The Burnout over Burnout Conversations

Burnout in healthcare is more than just exhaustion—it’s a deep disconnect from the purpose that once fueled a career in medicine. Dr. Ami Doshi and Dr. Julie Celebi share their personal experiences with burnout, reflecting on the systemic challenges, personal sacrifices, and early warning signs they overlooked. They discuss the complexities of navigating high-demand roles, the emotional toll of caregiving, and the pivotal moments that led them to reevaluate their professional paths.

As healthcare systems continue to grapple with workforce sustainability, Dr. Doshi and Dr. Celebi offer meaningful strategies for recovery and valuable perspectives on how both individuals and institutions can work toward meaningful change. Whether you are experiencing burnout firsthand or seeking to support colleagues in maintaining well-being, this episode offers practical approaches to restoring balance and fulfillment in the field of medicine.

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Transcript

Hello, and welcome to the Symptom Media Podcast: Bridging the Divide in Mental Health, I am your host, Dr Lindi van Niekerk. This is our very first episode, and I’m thrilled to have you join us.

To learn more about Symptom Media's mental health resources, go to symptommedia.com

Our mission here is simple but vital: to bridge the divide between the clinical and the experiential. By fostering dialogue between research, practice, and lived experiences, we hope to cultivate empathy and meaningful change in how we approach the challenges of our work—and our lives.

In this first series, we are focusing on the mental health of health workers. Today, we’re tackling an important and often misunderstood topic: burnout.  It’s a word we hear constantly—so much so, it’s begun to feel a bit like a car alarm.  Initially jarring, disruptive, and attention-grabbing, but over time, it fades into the background, losing its impact and causing us to overlook the real crisis behind it. That’s why, in this episode, we’re moving beyond the noise to discuss the Burnout over burnout conversations. We’ll hear from two incredible doctors, both of whom bring the academic understanding and the firsthand experience.

Dr Ami Doshi is the Vice Chair of Faculty Development and Wellness for the University of California’s San Diego’s Department of Pediatrics.

Dr Julie Celebi is an Associate Clinical Professor and Wellness Director, Department of Family Medicine, University of California San Diego.

Let’s dive in.

Lindi (00:04)
Ami and Julie, thank you so much for joining today for this episode of The Symptom Media Podcast. It's a delight to have you both joining this conversation.

Julie Celebi (00:12)
Morning, great to see you.

Ami Doshi (00:14)
Good morning. Thank you so much for having us here to talk about this.

Lindi (00:19)
So as we start the conversation, I'd like to take us maybe just back right to the beginning to kind of asking you both what experience or event inspired you to become a healthcare worker or a doctor in the first place.

Ami Doshi (00:32)
I would say it's hard to pinpoint. I, and maybe it's just because it's been so long since I came to that decision. I remember this sense of, I really like science and enjoy, biology and learning about.

body and things in high school and then definitely have always been driven by a desire to serve

Lindi (00:57)
Julie, how about you?

Julie Celebi (00:59)
Yeah, for me, think definitely a sciency nerd, like to kind of figure out problems. I think being a fixer, wanting to help people feel better. And I think particularly in family medicine, wanting to really care for.

the whole human being. I did sociology, Latin American studies actually, for my undergrad majors and I had this sort of difficult time of how do I merge all of these interests that I have and doing a year as a health educator in a federally qualified health center and seeing all these amazing family doctors being kind of leaders in their community and just changing lives day by day. I was like, I want to do this

Lindi (01:43)
Yeah, I think for me, I grew up under the table of the diabetes clinic, because both my parents were doctors and I always said, I know what I'll never become and that was a doctor. But then as well, there is something about being able to care and like you both said, make a difference in people's lives. And as much as what I got disgruntled that so much of my parents' time was taken up by their work, I think I always saw the difference they were making. And that desire I think is how we all...

Ami Doshi (01:52)
Yeah.

Lindi (02:10)
enter into this profession. So the topic of our conversation today is about burnout that we experience as health workers and Ami with your permission, I'd like to share a little bit of something that you spoke about in a talk that you gave. You said, once upon a time, there was a physician wellness director who was burning out. She'd like to create and build things, though she was just figuring that out. And her career work to date had stolen its construction.

She was frustrated, disillusioned, and uncertain of her purpose or her path. There was this inkling that there was something more out there and that this wasn't it. And so I wonder if you can maybe share a little bit about that moment when that realization dawned upon you that this wasn't quite it that you were experiencing and maybe there was some burnout that went hand in hand with that.

