"If you're not at the table, you are on the menu." How to be at the table as a female physician.

"Decisions are made for us by people that have no clue about healthcare. That's why we're in the situation we are right now with our electronic medical records. Because we weren't at the table to make these decisions. It was the insurance companies. It was the hospital administrators. But it wasn't the doctors that are going to be using these things. And that's why they're not physician friendly.  If you're not at the table, you're on the menu. And we've been on the menu quite a long time." - Dr. Ana Viamonte Ros

Dr. Ana Viamonte Ros currently serves as Assistant Vice President, Chief Well-being Officer, and Medical Director of Palliative Care and Bioethics at Baptist Health South Florida. She is also Associate Professor at the Herbert Wertheim College of Medicine at Florida International University. Previously, Dr. Viamonte Ros served as Florida's first State Surgeon General and first woman and Cuban American to head the Florida Department of Health from 2007-11. Through her professional and community volunteer activities, she is committed to advancing the opportunities for equitable and accessible health care to all.

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Transcript

[00:00:00] Dr. Asha Padmanabhan: Hi everyone. And welcome to the Leadership Prescription Podcast for Women Physicians. I am thrilled to introduce my guest today, Dr. Ana Viamonte Ros. She is a wonderful woman physician. I met recently for the first time and what just floored me was her warmth. 

And despite huge number of accolades she has received as a woman physician, the titles, the positions she's so down to work and so warm and welcoming to all women physicians that I met recently, that I absolutely had to have her here on this podcast. I'm going to have her introduce herself and do her bio, but very briefly, she's the Chief Wellbeing Officer at Baptist Health, South Florida.

And more importantly, she was the first state surgeon general for Florida and the first woman and Cuban American to head the Florida department of health. So welcome Dr. Viamonte Ros, and thank you for being here today 

[00:01:38] Dr. Ana Viamonte Ros: Thank you very much. And I'm honored to be part of the podcast. Like you said, I had the honor of meeting you. And I think when we both convened at the installation of the new Broward County Medical Society President we were both there, Dr. Vania Fernandez was installed.

And you really were the best part of the evening, to get to know you. So thank you so much. Okay. Very briefly. I have one brother who is a surgeon and he and I are actually the fifth generation of physicians in our family. I'm the first American born in the family of Cuban origin.

My parents came during the Cuban revolution early on. And my dad did his residency training at the University of Pennsylvania. And that's why I was born in Philadelphia. 

I grew up primarily here in Miami. Went to school at the University of Miami. Went to medical school here. Trained at Jackson Memorial hospital, trained at Mount Sinai also.

Lived in, let's see, lived here Miami, obviously, most of my initial part of my life, then we moved to Washington DC to the Armed Forces Institute of Pathology, where I did some training. Then we moved from there to Gainesville, Florida where I also did some training at Shands Hospital. And then we moved to Boston and from Boston came back to Miami.

Lived, like you mentioned while I was Secretary of Health and Surgeon General in Tallahassee for four years, and then came back to Miami again. And currently, like you mentioned, I am the Chief Wellbeing Officer at Baptist Health, South Florida. I'm also Medical Director for Palliative Care Services and Bioethics.

And I'm an Associate Professor at the Florida International University College of Medicine where I teach as well. I do a lot of community service also. And my two children and six grandchildren, unfortunately are all in New York. Uh, So I don't have them right here. But as much as I get a chance to spend some long weekends with them, I try to do so.But thank you so much. I have been part of the American Medical Women's Association at the national board. When I serve also here in the state of Florida. Many of you, have you have heard maybe a professional resource network for impaired physicians and impaired medical providers? So I'm the secretary for the board there.

I'm also head of the board. There's a very large homeless initiative here in South Florida in Miami called Camillus House. And in fact, since I was a medical student and I have volunteered there and I continue volunteering there to do street outreach, which I enjoy very much, but I'm also now head of the board there.

