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[00:00:00] Amanda: Hey guys, welcome back to the podcast. I am Amanda.
[00:00:02] Laura: I'm Laura.
[00:00:03] Kendra: I'm Kendra.
Amanda: And I could not be more excited. We are honored today because we are joined by the famous Dr. Sunny Smith. She's a pioneer in the physician coaching world, and she has been both a coach and a personal mentor to me. She is a family physician who started in the academic medical world at UC San Diego.
[00:00:20] Amanda: There she ran a free clinic and won multiple, multiple awards. After a devastating bicycle, good Lord, after a devastating bicycle crash, she found coaching while she was stuck laying in her hospital bed and somebody must have turned on some podcasts or something. And that's turned out to be a blessing for many people because she became a coach herself and she's helped loads of women physicians, physicians, myself included, and a bunch of other people that I know.
[00:00:44] Amanda: She does this both through her wildly popular. Empowering Women Physicians coaching program, but also she has some Bora Bora retreats that you might want to find out about. She's incredibly authentic and passionate about improving medical culture. And so we are so excited for you to meet Sunny
[00:01:00] Amanda: if you don't already know her.
[00:01:01] Amanda: Thank you, Sunny, for joining us.
[00:01:03] Dr. Smith: Hello. It's so great to be here. So beautiful to be here. So full circle to have you having been in my program and dreaming about creating this podcast and having it come to fruition. And then years later, me coming back and being
[00:01:16] Dr. Smith: invited on. And then in the true, as you said, known for being authentic, I literally have lost the window where
[00:01:24] Dr. Smith: I'm supposed to be able to see you guys right
[00:01:26] Dr. Smith: now.
[00:01:26] Dr. Smith: So I'm poking around trying to
[00:01:28] Dr. Smith: find it just so you're aware. Okay. I don't know where it's gone. You're fine. Well, it's an audio anyway. It's okay. Yeah. I will be looking at myself or my screen or whatever. Yeah.
[00:01:39] Amanda: I will tell the listeners that anyone who's followed us from the beginning, I literally was asking Sunny questions. Like, how do you do, how do you get a podcast uploaded? How do people do this? Cause Sunny has her own podcast. And she, she's part of the reason why we're here today.
[00:01:53] Dr. Smith: Oh, I just love that. Makes me so happy.
[00:01:57] Dr. Smith: Like, it's so, you know how when you have a medical trainee, as an example, right? Like a first year, second year, third year, fourth year, and then you see them out there in the world saving people, you're like, kind of amazing, right? So I kind of feel a little bit that way.
[00:02:09] Kendra: Well, thanks for coming on today and we'll get right to it. So there have been some recent studies published supporting coaching as an intervention for physician well being. Can you tell us a little bit about that coaching research and how you are personally involved with that?
[00:02:24] Dr. Smith: Yes. And I can actually see you now. So I'm very excited to talk about this. I would say, I mean, the thing that I'll talk about first in that space is, of course, the thing that I'm most familiar with, which is our data and sort of how that evolved. And I can talk about it in the context of the other data as well.
[00:02:40] Dr. Smith: So, for us, you know, I would say there are now since 2019. There have been published randomized controlled trials in physicians by coaches for physicians without changing their job or their workload or anything else, all the distress of the system that we are in that we know needs to change. And yet those things change very slowly.
[00:03:01] Dr. Smith: So what can we do in the meanwhile? It's both. And because 1st, I just want to say, people always bring up this argument whenever I speak, whenever I talk whenever we talk about wellness, people are like. You know, this is not some BS pizza party or yoga or mindfulness or something. Is it because you need to change the system?
[00:03:16] Dr. Smith: Yes, we need to change the system. Absolutely. And we need physicians have developed sort of a learned helplessness. That the system is what it is, and we just have to lay down and take it. And so one of the things that coaching can do is give you a sense of agency, self efficacy, autonomy, even within the same system.
[00:03:36] Dr. Smith: And you can believe that you can start changing some little things. So you start changing those things because you believe it's possible and you start to, especially in a group coaching program, you start to see other people are becoming squeaky wheels and making things happen in their own institution as well.
[00:03:51] Dr. Smith: So I'll say that the randomized controlled trials started being published in JAMA in 2019 I'll talk about those sort of and their characteristics and how the randomized controlled trials have evolved over the past four years, including one that just came out this month. And then there's also, I think where we fit in to that is when, when you have randomized controlled trials and evidence that something works.
[00:04:12] Dr. Smith: We need to take that out into the community, right? Because, like, for instance, when I was a medical student, I did a implementation project as my independent study project for folic acid in neural tube defect prevention, because my brother had a neural tube birth defect. And we all, we, we all know, right, that folic acid prevents birth defects, but are we all taking?
