Have you ever felt stuck and. And your professional life and your personal life. Have you ever. Thought about who to bet on or who to listen to. Well, whose advice is that? The matters the most. Well, listen up because in this episode,

You're going to find out. Whose opinion matters the most and who to bet on.  

welcome to another episode of the Worthy Physician, 

Combating physician burnout and reigniting your passion for medicine.. 

I'm your podcast host, Dr. Sapna Shah-Haque, 

   

And today I have Dr. Aio. Did I say that right? 

Yeah. How's 

I edit this. So how is it pronounced? 

It's Ekio. Ekio. Okay. 

Aio. I have Dr. Alasio with me and she's going to share some of her stories and tell us about her journey through burnout and moral injury and where she is today.

So I think there are some great pearls, tips and wisdom that we discussed even before the recording. So I think that the listeners will really enjoy this different viewpoint. I think of some of the other guests that we've had on. And so why do I have physicians on this podcast? This podcast is geared toward physician burnout, normalizing the conversation and combating it through awareness and giving us that love for medicine.

Again, it is possible, and that's gonna look different for each person. Dr. Alasio, can you please tell us about 

yourself? Sure. And thank you so much for having me on the podcast.  My name is Dr. Teresa Alasio. I, am based in the Northeast.  So I live in Connecticut and I've worked in New York for the majority of my career.

I was  I went to medical school in New York City at Mount Sinai, and I trained there as well. I am trained in, pathologies and laboratory medicine, so I've been an anatomic pathologist with a specialty in Cytopathology,  for the, almost 20 years. I have worked in academics. I have also I've worked with where I trained residents.

I was assistant program director for the residency program. I have also worked in third party reference laboratories ambulatory care facilities, multi-specialty medical groups where I was most recently, chair of pathology. At a very large multi-specialty medical group with over 500 doctors.

And I left that position in August of 2021 because there was something missing and there was something desperately wrong with the environments that I have worked in. And I needed to figure out a better way to live. To that end, I wrestled with a lot of different things and as a person who has had always the entrepreneurial spirit in me everywhere I have worked, I have created something, I have created a new service, a new practice, a different way of looking at at pathology.

I have always worked with patients unlike the. Typical pathologist who sits in the mi in the, in their office with a microscope. I've been the one to go out and talk to patients. I have best done that through finding aspiration biopsy programs that I've developed. In many places that I've worked where I've done direct patient contact I've either done the procedure myself or I have Done it in conjunction with a clinician, like a radiologist or an endocrinologist.

So I am very happy working with other doctors in collaborating. So I have done a lot of different things over the years and some of which have been extraordinarily satisfying and wonderful. There have been unfortunate areas of medicine where, there are, I have experienced toxic environments, I have experienced pushback from administration as a, when life hits hits everybody, as a mother of now a 15 year old and a 12 year old, when they were much younger, it was much harder because there were times when.

They needed me and there were times when I had to leave and say, Hey, I, things have gotta wait and I've gotta go and get my kids. As a, it's, and it's funny because when you see women who do you know, no matter what we do, Whether we're professional or we're not, or we work in, wherever or we don't work outside the home, we are the ones that are the frontline.

And we do all the invisible work, right? All the unpaid work and regardless of where you are or what you do. So if. If your kid has, if the school calls you and your kid has lice, you gotta get in the car and go and get 'em because that's that. And if your boss doesn't like it and calls you up and says how is that my problem then it's not his problem.

But it's my problem because then I've gotta figure out a way to, to have all these things. Because that's what it's really about. It's really about, people talk about work life balance and I don't know much about that, but I do know that all I want to have is a way to be there for my family and do the work that I was trained to do and the work that I love to do.

And. So after I left in 2021, I thought long and hard about that, and I looked at what my skills are and what the transferrable skills are and what I wanted to do, not what they wanted me to do, not get, because I looked at it and said getting another one of these jobs is just gonna, I know how that ends.

It's just gonna keep, it's. It's just keep plugging myself back in the system. It's, and it doesn't work. It doesn't work for me. I took a look at my family and I saw my kids, floundering a little bit socially I. After the pandemic, everybody was shutting their rooms.