So I thoroughly enjoy mentoring. I thoroughly enjoy volunteering. I've even had experiences with the incarcerated. Actually, we can talk about that later and doing some international travel and medical charity work in the prison systems and some of our Caribbean countries.

So that's been very interesting as well. So yes, it's an honor to be here with you and I've had an eclectic life and I can tell you all the ups and downs and what has worked, what has not worked. But to me I'm very passionate about helping others. I think that if we are fortunate enough in life to have receive certain privileges, certain talents, certain opportunities, I think it's our moral obligation to help others.

And especially as women, I remember, I always tell the women that I mentor at medical school. I think it's our obligation that as we rise, we lift. And I'm very committed to. 

[00:05:24] Dr. Asha Padmanabhan: That segues perfectly where I want to go next. You talked about let's lift. And so tell me a little bit about that.

Who was it that lifted you and what did you learn from that? And where did that take you in your career? Because like you said, there's been a lot of positions and leadership. So where did that start? Where did the first leadership position start? When did it start? And what were the challenges you faced there?

[00:05:51] Dr. Ana Viamonte Ros: I think my greatest role model was my mother. My mother was a pathologist and she was an extremely accomplished person who really believed in me and instilled in me a sense of motivation to excel. To do right by others, to give back. She was an incredibly generous woman. Also did a lot of mentoring in her life.

And I adored her. She probably was the most influential, the most important person in my life. I've had then in my professional career, Many people, men and women who believed in me and dear friends that if it wouldn't have been for them and for their advocacy of helping me out it just, I wouldn't have been able to have the experiences and the positions that I had.

[00:06:44] Dr. Asha Padmanabhan: And how did you get in from medicine into public health and the state department of health and those kinds of positions? 

[00:06:53] Dr. Ana Viamonte Ros: There was a very interesting path because it got to a point in my life. My mom passed away about 11 years ago. She, despite being extremely intelligent and extremely accomplished in many ways she became ill quite young and was both physically and mentally disabled. Since I was relatively young and I was her caretaker. And when I had my own children and a young family, it was at the time that we moved from here in Florida to Washington DC, I was all of a sudden faced with two babies, basically a mother who was quite ill,

who needed me, who always lived with me. And she passed away at home with me. And her own mother who she could not take care of. So my grandmother too, and it got to a point that I realized we're in Washington, DC. I had no family. I had no support system. My husband didn't know anyone there either.

And I realized that I just couldn't do it all. I could not keep pace with the type of career path that I was on and be responsible for the people that I needed to be at that point in my life, responsible for. It was a very difficult decision to step back and to step away at that point from my career.

And in fact, my own mother, who was a pathologist and who, while she was able to work, always worked. I grew up with a working mother and as I said, I don't think I could have had a better mother and a more engaged mother, but she worked full time. My parents had come during the Cuban Revolution, as did my grandparents, and her career for her was essential and very important to be able to not only contribute to the financial stability of the family, but, we had a lot of extended family also that we were responsible for.

So I remember when I decided. I can't do this all. I just can't. And at that moment I thought, where am I indispensable and where I'm indispensable was at home. It wasn't at work. And I think at the end of our lives, we'll realize that we're indispensable at home and not at work. 

But at the time it was a very difficult decision and she was very worried and upset that I was going to step back because rightly so,she was correct in that it wasn't going to be easy to get back in. That it was, from a professional standpoint, it was going to be a much harder struggle than if I had always plowed along. Even if I had maybe done something part-time or if I had that, it was just going to be hard and she was correct.

She was right. That it was more difficult. I think when she saw how much value and how much enjoyment and fulfillment I obtained from being full-time at home, and as a caretaker, I think she slowly came to realize. That for me, at that moment, it had been the right decision. 

I think for many women, society judges us.

And we judge ourselves and all as to, if you work, you're not being, a good mother, wife, daughter, granddaughter, whatever. And if you are full time staying at home, then you're not living to your full potential. I remember one time, actually, when I went back to work, somebody said to me, oh, You're finally going to do something.

