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Physical therapist and physician advocate Kim Downey, mental health counselor Nikolai Blinow, and family physician and physician coach Tonya Caylor discuss their article “Focusing on well-being versus wellness: What it means for physicians (and their patients).” Together, Kim, Nikolai, and Tonya examine why the language of “wellness” often feels performative and unattainable, while “well-being” reflects a dynamic, values-based, and relational practice that supports both physicians and patients. They highlight how well-being fosters flexibility, belonging, and system-level change, while empowering individual clinicians to reconnect with purpose and presence. Listeners will gain insights into how embracing well-being can transform physician culture, reduce burnout, and model healthier approaches to care.

Mentioned on the show:

Well-Being Toolkit of On-Demand Resources: https://caws.dukehealth.org/toolkit-on-demand/

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Kim Downey, a physician advocate; Nikolai Blinow, a mental health counselor; and Tonya Caylor, a family physician and physician coach. They all wrote the KevinMD article “Well-being versus wellness: What it means for physicians and their patients.” Everybody, welcome to the show.

All: Thanks, Kevin.

Kevin Pho: Kim, we’ll start with you. How did you find Nikolai and Tonya, and what brought you all together?

Kim Downey: LinkedIn, once again. Tonya and I have been connected for a while, but we hadn’t had a conversation until recently. Nikolai had recently reached out to me, and I was going to interview both of them. Right before that, I happened to go for a walk with one of my best college friends, who’s also a physical therapist. She unfortunately has some disabilities now and lives with chronic illness, and she happened to mention to me that the term “wellness” doesn’t resonate with her. That it feels impossible now for her to be well. She prefers to use the term “well-being” because she feels like that more accurately reflects how she feels and functions in daily life. As you know, I’ve been calling myself a fierce advocate for physician well-being, and I was thinking maybe I’ve been using those terms interchangeably. So when I interviewed Tonya and Nikolai, I asked them if they’d mind unpacking that for me because I figured they were both more experts in the area than I was. We had such a great conversation, I thought it would be important to expand that to a wider audience. So that’s why we wrote the article.

Kevin Pho: Thank you so much. Tonya, you’re a family physician and a physician coach. Tell us a little bit about your story and then what does wellness versus well-being mean to you?

Tonya Caylor: I was core faculty for years up here in Alaska and had my own burnout story before I actually knew that was a term. In the recovery process, I hired a coach. I was actually doing quite well myself, but I was missing some things, so I hired her more as a career coach. Through that, I was able to join one of her groups and saw the power of coaching. Even though we think about burnout being so related to organizational systems, I realized how much agency that 20 to 40 percent gives individuals with coaching. I thought, “OK, this brings together everything I love: I love residency education, I love well-being, I love medicine, and now I love coaching.” So I started my own coaching business working with family medicine residency programs with faculty teams and residents.

To me, “wellness” started to feel very performative, probably during the pandemic. It was something that was prescribed for you to do. It felt very binary; you were either well or you weren’t. When a lot of the GME academic leaders, like Tait Shanafelt and others, really started to shift their language to “well-being,” it felt right because it was “being well,” and it was multifaceted: not just your physical health, but your emotional, psychological, relational, and financial, etc. Then Shanafelt stretched it to this whole other level of team health and systems health, and that resonated. So that’s when I started using that term.

Kevin Pho: Tonya, in terms of your own coaching business, tell us about how you’re implementing that distinction between wellness and well-being among the clients that you are talking to.

Tonya Caylor: I think mainly it’s helping them identify where, in that multifaceted part of who they are, they have the biggest opportunities to grow and feel and be more well. Then it’s really helping them exercise their agency about how they go about that. Do they need boundaries? Do they need to work on mindset? Do they need to just exercise their agency and their influence in the cultures that they’re in? That’s one of the biggest ways.

Kevin Pho: Nikolai, you’re a mental health counselor. Tell us about your story and how your world intersects with some of the clinician stories that you hear about or that you read about on Kim’s LinkedIn feed.

Nikolai Blinow: As you mentioned, I’m a licensed mental health counselor. I made a career change early on in life because of becoming burnt out in my first career. That 20 to 40 percent that Tonya’s talking about, that there are systemic issues that can leave us susceptible to burnout, but there are also internal issues. I think I can definitely speak to that because I was burnt out before I was in the medical field as a licensed mental health counselor. I know for myself now, I’m also a late-in-life diagnosed ADHD person, so I navigate the world differently. A lot of my susceptibility to burnout is not just related to the systems that I’m in, but also just the fact that my brain functions very differently.

As a super high-performing ADHD person, which I think there are a lot of people out in the world who fit that, my hyperactivity that comes with the ADHD has also manifested throughout the years in being really productive, maybe a bit of a workaholic, and struggling with regulating myself. So, I became a therapist because I want to do meaningful work and I want to help people. I would say early in my life when I was more burnt out, I’ve always been a what we would say, wellness-oriented person. I grew up very concerned with prioritizing my nutrition and my fitness goals. I would say I was checking off a lot of boxes for being a “well” person, and yet I still was feeling burnt out.

