Episode 11: Minimize Burnout, Maximize Wellness: Strategies for the CV Workforce

Join our special guest, Dr. Laxmi Mehta,  professor in the Division of Cardiovascular Medicine, director of the Lipid Clinics and section director of Preventative Cardiology and Women’s Cardiovascular Health at The Ohio State University Wexner Medical Center. We discuss her contributions to our understanding of physician burnout and maximizing provider wellness. We also discussed her newly appointed role as the Chief Wellness Officer for The Ohio State University Medical Campus.

Please subscribe to receive updated episodes automatically! Visit https://www.ohioacc.org/cardiohio-podcast/.

For more information, see the following:
2022 ACC Health Policy Statement on Career Flexibility in Cardiology
2022 ACC Health Policy Statement on Building Respect, Civility, and Inclusion in the Cardiovascular Workplace
The Imperative of Addressing Clinician Well-Being (JACC 2020)
Prevalence and Professional Impact of Mental Health Conditions Among Cardiologists (JACC 2023)

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Please subscribe to receive updated episodes automatically! Visit https://www.ohioacc.org/cardiohio-podcast/.

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Transcript

0:04

Welcome to the Cardio Ohio Podcast, a production of the Ohio Chapter of the American College of Cardiology. This is Can Greyal in Columbus, Ohio. This is Ben Allen Cherry Cardiovascular Imaging fellow from Cleveland, Ohio. More information on the podcast, including past episodes, is available@ohioacc.org. And now for today's,

Kanny 0:34

So welcome back everyone to the Cardio Ohio podcast. Thanks for joining us today. I'd first like to introduce my. Regular co-host Dr. Ben Allen Cherry, who's back after a one podcast absence. Glad to have you back,

Ben 0:47

Ben. I feel refreshed from being on the bench, but

Kanny 0:50

I'm ready to get back in the game. Excellent, excellent. Well, it's my delight to welcome a guest that I've known. For many years a fellow colleague of mine here in Columbus and, and also somebody who I think is very well known to most of our listenership throughout Ohio, and that's Dr. Lakshmi Metta. She is a preventive cardiologist here in Columbus at the Ohio State University, but as many of you know, she's worn many hats over the years. Of course the president of our state chapter herself just recently, she's really contributed to, at the national level, to American college cardiology in many ways on on many different committees and initiatives. She has wide ranging clinical interests and. Prevention and women's health. And we're gonna hear more about her newest hat she's wearing for physician wellness. So, Lakshmi, welcome to our podcast.

Laxmi 1:46

Thank you, Kenny. It's exciting to be here and I really wanna congratulate you and Ben for putting together this podcast series to bring your voices as well as leaders voices across the state. So congratulations on that.

Kanny 2:01

That's very nice of you to say. So thank you. So Lakshmi, obviously I know you you've had such a you have so many varied interests that you've contributed to in, in cardiac care and, and cardiac policy. Could you kind of summarize your path to your current position? And also, I'm just curious how you divide your time now as a clinician between some of the initiatives like women's health and, and lipids and prevention.

Laxmi 2:28

Yeah, I mean, my path has been never like really planned. It just kind of fell into place taking just different opportunities. But during my cardiology training, that's when the field of women's cardiovascular health started becoming a thing where there was an interest in it. And, and I had an interest during fellowship at Beaumont Hospital, so just started getting. Interested in that and got recruited to Ohio State to start the women's program. And when, when a field is in its infancy, you can really be part of the forefront and develop things as, as well as be a spokesperson. And so it just naturally fell into place. I, I would say now for our listeners, there are women's heart programs out there where you can get actual formal training in it, in addition. through the years. You know, when you talk about women's heart health, a lot of the public campaigning, surrounded prevention. And so prevention naturally fell into place. And so after being recruited to start the Women's Heart Program and doing prevention things, I eventually went on to direct our Cardio preventative program along with the women's heart And currently I'm the Chief Wellbeing Leader for the Ohio State University, Wexner Medical Center and the College of Medicine. And, and that's a new role that really doesn't have training. It kind of Came to me after me doing research for the a ACC on burnout and then leading the national ACC C'S efforts on wellbeing burnout, where, you know, what should the strategy be for the college. And then over the pandemic, this position came about of Chief Wellbeing leader. It's interesting cuz it's different than most places if many people think of Stanford or Mayo and they've really been physician-centric. And what we're trying to achieve is the entire medical health system. You know, we can't function alone as physicians or apps without our entire team feeling well. And so, Essential. A and so I'm excited. I, I mean, it is a bit daunting to, to think of all 20 plus thousand employees to, to have an impact on their lives. But it's important in terms of how do I balance it all was your question. I don't know. I mean, being. Throughout my career as a cardiologist, I've never been a cardiologist without being a mother. And so as a mother and a cardiologist, you're always juggling things and there's always some ball up in the air you're trying to catch thing and keep up with things. But different days, different things take priority. But in the whole gram scheme of things, everything's about prevention. Whether it's prevention of our PA for our patients, or it's prevention of mental health conditions, or depression or burnout in our colleagues, that's important.

