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Creating a New Culture in Healthcare with Susan Hingle, MD – The New Future of Work Podcast, Episode 3

2022-11-28 By Monica Bourgeau, MS 2 Comments

Listen on: APPLE PODCASTS | SPOTIFY

Creating a New Culture in Healthcare

We are delighted to host, Susan T. Hingle, MD, FRCP, MACP (Sue) today to talk about her journey in medicine and the creation of the Center for Human and Organizational Potential (cHOP) at Southern Illinois University School of Medicine, for which she is the Associate Dean. cHop has a vision of “professional and personal fulfillment realized for all.” cHOP’s mission is to create an environment in which inclusive partnerships unleash the individual and organizational potential of SIU’s people and communities to learn, thrive, and excel. It is a model that includes pillars professional development, leadership and excellence, wellness, and organizational development and change management.

She shares how advice from her residency program director encouraged her to get involved in changing the healthcare system, leading her to create Rush Community Service Initiatives Program to help the uninsured and underinsured in Chicago. Sue continued her career in medicine and now leads initiatives at the cHOP.

One aspect of Sue’s work at the cHOP that really stands out is how healthcare and administrative professionals from across the organization study and learn together. This helps create a “leveling of the hierarchy”, a challenge that is prominent in healthcare today.

Sue also shares about her personal journey for wellbeing and shares some of her favorite books and resources, including the message on the bottom of her emails which reads, “Do not feel compelled to answer this e-mail on evenings or weekends, unless it makes your life easier, giving her team permission to take time off.”

About Susan Hingle, MD, FRCP, MACP

Dr. Hingle is a general internist and a professor of medicine and director of faculty development. Dr. Hingle is a fellow with the prestigious Executive Leadership in Academic Medicine (ELAM) Program. She has received several teaching awards including the Golden Apple Award, the Excellence in Teaching Outstanding Teacher Award and the Leonard Tow Humanism in Medicine Award. She earned a bachelor’s degree from Miami University and a medical degree from Rush University Medical College. She completed an internal medicine residency at Georgetown University Medical Center, where she served as chief resident of internal medicine. Dr. Hingle is married and has two sons.

During the podcast, Sue referenced the Three Good Things exercise which we highly recommend. Learn more at Greater Good in Action: Three Good Things.

To learn more about Sue’s work, you can visit the Center for Human & Organizational Potential at SIU School of Medicine or connect with her on Twitter or Instagram.

Listen and subscribe on Apple Podcasts, Spotify and wherever you usually find your podcasts.

Listen on: APPLE PODCASTS | SPOTIFY

***

Show Transcript (via AI – please excuse any errors):

Monica (00:05):

Okay. Well, I’m very excited to have a special guest with me here today. Dr. Susan Hingle is a general internist and a professor of medicine who serves as Associate Dean for the Center for Human and Organizational Potential. She’s also the Director of Faculty Development at Southern Illinois University School of Medicine. Dr. Hingle is a fellow with the prestigious Executive Leadership in Academic Medicine Program, and she earned a bachelor’s degree from Miami University, a medical degree from Rush University Medical College, and completed an internal medicine residency at Georgetown University Medical Center where she served as Chief Resident of Internal Medicine. Dr. Hingle, or Sue, as I’ll call her in the interview, is married and has two sons. She grew up in Decatur, Illinois and is extremely proud to be part of SI’s mission. So. Awesome. Sue, thank you so much for being here with me today. I really appreciate it. It’s good to see you again.

Sue (01:10):

Yeah. Thank you so much for having me. And thank you even more for doing this really important work.

Monica (01:16):

Thank you. It’s exciting. We were just talking about, it’s the, the Friday before a long weekend when we’re recording this and Sue’s been covering call for a little bit, so it’s been an interesting time.

Sue (01:33):

Definitely. Definitely.

Monica (01:35):

So maybe we could just start off by having you tell us a little bit about your story and your background and how you got to where you are today.

Sue (01:46):

Sure. you know, part of it was in my bio that you just read. So I grew up in Decatur, Illinois, which is about an hour from where I work. When I was growing up, my, I’m gonna probably do this in maybe there’s, I sort of view kind of three parts of my journey to where I’m at. The first part is related to growing up my mom was sick quite often. She had a couple of chronic illnesses and then ended up with two different cancers. And she passed away when I was 18. And when I was growing up I, I had a good, I had a good life, but we didn’t have a lot of healthcare in the region. The SIU School of Medicine was really pretty new. And in Decatur we didn’t have GI doctors, we didn’t have a lot of oncologists.

Sue (02:51):

So my parents traveled for healthcare quite a bit. And when I look at, so dad still lives over in Decatur and I have two sisters who live there. When I look at not only Decatur, but really the, the spans of central and Southern Illinois, it really has changed a lot in those 30, 40 years because of the school of medicine. So, SIU was founded to really train physicians who were going to work in central and southern Illinois. It’s a really, it’s a mission based medical school. And the missions are fourfold, it’s education, it’s patient care, it’s research. So sort of the typical missions of academic me medicine, but it’s one of the few medical schools that has service to the community embedded in the mission. And when you look at geographically the impact that School of Medicine has had on central and southern Illinois, it’s really amazing to, to see the changes that have happened.

Sue (04:03):

And so kids now growing up in Decatur and other places in central and southern Illinois, their parents, if they get sick, they can access healthcare. Right, Right. Where they’re at. And so that’s really what brought me to I, and has kept me at I u. So that’s part one. The second part is kind of my journey to, to advocacy. I have been involved with organized medicine since I was a medical student and definitely a resident. So when I was a medical student a friend of mine, a fellow medical student, we started a, a free clinic for pregnant women on the south side of Chicago. That’s amazing. And, and when we did that, we learned that medicine is a complex system. There’s so many, it’s more that obviously the physician patient relationship is critical, but it’s so much more than that.

Sue (05:06):

You know, patients have to exist and the physicians and other healthcare team members have to work within this complicated system. And so we were able to work with the system to figure out how to provide medications for our patients, how to get the hospital to agree most of these patients, this was pre Affordable Care Act. They were uninsured. And so we got the, the hospital to agree to let the physicians deliver their babies without charging them for that. And so we really, it was we learned about systems of care and the importance of that jumping. That’s amazing. Yeah. Yeah. It was really cool. That actually started something at Rush that is still in existence called the Rush Community Service Initiatives Program. And it’s all these community service programs that are all student run. It, there’s staff support for it and faculty support but they’re all student initiated and student run, which is really, really pretty cool.

Monica (06:19):

What a great accomplishment. How do you think you were able to get everyone to work together? Cause that’s pretty major. Getting people to deliver free care and really collaborate.

Sue (06:30):

I think reminding people of why they do what they do. Yeah, I think it’s like most, most things, if you can kind of get people back to, back to their mission, back to their why, identifying those shared common goals we’re more alike than we are different.

Monica (06:53):

Absolutely. And speaking of that mission, I’m wondering if you mentioned in your earlier story about your mother’s health issues. And I’m sorry to hear that. Do you feel like that’s part of what inspired you to go into medicine?

Sue (07:13):

Maybe So I actually, when I went to college, I thought I was going to do social work mm-hmm. <Affirmative>. And my mom passed away when, when I was a freshman. And my maladaptive coping behaviors was to just really engrossed myself in my studies and like not pay attention to, to all these horrible feelings that I was having. And I was working with a professor in the zoology department through a work study program. And he said, You know, Thompson’s my maiden name. You know, Thompson, you’re smart enough to be a doctor. Why don’t you just become a doctor? And I’m like, Oh, okay. I’ll just become a doctor. And so I, it’s

Monica (08:03):

Easy

Sue (08:04):

<Laugh>. Yeah. I think there have been several times in my life’s journey that other people saw more for me than I saw for myself. And I’m so grateful for that. And that was one of those times.

Monica (08:18):

Wow. Yeah. I’ve, I’ve had a few of those in my career too, and they can really make a difference. So

Sue (08:24):

Definitely another one of those was in residency. My residency program director, who has been one of my most important mentors. He was another one who kind of continued me on my advocacy journey. And I was lamenting to him about how different care was with patients depending on their ability to pay. And that really frustrated me. Yeah. And he said, You know, you can do something about that. And I’m like, What can I do? I’m an intern. And he said, You can get, you can get involved in organized medicine and change policies. And that was my entree into my work with the American College of Physicians (ACP) which has continued. And I’ve been part of the ACP for my whole professional life now. And it kind of culminated. I served as the chair of the ACP Board of Governors, which is the grassroots part of the organization.

