The Gold Connection: A Gold Humanism Honor Society Podcast
In Episode 7, join us for a special episode of the Gold Connection in recognition of National Suicide Prevention Month, which is every September.
We are honored to welcome Dr. Tammie Chang and Dr. Luisa Duran, with Gold Humanism Honor Society Director Louisa Tvito, for an intimate conversation about physician wellness and the higher risks faced by female doctors.
Dr. Chang and Dr. Duran met as college freshmen and went through medical school together. They happened to reconnect many years later as practicing physicians when they were both facing unexpected crises.
Dr. Duran explains: “Really, all of us in medicine have dedicated our lives to do the work that we do. And I love what I do every day, because every day I get to use the best of my skills and knowledge to help people control their diabetes, manage their complicated, chronic medical conditions, and help them live their best life and thrive. Which is why it was a real surprise that within the first five years of practicing in clinical medicine, I would think about leaving medicine altogether and quitting my clinical practice. And I now know today that the reason is because of physician burnout.”
In this podcast episode, they share their stories, the terrible data on burnout, and how their need for change in medical culture led to them to create Pink Coat, MD — space and support to help other female physicians thrive, too.
If you need help, or know someone in need of help, the National Suicide Prevention Lifeline is available 24 hours a day, seven days a week, at 988. Text or call 9-8-8 for help. The Physician Support Line offers free and confidential access to psychiatrists helping U.S. physicians and medical students Monday through Friday, 8 a.m. to midnight ET at 1-888-409-0141.
Tammie Chang, MD
Dr. Tammie Chang is an author, speaker, and fierce national advocate for cultural change in healthcare. She is a practicing board-certified pediatric hematology/oncology physician at Mary Bridge Children’s Hospital in Tacoma, Washington, the Medical Director of Provider Wellness for MultiCare Health System, the Co-Founder of Pink Coat, MD, a platform dedicated to helping women physicians to thrive in their lives and careers, and the Co-Founder and Program Director of ELEVATE, the American Medical Womens Association’s (AMWA) National Leadership Development Program for Women Physician Attendings.
She is the author of the bestselling Boundaries for Women Physicians, the co-author of the bestselling How to Thrive as a Woman Physician, and the creator and host of the LeadHER Podcast for Women Physicians.
Tammie has received numerous awards, including the 2022 Gold Maverick of the Year and Gold Woman of the Year Stevie American Business Awards, the 2022 Gold Maverick of the Year and Silver Woman of the Year Stevie International Business Awards, and Women We Admire’s Top 50 Women Leaders of Washington for 2022. Her book, Boundaries for Women Physicians, won the 2022 Living Now Evergreen Book Award, recognized for its contribution to positive global change.
Tammie earned her B.A. and M.D. from Brown University, completed a combined internal medicine and pediatrics residency at the University of Massachusetts, and completed her pediatric hematology/oncology fellowship at St. Jude Children’s Research Hospital.
Tammie is also a certified leadership coach and received her coaching certifications from the Co-Active Training Institute and the International Coaching Federation. She has additional training and certifications from John Maxwell Leadership, Gallup CliftonStrengths, Crucial Conversations, and as a Playing Big Facilitator.
Tammie lives with her husband, Matthew, and their three fur babies: Golden retrievers Gus and Toby, and cat Mimi.
Luisa Duran, MD
Dr. Luisa Duran grew up in the San Francisco Bay Area, where today she loves practicing as a board-certified endocrinologist. A graduate from Brown University, where she earned her bachelor’s and medical degree, she fell in love with endocrinology after researching diabetes at the Joslin Diabetes Center with Harvard Medical School. She completed her internal medicine residency training at Santa Clara Valley Medical Center, an affiliate of Stanford University, and her fellowship in endocrinology, nutrition, and metabolism at the University of Washington in Seattle.
Luisa is the Co-Founder of Pink Coat, MD, a platform dedicated to helping women physicians thrive in their lives and careers, and the co-author of the bestselling How to Thrive as a Woman Physician.
Luisa strongly believes that helping women physicians thrive in clinical practice creates a healthier, more equal, more joyful world! She understands the added challenges unique to women physicians, given her decade of clinical experience in various high-pressure healthcare environments across the United States. Speaking nationally about clinical practice, she realized how many women physicians share the same challenges. Learning of a colleague’s crisis following severe physician burnout AND hearing her young daughter say she wants to “become a physician,” propelled Luisa to collaborate with industry experts to provide solutions and improve the future of medicine for women.
Luisa is profoundly grateful for her supportive husband, family, friends, and her three young children, who inspire her every day to make the world a better place!
