of what I call mindful communication skills. If you want leaders to feel inspired and you want them to feel motivated, and you want them to feel like you’re on the same team, you have to actually show up with inspiring, motivating, on-the-same-team energy.

And so when you’re strategic in the tone and energy you bring, when you’re strategic with your messaging, and the messaging really is to think about what do we both want? We actually both want healthy patients and happy patients who continue to choose this health care system. And we want them healthier because otherwise it costs a lot more money for care generally.

And so, recognizing what their language is as a former operational leader. I think the other thing is to know what are they beholden to. So as a department chief, you are someone who’s held responsible for patient satisfaction scores; you’re held responsible for HEDIS measures and other metrics. And so when you can understand what those are, then you can actually say, “Well, how will this help that?” The other most effective thing I’ve ever seen done in physician wellness is when we started talking money and the money of how much does burnout cost? How much does it cost to replace a physician? How much do errors cost? And those come from burnout and a lack of wellness, and they come from not enough time.

So, understanding a bit about those costs, which you could get an MBA degree… I think that as physicians, we’re actually addicted to the degrees and we feel like we don’t have the knowledge. But if we were to pause and realize we have tremendous intimate knowledge of how the system works, that we actually potentially are the people who can come up with these answers if we step out of the moral crusade and the victimhood and into, “OK, well I’m going to be strategic.” And I think when physicians get their mind set on something, we do a really good job. We can work through lots of complex problems. And so recognizing that this is similarly another complex problem. I think the challenge is that it feels so personal and we feel so depleted that that’s where we don’t do our best work.

Now if you aren’t able to get that information, I actually think these days you can get that kind of information through AI and lots of other things, but figuring out how you can get that information or how you can get that information for another health care system if you can’t get it for yours. And I think if you have worked within your system and they’re really not interested in patient care and they’re really truly not interested in retaining physicians, that’s good information for you. You want to expend your energy elsewhere.

Kevin Pho: We’re talking to Jessie Mahoney, pediatrician and certified coach. Today’s KevinMD article is “Physician wellness is a strategic imperative, not a moral crusade.” Jessie, as always, let’s end with some take-home messages that you would like to leave with the KevinMD audience.

Jessie Mahoney: I think the take-home message is what I mentioned: not continuing to do the same thing over and over again that isn’t working and pausing and taking the time to get yourself healthy and well and thoughtful and using all that you know about patient care to advocate in a strategic, effective, purposeful, and deliberate way.

And I do want to say at the end it isn’t that there isn’t a moral injury and that there’s a crisis and that, it isn’t even that physicians aren’t victims because in many ways we are victims of this large mess of a system. But that from that standpoint, we’re disempowered and not able to use the incredible tools and wisdom and resources that we do have to try to move this behemoth problem forward.

Kevin Pho: Jessie, as always, thank you so much for sharing your perspective and insight and thanks again for coming back on the show.

Jessie Mahoney: Thanks for having me so much.