Monday May 31, 2021

20. Challenges Facing Women Physicians Today w/ Diane Shannon, MD, MPH, ACC

Tune into Swift Healthcare Podcast with guest Diane Shannon, MD, MPH, ACC

Ranked a Top 60 Healthcare Leadership podcast by Feedspot.

Dr. Diane Shannon is a former primary care physician, a certified coach, and co-author of the book, Preventing Physician Burnout: Curing The Chaos And Returning Joy To The Practice Of Medicine. Her personal experience with burnout and conversations with hundreds of physicians motivated her to pursue coaching training and certification. She now helps women physicians harness their superpowers and create lives in which they can thrive. She also continues to advocate for health system change through her writing, which you can find on LinkedIn or her website, dianeshannon.com.

Links for Diane Shannon, MD, MPH, ACC:

https://www.linkedin.com/in/dianewshannon/

www.dianeshannon.com.

Music Credit: Jason Shaw from www.Audionautix.com

THE IMPERFECT SHOW NOTES

To help make this podcast more accessible to those who are hearing impaired or those who like to read rather than listen to podcasts, we’d love to offer polished show notes. However, Swift Healthcare is in its first year. 

What we can offer currently are these imperfect show notes. The transcription is far from perfect. But hopefully it’s close enough - even with the errors - to give those who aren’t able or inclined to audio interviews a way to participate.  Please enjoy!

Transcript 

[00:00:00] Patrick Swift, PhD, MBA, FACHE: [00:00:00] Welcome folks. In another episode of the Swift healthcare podcast, I'm delighted that you're here and I've a wonderful guest for us. Diane Shannon, Diane. Welcome to the show.

[00:00:09] Diane Shannon, MD, MPH, ACC: [00:00:09] Thank you so much, Patrick. Glad to be here.

[00:00:11] Patrick Swift, PhD, MBA, FACHE: [00:00:11] It's a joy having you here, Diane and folks. Let me share with you. Diane's bio I want to encourage you to perk your ears. This is, this is going to be a good one. Dr. Diane Shannon is a former primary care physician. She's a certified coach and a co author of the book, preventing physician burnout, curing the chaos and returning joy to the practice of medicine. Isn't that delicious title. And I'm sure the wisdom in that book, doesn't just apply to physicians. It applies to addressing burnout in general, but, uh, with a passion for addressing physician burnout is what that book is about.

[00:00:46] And her personal experience with burnout and conversations with hundreds of physicians and motivated her to pursue coaching, training, and certification. She now helps women physicians harness their superpowers. I love that [00:01:00] and create lives in which they can thrive. She also continues to advocate for health system change through her writing, which you can find on LinkedIn.

[00:01:07] And we'll talk about her website. So stay tuned on that. But Diane. Welcome to the show. I'm delighted to hear Diane. And so let's jump right into it. And the focus of the show we're going to be talking about here is challenges. Facing women physicians today. And today is a loaded term because there's so much going on.

[00:01:32] Socio-politically in health care. COVID the aftereffects of COVID. There are so many elements in here that I'm, I'm delighted that we can be spending some time talking about this with Diane and talking about her research, but I'd love to start Diane with just your, why w what got you into this work recognizing you described yourself as a former physician.

[00:01:52] But I expect my MDs and respect what you've accomplished in your academic career. So tell us about that, uh, in, in how you perceive [00:02:00] yourself and how you've been contributing.

[00:02:02] Diane Shannon, MD, MPH, ACC: [00:02:02] Right. So I was inspired to become a physician because of my mother. Like a lot of physicians are inspired by family members. My mother was a nurse midwife. And I was lucky enough to be able to shadow her. At times with her patients, she had her own independent birth center, and I saw this incredible experience where she had these amazing connections with her patients.

[00:02:28] And I saw how satisfying her career was. It was really amazing and meaningful every day. And so that's what inspired me and I, uh, I happen to be good in biology. And so it was an easy movie, you know, Mo moved right into pre-med and then into med school and then into training and I chose primary care.

[00:02:48] Because I really, I really wanted that kind of connection with patients that, that meaningful connection that's healing. And now I understand healing both ways when that [00:03:00] connection works. And what I found is really starting in the clinical years, the third year of medical school, that the environment, the clinical environment was not really conducive to supporting that optimal relationship with patients.

