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Physician advocates Alae Kawam, Kim Downey, and Nicole Solomos discuss their article “True stories of doctors reclaiming their humanity in a system that challenges it,” sharing firsthand accounts of the cultural rift in modern medicine and the toll of corporate models on patient care and physician well-being. Alae, Kim, and Nicole outline how millennial and Gen Z physicians are redefining professional boundaries, resisting overwork, and demanding autonomy over cookie-cutter wellness programs. They highlight the divisions and biases among physicians, the erosion of collegiality, and the harm caused when outdated or false medical studies persist. The conversation offers actionable insights for health care leaders on valuing physicians as strategic assets, fostering collaboration, and restoring trust and compassion as the foundation of patient care.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Kim Downey, a physical therapist and physician advocate, and she brings together two physicians: Nicole Solomos, a sports medicine physician, and Alae Kawam, a surgical pathologist. Together they all wrote the KevinMD article, “True stories of doctors reclaiming their humanity in a system that challenges it.” Everybody, welcome to the show.

Kim Downey: Thanks, Kevin.

Nicole Solomos: Thanks for having us.

Alae Kawam: Thank you for having us.

Kevin Pho: So Kim, you always bring together such a diverse and wonderful group of clinicians that we can discuss in this podcast. So what brought Nicole and Alae together?

Kim Downey: Sure. So Nicole, I would say that we communicated, I’d say indirectly, related to you, Kevin. It was because my first article and podcast, as you know, were a tribute to my radiologist. And when I shared that on LinkedIn, Nicole commented that he was her doctor too. I couldn’t believe that. Nobody in my life knew him, and I did everything during the pandemic, so nobody could go with me to my appointments or my surgeries. It was a disenfranchised grief when I found out that he died. So to know someone else who actually knew him was incredible.

Around that time, I was starting my YouTube channel, and people told me I should have an introductory episode. But I didn’t want to just talk to the camera, so I asked Nicole, because she didn’t really know my story, if she’d be willing to listen to my story and to do this introductory episode. She graciously agreed, and then I interviewed her.

And then Alae. The day I published my first episode, it was with Dr. Todd Otten, and Alae reached out to me and she said, “Can I be on your YouTube channel?” And I said, “Sure.” So we had never communicated until we were on the video together, and she was such a delight, as you’ll see. So then they both graciously agreed to write chapters in the book.

And when I reached out to you—so thanks again, if people haven’t seen it, this is the book—and thank you so much for writing the endorsement. I even said to you, “I think you know most of these doctors.” And then when I explored it further, I was like, “Well, I think there are actually only two that hadn’t been on independently or with me.” So I thought that you and your audience would just love to meet them, and here we are.

Kevin Pho: All right, so wonderful. So, Alae, let’s start with you. You’re a surgical pathologist. Tell me the story that you’d like to share with my audience here today.

Alae Kawam: Yeah, I think a lot of the learning that I’ve done over the past few years is what I want to bring to the audience, which is: physicians struggle with burnout. Physicians are human too. I think part of the cure is reconnecting with people. I think part of it is acknowledging issues, and something that I really want to highlight is bringing the research that’s been done on what good leadership looks like into the medical field and taking ownership and responsibility for that.

In the context of the article, a lot of it was bred out of frustration and seeing my clinical colleagues being burnt out. One thing that the pathology field struggles with is severe understaffing, which can become a patient care issue when you have so many cases and not enough pathologists to spend enough time on each case. So there was frustration with certain things; obviously, staffing was one. But it really gave us a little bit of information on what leadership is doing about this. And is this truly a pathologist issue, or should we zoom out for a second and really look at what other issues are going on?

So I’d really like to shed light on that and how we can address those things. Obviously, I think a lot of doctors are frustrated with medicine, and part of what I want to bring out is that you’re not alone. There is a movement, and the more people who are doing things about it—and obviously Kim has taken the initiative to really bring people together and help create that movement—the better.

Kevin Pho: So, Alae, tell us what you’re seeing. Because when people think about pathology, sometimes patient connection isn’t as high on the list as in fields where you’re typically in the exam room or in a hospital. So tell me what you’re seeing in terms of the burnout among your fellow pathologists and how you think reconnection within that field can help.

Alae Kawam: For sure. A lot of it is systemic decisions on the large scale, which is: how many pathologists are we bringing into each organization? What other administrative tasks are we putting onto them? The research shows that too many administrative tasks and understaffing create a vicious cycle of overwork. And when you’re overworked and you’re spending until 8:00 p.m. every day looking at cancer case after cancer case after cancer case, you become disconnected. And rightfully so; we are disconnected from the patient to a certain extent, and you kind of have to be a little disconnected. Otherwise, you don’t want it to cloud your judgment. You do have to look at the glass slides as a specimen, but it’s very important to remind yourself, “This is a person, and there is going to be a clinical decision made based on what I say on this final diagnosis or on this report.”