Ben 5:24

That's, that's, that was an awesome answer. I guess just from a lot of our listeners are, are fellows in training or early career professionals? You kind of talked a little bit about how your early work in a ACC C led you to this area, but like now looking forward, you know, what do you think were the skills you gained in your training and your early career? That kind of give you that prepare you for this role and what changes are coming down the pipe?

Laxmi 5:53

You know, that's, that's a great question. I've never really thought of it that way. I.

Ben 5:58

This podcast will make you think hard. You

Laxmi 6:00

know, Uhhuh, I mean, I, I guess what I would say, and Kenny can relate to it too, is this, you know, we trained in an era that there were no work hour rules. There was no like, Restrictions on us. And you just worked to, to the core and, and you worked hard and there were times that you were stressed. Maybe burnout was a thing, but we didn't know it. Like it wasn't a word we'd ever accept. Or I mean, it would feel kind of weak back in the day. Right? So I think that But when we reflect back at our careers and at the the moments that we may have missed with our family, loved ones, especially as our kids go off to college, you kind of reflect of, gosh, you know, what could have been different, right? What could we have done differently? What could have been better? And, and those are, you know, those self-reflection kind of questions sort of help, but. The, the skillsets is, is is challenging because I think like it's hard to be a leader in this field without some. Already leadership skills that you may have attained in different leadership roles or leadership experiences because you're asking for a cultural change. You're advocating for things that's people don't necessarily believe in. And you're shifting people's concept from the patient to you as an individual. So, so that comes with experience, time and effort. But there is no training program yet that exists on this field. There's on the job, there's passion. There's learning from each other that, that brings people to it. I mean, people often ask at a acc like, how, what can they do? How can they, how can they come to this pathway? And I really don't have a specific answer, but I will say, and full transparency, when we first started looking at the burnout data at a acc and it was brought to my attention like, Hey, we should add these burnout questions. Cuz I wasn't even in my sphere of knowledge. Like I said, I mean, we thought we're all superheroes. When someone brought that up, I was like, gosh, why would we even test for burnout? Right? It just like, we're cardiologists, we don't, we don't burn out like That's, that's not us. And But as we got the data and I started inve, you know, researching it, like my eyes open, like, oh gosh, you know, this may, maybe we've labeled it differently amongst ourselves. And and, and it is a real entity. And, and so I, I think that this, the field is evolving, it does require a lot of. To open our eyes and you know, I'm, I'm a true believer in that we can all burn out, we can burn out at different times. We can be highly stressed at different times, but it's a field that we still have so much to learn about. So I would say like, gosh, you know, for the fellows interested that the first step to take is, is maybe to be on a wellbeing committee and fellowship or at your new job when you get there and, you know, think of things that you. Do to improve wellbeing. And, and you can be innovative. It, it's like it's an infancy, so you can paint it how you want it.

Ben 9:07

Yeah, I think, I think that's a great point. And just from the fellow perspective. Like you to, you touched on this, the generations before us almost definitely had a harder time as far as duty hours, but we have a different sort of stress in life. I'd say they're all comparable,

Kanny 9:24

Towards that end, Lakshmi I, I do think the, a ACC has been, had more foresight, I think, than some other medical organizations because obviously this is a problem we're not gonna solve overnight with easy solutions. But you can't solve a problem until you can measure it, quantify it, and at least acknowledge it exists. And I think the ACC has taken concrete steps towards that. And of course, one big step was. The article you authored back in 2019 on physician burnout, and of course this was, almost in a different era now, pre pandemic. I think that was the first time that, we really could quantify that that burnout was real. That it was seen, I think in over 25% of your respondents in that study. It was very common in mid-career physicians as well. I mean, we all are aware of the tremendous work stress associated with the pandemic on our professional life, on the care we had to give patients the compromises we made, not to mention the threats to our own health. So have you thought about how that survey might change now? as we're, you know, three years into a a, a life-changing pandemic and how that might affect what you're gonna do going forward in your new role.