And I thought to myself, are you serious? Are you kidding me? I've never worked harder and I've never done such work, if you want to call it that, that I'm more proud of, than what I've been doing, these number of years. 

So don't let anybody judge, you don't let anybody put their opinions and their experiences up against what each of us knows at a particular time in our life, what we need to do. And we all need to look ourselves in the mirror and we'll all at the end of our lives, have to look back and come to terms if we did what we needed to do at certain times. Don't ever let anybody diminish. Your choices and what you decide to do, because, like I said, you can't win.

You know, If you do one thing and you're not being a good this, and if you're doing the other, so don't ever let that. 

The nicest compliment I think that my husband ever gave me was he said, you went from being an AOA doctor to being an AOA mother. And and I truly, I can't tell you how I would never give up those years where I was the class parent, I was the speech coach, I was the soccer mom. I was the dance recital mom. I mean, I just went full force into raising my children and absolutely caring for a mom that had given me everything and that I owed her everything also to care for her and to care for my grandmother until she passed as well.

So what I can tell you is it's not easy. I think any decision you make, you do have to compromise other aspects of your life.

Gosh, if I look back now, there's nothing professionally that I have done, that I have achieved, that I could imagine that I would want to achieve, that can match. I think the joy and contentment, and I think the sense of, I did what I needed to do for the people that I really loved and cared for to the best of my ability.

And I don't regret any of that time. 

[00:12:46] Dr. Asha Padmanabhan: That is so powerful because you're so right. We get bogged down and in guilt, whether we choose to work or whether we choose to step back for a bit. And it's always the judgments, not just externally, but internally, because I think as women physicians, we tend to do that to ourselves too.

Did I make the right choice? And we judge ourselves sometimes more harshly than the external world does. And to hear you say that, no, just be proud of what you did. And because those years you're not going to get back. 

[00:13:20] Dr. Ana Viamonte Ros: You absolutely will not. 

[00:13:22] Dr. Asha Padmanabhan: Indispensable to your family. So those are words that every woman physician needs to hear.

[00:13:28] Dr. Ana Viamonte Ros: My best friend is a nurse and she's in Boston. And I remember when my children, youngest one was going off to college. My grandmother had passed. My mom was still alive at that point. But then from a personal standpoint, I have been married, close to 30 years.

And at that point, my husband left. And something that I certainly not only did I - it was a huge trauma in my life, and yes, if I had been perhaps working all along, it wouldn't have, from a financial standpoint, from a social standpoint, et cetera, it wouldn't have had that many consequences, but it did.

And at that point, my best friend Patrice said to me, you know, I just finished at Harvard. We were up in Boston. I finished at Harvard, the School of Public Health, and I loved the MPH program. And you've been now, you've been volunteering and you've been doing all this from a medical standpoint, but what, this would be a nice entry point again for.

That enjoys a lot of community work, et cetera. So I did, I actually applied got into the program and it was curious because at the moment that I was starting the school of public health at Harvard, all my children were at Harvard at the same time undergraduate. And I remember telling them, listen, Whoever gets the best grades.

The first semester we'll invite the others out for dinner. And I still say to them, it was the best meal I ever bought. So even though they were wonderful students, I beat them. And I think they saw an older woman at that time go back and go back motivated to do the best possible. I wanted to be an example to them because it was traumatic for them also to see their family break apart. But to see that we go on and and when one door shuts, the other one will open and, with dignity, with integrity we move on and we serve as role models.

So then it was hard. It was hard. I remember my mom who had a similar experience in her own personal life. I remember she taped for me, when CDs still existed she taped for me. I will survive the song, but every singer that ever recorded it. Every single person I had think I had 10 versions of I will survive.

And I remember many times putting too, he tell me, just put it in the, the radio and hear it the whole way as you're going to school. And many of those mornings, I was hearing it as it was as I was crying and driving to school. And but I did very well. And I graduated actually with the Gareth Brene award, which is the highest award in, at the school of public health at Harvard and again, as a, as an old student.

