This episode of Menninger Clinic’s Mind Dive Podcast explores burnout and emotional labor experienced by physicians and mental health professionals, particularly in women clinicians. Driven by their observations of burnout within their own psychiatry department at Harvard Medical School, Ashwini Nadkarni, MD, and Jhilam Biswas, MD, take a dive into their quest to understand the factors influencing women who are leaving the field or contemplating career changes.
Join hosts Dr. Kerry Horrell and Dr. Bob Boland for this discussion of issues commonly faced by women physicians, such as an increased likelihood of depression due to the strain of balancing work and family life and the emotionally charged experience of discarding professional aspirations for conflicting needs.
Dr. Biswas and Dr. Nadkarni are both instructors of psychiatry at Harvard Medical School Department of Psychiatry. Dr. Biswas serves as the Director of Psychiatry, Law and Society program at Brigham and Women’s Hospital and the Co-director of Harvard Mass General Brigham Forensic Psychiatry Fellowship. Dr. Nadkarni also serves as Assistant Medical Director of Brigham Psychiatric Specialties and Associate Vice Chair of Wellness in the Department of Psychiatry.
Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to never miss an episode of Mind Dive. To submit a topic for discussion, email podcast@menninger.edu.
Visit www.menningerclinic.org to learn more about The Menninger Clinic’s research and leadership role in mental health.
Listen to Episode 31: Neuropsychiatry, Connecting the Brain to Behavior with Dr. Julia Ridgeway-Diaz
Resources:
“Gender Disparity in Cognitive Load and Emotional Labor—Threats to Women Physician Burnout”
Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!
Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.
This episode of Menninger Clinic’s Mind Dive Podcast explores burnout and emotional labor experienced by physicians and mental health professionals, particularly in women clinicians. Driven by their observations of burnout within their own psychiatry department at Harvard Medical School, Ashwini Nadkarni, MD, and Jhilam Biswas, MD, take a dive into their quest to understand the factors influencing women who are leaving the field or contemplating career changes.
Join hosts Dr. Kerry Horrell and Dr. Bob Boland for this discussion of issues commonly faced by women physicians, such as an increased likelihood of depression due to the strain of balancing work and family life and the emotionally charged experience of discarding professional aspirations for conflicting needs.
Dr. Biswas and Dr. Nadkarni are both instructors of psychiatry at Harvard Medical School Department of Psychiatry. Dr. Biswas serves as the Director of Psychiatry, Law and Society program at Brigham and Women’s Hospital and the Co-director of Harvard Mass General Brigham Forensic Psychiatry Fellowship. Dr. Nadkarni also serves as Assistant Medical Director of Brigham Psychiatric Specialties and Associate Vice Chair of Wellness in the Department of Psychiatry.
Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to never miss an episode of Mind Dive. To submit a topic for discussion, email podcast@menninger.edu.
Visit www.menningerclinic.org to learn more about The Menninger Clinic’s research and leadership role in mental health.
Listen to Episode 31: Neuropsychiatry, Connecting the Brain to Behavior with Dr. Julia Ridgeway-Diaz
Resources:
“Gender Disparity in Cognitive Load and Emotional Labor—Threats to Women Physician Burnout”
Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!
Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.
00:02
Welcome to the Mind Dive Podcast brought to you by the Menninger Clinic, a national leader in mental health care. We're your hosts, Dr. Bob Boland,
00:11
and Dr. Kerry Horrell. twice monthly, we dive into mental health topics that fascinate us as clinical professionals, and we explore those unexpected dilemmas that arise while treating patients. Join us for all of this, plus the latest research and perspectives from the minds of distinguished colleagues near and far. Let's dive in
00:43
so we're really excited today we have Dr. Jhilam Biswas and Dr. Ashwini Nadkarni, both doctors and instructors of psychiatry at Harvard Medical School. Dr. Biswas serves as the Director of the psychiatry Law and Society Program at Brigham and Women's Hospital in Boston. And she's a co-director of the Harvard Mass General Brigham forensic psychiatry fellowship. And Dr. Nadkarni also serves as the assistant Medical Director of the Brigham Psychiatric Specialties, and Associate Vice Chair of wellness in the Department of Psychiatry. They're experts in many things, and there's many things we could talk about with you. But we're gonna be talking really about your expertise in wellness today, particularly around some important papers that you've written only recently that are in JAMA psychiatry, really about burnout and particularly burnout in women physicians. All right, so we're going to
01:34
thank you both for coming and for the work you've been doing around this welcome. Yeah. So
01:40
thank you for having us.