Laxmi 10:37

Yeah, I, that's a great question. And you know, I would say like with the pandemic, there's been a higher workload on people. They suddenly feel that. But as we mentioned, that high workload was there before. But what's the difference? I think the difference is, is we've, we've kind of. You know, medicine has industrialized, we're not working in independent practices, so we don't ha feel the same purpose that we used to feel years ago. And and, and so you don't have that same drive. And when you lack that purpose and greater cause, and then you're just held to numbers, that's where burnout occurs. And I think like early on in the pandemic, there was a lot of. heroism in medicine and, and we were considered heroes like the whole medical team and. It gave, it gave people a good feeling. That you were making a difference and, and there was a bigger purpose in what you were doing. But then it fizzled, right? And, and and then, and slowly became almost villainous, right? Like that we were asking to do certain things like masks and vaccines. So, so it, it really. Impacted the mental health of our healthcare workforce and what to believe, what not to believe. Everyone stood on different perspectives, but our a ACC data, we did collect data and presented it at the Late breaking sessions for 2020 and 2021. And what we've shown is the burnout rates increased with the pandemic. And, and we also at this time even had CV team member burnout data and, and the highest. Rise in or change in burnout with the pandemic highest was amongst C V T members and then fellows. And that was concerning. And I think some of that's related to, you know, the C V T members and fellows didn't really have control as much as attending cardiologists did and, and couldn't control their schedules. You know, just, which when you don't have control, it can affect your wellbeing. So how does that translate to, to now? And how are we all coming out of this? You, you know, it's gonna be hard to say, I think like, With the pandemic too. We know that people are a little bit more accepting of saying burnout. In the beginning I was saying we didn't, that word didn't exist in cardiology. Now it does. And it does even more and people can accept acknowledging that. So I think we're gonna see potentially higher rates if we continue to survey people. But I also. I am very concerned about some post-traumatic stress disorder that may come about in the field of medicine and, and we don't even have a grasp of what that's gonna look like or how long those effects are gonna be and who's that gonna be. It's not just gonna be the frontline workers, it's gonna be everyone and it's impact on them from our trainees on upward. You know, the trainees were so affected with this. So I think locally, Statewide and nationally, we really need to make bold efforts into recognizing that, you know, it's not just that the patient is the center role that we do, but the employee and learner. Has a big part in that patient care and needs to be well too. And I think that's the one thing the pandemic allowed us, is to accept that we can burnout and normalize the word, at least burnout in the news media. And to the lay

Kanny 14:11

public. Ben, I'm just curious, you know, you obviously started your training quite a few years ago pre pandemic in medicine and you went through a cardiology fellowship and now you're a sub fellow. You're almost a professional trainee in a way, right? I love it. Yeah. But seriously you know, what, what do you hear from your colleagues and the residents you work with about the, what are the biggest things they feel. Cuz I can relate how clinicians feel. I talk to them every day, attendings in practice. But I'm curious about your trainees and compared to, say, four or five years ago, what are you hearing from them now about the sources of daily stress?

Ben 14:52

Any great question before I answer two things. We, we tend to call it super fellow, like a superhero instead of sub fellow. And. I'm pretty sure my wife will leave me if I get to PGY 10, but so I, I will answer this question. I think, I think I, you know, I trained for about four years before the pandemic and then I'm just looking now. And I think like the real big thing is, is what Lakshmi had said is I just feel like now people are talking about things more. So I, I was a chief fellow at Cleveland Clinic and, and really intimately involved with a lot of the fellows in terms of their like stressors in life and, you know, if someone has to call off work, you know, some of the, some of the openness that I was hearing was definitely. Pre pandemic. And I think it's, it's a positive externality of, of a horrible situation is that people became more comfortable discussing this.

Kanny 15:51

Yeah. That, that's good to know. That's very good to know cuz that certainly wasn't the case in the past as Lakshmi alluded to my observation about trainees has been, you know, just like Lakshmi was saying, you know, 20 or 20 plus years. In my case ago when we were in training, of course we didn't have the work hour restrictions and so forth. Obviously it's, it's gratifying that those restrictions are in place. But you know, when I talk to trainees, including my son who's a second year internal medicine resident in Chicago, I feel like you have cut those restrictions have kind of traded one set of stressors for another. I mean, you're not working 36 hour shifts, but you're doing a lot of night float. A lot of ad hoc shifts on the fly jumping between night float and daytime and, there's a lot of literature just about how that can adversely affect your physical health and mental health.

