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Physician wellness coach Jessica Singh discusses the article “Physician burnout: Finding peace in a broken health care system.” Jessica shares a powerful narrative of a grueling swing shift in a rural emergency department, managing critical patients and a mounting waiting room with minimal resources. She describes the intense pressure of a life-saving intubation and the spiritual strength she drew upon during the crisis. The conversation shifts to the toxic interpersonal dynamics often found in medical culture, as Jessica recounts a difficult “changing of the guard” with a hostile administrator. This experience led to a profound reckoning with her professional identity and the realization that her value as a human being extends far beyond hospital walls. Discover how perspective, faith, and the simple act of a deep breath can help clinicians navigate the “trance of servitude” and find peace amidst systemic failure.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Jessica Singh. She is an emergency medicine physician and a physician wellness coach. Today’s KevinMD article is “Physician burnout: finding peace in a broken health care system.” Jessica, welcome to the show.
Jessica Singh: Thank you so much. It is a pleasure to be here.
Kevin Pho: All right, so tell us a little bit about what you do and then why you decided to share this article on KevinMD.
Jessica Singh: I never expected to transition out of medicine so early in my career. I transitioned right after fellowship. I wrote this article because at the time when I experienced this incident, I felt like I couldn’t share it with anybody. So many times I feel we physicians have these experiences. Yes, we have difficult patient encounters, but often we have difficult interactions with our own colleagues, and sometimes those are the hardest to share. So it actually took a really long time to be able to get this to a place where it felt comfortable sharing, and it was really important to share.
Kevin Pho: All right. For those who didn’t get a chance to read your article, just tell us about that story.
Jessica Singh: It was early after residency, practicing as an attending solo physician covering an emergency department. It was packed. It was winter. We know how it is after the holidays, and we were short-staffed, which is the story in most hospitals these days. A critically ill patient came in needing resuscitation, and there was nobody else there. I felt there was no surgeon, no anesthesiologist, nothing. That is what we train for in emergency medicine; we train for stabilization. So when you have a successful shift, sometimes it is like: “OK, nine to five, kept the patient alive,” or whatever time your shift is.
After that, there was a really challenging incident where someone came in unconscious with blood in their airway. The whole team came together, and we were able to stabilize him and transfer him to higher care. The part where it got very challenging was once my shift was over and I was ready to transition. The person who came in after me was also a hospital administrator. In the article, I just called them Dr. Regina. One of the first questions they asked was: “Why are there so many patients in the department?” Regardless of knowing all the systems issues—how there is one physician, maybe three or four nurses, and maybe 20 beds—none of that got acknowledged. It was just: “Why is it like this?” I was also handed a very busy department when I came in.
It didn’t stop there. This conversation was held in front of other staff. It was an accumulation of a lot of microaggressions. To be honest with you, I didn’t even understand what microaggressions were until after my fellowship when I started doing coach training. There are subtle things that we say to each other. There is a beautiful book called “Subtle Acts of Exclusion” by Dr. Tiffany Jana and Michael Baran. They rename them as subtle acts of exclusion. It is not about the person, and there is no judgment of the person. It is just that often saying things makes people feel excluded, and they have huge impacts on health. They usually happen unexpectedly. So when Regina came in and asked me why there were so many patients in the department, and then said: “I need you to function,” I didn’t even know what to say or how to handle it.
Wow. I just went home. As soon as I stepped out, it was cold, it was snowy, and there were the mountains. It just makes you redefine what you are doing as a physician, especially if you are in a certain place. It is such a small world. To be honest, I was even scared of writing this article. I waited a long time because I was like: “I don’t want to unfairly ostracize anybody. They were doing their job in their own way.” But it is such a small world in medicine that you have to have some psychological safety, which writing does provide. Otherwise, all of these things allow the toxicity to just keep reproducing itself. So the goal of this article was really to show how these kinds of interactions have a significant impact. For me, to be honest, it actually led me to look for a new job. I was considering staying for partnership, so you really look at the people you are going to work with. These are the people you trust in life-and-death situations, people who are supposed to support you and nurture your professional development. If they are not holding that space of psychological safety, what kind of job is that?
Kevin Pho: So you shared this very vulnerable story, a very powerful story about this resuscitation and how the whole team in the emergency department pulled together. Then you had a hospital administrator almost berate you or chastise you in front of the staff, asking you or telling you that you need to function. How long were you in this position? How long did you tolerate these microaggressions before you decided that it was time to move on?