But as doctors, and me as a pathologist, I had to keep going in while everybody was home and shut up in the house. My husband was working from home. My kids older. Activities. They weren't plugged into anything, but I was going to work and I'd come home and every and all the doors would be shut and they would be on the computers and the video games.

So after I left where I was, I said, this can't happen anymore. So I just said, all right, we're all, we're going back into life and that's what we have to do, and I'm gonna figure out a way so that we can be part of life. Again, 

few things that you've said. In that few things that you said that really struck me.

Everything, but that if you plug yourself back into the system, you still get the same results. So that's one. That's one big thing is that this is a work syndrome. It's burnout is not related to the physician. It's not that we're not resilient enough. It's not that we're not smart enough. It's not that we're not doing enough.

Many times we're asked to stretch ourselves too thin and do go above and beyond, which honestly, by our training, we've embodied that. We've really embodied that because we give up so much like you had said before, it's medical school, then residency plus or minus fellowship, so we also have that delayed gratification.

The second thing is that, We all wanna be there for our families. And when you work in an environment where you're told, how is that my problem? That's incredibly toxic. That is incredibly toxic. And how can we be expected to hold compassion for patients or for anybody else when we can't show it to those with whom we work?

Such an excellent point. But they I think that there's a missing piece because there, because the compassion is what's missing. Because obviously if they don't have, I'll tell, okay, I can say this in a s I give you a little anecdote because I have a million of them. I worked for somebody who was she?

She was a. She was a very enigmatic person. She was probably the age that I am now, which I'm not gonna say, but it starts with a five and it's not 500. I walked into, she was an incredibly toxic person in the way that. There would be just lots of mood swings. I don't know what she was going through in her personal life, but there was, there were issues, and this woman, one time I walked into her office and she was on the phone with someone that she was very angry with. She was on the phone, she was screaming at this person. She was berating this person. She was talking to this person as though I as though they were just beating them like a dog.

This person was her son and I was shocked and I thought to myself, if she is talking to her family like this, I have no chance. There is no chance for me, there is no compassion. I think there is, and you know what? Honestly, as physicians we're pretty tough. Oh yeah. We're tough. We're pretty tough.

I went through a surgery internship before I went to pathology. That toughened me. Any woman physician I've met, even, you can be nice, but you're still tough, so we don't ask for very much. It's not oh, like we were saying it's like I, I don't call in because my fish died.

I don't call in because, oh, I have a little headache. We'll show up, I'm not going ask for compassion and you shouldn't have to ask for compassion. That's the one of the things about compassion is it that it's just given, it's given it's given. You don't ask for it.

We don't, you don't ask for, you don't say, oh, please. It's like you sh it's show me mercy. It's I never asked for that in my life. But the fact that it's not given because it's just with, it's just withheld and you ask how can we be expected to show compassion to our patients?

Or how can these people who are not compassionate towards us show compassion toward their patients? The answer is they don't. They don't have to because everybody's got so much pressure. How many physicians do you talk to? Male, female, or it doesn't matter. It's like I have to see how many patients I have, this many rvus.

Now they re decrease the compensation for my rVUS and my production and I haven't, I have to do, I've heard, I took with a woman physician the other day. I have to do locums in another state because I'm not being paid where, at my place where I'm working without a contract, it's like all of this inequity breeds resentment and it, and nobody's showing anybody compassion until then.

There's just burnout and then people just leave. And say, this is not worth it. How would 

you explain inequity in medicine? Oh 

how much time do you have?

Maybe that's another episode, to be honest. Seriously? Yeah. I'm serious. 

Inequity is, being the being the only female in the room at the table. And then having to fight to get there. And then you're not listened to when you're not take it seriously at all when you are when you're, when you offer your opinion or you present your case.

I remember as a chair I had to even fight to get the title of chair because all the clinical departments had chair were, had chairman, were chair people or chairs, whatever you want to call it. And pathology had nothing said. I'm the chair, I'm the medical director, I'm the chair. So I had to fight for that and then get fight to go to those meetings and listen to everybody else and offer, offer what I had to say or how my department was running, not so this was something that, that we had to fight with in, in inequity, in, in hours, in pay. Come on. That's documented. There's a woman who I have a colleague who's a pathologist junior, very junior person. But her. They live in a, her husband makes, has a lot of money.