01:42
delighted that you're here. And then we fell in worked this out? Well, can you tell us you know, what prompted you to write the article in the first place by burnout?
01:49
So we were having this conversation about causes of burnout or the positions at our department? And remind me, Jhilam it might have been early morning, which makes so much sense because of course, early morning rush with your kid is really vivid in your mind, right? This idea? Oh, God, emails, what are the patient's What's up for today, but I still need to pack that lunch. And I need to make sure that they get to that doctor's appointment after school. So I think for both of us that was so salient. We were talking about, you know, what is driving women in our department to leave to go to other places, or even consider career ships? And we have this revelation? Is it possible that, you know, it's not just about the workload, being what it is, but also driving this differential cognitive load and emotional labor because we feel like we are often the ones in the family, managing everything that's going on, and having to, you know, toggle all the information to manage it. And so we kind of had that revelation. But Jhilam, you tell me what that was like.
03:00
I'm gonna pause y'all real quick, because we didn't do this. You were just hearing from Dr. Nadkarni. And now you're going to be hearing from Dr. Biswas. So you know, the onus is on their own on their own after that. Yeah,
03:14
this is Dr. Biswas. And so I distinctly remember, this is very synergistic conversation that I had with us, because Ash is the Vice Chair of Wellness at Brigham and Women's Hospital. And she was checking in on select faculty over the course, you know, over throughout the department. And she reached out to me saying, you know, I just want to hear your thoughts on how things are going, how can we do better to reduce position, you know, just fatigue. And we started talking, and it was like, it was a very synergistic conversation where we were realizing we were having this shared experience, really of humbling, you know, long term planning and short term planning and domestic issues and kid stuff and, and then, at the same time, all the various pieces of our roles and our jobs as physicians, and as educators and as researchers and as clinicians, and I think we were like, wow, you know, how do we think about this toggling that we're doing, you know, switching gears on a regular basis, and at the same time being the glue, that kind of, you know, like, I think we said in the paper that opera background operating systems so that everything can land and land in the right place at the right time and move forward smoothly. And I think it's being that glue, and also doing the toggling and making sure everyone feels emotionally secure and everything that we're doing is what was leading to a level of fatigue that was somewhat intangible. But until we started talking about the granular details of what was going on, we realized aloud this is what it is. This is a fabric of fatigue.
04:59
but this is one of those episodes where I wish the listeners could see our faces because I'm just my face is saying, hashtag retweet. That's what it's saying like, Wow. Yes, yes, yes. Yes.
05:11
I know, we don't usually spend much time background, but I do think there's asking because this is a relatively new position in universities and in, in medical schools. And so ash, I'm just curious, like how you got interested in wellness, and ended up being in charge of it. For your, for your director of Well, is it fair to say, I mean, what would you say is chair of I mean, most 10 years ago, no, no place had a had such a role. Five, maybe what, but five years ago and stuff places started developing them now. Now. Many places have chairs of wellness, wellness and such. So this Yeah, yeah.
05:49
So I got started on this, really, because of my level of connection to people in the department. You know, when I came in, I was really awed by my colleagues, mentors and leaders. I thought, Oh, my God, it's Harvard. And I do think people at the institution take what they do incredibly seriously. It's not a job, it's a career. And I was really wowed by the passion and the dedication of colleagues.