Show notes
Pink Coat, MD
www.pinkcoatmd.com
IG: @pinkcoat_md
Twitter: @pinkcoat_md
FB: PinkCoatMD
Tammie Chang
www.tammiechangmd.com
IG: @tammiechangmd
Twitter: @tammiechangmd
FB: tammiechangmd
LinkedIn
Luisa Duran, MD
LinkedIn
Transcript
Louisa Tvito
Hi there. I’m so excited to be here with both of you today to learn a little bit about Pink Coat, MD. And from when I first learned about your organization, I just felt such a kinship. And the work that you’re doing is so focused on the human story and the struggles that so many are facing, and I think that you’re bringing such a voice to people that are in need. And I’m excited to share a little bit about what you do with our audience. So if we could start with introductions. Tammie, can you tell us a little bit about yourself?
Dr. Tammie Chang
Yeah, you bet. I’m a pediatric hematologist oncologist in the Tacoma/ Seattle area. Luisa and I have known each other since we were 18, so I know we’ll talk about that in a little bit. And the other hats I wear, I’m also the medical director of provider wellness for my large healthcare system. So I have about 5,000 physicians and APPs that I look after, and I’m also a leadership coach. What else do I do? I write books. I have a podcast. I do a lot of speaking, and I’m a fur mom, most importantly.
Louisa Tvito
So you’re not busy at all, then?
Dr. Tammie Chang
There’s never enough to do.
Louisa Tvito
I hear you. Luisa, can you tell us about yourself?
Dr. Luisa Duran
Sure. Thank you so much for having me on, by the way. It’s really an honor to be part of this, and I am so honored to now collaborate with the Gold Foundation. I am an adult endocrinologist. I practice in the San Francisco Bay area. I’ve been in clinical practice now for about ten years. I also have co-founded Pink Coat MD with my dear friend Dr. Tammie Chang. And when I’m not in clinic, I’m busy at home. I’ve got three little kids who I am raising every day, my daughter, who is turning eight today, it’s her birthday, my son, who just turned five, and my toddler, who’s two. And so I’m super excited for this conversation, because actually, my daughter wants to grow up to be a physician just like Tammy and I, so we couldn’t be more passionate about the work that we’re doing.
Louisa Tvito
Yeah, I mean, you’re creating such a foundation for young women and female medical students to understand what the culture of medicine looks like of healthcare is right now and how to be able to navigate that. And I think as a mother, that’s a huge component, as Tammie, the incredible hours that you’re working to be able to say, we can do this. It’s possible to do it, and it’s possible to maintain your passion, and even if you feel overwhelmed at times, and it’s the support system that you’re creating. So I would love to hear a little bit about the history of Pink Coat MD and how it came to be. I have many questions about the work that you’re doing and the impact that you’ve already had. But if you could tell us a little bit about your story and what you led you here, that would be great.
Dr. Luisa Duran
Yeah, I can start, and I want to just start by sharing that part of my journey is one where I was actually quite surprised for what I would experience in medicine, as well as not prepared for what I would experience as an attending. So, like many of my colleagues, I was called to this beautiful profession to heal others, serve my community, really bring the best of humanity to my everyday work. And my parents sacrificed tremendously for me to go to medical school. They’re first-generation immigrant family from Latin America. They work days, nights and weekends to allow for me to attend the best schools, have the best education. And like so many of my peers, I worked endlessly to be able to have the career that I have today. I remember staying in the library until two in the morning studying. I remember the 36-hour shifts that I had at the hospital. Really, all of us in medicine have dedicated our lives to do the work that we do. And I love what I do every day, because every day I get to use the best of my skills and knowledge to help people control their diabetes, manage their complicated, chronic medical conditions, and help them live their best life and thrive.
Which is why it was a real surprise that within the first five years of practicing in clinical medicine, I would think about leaving medicine altogether and quitting my clinical practice. And I now know today that the reason is because of physician burnout. And at the time, what surprised me was I had no idea that physician burnout exists. I didn’t know about it, I didn’t know what to look for, I didn’t know the symptoms of it, I didn’t know how to manage it. And I am really very surprised that this is part of our reality. And today I know that one in three physicians is silently suffering from physician burnout. And physician burnout is actually a leading driver of people leaving medicine today.
Louisa Tvito
Thanks, Luisa. Tammie, what led you to this relationship? I know you and Louisa start go back to your medical school days, but to say we need to intervene here, what is your story?
Dr. Tammie Chang
Yeah, similarly, I was completely caught off guard, too. And not unlike Luisa, I hit a rock-bottom place. It was actually five years into being an attending physician, and that’s when I was so severely burnt out, severely depressed. I’d struggled with depression my whole life since college, and I was suicidal and almost drove my car off a cliff. Coming back from just after months of shifts and not sleeping and working and working and working for a host of reasons. And so that moment really has become the catalyst for everything we do. I do today. And it was actually where Pink Coat MD came from, was. And so, Luisa and I have known each other since freshman year of college, actually, even at Brown, so and we were in the eight-year medical school medical program together. So we’ve been friends for 20 something years. And it was after that period I took a leave of absence. And at the end of that leave of absence, Louisa, who I had lost touch with because we were so stressed and busy in our lives as physicians, even though she was one of my closest friends, she was visiting Seattle for an endocrine conference and, I’m so glad, reached out and said, “Hey, it’s been years! We should meet up or something?” And so, we met up, and we literally only had 30 minutes to walk around the block. And then I drove her to the SEA-TAC airport.