Sue (09:28):

And then I chaired the, the Board of Regents which is like the board of trustees, like the typical board. And through that was able to do some work related to gender equity to creating inclusive environments. It all kind of has led me to also the work that I’ve done at SIU which I think is maybe the third part of my story is you mentioned that I have two sons. One of my sons is on the autism spectrum. And has had a lot of challenging experiences in life without, with people not really accepting him or wanting to, to give him what he needs to be able to thrive. And I, I want a different life for him. I want him that he’s a, both of my boys are just amazing individuals. And I want the world to, to see all of their gifts and to appreciate all of their gifts. And so I really would love to, to continue to work to, to really create inclusive environments.

Monica (10:52):

That’s great. How old are your boys now?

Sue (10:55):

They are 17 and 20.

Monica (10:58):

Okay. Yeah. That can be challenging. Well, it sounds like it’s really helped fuel the work that you’re doing though, which is, is great.

Sue (11:08):

Yeah. Yeah. Everything’s all interrelated, for sure.

Monica (11:11):

Yeah. So tell us now about your work at SIU and the organization that you lead there. Cause I know you’re doing some tremendous things around creating a better workplace.

Sue (11:22):

Mm-Hmm. <affirmative>. So I have had the privilege to start up and lead what’s called our Center for Human and Organizational Potential. And our mission is really to create an environment where through partnerships we work with others throughout the, the organization to unleash individual and organizational potential for everyone here to be able to learn, Thrive and Excel. And we do that through kind of three main pillars. Those pillars are professional development, leadership, and wellbeing. And it’s a little different because it’s really across the organization. So a lot of academic places really focus on the faculty and the trainees, and they forget this really, really key part of our team, which is everybody else.

Monica (12:24):

Right, right.

Sue (12:25):

And as we were developing this, we started out with kind of that old mindset that it was faculty and our medical students and residents, but we learned that that was never gonna be successful if we didn’t really pay attention to everyone else. And the environment the things that were making faculty and students and residents frustrated and not well, we’re the same things that we’re doing that to our staff. And we were able to, to really develop that, that mission. And our vision is personal and professional potential realized for all.

Monica (13:12):

I love that.

Sue (13:14):

And we’re just about three years in. So the timing was really good or really bad, depending on your perspective. It was good because we launched a little bit before the pandemic hit. And so really early on we were able to, to demonstrate a huge need for this. It was bad because the financial impact of the Pandemic has you know, really strained healthcare and well really our society in has a whole, but Right. So we’re we haven’t been able to grow as quickly as we, we need to really help everyone that that wants, wants assistance.

Monica (14:12):

You’ve done some amazing things. I remember when we spoke earlier, you mentioned the Accelerate Program mm-hmm. <Affirmative>. And what I loved about that was that you are including everyone and like you said, not just the leadership or the physicians, but kind of everyone. And it’s a level playing field. Can you maybe tell us a little bit about the Accelerate program?

Sue (14:35):

Sure. so the Accelerate Program is part of our leadership pillar. We have a couple of other programs which are structured somewhat similarly, but it was designed by two of my great colleagues Sue Younga and John Mellinger. And it is really an emerging leaders program. And a couple of important goals. Obviously the, one of the goals is to, to train leaders. But I’d say just as important are two, two other goals. One is to really create a community of learning, and also in doing so, create a community of caring. And they’re learning together. They’re growing together, they’re getting to know each other as individuals, so they’re not just learning the content they are learning about each other. And we have people again, you mentioned we have faculty, we have staff, we have people who are early in their careers.

Sue (15:51):

We have people who are later in their careers who are having their first real leadership opportunity. And so they bring a whole different perspective and wisdom to conversations. There’s a lot of peer mentoring that goes on in the program. And this culminated the, we just started the second cohort, but the first cohort, actually, I think it was about this time last year that they, we had a virtual graduation ceremony. Oh. And each of them got to really say whatever they wanted. We, there was not a big script. We just said, you know, tell us what, what you wanna, what are you taking away from this? And it was incredibly powerful. The, everyone got something different out of it, but it was clear how meaningful it was to have had had this group to, to travel this leadership journey with. And so again, I think there’s the content piece. There’s the, the community of learning and the community of caring, which I feel are things that people really should pay attention to.

Monica (17:05):

I love that. And these groups, are they across different departments too? So people are having the ability to interact with others in different roles that they might not normally get to connect with?

Sue (17:17):

Definitely. Yeah, definitely. I don’t have, I’m not a numbers person, but I think we had people from maybe I wanna say 14 different departments. Nice. And that’s one of the, the challenges in healthcare and academic medicine is things are so siloed and so competitive. And when you do a program like this and you travel the journey together, I think whenever you can humanize things, it takes a lot of that competition out of it and opens your eyes to different ways to, to be able to do things. And that’s one of my big goals is to really just squash that hierarchy and break down those silos.

Monica (18:04):

I love that cuz we hear more and more about how we’re starting to make this shift to team based care. But it’s hard to have a team if it’s very hierarchical or competitive or you don’t know each other. And so, yeah, I just think that’s amazing work that you’re doing there.

Sue (18:23):

Well, I feel very very blessed to have this opportunity. And I’d say one of the, the highlights has been having the opportunity to build, build the team. And I couldn’t, we’re all very, very different than members of, of our team, but I couldn’t ask for a better group of people that they’re all fully, fully committed to that vision.

Monica (18:50):

That’s wonderful. And it’s a challenging time in healthcare right now too. We are hearing more and more about workforce shortages and increased rates of physical and mental burnout with caregivers and really kind of across the spectrum. And so there’s definitely a lot of challenges. What do you think it will take for us to start to improve that and maybe shift the culture of healthcare a little bit?

Sue (19:18):

That’s a great question. I’m on a quest to get people to, you’ve probably heard of the, the triple aim of healthcare. Yes. and then there is also some people will call it either the triple aim plus one or the quadruple aim. Yeah. So the triple aim is really to improve the patient experience, which is the, the quality of care, the patient satisfaction. The second piece is to improve the health of the population. So again, recognizing the importance of that system. And then the third is to reduce the cost. And a lot of the, the totally important work, you know, the triple aim, but it was done without additional resources. And when you’re trying to do all of those things without additional resources what’s gonna happen? Someone’s gonna have to do the work. And it ended up being our, our healthcare teams our physicians, our nurses, our medical assistants.

Sue (20:23):

And that’s when we really started to, to recognize the amount of burnout and unwellness and so my goal is to shift us away from the triple A plus one or the quadruple aim. And what I truly believe that we need to do to, to create a better culture and workplace in healthcare is to make wellness the priority. So take it out of a four part puzzle and have it be the, the priority because we know that when clinicians are healthy and well, they provide a better patient experience. There’s lots and lots of data that burned out. Physicians have lower patient satisfaction scores. We know that when you have a thriving physician, that patient outcomes are better. And now with the shift for paying for quality outcomes, you’re gonna start to impact the, the bottom line, the per capita cost in a positive way. We know that physicians and other healthcare team members, when they are healthy and well, they’re more likely to understand the entirety of their patients. So they understand the community, they get engaged with the community. And so they often have a different way of looking at population health. And so I truly believe that if you make wellness legal, that’s how you get to the triple aim. And if you make wellness, the, that’s how you really create a better culture because you’re really paying attention to the individuals who are doing the work.

Monica (22:11):

Yeah. Oh, I love that. And I think it goes back to that saying something about it’s hard to give from an empty cup. You know, if our providers and our caregivers and the staff are drained and depleted, it’s really hard for them to show up and give their, their full effort to the employees, even though they certainly do their best.

Sue (22:30):

Mm-Hmm. <affirmative>. Yeah, it’s interesting. Gosh, I think it was about this time last year, I one of my colleagues and friends sort of called me out for being a hypocrite. I know <laugh>, she no, it ended up being good. Yeah. Yeah. But I think a lot of people in healthcare do that. Again, we we’re caregivers, we take care of people Yeah. Often at the expense of ourselves. Absolutely. And I was struggling and she said, You know what? If you put all the energy that you put into the ACP into s I u and the ama, if you put all that energy into yourself, and my first response was, Now that would be selfish. And she said, Right. Listen to yourself. And I said, But it would. And she said, What do you say are your guiding principles in life?

Sue (23:34):

And one of the ones that I said was, Do one to others as you would have them do one to you. Yep. And love your neighbor as yourself, sort of different takes on that. And she said, I don’t think you love yourself. And I said, Yeah, I do. And she said, No, you don’t. You don’t take care of yourself. And she really got me reflecting. And I was not healthy. I was really, really overweight. I wasn’t exercising, I wasn’t eating well. I literally was surviving. Wow. And it took me a couple of months of reflection to, to realize that what she said was true. And this past year, I’ve really learned how to take care of myself. And for the first time in my life, I think I always intellectually bought into the concept that you’re better to others when you’re good to yourself. But I actually had never lived it. And interesting for this past year, I have lived it. I know that I’m, I’m a better physician, I’m a better colleague, I’m a better spouse, I’m a better mom, I’m a better sister. I’m a better everything because I’m healthy and well. Wow. And so I, I understand it really on a just kind soul level rather than just a cognitive level.

