EP222: A Doctor's Rhythm: Dr. Hornick's Pathway to Fulfilled Living

Dr. Jason L. Hornick on Balancing Academic Pathology, Parenting, and Personal Passions

Christine interviews Dr. Jason L. Hornick, a senior soft tissue and bone pathologist and academic leader, about balancing a demanding academic career with family and self-care. Hornick shares a personal love of cats and discusses parenting twins while managing work, emphasizing the importance of an understanding partner, being fully present at home, and separating clinical work from family time. He describes waking early to write and edit, prioritizing about seven hours of sleep, and critiques medical training culture that normalizes self-neglect and fatigue. Hornick highlights cooking and returning to rock music after a long break as key outlets that reduce burnout and model a well-rounded life for children. Professionally, he describes shifting from primary research to editing journals and textbooks and advises learning to say no to invitations to protect time and wellbeing.

00:00 Meet Dr Hornick

01:09 Cats And Family

02:01 Parenting And Academia

04:11 Early Mornings Sleep

06:00 Self Care In Medicine

07:39 Cooking As Therapy

08:37 Returning To Rock Music

10:12 Hobbies Prevent Burnout

12:31 Work Life Culture Shift

13:35 Evolving Academic Focus

16:16 Research Without Goals

17:07 Learning To Say No

18:46 Closing Thoughts Mentorship

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. Today, I'm pleased to be with Dr. Jason L. Hornick. Dr. Hornick is Director of Anatomic Pathology and Immunohistochemistry and Chief of Soft Tissue and Bone Pathology at Brigham and Women's Hospital, as well as Professor of Pathology at Harvard Medical School and consultant at Dana-Farber Cancer Institute. He is an internationally recognized expert in Soft Tissue and Bone Pathology and served as Past President of the United States and Canadian Academy of Pathology. Dr. Hornick has played major leadership roles in global cancer classification and pathology standards, including contributions to the WHO classification of tumors, AJCC sarcoma staging panels, NCCN guidelines, and TCGA working groups. He is Editor-in-Chief of the American Journal of Surgical Pathology, and has authored more than 500 scientific publications, review articles, and book chapters. Recognized with numerous national honors for his contributions to pathology, Dr. Hornick also [00:01:00] enjoys music and performs as a keyboardist and vocalist with his rock band, The Tear Downs.

Welcome to Jason. 

Jason Hornick: Thank you. It's a pleasure to be here, Christine. 

Christine Ko: Can you first share a personal anecdote? 

Jason Hornick: Sure. Probably not clear from what you just listed and some of my other hobbies, I love cats. When I was a kid, my dad was deathly allergic, so we couldn't have cats. My mother hated cats. I think she thought that cats are dangerous because her husband would have really bad asthma attacks. We never had cats, but when my wife and I first lived together and got married, we got cats, and we've had them ever since. And currently, I have four cats. 

Christine Ko: I recently got a chance to talk to you a little bit more personally, 'cause I was at some meetings with you and sitting next to you at a dinner. You are father to twins, 22-year-old twins, or are they 23 now?

Jason Hornick: They're gonna be 23 in July, so almost 23. 

Christine Ko: Okay. So almost 23-year-old twins. And we had an interesting conversation about parenting and just letting our [00:02:00] kids be who they are. And so, first off, with your 500 plus publications and a stellar academic career, do you have any tips on parenting while developing an academic career?

Jason Hornick: I would say that it's really hard. Balancing academic life with family is challenging for everybody, all the time. I don't think there's any easy solutions. I think that having a partner who's understanding and with whom you can share all the parenting duties is critical. But you're definitely making some decisions that are not always perfect for both. You're balancing between trying to accomplish some things to develop your career and spending time with your children and your partner, and that's really tough.

Sometimes I think I probably sacrificed valuable time with my kids I could have spent in that direction, and instead I did more academic work. But I think as long as you keep your head on straight and, if you have the right intentions, and when you are with your family, if you [00:03:00] can really commit to not working. Take time at home; you're putting everything aside and you're just totally absorbed with your children, your spouse, your partner: I think that's critical.

I've always really tried to separate the two, so I've never been able to log into my clinical system at home. So I can't review clinical cases or sign out from home. So when I'm home, I do any work, often really early in the morning, just editing or writing. It's not clinical work. And when I come home at the end of the day, I try not to do any work for a few hours when I'm with my family 

Christine Ko: Nice. May I ask, does your wife work? 

