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Pediatrician and certified coach Jessie Mahoney discusses her article “Why physician wellness programs must evolve beyond institutions.” Jessie reflects on her seventeen years leading in-house wellness initiatives and argues that while institutional programs provide legitimacy, they are ultimately insufficient for deep healing. She explains that true recovery requires stepping away from the very environments that cause distress to find spaces free from agendas and evaluation. The conversation highlights the unique power of independent, physician-led programs that prioritize mindfulness, somatic healing, and connection with nature. Jessie contends that physicians cannot transform the health care system if they are barely surviving within it, making external wellness spaces not a luxury, but a foundational necessity for sustaining the profession.

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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 coach. Today’s KevinMD article is “Why physician wellness programs must evolve beyond institutions.” Jessie, welcome back to the show.

Jessie Mahoney: Thanks so much for having me.

Kevin Pho: All right, so tell us what this latest article is about.

Jessie Mahoney: So this article is about the idea that we need to think beyond the wellness committee within the hospital or our institution’s responsibility for wellness. I say that as someone who led institutional wellness for a long time. I think that was a necessary first step. But I also think that we at this point have to evolve beyond that. What I see time and time again is that can only get us so far. We are offering wellness within a system and within a structure that is causing many of the things that we are trying to get well from.

So the idea is that we can and should look beyond our institutions as part of the wellness solution. I think what I have been seeing is institutions leaning even more heavily into trying to solve the wellness problem, but once again solving it from that medicalized framework and institutionalized framework.

Kevin Pho: What do institutional wellness programs typically look like?

Jessie Mahoney: They typically look like connection and collegiality. So there are lots of events where they will bring in speakers, which is helpful, but they usually look like they are in conference rooms still with no windows or plopped in during lunch. Even some of the more evolved ones will offer day retreats. I actually used to run these for my previous organization. They were fabulous in that we were able to take people out of the hospital and take some of the advantages of being in a separate space.

But you are also in a space with all of your colleagues, and so there is not quite as much psychological safety as if you are with people from across the country. Many wellness programs are done for departments who are struggling, so you are in a place with people from your department, and that clouds the wellness piece.

I also think that a lot of the wellness programs are built on seeing us as all a team working for this organization. But the people who are most unwell tend to isolate and withdraw, and so they don’t tend to join those. By only offering that, we are limiting ourselves. We try really hard within institutions, and it isn’t that it is not helpful. It is just that it is literally not enough given the challenges.

So there might be yoga, there might be mindfulness. A lot of organizations will actually offer trips or events or retreats in beautiful locations for people who have been there for a certain amount of time, for example. Yet they are still a part of the corporation and the system, which makes it hard for people who have real deep moral injury, for example, to actually heal from that and figure out what is going to work for them.

As institutions, we don’t encourage individualized plans for those kinds of things. I think there is also this sense that we are always being evaluated within our institutions to some degree. Whether it is a formal evaluation or not, you are still surrounded by the people that you work with and the leaders in your organization. In fact, it is important for leaders to partake in wellness, so therefore they are going to be there too, which limits its ability to have an impact.

Kevin Pho: So that is interesting. A lot of the institutional wellness programs take place within the institutions themselves. You are with your colleagues within that institution, and sometimes that limits its effectiveness. So what kind of changes do they need to make? I can’t imagine a lot of institutions wanting to stray from that team mentality that we are all working for that institution that you talked about.

Jessie Mahoney: Right. Well, I think institutions can support outside wellness, and that has been happening through people using CME funding to go outside and utilize programs that offer both wellness and CME. Wellness does improve patient care. If you are a not burnt out physician, it improves patient care and therefore it can be eligible for CME. I think a lot of institutions are supporting it as professional development.

So learning about communication and learning how to take care of yourself is important. I’ll say “self-care,” which is not a word I love. But if you learn mindfulness, you can share it with your patients and bring it back to your teams. I think offering stipends or allowing people to use professional education funding in different creative ways can be an amazing way to do it.

Some places will hire outside people and have wellness programs that are adjacent. So they are not within the organization, but they are available, confidential, and held in a separate space or virtually where hopefully there is no reporting back. Sometimes there is a one-way reporting where the organization wants to ask you to cover certain things but you don’t share anything back. If that happens, that creates a bit more of a separate space.

I think that organizations have to continue to offer wellness because if they don’t, there is a message there. But it can’t be the only thing that we offer. I think the other piece of this is that when we in medicine look to our organizations to solve the problem, then we are never happy with how they solve it. There is a bit of a feeling that it is not my problem to solve, it is your problem to solve. I think it is a dual situation where if we aren’t healthy, we can’t be part of the solution. This idea that our organization should do it creates tension and a pressure dynamic that over the years has not been as helpful or effective as we would like.

Kevin Pho: Now from the physician’s standpoint, if they are concerned about wellness, should they take the initiative and look for programs outside of what the institution offers? Or should the institutions themselves encourage physicians to take some of these outside CMEs?