Monica (25:07):

Wow. I love that. So you’re really making that effort to kind of walk your talk and, and really showing up as a role model. I noticed at the, the bottom of your email, you had a couple of things. I was going back and preparing for the show, and I, one, I loved the books that you listed. The, the Book of Joy is one of my all-time favorite books. But you also had a statement at the bottom that said that something along the lines of, if you get this in the evening or on the weekends, that you don’t need to reply unless it’s more convenient with mm-hmm. <Affirmative> for you, which I just love because, you know, coming from some healthcare organizations where it was the norm to email and there’d be a full back and forth conversation with multiple members of the team at 10 o’clock at night on email or Saturday morning, you know, it just kind of never stopped to give people that permission to mm-hmm. <Affirmative> wait to respond to your message. I just love that

Sue (26:05):

<Laugh>. Yeah. Yeah. And at first, I just, I, I had said I don’t expect you to answer this, but then someone said, But by you sending your email at nighttime, we still feel like you do expect that. And so I had to reflect, and I sometimes will work on evenings or weekends, because that allows me to be able to, if I wanna go for a walk in the middle of the day or to something at my kid’s school in the middle of the day, I still need to get the work done. Sure. But it frees me up. And so to me, it creates that flexibility. And so I hope, you know, when I change that wording, it really, unless it makes, you know, makes it easier for you, and it does make it easier for me to, to be able to live a full life and to decide when I want to do the work.

Monica (27:01):

Yeah. That’s great. I thought that was really powerful. And yeah. So I’m glad we got to, to talk about that a little bit. So are there some kind of emerging models or practices that you’re starting to see in healthcare or at I that are maybe kind of moving in the right direction?

Sue (27:24):

So I would say one, I have a couple of friends that I know who work for a primary care group called Iora. It’s a Medicare based group. And it really is a, a highly functioning team based approach that puts the patient at the center. They have health coaches, they have a lot of the support services, wraparound services for patients. They do home visits. That, that was one of the nice things I think in the pandemic in doing telehealth is getting invited, invited into the, the patient’s home. Yeah. Learned so much really important information that I wouldn’t have known otherwise. You know, about who all they lived with. You know, sometimes they bring family in, a lot of times they don’t who they live with, what hazards may be in the home.

Sue (28:39):

Medications, You know, I’d have them walk me to their medication cabinet and they’d have all these old medicines and things like that. And so we would have them dispose of those. Anyways, this practice that a couple of my colleagues work for home visits are part of it. But it really is putting the patient in charge. Like the patient can decide if they want home visits or if they want office visits. And right. Instead of the doctor deciding it’s an office visit or a home visit, the patient gets to decide. And I love the fact that, again, they in addition to a lot of the typical wraparound services, they have health coaches that are integrated into it. Kind of getting back to, to my experience of, even as a physician, I didn’t really know what I, as an individual needed to do to get healthy until I went on this journey this past year. And so that’s integrated into the care there.

Monica (29:38):

Nice. That’s great. So if you could wave a magic wand and really create a vision for the future of healthcare, what would that look like?

Sue (29:55):

Well, I think a little bit of what, what I just described, You know, as far as the, the I’d put patients in charge of their own they’d, they’d be the leader of their team. It would be really highly functioning, integrated team based care, but the patient would be the center of it. There’s always this I don’t know what the right word is, but this battle of who’s in charge of the team? Is it the doctor? Is it the, the advanced practice nurse? Is it the, the pharmacist who’s in charge to me? In the ideal world, the patient is in charge. They get to, they get to decide who’s on the team and how the team works. And it’s really allowing members of the team to function at their highest level. You know, one of the, the big challenges is again, in that drive to have high quality, cost effective care you have people doing things that they weren’t trained to do and that someone else maybe should be doing mm-hmm.

Sue (31:11):

<Affirmative>, you know, physicians providing information on healthy diets. We’re not trained to do that. The dietician should be doing that. Sure. We’re putting in data into the EMR so people can see if we’re keeping immunizations up to date for our patients we’re checking boxes that we checked the physician monitoring part of the, the record to make sure that the, the controlled substances were due and not being abused. All really, really, really important pieces of healthcare, but perhaps not the right people doing them. And so to me in that highly functioning team, it’s really letting people do the work that they’re trained to do.

Monica (32:09):

Yeah, I love that. Getting, getting the right people on the bus and the, the people in the right seat so that they can mm-hmm. <Affirmative> deliver care without burning everyone out too at the same time.

Sue (32:22):

Yeah.

Monica (32:22):

So one of the things that I’ve just really enjoyed about getting to meet you and visit with you a few times now is your bigger mission and just drive to kind of make the world a better place. How do you stay connected to that bigger vision? Because it can be challenging, you know, when you’re in the weeds and in the day to day of just working in an environment.

Sue (32:50):

Yeah. It definitely can get overwhelming. So I, I’d say a few things. I’d say one is I’m blessed to, to have my family who ground me and keep me focused. I would say another thing is my colleagues during the pandemic I started this exercise with one of my colleagues and friends who lives in New Mexico. Her name’s Eileen Barrett. And we started doing three good things. I don’t know if you have heard of three Good Things. It came out of University of California Berkeley, and it’s an evidence based reflective tool. And basically on a daily basis, you think of three good things. And we started doing it with each other. So we kind of became an accountability pair. And so either she would send them to me or I would send mine to her, and then it would sort of force the other one to, to do that. Yeah. And it was really, really helpful. And so whenever any of my colleagues or learners or other people in my life were struggling, we would start doing three good things. And Eileen and I still do it every day, and I have two other colleagues one that lives in Ohio and one here in Springfield that we do it on a regular basis. Some of the other people that I’ve done it with, it’s sort of, has fallen off. But so I think intentional reflection is another, another part of it.

Monica (34:43):

That’s such a powerful tool too. I’m glad you brought that up.

Sue (34:46):

And it’s so easy. It’s so easy. Yeah. There’s even an app that you can get on your phone that’ll send a, send a prompt to you saying, What are your three good things? You can set it for whatever time of day, and then you get this reminder, Oh, okay, I’m gonna reflect on this. Yeah. During my wellness journey, I started also meditating. Oh, good. I was having tachycardia and again, I wasn’t healthy and well, and so I learned how to meditate. And I start each morning out and, and each day with at least five, five to 10 minutes of guided meditation. And that again, kind of helps me get into that positive space. And then one other thing is I leave little sticky notes around like, like this one that says, Leave the world a better place. And so when I get frustrated, I’ve got this bright yellow paper that’s like, Okay, let’s remember what your mission is.

Monica (35:44):

I love that. And I think that that is such a simple but helpful kind of tool to just be a constant reminder to think about the bigger picture. So what, and who are some of your biggest influences? Like books, movies, people, experiences, those types of things?

Sue (36:05):

Well, I’ve talked about some of the, some of the experiences you know, with my mom and with my son books. So my all time favorite book is Man Search For Meaning by Victor Frankel.

Monica (36:25):

Yeah.

Sue (36:25):

And you know, that, that also is something that I, I’ve read that, gosh, dozens of times in my life. And that’s something that will always motivate me when I’m struggling, you know, to, to understand what what he went through and how he was able to, to still carry on with a positive mindset is really remarkable. So that, that’s my favorite book. I’d say two other books that have really influenced me are The Infinite Game by Simon Sinek. I dunno if you’ve had the chance to read that.

Monica (37:09):

I haven’t. But I love Simon Sinek, so I’m a, I’m a fan. I don’t know why I haven’t read that one yet. And I’ve heard about it from Gabe Charbonneau, MD who was a previous guest. I know he’s a fan of that book as well. So tell us a little bit about that.

Sue (37:23):

Yeah, so it’s so a finite game is a game that there is an end. So, you know, at the end of four quarters or nine innings, the team with the highest score wins. So it’s a game that can be won. And the infinite game is really the pursuit of like a just cause. So committing to a vision, so like the work that you’re doing with the new future of work yeah, you’re committing to a vision of what that, that future looks like. That’s what the goal is and Right. You’re never gonna really reach that goal. Right. But that’s okay. That’s, you know, it’s infinite. And so it’s really working day after day, week after week, month after month to, to really make progress towards that, that infinite goal. And a lot of times when you do that it’s focused on what that causes, what that vision is rather than, than winning.

Sue (38:32):

Wow. When I first started cHOP, that’s our center here mm-hmm. <Affirmative> we our mission was actually very different than it is now. And a lot of it was about gaining recognition and it was sort of traditional academic missions. And I just kept saying, there’s, this just doesn’t feel right. This is not what our mission is. And we evolved our mission to, to what it is now, which is really helping people thrive, excel for the goal of making the organization better. Because when we do that, we’re going to make life better for patients for our community. And so that’s, that’s kind of the premise of the Infinite Game by Simon Sinek. Definitely worth reading.