[00:04:34] Dr. Smith: A multivitamin or a folic acid vitamin? No, and half of women who become pregnant didn't intend to be pregnant. So I know this is a random tangent, but it's, it's like, there's an implementation science as well. And in public health, there's a framework called RE AIM, you know, or you can look at any kind of framework, but taking the implementation science.
[00:04:53] Dr. Smith: And so most of your listeners, the reason I'm mentioning this is most of your listeners will not be running randomized control trials. They will not be PIs. Right? So we need to know that the randomized controlled data can be translated into the community and into one physician, taking it by themselves, not with a whole cohort of people from their institution doing it.
[00:05:14] Dr. Smith: So, and in part, that's where I see our data contributes to the literature and is under review and should be published soon. We have a DOI, et cetera, but they're on their last steps of approval. And so. Our data shows that if you take random physicians who sign up on the internet, ours is targeted at women physicians.
[00:05:30] Dr. Smith: We have 77% of our physicians are burned out when they come in, which is record high. Right? Ridiculously high, completely unacceptably high. And these physicians obviously aren't broken because. Where we go into a system that creates a situation where on average, the data this year shows that 63 percent of people are burned out.
[00:05:48] Dr. Smith: And in our population, it's obviously not surprising that more people who are burned out are more likely to self pay and sign up for coaching programs and spend their time and energy to get better. So, 77 percent at baseline and 8 weeks later, which is not very long, 33 percent are burned out.
[00:06:03] Laura: Wow.
[00:06:03] Dr. Smith: And I know, right? There isn't any other intervention that I am aware of that is as effective. So, our program and coaching, obviously, is our program. is the most effective physician wellness intervention that we know of. And I think our data is the most effective of large and very large effect size because our program is so intensive.
[00:06:22] Dr. Smith: I mean, you've been in our program, so you have an idea that you know, some of the other interventions are like two and a half hours. And I'm like, you get two and a half hours in one day with us. One time I got five. Exactly, exactly. So we need to like an immersion, just like when you did Ochem in summer, or when you did something, you know, like a summer Spanish, we do an immersion model where people really get immersed in, no, you really do have agency.
[00:06:44] Dr. Smith: No, you really can change your life. It is your life. You do have choice. I know it doesn't feel like you have choice, but you really do and help people to see where they do.
[00:06:53] Dr. Smith: And then our
[00:06:54] Dr. Smith: professional fulfillment goes from 27 percent of baseline to 68 percent eight weeks later. And then self compassion goes from 17 percent to 63%.
[00:07:01] Dr. Smith: So that's our data. It's how do you move the needle on things that really matter. And most importantly is like the subjective experience, right. Of how. how people are really significantly improving. And then the question becomes, you know, it's the program's over after eight weeks. Does this, like, does it have any lasting effect?
[00:07:19] Dr. Smith: And so the the 2019 study in JAMA is by Lottie Derby, Tate Shanafelt, Colin West, the leaders in physician wellness. And so if the most widely recognized, most widely published, most immersed in this, um, decided that they should run a randomized controlled trial, they also advocate for systems based change.
[00:07:40] Dr. Smith: That's what they do. That's their job. That's their full time job is to advocate for systems based change and any other intervention that can improve physician wellness. And so they published their study where it was at Mayo, and they emailed all the physicians there and said,
[00:07:55] Dr. Smith: Hey, we're going to be offering coaching.
[00:07:57] Dr. Smith: Is anyone interested? 88 people responded and they got a 1 hour phone call. At the beginning for intake, what matters to you? What do you want to talk about? What's important to you? Notice that in coaching, we don't say, Hey, here's my curriculum. You have to follow it, right? We say, what's important to you.
[00:08:12] Dr. Smith: Your life is the curriculum. What are you struggling with? Come in with that. And then they did five more sessions that were 30 minutes each. And that's it. And that alone, hearing a physician, and these weren't physician coaches, they were external traditional coaches, and they were not based in the, in the institution, they were external.
[00:08:30] Dr. Smith: And for some people, they feel that brings in a little sense of psychological safety, so that it's not coming from your institution, you're speaking to someone outside the institution, you'll hear something different in the other studies I'll talk about but so their outcomes were that it improved overall quality of life of these physicians that improved emotional exhaustion, improved burnout and increased their resilience. I know we're all already incredibly resilient, and they kind of weaponize our resilience and use it against us and keep making us do more and more and more yet. If you have someone, because how often is it in your life that you have skilled person that will put down their phone? Listen to what's on your mind and what's weighing on you and say, you know, validate what you're thinking and feeling your feelings are real.