[00:03:17] And one of the things I noticed first, I think was patient safety issues. And that really concerned  me. Um, and this was back before the IOM report came out in 2001 that really, or 1999 and then 2001 that really focused attention on patient safety. So I was constantly aware of, okay, what do I have to navigate in order to protect my patients from something that might fall through the cracks?

[00:03:44] And I looking back now, I can say, I think that's part of what led to the burnout I experienced. Um, it probably wasn't all was also exacerbated by the conditions then, you know, there weren't work hour restrictions and was regularly working a hundred [00:04:00] hours a week. And sometimes as many as 130, I mean, it really was, um, overwhelming.

[00:04:06] So, uh, I thought about leaving, but I kept thinking, Oh, I'll just do the next thing. I'll just finish internship. I'll just finish residency. I'll just, you know, get my boards on, you know, pass my boards and then I'll, I'll start practicing and things will be better. And they were a little better, the worst rep, the worst burnout experience or symptoms that I had were actually during residency.

[00:04:29] Um, and I really, uh, I struggled, I, I felt like I gave up so many parts of who I am in order to, to be present for patients and get through training. Um, I, and I actually started having memory problems at home. Like within work, I was fine, but then I would come home and I'd forget things like zip codes, you know, just. Basics. Um, and I just, when I practiced, I, you know, I, I thought about, well maybe if this were a little bit different, so I changed [00:05:00] to a different practice site. Maybe if this were a little bit different and I just didn't see the kind of wholesale change to create an environment where I would feel I could connect with patients and also have a life. And so I made the decision to switch. And so I, I actually, in the last year I was practicing was part-time got a master's in public health because I really love looking at the big picture. And then I transitioned into a job at a communications company. So really overseeing the accuracy of medical documents that they had and what I found, I fell into writing while I was there.

[00:05:42] I loved it. And I thought this is what I want to do. So I left and I was a freelance writer for more than 20 years. And I gravitated towards writing about the healthcare system to try to understand what's going on with it. What are some of the patient's safety issues? How could things be [00:06:00] better and was I'm so inspired by. Individuals and organizations who see that and then make a change and have improvement and watching how that improvement can have a ripple effect. So that was really inspiring to me. And while I was doing that happened to, um, run across the definition of professional burnout, a light bulb went  off and I thought, Oh, there's a name for it. I had no idea.

[00:06:28] Patrick Swift, PhD, MBA, FACHE: [00:06:28] Uh huh.

[00:06:29] Diane Shannon, MD, MPH, ACC: [00:06:29] And I happen to be working with a coach at the time. And she said to me, Diane, why have you never told your story publicly about leaving medicine and burnout? And I said, are you kidding? Why would I do that? Like, it just, it felt like such a w and I carried shame about it. Like, I should have been able to hack this.

[00:06:53] You know, and so over time I began to see that it actually was courageous to leave something that [00:07:00] wasn't working and to recreate a life that had some meaning. Right. And that worked for me. And so I did, I told my story, um, I wrote it, um, In a guest post on an NPR website and there was this amazing uptake.

[00:07:17] So there was something like 26,000 views in the first week. And this was, this was before much was written about physician burnout. So I think that came out in 2012 and physicians began contacting me and they'd say, I didn't know, anyone else felt this way. Right. Here. Here's what, here's what my life looks like right now.

[00:07:40] And I can't do this. Right. So that just inspired me to continue writing about it. I started a blog, um, ended up writing the book with my coauthor, Paul DeChant another physician. Now the book after interviewing all these experts about healthcare and the healthcare [00:08:00] system and burnout and physicians with burnout, what became so clear to us in writing the book is burnout is a reflection of a system problem.

[00:08:09] Patrick Swift, PhD, MBA, FACHE: [00:08:09] amen to that.

[00:08:10] Diane Shannon, MD, MPH, ACC: [00:08:10] Yeah. So I left that experience of, you know, writing the book. It's thinking. The only way to fix burnout for clinicians is to fix these deep complex system problems. And that's the only way that that was my thinking.

[00:08:27] Patrick Swift, PhD, MBA, FACHE: [00:08:27] yeah.

[00:08:29] Diane Shannon, MD, MPH, ACC: [00:08:29] And then I had an experience. What has helped me to see that it's a, both and situation.

[00:08:35] So that is the core of what drives burnout are system problems? No, it's the, it's the incredible amount of administrative work, the documentation, um, all of the, you know, changing patient expectations, the productivity pressure. Right. All of those kinds of outside factors that are in the system. And at the same time, what I now [00:09:00] understand is that there are actions that individuals can take that mitigate some of those factors for them so that their individual daily work experience or life experience is better.