Monica (39:33):

I love that because often we’re challenged to create a goal and then figure out every single step that it’s gonna take to get there. But I think a lot of times when you do that, you’re not really thinking big enough. Like I always say, if you know all the steps to get there, you’re not thinking big enough. So mm-hmm. <Affirmative>. Yeah. I’m never to read that book, but I also, I love the mission for your organization and I love the term Thrive and I actually use that in some of some of my materials as well, cuz that’s just so far beyond what we think about in the workplace. You know, we, we just haven’t really used that term in the past. And yeah, I think that’s interesting when you look at the statistics about how so many employees are disengaged and now we have this whole thing that’s been in the news lately about silent quitting, where employees are just doing the bare minimum. And one in, one in only one in four employees, I think was this statistic that actually feel like their organization cares about them. So three quarters of us don’t feel like our organization cares about us, so, Right. It’s really hard to do a good job when you’re going to work at a place that feels like that, but with that mission of helping employees thrive that just seems like it could be a game changer.

Sue (40:55):

Right. That again, that’s kind of the infinite mindset. Yeah. You hear a lot about zero burnout being the goal, and I think that’s so shortsighted. Again, that’s finite mindset. Yeah. So we can get to zero burnout, who cares? You know, what, what does that really accomplish? Do we know that that helps people to, to really be able to meet their full potential? You know? Right. It’s, it’s part of it, but it’s not the entirety of it.

Monica (41:23):

Yeah, absolutely. And, and I think if people are thriving at the workplace, it’s gonna have this ripple effect because then when they go home, they’re not gonna be cranky and mm-hmm. <Affirmative> short with their kids and their husband and just, and their neighbors and their community and it just, it ripples out if you’re, if you’re thriving and you know, really feeling like you’re doing well in the workplace.

Sue (41:48):

Right, right.

Monica (41:51):

Awesome. Well, what is one kind of key takeaway from our discussion that you wanna make sure our listeners leave with from today? I know we’ve covered a lot of ground, but

Sue (42:05):

I’d like to circle back to trying to challenge people to make wellbeing the goal. Yeah. Whatever that looks like. And as part of wellbeing being the goal is to start with yourself.

Monica (42:24):

Yeah. I love that. It seems so simple, but like you said, a lot of us are, are saying that message, but then living it is a whole other thing. So if we can really prioritize our own wellbeing and the wellbeing of our organizations, we’re really gonna create a shift out there.

Sue (42:40):

Definitely.

Monica (42:42):

So where can our listeners find you? Do you have organizational website or social media or anything like that that I can share in the show notes?

Sue (42:54):

The IUS website, we, we have. Okay. But Perfect. And I can send that to you. I am on Twitter. My Twitter handle is at @SusanHingle. Okay. And then I’m on Facebook and Instagram at @SusanThompsonHingle.

Monica (43:20):

Okay. Awesome. I’m a Twitter user too from, from the early days and I’ve been using it more lately as well. So I’ll have to connect with you there too.

Sue (43:29):

Yeah, definitely. I’d love to.

Monica (43:31):

Awesome, Sue. Well, thank you. Yeah.

Sue (43:32):

That was how, that was how I met Gabe was through Twitter.

Monica (43:35):

Yeah. He’s done an amazing job of connecting kind of like-minded physicians that are, are trying to create a more human-centric healthcare system and yeah. One where we can all thrive, so,

Sue (43:51):

Yeah.

Monica (43:51):

Yeah. Good work. Awesome, Sue. Well thank you so much for joining me today. I really appreciate it and I know our listeners will enjoy it too. So

Sue (44:01):

Thank you so much for having me, and again, thanks for doing this important work yourself.

Monica (44:07):

Thank you.

Filed Under: Future of Work, Healthcare Tagged With: Center for Human & Organizational Potential, culture, development, doctor, healthcare, medicine, medicne, physician, residency, training, work, workplace

Making Primary Care a Great Place to Work & Overcoming Burnout with Gabe Charbonneau, MD – The New Future of Work Podcast, Episode 1

2022-11-11 By Monica Bourgeau, MS Leave a Comment

Listen on: APPLE PODCASTS | SPOTIFY

Gabe Charbonneau, MD on The New Future of Work (TM) Podcast

I’m excited to launch the first episode of The New Future of Work (TM) Podcast with a very special guest, Dr. Gabe Charbonneau. Gabe is a rural family physician and high-tech entrepreneur. He is a founder of Medicine Forward and the co-founder of Fluent Systems, an EHR automation software company. He serves as EHR faculty at Practicing Excellence and has been a physician advisor to the AI scribe companies, Tenor and Saykara. He is also the passionate creator of the #FightBurnout movement on social media, and FightBurnout.org. Gabe lives and practices in Stevensville, Montana.

We had a wonderful discussion, here a few of my favorite comments:

“You’re not allowed to complain about a broken system if you’re not willing to do anything about it. We all need to realize that we can’t sit still and wait for someone else to fix it anymore. So get out of your seat and get involved in something.”

“When you start showing up, you find where you fit and and where you can help, and can hopefully be a voice for good and improving things.”

“I’m an accomplice in a broken healthcare system, fighting to transform it.”

During the show, we referenced two organizations, Buurtzorg, the home health company based in The Netherlands that operates from a very different model, and Orchid Health which is a group of Rural Health Clinics in Oregon that is structured around four pillars, the first of which is their people.

Gabe also referenced BurnoutIndex.org, a tool for measuring burnout.

You can contact Gabe on Twitter @GabrielDane, or visit his organization’s websites at www.MedicineForward.org and www.FightBurnout.org.

Listen and subscribe on Apple Podcasts, Spotify and wherever you usually find your podcasts.

Listen on: APPLE PODCASTS | SPOTIFY

***

Show Transcript (Transcribed using AI – please excuse any errors):

Monica (00:04):

Thank you so much for joining us here today. I’m really excited to have a very special guest. Dr. Gabe Charbonneau is a rural family physician and high-tech entrepreneur. He’s the co-founder of Fluent Systems, which is an EHR automation software company, and he serves as faculty at Practicing Excellence. He’s also been a physician advisor to the AI scribe companies Tenor and Saykara, and he’s passionate about fighting burnout and actually created a movement on social media at fightburnout.org. Gabe lives in practices in Stevensville, Montana. So Gabe, thank you so much for being with us here today. I’m really excited to talk to you about the new future of work and what you’re seeing in the healthcare industry today. As we get started, maybe we could just start off by having you tell us a little bit about your story and how you got started.

Gabe (01:03):

Yes. Thank you so much for having me Monica. It’s, it’s really fun to do a podcast with such a good friend and someone who I look up to so much as a positive force in this world of trying to make things better for everybody. So yeah, I’m a family doctor in Stevensville Montana, and I usually start my story at the beginning of my doctor journey. So the first time that I realized I was interested in medicine happened when I was about six years old and I had this rash on my body that neither I or my mom knew what it was. And she took me to our local family doctor and he had exactly the things that I needed for care. I mean, he was gentle and kind but he also knew what he was doing and immediately put me and my mom at ease, quickly named what it was that I had, which was not a serious thing at all.

Gabe (02:07):

It was Maluma, which is a super common childhood rash. But the way that he cared for me left this indelible mark of, oh, there’s something special going on here. And it took me a while to realize that that was one of the big things that really imprinted on me about why I became interested in medicine. Reflecting on where we are today and, and what I would like to see more of it really was that whole package of his, his humanity and the way that he cared for me. And there were, there were no distractions in the way, there was no computer in the room at that time. There were no misaligned incentives trying to get him to do something other than just take care of me and my mom. And that’s become more and more clear about how special and important that is. And so has really become part of my guiding what guides me to want to fight for. And also a lot of other people too, are realizing that, Hey, that that’s a super important part. This relationship, the human doctor, patient relationship is such a precious part of what we do. And so, so that was the beginning. And then I went to, oh, did you

Monica (03:27):

I was gonna say, I love that story and I could totally see you bringing that type of, kind of warmth and caring and energy into the work that you do with patients. And also the work that you’re doing now at medicine forward. So go ahead and continue with your story.

Gabe (03:45):

Okay. Yeah, yeah. So it, it is so, so fast forward. So I went to medical school in Utah and then residency in Spokane and then worked in this community health clinic in Spokane for a few years after graduating. And, and that experience was really hard. I experienced burnout, I would say for the first time in, in that job back then, I didn’t have the word for it. Burnout wasn’t talked about so much, but it definitely was burnout. My wife and I actually both practiced there and she and I felt like it was just total survival most of the time. And then I guess the other thing is, is that I have always been a computer person. And so in that job, I was always trying to figure out things that might make it a little bit better.