We might be disconnected from the patient, but we always come back and remind ourselves that we are physicians. It’s easy to forget that when you’re just overburdened. It becomes very hard when you have to keep up with a certain amount of income because you have to pay your bills. But the slides don’t cut themselves; the tissue doesn’t cut itself. So, really what it comes down to is leadership not just approaching the patient with compassion but approaching the physicians with compassion too and what they can tolerate.

I think a really big solution or a very important way of looking at this is to understand that physicians need some level of autonomy, some level of personal growth and connection. Whether it’s with other clinicians or with their family, just reconnecting with people is going to help, in addition to the systemic changes that need to happen to mitigate the burnout crisis.

Kevin Pho: Nicole, you’re a sports medicine physician. Tell us a story that you’d like to share with us today.

Nicole Solomos: Well, I think that when you ask about the article and what brought me to this space, it’s that I think more than one thing can be true. That’s always been the theme for me. Yes, I went into medicine, but I also identify as an athlete. I have other interests, and I was never one of those physicians who really thought that my job was my only identity. My story in the book is that when I was a patient, when I was seeing another doctor, I really felt slighted. I truly identified with being a patient and feeling that almost mistreatment and the aloofness of the physician that was treating me.

I really feel like I am very grounded in being just a normal person. I don’t just identify with the “physician” thing, and sometimes I even find myself pushing back on it. Another thing that I want to bring forth is that I think more than one thing can be true, and that includes that I can have a lot of feelings about the system being broken, as we all do these days, especially the people in this space. We talk about insurance companies and private equity and hospital systems. And I can also love my job. My most recent job has shown me that, and I have come to love seeing back pain and neck pain. I never thought those words would come out of my mouth, but I look forward to it, and I’m very fulfilled by it. But I can also have a day where I’m frustrated and feeling the negativity. My theme is that more than one thing can be true, and we can embrace all of those things.

Kevin Pho: One of the things that I always mention on this podcast, and Kim has heard me say this before, is that physicians are more than their degrees. One of the things that we like to highlight, of course, is exactly what you said, Nicole, that we are just more than physicians. We can be several things at once. So Nicole, when you said that sometimes you had to push back against that single physician identity, that you are defined by more than just being a physician, what do you mean by pushing back? Did you feel pressure to solely identify yourself as a physician? Give us a story or an example where you felt you had to push back against those traditional norms.

Nicole Solomos: Yeah, I mean, I was in a practice for a long time where I wasn’t an actual partner. I was called an “associate partner,” but they had a code of conduct or unwritten rules. To be honest, they were all men, but I heard one or two of them say that their first priority over their family, over everything, was their being a physician and their job. I even had a relationship with someone early on, when I was in medical school, where they said that was going to be their priority. That was their first. It may have been tied at one point, but I would say it was never my priority.

I was never going to be that person. I knew it then, and I still know it. If I had to walk away or if I made the decision to walk away, I have so many other things. And I also play soccer—well, I did until March. I tore my ACL again, the other one. And I still get comments. Some doctors that I talk to are like, “You have to fix it. You have to play.” Because I’m 51, one could argue, and it’s a strong argument, that I’ve played enough soccer in my life. But I love it. It’s my passion. I might play again. I might get my knee fixed when I have time.

That’s another example of it where some doctors will look at me and be like, “What?” Literally just two weeks ago, one of the physicians I was working with was like, “Why are you still playing soccer? What are you doing playing soccer?” And I’m like, “It’s my passion.” Without thinking, that was my answer. So that’s a few examples of what I mean.

Kevin Pho: So, Kim, when you hear these stories from both Alae and Nicole—Alae talking about burnout among pathologists and the need for leadership to recognize them, and the multiple passions that a physician can have, as Nicole articulated in her story—what struck you most about hearing their stories for the first time, Kim?

Kim Downey: Well, I love that Alae’s chapter, I believe in our book and on the YouTube channel episode, was like “the people’s pathologist,” and that she was a human. She shared that, “I’m a human too. I’m a doctor.” Even though she talked about in some ways dissociating from patients, in other ways, she knows that they’re human, that they are patients, and it’s just that connection.

Nicole had shared stories. She had been in a practice for a long time, and then things happened to that practice and she had to leave. Then she got another job and things weren’t well there, but she pivoted again. And Alae, I think you had recently switched jobs. Did you? Yeah. So I love that, and it makes me happy and proud. I almost feel like a proud mom to all my doctor friends, and I’m like, “Go you!” Realizing that you don’t have to put up with so much stuff and that you always have choices and that there’s always a path forward.

Alae Kawam: I’ll let you talk about leadership and the need for leadership to recognize some of the issues that directly contribute to burnout among clinicians. So tell us what you would like to see among leadership to fix some of these systemic causes.

Oh, this is something I’m so passionate about. You have no idea. I’ve become obsessed with leadership and I’ve been doing a lot of reading based on what good leadership looks like. There are so many different theories out there, but I think that there’s one common theme, and that is compassion and caretaking for the people that work for you. When you look at your physicians, they are an extremely important part of the function of the health care system. You should take care of them as if they’re your own children. There’s research out there that shows that when you nurture people who work for you and they feel a sense of belonging, they feel like they’re contributing, they feel like they’re having an effect, their voices are heard, and they have some level of independence or autonomy, people perform better.

