Hi, welcome to the worthy physician podcast. I am your host, Dr. Sapna Shah-Haque, a board certified internal medicine physician. Keep life simple. You are human. You are worthy. Remember what matters to you Our goal is to help physicians remember this and to make it a reality through addressing various components of physician burnout via podcast. This is meant to be used as a tool to help guide physicians. It does not take place of professional medical help opinions reflected in this are my own.
Dr. Shah-Haque
00:58 - 01:27
And this episode of the worthy physician podcast, I sat down with Dr. Simon Maltais, who is a cardiothoracic surgeon, but also gives his personal take on what he's gone through in medicine aspects of burnout and discusses his not only his career as a surgeon, but also his coaching business and his book. I'd really encourage the listeners to grab ahold of what he has to say has a lot of good information. And tell me about yourself. What is your name What do you do
Dr. Maltais
01:29 - 02:15
Yeah, so my name is Simon Maltais. I'm a cardiac surgeon. I, practice still. I'm also, so I'm in Montana now. I also have a, we have a vacation place in California. but, yeah, practice every, every week I do have a coaching business as well. you know, which we're trying to build. And then, I have my own personal medical, business, you know, sort of the medicine online thing. And, I just wrote a book, you know, about, about, healthcare and mental illness and anxiety, work and how to balance work life balance. So,
Dr. Shah-Haque
02:17 - 02:27
And given everything you named off plus your specialty, how do you find time for work-life balance
Dr. Maltais
02:27 - 03:12
Well, it's a, it's always a challenge, but, the, what I'm noticing is that, I mean, I've, I've changed. I used to work at the Mayo clinic where we're 90% of what I did was heart surgery. so, I, I found that I was able to find some flow into managing that schedule and sort of diversify what I was doing. you know, sort of making the pie of that difference. you know, having the family, having the, I mean the family, having the work, having like virtual time and so as opposed to having just work. So, so that the others things in my life will, all, all things don't just depend on work. And then
Dr. Maltais
03:13 - 03:54
The things bring me some different aspects for which I can, know I enjoy doing it doesn't seem quite as work, so to speak. you know, the, you know, as always been just, many cases, I mean, I've been for years for over a decade, I was there from, you know, 6:00 AM to eight, 8:00 PM every day, just doing cases, seeing patients and, and overall for me that wasn't, it wasn't fulfilling enough that, whenever work was not going well, I was not going well together. So now I think balancing means making sure that the pie is a bit different, so sort speak.
Dr. Shah-Haque
03:55 - 03:60
Sure. And can you tell me a little bit about your coaching business
Dr. Maltais
04:00 - 05:10
Yeah, so, www.breakthroughpoints.com. So the, the, the company's called breakthrough points. I'm actually, I'm one of the partners, but we're four people. my wife is a cardiologist, but she also is a breathwork facilitator yoga teacher. So should we offer those services and we, it's basically an extension of the book. So the book addresses, you know, mental illness, flow, resiliency, and high intensity environment, healthcare, but a lot of the themes that we talk about, you know, time management, resilience, culture, making sure that you take time for yourself, is, are applicable to other environments, high intensity environments. So, the coaching company really extends the concept of a flow state, the resiliency in health care, but also other high intensity environment. So business, sports now, you know, we hear a lot about that then.
Dr. Maltais
05:10 - 06:28
So, so my wife and I, started that, and then we affiliate ourselves and it also includes mentorship, right How to progress into, you know, a, a high intensity environment, but doing it right, right when you start. And so you've set yourself up for a long long-term plan. and so I've, we were fortunate enough to partner with a surgeon at the Mayo clinic. Who's a master educator, that I knew, and then also a retired professional athletes who just retired from, MLS, the soccer league. And, and, he, he was also an ex you won an award during his career, the comeback or the coming, because he was struggling with pain and surgeries and things. So the company really addresses widens, I guess, the approach and we offer one-on-one coaching. We offer anxiety relief, we have a whoop analysis project. so we really have, we're really kind of a one-stop shop to help people just manage their life better, and then have mentorship throughout their career. We hope that, you know, through the experience that we went through, we will, we're able to help some people, you know, sort of not get to a point where we all were.