Ami Doshi (03:05)
I practiced pediatric palliative medicine, which I find,

incredibly meaningful. And I know usually when I tell people that I do that work, you know, there's a sense of, I don't know how you do it. And certainly it comes with its challenges, but I just found it to be such a privilege to walk alongside these children and their families and try to find ways to ease their suffering. then I'm grateful to learn from their journeys. And so that far outweighs the heartbreak that sometimes occurs.

And in that journey, I had been building a palliative care program. so there were several moments. know, one was I was speaking with a fellow palliative care physician across the country and sharing with him that I had applied to be the wellness director for the department of pediatrics. And he just sort of offhandedly said, hmm, maybe if you're starting to look for things that are a little peripheral, you're getting, you're getting crispy. Maybe you're starting to get a little burnt.

And then I remember talking with my division chief and I didn't call it burnout. I called it not sustainable because we weren't staffed to see the volume of patients that we needed to see. And I remember talking with her about it and found myself saying that I was actually dreading coming to work and that

Lindi (04:12)
you

Ami Doshi (04:27)
the joy that I used to find in seeing my patients was no longer there. And so that was a big signal. And I didn't want to acknowledge both when my colleague said, you're getting crispy. And when I heard myself say this, I was still like, no, no, I'm not, I'm not burned out. This is like I said, sustainability or whatever. And then

as I started to delve into other areas, the people around me were pointing out how different my energy was when I was talking about some newer elements of my work compared to running this palliative care program and that dimension. And then I think finally, I was just like, I'm very grumpy at home and I don't know why. And I don't particularly like it.

Julie Celebi (05:08)
Thank you.

Ami Doshi (05:12)
So there was all these little moments I think where it was becoming apparent that that's what I was experiencing.

I think the big sort of acute moment of realization came at around 2.30 in the morning when I was up with insomnia, which had been plaguing me for some time, and I found myself just sobbing. there's the quote by a nice nin about the risk.

remaining tight in the bud is more than the pain of trying to blossom. That was that moment for me. But while that was sort of the big, acute moment, I think there was a lot of small moments along the way that were signals that I was experiencing burnout.

Thank

Lindi (05:59)
Thank you

for sharing that I myself recall moments of waking up in the morning, lying in bed and running through like, could my head be sore? Could my throat be sore? Could I be sick in any way so that I just don't have to go to work today? And that too was a sign, like maybe something's not quite right. So I feel you've already touched on that a little bit, but they classify burnout as an occupational syndrome that's a result of chronic workplace stress, that unsustainability I think that you've mentioned as well.

Ami Doshi (06:07)
Yeah.

Julie Celebi (06:08)
Haha

Lindi (06:26)
that's not been successfully managed with characteristics of feeling energy depletion or exhaustion, increased mental distance from one's job, negativity or cynicism when it comes to it, and reduced professional efficacy. And so Julie, what was your personal experience and does that definition kind of do you experience justice?

Julie Celebi (06:49)
Yeah, I think I struggle with the idea of my own experience with burnout because I feel like I would come back to that definition and say, well, no, I always felt like my patients were always human beings. I never had that depersonalization. I always felt connected with them. And if anything, I think sometimes those relationships helped buoy me in those times where I was just feeling so, you know, going through a hard time.

If I would say that I experienced burnout in the typical sense, was the depletion, just complete exhaustion, just feeling like I had nothing left. And I think what ended up happening is I was never gonna sacrifice patient care. I was never going to give up on caring for my family. So something had to give, it was me. So all just taking care of my own self.

suddenly became the last priority and sort of my wellness became negotiable, I guess. And I kept cutting corners in that way. And so I think the way that it did manifest for me was just that complete exhaustion and depletion, which to be fair.

overtime did progress to clinical depression and required me to really do a lot more work turn that around and heal. So I feel like I only really experienced burnout, burning myself at both ends. And I think the personal efficacy piece, I did feel like I was still having an impact on people. I felt really good, a lot of fulfillment. But I think if anything,

the way that manifested for me was just the never enough, like feeling like I always had more than I needed to give, more on the to-do list, more, like I wasn't living up to someone's expectations, so I, there was that piece for sure as well. And so I think over time that kind of transitioned to something a lot more that really led to much more severe symptoms

Thinking back now, the fact that I had suicidality, I had this despair, I had this background desperation that I think I just normalized until finally I was like, this is not something that can continue. It's definitely not sustainable.