[00:09:14] Patrick Swift, PhD, MBA, FACHE: [00:09:14] Diane. And I'm sure that the experience you had as a physician absolutely must have helped you. Number one, have the empathy and the compassion and the wisdom to guide the colleagues that reached out to you right after you, right throughout that NPR article, , to , have that conversation, but then I'm sure that made you an even better coach, , because you've been in on both sides, , , in the direct care, as well as supporting the efforts that our colleagues are, , making and providing, and you acknowledging the, the documentation loads and stuff like that.

[00:09:46] I've, I've kind of crossed my eyes there first. Yeah. Cause I'm, I'm seeing patients and it's just the thought of documentation still. It's just it's , I've I've got to shift that, that word for myself because documentation, all the struggles our colleagues you're experiencing is very [00:10:00] frustrating. And the system that we work in, the healthcare system, so there's systemic issues.

[00:10:05] And I, I want to acknowledge it and celebrate, , your decision to follow your Dharma, to, to follow that calling and to be there for others, , and bring your wisdom to it. And I know you're doing some incredible research. , I know you were working on a white paper last we spoke. , and I'd love to hear, , , what drew you into this topic?

[00:10:24] Um, and what have been some of the top findings that had come out of the research you've been doing?

[00:10:30] Diane Shannon, MD, MPH, ACC: [00:10:30] Well, I I've been working with a number of women physicians and was really more, became more interested in what are the challenges that they're facing. And I knew what I had experienced, but I really wondered beyond my experience and what I've. Noticed or observed with these women that I've worked with. What, on a larger scale are the challenges women physicians are dealing with today. And so I started thought, well, I'll interview a few people, right. A few women physicians. [00:11:00] So I thought I'll interview three. Just didn't kind of set up some questions and I'm, um, I feel like I'm an experienced interviewer after years of writing.

[00:11:09] Like that's a lot of what I did and I love interviewing and their responses were so interesting that I decided to expand the project and interviewed 30 women from across the country. And I really try to get different specialties, , different kind of demographics. So they're women from post-training.

[00:11:31] So I, I worked on worked focused on those post-training through post retirement and ask them about their top , their top challenges, what they want what's getting in the way.

[00:11:44] Patrick Swift, PhD, MBA, FACHE: [00:11:44] Uh, uh,

[00:11:46] Diane Shannon, MD, MPH, ACC: [00:11:46] what I learned was some of it was, you know, what you might expect. Right. The top challenge that they virtually, all of them named on their own was work-life balance. Others [00:12:00] call it work-life integration or work-life harmony. And when I looked at the, the demographics of the 22 women who had caretaking. , responsibilities at home. So either children or caring for an elderly parent, every single one of them said work-life balance was a top challenge. And then most of the other eight did as well. So it's kind of a, a widespread, this is what we're seeing. Other things that came up kind of very, , more commonly than I would've thought, imposter syndrome and self doubt. And also some of the issues related to what's been called the motherhood penalty. So policies that are in place that make it really challenging to come back to work after having a child or just parenting young children.

[00:12:54] So policies around maternity leave around lactation [00:13:00] support around child, uh, childcare access. , so that those were the, probably the top three that came up. What surprised me was how many times women mentioned some of those very particular challenges they faced, for instance, the lactation that came up over and over again.

[00:13:21] And what they said was we need more than a room in the basement. We can't get there. We don't know where the room is. We don't have time to get there. And if we go to go down to the room to pump we've then run behind in our clinic. Like there there's just so the stress for coming back, you've got a newborn, you're trying to manage all of these new responsibilities and trying to get back to work.

[00:13:49] Patrick Swift, PhD, MBA, FACHE: [00:13:49] okay.

[00:13:49] Diane Shannon, MD, MPH, ACC: [00:13:49] So I see that as really, um, you know, an equity issue. And we want really, ideally we want to [00:14:00] support everyone with the accommodations. They need to do their best work and remain sustainable clinicians. Right.

[00:14:08] Patrick Swift, PhD, MBA, FACHE: [00:14:08] Yup. Yup. Yup. And I, I, you you've covered so much there. And, , I want to unpack that, , also in. The research that you did touched on the work-life balance and a listener, and God-willing, there are those who identify, however you identify. , but certainly not just women listening to the show. , yes. You touched on the work-life balance.