Jason Hornick: She used to. She doesn't now. She has a PhD in film studies and she used to teach. She was a Professor of Critical Studies in Cinema Television, Gender Studies, and all this really cool stuff, much more interesting than what I do. When the kids were growing up, we lost our nanny, and she decided she didn't wanna be an academic, so she stepped away from that. She became a political activist and organizer, and she co-founded a statewide [00:04:00] progressive political organization, which now has its own legs. There's lots of chapters. With the pandemic, when my kids were really struggling in lots of ways, she stepped away from that, so right now she doesn't work.

Christine Ko: It sounds like you wake up early then from what you said. Do you always wake up early or just sometimes?

Jason Hornick: As I've aged, I get up earlier and earlier. I just can't sleep in anymore. It's horrifying. I don't set an alarm. I barely set an alarm, and I'm up at 5:30 no matter what, often at 5:00, and I try to get an hour or two of work done before the workday starts. I've always found that to be really helpful, just to jumpstart some projects or editing that I'm working on.

Christine Ko: Yeah. I specifically asked you that when you mentioned sometimes you do stuff before others wake up because people say that is a very productive time. No distractions, and you're fresh and you can get a lot of stuff done.

Jason Hornick: Yeah. Everyone's circadian rhythms are different. So my wife, when she was working, she could work all [00:05:00] night, and she has trouble getting up in the morning, and I'm the opposite. By 10 o'clock at night I'm exhausted, and I just can't really focus in the night, so I just shift my productivity early in the day.

Christine Ko: Yeah. So I was gonna ask you if you do have a time you go to sleep, but it sounds like you do.

Jason Hornick: I try to sleep seven hours when I can. I go to sleep at 9:30 or 10:00. And get up at 5:00 or 5:30. 

Christine Ko: Yes. When I talk to sleep doctors, they're like, "Everyone generally needs about minimum six to eight hours." Sometimes we don't get it, like in residency, internship, new parents, illness in the family, or travel, or something. I find it refreshing that you are so productive, but you do need seven hours of sleep.

Jason Hornick: Yeah. At times when I got much less, I was just exhausted. I didn't feel great, and I've realized that really trying hard to get a good night's sleep is so important. Also just dealing with kids and your family, you're not so great at relating to people when you're really overtired.

Christine Ko: [00:06:00] Exactly. It sounds silly in some ways, but I think physicians are actually taught to not take care of ourselves during internship and residency training. A lot of times, we don't have a choice. Work hours have changed, but I trained before work hours had changed, and if you have to be in the hospital for 36-plus hours, you did it. Almost everyone did. We might complain and be like, "Gosh, I'm tired," or whatever, but that was the job, and unless you were literally dying... People would tell "war stories" where, I had the flu, but I hooked myself up to an IV and pushed the IV pole. And people are like, "Wow," like, "Wow, you're a good doctor," for doing that. And are you really being a good doctor when you're sacrificing your own self-care to that extent? 

Jason Hornick: No, I don't think so. There's always a balance. If you're not really committing yourself to a lot of really intensive study, and reviewing cases, and reading literature, and working with colleagues, and really pushing yourself to be the best [00:07:00] you can be, then certainly your professional skills acumen can suffer. But I totally agree. If you're not taking care of yourself, there's increasing chance of making big mistakes. It's a risky way of living your life, not only professionally taking care of patients, but getting into a car accident, or making a rash decision, sending an email that you regret, or having an interaction with a colleague or a trainee that you regret. There's so many ways you can make mistakes that are careless and sloppy because you're just so thinly spread. Taking care of yourself is so important, and I've always valued that my whole career. 

Christine Ko: Yes. Part of what you do for self-care is sleep, so that's really important, and music and food.

Jason Hornick: Yes. I've always cooked some. My wife and I would cook, but it wasn't really until the pandemic that I started cooking a lot more. I always cooked a few things but now I get the New York Times recipes emailed to me every day. And maybe twice a week [00:08:00] I try to cook something totally new and fun, and they're always pretty easy. It's an hour max. Sometimes you have to pick up ingredients you might not have. But for me, that's so enjoyable. I love just spending the hour listening to the radio, NPR or music, and doing nothing else, and just obsessing about this recipe and enjoying chopping something and putting it in a really beautiful little bowl. I go a bit crazy with my mise en place, but it's really fun. Then I photograph them and put them on X or Facebook so my friends can see it. It's a little exhibitionist, but it's also something I really enjoy. It's so much fun. And then having a fun meal that's just different.

