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Pediatrician and certified coach Jessie Mahoney discusses her article “The broken health care system doesn’t have to break you.” Jessie discusses the profound changes in the practice of medicine that no longer align with traditional training models. She identifies outdated beliefs prevalent in medicine, such as self-sacrifice, service at all costs, and avoiding discussions of compensation, which contribute to widespread physician burnout and mental health issues. Jessie emphasizes that the pressures of electronic health records, administrative burdens, and corporate medicine demand a new approach rooted in adaptability and self-awareness. She offers actionable strategies for physicians to reshape their approach, including recognizing harmful conditioning, setting boundaries, cultivating a growth mindset, managing energy, and advocating for systemic change. Jessie highlights mindset coaching as an evidence-based approach to rewiring old thought patterns, enabling physicians to reclaim their purpose and passion in a challenging health care environment.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jessie Mahoney, a board-certified pediatrician and coach. Today’s KevinMD article is “The broken health care system doesn’t have to break you.” Jessie, welcome back to the show.

Jessie Mahoney: Thanks so much.

Kevin Pho: Alright. What’s your latest article about?

Jessie Mahoney: Well, this article came to be because it comes up all the time: these ways we were taught to practice in medicine. I work with a lot of people on changing their thoughts and changing the default approach, and that leads to this kind of personal blame or blame of the system. And so it becomes, “The system’s broken, and that’s the fault,” or, “I’m broken, and that’s the thought.” And so I really wanted to make this point that we were taught to practice medicine in this way when medicine was different. And so it’s a mismatch more than anything.

Kevin Pho: So for those who aren’t familiar with medicine and medical training, talk to us about how we were trained in the past. When you say that this is the way medicine was and this is the way we train in a system that isn’t what it is now.

Jessie Mahoney: So, when we were trained, and I was trained almost 30 years ago, we were trained to sacrifice at all costs. Self-sacrifice and martyrdom is the definition of a good doctor. And we were trained to serve at all costs. We were trained to be what I like to call “over-responsible,” so taking responsibility for things that aren’t even in our control. We were trained in what I like to call “toxic independence,” meaning we do everything ourselves because we do it really well and we’re fast and efficient, and that’s glorified. And we were trained that rest is not valuable and harder is better, more is better. All of these things worked OK in our older system. They worked OK when usually the physician had a stay-at-home partner to help with other things, and we didn’t have this, I’m going to call it a “middleman,” or the institutions or managed care. We weren’t employed physicians; we were responsible for our own practices and patients, and that’s rare today.

The other thing is just the culture of medicine. What we know in medicine, what we have available, the way drugs are handled—all of those things are very different. So if you’re bringing this lens of sacrificing yourself to a system where there’s a whole layer in between and things are not in your control, you just end up exhausted and depleted and, I’ll say, broken. Which doesn’t mean we don’t have to provide good care. It’s really how we provide the care, how we think about it, how we show up, and having boundaries and structures and ways of thinking about things that keep you safe and happy and whole and healthy so you can keep practicing.

Kevin Pho: So talk to us about that mismatch. You mentioned that the traditional martyrdom way that physicians are trained, that toxic independence is a mismatch to a lot of our current health care systems where a minority of physicians are practicing in private practice and a lot of them are employees in larger corporations. Why is that traditional martyr mentality a mismatch for today’s health care systems?

Jessie Mahoney: Because in the system today, you see your patients, but that relationship is very different. And so when we take on over-responsibility, we take on the responsibility for patient satisfaction scores, for example, which are largely not in our control. We take on responsibility if you happen to be a leader for everyone in your department and their health and happiness and wellness, and we take on responsibility for many of the things that our health care organizations are doing, which are also completely out of our control. So we find ourselves trying to compensate for the broken system. We find ourselves trying to help patients navigate everything. And what happens is we run out of energy and people are leaving medicine because they can’t do it. There’s such a high rate of physician suicide; there’s a high rate of physician dissatisfaction and burnout. So what we’re finding is the system is collapsing because of, I believe, this mismatch.

Now the system obviously needs to have change. But if we as physicians are not healthy, we’re not going to be able to contribute to that change. And if you see what’s happened, we haven’t. We’ve been busy doing what they told us: take care of the patients, do it all on your own, and try to take care of all kinds of things that are out of our control. And then we don’t have the energy to try to find the solutions.

If we’re acting from a place, I like to say of caring, and really caring, I think is the best word, because someone who’s caring wouldn’t self-sacrifice and wouldn’t be a martyr. They would still provide excellent care and focus on what is in their control and that specific relationship with the patient, but not be trying to overcompensate for all of the potentially the metrics or the med-legal requirements and all of these regulatory things that are out there. Because that’s impossible.