And during that time, because we have this lifelong friendship, really, and this deep trust with each other, I was able to share my deepest, darkest secret, because I had not shared that with really, anyone. And then Luisa shared her struggles of isolation and burnout and almost quitting medicine too. And it was really during that moment, I think it was somewhere along that 30-minute walk around the block in downtown Seattle, and we said, we’re going to do something about it. We don’t know what, but we have to do something, right? And Luisa had even already come up with the name Pink Coat. She didn’t know what it was going to be yet, but she said, we got to do something about pink because we want to celebrate being women and girls. And that honestly very much encapsulates joy, love, and compassion for both of us. That color.
And so that’s where all of this really started.
Louisa Tvito
I think the Gold Foundation is so relationship-centered. We focus on the relationship between the caregiver and the patient, the relationship, the support system that you have when you’re in medical school, your medical school cohort, but the friendships that get you through this community that you’re talking about, that you were able to lean on each other, is very much something that Pink Coat MD is trying to create. It’s one of the pillars of what you’re trying to institute here. So I wonder how you’re utilizing your story, your stories from your experience with physician burnout, your relationship and the impact of that emotional connection. How are you utilizing those things to create community? And what does that look like for Pink Coat MD?
Dr. Luisa Duran
Yeah. So we absolutely know now, because Tammy and I have researched this issue incredibly, we now know that a breakdown in community is a key driver to burnout for physicians. We also know that our medical culture has a very strong stigma against physician needing help, seeking help, disclosing with each other their personal struggles. So part of what we’re trying to do with our safe community is give physicians the space to come together with other physicians who share in their unique experiences and their unique struggles and allow them to share what they’re experiencing and feel that they can safely share with each other. With our community. Their personal struggles. So that they have a space to heal, and they have a space to connect. As well as feel that they’re not alone. And burnout is just part of our experience as physicians. We’re really trying to remove the stigma around mental health physician burnout and help people get the help that they need in order to do their best work and live their best lives.
Louisa Tvito
Yeah, I want to go back a little bit just to understand. We talked a little bit about the statistics that led to this, the development of this organization, but maybe if we can help ground our audience in what those statistics are, what is really happening in health care right now in general, but specifically for women to understand what that looks like and then to understand really what the structure of Pink Coat MD does and is. And then I would love to kind of ask some more detailed questions, but maybe Tammie, do you want to talk a little bit about the statistics that led us to this point?
Dr. Tammie Chang
I think that it’s important to underscore what the struggle of all physicians first, and then we can highlight that of women. So what is little known to the public is that physicians have the highest rate of suicide of any profession. One in five physicians have considered suicide, and that is more than two and a half times the rate in the general population. And Louisa was saying one in three physicians experiencing burnout, that was pre-pandemic. Now we’re talking during and post pandemic, and we’re talking about more than 75% of physicians today are experiencing symptoms of burnout. And that puts those who have depression already much higher than general population at higher risk for horrible things like suicide. So I think it’s really important to underscore the entire where we’re at today in medicine. And then we look at what’s happening with women doctors, which is where our passion is, because women doctors are experiencing significantly higher rates of burnout, depression and suicide than physicians who are men. We have a 400 — FOUR HUNDRED– percent higher risk of dying by suicide than women in the general population. And we’ve actually known that since 2003. And no one talks about it, it’s buried in literature.
And we now know that 51, which is great, 51%, I know a lot of your listeners are students, 51% of medical students are now women, which is enormous, huge, in the United States, we are the majority. It’s a big headline in the AAMC, and yet we are less than 35% of the physician workforce, because 40% of us women doctors are either quitting medicine or being forced to go part time within six years of finishing our training. And that’s residency training not even fellows. So this is just like the tip of the iceberg. We’re not making into leadership either because we’re not lasting long enough. So less than 16% of hospital C suite leaders, less than 18% of medical school deans are women and women of color. And Louisa and I are women of color. It’s something we don’t actually talk a whole lot about. But Luisa is a Latina doctor. Less than 2.5% of physicians are Latina. There’s a lot more Asians. But in leadership, in healthcare, we’re less than 5% of leaders. That’s just some of the data that we’re dealing with here today.
Louisa Tvito
And I think the conversation around the pandemic and the hours and the figuring out the work life piece and caring for children is one part of the story. But what else do you see as being the leading contributors to this story? What is making this so that women are leaving healthcare?