Jessie Mahoney: I think it is both honestly, because I think that physicians can, should want to, and will benefit from doing it on their own. I actually think that when I see people who take the initiative on their own, they actually often get more out of it than when it is paid for by someone else because they have invested in themselves. For us in health care, that is a big deal. We tend to not invest in ourselves beyond going to medical training. We think we should be able to do it on our own and we shouldn’t need extra support. So I think there is tremendous value in doing it on your own.

I also think that if physicians can encourage this as a valid thing to do and to note how it has helped people, then that gives those people who tend to hesitate more a willingness to approach it. It also creates an acceptance within the organization that lots of people do it.

Kevin Pho: So when looking at these outside CMEs for wellness, what should physicians look for in these programs to make sure that they are effective?

Jessie Mahoney: Well, I think it is looking for programs that don’t just speak to the usual things but really look at things that we know help, like physiology and teaching you how to be mindful. Look for things that are happening in nature that your organization can’t offer. So look for things that are different. You shouldn’t necessarily go into a big conference room and do the same thing that your organization does. How can you put yourself in a separate space or how can you find something that is one-on-one or a very small group?

I also think things that are tailored to you are important. So women physicians partake in a lot of programs specific to women physicians. I think physician moms are a realm or even groups of men. I think that we can find safety in different pockets of learning. That being said, I think there is also tremendous value in being in spaces with people who come from different organizational systems, like some from private practice, some from the VA, and some from big HMOs. I think then we have this normalization of the culture of medicine versus where you are. It gets you out of the victimhood of where you are and into a realization that we are all in this together and asking what we can do.

But I see a lot of people signing up for things that look similar to what their organization is offering. So my thought is to look for something that is different and look for something that is tailored to the things that you are specifically working on. So if you are really working on your relationships, or you are really working on leadership, or you are really working on boundaries, look for things that offer that type of focus. That can also get you a lens of other people in health care in different specialties and different parts of the country with different backgrounds who are also working on the same thing.

There is tremendous insight in that and a sense of belonging and a sense of not being alone that I don’t see when people show up in their institution. There is just that cloud of not having a hundred percent psychological safety and not being a hundred percent free from evaluation. Because anytime you are with your direct colleagues who you work with every day, like it or not, we evaluate each other and judge each other all the time and try to figure out how we measure up. So there is a very different level of access to wellness and healing that can come when you are not in the medical space.

Kevin Pho: And one of the things that you wrote in your article is that it is important that these external programs are designed by physicians for physicians, right?

Jessie Mahoney: I think that a lot of times they are not designed by physicians, and it is very hard to understand the physician experience and address the real drivers of burnout and unwellness if you haven’t lived in that world. I think that we spend a lot of time then trying to explain the physician perspective and we use that as something that kind of becomes a barrier to healing because we feel they can’t understand or they don’t understand.

So I think that programs designed by physicians for physicians are ultimately more healing and can get right to the crux of it. We are not very patient in medicine. We want to get to the crux of it and get to the healing, and physicians can do that for one another. I have seen a bit of backlash suggesting they shouldn’t be doing this and they should be doing something else. My thought is we have to take care of each other. No one else is out there taking care of us. That physician lens is a very different lens that you cannot bring unless you have practiced in health care. People can’t even comprehend what it is like from the outside.

Kevin Pho: Can you share a success story with us? Maybe one of your clients or someone that you know who looked beyond the institutional walls and found success and made a difference by looking for a program outside of their institution?

Jessie Mahoney: I see it all the time in small coaching groups where people find that support and recognize that where they are is part of the problem. Maybe it is not a fit for them, or they actually can start to see what is happening in their own space that is not their fault. When they are in a group with people who are either in a similar specialty or just in medicine elsewhere, there is this sense of belonging and safety. This allows people to leave toxic jobs or allows people to actually decide that where they are works pretty well for them if they let go of certain stories.

It is so much easier to see stories in people in different settings and to say: “Oh, wait, this is just what I am describing about this.” So I see people all the time in these smaller settings find support and connections from across the country and across specialties that can really work as a buoy or a ballast when they go back to their setting. That is very different than doing it in your own setting. Especially for people who want to pivot or who might want to change or who need to get out of a difficult situation, I see it as helpful all the time. It is sort of like a reset as to where you are in the situation. I think it also often makes the path outward so clear if you are in an unhealthy situation.

Kevin Pho: We are talking to Jessie Mahoney, pediatrician and coach. Today’s KevinMD article is “Why physician wellness programs must evolve beyond institutions.” Jessie, as always, we will end with take-home messages that you want to leave with the KevinMD audience.

Jessie Mahoney: The message today is that I think it is an “and” situation. So it isn’t that institutional wellness is not effective. It is just that it is not enough. When we expect it all to happen there, we miss out on tremendous opportunities for healing, growth, and changing the culture of medicine. So if we are willing to look beyond that and willing to jump into it, and if institutions could ultimately be willing to support it and encourage it as a solution, I think that we will actually be able to grow and heal to a much greater degree than we have been able to so far.

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: Thanks for having me.