 So I told the kids, if I could do this, with all the stuff that I've gone through and that I, and with your grandma at home being quite ill and all that, you guys can do this too. 

[00:16:45] Dr. Asha Padmanabhan: So what a wonderful role model. 

[00:16:47] Dr. Ana Viamonte Ros: yeah, I made many mistakes I'm sure. But I did the best I could.

[00:16:52] Dr. Asha Padmanabhan: Yeah. Yeah.

That's wonderful. As a role model for not just your kids, but to everyone listening here. Yes. 

So from there to the Department of Public Health in Florida, and then now to the chief Wellbeing Officer, what are some of the challenges that you faced while being in public health? Before we segue into the wellbeing portion?

[00:17:12] Dr. Ana Viamonte Ros: We moved back to Miami and moved back with my mom and all, and I started becoming engaged and involved in professional medical associations. With the Florida Medical Association, the American Medical Women's Association, the Dade County Medical Association.

And what to me was really interesting. And that's how I came to the radar of the Governor. At the time was a new Governor. I think he was looking, I fit the quota. There had never been a female, a woman in that position. There had never been somebody of Hispanic origin, which obviously here in Florida is a huge contingency.

There had never been somebody that I think. At that time, both not just a medical degree, but also a public health degree was interested in public health. So I fit the bill in many ways. I had never, in my life been to Tallahassee, even when I lived in Gainesville, I had never been to Tallahassee and something that to me was really curious.

I had never been up close and personal with politics. And that was a huge learning curve. Huge. And, I met phenomenally successful and interesting and people that helped me along the way and that I was in great admiration of, but I also saw, up close and personal, politics and how politics drives public health and everything else. And that to me was very disillusioning also. 

I think the average tenure of secretaries of health. And if for the very first time the title as a healthcare advocate for the state of surgeon general, the average tenure was about 13 months because it's such a, it's such a difficult environment that people just don't last very long.

It's really quite difficult. But I was there all four years and I'm telling you I don't know how often I had in my jacket pocket, my resignation letter, because there were so many moments that I thought no, I can't do that. This is a line in the sand that I can't cross. And I can tell you some anecdotes about vaccines and all sorts of things. But but I lasted the whole term of the governor. 

That to see how. And I think we're seeing it also, we're seeing it even now, always how politics really runs and determines decision-making and not necessarily science and not best practices or anything else, but a lot of times political convenience.

 And it didn't matter what side of the aisle you were on, it didn't matter if you were Republican, Independent, democrat. I think they all function that way and they all function trying to serve special interests. And as I said, that was very tough, very tough. I had great people to rely on, great people that I could trust.

In an environment where it's hard to trust people and where it's sort ofthe dog-eat-dog kind of,environment. But I did learn a great amount and I was in awe of our public health workers and individuals that really are many times the government employees and are spoken of as being, not particularly effective.

And I was just in awe of them. It's easy to blame other people to take the brunt of whatever's going wrong. But boy, I was just in awe of them, of how service-oriented they were, how dedicated they were, and how little appreciation they many people extended to them. 

[00:20:48] Dr. Asha Padmanabhan: Yeah. And this is something I don't think many physicians realize.

Now I just came back from Tallahassee yesterday, going there to advocate for the Anesthesia Society. And five years ago I would have had no clue and really did not want to get involved in politics, but to learn how important that is physicians, for all the things that we do. The decisions that are made that affect our daily lives, our work, our patients all yet made up there on the state Capitol or the House or the Senate.

And so I really appreciate your service and that position, which is not an easy position to be in. 

[00:21:31] Dr. Ana Viamonte Ros: And decisions are made for us by people that have no clue about Healthcare. And a lot of times when I, cause I mentor also students at the medical school that are involved in professional associations, like the student division of the FMA or the AMA and all that. And I just tell them, listen, that's why we're in the situation we are right now with our electronic medical records, with all sorts of things. Because we weren't at the table to make these decisions. It was the insurance companies, it was the hospital administrators, but it wasn't the doctors that are going to be using these things. And that's why they're not physician friendly. If you're not at the table, you're on the menu. 