Dr. Tammie Chang
It is multifaceted. And the number one reason is that our culture of medicine is male dominated still. And it’s a culture of silence. There are not support structures universally in health care that support women who have families. So basics, paid, familiar leave, lactation accommodations, emergency and on site healthcare accommodations, like the basics, right? And this is all parents too, deal with that. And then we don’t have structures that are in place to ensure that there’s equal advancement of women into leadership, right. That they’re getting the same mentorship, sponsorship and grant funding that men are. Because we know, we’ve seen a lot of data that we’re not getting the same opportunities still. There’s so much gender bias, maternal law bias, sexual harassment that we deal with on a daily basis. A lot of discrimination and bias comes from colleagues and staff, but also patients. So one in three women doctors has experienced discrimination for pregnancy or breastfeeding. And that’s just at the workplace. Another huge piece of this is outside of the workplace. Sorry, I could keep talking about this all day long!
Louisa Tvito
It’s important for us to understand what led to Pink Coat. Why it’s so critical to have this support system that so much that is educational and leadership. All of these things that you’re doing, there’s so much need because of all the things you’re saying.
Dr. Tammie Chang
So please share three more things. One in four women physician has struggled significantly with infertility. And that is something that’s little known to the public. And that’s more than two times women in the general public. And women doctors are eight and a half times more likely to manage the household, take care of the kids and care for elderly parents than men still today. So, when we look at all that women are trying to do, we are like we have three jobs. We’re doing our job as women doctors. We’re doing all the extra workload at work because we’re women, we tend to take on a lot of extra loads at work, right? That’s a whole other conversation. And then we come home, and we do the third shift and take care of everyone else. So, it’s not only do we not have support within the systems, our society, and the supports outside to also contribute. Anything you want to add?
Dr. Luisa Duran
Louisa yes, I would just add that everything Tammy has shared in terms of the numbers and the statistics is what I’ve lived in my life as a physician. And everything from the maternal wall bias to the general bias, to the lack of resources for advancement, to experiencing just more barriers and hardships to do the work that I love to do, that I trained my entire life to do. And this is why Tammy, and I are incredibly passionate about what we’re doing, because we don’t think it’s right for us to leave our jobs, our callings, our careers, because of failures in the system.
Louisa Tvito
And when you described your excitement about getting into the field. Thinking about the desire to heal and to care for people. And that you didn’t realize that this state was even a possibility. And so I wonder. With all of the things that we’ve talked about. All of the things that have led up to this. A female physician who is behind on her notes and has the responsibilities of caring for her family. And then if the burden becomes overwhelming. Can you talk about the structure. The framework that you’ve created with Pink Coat MD for people to begin to lean on and tell us a little bit about what the different components are so that we have understanding of how we’re going to begin to answer some of these questions and keep women in medicine? Because that’s the goal that they had these incredible ambitions and excitement to becoming a physician and the passion to do it, and how do we keep that going to keep women in medicine?
Dr. Luisa Duran
Yeah, that’s exactly right. And that’s why we created an organization, Tammy and I and our other co-founder, Betsy Flanagan, who is a wonderful women’s leadership coach and has done tremendous work in this field. We created this organization specifically for women physicians because we believe our world is a better place when women physicians are thriving. And so, everything that we do is thinking about how can we stay in medicine, how can we continue doing the career that we so love to do, how can we be of best service to our patients, to our communities, to others? And the number one thing we need in order to keep doing this incredible work is support and community. And we want to see a culture of love, compassion, optimism, and health care. To Tammy’s point earlier, we’re not seeing that today. And we do believe that the culture of medicine has to change to be one that is more forgiving, loving, compassionate, understanding, especially of the struggles that we face as women physicians who, as Cammy spoke earlier, are disproportionately impacted by physician burnout so we do three things really well at Pink Coat MD. One, we offer easy access to the best evidence-based resources promoting physician wellness.
We can talk a lot about the different resources that we know are out there that have been proven in the literature to work that are yet to be made available to a front-line worker. Second, we offer a safe, dynamic community for women physicians to come together from anywhere and everywhere. Thankfully. With technology today. We can have this digital platform where physicians can join us from their cars. Their call rooms. Their office. Their bedroom.
Anywhere and everywhere. To have community and to learn from each other. To share each other’s struggles and stories. To learn from experts who we bring on to teach us leadership skills and things that we need for personal and professional development and to thrive together. And third, we are really proud that we offer world class leadership development to support a women’s position throughout her entire career. We believe that we need more women in leadership, and we are poised to support any woman who is looking to gain the skills to really rise in that role. And I know Tammy is very passionate about that and she can speak more to that. Tammy, I don’t know if you have more to add on that.