06:15
But if your current and your clinical expertise is remind me in GI, right,
06:19
yeah, yeah, that's right, I collaborate with the Crohn's and Colitis center. And actually, the the clinic ran base, I had a number of colleagues from the women's mental health division as well. And we were great friends, and you know, always texting each other and providing support, bad thing, but a few years. And, you know, there were some institutional changes that caused some doctors to leave. And you know, there's nothing that makes you rethink your career or the culture, or what drives you want a job and people leaving. And I thought to myself at that time, like, oh, people are leaving people, I really, really liked being around. And so I started to have this passion around, you know, what's making these people leave. At the same time, I had a chance to do what's called the Brigham leadership program. It's this joint program with Harvard Business School, where you get a chance to meet colleagues from other departments and hone your skills and leadership. And I picked a project on physician burnout. And that was the first year that the Brigham distributed what's called a professional fulfillment index, which is an empirically supported survey to assess burnout, and professional fulfillment. So I worked on that project, and the Chief Medical Officer of the hospital at the time mentored me on that project. And we actually published a paper on some research that we'd all done together in this interdisciplinary inter departmental group. And then, you know, the institution wanted each department to pick a wellness champion, and our chair, David Silbersweig, gave me a chance to hold that role. And I just, it was, it was such a source of passion for me, you know, I really wanted to make it something and make changes. And I was thrilled that our department put so much support behind us, and really gave me the license to do what I wanted to do with that and collaborate with everybody.
08:14
Well, that's fantastic. That's
08:15
super cool.
08:16
Yeah, I'm sorry. I was I interrupted. You know, I
08:18
think that's a really interesting point, because I don't think I also have known much about what that role entails. Yeah. Um, it does seem so important. And so you had mentioned emotional labor. And in the paper, you also discussed cognitive load. So when I was in grad school, I was in a research group on women's issues. And one of my dear, dear colleagues, Lindsey Robertson, she she did her dissertation, doing a qualitative paper, looking at emotional labor and just trying to like begin to understand like, what are the roots of this thing called emotional labor and how invisible it is and how, again sort of insidious feels like a really, I don't know if critical word, but it feels like that. But I wonder if as we're thinking about this, and you guys are talking about these, behind the scenes of class, you had the best word to describe it, like computer like like this back system that's churning. Anyways, I wonder if you can you can explain or sort of define for us like cognitive load emotional labor and why particularly for women, this is so essential and understanding burnout.
09:21
You want me to answer or should we have Dr. Biswas Go ahead? Up to
09:25
you to your Okay, why don't you use cognitive Alright, so cognitive load and then as you take emotional labor, it's a cause cognitive load is essentially that toggling that we're talking about the shifting of attention and gears towards disparate subjects you know switching from your you know, your roles in your career to your roles in your family and with your friends. I mean, let's not also forget friends and maintaining relationships and maintaining, you know, work related relationships and Kid related relationships and your own friendships from the past and like doing all of that. That's the toggling with the background operating system, like we talked about being sort of the background glue, so that if the ball falls out of the air, there's some sort of system that captures it right? And so it's this work of toggling between multiple different subjects and also being there to make sure nothing really falls off off course. And that's how we perceived cognitive load.
10:29
Yeah. And then we saw sent you could really relate to that right? No, no, not at all. Shifting from Yeah, really, really? Well. You don't think of it as work, but it's work?
10:39
Well, and I want to get rid of labor. But then I do want to come back to that point of like, what is the impact of it? Yeah. Anyways, but let's let's hear from Kearney first,
10:47
yes. So emotional labor, we define as that management of emotions, feelings and expressions. And there's also a sense of accountability, I think for that both in the domain of one's personal life and at work, you know, so I think this is best explained by an example, where, let's say you see an uncomfortable interaction and a meeting. And maybe you feel the accountability and responsibility in that meeting, to decompress with the individuals who are part of that interaction, and try to regulate some of the emotions and reactions that took place. Or say, you know, your kids come home from school, and they say, Gosh, Mommy, you know, Philip didn't want to work with me as my science partner. And suddenly you're the one listening to that, and trying to do something about it, and regulating some of the emotions that might have taken place in that interaction. You know, there's that accountability, that's part of that. And then there's the actual work of doing it, the labor that comes about. And it's interesting, because I think that there's some gender bias, that winds up allocating that work to women. But I think it's also, in some cases, the issue where, you know, we just, we intuitively take it on, too, you know,
12:06
whether it's a societal expectation,
12:09
yeah. Can you say more about that? Because, right, because it's, I think most people would say that what you're describing anyone could relate to, and like, we all have a finite amount of energy to deal with these things. Why? Why do you think it's particularly challenging for women?