Christine Ko: Yeah. 

Jason Hornick: And so that's new for me, but I've been a rock musician since I was 12. I was very serious as a kid. I actually thought I might go into rock music before I decided to go to med school, last minute, and a lot of my friends were in music most of my life. 

Christine Ko: Oh, wow, I didn't realize you were a rock musician from age 12. 

Jason Hornick: Yeah. I had a trio in junior high, then I was very serious in high school, [00:09:00] serious in college. Really almost decided to take a very different career path. 

Christine Ko: Yeah. I don't know if you were able to or not, when your kids were younger, keep up your music?

Jason Hornick: No. I really didn't. I took a pretty long break. After college, when I started residency, as everyone who goes into medicine knows, it's impossible to do almost anything else. I think even simple self-care becomes really challenging, as you said a few minutes ago. I just didn't have time, so I really checked out of music for quite a while. I always had a piano. So I had a digital piano at home, and I could play and sing, but just on my own. I didn't play in a band for about almost 20 years. Took a really long break, and then I came back to it maybe eight years ago. And now I play with a bunch of guys, maybe twice a month, and we have shows around the Boston area. We play six or seven times a year out at clubs, or at community events, or town events outside when they have a summer concert series. There's so many different venues, and we actually play quite a lot. In [00:10:00] fact, we even have a show on this coming Saturday where we're playing in our town at the town hall. They have a summer event, and we're playing for a few hours in the afternoon, which is so nice outside. 

Christine Ko: Oh, that's cool. Yeah. Do you think that being able to come back to music eight years ago has helped you in your career, also in your family life? 

Jason Hornick: Yes. It's definitely helped me. I'm a lot more relaxed when I have this outlet. I always advise students, trainees, that finding some hobby and finding some way to spend your time that's really enjoyable for yourself, that's very different from what you do in your work, is so important. And I think in general, doctors really struggle with that. There are a lot of doctors who almost have nothing else. They might have their family, but otherwise they're entirely consumed by their profession. And I feel like that's dangerous because it's easier to get burned out that way because you have nothing [00:11:00] else to spend time to, to give you joy and pleasure, something else in your life. And at the same time, when you're winding down and you're getting closer to retirement, I think for a lot of people you retire, and there's nothing. I feel so sad for people who don't have other things. For some people it's athletics. It can be art, it can be travel. Movies, film, whatever. There's so many things you can do.

For me, it's really helped me feel much more whole. I'm not sure it's helped as much with my work productivity, but I don't really care. I love what I do. I feel very lucky every day. I love everything I do except for some of the administrative tasks that are less fun. So I always feel good about my work, but checking out and doing other things is wonderful. 

Christine Ko: Yeah. 

Jason Hornick: That's for me and for my wellbeing. Certainly my family's happy. My wife and my kids, they like that I do other things. I'm not sure what it does for them, but maybe I'm happier and more relaxed, which is good for your people you're spending your time with. 

Christine Ko: Yeah. I also do think it's [00:12:00] really important for kids and partners to see a good example being set, of being your own person, and not just work defining you, but that other interests, and having that, sets a really good role model.

Jason Hornick: I totally agree. When you're young, seeing parents, other significant adults, having different interests and having passions and hobbies, I think that's really helpful for kids to see what life can be like. I totally agree. 

Christine Ko: Yeah. I heard, within the last couple years, talking to someone who's from Europe. They were "Oh, you Americans, you live to work, and we don't do that here. We work so that we can live." And I thought it was true, especially in medicine, a very workaholic kind of culture.

Jason Hornick: Yeah. I have so many European friends, and it's very different. People really take holiday, they take vacation much more, weeks at a time. Summer is very light. A lot of people really [00:13:00] shift their work-life balance at that time. And with few exceptions, people aren't as consumed by their profession. It really is a very different perspective. And it's not only medicine. Because so many countries have universal healthcare and universal childcare, parents take very large amounts of time off to take care of their kids, both parents. We don't have that in the same way, and sadly, our country has not prioritized taking care of people in all these ways that are very different in much of Europe. 

Christine Ko: Yeah. I have to just circle back to something that you said, though, because you mentioned coming back to music in the last eight years hasn't really helped your academic productivity. I just have to go back to that, because you're probably one of the most academically productive individuals. 500 publications and your career is not even by any means over. So you would've been more productive [00:14:00] than that? 