Dr. Tammie Chang
Yeah, it’s a huge component of what we do. And all the evidence-based resources we offer are really based on the Stanford model of professional fulfillment for physicians, which is the gold standard today in all the work that Tait Shanafelt and all the leaders in the wellness space have really forged for us. And so, a huge component of that is leadership and organizational development and we get very little of that in our long years of training. And so that is something we are deeply passionate about. I’m super passionate about it. It was a huge part of what we do in Pink Coat. It’s a huge part of my life. Outside of Pink Coat Too is helping develop women into leaders and helping them realize that every single one of us are leaders. And especially as physicians, we are viewed as the leaders on our team and yet we don’t realize it and we don’t learn the skills. And so, it’s to arm people with those skills so that we can be more effective and have the influence that we actually really all do have.
Louisa Tvito
Yeah, I think I want to dig into each of these new components, but the leadership piece as the director of the Gold Humanism Honors society, I have this honor of watching medical students become leaders of compassionate care in their institutions. And as I watch this evolution and what they bring to the table and how they lead their peers, I think about how critical it is in the type of physician that they will become. And I think that being able to have a skill set that is something that they can lean on. A toolbox of leadership skills is going to continue to fortify these skills that are starting in medical school but can continue to be evolved. So can you tell us a couple of the skills, specifically the leadership skills that you work on, honing, or that you work with in this component?
Dr. Tammie Chang
I can talk a little bit and then I’ll pass it to Luisa. We really start at the basics at the very beginning, which is creating that foundation of self-leadership.
So, for our leadership development, we really start right at the very beginning with the core foundation, because that’s something we don’t learn a whole lot of and we learn very little of as students in training. And it really has to start with self-leadership and self-awareness, because we really, honestly can’t get to the skills until we’ve mastered that. And often a lot of leadership programs out there jump to a lot of leadership skills before they help people understand who they really are as leaders. And so that’s a huge part of what we do. We actually take every single one of our new members through a twelve week program in foundational leadership. So it’s basic. It starts with our core values, our why and our purpose, our personal mission statement, right? Like these really core fundamental pieces of who we are in our own self-awareness. Then once women have started to explore and become aware of who they really are as a leader, and they have to define their own form of leadership for themselves, we can’t do that for them, right? It needs to come from them. Then we can talk about skills like emotional intelligence, we can talk about being aware of implicit bias.
We can talk about self-care skills and setting boundaries, because that’s a big part of self-leadership as well. Communication, difficult conversations, negotiation, how to lead a team, how to run a meeting, right? These are all different skills. Giving feedback, receiving feedback. These are all really difficult things. If you don’t have a sense of who you are at your core. That’s just a taste of a lot of the things they do. Anything you want to add to that, Luisa?
Dr. Luisa Duran
Yeah, absolutely. 100% everything. But Tammy just shared, I echo, and I will just add that in order for physicians to do that work, whether you’re a male or woman physician, any physician, any healthcare leader, we need the space, the safe space to do that work because it’s inner work. And that means we need to be in community with one another. We need to feel safe, to share our innermost thoughts and feelings, and we need somebody to guide us through that inner work. And that’s really what we create and what we’ve created and what we provide with our platform.
Louisa Tvito
Yeah, I think that it all comes back to that sense of community. Not just understanding, as you mentioned, that there’s this twelve-week course, but they travel through that as a cohort. Right? I mean, they’re together in that from the beginning to the end, right?
Dr. Tammie Chang
Correct. Yeah.
Louisa Tvito
So it makes me think they’re doing this internal work to figure out who am I, what is my why, like you’re saying, and what is my contribution to leadership. But then to debrief and to talk it through, not just what is the story of healthcare, but what does it mean to be a female leader in health care. And to have that opportunity is a real gift. I also wanted to ask you, you talked about having support through that. So, is there a coaching component? Is there an opportunity to kind of talk one on one beyond the group? What does that look like?
Dr. Tammie Chang
The way we run the courses are actually very similar to how a group coaching program runs. So, there’s a didactic portion, but more than 50% of it is discussion either as a group or in small group. So, some dyads or small groups of three. And then we also have multiple really excellent one on one coaches who are on our platform as well. We offer that to all of our members, so they have the opportunity to work one on one with a coach in addition to the group sessions that we have every couple of weeks.
Louisa Tvito
I think from my experience and my conversations, there is a sense of I need to see others like me in these positions, that I belong, that this isn’t a fluke, that I am in healthcare leadership. To see that unfolding in a successful way feels like it could be really grounding. Have there been conversations around that of belonging in this part of health care?
Dr. Tammie Chang
Absolutely. Because again, we’re less than what, 15%-18% of leaders, so there aren’t a lot of people who look like us. And if we’re a woman of color, there’s even less. Right. And so, we have to be that for each other. And a big part of what we do too, is addressing that. We try not to call it imposter syndrome anymore. We’re trying to call it self doubt, navigating self-doubt, because it’s a human experience. But every single one of us feels significant. Like that inner critic is strong. Right. We don’t feel like we belong. And the reality is, when we’re together, we can then realize, oh gosh, we’re not alone at all, and feeling as insecure as we are because we don’t have role models to work toward. A lot of the time, many of our organizations, there are not women in leadership for us to model ourselves after. So we have to do that for each other.