Dr. Shah-Haque
06:30 - 06:32
Sure. Now, what is the title of your book
Dr. Maltais
06:33 - 07:04
So it's called health care anonymous, put yourself first to avoid anxiety, burnout, addiction. so it's, it's, and yeah, and it's also translated and it's been bought by a French editor it's called code blue and French, so that, it just released, it just released this past Monday in the U S and it will be released next week or the 25th or 26 in, in French. So
Dr. Shah-Haque
07:05 - 07:13
Very cool. So tell me, can you share a little bit about the book with us, which you would feel comfortable sharing
Dr. Maltais
07:13 - 09:04
Yeah, so, yeah, healthcare anonymous is really, is really, no man, it's just not just me, right. It's my sort of life experience on building on my life experience to, provide a dissection of what I feel is what I call in the book, healthcare disease, sort of a new concept, but the book is describing it as a disease to which when the same thing as when you start, when you have a disease like diabetes, you have to cope with a chronic problem. and, and in that case, it's healthcare. So we go over the culture, the historical influences, the mentorship, you have the school, the, you know, the personality traits development over a period of time, better forced on us as opposed to, you know, because dealing with death, tragedies and, and responsibilities, then I go into, then I go into explaining that the disease, what I, what I think when we talk about burnout, anxiety, addiction, that's all an acute moment of the disease of it, more of a chronic problem. And, and the way I explained the problem, like kidney diseases is there's three major vortex or three major poles that needs to interact together for the manifestation of the burnout or other diseases. So I talk about the individual. So the host, right. the, and I talked about the main character traits, that the host has in to develop this chronic maladaptive process within healthcare. A lot of it is perfectly professionalism, the plus and minuses of perfectionism.
Dr. Maltais
09:05 - 10:34
Talk about that. We talked about, we talk about the trait, the personality traits and how they're developed during their teenage years and early adulthood. And they're sort of imposed on us moving forward. then we can go about the environment, right So the hosting environment, we talk about the culture and the administrative changes, the administrative demands, the finances, the call schedule. So the, the, really the, the setup or the, the environment in which the disease progresses. And then we talk about the, what or the, or the way you interact with it. And when those three, four to six vortices becomes unbalanced, that's where you have the burnout and the middle of the book, or the other issues. and then the middle of the book, we have a big part. I build the book with testimonies. So we have about when it comes to the manifestation of the disease of the healthcare disease. I described this in four different categories, whether they're physical, whether they're psychological, whether they're behavioral, right. So being angry, being, sort of at work and then personal infestation. Cause we always think that, you know, divorce or financial issues or friend, you know, issues are always singled out then are related to one thing, but usually it's a process right
Dr. Maltais
10:35 - 11:29
Over years and things. So then to represent those stories, we have, we have about 20 people, not just doctors, but healthcare providers, technicians, nurses that really talk about their life experience and how they fit into those categories. And then finally with the last three chapters are really about recovery, step by step sort of what I think has helped me or what I think came out of the stories. and what has helped people, to move forward from it. So a lot about education, seeing things differently. And then, the things that we talk about as burnout, suicide, you know, addictions and things, that's, I think to me an acute problem. And if you don't talk underlying issue, I think we're just postponing, you know, the recovery or delaying recovery potentially.
Dr. Shah-Haque
11:30 - 11:35
Oh, absolutely. Because as a system goes on the way it is, it's just perpetuating all that.
Dr. Maltais
11:36 - 12:58
Yeah. And the system is pretty good about, you know, when someone depressed or someone's going through, anxiety disorder or something big, or it comes up at work, you know, drinking or, the system is pretty good about identifying that right there, you know, but then what they do is they send you to anger management and this thing here, the rehab, this anew, like some sort of like psychiatrist for six months, they put me on this sort of leave to check boxes and then these same behaviors, the same call schedule, the same, you know, in constraints. And so we don't really solve the problem. And that's what through the stories people can. And the reason why it's called healthcare anonymous is at some point in my life, I had to read the book, you know, the, the blue book. And, and in the middle that you realize that people that are alcoholic or not are not the ones you think on the street with the brown bag, you know, Are just, most of them are just chronically functional and, and, and so that it represents a, did the same, it's built a bit the same. So which you see that there's a lot of shades of gray, you know, sometimes it's lack of empathy sometimes full on, you know, heart attack from anxiety. And so there's just a lot of different variations of it,
Dr. Shah-Haque
12:59 - 13:42
The way that you describe it. I really, I really want to read the book and it's not because you're here. It's not because you're here on the podcast. It is because I think that you've really spent a lot of time. You've poured a lot of energy into it. I can tell by the way, you're talking about it. And you really look at it at the human aspect, which I think is wonderful. looking at healthcare workers, physicians as humans, because we also have a threshold. we also can only handle so much. And when we're in a field where there is a lot of loss and each patient, you, you lose, whether it's expected or not, it still hits you.
