Amanda: Hi guys. Welcome back to the podcast. I am Amanda.
Laura: I'm Laura.
Kendra: And I'm Kendra.
Amanda: And today before we get started, I wanted to share another podcast review. Listen, it is as annoying to myself as to you all, but we're gonna keep on asking until we get to 500 reviews so that more doctors can find us. If you scroll down right now and underneath the podcast, if you will just go ahead and hit five stars. When we get to 500, you will never have to hear me ask for this again. But in the meantime, I'm going to share a review that we got from Teresa737 that like, it just was the nicest. So it says, “okay, quit reading reviews and start listening to these amazing physicians. This podcast has been a godsend. This podcast has let me know I'm not alone and feeling tired and frustrated with practicing medicine. They deliver practical suggestions to deal with this in real life. These women are smart, relatable, funny, and insightful. You can tell they care about caring for healers. I've learned so much from them. Do yourself a favor and give them a listen”. Thank you so much, Teresa. And we know a Teresa, so I don't know if it's the same Teresa, but if it is, thank you so much. It's just amazing that somebody's even listening. And then if we can help somebody that is, that is the creme de la creme. This episode, I'm excited because we have Dr. Tonya Caylor. She is joining us to talk about coaching and residency programs. We run into Tonya at our yearly coaching conferences and thought it might be fun to share things she's doing to give us all hope for the future in medicine. Listen, we hear from a lot of you residents that the plan is just to make your money, pay your student loans back and get out. I just want to give hope to everybody out there. There is a tiny army of coaches that are starting to infiltrate the system and starting to really try and change the culture of medicine. And Tonya is one of these people. She's a family physician by trade and started Joy in Family Medicine coaching services in 2020. She's a certified life and trauma informed coach as well as a culinary coach through Harvard's Institute of Lifestyle Medicine. We are so excited to have her on the show. Welcome, Tonya.
Dr Caylor: Thank you so much, and thank you for having me. I love to talk about my favorite subject, which is coaching in residency programs, so thank you.
Kendra: Thank you, Tonya. This is such groundbreaking stuff, and just to be on the front end and to collaborate with, you know, awesome coaches like you, Tonya, paving the way for med students, residents, anyone in GME that is ready to take on this career. So, If we could start, just tell our audience a little bit about you, like your training, your family background, how you found coaching, any personal testimony that got you there, etc.
Dr Caylor: Okay. Yeah, sure. So I, like you said, I'm a family medicine physician. I actually live in Anchorage, Alaska now. I've been up here for about 16 years. Born and raised in Florida, so polar opposite corners, right? I always tell everybody I'm a really good wife and that's how I got here. But it was a great move. I am married, both of my girls, we had two children that went through medical school and residency with us, and surprisingly neither one of them decided to become physicians. But they are well adjusted despite the adventures they had growing up with a two physician trainee household. Was in practice in Florida after residency for about eight years. And then when we moved up here um, entered into the world of academic medicine, which I had been desiring to do and was core faculty for several years before I hit my burnout. So that's kind of the backstory.
Kendra: Man. That is a big change. Let's go from Florida to the furthest possible state away. Wow, that's an amazing adjustment. And I love how you say your two girls are well adjusted despite the adventure. So, yes, congratulations. Tell us about your story of burnout. I know you mentioned that briefly just now. So could you elaborate on that for our audience.
Dr Caylor: Yeah, sure. So, I don't know that mine is much different from anybody else. The one thing that I think was surprising to me, number one, is at the time I was unaware that that was a term or a phenomenon that happens. And it was so insidious, like I thought, in fact, I remember saying at a faculty retreat, like, I feel completely balanced in life. I remember pronouncing this. You know, the joy that I was experiencing in my role. And then it was a few years later, but I was in deep by the time I figured it out. And what I thought is I just wasn't made for academics, right? Like that's, I just thought, I just don't have the personality, but reality was I had really high standards. Some of you may relate. Unrealistic expectations of myself and being able to fulfill the 22 different hats that you wear in academics and making sure all the boxes are checked at the end of the day. And I had become like an approval addict. I was so over reliant on external validation that when all of my colleagues were super busy and not having the time to, you know, gimme a pat on the back. Really got in my head. So there were a few things that culminated. But we know that burnout really is an occupational issue. Those are the pieces of the pie that I contributed to it. But anyway, so that's it, I burned out, left and changed to an on-call position. Went to work for a husband and wife that owned their own outpatient family medicine practice and they had set it up to enjoy the job, instead of maximize profits and it was the perfect place to recover. So, I can't thank them enough. And so we always talk about you know, you wanna like work within the system and see if you can make it work for you. But there's a huge difference when a system is working for you rather than against you. And I think we're starting to see institutions recognize that now.