Louisa Tvito
Yeah, absolutely. Another question that I have is about the resources. So you have mentioned, I know you’re both practicing doctors, your parents, two children and fur babies and full schedules. How are you working to create, to curate these resources? And then do you have a sense of which ones are being tapped into the most? Does that help guide further work? What are these resources? What does this look like?
Dr. Luisa Duran
Yeah, well, I think Tammy and I are examples of women who have done the inner work and are now aligned with our values, are why our purpose. We’ve been at this now for we’ve been at Pink Coat for a couple of years, but we’ve really been doing the inner work now for the past six years, since we hit rock bottom with our physician burnout. And that has gotten us to a place where we have a better sense of who we are, what truly matters to us. We feel more comfortable in our skin as the authentic women that we are. And then that allows us to bring the best of ourselves to every encounter, whether it’s seeing a patient, taking care of our fur babies, trying to make the world a better place. So, this work that we do with Pink Code MD, we get the ask this a lot. How are you doing it all? Because you’re still working full time as physicians, you’re doing leadership roles, you’re managing homes. We do do a lot. And one of the things that we’ve learned in our coaching, professional development and leadership development is that human beings have the capacity for unlimited vitality and creativity.
And when we can tap into that inner strength, our inner mentor, our inner power, we really can accomplish so much. And so, what the work that we’re doing at Pink Coat MD is actually really fun work for Tammy and I. Part of my strength is I’m a learner. I love to think about complicated problems, simplify them. I love to create. And the work we’re doing here allows us to really hone in to our strengths. And I’m also a maximizer, which is somebody who takes something that’s good and makes it great. And so, you know, this is an opportunity for us to make healthcare even better for all of us. And so, when we’re doing the work that we love, that’s aligned with our purpose, our why, our strength, that allows us to be who we are, to show up as our most authentic self, then we can do wonders. And so, I think what we’ve created with Pink Coat MD is just one manifestation of that.
Louisa Tvito
Absolutely. Tammie, do you have something to add to that also?
Dr. Tammie Chang
Yeah, I think you also asked us, too, about the actual resources that we offer through Pink Coat, the ones that we and we survey our members regularly, so we try to get as much feedback as possible. And they’re so giving. They always want to help us. Right? They love the leadership development, and they love the mindful self-compassion. We do. We do one to two mindful self-compassion sessions each month. With our wonderful instructor Barbara. And we’re about to offer a mindful, self-compassion six-week course as well, which we offered last year. So those are the two key ones that come up again and again. We also do offer positive parenting. We also offer pinko connection now, which is very people love that, too. We created space and time just to connect, literally, just to talk. Right. It’s not structured as structured as the other ones. And we also do charting boot camps too, to help people with their charting and their EMR, because that’s a huge pain point for physicians today.
Louisa Tvito
Yeah, you offer a tremendous amount of support in all different areas, mental, emotional, all of these, you have such a support system. And we’ve talked a little bit about the stigma of catering to your mental health and opening up the conversation, you know, from when the fact that you were in medical school and entering into residency or becoming an attending and didn’t really understand the culture of physician burnout, what that even could be. I wonder what the impact of Pink Coat MD and all of these women that you’re supporting are having on changing the conversations around stigma. How is that shifting now?
Dr. Luisa Duran
Well, we’re definitely seeing more women physicians comfortable with talking about their own struggles and being vulnerable because vulnerability, again, is not something that is readily embraced in healthcare. And so many of us are afraid to share how we’re truly feeling and what struggles we are facing. And so, part of what Tammie are really trying to do is change that conversation to say that, hey, when you can share with your colleague that you’re having a hard day, that you’re overwhelmed to even have that conversation, to ask for help, those are signs of strength, those are signs of leadership. And that’s the kind of conversation we ought to be having more of in our day-to-day work environments. And so, really, just being able to get somebody to a place where they’re comfortable having that conversation with another physician, I think is huge. And now we’re seeing some of our community members saying that they are actually finding other colleagues in their workplaces, in their clinics, hospitals OR rooms. They can actually spot burnout among their colleagues. And they have such an awareness, such a self-awareness and awareness of the reality of medicine, that they can now see it in others and go to them and say, how are you doing?
Let’s talk and actually start to model this more compassionate, empathic action in medicine that we want to see more of in our everyday work.