12:21
One interesting point, and this is supported by the empirical literature, really, for every, really, for every profession, is that that work often is assigned to women, right? Like women in the office will often be told, okay, you set up the party for Christmas, you do the planning for, you know, this person's retirement party, you have the job of making sure that people feel a little bit better during this particular meeting, right, we're often a sign that so I think that's a key point about the gender bias. And you know, we don't really end up getting the time given, we're doing that work, right. And that's another way it is like that differential administrative time and resources that are given out, you know, sometimes you're given the work, but you're not necessarily given the resources to do the work. And that's why there ends up being that differential load.
13:17
So this is happening at work. And I mean, at home, particularly from like, I'm even thinking about, like, I feel like a common example, with emotional labor. Maybe there's actually more cognitive load. But, you know, even if, like in the family system, the dad, like, took picked up the kid from soccer practice, went and got them a snack, got them home. Like, it's common that it was the mom who was like, Hey, Jimmy has soccer practice today, I've laid out his I've laid out his gear on his bed.
13:47
Here's what we have. Here's a bathroom.
13:49
Don't forget that he's gonna need a snack. First. There's fees in the fridge, I would lose the door. I was at Kroger this weekend. And I got it. And then like so even though like the actual like, stuff.
14:01
That's the glue. Yeah, that's the cognitive load.
14:06
In my head, I have some of the pieces in my head. I'm holding on to it all. And like, Yeah, like that. And I think that's the part that feels like, it is hard to like, have resources thrown to that, because it's so hard to pin down. It's so hard to hold. And yet again, it seems like more and more literature and research is coming out to show that like this does have an impact. It is taking energy from people that's not being accounted for. Because I feel like that's the piece of problem. Maybe, I don't know, this, I could imagine it would feel like really bad. Like I'm doing this thing. It's taking energy, but like, no one even knows about it. And I'm like, I'm kind of curious, like the
14:41
guy will go ahead and feel safe experience and do all those things that you just assigned. And then you're a big hero,
14:46
huge hero. What out of the years.
14:49
Exactly. Yeah. Yeah. And I think we say that. I think in one part of the people were saying when when a father helps, they're seen as helpful. And I think when a mother does The, it's expected. So it's the default. And when a father does it, it's helpful. And I think that piece of it and it's not it's not. This is about women and men, it's not just that men don't experience burnout, and they do try to help. It's just almost like the societal expectations, like when your child has a fever of 100.4, and the school calls you, you know, it, they default to mom, you know, that's, that's sort of you take that first call. And
15:29
I think nowadays, both parents definitely are thinking, let's just wait till it's 101 Keep on them right now.
15:35
Call me--give them a little little Tylenol.
15:41
I was thinking about how something you said, and if I do have any of my colleagues, I work closely with listening, they're gonna be like, Kerry, this is you. Like, I call myself the unofficial party planner of our unit. And like, I, I take these things on, I'm, I'm good at it. I like
15:58
it, like people give you lots of extra time for that, right? No one gives me a shine for
16:01
it. But I do get lots of compliments for it, which you know, that's a type of currency. But I do like, I'm thinking just about, like, you know, even to be vulnerable for me, even in my own marriage, like, we've talked about this a lot. But I'm like, ultimately, like, I don't really want to give this up. Like, I like to say, I'm gonna give this to my husband, or if I'm gonna say, I'm not going to plan the parties. I'm just like, I don't want to do that. I'm, first of all, I like doing, I like being in control. And I like doing things to help people. But also, I don't like the stress of thinking, well, who's going to do it? And I don't like, and it does sometimes feel easier to just like, be the one to step up. And, and I'm just thinking about the complexity of this system. I think Dr. Nadkarni, you were saying this to like, it's a, everyone's involved at this point in keeping the system going. Because of just like how much we fall into these roles. And we were used to thinking about it. And it was, I don't really have a question there. But any thoughts on that, um, I'm rambling.