Jessica Singh: Thankfully, there were multiple sites, but it was almost every time I was there. I want to answer the question, but there is a voice inside of me saying I wonder if I don’t want to be able to identify them. I will just say I was relatively new in the position.
Kevin Pho: During these times where you received that type of feedback, go into more detail about how that made you feel.
Jessica Singh: For this one especially, I can say I was silent, but I was furious. I was furious and wanted to cry at the same time. Dr. Regina also asked me to shadow another physician like I was a med student again. The place was quite a travel distance, and it was just infuriating. I had passed my boards. It wasn’t with me; it was with the system, and there was no acknowledgment for that whatsoever. I actually did call another administrator for this one, which I wrote in the article, because it shouldn’t be tolerated. When they told me that this person was known for this and that they made themself and other administrators cry, it was almost just like: “OK, this is the culture here. Am I going to stay, or is there something else?”
Kevin Pho: So during this time, who was there to support you? Thankfully you had more sympathetic administrators who could empathize with your situation, but among your colleagues and confidants, who was there to support you through this very, very difficult time?
Jessica Singh: I didn’t feel comfortable sharing with my colleagues at the time because we were a very small group, and I didn’t want to. I feel like there is a magical moment when you go through periods, especially of burnout, stress, and very hard times. It is so ironic because burnout is often described as a decoupling of a sense of purpose. It makes us very ready for that spiritual component to redefine our sense of purpose. I remember even just looking outside at Mother Nature; it was so beautiful at night. It was so still, and there was so much snow. It was almost just like there is more out there than these hospital walls. You ask where the support came from. I feel very fortunate as a family to have faith and a creator, higher power, call it what you will. I feel like it was almost a blessing that eventually came to me because I had been wondering if I was going to stay here, settle here, and build a home, or if I needed to look for something else. For me, it was a sign that we needed to look for something else, and that was it. There was no turning back.
Kevin Pho: How difficult was that for you to realize that you needed to course-correct and get a new job? A lot of physicians go through a linear path of medical training all the way from medical school through fellowship. Sometimes when they have to admit that the current situation isn’t right for them, it is very difficult to course-correct. Was that difficult for you?
Jessica Singh: Absolutely, because when you are a young attending, it is the first time in your life you are making an income that matches the work you are putting in. When you have a comfortable environment, there is so much financial security. I actually left that job to go to a fellowship because I felt that I wanted to contribute. I thought an academic environment would be a place to actually make a contribution and a culture change to medicine. That was really difficult to do, but there was no other choice for me.
Kevin Pho: Obviously now you are a physician coach, so you have the vocabulary and you have the conceptual framework to describe what happened to you. A lot of physicians were like you were back then; they didn’t have that vocabulary and they didn’t quite know how to handle it. As you reflect on the situation and understand a lot of physicians are going through the same thing that you went through, give us a piece of advice or wisdom to these new physicians who may be dealing with toxic administrators like the one that you described.
Jessica Singh: It is important to realize that it is a systems toxicity that we are a part of. I feel like sometimes we feel like we have to survive and just get through it because you are expected to be strong. But tolerating aggression and tolerating all of these insults has an impact. You can put on a strong surface, but on the inside it has an impact. It has a mental health impact. Emotionally, it really makes us question ourselves, whether or not we admit it. These are all great moments because then you get to really look inside and redefine yourself and your values. Where we are working has to align. The job is too high-stakes—caring for people’s lives when they are most at need—to be in a place where you feel psychologically unsafe. Obviously, the first step is to see if culture change is possible. Can your current environment work? If it doesn’t work, what else is out there? Know that it is not you; it is the system. Just because these things aren’t discussed openly doesn’t mean that change isn’t possible.
Kevin Pho: I want to talk about microaggressions because one of the things that you said earlier was that you didn’t even realize there were microaggressions until you went into coaching and had the vocabulary to describe what happened to you. Now, one way to create that psychological safety is not to tolerate these microaggressions. For new physicians in a new situation who may be experiencing this for the first time, what are some ways they can push back?
Jessica Singh: I think the first is to raise awareness and to hold the space of not reacting because it is about processing inside what is coming up. For instance, a common one that I know a lot of women get is: “You are too nice to be a doctor,” or “You look too young to be here.” That happens often from patients and from providers. See what that brings up for you, where that is coming from, and raise awareness by saying: “Hey, I noticed you’re using this phrase. However, this may not be true, and this is why I’m here.” It is not that we have to prove ourselves, but just sharing it with them to raise awareness rather than pointing blame is the biggest thing. Often the biggest thing that I have learned about microaggressions and subtle acts of exclusion is that they are unintentional most of the time.