When I think about reflecting on what is the difference between wellness versus well-being, I think the difference is encouraging mindfulness, both in myself and with my clients. When I say mindfulness, I really just mean observing within ourselves, and also in the world that we’re existing in, just what’s working for us and what isn’t. I think when we think “wellness,” that tends to be very goal-oriented and so externally focused. We’re trying to eat nutritious foods, we’re trying to get enough cardiovascular exercise, maybe we’re trying to abstain from unhealthy habits like smoking. Those are all wellness goals. But I think when we use a “well-being” sort of frame of reference, it’s encouraging us more to have a practice of checking in with ourselves about what’s working for me today, and doing that checking in over and over and over again.

Kevin Pho: Nikolai and Tonya, you’re both coaches and obviously you see a lot of clinician clients, so I’m going to ask both of you the same question. Among your clinician clients specifically, you said that maybe 20 to 40 percent is due to systems, but the rest is something that they could work on, recognize, and improve among themselves. Nikolai, I want to start with you. Are there any themes that emerge among your clinician clients in terms of how they present to you and any commonalities among them that they could improve on when it comes to well-being?

Nikolai Blinow: I think a lot of clinicians are very high-performing and also highly empathic people. Not all, but the nature of becoming a physician is that there are a lot of goals that you have had to achieve to end up doing the work that you’re able to do. I think sometimes with clinicians, turning off that almost goal-oriented brain can be a real challenge with burnout. What I often tell my people is that the data shows us that we really need to be allocating rest, and rest is as much of our productivity process as everything else that we’re doing. About 40 percent of our time should actually be spent resting. Sleep counts, so that’s good because a lot of us are sleeping.

But if you take a 24-hour day and you calculate what’s about 40 percent of that time, it ends up being around ten hours. Most of us as adults with lives, either working in a practice or a hospital or maybe operating our own practice, maybe we’re sleeping for six to nine hours, and that means every day we should be making active rest part of our process. I think a lot of physicians sometimes struggle with that because you are also naturally high-achieving and doers. I also think understanding that rest means you have to rest your nervous system. Sometimes I see clinicians or physicians whose methods of rest are through that wellness lens; they might be running. That’s very good for them, but really what their nervous system might need if they’ve been seeing patients back-to-back all day, is that running on that particular day at that particular moment actually might be very aggravating to the nervous system, and they need something that feels more restorative.

I think a lot of physicians want to make their patients healthy and better, and so sometimes boundary setting, whether it’s with patients or with colleagues, is a challenge. I think most of us are drawn to this kind of work because we care and we want to have an impact, and so we also have to do our own internal work with figuring out maybe where we could let go of guilt when we maybe can’t do all of the things.

Kevin Pho: And Tonya, what about you? Any common themes that you’re seeing among your clinician clients that prevents them from achieving that goal of well-being?

Tonya Caylor: I have to say it’s 60 to 80 percent systems and organizational things, so I can’t not mention those. But in addition to those common themes, because it’s just really hard, especially in primary care, to do all that you want to do and all that is expected of you, that leads to this tension. If you combine that, some of the common themes that I see are, again, that maladaptive perfectionism. That all-or-nothing thinking really gets in the way. “If I dial it back and I only deal with a few of my patient’s most important problems rather than all of them, I’m going to be failing. I’m mediocre.” It is just like a binary switch. So I think helping them figure out how they can deal with the realities that we are in instead of arguing with reality, getting away from that idealism and focusing on what you can do for this person at this time.

I think the other thing really is there are a lot of socialized narratives in physicians’ minds, where there’s a lot of negative self-talk. It goes back to what Nikolai was saying, like that guilt: “I’m not doing enough. I’m not being a good enough mom and a good enough doctor and a good enough team member and a good enough friend.” There’s a lot of negative, and that’s why so much of the work is mindset. I also just want to acknowledge that for every individual, and I know Nikolai sees this too, while there are themes, the solutions and the unpacking are so individualized that there’s not a prescriptive “do these things and you’re going to feel better.” I think those are some of the biggest ones I see.

In trainees, some of the biggest things are they still feel like they’ve left medical school and are on the stage. They have this performance-oriented mindset, and when they’re in that state of mind, they’re performing, they’re trying to hit all the boxes. If they get feedback that there’s an area for them to improve, they only see that and take that personally as if they failed. So I think there’s so much within the mindset piece in addition to some of the other structural pieces that people can put into place.

Kevin Pho: And to that point, Tanya, just the fact of getting into medical school, they have to jump through so many hoops. They literally have to be perfect, whether it’s GPA and MCATs and then clinical rotations. They have to be performative in a way to get to that point, and all of a sudden we’re telling them to change their mindset to be less performative, to be less perfectionistic. That’s very difficult for a lot of doctors, right?