16:58
I think that's a really great point. And one thing that I have learned in being a physician and then becoming a mother and kind of having to renegotiate all of that, like, it's kind of a funny thing where your career comes first, right? Because you spent all that time creating it, and then all of a sudden, you have kids, and you don't have a training manual for that. And it's, it's sort of this all sudden change. What I've learned is, you know, the world right now, I think post pandemic is uncertain. And I think in some ways, learning to be flexible. And the other piece that I think I have slowly started to learn is that if I want freedom in my life, I sort of have to give up control. And if I want more control in my life, I have to give up freedom. And there's an accountability love either. Exactly. And it's kind of and I think the process is always kind of moving between the two spectrums. As a mom, as a physician, as a friend of a person in the world who wants all of it. I think it doesn't mean you have to do one or the other at any time, but maybe us taking our some of our own accountability and deciding in this moment in my life, or this phase for the next two years. Which way am I going to go? And I think that that is some of the work. And I don't know how well, you know, to do it.
18:24
I mean, in your article, you talked about some of the consequences of this. And can you say some about that? And there was why, why? Why should this be important to everyone to know about?
18:33
Well, first, it really impacts some unexpected areas of work, right? Like a great example of this is the electronic medical record. And we reference this fantastic article published by a colleague in primary care at the Brigham, who found that women are 24% more likely to receive messages in the electronic medical record from staff and 26%. More
18:57
likely from patient who wrote Casey, who wrote that, do you know,
19:01
Dr. Eve Rittenberg. And I believe it's in the Journal of Internal Medicine and highly recommend reading app, because it has, you know, pushed that boundary of understanding gender bias and how it percolates into electronic medical record burnout, right. And pajama time as we call it, the time you spend on a weekend or evening doing that work. That that astonishes me right like that. It's not just coming from our society, in our culture, but it is moving into the work that we do in the electronic medical record. And so it's really affecting all these unique dimensions of work. There's also extensive literature out there showing you know, that women overall have more administrative workload, or that we even spend more time with patients. And that of course, is you know, this concept of patient centered care, right that we focus on collaborating, having empathy. I.E. establishing good rapport with our patients really sharing information enhancing autonomy and decision making. But it's interesting to me that women are more likely to engage in patient centered care. And it takes time that we have in the clinical encounter, you know, so it's really percolating into all these dimensions of clinical care that we have not known about,
20:24
about the emotional toll things like depression, anxiety,
20:27
which women are. Yeah, yes, I
20:31
think that I was just reading a Medscape article that women, women are, you know, 63% more likely to report depression, and of physicians reporting depression, 67% identified feeling down or sad, and it was related to their burnout at work for physicians for women physicians, and that's 20% higher than then. And I think particularly, I think a pandemic created some stark relief in the in the gender disparity, which is, I think, where our papers stemmed from, to see that there was this significant difference. Like there was a JAMA Network open article that found the COVID 19 pandemic had created these strains on physician families, and that women were 30 times more likely to manage caregiving and school related responsibilities while maintaining their job. And what was more likely 30 times 30. And dual physician families, not one male physician reported taking on the primary caregiving role like zero, so it was 100%, the female physician in dual physician families. So I remember, I think ash and I were like, This is crazy. This is crazy. And I think it really brought societal expectations of what should happen in a crisis in stark relief, and I think it gave credence to the data that was percolating before I remember in 2018, and 2019, there were all these initiatives by the AMA, and even at the federal government level to talk about physician burnout, but it wasn't as big as post pandemic were women physicians started leaving in droves, you know, 20% of the workforce was was threatening to not threatening to leave but leaving, because they had to,
22:28
to me, that was like one of the more practical, upsetting parts of the pandemic is right. I think a lot of talented women physicians had to leave. And they were getting no reinforcement about this. I mean, you you remember, like, you know, all the Zoom calls where you'd see like, people trying to manage their kids as they're having the call and and then to be honest, there's not a whole time. Yeah, exactly.