I think my personal belief is that also systems understand how we were trained to think. They understand that we see medicine as a calling and we will give all. And so there is a bit of taking advantage of that when we are not aware of it. It doesn’t mean, again, that we don’t want to provide exceptional care. I think we can provide exceptional care if we focus on being, focus on the patients and focus on caring for ourselves and focusing on, I like to say, sustainable medicine. And I think that many people ask, “Well, what’s wellness?” or, “How do we keep going in this system?” And I think it’s both sustainability—so that’s not doing things that deplete you and leave you empty and exhausted—but also self-advocacy. And we don’t advocate well when we are martyrs and self-sacrificed and over-responsible. We just react. We can’t be intentional about how we want things to change.

So I think that this idea of, “we don’t have to break,” it’s almost a people consider it almost already a done deal. Like, we have to break in the system because the system’s broken. And as physicians, that’s just sort of our role and our job. And yet I would say it’s great modeling for our patients and great modeling for our colleagues if we choose not to. I think medicine also has trained us a bit to be victims, right? We aren’t supposed to advocate for ourselves. It’s a calling; anything is justified and expected and we shouldn’t talk about our value or worth. And so when we can begin to say, “Well, wait a minute, we bring tremendous value, we bring tremendous worth,” and we can start to shift things in a more positive way, that’s when things will start to shift. I will say I think we are a bit victims of a broken system, and yet we can choose to opt out of that victimhood. That’s where I think you can get your power back, and we can choose to opt out of all of these old thought patterns that make what’s really hard a lot harder right now. And it’s almost like a runaway train if we show up that way.

Kevin Pho: So when you said that medicine is a calling, I had a guest on the podcast who said that those words are just code for being taken advantage of, and a lot of systems are just weaponizing that phrase, “medicine is a calling,” and using it against physicians, right?

Jessie Mahoney: Absolutely. Absolutely. And I think that’s the point. The system will break you if you say it’s a calling. “Calling” really justifies unfair working conditions. It justifies being held responsible for things that are not in our control. It justifies metrics and all kinds of things that aren’t reasonable. I think the medical system today has so many unreasonable expectations because there are all these layers that have nothing to do with the art of caring and the art of medicine. And so I think we really do have to say that, I love the idea that medicine is a calling, but that’s used against us and we use it against ourselves. So what if it’s caring? We’re here to care. We’re here to provide good care. We’re here to take care and to help, but to help doesn’t mean to sacrifice yourself.

Kevin Pho: So you mentioned or alluded to something earlier, that sometimes this pressure isn’t just coming from the health care systems, but it could be coming from other physicians as well. Right? We do it to ourselves. Perhaps those physicians who trained in the era of martyrdom, they have these antiquated notions of what physicians should be, and then they themselves, aside from the system, are also part of the problem as well.

Jessie Mahoney: Yeah. And that’s the culture that I think we have to change. And that’s where I think this idea that we were taught to practice medicine for a practice of medicine that no longer exists. So that it’s not that they’re wrong or to blame either, but that the system has changed and we have to change the culture of medicine to keep up with it if we want medicine to be sustainable and not break ourselves. If the physicians break, the system’s just going to break further. And so I do really believe that if we ignore this, we won’t make change.

For those folks who were raised in medicine that way, I was trained in the time before work hours. But being angry about what happened is just living in the past. And it’s only going to make this profession that most of us love and most of us want to practice in fall apart. And so if we take on the idea that the system has changed and therefore the culture of medicine has to change to be sustainable, I hope that that will inspire people to work together. Part of that is also our training. We were trained to judge each other, judge ourselves super harshly, and judge each other super harshly. And so it’s this idea that, “Well, I did it, you should do it.” And really, we’re all on the same team. But we weren’t really trained in that way of thinking about it. And when we all work for big organizations, not all of us, but most people do, that we really do have to be on the same team as physicians.

Kevin Pho: So tell us a path forward for an individual physician who perhaps is coming out of training. Medical inertia, of course, and the culture of medicine is very, very strong and difficult to change. What are some individual things that they could do to protect themselves or even change medicine from within?

Jessie Mahoney: Well, I think the first thing is to be aware of the way you were trained, to be aware that you were actually taught these things. And if you’re taught them, you can decide whether you want to make them your reality or not. And while it might seem lofty, I really think we can change one person at a time. If each one of us changes ourselves and is aware of how we’re thinking and aware of the mismatch, you can then choose what’s going to work for you. I think the answers for each person are a little bit different and a little bit different for each culture. But if you decide that you commit to no longer breaking, essentially not sacrificing yourself, not being a martyr, I think the more important thing is to choose what kind of doctor you want to be. And that’s where I think if you can decide, a caring doctor doesn’t sacrifice themselves.

A kind and physician who practices sustainably isn’t a martyr and isn’t over-responsible and isn’t toxically independent, and we can model that and believe in it ourselves. When we look outside for feedback, that’s where we go into these old patterns, and so it is going to take each individual physician being aware of their thought patterns, creating new thought patterns, and standing tall for what they believe in. And we are a group of people who have strong beliefs and can do that if we step out of this victimhood. When we’re in victimhood, we just don’t do it. So, I believe that coaching is really one of those things because it really helps you with your mindset, but it’s mostly the awareness. It’s the awareness of how you’re reacting and what your default patterns are. And once you can see how those impact how you show up, you get your agency and choice back. And physicians with agency and choice can do a lot of things.