Gabe (04:34):

So even then I started tinkering with stuff that might make our, our back then web based, very slow EMR work, a little better. And so I, I played around with some macro software and text expansion and built all the shortcuts I could trying to make this impossible job doable. And, and then then we moved to Montana, which is where, where I am now. And then we had the big go live with the major EHRs. And I met a fellow physician that was our partner in the clinic and he, and I hit it off quickly. And we’re, we’re both sort of these people interested in being problem solvers when you were presented with a big challenge. And we came at it from slightly different angles, but we challenged each other to build tools, sort of like the ones I made in my first job that would make things better. And so we just, we, we jumped right into making a lot of macros and eventually made a company that was all about macros for doctors, like basically add on software to the EHR where you could add buttons to the interface that would do whole series of things that were more like how a, how a physician would intuitively think. Because I’m so I’m sure you’ve heard, there’s nothing intuitive about the EHR. Not

Monica (05:53):

At all.

Gabe (05:53):

So, yeah. And that was, that was a lot of learning. One of the things that I learned is that that you can, you can build a product that you think solves the problems, but you, but getting it to be implemented and interface with the healthcare system is a whole other challenge. So we built this, this very custom thing that a lot of doctors loved, but we couldn’t figure out actually how to get it to, to fit inside of healthcare systems so that it could get any kind of significant traction. And then I took a little bit of a, as I was still interested in how technology could maybe make things more human. And I got interested in the voice AI idea, and that’s how I got into working with tenor. And then also S the, the way that I got into the fight burnout stuff was actually that I kept running into similar and similar problems that it was like okay, why is it so hard to fix things and, and improve it?

Gabe (06:56):

Yeah. And what the, what the thing that came to me was that I don’t really have the answers, but what I know for sure is I’ve met a lot of really wonderful people inside of medicine and healthcare who are very motivated to create this better world. And we don’t quite know how to do it. So I made this t-shirt that I know you’ve seen that the design is the design is a Phoenix raising the rod of medicine out of the flames, as a symbolism for that, as people we can overcome hard challenges because it, it, you know, if we don’t know how to technically do it today, it doesn’t mean that we’re not gonna figure it out. How many times in history have people had incredible challenges that it seemed like there was no way to solve it.

Gabe (07:41):

And then the right circumstance happen, you get the right people together and, and amazing things happen. And I just, I, I have to believe that that’s possible for getting unstuck in healthcare as well. And that led me to getting involved with some other, other friends through that project. Yeah. I started giving that shirt out to people that I thought were doing inspiring work and got connected with Eric Topol and a few other interesting leaders in medicine. And there was this interest in creating a new doctor’s organization that was really about standing up for the human doctor patient relationship. So that’s been a huge part of my volunteer work for the last three years. And I think that’s part of what we’re gonna talk about today.

Monica (08:26):

Yeah. So that’s medicine forward that you’re referencing there at the end, and yes. You have such a fascinating journey and we actually connected a number of years ago at the time when you were developing the EHR interfaces. And you participated in a rural medicine hackathon that I helped to organize. And so you’ve been doing innovation and kind of testing out new things for a long time in the healthcare system.

Gabe (08:53):

Yes. And I have to say thank you to you for, for doing that because when we were first starting out trying to create software, I had never created a company or really built any significant technology. I played around a lot. We made an iPhone game about diabetes with, with our son, but I had never made anything that I thought could be like a serious commercial software thing that might be disruptive of like, you know, the current ways of doing stuff. And you brought MIT to Missoula. And I was like, okay, I have to go to that. <Laugh> what is that?

Monica (09:25):

Everyone thought I was crazy <laugh>

Gabe (09:27):

I did not think you were crazy. I was like, there are not that many things where I just have to like clear my schedule and make sure I go to that. Not even knowing for sure what it’s all about, cuz I’d never been to a hackathon before, but I just knew that the energy of this was like something that was worth paying attention to, and it was totally it was to totally amazing. I mean we could go into some of the things that I really loved about that, but the, just the, the creativity of people and the some of the things that I learned about how you could get groups to work together and sort of organically create ideas and then sort of work through those and, and, and bring, you know, people from a place like MIT, where they’re on the leading edge of technology to like our little Montana to talk about it and try and help us. I just thought was so cool.

Monica (10:16):

That was amazing experience. One of the things that I think is so interesting is bringing together kind of the diverse perspectives from different fields to try to solve kind of a shared problem. So I’m really glad you were able to participate in that with me, and I’m glad we were able to get connected. But one thing that really kind of stood out to me about your story is talking about experiencing burnout in your career in actually when you were in your residency kind of early on, is that something that’s pretty typical of physicians during their training and or practice that you see?

Gabe (10:57):

Yeah. Well, okay. So I will give the best answer to this that I can I, I don’t think there’s anyone who goes through residency and thinks that it’s that’s easy. It’s, it’s usually one of the crucibles of life. It’s one of the hardest things that you go through. I think for a long time, people really knew what to expect with residency. And so there wasn’t necessarily a mismatch between your expectations and, and what it was. It was like, okay, there are gonna be these long hours and it’s gonna be grueling and I’m gonna sleep at the hospital a lot. And I’m gonna be challenged in ways that are beyond my comfort zone, but like other people have gone before me and done this and, you know, I’ve made it this far. I probably can do it. Yeah. And so, so the it’s not that there has never been burnout, but I think one of the things that’s come up is that burnout often happens when there’s a mismatch between people’s expectations and what happens.

Gabe (11:54):

Interesting. And yeah, and I think more and more since I’ve graduated and moved on, I been hearing about elevated levels of burnout throughout the entire education spectrum, even from the beginnings of medical school. One of my friends did a, did a research study on medical student burnout. He was really inspired to do that because he lost a, a friend who died by suicide and found really compelling information about that in medical school, burnout is already a huge problem. And some of the some of the things that seem to be linked to that in drivers and the we’re just in a really weird time right now. I mean, in some ways we have made so much technological progress, but in other ways we’ve got like, mm-hmm, <affirmative> lots of layers of bureaucracy and things that aren’t really about doing your work and do create that mismatch between your expectations of what you should be doing versus what you’re actually find yourself doing.

Gabe (12:53):

So as an example some of, some of my doctor, friends who are a little bit older or retired say that they don’t remember burnout being as much of a problem when they went through training, but they went through well before there was any kind of work hour restrictions. So it was like, you know, it’s not just like how hard people are working, not saying that, that means that was a good idea. Yeah. But just that, like, you know, the, the, the level of burnout has actually risen and it’s not entirely about how much we’re working. That’s a factor, but it’s not the whole story.

Monica (13:27):

That’s fascinating. Well, when you think about your kind of origin story about going to your family practice doctor and having that one-on-one encounter, that was so meaningful healthcare has kind of come a long way from that time in healthcare. And, you know, do you get to have those kind of moments in your practice today still?

Gabe (13:49):

Yes. And I have to work hard to intentionally see if I can make that happen more often. I’m on the same treadmill everybody else is. So I, I work at a large hospital system and I, you know, I think we do it as well as anyone’s doing right now in our current system, but I am on a treadmill of production and have short amounts of time for visits and lots of requirements of boxes that need to be checked for every visit that are driven by the incentives. And we can’t seem to figure out how to, how to change that. I do a few things on purpose that I think, give me more time to connect. So, and back to an earlier part of the story, so like the voice AI we’ve been piloting yeah.

Gabe (14:38):

Voice AI software. We’re now on our two, our second version of that, with the idea that instead of spending time typing in the exam room, you can just have a natural conversation and that all gets captured and then transcribed and structured into your, into your notes. And that actually, that has been really helpful. I, I made a rule for myself pretty early on with the EMR that I was only gonna use the computer in the exam room. If it actually like made me a better doctor and that I wasn’t gonna turn it on as the first thing or log into it as the first thing that I did so interesting. So even though you’ve got limited time, I, I walk in and the first thing is about, is about connecting and making eye contact and trying to trying to ask a question about how someone is doing, and then not interrupt right away, which there’s, you know, you probably know the research that doctors are horrible at this. Like we <laugh>, we can’t wait to jump in and say something <laugh>

Monica (15:36):

So get to the problem so I can

Gabe (15:37):

Fix it. Yeah. But also the, the flip side of that is that if you let people just speak, they often tell you important clues to their story and what’s going on. That helps you find what you need to do most to, to, to help them medically at that visit. And so it’s, it doesn’t help you to interrupt <laugh>. So anyway, those things, and then I have to give a shout out to the team that I work with is outstanding. I mean, beyond remarkable in terms of the ways that they help me to, so that I’m not the one doing a lot of the one of the movements that I love, the name of is get rid of stupid stuff. Oh, my nursing team does a lot of stupid stuff for me. Wow. But I know that a lot of people don’t have that that privilege. And so I feel a little bit guilty, but also very lucky.