Kendra: That's amazing. Yeah.
Amanda: What a concept to like build it so that it was enjoyable. That sounds radical, right?
Kendra: Also what you said Tanya, about what an amazing place to recover. Like I love that. It just really is going to resound with a lot of our listeners. I just love how you said, you know, you, you went there to recover. It made it sound like it was a safe place. It was a place that you went to that was actually working for you on your terms and allowed you that growth. So, what personally led you to coaching? How did you find coaching?
Dr Caylor: Yeah, that's a great question. So I had rediscovered the joy of practice, you know there, and was actually finding coaching is kind of an interesting way because I had recovered so well and had created so much extra margin in my life. I knew I needed to start filling back in, and I wasn't sure what that looked like. And was talking with a friend who said, oh, you should talk to Ali Novitzky, she's a coach. And she'll like, and I'm like, oh yeah, didn't she just do like workout stuff? I've got that kind of dialed in, but thank you. And she was like, no, no, no. She would be great. And so I hired her to be a career coach and she was more than happy to do it. And the other key piece is she invited me to be part of a group coaching cuz I didn't really quite understand what coaching was at the time. I was just like, okay, somebody's gonna help me. Great. But through coaching with her on my own personal career goals and at the same time watching all these other physicians figuring out tools in their own best way forwards. And some of 'em were like in the military, like restructuring within their departments and just like mind blowing the power that coaching could give. And so through that experience, knowing I was trying to figure out which this next step in my career was. Knowing I was passionate about residency education, everything just came together and I was like, this is it. Because I had residents, just like you were talking about at the beginning of this, Amanda, like, how can I, how fast can I pay off my loans and do something non-clinical? And if they think about the time, blood, sweat, tears, money that went into it, like realizing that coaching could give some tangible traction for them to re-discover the joy in their chosen career, that's how I ended up starting my coaching business.
Laura: Love it. That's awesome. And you call it Joy in Family Medicine Coaching Services. How does it work for your clients, the residency programs that you work with?
Dr Caylor: Yes. That's a good question. So for residency programs, there's two different options I offer. And, I work with faculty and residents. So, the two different options. One is where I do a hybrid program, where I will do some group coaching. I usually ground it in a foundational professional fulfillment topic or a wellbeing topic, and then do some group coaching. So we do both group and as a hybrid and then we do individual. So each individual can bring their own personal things that they are wanting to work on over time. And so that's kind of the hybrid. Other programs aren't quite ready for that, but they have a faculty member or a resident that is maybe struggling and they think that coaching may be a good resource. And so by allowing them to consider coaching then they can access me through their program that way. I do have residents and faculty that coach outside of their programs, but that's my main thing is family medicine residency programs.
Laura: So what are some of the common issues that you see in the residents that you coach?
Dr Caylor: Oh gosh. I think they're common to most all of us, right? Things like the unhealthy perfectionism that I admitted to. I would say feedback distortions is a big one where positive feedback is completely dismissed. Even when it's given well, constructive formative feedback gets turned around inside their brains and used to beat themselves up and feel like they're a failure. So feedback distortions is a big one that we coach around. Feeling like they're working hard and they're not feeling that appreciation or feeling like no matter how hard they work, they always get something wrong and forgetting that they're in a growth period. You know, faculty members we're wanting to, like, wherever they are, we're wanting to hopefully tell 'em what they're doing well and challenge them to take them up to the next level. Right. But sometimes it's how it's said and sometimes it's how it's heard that they don't feel that. All of them struggle with, like every physician I know of, trying to leave work at work and not take it home. And with the way things are working currently with the EMR systems and doing what we have available to give is really challenging, but figuring out how to reconcile those. Right. And I think, you know, if you think about residency, so many residents have moved away from social support. And they're in a new setting. And they're immersed in very stressful times and just feeling socially isolated and just kind of troubleshooting and thinking about how that can turn around for them. So those are a few of the things. There's so many, but you know, I am a generalist at heart, so like whatever the person is really wanting coaching around, like, I'm ready and happy to help them figure out their own best answers.