Jason Hornick: I don't know. I do everything I like still. I haven't stopped doing the things I like. At this time in my career, I've shifted away from primary research. I'm letting my junior colleagues do most research projects in soft tissue tumor pathology in my areas of interest. I help them out as a collaborator, but I'm letting them run all the projects, and now I'm mostly editing.

You mentioned that I edit AJSP, American Journal of Surgical Pathology, and I'm editing a couple of textbooks this year. For me, it's a very different type of academic work, and I love that. In college, I was a Russian Literature and Language major, and I love liberal arts. So I really see editing and writing very differently. For me it's fun. It's easy. It's not a chore.

Christine Ko: In other careers, say business or something, there are maybe more natural shifts, too. At first you're, like, working hard. If you're a finance person, at first you're working hard on the floor, and then become more senior and you supervise people, and you're not doing so much [00:15:00] active tasks, maybe. And then you found your own company or something and you shift again. I think we tend to do that less in medicine, where throughout our career maybe we are sticking to, oh, clinic however many times a week or pathology slides, X amount. 

Jason Hornick: Yeah. 

Christine Ko: You're a good example of shifting, the way that you've changed your academic focus maybe from primary papers and research to journal editing, textbook editing. 'Cause someone senior with a lot of knowledge needs to do something like that. That's cool to hear. 

Jason Hornick: Yeah. My clinical work, I do exactly what I've been doing for years and years. I cover lots of different specialties. I love reviewing cases and teaching across the microscope. For me, that's the most fun, so that I haven't shifted or slowed down.

But definitely, my academic work outside of teaching has really changed. Yeah. And I think for many people it's not as intentional. I really have made an effort to shift, since the pandemic, essentially. It wasn't necessarily a turning point in any particular way. But as I have junior colleagues who have moved up [00:16:00] to some level of independence, and they're amazing, they're doing great work. I can facilitate without driving projects with trainees now and really think about my perspective on academic oncologic pathology as a whole from a different position.

Christine Ko: Yes. You mentioned you really were intentional about this shift. When you were writing papers primarily, and you enjoyed it, you loved it, did you set goals or did you just "Oh, I'm interested in this and this," and you would just write? 

Jason Hornick: Yeah. I didn't really have any particular goals, essentially ever. I know some people consolidate work and write paper after paper in one field. I've never felt like that. For me, it's always just been what I found interesting. Almost everything I've done is very directed toward changing clinical practice, making our value as pathologists greater, prognostication, making diagnoses more reproducible. Practice-changing type of projects. But always something I found [00:17:00] interesting. I've been lucky. I've had a lot of great opportunities, a lot of great mentors, and I just do what I like. 

Christine Ko: Yeah. It's inspiring. Is there any advice you wish you had known earlier?

Jason Hornick: A lot of people say this. I think that saying no to invitations can't be overstated. It's very hard to say no to offers to write a paper, to write a chapter, to write a review, to give a lecture. And learning to be selective and make decisions on what you think are gonna be of most value to you or most enjoyable. Doesn't have to be of value, but it has to be something you really enjoy. If it's something that you find tedious or miserable and there's so much anxiety surrounding some project you're working on, and you're only doing it 'cause someone invited you, that's terrible. I've been there. Earlier on in my career, I've definitely done things that I probably would not have done had I been more selective. I'm not saying you should say no to everything, but it's okay to say no to some things. 

Christine Ko: Yes. 

Jason Hornick: Yeah. When senior colleagues or collaborators are [00:18:00] asking you for help or for collaborations, it's okay to say, I'm so sorry, I just don't have time. I'm doing so many other things right now. For me, that's the most important lesson. Had I been taught that better, it would've served me well. 

Christine Ko: Yes. In medicine in general, the culture is to say yes. "I can do it," yes, all the time.

I agree. Being able to say no is very important. 

Jason Hornick: I've almost never said no. Now I do, but it's hard. You feel like you're disappointing people, too. You're wrapped up in it in ways that you don't need to be because of professional or personal relationships. Being able to separate that, to step away from that, and really consider it before making a decision that's gonna be tens or hundreds of hours of your time, that's a big deal. 

Christine Ko: Great advice. Do you have any final thoughts? 

Jason Hornick: I think that the podcast you're doing is great. It's good to talk to people and for more senior people to be able to give advice to more junior people. And I think in general doctors and other [00:19:00] professionals don't always have great mentorship, and mentorship comes in lots of ways. So I think having discussions about these topics is wonderful.

Christine Ko: Thank you. Thank you for spending the time to do this. 

Jason Hornick: My pleasure.