Monica (16:27):

Yeah. I’m sure that makes a huge difference because and it sounds like you’ve been able to kind of cope with working in healthcare still, even with all of the challenges with the pandemic and mm-hmm <affirmative> other physicians are experiencing burnout, that sort of thing. One of the things I wanted to ask you about was a study that I read from the AMA recently about what they’ve learned about COVID burnout and the doctor shortage. And they’re talking about more than 3,200, almost 3,300 physicians have left healthcare and left the workforce in just the past couple of years. And what they’re finding is that employees in general are a little bit slow at returning to the workforce post pandemic, especially in healthcare, but doctors specifically have been very slow the ones that have left to return to the workforce. So why do you think that is you think that’s the kind of the bureaucracy that you mentioned and, and the difference in those expectations or what are the factors?

Gabe (17:30):

Yes. Well, okay. So, I mean, this is I, I am not an expert on this, but I can tell you what my experience is. And also friends of mine and, and what they describe. And I, and you know, that my wife is also a family doctor. So we have lots of conversations about these things. The, the, the practice, especially of primary care was unsustainable even before the pandemic happened. And so I just got done telling you the things that I do to try and stand up for a little bit of humanity, but I’m, I can’t say that my job is easy or that there aren’t times when I still actually get some burnout symptoms myself, in fact, I track it <laugh> every Thursday I do a burnout survey and I’ve been doing that off and on for a few years.

Gabe (18:17):

And because once I got interested in burnout, I’m like, you gotta, you have to learn about this, right? Like, what are, what, what can I learn? And I’m sort of a learn by doing person. That was how the, like, building software thing happened too. And I found that like, burnout is not a static thing. There’s a lot that affects burnout. So this last week I had very low levels of burnout and part of it, I can name a few things that made a difference. Mm-Hmm, <affirmative> things were going smoothly in our clinic. We don’t have any major kind of disruptors of kind of what’s going, like, sometimes there’ll be a big tidal wave of challenges that just make everything hard. And we’re, we’re all stressed all at once, all understaffed. But we had, we had our regular staff we didn’t have any major fires happening and no, like existential threats that we might not be able to stay open.

Gabe (19:07):

<Laugh> like, those are all huge things. Yeah. And also it’s summer, and it’s beautiful and I’ve been riding my bike to work, and that actually has had a protective effect for me. And then the other thing that I haven’t brought up is I, I work part-time and have for the last 12 years. So I worked three days a week instead of four days a week. We started doing that when our youngest son was born and I, I never went back and I just, I wanna highlight that, like, you know, this exit, like for, so I talked about the expectation mismatch, but the other thing is like, if you think of burnout as like you, you’re a human battery of sorts. Yeah. And as you do this work and it’s really grinding on you, and there’s all these challenges layered on top of challenges, it like drains the battery and it keeps draining the battery.

Gabe (19:56):

And if you get too much drainage of the battery without enough recharging of the battery, that’s when, like you don’t come back from the burnout. And I think that’s what COVID and all these other social stressors have really done is like, mm-hmm <affirmative>. So doctors have been these people that are used to just like pushing ourselves really hard and yeah. You know, through all kinds of crazy stuff, medical school, residency, overnight shifts for too many hours, you know, <laugh> not going to the bathroom when you need to all this stuff. Yeah. But like, at some point you just can’t push yourself beyond anymore. And that, and, and you know, not all the, not all the challenges with COVID have been that it’s been more hours. Some of it has been that it’s emotionally, hugely challenging. You know, people who have philosophical or political beliefs that are like making it hard to care for, for them right.

Gabe (20:47):

Or for your community. And like, you know, so you show up to try and help people. And the first thing that you have to do is actually like deescalate someone, who’s throwing a temper tantrum in your waiting room because they don’t want to wear a mask. And it’s like, traumatizing your front desk. Who’s trying to help you. Yeah. Right. Those kinds of those kinds of things. And it’s, you know, it’s just like when society has all these pressures going on, on top of this already, like pressure cooker, right. Or battery that’s running on empty. Like you just, it does not surprise me about that. The exit and people not wanting to come back. Another thing is doctors are smart people and, and we’re waking up and realizing like, well, I’m pretty smart. And that person over there, like isn’t necessarily smarter or hard, harder working than me in this other industry. Why am I putting myself through this again? I mean, I do care about people, but this is crazy.

Monica (21:40):

Yeah. At some point the personal cost for what they’re doing is, is too high. So a couple questions come to mind. One is I was curious and I’m thinking our listeners might be curious too, about what type of burnout survey do you take every week? And that sounds like an amazing practice, cuz I’m one, that’s also suffered from burnout a few times in my career and it kind of sneaks up on you if you’re not paying attention and then, then it’s hard to come back from it.

Gabe (22:08):

Yeah. Well I’ve so I’ve tried a lot of ’em I’ve done the, the Maslak index, which is sort of the gold standard that one you have to pay for a copy of it and score it by hand. There are a few things that will sort of automate that for you, but I, yeah. It was a little bit too much work for me and didn’t also provide an easy way to track it. So I, so I’ve done that a few times, but then I, then I started playing with things that might be simpler. Mm-Hmm <affirmative> there’s a mini Z burnout thing that, that that’s easy and has a lot less questions. But the thing that I discovered, which is was actually not created for healthcare it started us, this website, burnoutindex.org, and it was actually for the it industry and it’s this little startup in Brazil called Yerbo.

Gabe (22:59):

And I just loved how simple they made it and they made a lot of their things that they put together, very evidence based. And it didn’t seem like it mattered that I wasn’t in the it industry, I just sort of ignored that question because the results seemed to be very like they were, they, they weren’t occupation specific. They, you know, that was just their target sort of customer. And so I still use that and they have a little slack plugin that pings me whatever day of the week you want it pings me and asks me these questions. And then it creates this graph over time of my burnout risk and also my level of engagement at work. And then I just reflect on that.

Monica (23:41):

Wow. That’s awesome. I’ll make sure to share that link in the comments below the show, but what a great resource. And one other question that kind of came to mind as you were talking too, is with the physicians leaving, there’s gotta be even more of a shortage. We were already facing kind of a physician and medical staff shortage prior to the pandemic, but now with even more physicians leaving, that’s gotta increase the burnout. And just kind of the, the stress on the providers that remain. Are you starting to see some of that as well?

Gabe (24:16):

Yes. And that, that trend is really alarming and, and as far as like common interest that you and I have of, of sort of future thinking and how can we, how can we, co-create a better future, right. I have become obsessed with how can you make primary care, a great place to work? Because to me there’s an overwhelming amount of evidence that yeah. That thriving primary care is actually a, a huge foundational component of a well-functioning healthcare system across the wor world. There’s lots of data to back that up. Yeah. That that primary care doctors being around improves people’s health and reduces all kinds of things. We don’t want like hospital admissions, if there’s enough of us. And and, and, and I mean, that’s my, I know I’m biased because that’s what I chose to do. Yeah.

Gabe (25:08):

But I chose to do that because I believed it had the potential for this widespread impact at the local level and, and our communities need great primary care physicians. And so yes, I’m, I’m alarmed by that trend. And also, I think we’ve gotta channel that energy into saying like, how can we deconstruct this broken primary care workplace and rebuild something that actually works? I, I don’t think that’s impossible. In fact, you and I both know someone very well in, in rural Oregon, who’s, who’s been working on that Orion and orchid health. And that still is one of the highlights for me. In fact, I have talked to multiple people in Montana about like, what would it take to get this modeled going here? That includes insurance and starting to talk to the Montana medical association and people in the business world and even just, you know, sort of surveying my friends who practice about like, would you be interested in this and what would need to happen for it to take place? And really the core of Orchid as far as what I figured out is that they put their money where their mouth is for putting wellbeing as the first priority. Not the second, not the third, not the fourth. The number one priority is people’s wellbeing. And absolutely, I, I think that, that, that is the future that we need to fight for where human, human, flourishing human wellbeing is our top priority. And the other things can only happen if we are getting that right.

Monica (26:42):

I love that. And I loved how you posed the question about how can we make primary care, basically a great place to be. Because I think that so many healthcare administrators are going about it the wrong way. Like, I hear a lot of questions, like, how do we recruit, or how do we retain employees those types of questions. But instead of asking those kind of questions, they should be asking, how do we become a desirable place to see how do we become a workplace where our employees can thrive and serve our patients and where they want to work? So I think taking that, you know, kind of flipping the question really helps come up with the right answers. And yes, you know, some earlier in my career, one of my roles was leading a national transforming clinical practices initiative where we really focused on primary care. So, you know, even healthcare payers know the importance of primary care because that’s where everything starts wellness and prevention and keeping people healthy and keeping people out of the emergency room. So it seems like there’d be a lot of incentives to make this happen. You know, that there’s a lot of alignment.