Louisa Tvito
Yeah, it’s like honing the leadership skills to be leaders in healthcare, but also leaders amongst your peers to allow for this type of conversation, which is a huge strength that you can be able to give others the opportunity to come forth and say, I’ve been there. I can see that you’re working a lot of hours. Are you eating enough, whatever it is, to be able to open those conversations feels like a type of leadership in and of itself. Also, we know that there’s a strategic component at the very high levels of health care about how we’re going to begin to handle this conversation. So, there’s part of the peer-to-peer work in the community and the work that you’re doing. But Tammie, I know that you sit in a wellness leadership position, and I wonder if there are any real changes in the conversations that are happening at the higher levels, either since COVID and understanding the impact of the mental health of individuals all along the healthcare spectrum. But are there changes in that conversation with the Lorna Breen Act or what are your experiences with the changes that are happening there?
Dr. Tammie Chang
Yes, I do have to say that this is probably one of the huge silver linings of the pandemic, which is that it’s brought burnout, mental illness, mental health, suicide among healthcare workers to the forefront. It’s not the way I wish we could have gotten here, because this stuff’s been going on for decades, but it really pushes us to the brink. And so it is front and center in the front of healthcare, which is, I think, a big part of why we found each other. Right. And we’re so grateful too, and that we get to be here to share our collective experiences today. So, we are seeing that across the board. What gives me hope is that if you look at across the country, there are systems that are investing in having chief illness officers, in putting resources toward building wellness programs, to beginning, to changing the culture of medicine from within. And it really has to start. I agree with the top levels of leadership because we have to model for everyone else that is safe and okay to ask for help. In fact, it’s a sign of strength, just like Luisa said. It’s a sign of self-leadership and strength to ask for help.
And that means our highest leaders, most visible ones, coming forth and sharing their stories, to be more vulnerable, to be vulnerable and to show and actually seek help themselves and be open about it. Because the reality is, until we do that as leaders across systems, no matter how the size of the organization, people are on the ground, are not going to feel safe too, unless the people in charge are doing that too as well. So that’s a big part of the work I do on a day-to-day basis. My system is 22,000 people. So that’s my sphere, right, and then there’s the sphere outside of work too, and the work that Luisa and I do, which is really goes far beyond the walls of any healthcare system. And I’m so deeply honored to get to be that and to have the voice and the position and the platform to be able to share, because I am very open in my system. I’ve been in my role only not even two years now. And I’ve seen tremendous change even in just this year and a half. So, I feel that if we can make the difference for one person, even if it’s just one physician, it is so worth it, everything we do.
And I cannot tell you the number of physicians and providers who come back, come up to me after I’ve spoken publicly or shared my story in a meeting, because I speak all the time, and they say, wow, you were the last person I would have ever guessed to struggle. And I’m so grateful that you shared your story, because I struggled too, and I’ve never told anyone, or my friend from residency died by suicide, and no one talks about it, right? So, everyone, through someone else, knows someone else who has struggled, or they themselves have struggled and have never felt safe enough to share. And so, by us modeling that first, it begins, that conversation, which is how we change the culture.
Louisa Tvito
Yeah, and I think about like you mentioned, a lot of our audiences in medical school and in residency. And I am very much immersed in the culture of medical education, which we have many GHS chapters. And I just wonder, because the two of you go back to medical school, what was the conversation like at that point? And was there any education about anything? About burnout? Nothing like that?
Dr. Tammie Chang
Nothing, I didn’t know what the word burnout was until years later.
Dr. Luisa Duran
Which is why part of the passion that fuels us is that deep frustration that we experienced five years into our clinical practice. We even have a talk we give within our community called The Physician’s Broken Dream. And we show a picture of Tammie and I graduating from medical school, standing in front of the Brown gates, and we’re so happy, and we’re smiling ear to ear, and we’re just so excited and joyful to finally start practicing medicine.
Dr. Tammie Chang
Hopeful. There’s so much hope.
Dr. Luisa Duran
Very hopeful. And that’s why we call it the Physician Dream, because nobody warned us that within the first five years, we would experience what we experienced and actually think about leaving medicine entirely. And just the personal suffering. And the other bit, too, that I think doesn’t get talked about enough is when a physician or anyone really in their job is silently suffering, that not only impacts their work. So we know that a physician experiencing burnout is more likely to have medical errors to just not perform optimally, but they also bring back that negative part of themselves to their home, and it really starts to disrupt their personal relationships. And so for me, one of the red flags that went off was just seeing how at home I would be incredibly irritable, and I was just feeling miserable and exhausted and not able to do the jobs that I needed to do in my own home. To take care of my kids, to nurture a loving relationship with my spouse. And, you know, it really is an issue that affects the whole person, which is why we really need to start talking more about it and addressing it and really help people get to a better place.
Louisa Tvito
And we know that the conversations about we know that the stress of being in medical school is yielding the same type of fatigue, the same type of emotional exhaustion, trying to keep up with getting the best grades, scoring the best on tests. If I say, what about getting into residency? It’s the same types of conversations. It’s almost like this trajectory of burnout that starts in medical school. This is what the story is here. And then as you evolve in your medical career, it should be almost like a parallel learning structure. Like your learning continues with CME, but then your understanding of what burnout looks like changes as you move into the field. So I wonder what your advice is for medical students to begin to move the needle or to begin to open up these conversations in an open way. What would you advise the medical students?