It really takes a step away from the performative ways that leadership is trying to mitigate burnout. In today’s world where you have extremely large health care systems, how do you maintain that compassion on a very personal level? The wellness things that they try to do, whether it’s a lunch or yoga or whatever, that’s great, but that doesn’t solve the root issue. Part of burnout, as I wrote in an article, includes feeling ineffective, feeling like you’re not accomplishing anything, and emotional exhaustion. These are all different factors of burnout, and everything else is kind of a symptom.

I want to tell leadership: stop looking at us as billing machines and look at us as people. When you really bring the person into the health care system, you will have better performance. People will be more engaged. I know disengagement is a huge issue in a lot of workforces, but particularly with medicine and the burnout crisis. Start looking at the doctors as people, nurturing them, and listening to them. Everyone’s needs are different. Burnout is not like a box; the things that we do to change are not boxes to check. These are things that we need to take more seriously in terms of systemic action.

A very big piece that doesn’t get enough attention is making the workplace conducive, not just through the people—you can’t change people’s personalities—but if your EMR system is terrible and I have to fight with it every day, little changes like this can actually make a huge difference in the workforce. Making the administrative tasks that are meaningless but burdensome more streamlined, using AI, basically getting rid of the tasks that don’t give us fulfillment, is one way to look at it. There are tools out there. AI is a great tool. Remote options for certain things, like answering emails or whatever it is, can give people flexibility. Just look at the person as a person with needs, not a cog in a wheel to bill. Approach it with compassion. Approach it with love.

I think that when leadership takes ownership and responsibility for the people as individuals, then their return on investment, or whatever you want to call it, will show better results because that’s what they want to see. Intentionality is important too. It would be nice for everyone to look at it as, “I want to take care of my doctors because I really care about them.” That’s very idealistic, and I understand that may never happen. But at least approaching it with some compassion and some humanity, I think, would make a huge difference.

Kevin Pho: Nicole, you talk about physicians pursuing passions sometimes outside of medicine and how important that is, and I completely agree with you. Now, you talked about when you were in a prior practice, some of the unspoken rules perhaps pressured you to only pursue medicine as a passion. Tell us the advice that you could give to the physicians listening to you on how they can pursue passions sometimes outside of medicine and push back against that traditional mindset.

Nicole Solomos: I make time for it. I prioritize it so much that I go to bed at a certain time and I wake up at a certain time to get things done. Soccer was a little different. I did it on the weekend; I had a traditional job where I could do that. Most of the time, I was able to do that, so I could play on the weekend and call it a day. But for me, we all have the same 24 hours in a day, and having a routine has been key for me. I’ve always had that. I was an athlete, and I think I got into that habit. I think having a routine is really key to pursuing your passions, making it a part of your life, and prioritizing it and building your world around it.

Kevin Pho: Absolutely. I think scheduling it is one way that I’ve heard other physicians say it. Because sometimes if these passions outside of medicine don’t get scheduled, they don’t get done. Right?

Nicole Solomos: Right.

Kevin Pho: We’re talking to Kim Downey, Alae Kawam, and Nicole Solomos. Their KevinMD article is “True stories of doctors reclaiming their humanity in a system that challenges it.” Now, I’m going to end with asking each of you just to share some take-home messages for the KevinMD audience. I’m going to start with you, Alae.

Alae Kawam: For the KevinMD audience: don’t be afraid to connect with people. Don’t be afraid to connect with yourself, and don’t be afraid to connect with your passions and other clinicians. Just don’t be afraid to reach out and reconnect with what feels disconnected.

Kevin Pho: Nicole, your take-home messages.

Nicole Solomos: So I think I spoiled it already, but my take-home message is that you can feel burnt out, frustrated, and not like the system, and you can also still find joy in your work and still find joy in your private life. All of those things can be true.

Kevin Pho: And Kim, as always, we’ll end with you, your take-home messages.

Kim Downey: Sure. So Alae had spoken about connection and caring for the caregivers and just prioritizing those connections. Nicole and I made a point to meet in person for coffee once, and then I wanted to introduce her to another physician, Dr. Beatriz. We got together recently, and we’ll be doing a book signing together next month. Actually, tomorrow I’ll be meeting Alae in person for the first time because we’re doing the very first book signing.

I wanted to give a shout-out to Dr. Emmy Vlachoyannis, a health psychologist in Greece. She was our editor, and she wrote the afterword. She said, “There are more voices to hear, more stories to share, and more ripples of change to create. So, dear reader, where do we go next? We keep telling the truth. We keep pushing. We keep standing up for doctors, for the future of care, for a system that doesn’t just save lives but protects the people doing the saving.” And that’s what I’m all about.

Kevin Pho: Well, thank you all for joining us today and sharing your stories and insight.

Kim Downey: Thank you so much for having me.

Alae Kawam: Thanks, Kevin.

Nicole Solomos: Thank you. Thank you so much.