22:52
The myriad of factors that go into this, like, I just recently gave a talk on health inequity for women. And one of the things we talked about COVID-19 Pardon we were talking about was that many couples who were negotiating this and figuring this out, the man made more, even when there was women, husband, wives, who were in similar positions, like ultimately, when families are having to negotiate this, like the husband made more money because of pay inequality.
23:16
So I'm sure they saw this as a practical choice. Not a no.
23:20
And like, yeah, no even thinking about and maybe this is a generalization. I am a I'm a psychologist, I'm not a physician. I'm curious, what do you ladies think about this, but like, I feel like anecdotally, women I know who become physicians are super, like, hardworking, type A, go for the goal. Get it done. Like kind of ladies, you know what I mean? Like, these are super, I think, all right, to become doctors or superstars. I think everybody becomes Dr. Bob isn't over. But like, like, these are usually very career oriented. Like you can't give up like 10 plus years of your life to go do something if you're not, like, deeply invested in it. And so these are, like, I imagine this would just be such a huge blow,
24:06
and huge grief. I mean, I think I think women, this was your identity. I mean, it's anywhere between, what 13 to 1517 years of your life of training to do it. And then you become, you know, you're already somewhat past or into childbearing age. So you're you're literally training and then having kids then you know, and then all of a sudden you're left with Wait, I just did all of that. And now, you know, the decision is leave so that I can make sure you know that since the schools have shut down. I need to take care of my kids. I think that that was a decision a lot of women were left with, and I think it I think it certainly stoked a lot of the mental unrest, the depression being anxiety that people experienced that loss of identity with being a physician and then basically having to leave that in some way or another.
24:59
Well, and what I'm thinking And again, this is the part where I'm like, I don't know if this is totally true, but it's the connection that's forming in my mind. You have the particularly women, psychiatrists, no women, physicians, you have badass how superstars meets going into a helping profession, like, Are these people who are just more likely to also like, take on more, which then like, further facilitates the burnout. Like, again, if I, if I already use myself and a bit of an example here, like again, like, just as a, I think part of my personality is like I do just take on, you know, there's like something floating, like, oh, we need someone to get a card for a colleague who's, you know, families not doing well. I'll do it. I'll do it like I step up and do it. And so I wonder if, again, there's like some of this. It's all, like, meshed together, like in this messy conglomerate of like, are women physicians also, perhaps temperamentally more likely to like, take on more and,
25:54
you know, the literature out there that does show the institutional and systems based factors, which live the gender disparities and workload? You know, I had mentioned what's going on with the electronic medical record. But also, there was an interesting study that was done from some of our well being data that came from 2017 that showed, you know, differentials in pay equity, you know, you had mentioned that referenced that carry, which I think is a key point, you know, we may be taking on more, but then why aren't we paid for it? And, you know, a colleague of mine, sent me this great research done by a professor of management from UC Berkeley, which showed that women are negotiating women are negotiating theirs, but they are actually turned down more frequently for what they negotiate, you know, interesting. Yeah, I just, I think it really speaks to some of the gender biases out there and institutional factors, which do demonstrate that that differential, there's also data out there that shows that women are less likely to be sponsored and mentored, you know, less likely to be thought of for that promotion, but they do all that work for and volunteer for, you know, are women physicians consider for academic promotions? Are they considered for awards? Are they considered for that administrative team member when they are volunteering to do everything? No, no.