[00:14:32] Work-life integration. , but it's so much more than that. And, , you're touching on the, the motherhood penalty, , the challenges, , in even having lactation rooms that are accessible and not coming back to an onslaught of having to catch up essentially even a penalty, , for, for taking time to, to pump, , and balancing all that.

[00:14:51], from your perspective, Diane, what can we do to address this in addition to, in addition to just colleagues saying, yeah, that's [00:15:00] an important issue.

[00:15:00] If someone's thinking about that, what can we do about that? What needs to change from your perspective?

[00:15:06] Diane Shannon, MD, MPH, ACC: [00:15:06] And are you talking specifically about lactations.

[00:15:09] Patrick Swift, PhD, MBA, FACHE: [00:15:09] I'm talking specifically about, , , if we acknowledge there's a larger cultural challenge here and you've identified, um, challenges women physicians are facing today, , I guess tying it to your findings, , that work-life balance. , I think of. , the administrator is willing to have a conversation having been in a hospital administrator, administrator myself, , having that for goodness sakes, just to bring up the topic of work-life balance with these female physicians.

[00:15:35], first we got to have a conversation about it, right.

[00:15:39] Diane Shannon, MD, MPH, ACC: [00:15:39] Yeah. So, so I'll mention too two, um, initiatives I think are really interesting and there are a lot of, this is what gets me really jazzed is when I learned about some of these things going on. So one of them is that after I wrote a piece about, um, lactation specifically on my blog,

[00:15:57] Patrick Swift, PhD, MBA, FACHE: [00:15:57] okay.

[00:15:58]Diane Shannon, MD, MPH, ACC: [00:15:58] , I learned that at [00:16:00] UCF, they started a program recently, specifically to support lactations for physicians.

[00:16:06] And so they looked at how do we provide education and resources that work for them. And they started without physicians in the outpatient setting and, and what they also did was for every four hour shift or, or clinic session they provided, I think it's 20 minutes of paid time to go and pump. So now they're working with, okay,

[00:16:31] Patrick Swift, PhD, MBA, FACHE: [00:16:31] That's a strategy we can implement.

[00:16:33] Diane Shannon, MD, MPH, ACC: [00:16:33] Right. So that, that is for the outpatient. Now they're looking at, let's go talk to the anesthesiologists, the surgeons, and find out what do they need, because that same system is not process. Isn't going to work for them. So that's one. And that was, that was, you know, it's, it's understanding what are those pebbles in the shoe for specific groups and, and, you know, [00:17:00] And then what can we do?

[00:17:01] What's an innovative piece that we can do to address that. And the feedback they got from women who were, had accessed the program, once it started was phenomenal.

[00:17:12] Patrick Swift, PhD, MBA, FACHE: [00:17:12] yeah. Yeah, that's phenomenal. And the retention also, I mean, medical centers, health systems in a, so much in recruiting their staff and the phys, our physician colleagues want to have a diverse workforce. There's no one there's, uh, if, if they are, it's a Neanderthal, the stuck in the past, we want to have a diverse workforce of, of, , colleagues from, from multiple perspectives.

[00:17:35], and so if we're going to have an inviting workforce, we're going to have women. That can take time to do what needs to be done in the short term. This isn't a forever thing for goodness

[00:17:44] Diane Shannon, MD, MPH, ACC: [00:17:44] That's exactly right. It's not a forever thing. And I think the same applies for men, right? When you have young children, you want to be there. So if it's possible to have a more flexible schedule for physicians with young children, right, that's supporting [00:18:00] them, they're going to be more loyal to that organization.

[00:18:03] And later when their time frees up in a different way, they will be able to, you know, work a different schedule or work longer hours. So I think it really pays to understand. What are the top challenges for this individual and maybe for this group of, of individuals. Um, and the other thing I'll mention with that is that, um, it, one of the, the, I interviewed the physicians who founded this program at UCF.

[00:18:29] And one of the things they said was there was a physician couple. Right. So the, the parent, they had a newborn, so the wife was going to pump and she was losing time and money and falling behind and getting stressed while the father of the child was working the same hours and had no right, right. Cause he wasn't needing to go and leave to pump for their child.

[00:18:51] And somehow that just brought it home to me that these physicians, you know, they're both trying to do their best job at work. [00:19:00] And she is struggling in a way that could be helped and that eventually they started the program and that has helped other physicians there.