Kevin Pho: I love the vocabulary that you use. You framed it as “I noticed” or “I observed,” and that is a fantastic way to bring up awareness of what is happening without being overly adversarial. I just want to emphasize that point. What are other situations or examples from physicians that you have coached where that particular technique has helped resolve an issue?
Jessica Singh: So many hostile situations. It really requires a lot of reflection first, and I will keep saying that, to really keep cool and figure out what is going on so that we can communicate. Often in medicine, there is so much stress in the environments and everyone has their own needs, so they may feel like they are justified from where they are coming from. It is really important to just come together and meet together. For instance, if a code didn’t go well and someone is saying something to someone else, or a patient interaction was difficult where one staff member might be undermining another, it is really important to come together. Realize the shared values, which is that you are both here to serve patients first, but you are also here to respect each other as a health care team, to support each other, and to have a mutually respectful, inclusive environment where that can happen.
Kevin Pho: I am so happy to see that you are in a better place now, and of course, you have had several years to reflect on this. Now I am going to ask you to replay that scenario in your mind. Knowing what you know now, is there anything that you would have done differently in that scenario if it were to happen again?
Jessica Singh: It is so interesting you asked that because it even happens in the coaching world, right? You have a lot of corporate executives, and this toxicity follows. If it were to happen again, it is an interesting question because as difficult as it was, it was a blessing because it got me here. Otherwise, I might still be in that same job and working. But if I were to handle it differently, calling the administrator is something I would do all over again. I would reflect on myself and let whatever emotions come express themselves at home. What I didn’t do then that I would have done now is have a conversation with the administrator directly. I would address them directly, and if I didn’t feel comfortable by myself, I would have asked a third person to be there just to say: “Look, this is really the impact that it had.” There was a conversation after that event, but I didn’t speak up like that at the time. I didn’t know how. So I would just do everything possible with a third party there. If you don’t feel safe one-on-one, having a trusted colleague really helps.
Kevin Pho: What kind of resources can you recommend for physicians as they navigate through these potentially toxic workplaces? Obviously, you are a physician coach, and certainly, coaching is an option, but what are other resources that physicians can learn to handle this so they are not caught unprepared?
Jessica Singh: Honestly, our colleagues, the people we work with and know, are such a source of wisdom. We all have so many stories and encounters to share. When you go through training or residency, I feel like one piece of advice that isn’t taught that is so important is to connect with your peers. Sometimes you are in med school and you have this class of 100 or 150, and they are all going to go into different specialties and do amazing things in the world. Be friends with them, genuinely be friends with them, and care about them because you never know where you will be in life. Your resource of who you have gone through training with and who you work with is valuable. Of all of those people, there should hopefully be at least one person you can trust for peer support.
Peer support is something offered in many hospital systems, and if it doesn’t exist, there is training even through the AMA where you can learn how to do that. Formal mentorship is so important. Obviously, there is so much literature now. There are so many books on microaggressions and on culture change in medicine. Trust your gut. If something doesn’t feel right, it most likely is not. You have so much intuition that you have developed. There is plenty of language out there to go figure out how to handle this. There are human resources for medical residents. There is the office of GME, and there are always the program directors and medical student deans. There is always somebody that hopefully you can go to if you are in a setting like that.
Kevin Pho: We are talking to Jessica Singh, emergency medicine physician and physician coach. Today’s KevinMD article is “Physician burnout: finding peace in a broken health care system.” Jessica, let’s end with some take-home messages that you want to leave with the KevinMD audience.
Jessica Singh: Have that space of self-compassion and honor yourself for what you have been doing. Because when these events happen, as challenging as they are, I feel like human tendency is to focus on the challenging encounters. But even when I reflect on my time at this place, there were all these amazing encounters, very touching and fulfilling ones. So the big picture would be to zoom out, see the big picture, ask what your purpose is, and find your “why” of being in medicine. Then work down from there to ground yourself because you have worked so hard to get to this point.
Kevin Pho: Jessica, thank you again for sharing your story, time, and insight. Thanks again for coming on the show.
Jessica Singh: Thank you so much.