[00:09:14] Dr. Smith: You're not crazy. We're not going to defend or justify or criticize, just feel heard, right? A space to feel heard. And then in a skilled way, say, now, what, what do you want to do? What can you do? Do you even want to do anything? Because sometimes we just want to say we're feeling miserable and we're not ready to change anything. But sometimes if there's the imitation, what would you like to change, if anything? Then you can find that little thing, go do it and
[00:09:40] Dr. Smith: come back and the person's there for you again. Again, not on their phone, looking you right in the eye, an individual, undivided
[00:09:47] Dr. Smith: attention. And it's not because people will say, well, a psychiatrist or psychologist can do that.
[00:09:52] Dr. Smith: Yes, they can. And those are very, very important things in physician wellness. And I utilize those interventions as well. And I highly recommend people do. However, those are generally pathologizing and diagnosing someone, right? I mean, they don't have to per se, but they do have medical notes. And you do put something at the end in the assessment and plan, right?
[00:10:12] Dr. Smith: And so in a coaching context, it's we are identifying someone's strengths. And this is what that paper that's in JAMA that I can give you all the references, right? It's in 2019 first off with Lottie Derby, it says, you know, coaching identifies people's strengths. And it helps them recognize their own internal assets and resources and helps them prevent or treat any burnout and not say like, oh, you have depression, you have anxiety, you have this, you have that.
[00:10:39] Dr. Smith: Let's do some medicine. Can medicine be helpful as well? Absolutely. 100%. I believe and data shows that help seeking behavior begets help seeking behavior. So I hear a lot of physicians be like, well, do I get a coach or therapist or psychiatrist? I'm like, the answer is yes. Just start. Start by starting.
[00:10:55] Dr. Smith: Just go. Go talk to someone. Go tell them that you need help in some way. Identify with which one you think you might want to do first. You know, if you want to take a PHQ 9 screening test for depression, feel free. And if it's positive and concerning, you might want to see a psychiatrist, right? Yet, any of these can be helpful.
[00:11:11] Dr. Smith: So that was the first RCT data that felt very validating to so many people and highly cited article. After that, as I was mentioning, people will say, well, what about after? Does it sustain? Is this something, a skill that you learn or is it something that you need to be immersed in? anD so the next paper came out in 2020 and that's by a group it's a journal of occupational health. It's by a group at Beth Israel and they did primary care providers. And they said they did the randomized control trial and a 6 month follow up. And the answer is that
[00:11:42] Dr. Smith: not only was the data strong at the end of the intervention, but the data was still strong and lasting and effective 6 months after the intervention was over. So that's currently the only published paper that shows after the intervention that it still is effective. Yeah, I think it's important. I think there needs to be more of all of these things, but that is important to know that it does last because once you learn these things, they're skills, they're tools, you don't un-learn them, right?
[00:12:08] Dr. Smith: We learned the helplessness. We can unlearn the helplessness and we can be reminded and remind ourselves over and over and over that we do have agency. So then I can pause for a second before I tell you about the most recent trials. Do you have any comments or questions before I get into the most recent ones?
[00:12:23] Amanda: No, it's good. It's great.
[00:12:25] Dr. Smith: So then in 2022, some of our colleagues, compatriots, people who trained where we are because in 2020 ish, I would say you know, there's a lot of physician distress and a lot of physicians started finding coaching after the evidence was coming out, people were more and more interested.
[00:12:41] Dr. Smith: So now there are hundreds of physicians who have trained themselves as coaches. Some of them you. Like us are taking it to their institutions or to wherever their world is, right? Whatever. And, and so, two women physicians who trained with us, Tyra Fainstead and Adria mann decided that they wanted, they had become coaches for their own selves. This is what we all do. We do it for our own selves. That's why we do coaching and even coach certification because we want it. We need it. Every physician, we needed it. So we did it. We thought it was so effective. We decided to train in it. And then we're going to see one, do one, teach one, right? We're going to pass it on.
[00:13:14] Dr. Smith: And so they went to their own institution and they work in the residency and they said, Hey, we want to offer coaching to women physicians. And. There was such significant, it was for residents actually, and think of what physicians have the least control over their circumstances, residents, right? If you have an MD or a DO, how could you have the least control?
[00:13:35] Dr. Smith: Still be in training is the answer. So if you want to see if you have no control over your circumstances, can this still work? Then do it in residence. And so, so many residents responded that they said, well, we should probably do an actual trial like this. Let's do a randomized controlled trial. And so they got some help and people who are who do that to assist them and they started and they did a randomized controlled trial pilot study at their own institution and found and published in JAMA open in 2022 and they found let's see what they had.
[00:14:01] Dr. Smith: It's emotional exhaustion, self compassion and imposter syndrome for residents was improved. So. Again, who hasn't had imposter syndrome? Which ones of us have not, especially in residency? Of course we did. Which ones of us have not had burnout? Of course we did. And emotional exhaustion is, I mean, it's very heavy to carry being, we all remember that, that real exhaustion in residency.