He's very wealthy, but she trained she trained, she did three fellowships and now she's working, she's a smart cookie. So I. And I know her because she lives near me and she's a lovely person. But when I've spoken to people about her, they've said, oh we know you know her, we've seen where she lives and we don't know why she needs to work.

She doesn't wanna work. She's totally set financially. Why should she work? And this is something we were talking before for the recording. It's like, why would you say that someone going through all of this would not wanna work? It's I went through all of this. Yeah. I wanna work.

Why do you say, oh oh, they've got money. They must, she must not wanna work. That's is a hobby. Crazy. Is it's crazy medicine, a hobby job? Is it a hobby job? Oh 

yeah, I definitely put myself through medical school and then did residency and undertook all those grueling hours and tests and debt for this to be a hobby.

Yeah. Scuba diving is a hobby. Yeah. Podcasting. 

Scrapbooks a hobby, scrap. Booking's a hobby. But medicine is not a hobby. 

No. It's definitely something that you go into because you're called to do it. There's a different, there's definitely a better way to make money with a less liability, and it's not even about if you have money or not.

It's about purpose. It's about purpose and Absolutely. And personal fulfillment. 

Absolutely. But you know the assumptions that are made when people see you or they see if whatever the town that you may live in or what your husband does. Since when does what your husband do does make an impact on whether or not you should be working?

What if the roles were reversed? You don't see women's CEOs and people would say, oh, her hus, why does your husband work? You shouldn't have to work. It's since would that happen? It what universe? No. Would that happen? It wouldn't. 

It wouldn't. And it doesn't. And if it does, the listener can email me and let know what I would love to have them on here and we'll have that conversation.

Exactly. 

Exactly. Yeah it's astounding. It's really astounding. And, the the invisible work that we do as women, and it doesn't matter if we're physicians or, now I do, Now I am setting up a practice five minutes from my house so that my kids can leave school and walk to my office.

Yeah, that's awesome because you're able to be there for your family. You're able to be engaged with them. You're able to be there in times of crisis, God forbid. But also with 12 and 15, those are very formidable ages. Now, one thing that you did say was that you looked at the skills that were transferable from being a physician that we learned in medical school and that you learned through your training.

So what are you doing now as far as practice and what skills are transferable? Because one thing is that we learn a lot in medical school and I don't think that we as physicians, really, not everybody can think outside the box and tr so can you create that bridge for us? 

Excellent. This is a positive conversation now, which I love.

Yeah. 

We had to go through the mud because that's how you, that was your experience with the system and burnout, and so what are you doing now? How did you make that transformation? I really, we've talked before and I really am impressed with what you've done. 

So what I have done, and it's all developed like organically, and that's the way these things have to develop.

It just has to develop organically. It has to come from inside of you. And if you paint yourself into a container of this is all I can do, this is what I can do. Full stop, then you're limiting yourself. And that's what I would tell anybody who is in a situation where they're, they feel stuck. I would say, don't limit yourself.

What I did, I asked myself what would it look like if I did not do pathology? What says, who says I have to do pathology? You don't have to do anything. You can do something else. You don't have to do anything. Yes, and I know we all trained as internists or we trained as pediatricians, or we trained as er.

Yes, I know all of that. And all that set aside medicine is changing. Medicine is still a field where we can. All, we could all be happy and we could all find a space. So after asking myself I don't have, what would it look like if I didn't do pathology? I decided to open an office that was based on aesthetics.

So I decided to do medical aesthetics and and. I trained, I've trained for the past year plus in all of the different procedures. I've also discovered the amazing field of functional medicine and become a big proponent of gut health and testing for gut health. And looking at. The root cause of people feeling the way they feel.

As a laboratory person, I've been on the receiving end, I've read thousands of biopsies, thousands, and I know that gis, God love them, but when all you have is a hammer, everything looks like a nail and they have a scope and all they wanna do is scope you. And then they give out PPIs like candy and they just wanna say, okay, here is medication.

But from a functional medicine standpoint, That's not the case. It's let's take a look at what your gut looks like. Let's take a look at the microbiome. Let's rebalance you. Let's work with your nutrition. Let's work with your stress. Let's work with all those things. Let's little that co cortisol, and look at that whole person to feel, to make them feel better inside.