27:25
Right. Yeah. I attended a women in medicine conference a while back about sort of a woman leadership. And that was a crucial issues for him. And yeah, I mean, that was the you're basically say, you could have spoken there. That was basically a lot of the themes I asked you to, though you also did a recent article, another important article about sort of the effects on professionalism, I wonder if you could say something about that burnout, and how it affects your ability to be good doctors, essentially,
27:53
yeah, that I really came from me to tell you some of my own personal experiences and a clinical realm, where, you know, I think for a long time, I've been practice now 10 years after residency. And I have felt this constant tension between trying to be the best doctor that I can be, and really embodying those qualities of altruism, and compassion and integrity, whilst also taking care of myself. And it's, it's pretty consistently felt like, there's this zero sum relationship between those two and a number of my colleagues and I have begun to know, these generational shifts, you know, as we see trainees come forward, how they think about their careers, you know, how they operate in clinic, we can see these differences. And it felt like there's this kind of trade off between professionalism, right, those qualities of integrity, and altruism, and professional fulfillment and feeling like a personally satisfied and doing the work that you do. And that tension, I think, is so powerful when you're at the frontlines taking care of patients, you even feel it, you know, when you have to do all that extra work outside of the clinic visit. And when thinks to themselves, you know, I'm doing all that pajama time, right, like two to three hours in the evenings. You have to keep doing it. But that tension just feels so powerful right now that you can slice it and that's what we really elaborated on in that article and my colleagues, Dr. Kayla E. Behbahani, and Dr. John A. Fromson, and we will ponder that with a number of different examples.
29:35
I'm like trying. I'm like thinking about how this is just very close to home.
29:43
For a lot of listeners, yeah, absolutely. And I mean, we don't have time to go into it. But I think regardless your profession, I would think it's probably resonates. It's not just women,
29:52
and you know, podcast is geared towards mental health clinicians, and I'm especially thinking about being in the mental health field, like What we do? You know, I feel like I make this joke like, what compelled me to get into the business of suffering? I mean, I just don't. We are face to face with human suffering, and pain and grief and sorrow and hurting, like, so much of our day and like that takes on this extra toll. And then, yeah, add in, like administrative stuff and systems level staff and family stuff. And it is it just, it makes sense. Like, it makes sense that people get exhausted. And I think it is a grief in my life and in the field to see that like, I do feel like especially right around when women have children, I'm watching a lot of my colleagues have big shifts in their careers. And it does, it does, it just feels like there's a grief there. And I'm guessing that's probably why I feel so grateful. It's part of the reason why I feel so grateful that there are papers like this, that just name it. And I wonder if if one thing we can end on like or just think about on, you know, I'm a hopeful girly, I'm an optimistic early and we like to, we like to end on that note. But I wonder how you how you both suggest sort of tackling some of this? And what needs to
31:06
wait for society to change what what can individuals do? Y'all are changing
31:10
society like this. So how do we continue to kind of maybe do both, like, do the side of like taking accountability personally, like, how do we do that? And also, like, think about the societal pieces and move that forward as well. An easy question.
31:27
Yeah. So you know, we're in the mental health field. So I think acknowledgement first, that all this is happening means so much good people, you know, people often say that realizing, it really helped that you were just honest, you just named it, you called it, you talked about it, you put it in the room and putting it in the room means a lot to people, you know, it takes actually, believe it or not more courage to do that than you would think, you know, because people don't want to talk about what they're thinking or experience. So naming it I think is important. But also, I must
31:59
say, when I read your article, the first time, I'll just say that my first reaction was like, oh, yeah, people talk about this, but they actually put it imprint, oh, my god. That was courageous.