And we've been on the menu quite a long time. 

Now you have to have a pretty sturdy stomach to, to be at the table because it's really something, something else. I'll give you an example. The governor had a very prominent contributor to his campaign who unfortunately had three children, two of which were severely autistic. And he decided that it was because of Thimerosal, the mercury, in the vaccines. And it was because of the scheduling of vaccines and convinced the governor. 

That we not only had to increase exemptions to not just cover medical and religious exemptions, but philosophical exemptions for vaccines. And that we had to do way with the scheduling of vaccines. And here we are in a state where we have a huge immigrant population, 20% are uninsured and a certain percentage, even more so under insured.

How could we even be going in that direction? We had not had Thimerosal in children's vaccines for like 10 years before that, but that didn't matter. Come to find out later that he was involved in a huge class action suit and that's why he wanted to do all this. And basically I was told this is the direction the Governor wants to go on.

And you're, you're the public health advocate and the face. And I said, I can't, I can't there's no, the pediatric, at the state level society, at the national society. There's no reputable scientific organization that has found any linkage between anything of what you're stating. 

It would be a huge error in a state with 20% of the population that's uninsured and a certain percentage under insured that we give them another reason. And another way to not get vaccinated with philosophical. I mean, what a disaster, what a public health disaster this would be.

And I remember one of the people that work closely in the governor's office said to me, Listen, you are not elected. You serve at the pleasure of, which is absolutely true. This is like a football team. The governor is the coach and you're the quarterback. And the governor calls the play, and you go out onto the field and you run that play, as you're told. 

If you can't do that, you get off the field. Basically you do as you're told. And at that point I said, got it. You're right. I was not elected. But this is so, so contrary to the wellbeing of our residents here in Florida, that it would be easy to resign over this.

But knowing that I would imagine that they would very conscientiously find somebody that would do exactly as they were told. And if turn right, turn left, or left, wouldn't challenge this in any way. And I thought, you know what, I'm not going to resign, but I'm going to use my position.

I knew I couldn't preempt the governor and, call a press conference and say what I thought and publicly challenge him, but I did have a lot of information and I could rally organizations that could speak up that could write letters that could write editorials that could show up at legislative conferences that could give testimonial during committee meetings, all sorts of things that I could not do. So I, got in cahoots with a healthy start coalition, with a Florida pediatric association with, I mean, you name it and I would, give them information. This committee's meeting such a day. You need to be there. This is going to happen.

You need to speak up, you need to write an editorial, you need to go to this meet. And we were successful that none of those things happened, but it was in that type of environment. When you realize that decision-making is occurring based on political expediency and not on what's truly the right thing to do.

[00:26:38] Dr. Asha Padmanabhan: This is exactly why anyone listening to this podcast, you need to start getting involved at the local level in the politics, because as you said, Dr. Viamonte Ros, if you're not on the table, you're on the menu. So it's no point us cribbing about all these decisions that are being made. If we don't actually. Sit up and voice our opinions.

And traditionally physicians have tried to stay above politics, but it doesn't help us. Yeah, 

[00:27:07] Dr. Ana Viamonte Ros: You're absolutely right. And the other thing that, to me, was discouraging is to see how money and contributions really call the shots a lot of times. And obviously in the Department of Health, this was between 2007 to 2011, we had over 350 clinics throughout Florida. Unlike many other health departments in the United States, we were a very centralized system. And we did provide not just public health education and public health services, but we provided primary care services. Especially in very rural and in very underserved communities where there weren't any community health centers, FQHC's, available.

We were it. We were providing not just a physical care. We were providing dental care. We were providing optometry services. We were providing sometimes even mental health and substance abuse services. So I remember telling our folks, listen, when I go speak to a legislator and his or her staff were in the line, outside the office.