[00:14:26] Dr. Smith: It's an, I ended up in a coma. Many of you know, intubated status epilepticus from sleep deprivation during residency. Most people don't have that. But most people do have this incredible exhaustion and even other studies, non coaching studies. But actually they're, they're studies of online CBT. They also in JAMA, I believe it's in JAMA psychiatry.
[00:14:48] Dr. Smith: Show that 20 percent of interns are suicidal within three months of starting internship. And if you give them online, not even a live interacting person, but there's something called mood gym, which was online CBT, which this is before the coaching literature came out, it decreased suicidal ideation in half.
[00:15:05] Dr. Smith: If you gave them that before they went into internship, again, just knowing. That you can reframe some of catch how you're thinking about stuff, reframe how you're thinking about stuff and find your agency and find what you can do. So, they did their single trial, which was very important. I think a lot of us were really excited about that.
[00:15:24] Dr. Smith: And then I was going to say, and I definitely want to let you speak and say, and then they went to do multi institutional and they went big, so they had 28 sites. And so that they enrolled over a thousand women residents at 28 sites. And reported out on about 400 or so of them and showed again that it was incredibly effective. That there's a, that intervention is actually. More similar in some ways to the intervention that I do, as opposed to the, you get one phone call as an intake and then three half hour follow ups that are individual one on one, because this is important to know that individual one on one is effective.
[00:16:02] Dr. Smith: And that's what the initial trials I already told you about. We're studying until we came to Tyra and Adrian's where they were studying group. Because how do you scale this? Right, and how do you get it to trainees who aren't going to be paying thousands of dollars themselves to have their own person?
[00:16:15] Dr. Smith: And so their intervention, again, is somewhat similar to mine in some sense that there's online portals and access to some recorded material. There's online group coaching programs. Group calls, and then there's for them. There's the ability to also type in and get some written coaching support. So I think that their group, their coaching also shows the power of community. I think it's a very important for. Physicians to know they're not alone, they're not uniquely broken, and when you see what you're thinking in your mind show up in someone else's world, you're like, wow, I can't believe she's being so hard on herself. Wow, I can't believe, right, she's So amazing. And she thinks she's terrible because a patient said something mean to her or an attending said something mean to her, or, you know, there's just such a common, or I'm not the only one behind on my charts or I'm, we all make sense.
[00:17:08] Dr. Smith: Like when you get in a group of people, just like you and you're coached on very similar things, you're like, maybe we all make sense. And maybe we all can experiment to try to do some things to move ourselves forward. So I'll pause right there. And that's, those are the things that I would have to say about where the literature is right now.
[00:17:24] Amanda: Yeah, no, I love it. And you ended up answering my question because I was just going to point out that that was at the University of the pilot was at the university of Colorado with all female residents. And then you ended up saying it. Do you know? I mean, we're, we're all ER physicians, which is, you know, of course, the highest. Burnout specialty of all, we're really interested in doing a study of both men and female. Do you know of anything like that going on or is that still, maybe we just have to do it ourselves?
[00:17:51] Dr. Smith: So in, in emergency medicine specifically, I don't know. I mean, I will say that one of my coaches is a, an emergency medicine program director at one of the largest programs in the country. And she was telling me when she was at Puerto Rico retreat earlier this year, she said she just got back from the. Conference where she said something like women, emergency medicine physicians are leaving medicine like 17 years earlier. I mean, something horrific, because we bear the burden of so many other things, child care, of course, misogyny, et cetera, et cetera.
[00:18:23] Dr. Smith: But in terms of both genders, there are employers, for instance, that are like, there's a study, actually, it's published in Mayo Clinic proceedings, but it's out of Stanford where Stanford just provides coaches access to coaches for physicians for all male and female. And they did pre post, so I'm aware of mixed gender pre post things. I think most of us are going to be end up doing pre post and not randomized controlled trials. I actually spoke to Tate and Mickey and said, and showed them our data and said, what would you do if you were me? We had, this is our data. This is where we are. We have this program.
[00:18:57] Dr. Smith: It's very effective. Should we be doing randomized controlled trials? What, what should we be doing? Because every physician deserves a coach. Every physician needs a coach. How do we advocate? How do those of us who know and believe in this and have seen the data and have experienced ourselves, how do we best advocate for this?
[00:19:11] Dr. Smith: How can it be like a healthcare insurance benefit and every other benefit that we have? It's just. This is hazard pay, right? For what we do, what you take a normal functioning person with mental health, you know, that are the same or better as age match peers when they come into medical school, and we systematically create mental health distress in them.