32:11
There's so many things you can do day to day that are so easy to do, you know, you think you're working on a project written in a paper, reach out to a junior woman physician and put her on the paper, you know, you are thinking to yourself, oh, here's an award, reach out to that junior woman physician, nominate her for that award. You know, you hear a female physician talking about something on a controversial topic. And Grand Rounds amplify what she is saying, really get behind what they're talking about. You know, there are so many easy ways to reinforce a culture of support for women in the mental health field. But I think that that third piece is putting some money where our mouths are and allocating resources to this. In our department, we sought funding to hire what we call an Academic Coordinator. And that's an individual who helps our faculty with things like, you know, matching up journals with different topics. Helping them with NIH biosketch is formatting their HMSCB's formatting, the references, these are all Wow, that's great work. That takes time and it's totally below licensure, right? A really smart college student can help out with these things and work with you and you put their name on that paper that you're going to write about this, you know, it's all about giving back in really small ways and then allocating resources because you know, the Surgeon General said to us, make people feel important, you know, how you make people feel important, recognizing the time that it takes for them to take to do the work that is incredibly annoying to do
33:53
Doctor bizarre
33:54
anything to add. I was just gonna say a this paper was almost cathartic and healing just by naming the problem, I think I have felt less just more relieved and less fatigued since this paper was come out. It's like, okay, it's out there. We've said it. And, and then on top of that, the other thing is, ashes work as the wellness Vice Chair, just being in that role at every hospital, I think is a necessity, because even at the federal level, Vivek Murthy has put out a call for physician burnout as being a national crisis, not a mental health crisis, but like a health care workforce crisis. And one way to really put that make that visible is have someone as passionate and as forward thinking as someone like Ash, Dr. Nadkarni, who's a wellness physician who the wellness Vice Chair, always bringing that point to the forefront in every discussion just like we're doing with DEI, just like we're doing with other initiatives that are theory issues that we need to address, making them visible and making an advocate have a side position in leadership conversations is, I think, a way to change the culture.
35:13
Well, I do recommend the articles and it, like we could put it in our show notes, right, but, but obviously, if people just Google your name and burnout, I can, I can let them know it definitely comes up. And I think you've really hit on something incredibly important. I mean, I would stress that, even though you're talking about personal experience, these are very scholarly articles, and is no mistake that they're in a major journal, one of the most important journals in psychiatry. So that says something about how important these topics are and, and your colleagues are similarly getting articles into some of the most important journals in our field. So thanks for doing this for psychiatry.
35:52
For putting the words out there. Yeah, for doing this work. I'm, yeah, I'm remarkably grateful.
35:57
So we do want to give you the last word, anything that you any last advice or thoughts that you'd like to leave with people?
36:04
That, you know, burnout is such a gargantuan problem, it sometimes feels like how on earth do we wrap our heads around this? How do you make a change, and I would emphasize that change is always possible, it just involves putting one foot in front of the other. And, you know, that's why I recommended those small things that we can all do. I'm a huge proponent of culture, you know, culture, cultural change has to do with changing the way that we talk to each other, changing the way that we behave. And those are changes that we have control over. So doing those small things for each other that enhance connectivity, but also make people feel more seen and heard. Those all lie at our footsteps in our and we can be accountable for them, to encourage everyone out there to think about what you can do to make us make someone feel seen today.
36:59
Right. And I think this paper came out of the synergy of us realizing it was a shared experience. And that I think this is a shared, I think we all feel this, we're just, you know, I don't think we have the words to talk about it. So not You're not alone. We're all feeling it. And if we're all feeling it, then we need to create change, because it's obviously resonating across the board.
37:21
I am so obsessed with you both. Like I'm just I'm just saying you're being like these are Harvard instructors, directors at a big hospital, who are doing the work of wellness and caring for women and like that is badass or I'm so grateful to you both and thank you for coming.
37:40
Thanks so much for sure appreciate
37:42
you for amplifying this we really appreciate
37:45
you really do.
37:46
You've been listening to Drs. Biswas and Nadkarni of Harvard Medical School, and you've been listening to the mind dive podcast. I am your host, Dr. Kerry Horrell
37:57
Dr. Bob Boland. Thanks for
38:00
the Mind Dive Podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.
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For more episodes like this, visit www.menningerclinic.org.
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