We're the last person in the line because we are our constituency many times doesn't vote, certainly does not give money to campaigns. And we have no lobbyists. So how important is our message, or what kind of acceptance to what we say, do you think there is? Very little, very little. And I said, w we're the voice of people that have no voice and whether they like it or not, we're going to speak up, we're going to try to advocate for these people that really don't have anything else. 

I remember also another anecdote. I don't know if any of your audience has ever gone and driven through the central part of Florida. And we are a state with a lot of affluence in the coastal regions, especially in the south, but the rest of the state is quite rural and quite poor.

We have 67 counties. I visited each and every one of those counties I thought that was very important, not only to support our service providers, but also to understand the type of community that we needed to serve and what their issues were. But I remember going up state route 27, which goes and crosses Lake Okeechobee.

And it's really poor. And I remember going to one of our health departments that was just on the edge there of Lake Okeechobee, mostly immigrant, workers, migrant workers, mostly citrus plantations there. And I remember going with one of the citrus growers to visit the health department and they told us everything that they were doing and the primary care services free of charge.

We wouldn't have sliding scale fees or anything like that. And this gentleman said to me, Really insulted. And he said, oh, I cannot believe that you guys are providing free care. These individuals that are accessing your services are my workers. And these are people from mostly central America.

Everything I give to them and I pay them, they send back to their families. They don't contribute financially at all to the community, they don't pay taxes, nothing at all. And here you are giving them free services. And I said to him, you know what? I agree with you. And I think that if you are in this country, it would be a phenomenal thing to do to find a mechanism whereby we make it so that these individuals can contribute to their communities and can give back monetarily to where they're living. But let me ask you something. Why did you hire them? Well, it was obvious why he hired them, because they were very cheap labor. So I said, so you're actually enabling that behavior that you're so critical of.

Unfortunately, these individuals are going to get sick. We can't prevent them from getting sick. So what is better for you and I as taxpayers to pay. A much higher ER, visit, then they will, eventually go to when they get sick, in a very high cost setting like an ER in the hospital, or is it better to provide them lower costs, preventive services, and primary care services in this setting?

Because they're going to get sick. So what's better, the high cost or the lower cost. So, as I said, there's just so many things that are that we see amongst the people that we live with and we live around. Or 

I remember my son one time. My, my oldest when we lived in Gainesville, I got them always involved in a lot of community service.

And since they were little, they started volunteering with meals on wheels program. And my oldest one, I think he must've been like three and a half years older and it wasn't even four years old. He could actually stand in the back of my minivan as went into trailer parks where very poor people and people, elderly people that had no one else.

And we would hand out the food. And I remember one time when we went into one of these trailer park communities, he looked around and he said to me, where are we? And I said, what do you mean? Where are we? We're here in Gainesville where? And he said, no, I don't live here. I said, yes, you do. You live just down the street.

you live down the road from here, but this is not what you're used to seeing. This is not an area you're even aware that exists unless you intentionally go there, but these are our neighbors. Yeah. So I think it's very easy sometimes to put blinders on and to not recognize that amongst us live quite needy people, that for whatever reason are struggling. 

And I think whatever we can do to help them, some people say, oh, people will take advantage of these things. I'm sure if there are some people that take advantage of situations and of programs or whatever, but the majority of people are really struggling and they honestly, for whatever reason in their life and situations that they've had to go through are, this is very tough and they've had tough lives. So we shouldn't necessarily jump so quickly to judge others. 

[00:33:43] Dr. Asha Padmanabhan: Yes. And like you said, there are people in the community that need the help and we cannot just, focus on that straight road with the fancy houses on either side, we really live in a community.

So going from that, the people need to the people in need in medicine now. I don't know if you read the recent article about physicians quitting medicine and burning out. And I know you are the Chief Wellbeing Officer for Baptist, and you were brought in because of the current crisis facing health care with the staff, physicians, nurses, all burning out.