I don’t think any of us want medicine to collapse. We all want healthy patients. We all want to be able to practice medicine. Nobody went into this profession because they don’t want it to work. And so if we can go back to that purpose as opposed to it being a calling, but that we want to help people and that we want to be able to do what we loved and trained so hard to do, that’s where the change will begin.

Kevin Pho: So let’s say a physician is past that first step; they have that recognition and insight that the traditional ways of training is a mismatch for today’s system. So they have that insight, as you said, they recognize it. What’s the next step after that? And now that they have the agency, what did they do next?

Jessie Mahoney: Well, it’s really choosing, I like to say, the power of intention. So it’s not a goal, it’s how you personally are going to show up for it, what kind of physician you want to be. And I think many of us choose a definition of success that’s medicine’s definition of success, or a parent’s definition of success. But what kind of, what is success for you as a physician and leaning into that, not letting it be the metrics, not letting it be external validation, which we are all trained to do, but leaning into who you want to be. And I do think for most of us, that takes some kind of support and some kind of lens of awareness, whether it’s a mentor or a coach or even therapy to have real understanding of where you’re coming from. A lot of these patterns are ingrained in people who become physicians as well, so it’s a multilayered thing.

But I think it is not an easy thing to do. And so recognizing that, of course when you stand up for what you believe in and you show up with your own definition of success, you’re going to question it. We were trained to sort of evaluate ourselves by what’s happening around us, and yet how beautiful would it be if little pockets and little ripples come out of those pockets to begin to change this culture? We can’t change it if we ourselves don’t change.

Kevin Pho: Now tell us an individual success story. You’re obviously a coach and a lot of physicians come to you with the exact problem that we’re talking about today. What would a typical success story be? Someone’s mindset evolving based on our discussion today.

Jessie Mahoney: Yeah, I work with a lot of physicians who show up to me in victimhood, that their system is the problem and they usually think they have to leave to make it better. For physicians who work in, there are a lot of decent health care systems. And so if you work in a place that’s not toxic, I see all the time people choosing to opt out of that victimhood. So it’s like, “Well, I get to choose how I’m going to show up here and I do want to practice medicine.” And so my intention is to care for patients. My intention is to have boundaries, not this over-responsibility, focus on what’s in my control. Which I always say is what you do and what you don’t do, and what you say and what you don’t say and how you think about things. And then the most important part is the tone and energy with which you do it.

And so the success for individual physicians is truly stepping out of victimhood and deciding they have agency and control to show up for their practice to notice what’s good about it rather than what’s problematic about it. And if you can recognize that you have this power and agency to choose, most physicians, if their workplace is not toxic for other reasons, actually choose to stay in medicine. And I would say almost everybody I work with chooses to stay in medicine in some capacity. They might need to make a change to have it work better for their home lives or where they live or to get out of a situation that really is taking advantage of them. But physicians are amazing humans, and when we begin to work on our brains and actually make changes, people will, they’ll stay and they’ll actually like their job and be able to stay for long periods.

I have a client who I was actually talking to yesterday who said, “Yeah, no, I have no intention of leaving now. My job is good. I remember the things I like about it. It’s not perfect.” We’re also trained to always notice what’s wrong, right? We’re problem spotters in medicine, and so it’s very hard for us to like a job. So once you decide you’re not going to be that problem spotter anymore, you’re going to be the positive spotter, which isn’t all Pollyanna, doesn’t mean that you ignore these things. You maybe even give equal value to them. Many, many people are able to stay where they are or find a place that works for them or create a way of practicing medicine that works for them. There’s so many options out there. We are just taught, and if you are in this self-sacrifice, martyrdom, “My job is to show up, this is a calling,” we don’t actually get creative and think about effective ways to change.

And I think when one physician changes in a department, other people actually begin to say, “What happened to you? How come the way you’re moving through your practice and the way you show up at our meetings is different?” And that has a ripple effect. So people then understand, “Oh, it is possible to show up today.” I think the other piece that’s so helpful for people is they actually learn to advocate effectively. Because when we’re a victim, we don’t advocate effectively. But when we’re standing tall and being a healthy and happy physician who provides good care, nobody can really argue with advocacy from that standpoint. When we’re complaining, we usually don’t get what we want. And so I think this, it’s not only not your own depletion, but it actually allows you to move forward and many people end up getting promotions and leadership where they can then actually make change.

Kevin Pho: We’re talking to Jessie Mahoney. She’s a pediatrician and coach. Today’s KevinMD article is “The broken health care system doesn’t have to break you.” Jessie, let’s end with some take-home messages that you would like to leave with the KevinMD audience.

Jessie Mahoney: I think my biggest take-home message is don’t be a victim of the broken system. All physicians have incredible capacity, resources, and brilliant minds. And if you choose to use it for you and be aware and notice what’s going on and choose to bring a mindset that works for the medicine that we’re practicing today, things can change.

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

Jessie Mahoney: Thank you so much for having me.