Dr. Tammie Chang
I have to say that our medical students and our next generation are going to be what changes this culture. Really, they are our future. And the fact that we’re even having this conversation today and the Gold Foundation exists and you are spreading this awareness to your students is huge because they are the people who are going to be in leadership that’s going to really change this over time. I don’t know if advice is the right word, but it’s more I want to inspire them and empower them to know that they have a voice, that their voice is valuable no matter who you are, and that every single one of their voices has an impact, and they can’t have an impact on their system together. Because when we come together, one person starts, okay, one person has to be a squeaky wheel. But then if two or three people join them, they’re like the early adopters, right? You’re thinking about change management, and then you keep adding more and more people, and soon, before you know it, we’ve got the majority of people who are thinking and talking and acting the same kind of way. And that’s really what we have to do in medicine, because the culture we have now and the training history that we have, even though it’s a lot better, but it’s still not great, right?
Like 3 hours and the stressors that we put on trainees and students is still insurmounted. It just, to me, boggles my mind. But that is history of the history of Western medicine. We’ve been this way for hundreds of years, right? And so things aren’t going to change overnight. But I think another thing that Luisa and I, we really love this concept of the transition team. It comes from Tara Moore’s book “Playing Big”, which we both really love. It’s about women helping women to speak up and to lead. But it’s really the concept of we have struggled as women for centuries, right, as far as long as history, and we have actually made tremendous strides, even in the last 100 years. It’s a reminder to us that 102 years, we just had National Women’s Day, not like this last month or last week at the time of recording this, and we couldn’t vote in this country 102 years ago. And we have come a long way. It doesn’t feel like it right, but we really have. So we have to remember that change is slow, it takes time. It’s going to take generations and generations, and that’s okay, because every single one of us who are part of the conversation now are helping to make it better for the next generation.
And to us, that’s what really keeps us going, is knowing that there are young people who we’re doing this for them. I don’t know if, Luisa, you share at the very beginning your inspiration, your daughter. I wonder if you just want to share that really briefly now, because that really is the essence of the core of everything we do and why we feel so strongly about empowering our young students.
Dr. Luisa Duran
Yes, I was leaving for clinic one morning and my daughter stopped me in my tracks and said, mommy, I want to be a doctor too. And that really was a defining moment for me because it forced me to critically evaluate my life, our world, or medical culture and ask, is this the world? Is this the culture I wish for my daughter? And at the time, my answer was no. Because really, who wants to see their daughter into a culture where they are likely to get burned out, likely to have health consequences and possibly lose their life? And we know actually from the statistics that 70% of physicians today don’t want their kids to go into medicine. So again, that was another driver for me personally and for Tammy, is that we want to take action now to make it better. And we are optimists at heart. So, we have hope and compassion and optimism in our DNA, and we believe we can. And we believe that the world can be a better place, health care can be a more compassionate culture for all of us. And I think we exist today to show and model that because we were able to overcome our burnout, we’re in a much healthier, happier place in our lives.
We’re still practicing physicians. So I still everyday go in and take care of my 20 plus patients with chronic medical issues. Tammie is still saving the lives of young children with cancer, and we are also in a much healthier, happier place, and we wish that for everybody. So, I think for any medical student listener out there who’s feeling a little hopeless and burned out. Don’t give up hope. This is still a wonderful, beautiful profession. We need you more than ever. By 2033, the estimated physician shortage is predicted to be over 139,000 physicians. So, we need all of us to stay in medicine, and we believe that it is possible.
Louisa Tvito
Oh, I was going to ask you what success looks like, but I feel like you just answered that in so many ways that you said it taking something good and making it great. And that, to me, is what this organization is doing. It’s taking a challenging topic, working with women who are passionate and excited and want to continue their career in healthcare and making it possible and bringing the love back into the field and allowing them to have the tools to do this in a successful way. And a community, which is something that we believe in so firmly in the Gold Foundation through our entire network, but through GHS and our 45,000 plus members, that community is a saving grace in so many ways. So, I am so grateful for speaking with you both today, and I want to be able to share your website and your social media handles with our listeners. We’ll make sure that they’re in the podcast notes. But is there anything else that I didn’t ask? I mean, important areas that you wanted to share, but I would give you the opportunity to share.
Dr. Tammie Chang
I usually close with asking those of you who are listening to just give yourselves the same grace and compassion that we know you strive to give to others, because that is sometimes the hardest for us as physicians and health care workers.
Dr. Luisa Duran
Sure, absolutely. And having that self compassion allows us to have more compassion for others, and we know that compassion is actually taking action.
Louisa Tvito
Absolutely. Well, thank you both so much, and I look forward to further conversations with both of you.
Dr. Tammie Chang
Thank you so much for having us.