Ben 16:43

Yeah, I definitely agree. And, and like you said, you know, there's even just something about, you know, the shift work disorder about sleep irregularities, but also, you know, you, you're jumping into patient coverage. So these are all, like, all things that have come up with this kind of shift work mentality. I guess I'll, I'll, I'll pass it over to Lakshmi and, and just ask, you know, I know that. Early in your, in your work as as being involved with Chief Wellbeing Liaison at Ohio State, and I don't want you to spill any sort of programs that are still in development, but I kind of just wanna know, you know, from someone who has now spent dedicated time thinking about this, what steps do you think training programs can do to, to kind of address this? And this is focused on fellows, I guess I'll say.

Laxmi 17:29

You know, that's, that's a really good question. And, and you know, I would say though, like besides the sleep issues for you fellows compared to cans in my time is the sheer amount of data that is coming at your guys'. Way. I mean, science keeps changing like second to second it feels like, and the amount of journals and things and how you ha you know, it's a pressure of keeping up that's problematic. So for training programs, there's, there's actually an a ACC program Director's Data actu on Burnout as well that came out a couple years ago and that. Showed that it was the, your own program directors are struggling with burnout and very similar to our data amongst all cardiologists. The higher rates were in the mid-career program directors as well as female program directors. So top down, bottom up, everybody's gotta be cared for. Big thing is this changing the culture, right? If we can't fix the culture, we can't fix anything else. And so you know, tackling what a culture of wellbeing would be, would look like. You know, some of the simple things, this is that. people taking vacation, taking all your vacation and not feeling pressured that you, that if you miss a day for vacation or a week for vacation, you're gonna be behind. That, that concept we have to remove for our trainees and ourselves as attendings. Having. You know, setting boundaries on our, what our workday looks like because we can, we can make your workday long as a fellow or super fellow, right? But setting boundaries of like what those hours are like, even though it's not in, it's still in the work hour rules, but like, Hey, I can make you stay till 7:00 PM to read all my echoes. Well, that's not appropriate either. So set learning how we can set appropriate boundaries, time boundaries for our fellows, and, and giving that culture of you need a life outside of cardiology as well as essential. For us to bring our full self here, we also have to have a life outside where we feel supported as well. And so culture in those regards, you know, limiting email time is important as well. So not having to respond to emails after hours, not sending emails after hours as much as we can or and, and that sleep culture is also going to be important, acknowledging that we all need sleep and we don't need to be a super fellow anymore. One other very important aspect of the culture that has to change within training programs, but in cardiology itself, an area I'm passionate about as well is the hostile work environment in cardiology. So we've written data also. on the existence of discrimination and harassment and cardiology. And we will not be a field that is well until all feel included and belong belonging in, in the field. And so we have to make it psychologically safe and physically safe for, for everyone in the team. And so, you know, Fellows, you know, advocating for diversity, equity inclusion's gonna be important. Your fellowship programs should also have a venue where people can dis discuss or bring forth their complaints, and if necessary, even having an oban person. in training other important aspect is mental health. Mental health is important. So destigmatizing the need for mental health care is gonna be important amongst our trainees. And, and then figuring out like what are the systemic issues that the training needs to do versus not do, right? Like I is is there. We ki and it's a new thing that I heard about, is. Aca, an academic culture versus a learning culture and, and an, and really, we want our culture and our programs to be learning. So is this a benefit for the trainee and are they learning? From this experience or, or whatnot? Or is it just just one more thing to put on. Like they read a hundred echoes, but if they didn't really learn anything, then what's the point of it? Right. So trying to make it, and also the point of not being punitive, like in a learning culture, you're allowing people to. Learn and not be punitive or demoralizing to them if they don't know the answers or they make mistakes. And, and that's a shift that we need to make as well. So those are a few things that anyone could kind of consider in their local programs.