[00:19:07] Um, the other, uh, another program that, or initiative I'll mention is, was started at mission health in North Carolina, and it's called immersion day.

[00:19:17] And in the course of this, uh, program, they invite. Co of top leaders. So the C-suite basically executives and other leaders who don't have clinical backgrounds to shadow a clinician for an entire shift. So they signed privacy agreements. They put on scrubs, they are with them in the OR . They're sitting next to them.

[00:19:42] As they click a thousand times, they're seeing the inefficiencies they're seeing where there may be understaffed. Um, or staff who are not trained in, in the way they need to be to support the clinic. Other clinicians. And it, the effect of it in [00:20:00] terms of the relationships between the clinicians and top leaders, the understanding that top leaders then have of what the clinicians daily life is like, opened up so much for them.

[00:20:12] And. They also began to extend it and offer legislators, local legislators and journalists to come so that they had a better sense of what is it really like to be a clinician. And I just think that kind of opening up and what that says about the for for the culture of the organization is huge.

[00:20:33] Patrick Swift, PhD, MBA, FACHE: [00:20:33] Speaks volumes. And I love, uh, that, that this full circle of acknowledging the experience overall, um, for being aware of what the provider, the professional's experiences are, uh, the focus of physician experience or provider experience to the C-suite paying attention to what, um, the healthcare professionals are going through.

[00:20:55] Um, and I love that it also heightens, um, the awareness [00:21:00] about. Challenges women physicians are facing today. Um, especially in light of, um, is getting back to lactation rooms time, uh, to be able to do what needs to be done, um, support from caregivers, um, uh, looking at the bigger picture. And so this, this compassion we're talking about in leadership, this compassion, we're talking about changing, moving the culture of health care toward, um, toward, toward more a heart-centered approach, um, is a benefit to all.

[00:21:29] And so I just, I, Diane, I want to applaud the work you're doing in looking deeply at that these challenges women, physicians are facing, but also being part of conversations about bigger pictures and how this is all connected. And I'd love to ask you the, the, the question I love to ask my guests, which is if, if you had the attention of all the healthcare professionals, all of us around the whole planet for a brief moment, what would you say to us?

[00:21:54] Diane Shannon, MD, MPH, ACC: [00:21:54] I would say the same thing that I wish I had known. When I was in training [00:22:00] and that is it's okay to be human. And that means you have feelings, you have needs, like you need to sleep, you need to eat, you know, you need to exercise. Um, you need to have a place to talk about a strong emotions when they come up from work.

[00:22:16] Um, All of those human needs that we have, that it can be so easy in medicine to just try to deny, you know, we learn so much about, um, just denying our needs to keep going and push through that delayed gratification that it can become a way of life. And I think one of the lessons that I learned from my burnout was, no, I am human.

[00:22:40] And by embracing that and helping others to embrace that, um, I think that that leads to, you know, stronger clinicians and a more resilient workforce and better satisfaction, um, you know, for work and also for your whole life.

[00:22:58] Patrick Swift, PhD, MBA, FACHE: [00:22:58] I love it. I love it. And [00:23:00] I heard many things in that one, um, being you may push through. Something I, what I hear between the lines, you're also saying, yeah, push through. If you got to push through, push through, but I heard you say the word  about a way of life. And if it's becoming a way of life, then that's a zero sum game.

[00:23:17] And if you need some support on that, um, that's a great opportunity to reach out to Diane. So I'm going to, I'm going to just turn it to, if folks are, uh, interested in continuing this conversation, , , this delicious conversation. How can folks learn more about you and the work you're doing?

[00:23:34] Diane Shannon, MD, MPH, ACC: [00:23:34] Yes. So my website, very easy to remember DianeShannon.com. And the report that we were talking about is available on that, on my website. And I'd be happy to speak with people. Um, short conversation, longer conversation. Yes.

[00:23:51] Patrick Swift, PhD, MBA, FACHE: [00:23:51] Good. Good. Outstanding. Diane, thank you so much. And thank you for, , I think it's a good point to,  just say thank you and, and, , encourage folks to follow [00:24:00] up, , and take care of yourself. Apply this wisdom that Diane is touching on. And, , Diane, I just want to say thank you for being on the show

[00:24:07] Diane Shannon, MD, MPH, ACC: [00:24:07] Thank you.  It's a  pleasure.

[00:24:09]

 

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