Lindi (09:11)
Yeah, so I think that unsustainability piece seems to be kind of where the light starts going on for us. And so maybe looking back on both of your experiences, what about the workplace and the factors within the workplace do you think kind of fueled this to happen? Ami, what was it for you kind of being in that position as a palliative care director and some of the stresses that you experienced?

Ami Doshi (09:34)
you know, I remember telling my husband when I would be up late writing notes and also trying to figure out how we're gonna grow the program and get the resources we need to serve the patients who need it. I remember telling him, you know, what's crazy is that the hardest part of my job is not the fact that I'm taking care of dying children.

That fills me up and is fulfilling, but the hardest part of my job was this excessive demand relative to the resources available and just knowing there was all these children out there who really needed what we could provide and yet I was unable to deliver that.

And I think there was some moral injury that occurred. kept me up at night to know that there was these patients that I wasn't getting to, and not being able to do what I knew needed to be done. And also some exhaustion from banging my head against that wall and trying to, you know, make the case, make the case, make the case, and feeling like we weren't really getting where I needed us to go.

And then I think that, there were elements of the culture that didn't leave, be feeling very valued, or at times didn't leave the work we were doing feeling very valued. And so that was sort of the muck we were swimming in that touched everything, you know, that we were doing. so.

It was multifactorial, but I think a lot of it was around that sense of just not feeling valued, whether that value showed up as here's the resources that you are rightfully looking for or other ways of showing it up.

Lindi (11:10)
Ellie, was that similar for you?

Julie Celebi (11:14)
Definitely, I think that just the demands exceeding people's bandwidth is something that really resonates for me. think particularly in primary care, we sort of almost have a chip on our shoulders. like, oh, I can handle it. I handle all the things. Like, we're just all comers. We got this. We're here for you. But I think that that can get abused, to...

have to take on much more than we should as a primary care physician and doing more things that really could potentially be delegated. I I used to hours at night doing refill authorizations or answering patient messages that had piled up and not even all of them needed to be answered by me. Or...

being in the middle of a busy clinic day and having a patient, sending a message about that they have chest pain and then me sort of figuring out like, my God, how do I handle this right now when I'm in the middle of, seeing a patient who's depressed and suicidal and then the well child check and they've been in there and the baby's crying and like juggle, juggle, juggle. And just feeling like I had to do it all. And it was, yeah.

exhausting.

Lindi (12:29)
I think it's such a, admirable. We all come into this with the ability to handle a lot and wanting to say that we can handle a lot. And there is, there's a real strength in everyone. And then it's like the system kind of just takes advantage of that and say, well, let me see how much more I can throw at you and see how long you can keep running. Which makes it hard to keep going. I wanted to refer to this article in the New England Journal of Medicine by Vivek Murti where he writes,

Burnout is not just about the long hours. It's about the fundamental disconnect between healthcare workers and their mission to serve that motivates them. And you both started off this conversation kind of saying that you had this desire to serve and somewhere we just get disconnected from that. And so I'm wondering, is there anything in your kind of any personal factors that you also feel that just kind of contributed to this disconnect happening? You've mentioned the workplace ones, but.

Are there any personal factors that added fuel to this fire?

Ami Doshi (13:29)
Yeah, I think there were several. One, I think, surrounds maybe elements of being a woman of color and some of the cultural dimensions of who I am. so holding boundaries.

was a challenge for me and felt like that's not culturally what I was raised to do. you know, humility is a core value and that sometimes made it difficult to advocate. And so I think those pieces probably contributed to not being able to connect to...

you know, what really motivates me. think I also experienced imposter phenomenon, which I know is very widespread, but I think it did hold me back in, again, being able to voice, not even voice, just identify what I...

really wanted to be able to do and then being able to take steps to achieve that without feeling guilty or feeling, you know, I felt an obligation to continue in the roles that I was in. And then I think the other piece...

was I struggled with anxiety and so I eventually also needed to get that addressed

And then I think some of it is just, you like you said, who we are and how we come to this. Like I remember asking myself, like, why can I not be a physician who is content just seeing her patients and coming home? Right. And why do I feel the need to build this or teach that or, do something bigger? But I do. And, you know, it's just a part of who I am.

Lindi (15:27)
I I feel like our biggest virtues sometimes are our biggest downfall because it's amazing. You see need and you want to address it. It's not just okay to see it in one area and then leave it be for someone else to do. The more need you see, the more you want to do. And that's such a good thing until we can't kind of navigate and manage that and put boundaries around that. Julie, what is that like for you?