[00:19:31] Dr. Smith: So how can we not want to vaccinate or improve or address this system based? They felt for me, and so it would be interesting to hear what you guys think for what you want to do. They were like, I don't think you need to do a randomized controlled trial. They said, teach what's effective. You know, you're obviously know what's effective because it's working what you're doing.
[00:19:50] Dr. Smith: So take out the pieces that you know are effective and go forth and train people and get this implemented in more places. And so. I think it's kind of in some way, it's like when we study burnout and people are
[00:20:02] Dr. Smith: like, let's do another survey and see what the burnout rates are. Like we know it's bad. Or when people are doing something with gender based, for instance, pay, what is, is there a discrepancy? Yes. There's a discrepancy. How many more studies do we need? And so, yes, I believe randomized control trials are, are essential. They're absolutely essential. And then it's like, and then what? Right. How do we, how do you in your field? I mean, I was just a conference, passive income MD, my co investor, who is an emergency medicine physician, showed the data on mortality.
[00:20:33] Dr. Smith: Like, it doesn't, you know, we talk morbidity and mortality and well being and quality of life and all these things, but like, you guys are dead. More than a decade. Yeah, more than a decade earlier than most other families and certainly earlier than the population. That is not okay. Why is that? Right? Like, why is it that we are not doing things that make emergency medicine physicians healthy and live at least as long, right, as their age match peers or people who aren't in medicine. And so how do you, like, it's a, it's a sort of a bigger question in some ways, like, there is so much distress in emergency medicine physicians.
[00:21:07] Dr. Smith: We, I believe we have to get people to realize. You have to allow for this workplace flexibility and the accommodations that human beings need because it's otherwise we have to walk out. And even if we do walk out, we're still dying. We're paying this cost. Like the body keeps the score. This is no joke, right?
[00:21:26] Dr. Smith: Whether it's mental health, whether it's physical health, all of the things. So how do we take this information that is basically what coaching says, in my opinion of it, is we are human beings. And how we think and feel matters, and our experience of this life matters, and it impacts ourselves, our patients, the bottom line of the institution, it impacts everything. So why not create systems where we can make some requests and they could be met, right, where we could sleep in, where we could, some people want predictable shifts. Right. Like give people what they want. And so it's like, allow people to customize and individualize a little bit based on where they are in their phase of life, stage of life, financial needs, all of the things. And that's what medicine, one of the things medicine is missing is it's just like one size fits all. And square peg round hole. And if you can't square peg in this round hole, then you have to get out. And it's strong work to fit yourself in there to never sleep, to not eat. That's strong work. Like what if we try to change the definition of strong work?
[00:22:28] Dr. Smith: Like strong work is saying when you need a break saying this is traumatizing, right? Saying that I. Need help. And we need a deeper bench. That's one of the things that I think would be strong work, a deeper bench in every institution. So if someone needs to go on leave for any reason, it's okay. So, anyway, I think this is how we, like, translate the, from coaching into believing that we deserve these things and we can have these things and showing up and advocating for them. So those, those are my thoughts. What are your thoughts about what you're doing for emergency medicine and how to bring this. And as a tool, because it's the thing, it's a tool in the toolbox of many things that are needed to address physician wellness, because this is a crisis, right? Like, oh, totally.
[00:23:13] Dr. Smith: It's a public health crisis, just like when the Southwest Airlines went down, right, in that one December, where it was like, oh my gosh, this is from like 20 years ago, and
[00:23:23] Dr. Smith: one thing went down, and now the whole world is falling apart. Yeah, medicine is absolutely, I think post pandemic in particular. It's a crisis and we're, we lost over a hundred thousand positions last year.
[00:23:34] Dr. Smith: They just stepped away from clinical medicine out of around a million in the U S we have to do something and this is one tool. So again, tell me your thoughts.
[00:23:43] Dr. Smith: Absolutely.
[00:23:43] Laura: Well, you may or may not know that like we're, we're all three burnout survivors. A couple of us actually quit medicine for a period of time.
[00:23:54] Laura: So learning these tools that we have acquired through our, through coaching and through our coach training. Yeah, we are so passionate about getting this out to every physician. Who will, who's, who's willing to receive it because it really is transformational. Yes. The system is a hundred percent broken.
[00:24:15] Laura: Yeah. Yes. However, we don't have to fix it right now today to be able to survive and improve our own wellbeing and health, which we have to do otherwise, like we. The crisis will get worse and we will not have any physicians to take care of people who are sick and injured in the emergency department.
[00:24:38] Laura: When we really want people that we want, the smartest people taking care of those situations, not not people. I mean, I like the worst. I just think about how thinly stretched we feel sometimes now and, and that, that could get worse is terrifying. So it's so important that we all get this.