Tonya Caylor: Oh, absolutely. Totally. And again, it goes back to the fear, like, “If I stop doing it to impress people or to show people what I know, what’s going to happen?” It’s that transition to learning to trust that this is part of the process. If they’re doing it for the person in front of them, if they’re learning for their own sake and for their future patients’ sake, it helps them make that shift. But absolutely, what got you here isn’t going to get you there, you know that saying. And that performance orientation is one of those things.

Kevin Pho: Kim, after interviewing Nikolai and Tonya and hearing their perspectives in terms of wellness versus well-being, tell me some of the key points that you’ve learned after talking and spending time with them and listening to them here and interviewing them on your own podcast.

Kim Downey: Sure. So perfectionism comes up over and over and over again and how that is an obstacle, and then also being productive. It’s interesting because I’ve found that in my own life, the feeling of always needing to be productive, even when you’re home, and being able to say, “OK, well I did this, I did that, I was productive,” or “I have to do all these things and then I can rest.” You don’t have to earn rest. As Nikolai pointed out, rest is so, so important, and that needs to be built in.

Also, interestingly, what I’m finding is I think being built into being a physician is you’re going to let people down. It’s part of the job. Either diagnosis-wise, you’re going to have to tell them hard things, and also with your work as doctors, when you get called in or you’re on call, you might have plans with a friend. Even for myself, when I have conversations with doctors, sometimes we get interrupted. They have to go to the hospital, something comes up, and so many doctors have told me, “I’m sorry, I’m sorry,” just in my work where all I want to do is support doctors. So give yourself some grace and understanding.

Kevin Pho: We’re talking to Nikolai Blinow, a mental health counselor; Tonya Caylor, a family physician and physician coach; and of course, Kim Downey, a physical therapist and physician advocate. They all wrote the KevinMD article focusing on well-being versus wellness, what it means for physicians and their patients. I’m going to ask each of you just to share some takeaway messages that you want to leave with the KevinMD audience. Nikolai, why don’t we start with you?

Nikolai Blinow: I would say the number one takeaway is to really look at your relationship with rest. View that it’s part of the process. Just like Tonya is saying, and like you have said as well, Kevin, the nature of being a physician is there’s so much natural perfectionism and performance orientation that is built in. Know that what serves you in one aspect of your life also sometimes is not so helpful in other aspects. I don’t think it’s about turning those parts off completely; it’s about learning just when to honor the performance orientation and when to resist it and be OK with maybe some of the guilt or the uncomfortable feelings that we’re talking about, and trusting that if you can, on the other side there is more well-being and more recovery and nourishment.

Kevin Pho: Tonya, your take-home messages?

Tonya Caylor: I think a couple. One is really starting to look at putting perfectionism on a dial. You don’t have to stop striving for excellence. We’re not trying to change the core of who you are, but putting it on a dial and dialing it down or up based on the situation at hand and starting to play with that can be very useful. The other thing is to start to look at the mindset, start to identify the narratives you have and challenge them just a little bit. Push back.

A couple of things I didn’t say, but one is a practical tool. If you Google “Duke Well-being Toolkit,” they have these nice, bite-sized things to do for a couple of minutes over fifteen days, and they’re evidence-based and make a big difference. For those of you who are just feeling really crispy, it’s easy to access. The last thing I want to highlight is the concept not only of shared responsibility for our well-being (our systems own part of the well-being for their providers and their caregivers, and we cannot give up on our own well-being; we have our own responsibility) but also shared power. They have power over there, but boy do you have agency over your own well-being that you may not even give yourself credit for. So those are mine.

Kevin Pho: And Kim, your take-home messages?

Kim Downey: My hope is that this conversation will genuinely impact how you think about well-being. Take time to pause and really think about what does well-being mean to you as an individual, and what does it mean to each of your patients as individuals? One specific example for physicians, we’ve been talking a lot about rest, is that I recently communicated with a doctor who has a side business. They decided that one thing they need is more rest and sleep, and they’ve been spending up to an hour a day engaging on social media related to their side business. But they’re going to try reducing their time on the platforms, and that’ll give them more time for rest and sleep, which is what they need right now. That’s just one example specific to that physician, though you can use it to think about ideas about what you could do to honor your own personal needs at this point in time, because it’s dynamic.

A specific example when having conversations with your patients is to think about how you could support them as individuals with their own well-being. For example, you could use a motivational interviewing question. We’ve had Bruce Berger on talking about motivational interviewing, and if you don’t know what that is, you can even Google it. Instead of just saying it would help your patient if they lose ten pounds or offering meds as a first solution if they’re struggling with sleep, you could even Google “what are good motivational interviewing questions about sleep or about losing weight?” Although you likely don’t have the time or the bandwidth to be their primary support with these issues, by asking the right question, you could offer to refer them to someone who does have the time, whether that’s a registered dietician, a sleep medicine physician, a physical therapist, an exercise physiologist, or a mental health counselor. You want to support your patients, and by asking the right question, you can. They’ll get the support they need, the other professionals will appreciate your referrals, and everybody wins. Everybody wins when physicians are well.

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

All: Thank you.