So I thought that would be a really Symbiotic marriage. If you look beautiful on the outside, but you feel like crap on the inside, then I haven't helped you. But when you have people with glowing skin because they have made nutritional adjustments because they feel healthy on the inside.

Then I've done something for you, then I've helped you. And that's whether, you're a teenager with acne, which is, can be devastating. For teenagers and in their growth. It has real psychological ramifications. It's a big contributor to depression in teenagers and even the scars that acne leaves goes on into adulthood.

And I think really, finding that way to work functional medicine into our, into the way we talk to patients is so much more satisfying. So this is what I've found it, I've found, is to be the, to be just a beautiful way to, to connect with people. And be part of the community.

Cause it didn't make sense for me to say, okay, I'm just gonna go and open a lab because everybody and his brother who opens a lab, it's a losing proposition because while it's, it's, again, it's this, it's an iteration of doing the same thing over and expecting a different result.

Einstein's definition of insanity. Definitely. One thing I. I absolutely am a fan of functional medicine, and I wish that insurance God bless them, actually paid for it. Because the, that's the reason why many of us went to medical school, that in lifestyle medicine, it really gets to the root cause.

But, and this system today in Western medicine, we're really trained to push pills instead of getting ready, getting really at theri of the solution to the problem. So that's awesome that you're able to do that and you're able to take your knowledge of pathology and apply it differently.

Look, you go to a psychiatrist, they're gonna, they're gonna give you antidepressants. You go to a cardiologist who's gonna give you statins. You go to a gi, he's gonna give you P I, right? There's medicines for everybody, and this is really, the United States is one of the only countries.

That has drug ads on tv, big pharma is everywhere, and that's all they do. I went I had a conversation with a cardiologist and I said I'm not really convinced that the, all the literature and statins and that, all of this, these studies, it's been shown that it's, that it's flawed.

The evidence for that is, is flawed. And from a functional medicine standpoint, there is no case for statins. They don't do what they're, they just make you feel bad. They make you feel worse. But, I realized cuz he, he was just, he looked like a bomb went off, or it looked like I just, shouted profanity at him because he looked at me and he was like no. Statins are good. We all need the lowest cholesterol possible. And, and that's how, that's the best thing. And he was like, and I realized it was like, if I like, disrupt his dogma, he's, his whole reason for what he's doing is gonna be gone and he has to question everything and he can't do that.

They can't do it. So I'm fighting a losing battle, so I'm gonna go take my battle someplace else. That's all. 

No, absolutely. Absolutely. It's it's one of those things where I think we're so deep into a way of practicing that if we try to question, what am I really doing here? It starts to spark that curiosity at that we as physicians have, and when we go looking for an answer and it really just disrupts what we have been trained to do, it absolutely makes you question, what?

What am I doing this for? What have I done in the past? Was that right? And it's very difficult to sit with, but at the same time it's interesting to, to look at that. There might actually be other ways to heal other than pills, a pill for every ill, but unfortunately with our system and the way that physicians are reimbursed, going back to it being a system problem, not a physician problem, we have to have patients in and out and.

We don't, we're not compensated for taking the time to really look at what is the, why do you feel this way? Why are you bad? Okay, why are you feeling bad? And here's a pill, and I'll see you in three months. Average eight, eight minutes maybe. 

Yeah. And y I think they try to fix that with like ACOs and looking, the reform of the healthcare system and, all this, incentive for wellness and this, the word wellness, like propagated and.

In the end, I think that was just lip service, frankly, because it is wellness if it suits them the one very disturbing thing I heard, and this was in fact yesterday. I was in a, I was at a conference in Boston and this was a laser conference, so it was all about like lasers and what you could do with lasers on the skin.

And you could do amazing things, right? You can, and you can really treat people and make them feel better. Like you could treat melasma, you can treat it's not just cosmetic. It's really affects people's lives, right? Anyway, that's a side. But somebody gave a talk on like the aesthetics industry and the aesthetics industry is cash-based industry.

So when you talk about insurance that like, no. But having said that, plenty of people will pay for it. Plenty of people, that's what they pay for. They'll pay for Botox over something else. Over something that they really need, quote unquote really need the real health. Which is another conversation.