Gabe (27:55):

Absolutely. And I think it’s, it’s interesting that the, the, the story that you just shared about kind of people’s questions that they want to ask versus asking different or better questions and yeah. And, and one thing that Orion had that I think is really important and special, and maybe why this hasn’t bubbled up other places is he was 21 years old when he started a primary care company and had no background in healthcare. He truly had beginner’s mind. Yeah. Like we’re all looking at it from the perspective of like what it already is and all the rules and constraints of what we think it has to be. Right. And he started this thing with the question of like, well, this is a huge problem. And I want to create a social business to make a big difference. And so everything was on the table and we’ve gotta start looking at stuff like everything is on the table.

Gabe (28:43):

And yeah, and we’re not, we’re not doing that yet. I have a few other thoughts I wanna make sure to, to get in, get in there. So a trend you talked about the trend of like people leaving primary care. Yeah. Back to burnout. One of the, one of the trends has been consolidation where lots of people are going from private practice to being employed mm-hmm <affirmative>, and that is not unrelated to burnout. So more and more studies show that private practices are much more likely to have lower levels of burnout and, and a huge factor. There is the level of control or voice that you have in, in your practice. Right. And so I, the way that I see it, we either need to shift incentives. So it becomes reasonable again, to have small private practices, because a lot of doctors choose medicine because we want to have autonomy.

Gabe (29:28):

Yeah. We want to be able to lead. We want to be able to right. Be in charge of something. Cool. and that’s not happening a lot of times in our, in our big systems or our big systems have to like start dismantling the hierarchy that says that, like, all the stuff comes from the top and you people who are like in the bottom, just do what you’re told and make widgets all day and right. We’re not listening to you enough. So, so my feeling is in the near term, it’s gonna be upstarts like orchid that create, if you can create a better workplace that people are gonna notice and say, Hey, I’m gonna go work there because I’m not gonna get burned out every day. If you don’t get paid less, they actually pay at the higher end of, for community health centers on purpose.

Gabe (30:15):

So it’s not like lower pay for like the same kind of a clinic would be where they are. And, and you can have wellbeing baked into the operating system of the place that you work as the top priority. Like, I mean, once that starts happening, who’s not gonna leave the incumbents and go work there. And so the choices are either that like big hospital systems are just gonna throw up their hands and say, we’re gonna let other people take over primary care, cuz clearly like they’re able to solve this and we’re not, or they’re gonna have to make some of those changes. Those fundamental changes that haven’t happened yet.

Monica (30:50):

I agree completely. I think more and more people in general are looking for more work life balance, you know the pandemic did change a lot of things for us because we were able to spend more time with our families and see how life could be if we weren’t, you know, constantly going places and doing things. And yeah, so that there seems to be a trend toward people wanting more and more of that work life balance, including physicians and wanting to really be able to be more involved in the process and not just being, like you mentioned, producing widgets and a hug on the wheel. And one of the factors has to be, you know, this week we were sharing some articles back and forth and one of those articles showed the trajectory an increase of administrators compared to physicians over the last 20 years. And I’ll, I’ll share a link to it in the comments, but essentially the number of administrators in healthcare has just exploded while the number of physicians has remained pretty consistent. And so you have this huge layer of administration over this small layer of physicians. Yeah. And it’s just continuing to grow. I think it was something like 10 administrators to every one physician, something like that. Yeah,

Gabe (32:07):

Yeah. Right. And it, and it, it just, I mean, if it, if it continues the way that it’s going, it really highlights where some of the incentives must be mismatched because yeah, because here we have this healthcare system that in so many ways isn’t working, it’s very expensive compared to the outcomes that we get. And we’ve got more and more bureaucracy who are people who are, and this is where I wanna choose my words carefully because a lot of, I love a lot of the administrators that I know. Yeah, sure. But they don’t, they don’t directly provide care. And so that’s, that’s one problem. And also they have this power over dynamic. And so it’s not, they’re not equals, there’s not the people who are the clinical teams, the doctors, the nurse practitioners, PAs nurses, front desk don’t really have a real seat at the table. And so there’s these, these kind of structural incentives that are like really, really making it difficult for people right now. And that’s some of what I would like to help unpack back to what I think is interesting about Orchid. I ask, I ask this question of like, well, how do you guys, how do you guys pay the bills? And one of Orion’s answers is we’re, we’re very light on administration. Well, how do you, how do you do that? Yeah. <Laugh>

Monica (33:29):

Yeah,

Gabe (33:29):

Right. Like, so they I mean, they’re, they’re relatively small at this point, like four clinics, but they, I mean, they get all their administrative work done. Part of it is, is that they, they don’t have so much like absolute, like what people’s roles, roles are or titles, I guess they’ve got, they’ve got roles and he’s gonna be better at describing the language, but, you know, they, they figured out a way to not create this administrative bloat because one of their priorities is they they’ve got to, in addition to caring about wellbeing, be financially sustainable. And so when you try and mash those things together, you’ve gotta get creative.

Monica (34:06):

Yeah. I’m sure that that’s the major factor. And as a result, I think that it gives opportunity for the clinical staff to be more involved in the leadership and development as well, which also has gotta seem like it would help increase job satisfaction if you’ve got a role in helping to create what’s gonna happen versus, you know, the top down model of being told, this is how we’re gonna do it type of, well,

Gabe (34:31):

One of the, one of the radical ideas that Orion and I came up with is and this might sound crazy, but I think you’ve gotta sometimes have wild and crazy ideas when you’re talking about future thinking and moonshot thinking is to get rid of the concept of having an administrator at all. Yeah. As in, like, there are no administrators and and this, and I’ll explain what I mean by that, but that you change it from there being clinical teams and administrative teams and all these power dynamics power over versus being on the same team, working for the same kinds of goals and administration in bureaucracy become service to care. So we came up with this concept of administration as a service. And so, wow. No one is an administrator. Yeah. You could have a healthcare organization that has zero administrators.

Gabe (35:19):

Yeah. So you, all of a sudden, like that changes the whole dynamic of how people interact. And so then you have the care delivery team, but then we also were getting kind of having fun with it and thinking like, well then the people that do things like billing, or, you know, figuring out this or that sort of logistic thing of how the business works called that maybe like the care enabling team, but there like the language change changes the intention of the whole thing. And like putting us aligned that we’re working towards the same things rather than like, you know, there’s the, this team and this team and they actually are fighting a lot and therefore not getting anything done sounds like Congress <laugh>

Monica (35:57):

Right. Well, I love that suggestion and I could totally see healthcare moving in that direction. And what you’re talking about has some resemblance to the BOR model mm-hmm <affirmative> in the Netherlands, BOR is a, a home health agency that was developed around these kind of self-managing teams. And I don’t know if it’s structured in the way you’re, you’re talking about, but the administrative kind of support role. But it, it sounds very similar.

Gabe (36:28):

Yeah. I, I know, and I, I share that interest in Buurtzorg too, and I hope that people who don’t know about them will, will definitely check it out. I just think there’s so much to be learned from these like interesting organizations doing things differently in other, other parts of the world. And Buurtzorg has just come up in so many different books we’ve shared and read over the past few years as like this super cool different model that is all about empowering people. Yeah, so like care teams sort of autonomously form in local areas to meet and need. And they pull for resources that they need rather than having like a central agency tell ’em like, here’s your standard issue of all the things that you need to get your job done? That’s that’s not at all how it works, which is like, I think so many of us in the states can’t even imagine working <laugh> in a, in a system like that, but it sounds so exciting. Like, I mean, if we could figure out a way to transplant that here and, and try it out, like, I mean, sign me up. I would be a volunteer to, to try it out and pilot it for sure.

Monica (37:32):

Me too. I’ll make sure to put a link to Buurtzorg in the, in the show notes as well. So the Buurtzorg model is really interesting and is certainly one thing we could look at, but one question I have for you is do you think that we’re ever gonna go back to the way things were before the pandemic mm-hmm <affirmative> and if not, what are some things that we can do kind of going forward to make the workplace a little bit better in healthcare?

Gabe (38:01):

<Laugh> great question. So the first thing that I thought of is like, be careful making predictions because we’re almost always wrong

Monica (38:10):

<Laugh>. Yeah, exactly.

Gabe (38:12):

And so this, like, could we go back to the way things were before the pandemic? It seems unlikely. I mean, it, it it’s been a collective trauma. Yeah. And I don’t think people go back to the way things were before, before, after going through a big trauma. So it feels very unlikely to me that things will be the same. Some things are losses. I, I think we’re, you know, it’s like hard things like a grieving process for things that were the way they were before. And now it’s not like that anymore. And I, and so some, some shared grief about those losses sure. Some, some things are like we’re being pushed to, to be innovative and creative and try new things that we wouldn’t have, like all the people that have been able to, to do work from home.