[00:24:57] Dr. Smith: Right, like can you imagine it getting worse? Can you imagine there being less coverage in the hospitals that we already are working in? I mean, how is that possible? People already in the hallways. People are already waiting zillions of hours. We already are drowning in paperwork and all the things. Right? And I mean, it probably is going to get worse before it gets better. And so that actually is the opportunity, right? Is it if things were all, you know, hunky dory. Nobody would act. So it's like the crisis is the opportunity to try. Yes. To make a difference and to every time someone leaves. Right. God forbid. Don't let it be every time someone dies, which is literally every single day. Every day a physician dies from suicide. This is completely 100 percent unacceptable to have these as predictable outcomes of our training and our practice and so is it every time someone dies? Is it every time? Hopefully is it every time someone leaves? Is it every time? There's no coverage, right? Like, if there's no coverage, there's just no coverage because most people, you know, that are physicians aren't emergency physicians. And so it's like, okay, if you're a vascular surgeon, if there's no one else, do you just say, okay, listen, you guys got to go on divert? Like, you've got to, I'm not coming in. I can't come in. I can't do Q2. Right? Like, are we willing to say that? How are, what are the systems and those whenever there is that kind of crisis?
[00:26:18] Dr. Smith: It doesn't have to be a crisis, but when there is, that is especially the time to say things must change. Kind of like during cOVID, you know, how previous to that, I'd been coaching women physicians who were trying to implement telemedicine in their institutions and they didn't have enough budgets and they were banging their head against the wall. And then suddenly in like three days, the impossible became possible. Right. Right. And so there's such an example of the impossible can become possible if you decide it has to be, it has to happen, then it does.
[00:26:47] Amanda: Well, and I know, you know, Michelle Chevi. But when we interviewed her, the thing that made me, I, we've just gotta drive it home. Her sister, you know, had picked what had to cover. Even though she was exhausted and then ended up, you know, committing suicide. Do you think the hospital shut down? I mean, they didn't have her working after that. Absolutely not. They carried on. And that's what we have to remember is like, yes, we owe it to ourselves to keep ourselves healthy because no one's going to do it for us.
[00:27:18] Amanda: And if we don't do it, it's just, it's unacceptable to me that we continue to be the hamster on the wheel and try harder and harder and harder, like something has to give.
[00:27:28] Dr. Smith: Yeah, I think that's what we do is try harder and harder and harder, run faster and faster and faster. Yeah. Until you fall off of that treadmill because it's going so fast you can't possibly keep up. And then you injure yourself.
[00:27:38] Amanda: And then the hospital continues on, just fine. Mm hmm. Mm hmm.
[00:27:42] Dr. Smith: And I'll say, for instance, like that's, that's sort of how I discovered that everything that I thought I was so essential in the world. You know, like I was a course director, I was a medical director, I was a community director, I was, you know, if I didn't write the letter of rep, who would, if I didn't do the grades, who would, if I didn't stay late and made sure all the clinic patients were seen, who would, because there, I didn't think there was anyone until, as you said, I got in an accident and there was months that I couldn't do anything and I'll tell you, every single patient got seen, every letter of rep got written, everything got done.
[00:28:14] Dr. Smith: And so we have to, every single person listening to this, even my kid got picked up from preschool by someone else, right? We will one day no longer be on this earth. All of us. And the world will keep spinning. And our institutions will keep functioning. So, knowing that, like, don't wait for some injury or COVID or illness to remove yourself from the situation.
[00:28:37] Dr. Smith: Create a situation where you can come and go and you realize, oh, look, it's like testing, little experiments. It's like with a toddler in a way, you know, how a toddler will like go away from the parent and then come back and go away and come back. Like, what if we could go away from our institution and be like, oh, look, it does actually keep functioning.
[00:28:51] Dr. Smith: And then we come back and we're like, oh, I actually, cause if you do that and then you come back, you're like, actually do kind of miss it here. Actually do kind of value seeing patients. I would love to contribute as opposed to Resenting the place that is providing you patients to care for right because they're asking more than any human could possibly provide Yeah, yeah,
[00:29:11] Laura: so we've heard you say before that every physician deserves a coach. Can you elaborate on that?
[00:29:16] Dr. Smith: Yeah, I mean if every single baseball player, like there was a time for real. And I actually went to the American college of physician health in 2019. And this was, I want to say it was Mickey trockles like keynote where he talked about the time. And most people didn't know about coaching yet.
[00:29:35] Dr. Smith: Then I was like, one of the only coaches, the only coach, I don't know, in the audience and, you know, amongst hundreds of physicians working on physician wellness and his keynote and he's not a coach. Psychiatrist was talking about a time where there weren't coaches in baseball. And then there was like these transition times and he used certain teams and names and examples. And of course I don't know them because I'm not into sports or baseball. But, but the examples that he gave, I mean, it really, truly mattered and it changed the game. And it was, we weren't saying they were broken, right? Because there was a time for physician coaching where it's like, Oh, you're broken, your charts aren't done.