Laura: How has coaching helped some of the residents that you've worked with?
Dr Caylor: There's so many wonderful stories. A couple of things that stand out to me. One was an intern who was, I think, you know, maybe a third of the way into his intern year. And I don't get to coach as many of the interns because of time requirements. Right. But I was really thankful that the program that he was in allowed me to coach with him. But he wanted coaching around a preceptor who had it out for him. In his mind, that's exactly what was happening. And so we worked through a lot of questions and things and looking at what the evidence was. And it was really interesting, once we started looking at what the evidence was that the preceptor was out for him. One of the things was on the milestones he was given a 1 because he didn't understand that a milestone of a 1 is on target with your intern year, right. Like just understanding the tangible thing. So we're like, okay, and what else? And so we just started peeling apart and then even got to the part, what would happen, even if that preceptor is “out for you”, what would happen if you just extended positive intent? Like assume that they want the best for you and that maybe this is the way they teach. What would that be like? And he was able to discover that he would probably sleep better at night. Because it would take one precepting session and he would, it would interrupt his sleep for a week. So just getting ease and realizing, like leveraging the benefit of the doubt, how that can work for him. Actually he ended up having a good relationship with the attending over time. So that's one of the stories. Another story that stands out to me was a resident who, their program had offered a gratefulness training the year before. And in our first session, on the one-on-ones, we were just kind of walking through the fact versus story that we have around the sets of facts. Just that nice exercise. And we were doing that and he had like this light bulb moment and I was like, what? And he was like, “This is why that gratefulness stuff just seemed like a bunch of crap to me last year, because I couldn't separate out what I was thinking from what was real, what the actual facts were”. And so anyhow, he was just like, “oh my goodness”. It was just like I was glad to hear that. So now when I talk about gratefulness, I now spend some time about let's think about the story versus the facts. I could just go on for days. Just another example was a person who we just went through approaching the in-baskets and getting notes done and like all the different barriers. We all understand there are a lot of challenges that we have absolutely no control over. So if we could only work on the ones we have control over. And so once we realized there was this whole story in their head about what the in-basket had for them. They were basically, when they opened it, they were gonna find people upset and angry with them, labs they didn't know anything what to do with, a note from an attending criticizing them, like in their minds. I was like, well, if you think that's what's behind that door, why would you wanna open it? Right? So just kind of working with mindset shifts to where, “oh, they're just, they're typed words in a computer”. That’s all they are. Devoid of meaning. Now let's just open and just tackle one at a time. And it just created so much ease.
Amanda: That's one of my favorite things whenever people are future tripping, you know, like just assuming the worst and all of that, and like, let's just say that it is painful at some point. Why are you pre-living it over and over and over? Like, let's just live it once. How about that? I know mostly with family medicine residents, but I mean, your advice is going to extend to all residents, probably all physicians, all people probably in general, do you have any general helpful advice that you could give? You know, people who aren’t even in family medicine residents based on your experiences?
Dr Caylor: Yeah, I think there's a couple of things. I think one is just remembering what's within your control and what's not. And then with what's in your control, if it's not going well, like somebody's put somebody on your schedule that for all intensive purposes, they should not be on your schedule. Like instead of going straight to judgment, which many of us are, you know, trained to do well. Kind of flipping it and just getting curious. I wonder why this person is on my schedule. And then extending that benefit of the doubt to the poor person who answered the phone who had to put them somewhere, doesn't mean you can't work the system later to figure it out. But if that patient's gonna have to be seen by you no matter what, like the amount of drama just drops when you access curiosity, extend the benefit of the doubt. I think that's a key one. And again going back to that feedback distortion. Give as much airtime in your brain to the positive feedback and even positive things that happen during the day. As much time as you're going to think about the negative or the constructive feedback, spend that much time, if not more savoring the good parts of your day. And then the last one, and I think that I still remind myself of is, perfectionism. You know, it's not like it's a light switch and it's on and you're perfect.