So what is this initiative and what have you seen as you roll this out? 

[00:34:24] Dr. Ana Viamonte Ros: So, lots to talk about in that sense. I think even before the pandemic, before COVID, I was really interested in women's trajectory professionally, and it's not so much the pipeline, because I think even when my, daughter started college, it was the first year that I think there were more women than men that had been admitted. 

In our medical school class, I think even in my kids' law school class also, it's not infrequent to see that women attendees, you know, or students surpass numbers, men. So it's not so much the pipeline. But it's retention later on and it's a, it's like a peak and it's you quickly, you don't we don't negotiate well salaries. We are pulled from a family job, balancing situation. 

Even men that are stay at home a lot of times, the care-taking swells on them disproportionately tremendously. I even see it in my own children, the men, the son-in-law and the, my son and et cetera, their wives all work and they're wonderful fathers and they're wonderful husbands, but there's no question that the caregiving is disproportionately allocated to the women. There, there isn't. 

And the other thing I remember, this is pre COVID. I remember reading a statistic one time that was just floored me, that it was 40% of all women, six months after completing their residency or fellowship. Either completely leave medicine or change careers, 40%, 40% you think?

Oh my gosh, that's incredible. And now with the pandemic, I think, yes the well-being and the mental health issues have, I think disproportionately impacted, I think women as well imagine working full time, but also being responsible for negotiating the zooming education of your children.

W H how could that be? And how could you do it all? And we had at Baptist specifically, a number of years ago, pre COVID. several very high profile suicides among the medical staff and a couple of doctors that were really revered and highly respected. And at that moment, The issue of burning out, this is again, preceding COVID, was front and center. 

The President of the Florida Medical Association there in Broward County and the Board of Medicine, he took his life also. I mean, obviously everybody's life is complex and there's not one thing that you can put your finger on that would have been, but certainly I think the disenchantment and the disengagement with their profession ranks high as well and getting people to feel less burdened by documentation and the regulations and the electronic medical records.

I was telling one of the doctors the other day, I realized to teach resilience and to teach mindfulness and to be able to offer all these resources are important, but I think we have to work very intentionally to recognize the root causes of why people are disengaged. we have to realize and do something about that too. Not just teaching them because those are band-aids. We really have to go and that's the hard part to do. And that's very, sometimes political to tackle that. 

What I'm very pleased to say is that this past summer at the corporate level, they recognize this is something important.

I think we need to be transparent and we need to be honest about how people feel. We have to survey individuals and come to terms and not just whitewash the results and not be honest about things. People are not happy and people are disengaged. And what is it that they need from us from a corporate level, at the institutional level?

So we did create our wellbeing program. I think the other thing that's really important is to recognize, to normalize, to de-stigmatize mental health. Yes, and that it's not easy and it believe me there may be a handful of people in our in our staff that I've been able to that feel like I do. That we need to set the stage and be role models of talking about mental health challenges, whether they be with ourselves, with our family members, with our dear friends, everybody, if they're honest has been affected by this.

And if we, if we had a spouse, a child ourselves or whatever, they were diabetic, or we had osteoarthritis, or we had high cholesterol, there'd be no problem discussing that very openly, but God forbid, we're depressed. Or where, we're seeking counseling, or we therapeutically have to be managed, whatever.

And I remember in medical school, one time we did that, we asked a class of 130 students. How many of you yourselves close family members, close friends are dealing with diabetes. Many people raised their hand. How about mental health, nobody raised their hand. And I thought, that's more prevalent even than diabetes. 

So I've been involved in a number of webinars where the head of pastoral care or one of our chief medical officers in one of our hospitals at South Miami Hospital with one of my Palliative Care docs where we've all spoken about our own vulnerabilities, our own challenges, everything, because unless we do that, it's really hard and it's not only.