[00:30:10] Dr. Smith: You better get coaching. And that's kind of like. You're on your way to being fired. It's like a performance improvement plan, you know, but it
[00:30:15] Dr. Smith: wasn't like that for the baseball players. It was you're good. How do we make you better? You're doing fine. How can we support you to be your best self? Because there is a financial incentive to the team, and there is also just a performance incentive to the team.
[00:30:32] Dr. Smith: People want to win. And so. If that's so important that you do it for sports, I mean, from the time that people, they did it in, you know, Major League Baseball was his story, but if you do it for little children who are like five, right, and you do it for Olympic athletes, we had an Olympic athlete a two time gold medal winner come into our coaching program to do like a session because she was one of my former medical students, she's now an attending physician and she says, being a physician and being a physician mom, And Is harder by far than being an Olympic gold medalist. It's a harder skill set. It's 24 7. It's always on. And so, and she talked about her sports psychologist and, you know, there was a lot of drama with going, she was in women's soccer going for the gold. And then what happens in between what happens when people come after you, if you. Don't perform right on social media or elsewhere and then going back and having the pressure of trying to win gold again. But she was just talking about how the importance of the coach for her and her own coach psychologist type person, but not a psychologist was essential in building her back up to feel that she could go forth. And that she could step out and step down when she needed to, and that that was okay, and it didn't mean she was broken, and then come back and kick ass and develop a plan on how you're gonna kick ass, right?
[00:31:56] Dr. Smith: Like, how is it? That physicians who are struggling are not offered a support person, except if you are diagnosed and seen as broken in some way, and you're crying uncle at the end of your rope. Why? When we know this is going to happen to you. We know it's predictable, right? We can tell people the USMLE.
[00:32:17] Dr. Smith: There is, there needs to be some support there, right? We can tell people internship is going to be a very difficult time. We're going to give you some tools and support ahead of time. And as you move forward to not to expect these things and navigate them and have a safe place to go. And then the terrible thing is that we are sold this bill of goods and it's going to get better when we're attendings.
[00:32:37] Dr. Smith: So then we get there and we have this crash where we're like, it was supposed to be better here. We did everything to get here, and it's horrible. And who do you say that to? Because your friends who aren't physicians, they're like, cry me a river. You make multiple six figures. You got that house, you got those kids, everyone respects you. And you're like, it's really hard for a non physician to understand how painful it is and how trapped we feel. We do not feel we have other options, right? We trained our whole lives for this. What are we going to do? So you kind of need someone there who is a safe space, who won't pathologize you, who normalizes your entire experience and is just there to support you and help you be your best self. Step down a little. If you need to, just like in soccer, right? Step up a little when you're ready to train hard and go for your promotion and go for leadership and be there with you. And in the business world. They've been doing this for a long time. In fact, when the pandemic started, the former dean of the business school at USC called me and said, will you help come help?
[00:33:42] Dr. Smith: Because I'm from the business world. I know coaches are important and. I think that because he was in charge of the California Medical Association at that time, and he's like, I think we need to bring coaching to medicine during this most stressful time ever. And the only reason we thought that is because he's from the business world where executives get coaches. I mean, the thing is who has coaches right now in medicine, for the most part, it's either someone who's incredibly distressed and about to be fired historically, or it's the C suite. Right. Your CMO, your cEO, your dean, your chancellor, like when I was on the interview committee for people were coming in to be the big D dean of our medical school or the highest level executives and leaders in academic medicine, they would say, I have a coach. And I was like, I was like, what? I was the only coach I knew at that time. I was like, how do these people have these and why is no one talking about it? How do we not know that our highest functioning people have coaches and that the boots on the ground deserve it every bit as much as everyone else does and that it's actually most effective? More so! More so. And it is cost effective.
[00:34:46] Dr. Smith: There are articles, again, you can, people can Google and I can give it to you, but Tate Schoenefeld, the business case for investing in physician wellness, there is an actual business case because it's much cheaper to pay for someone to support us. Then it is for us to leave and not bill and then have to recruit and replace us, right? People will say five hundred thousand to a million dollars to replace one of us. It doesn't cost a million dollars to get someone some support, right? So I just think it's an it's a no brainer and I hope and believe but certainly hope that one day It will be normal for physicians to just support people.
[00:35:20] Dr. Smith: They're starting to try to do this in some medical schools they started with either like Mandatory opt out psychology appointments would be where, like, how some were doing it. And then they sort of are switching at some places to, to label it more coach than psychology. So I think we're, we're, we're still at the beginning of the movement.