Dr. Maltais
13:43 - 15:00
Absolutely. And, and COVID, we, you know, we talk COVID is just, I think, put things exponential, right. So it really has, the problems were there. It just really put the accent on it. And, and we have a chapter where we talk about COVID and the influence of that on the system and how, I mean, to me, that's mental illness or depression burn, Alvin healthcare culture is really the threat for the next 10 years because people, as you know, I'm sure you you've seen people do that, but I have, I mean, it was barely a month that goes on right now. And I don't hear about someone either leaving medicine, changing jobs, going through some sort of depression. I mean, nurses, you know, for 25 years been in the ICU that just go on and go to work at just completely different job, which is a loss for the system. So I think in the long run, if we don't really kind of Ash stack this as the main problem, just like other things, right. I think that's where we're going to the turnover, the cost related to experience and that's unmeasurable. And it ultimately, I think it's the public and the patients who will suffer, you know
Dr. Shah-Haque
15:01 - 15:15
Absolutely. And I'm not, I'm not anti mid-level, I'm not anti nurse practitioner, anti physician assistant. I work with with both. And they're excellent, but that's not the answer to fill the gap.
Dr. Maltais
15:19 - 16:06
And, I just wrote, I just wrote a, you know, we're being eaten between us. And I don't know if you've seen this, we talk about this in the book is how the competition were. I mean, now the things are starting back. A lot of people have lost money through COVID and a lot of people, you know, I've lost patients. And so between us, we're really ruthless, especially in heart surgery. And I, I just wrote an editorial to one of our major journals who got accepted real quick. So I guess the editor thought it was, you know, an important topic, but I wrote how, you know, the main, the main threat for cardiac surgery. You know, we talk about interventional cardiology clips, the percutaneous things, and that we won't do surgery in the next 10 years, the real threat. This is not that it's not the cardiologist.
Dr. Maltais
16:06 - 16:59
It's not it's us between us. I mean, we just, it's, it's a, an environment where we now even more, we just kill each other, we talk about each other and each other. We, you know, we, we just, we, we shame people for taking vacations or speaking up about how they feel. And so, I mean, to me, that's the real threat. Ultimately. I mean, the, the, the sad part is I have residents right. Then students, they come to my patient and I'm like, Hey doc, what, what do you hear that you shouldn't ever go into surgery and cardiac surgery And well, now I just don't have a good answer for them. Maybe it's not for everybody, but it's certainly a culture that's tough to live with, you know
Dr. Shah-Haque
16:59 - 16:60
Sure.
Dr. Maltais
17:00 - 17:02
I mean, as the real threat, you know,
Dr. Shah-Haque
17:03 - 17:31
And I, I think that's, that's the biggest thing in healthcare right now is that we were not allowed to be human. We're not allowed to just say I'm tired, as physicians and I, I can only imagine it's worse than surgery and I'm not, and I'm serious just because of the, the culture. I mean, we can go to the same university and the culture in the surgery department is different than the internal medicine department.
Dr. Maltais
17:31 - 18:25
Yeah. And I, you know, and, and, and I think I have some medical doctors that have corroborated in the book to talk about like the early, you know, comments on the book. And they like Simon. I can't, I didn't realize you guys in surgery was such under scrutiny for like outcomes and public reporting and, and then pressure to do cases and save money, doing the cases. And, and now it, it, because, you know, we get reports now report cards of how much money we use during a case how much sealant we've used and how much that costs. And, and it's, I mean, it just gets overwhelming. And, you know, I have art in the book where I talk about influences, right. Art, right. So mentors and things, I mean, in heart surgery, for example, our mentor is Dr. DeBakey, which is a name that everybody knows
Dr. Maltais
18:27 - 19:27
Or feels he was known tiring. Right. So when you look back and try to sort of look at someone in our field that would inspire you, you're looking at a person that was very talented, but it was a complete animal on rounds, or like, and it was living in the hospital and which is a different time. And so if you're not completely bought into this, and you're, you're looking for some, some help, you could feel destabilized. And then when you look on TV, right, whether it's Dr. House Dr. Austin, or the doctors on the residents and they all they're dysfunctional. So how do you expect to build a career where, you know, you want to be the best of what you do, but yet you have to be not nice with people, you work with them, and how do they expect people to train in this environment and be the difference like you would, you know, show kids something on TV and expect that they don't, you know, become a certain way. So, you know, it's, it's, there's a lot of work to do.
Dr. Shah-Haque
19:27 - 19:40
Sure. Well, I'm, I really appreciate your insight. And I had no idea that surgeons underwent that type of scrutiny as to how much sealant you used on a patient.