And if you turn it off, then you're just gonna be mediocre. This there, it's actually on a dial, right? So we can turn it up when the situation at hand requires more energy and effort and dial it back down other times. We can learn how to do that. And when we look at it in a growth mindset
standpoint, like we can actually just start to strive for mastery instead of unhealthy, unrealistic expectations of ourselves. So I think those are the three.
Amanda: I feel like my dial's been broken at times. I do. Mine has been stuck or jammed several times in my life. Okay, so correct me if I'm wrong, you work mainly with family medicine residencies, is that correct?
Dr Caylor: That is correct.
Amanda: And so do you have room to take on more?
Dr Caylor: I do, I do have more room to take on and like I said, it could be residents or faculty, or both. I have one program that I coach both, and the rest of them are either the faculty or the residents. So, yes, thank you for asking.
Amanda: Very cool. Well, how, if this is striking a chord with somebody, which I know it will, how do they get in touch with you?
Dr Caylor: So they can find me on my website, joyinfamilymedicine.com, or they can email me at [email protected].
Amanda: Okay, perfect. Are there any closing thoughts before we head out?
Dr Caylor: Just that I know that not every program is ready for coaching. And so if there are individuals out there who would like to hop on a call with me and we can discuss that. And for those who aren't ready to coach, but they want some of those topical pearls, I do have a blog on my website that kind of walks through a lot of the material that I use in my group coaching sessions.
Laura: And if there are emergency medicine residency affiliated listeners, you can contact us. If this is something that you're interested in for your residents, you can contact us.
Dr Caylor: Yeah, and for those of you who are not family medicine or emergency medicine, I have a feeling that all of us would consider working with you.
Amanda: Yeah, anybody out there, just hit us up. Contact us if we're not a fit for you. I promise, I promise you, we know the person who will be the perfect fit for you. Just like we had when we had Michael on, we know that some people are gonna work, wanna work with another guy. There's tons of people. Our goal is to help people. And if it's not us, totally fine. We love our clients like crazy. I don't care who it is. I want to get you the help. It makes me so happy to see our colleagues relieve their suffering, you know?
Laura: Yes. And medicine will just be better. The more people get this kind of resource and help medicine will be so much better.
Dr Caylor: Yeah. And I wonder if I can just wrap up with one thought of. We talked about how the majority of the issues with burnout are systems and how the coaching is tackling the front. But as each individual person starts to learn these tools and new ways, approaches those, that's who are gonna be the change makers in our systems to overhaul this crazy place we've gotten ourself into. And that's exciting to me.
Amanda: I think it won't take long until we get to a tipping point. Like, I spent 15 years in utter despair. Like the system will never change, but I've seen enough from this side that I know that the tiny army is coming, and so I just want to offer that hope for people out there for sure.
Kendra: Awesome. Thank you so much, Tonya. This has been an amazing talk, not only just for the tips that you brought in our short time here, but also just making yourself available and having the niche to really get our boots on the ground, baby doctors, I don't know what you call 'em, the newbies, the rooks that are coming out, just getting ahold of them and paving the way so that they don't do like most of us, you know, grow crunchy, and then look back and go, what am I doing? So thank you so much and we appreciate all the listeners out there. We want you to know that we have launched a new webinar series with topics that come directly from you. We sent out a poll to ER docs. So join us for the next one. It's Wednesday, March 29th at 12:00 PM for tips on how you can thrive in the crazy circus we all work in. It's called “What's the ICD-10 code for Injury Sustained in a Dumpster Fire”. We will dive into how to manage the frustrations of working in the current environment of healthcare. So go to our website, www.thewholephysician.com to sign up, and as always, you'll find a link to our CME courses and coaching packages.
So until next time, you are whole, you are a gift to medicine and the work you do matters.