Gabe (39:01):

And I mean, that’s a whole huge conversation about what that means, but yes, it wouldn’t even been possible to try it out before the pandemic. And so we’ve, we’ve really learned to push the envelope on being adaptive and some neat technologies have really emerged as things that like, okay, we we’re gonna, this is something there’s something there that’s worth leaning more into and learning more about. And so well we’re in this time of a lot of stress right now. Yeah. My I’m an optimist by nature. And so that, I don’t, again, I don’t know if you should trust my predictions or if I should even make them, but the world that I want to live in gets better from here. And that we are, you know, we’re in this sort of dark era where there’s a lot of stress and strain.

Gabe (39:56):

Technology’s not living up to its potential. You know, we’ve got social media that like connects us all, but mm-hmm <affirmative> but influence us and polarizes us in all these negative ways. And the business model of it with it being funded by advertising may, may just be bad for our society. But it doesn’t mean that it has to stay that way. I mean, there’s a lot of people that are realizing that that problem exists. Like part of the thing is change has really accelerated, like our rate of like learning change is accelerated. And I actually wanna flip the question back to you because I know you have an interest in spiral dynamics and say, yeah, what, what do you think, hang on my robot vacuum is turning on. I’m gonna stop that.

Monica (40:35):

<Laugh> <laugh> well, I think we’re gonna definitely see more robots in the workplace. So

Gabe (40:41):

<Laugh>, I know that was on, that was on cue. I actually love robot vacuums, by the way, like I’ve, I’ve geeked out on playing around with like what they can and can’t do. And awesome. Yeah. Anyway, but the <laugh> what never been interrupted on a zoom call by that before you the dog or the kids or phone call or the doorbell now it’s the robots.

Monica (41:02):

It was very timely

Gabe (41:03):

<Laugh> it was really time. It was really timely. Yeah, but so I think what I was talking about is how the accelerated rate of change with just how much is happening in society. And we tend to see so much of, like, what’s not working our outdated laws, our polarization, our EHR that is so cumbersome and horrible to use. And we think like, is this it, like, we’ve learned all these things and ended up in this like black hole of <laugh> like nothing can work and it’s just gonna get worse. I, I can’t believe that that

Monica (41:38):

We’re gonna see, I can’t either, but I’m an optimist too.

Gabe (41:41):

<Laugh> yeah. Climate change. I mean, the I’ll, I’ll give an example of things that I didn’t expect. So I just got an e-bike when I was talking about riding a bike to work. So I you know, I’ve known for a long time that fossil fuels are not like gonna be the way that we keep going for transportation, but I wasn’t quite in the market for an electric car, although, and I came out to Oregon. Last time one of our friends had an electric car and of course that was lots of fun. Oh, neat. And it was it was maybe a more affordable model. So I got excited. And then I had another friend in Bozeman who posted on Twitter about how he got this e-bike and he was surprised about how accessible it made, like getting around town. And I was like, I was like, you know, an e-bike is a lot less expensive than an electric car <laugh> oh,

Monica (42:27):

Yeah,

Gabe (42:28):

Yeah. And so I had so much fun sort of learning about them and I got this bike that like you know, I, I, my goal is for this summer and as long as I can to ride it to work which has proved to be like, you know, dabbling in this, like what would a world without transportation with fossil fuels be like, yeah. And also it gets me outside and I’ve been enjoying like getting a little bit more vitamin D and slowing down just a little bit. It’s actually remarkably fast, but slowing down a little bit from being in a car, you’re much more aware of like, yeah, what’s going on around you. And my mood has been boosted from that. So anyways, I sound like I’m a salesperson for e-bike, but the, the point is like, like these ways that you don’t see coming where things might get a little bit better as you’re like, moving on your way to this future.

Monica (43:16):

Yeah. Just tapping into those and being open to doing things in different ways, even outside of the workplace. For sure.

Gabe (43:23):

Yeah.

Monica (43:25):

So Gabe, we’re getting close to our time here, but I do wanna ask you, like, what is one action item that people can take away from this to kinda help reduce burnout in healthcare, but in the workplace in general and make things a little bit better going forward?

Gabe (43:42):

Okay. Well, you, you, I’m sure you know, that I have more than one thing that I’d like to say <laugh>. But, but I, but I think that the thing I’m gonna say that brings it together is to find a group of people. If, if this speaks to you that this is important, find a group of people that’s working on something and get involved. And so you know, the group that I’m involved in are nonprofit medicine forward. Like we, we are working on advocacy right now. Our focus is on prior authorization. It’s like one of the main dysfunctions in our legacy healthcare system. Right. And, but I, I think the thing is, is like, we, we can’t wait for other people to come and fix problems for us. Like it’s, it’s time to get involved in things that speak to you that are important to you.

Gabe (44:30):

And sometimes people say, I, you know, I have doctor friends who will say like, advocacy is not my thing. my job is hard enough to show up and see patients. That’s what I signed up for. And, yeah, I push back at this point and say, you’re not allowed to complain about a broken system if you’re not willing to do anything about it at this point in time. And we all need to realize that, like we’re beyond the, we can’t sit still and, and wait for someone else to fix it anymore. So get out of your seat and get involved in something. And it doesn’t have, I mean, there, there’re simple things like voting, talking to people who are in positions of power and business and politics. And I never thought I would be doing that, but I have found myself just naturally having conversations with people because that’s what happens when you start showing up is that like you, you find where you fit and where you can help hopefully be a voice for, for good and improving things and not letting us stay stuck in a black hole.

Gabe (45:33):

<Laugh>

Monica (45:34):

That is such good advice. And it reminds me, what is the, the kind of tagline on your Twitter account again?

Gabe (45:41):

Oh, <laugh> that I’m an accomplice in a broken healthcare system. Yeah. Inviting to transform it.

Monica (45:47):

<Laugh> exactly. Cause we all are, especially if we’re not gonna, you know, you know, take some type of action and help move things forward, for sure. We’re accomplished

Gabe (45:56):

That’s there. That is there as a reminder to me that as long as I work in this system, that I am in a way and accomplice, and that actually was so freeing once I, once I was able to say that it, it sounds a little sort of weird at first to some people I think, but it’s totally true. I am, I am part of the problem. Not intentionally, but I, I, you know, I show up and contribute. We

Monica (46:19):

Are

Gabe (46:20):

<Laugh>. Yeah. Yeah. And I, and I don’t want to keep doing that.

Monica (46:24):

We have to choose to be part of the solution, I think.

Gabe (46:27):

Yes, absolutely.

Monica (46:28):

So, so speaking of your Twitter, Gabe, where can we connect with you online, your Twitter and website and those types of things?

Gabe (46:37):

So the place where I really want people to connect is medicine.org. Great. I, we have a, a free newsletter for anyone, whether doctors or anyone, even outside of healthcare, who’s interested in this can subscribe and can see what’s going on with our organization. And one of the things as it, as it’s meant to be a conversation. So if you have something to say about these things, you can reply to the newsletter and we’re small enough at this point in time that you’re, you’re, you’re gonna be heard and you might be responded to, or brought into the group if you’d like to get involved. So that would be the first place on Twitter. It’s at Gabriel Dane, like a great Dane. And yeah, I that’s the place I’m most active on social media and then fight burnout.org. If you wanna see the t-shirts that we were talking about earlier.

Monica (47:30):

Great. And can people still get the t-shirts? Are they available?

Gabe (47:33):

You can order them there’s a link to get them from Teespring, they’ll print one up and ship it to you. And proceeds are actually donated to Medicine Forward for the nonprofit work and advocacy. And the other thing is I still periodically will send them to someone if I think they’re doing something really inspiring. So that’s my challenge to someone listening to this is like, do something that knocks my socks off about burnout and you’ll for sure get a shirt.

Monica (48:01):

Oh, I love that. That’s a great challenge. So. All right. Well, thank you so much for being with us here today and I’ll, I’ll post those links in the comments below as well. So thanks Gabe, and keep, keep doing what you’re doing.

Gabe (48:16):

<Laugh> thank you, Monica. I, it was a lot of fun and it was great to catch up,

Monica (48:21):

Talk to you soon.

Filed Under: Healthcare, The New Future of Work Podcast Tagged With: burnout, culture, doctor, Gabe Charbonneau, healthcare, medicine, overcoming, physician, primary care, residency, work, workplace

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The New Future of Work Podcast

Latest Podcast Episodes:

The Exhaustion Gap for Women in the Workplace with Kayla Osterhoff, The New Future of Work Podcast, Episode 7

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