Dr. Maltais
19:41 - 20:36
Yeah, absolutely. And, I mean, we, you know, some states now it's even, it's even worse. You get, I think New York and California, I'm not sure California doesn't need more, but you have, you have public reporting. So you get your complications and mortality rated against everybody else in the state, whether you do five cases and they're all high risk, or whether you do a hundred cases in all low-risk and whether you work in a system or not. So, and then they, the media picks it up. And I remember seeing an article like too long ago, where they talk about individual surgeons in the state with the worst mortalities, and they actually called the surgeon to say, can you explain yourself And I'm like, well, I don't know. I know I've dealt with a bad run. I have tough cases. We can imagine having the media call you for your outcomes and how this affects your life and why.
Dr. Shah-Haque
20:37 - 20:40
No, I, I that's. How D how is that at the goal
Dr. Maltais
20:41 - 21:09
It's, it's terrible and it's actually rewarded by our societies because, now, you know, for the scores national scores for hospitals, public reporting is one of the things that gives you a point, right So if you public report your results in surgery, you get points for the national ranking. So it's, it's sort of caught up in this vortex where you're like, how do I survive in this very stressful environment
Dr. Shah-Haque
21:10 - 21:23
And 20 years ago, it wasn't like that. And reimbursement was a heck of a lot better. Now. I've always had a problem with ranking with hospitals and physicians, because we're not restaurants and we're not hotels.
Dr. Maltais
21:25 - 21:36
Exactly. Five star surgeon, you know And I just, and I just, I don't, I mean, it, people don't realize that. So when patients go online and they go to Google use, how many stars you have
Dr. Maltais
21:37 - 22:37
Well, it's not that you're not good. It's, it's usually because your system is not made for patients to make it easy for them to remind them the rate you sometimes, because internal systems have these special ways of turning some sort of national internal score into a public score. So when you see these doctors with 150 reviews with five star review, that's usually an internal process or survey that's been transformed into a online scoring from the people you work with. So it's not like a hundred, 150 patients went online and give five star review. It's an internal calculation that the hospital has set up. So it's all a bit made up. Right. So they compare each other. And so, but, but, but for, for, for position though, it's, it's, it's tough to live with that. I mean, when you, when you, when you see other people, you compete with other people, and unfortunately that's how we're measured, you know, in terms of success and things like that,
Dr. Shah-Haque
22:37 - 22:52
Right. I've learned not to Google myself. I mean, more people are, you know, that, that don't have that, Hey reminder, rate us. Right. Right. If you,
Dr. Maltais
22:58 - 23:23
by med ranking your number of publications, your bad reviews quarterly, and, you know, as well as I do right. And how it affects it, sometimes it's either just, it's a bad outcome. You know, mom dies from a surgery and the son is pissed. Maybe you haven't been the greatest at communicating outcomes. And then he writes you like a one-star angry review. That sticks, right
Dr. Shah-Haque
23:23 - 23:27
Yes, it does. It does. I've had it as an internist.
Dr. Maltais
23:28 - 23:33
Everything goes, goes to, it goes to that thing. Right,
Dr. Shah-Haque
23:33 - 23:33
Right.
Dr. Maltais
23:37 - 23:37
Anyway,
Dr. Shah-Haque
23:38 - 23:50
But I really appreciate your time. And I I'm really interested in reading your book. And I would, I would the listeners too, to really consider picking up a copy, how would, how would they order one
Dr. Maltais
23:51 - 24:41
Yeah. So they can go on all the usual stuff. the Amazon, the bam, the, you know, all that's available and book a million. and then, if they, it will be, distributed in bars and Nobles and targets and things like that. it will also, if you go to healthcare, anonymous.com, all the one word, you get testimonies, you get samples of the book you get, invite me to give it talk about resonate, resiliency, and, and, and give a summary of the book. And, and you can order it as well. All the links are there. if you go to breakthrough points with an s.com as well, all the links are there are from coaching and then book links and things like that. So, I mean, to me, it's all about the why, right
Dr. Shah-Haque
24:41 - 24:42
Exactly.
Dr. Maltais
24:44 - 25:13
You know, I like Simon's to neck is not as one of my favorite, these simple, it's easy to understand. These really has this ability to describe, and he talks about the wine, right. Start with why. And I think the book that the book is really just to start as much movement as possible. It's not about Simon or Simon, his experience. It's really this sort of raised awareness to, I mean, to this problem, which I think is going to be a real, real big one moving forward.
Dr. Shah-Haque
25:13 - 25:17
I agree. Well, thank you so much for your time.
Dr. Maltais
25:17 - 25:20
Absolutely. I'm glad we can meet. Thank you.
Dr. Shah-Haque
25:20 - 25:36
Thank you. Thank you for joining us today. This concludes the podcast. Subscribe, tell a friend, follow us@wwwdottheworthyphysician.com. Remember, you are worthy. You are human Take care.