So the aesthetics industry is booming. They expect like 14% growth over the next 10 years, which is nuts, right? This is the disturbing thing, is that it was said in this whole mix now healthcare. Companies and we're talking about whatever out here we have, the healthcare like systems, right?

Like the big systems, the big conglomerates are getting into this business. That was so disturbing to me. I was like, whoa, my head exploded a little bit. How can this be? They see it. If they see money, 

they see nothing money. 

They see the money they see money. And what are, and what is that gonna do?

What is that gonna do? Because then what are you gonna do? Are you gonna have You're going to be giving you go to your favorite family practitioner, and I see it too because I see it tr people training all the time to do like injectables. So you're gonna go to family, so you're gonna go to your family practitioner and they're gonna offer you Botox, which you pay for in cash.

That's, that is what is coming. 

That doesn't seem to be safe.

Botox is not unsafe. Botox wears off last three months. You can't really kill anybody with Botox. To be honest with you, you cannot. There's other things that you can do really harm on the scale of like harmful. On the harmful scale. Botox is less harmful. You can distort somebody's features and make them not look good if you mess up and you don't know what you're doing, but it wears off and.

Pretty much you're gonna be okay. However, things like if you start getting into like fillers, you can cause vascular occlusions and those could, those are medical emergencies. So you really do have to know what you're doing. You do have to be doing your, you do have to do the proper training. For those kinds of things.

And certainly doing if you're gonna do any kind of like lasers and you can really cause a lot of harm, but so on the harmful scale, Botox is not so bad, but. If you start getting into other things, then you start talking about harmful. But this the concept of let's see how we can get more out of people and maybe we offer this, maybe we, have them have providers do that.

So could you imagine 

No, I doing this. No I would not want to do that. I would not want to do that at all. 

No, I know you would not want to do that at all. That's funny the way you just said I, no, I would not want to do that at all. 

No, because it's, I can receive all the training day in and day out, but it's not gonna give me any type of fulfillment.

No, you don't wanna do it. No. 

No, but just saying, but this is what really shocked me was like healthcare systems are looking at being involved in this because they see aesthetics as a cash business. I might be and that, you know what? You heard it here first folks, because it sounds crazy, but you watch, I bet you what happens.

Yeah I 

don't doubt you, because they're wanting to increase that bottom line. And that's just, and the reason why I say another thing I would not wanna do it is how in the world would I create a. Time and minority booked schedule to do something like that is not gonna add any value.

It might, it's not gonna add any value to my schedule or to my right reimbursement. It's all gonna go to the system. Yeah. And so that's just gonna put 'em on overload even more. 

It would, certainly that, I guess it depends on what specialty you do but I know OB GYNs do it.

There are, the urologists do it. Dentists do it.

Oh yeah, they do it.

Dentists actually, one of the, a treatment for TMJ is Botox, right? Is giving neuro is giving neurotoxin. So if they have it, then they're gonna be like, Hey, let's just do, oh, let's, let's live in your forehead and that you can make the, you make the leap now.

It's not a real money maker, but it's, you could do mu many other things that are much higher, much that'll bring in much more cash Sure. For a practice. But if you add that, it's a little extra. It's like putting the, it's like the impulse buy at the checkout counter. It's I'm giving you, I'm giving you this.

You've had your treatment, so how about little Botox? Yeah. Take a little bit. It's like a pack of gum or people magazine, little Botox, yeah. Little. That's the way 

it's being, that's the way it's being treated as just a commodity like that. And that's sad that's where medicine is going and that's where a lot of the moral injury takes place is that we're now looking at, we're working in a system that has gone astray even more so with why most of us went into medicine.

So 

exactly 

what are some, what is the one blast pearl of wisdom that you would like to leave for our 

listeners?

What I've been saying to myself for some quite some time now is, bet on yourself. Always bet on yourself and follow what you wanna do. And you won't go wrong. 

And if our listeners wanted to reach out to you, where can they find you? 

My website is intentional self ct.com. I can be reached, my Facebook page is Intentional Self.

That's the name of my company. And my Instagram is Dr. Terry Alasio, t e rry A L A S I O. 

And all these will be in the show notes. Dr. Alasio, thank you so much for your time. 

It has been my absolute pleasure. Thank you. 

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