Ben 22:06

Yeah. Lakshmi, these, this is you brought up education, which is particular interest of both mine and can is like in residency and fellowship. I was very lucky. Two stellar program directors who, who really valued noon conference. And not even just you know, it's not like a, a thing where people get pimped. It's, it's really just like a time where you value and prioritize learning. And, and I think when you do this in a sort of approach where you're, where you explain to like the Echo lab and the nursing staff that, hey, all the trainees are expected to be at noon conference from 12 to one, please hold any sort of non-emergent pages. I think when you, when you start to put value on, on things like that, that means more than any sort of like statements, and when, when trainees, I think, feel. That hey, the, the institution values not only my education time, but also it's a time for community. I think that can like reinvigorate trainees who, you know, we often work six days in a row, in a row. It's like things like that where it's kind of to what you're saying, that one, when the institution shows that they want to put value on certain things, it means much more.

Laxmi 23:13

Absolutely. And so as a trainee, it's the fact of you not having to ask, Hey, can I go to noon conference? But the culture is, Hey to noon conference, it's in 10 minutes. Get outta here. Right. So that's, that's the kind of thing that we need to, as attendings kind of instill is, is that it's coming up. You need to go, I can finish the rest of this myself. Take off. And advocate for that. I think also when, when there's food, we can attract the fellows more easily too, because, you know, part of that social connectiveness and breaking of barriers is actually when, when there's food involved, Food also brings people together in connectiveness and there's research on that too.

Kanny 23:55

Well, locksmith, I think there's so many other areas we could get to. But just in our last couple minutes one thing I did wanna touch on Before we finish up is you know, I know the A ACC C did put out a very nice statement in the fall about. Career flexibility for healthcare and CV professionals. I really thought it was a nice statement, that emphasized, flexible work hours time away for new parents, et cetera. Are you planning to incorporate some of those things into, into your role at osu or do you think at, at osu they've already started to be, to accept some more flexibility for cardiologists. Cause I really think for people like me who are mid slash late career, That kind of flexibility may be a way to keep cardiologists productive and working when they might otherwise think about retiring,

Laxmi 24:43

you know? And that's, that's excellent. And, and that's an excellent point because, you know cardiology is a, is an older field, meaning they're. We're heavier at the later, you know, the 45 and above age bracket than the younger bracket. So, you know, if, if suddenly everyone starts retiring, we're, we're, we're gonna really struggle and affect the, the burnout. So I feel bad for a super fellow Ben there. But I. Yes, at Ohio State, we, we have done flexible careers for some time. So we ha we've had cardiologists that work part-time and, and we've even had some late career cardiologists or even mid-career who kind of chose like, Hey, I just wanna work outpatient and things like that. Flexibility is, is great. But we also need to recognize that that, that there, there, you know, there is higher workload on those who are working full-time and take calls. So there there's gonna have to be frank discussions of what does salary look like, what does call look like? What, what does it, and. And also who's gonna like, manage your in basket when you're, it's your day off. Like what are those work expectations? And, and you want, you know, if you're gonna do a, have a flexible career, you wanna. Make sure you're doing it the right way and not regret it. Right? So like if you're working three days on paper but you're really working five days and it ain't so flexible, cuz flexibility doesn't mean that you have to on the two days off, you're still attached to the computer. Right? So really thinking it through, but I really applaud the a ACC C for de, you know, creating that document and normalizing the conversation of a flexible career. And we need to recognize that happens not only at the tail end or when people have children. Throughout our careers, you may have a un, un, unfortunately, a colleague or yourself who has a medical illness that needs to take time off. And how do you. How do you handle that and how, how to approach that and be supportive of your colleague or yourself and, and still make your your practice thrive are are real challenges. So it's, it's, there's a lot in that document and I would suggest a. People to read it. But as I also said is to suggest like, if you're thinking of a flexible careers, talk to others who are doing it or who have experience, or who lead efforts like that to, to figure out what's the right mix for you.

Kanny 27:10

Well, that's wonderful. Lakshmi I think we unfortunately do need to wrap up the conversation. There's so many other areas I think we could touch on. So I do hope we can have you back in the future as you grow into your role at osu and maybe enlighten us a little bit more with your experience there as time goes on, cuz this is obviously a conversation that's gonna be continuous. I wanna remind our listeners that we are gonna put links to a few of these documents in our notes, including the wellness. Policy, but also the survey on mental health conditions that Lakshmi co-authored just a few months ago. So there'll be plenty of resources as well as a resource from the Ohio State Medical Association, which has a portal for physician wellbeing for clinicians here in Ohio. So thank you Ben, and thank you lmi for your insight and we look forward to your future input as well.

Laxmi 28:03

Thank you very much for having.

28:06

Thank you for joining today's podcast. For more information about the speakers or the topics, please go to Ohio acc.org,