Frowned upon and embarrassing and ashamed. And I see even from a parental standpoint, you know, we'll talk about our kids diabetes, let's say, but we won't talk about their depression or their anxiety or because then that's it, does it mean that I'm not a good parent? If my kid is having to, struggling in this it has so many layers of judging.

From ourselves to society, to our colleagues, to everyone, and we have to change that. So, we've really very, been very intentional in trying to speak very openly about it, but we have a lot more to do in that regards to, for sure. 

[00:41:13] Dr. Asha Padmanabhan: Lots of work to be done, both in that and in making sure people in healthcare are supported.

And every way, especially at this time of crisis, because our ongoing crisis, there needs to be a lot of support. Yes. 

[00:41:29] Dr. Ana Viamonte Ros: Absolutely. Absolutely. And people, I remember a couple of things that, we've had to work through our member, somebody with, I remember before Omicron, Delta was subsiding.

Okay. So we're good now, the COVID has gone. Do we really need all this programming and all this, and I'm thinking to myself, oh my gosh, absolutely. You're just not aware. And you're just, you know, it's very easy to put your head in the sand and not recognize the struggles people have.

And most recently also somebody said to me, Okay from the Omicron. So again, we're good. Now we're done. Problem solved. Kind of thing. Yeah, exactly. Exactly. We can turn off the lights. We can all go home, but but I think it's, like you said, it's very important to talk about it, to be honest about it there, I know there are a lot of cultural and religious taboos around all of this that we need to very aggressively fight against and, and fight against this culture of silence that we're all a part of. 

[00:42:42] Dr. Asha Padmanabhan: Exactly. Exactly. Any parting words of wisdom for women physicians as they navigate these challenging times and the challenges of being a woman physician and aspiring to leadership, or even thinking that you don't want to aspire to leadership, you just want to put your head down and work.

So all sorts of different places that women physicians are currently. Parting words of wisdom? 

[00:43:08] Dr. Ana Viamonte Ros: Be kind to yourself. No, that if you don't care for yourself and you're not cognizant of what your needs are, you won't be a good caretaker. You won't be around for others. So take time for yourself. It's not in a selfish way at all, but in a selfless way, because you want to be there for other people, be kind to others.

And it's not sometimes we rail against, oh, the men and we have to be, sometimes women are each other's.

Not good friends, you know that there's not a lot of room up on the top. So if I got there, I'm going to. You know, not be. 

No, what you give to others. It does come around. It really does come around. And so be kind to other people, be kind and be kind to people that maybe haven't had the opportunities that you've had.

I think that's really important. I always told my daughter several things. I told my daughter I think it's really important as a woman that we feel respected and we feel. Loved and we feel hopefully admired. And if it's a partner, fantastic. But if not more importantly, it's ourselves. Yes. And to recognize that. I don't care if you marry, Bill Gates' son, you will be an independent woman. And that's why I'm working so hard and I've made sure that you, from an academic standpoint and from a professional standpoint, you achieve the most you can, because I never want you to depend on anybody.

I want you to be your own person. I want you to be able to financially support yourself and support your children. If God forbid something happens, I want you to be prepared, and I'm willing to help you get there. And I'll always help you, but I want you, when I'm not around to be able to not have to rely and not have to with what you don't deserve.

And I've always told my son, at the end of your life, what's important that you leave your own children is not a huge trust fund or, a fancy home or you know, whatever. It's a good example. So always be cognizant of that because they're taking their cues from you and how you treat others and what you value is going to really, and again, you can do the best you can and sometimes things don't turn out the way you want it, but at least you have a little part of you that says I did the best I could. 

[00:45:32] Dr. Asha Padmanabhan: Absolutely. Well, that was so useful for not just our listeners, but for me personally. And that was wonderful. So thank you. I really appreciate you coming here, Dr. Ana Viamonte Ros. 

[00:45:44] Dr. Ana Viamonte Ros: My pleasure. And I can't wait to have you here in Miami to enjoy you again, to enjoy your presence again. Thank you. Thank you.