[00:35:39] Dr. Smith: But there are lots of signs and I've been a part of lots of various movements. I would say like one is, you know, I ran a free clinic and then we taught people how to run free clinics and we're part of a movement. And then nearly every medical school now has their own student run through clinic. And then I became a part of a movement of academic communities where students need like.
[00:35:58] Dr. Smith: Smaller groups of mentorship and longitudinal communities. And now nearly every, there was very rare, maybe 10 years ago. And I published a study on the data and how quickly that took over medical schools and now really literally nearly every single medical school has some kind of learning community built in.
[00:36:16] Dr. Smith: And so I just think this is the next thing that is going to be spreading across the nation, where it's going to be seen as. Sort of behind the times or unattractive if you don't have this available. So when people are interviewing and looking Well, what do you have available for me? You know you you have PTO This is your benefit. This is your CME Do you have support for me because I know I'm gonna need it. I'm gonna be a human And someone in my family's going to die and, you know, someone's going to get sick and there's going to be some financial something and like things happen. We're human and we're going to need the support.
[00:36:50] Dr. Smith: So if we let people know at the beginning, Hey, I know you're going to be human. Let's support you through all of this. It's good for career longevity and immediate outcomes.
[00:36:58] Amanda: I am. I was laughing because I was watching my husband's obsessed with the golf channel. So the masters was on and they were talking about, Oh, Rory is meeting with his sports psychologist the day before he starts playing the masters.
[00:37:11] Amanda: And I was like, see, no one even bats an eye. Like it's expected that he is supposed to be in the right mindset. Whereas we're literally at the bedside with the people with their worst day of their lives experiencing secondary trauma. This guy's knocking around in a beautiful location, a little white ball.
[00:37:27] Amanda: No one dies.
[00:37:28] Amanda: Yes. And everybody's just cool with him having a sports psychologist. Like I know it's your dream. It's my dream. It's our dream that it is just expected to to start your job and to have a coach. Maybe it's an opt out sort of situation. But until then I know that people are gonna want to learn more from you and and want to be able to get in touch with you. How could they do that?
[00:37:48] Dr. Smith: Yeah of course I would say most people know me from our Facebook group. So people can, if they're a woman physician, I identify. Physician or socialize as a woman that can go into our facebook group. But given the context, I also have a podcast. There are podcast listeners if they're here, right. Listening. So they can look up empowering women physicians. And then I would say because of the topic that we discussed today, they can go to empoweringwomenphysicians. com slash. References. And I pretty much always try to keep that up to date. When the new references come out, I try to you know, sort of update the email that will go out to people so that they can have that available.
[00:38:24] Dr. Smith: Cause sometimes people will want to like, you know, make a PowerPoint, make a case they'll show. Cause I would encourage people here who feel, who resonate with what you're saying and resonate with this to choose one thing to do. Like Michelle Chestovich, who you referred to. Earlier would say this to in her talks, you know, any of us who try to be advocates is if you're feeling passionate, if you're feeling inspired, choose 1 thing to do. And so you can choose to forward a reference to someone at your institution. You can choose to decide that you're going to schedule your vacation. Even if people are pushing back and you're feeling guilty, you could whatever that thing is. But so if you have. some references available to you whenever and if ever you want to include them in anything, anytime, then they're available to you.
[00:39:09] Amanda: Okay. Well, we will include those links also on the show notes, but thank you so much for joining us, Sunny.
[00:39:15] Laura: Thank you, Sunny. You are the best. Thank you. We appreciate you so much.
[00:39:19] Dr. Smith: I am so appreciative of you inviting me on, and I will say I feel a little bit sad that I spoke so much and gave you so much time to be asking questions. I just want to acknowledge that because I acknowledge very much that each of you are an incredible, amazing physician, and I'm so glad to see you speaking and leading in this space.
[00:39:39] Amanda: We had you on for a reason. We wanted you to say all of this good stuff.
[00:39:43] Laura: Yes. It was all perfect.
[00:39:45] Dr. Smith: Thank you.
[00:39:45] Kendra: Yes. Thank you so much for your time, Sunny.
[00:39:47] Kendra: And we honor you for being the pioneer, for just stepping up for all of us and starting the conversation for. Having the boldness and the courage to say like, okay, this is not okay. And this is not popular right now, but I am going to take the first step. So thank you. We honor you today for doing that and paving the way for the rest of us.
[00:40:07] Kendra: So thank you. Thank you. And for our listeners, we are going to send you a never before offer to your inbox this Black Friday, so stay tuned and visit our website for more details, www. thewholephysician. com. And until next time, you are whole, you are a gift to medicine, and the work you do matters.