Julie Celebi (15:50)
Yeah, I feel like the culture of medicine definitely takes advantage of all of the traits that we bring to...

Ami Doshi (16:02)
Sorry. It's a fire. It's a fire alert.

Lindi (16:03)
That sounds like some amber alert or something. Fire.

Yeah, we've had a lot of them recently.

Ami Doshi (16:11)
apologies, there's no way to silence that, sorry.

Julie Celebi (16:13)
No.

Lindi (16:14)
That's

Flashbacks.

Ami Doshi (16:17)
I'm sorry. I'm sorry.

Julie Celebi (16:24)
It hurts.

Lindi (16:30)
haha

Julie Celebi (16:42)
It'll go away. Okay. Yeah, right.

Lindi (16:42)
Boom.

Ami Doshi (16:46)
I'm

Lindi (16:47)
Ha ha!

Yeah, maybe

I'll just, yeah, no, no, I'll just start ask Judy the question again before she answers. I think we got most of our means before that, before that.

Julie Celebi (16:57)
Yeah, that helps so I can get re-anchored.

Lindi (17:02)
Julie.

Julie, what personal factors contributed to your experience and are they quite similar to what Amita shared?

Julie Celebi (17:14)
I think definitely being the person who wants to take things to the next level on a regular basis is like, it's great to bring that energy and the workplace loves it, right? Cause they're like, she's a doer. I'm gonna, we're gonna get you into this role and we're gonna ask you to do this and that. And definitely as a people pleaser, I acknowledge the fact that I say yes a lot.

But also because I like doing a lot of things. feel like in family medicine, we always talk about like, love all the things, everything's interesting. that sounds like a cool opportunity. This might be important for my professional development or advancement. so I think kind of my own internal dialogue of feeling that need as an early career woman to show that I belong and that I have.

things to bring of myself, strengths, just yeah, a lot of saying yes, a lot of continuing to do more, continuing to pile on and forgetting to sort of pause sometimes and be like, hmm, maybe this is like not something that's doable for a normal human being. think just, again, it's back to that chip on the shoulder of like, I got this, I can do a little bit more, it's fine. Until suddenly it's like.

Ami Doshi (18:04)
Thank

Julie Celebi (18:31)
nothing left to give and how did it get to be this way. So I think all of those pieces, the culture of medicine definitely, I think, depends and takes for granted sometimes all of these traits of many of the physicians who come into this space and also being sort of perfectionistic. think many of us struggle with that.

Ami Doshi (18:34)
Thank

Julie Celebi (18:59)
always trying to go above and beyond can be great in terms of patient care, but also it's a lot of that distress of like, am I doing everything right? The patients that I saw in the day sort of thinking over problems that I haven't been able to fix for them, but is it my problem to solve? all of these little factors I think can feed some really difficult.

emotional experiences.

Lindi (19:27)
You both touched on so many different aspects of one's own identity as a helper, a fixer, a pioneer, a visionary. And if we can talk a little bit more about how our self-perceptions or our identities are intertwined in healthcare. And sometimes that connection becomes problematic if we take so much of that who we are and it becomes so close to our work. And I mean, this piece that you delivered you also said,

There was a growing incongruence between what mattered to me and the work I was doing. And this was hard for me to accept because of the identity I had spent over a decade cultivating, that of a palliative care program director. And this was the one that was weighing me down and dimming my light. Can you share more about how you navigated and kind of resolve that tension? Because your work was very much who you were as well.

Ami Doshi (20:21)
Yeah. It's funny hearing you say that. It's like it takes me right back. The pit in my stomach is there again. like I mentioned in that little talk I gave, I really had, focused on this is who I'm going to be. I'm going to be

Julie Celebi (20:26)
you

Ami Doshi (20:38)
palliative care program director of this excellent program. And I think some of what was embedded in that is that in academic medicine, especially, there's a very clear progression. You do this, then you do this, then you do this. And so being a leader of the program was the natural next step and something that I should be grateful to be doing

I think I began to realize that that identity was too narrow in fact it was a role and a title, but I had made it my identity.

But through journaling and a lot of conversations,

I was exploring more about who I am, not what I do. And, you know, I'm very blessed to work with a chaplain in my palliative care work. And we talk a lot about meaning making. And she pointed out to me, you know, at your core, you're a teacher, right? Like, yes, you're a doctor, but look at all these things that you jump to do and how you respond. And so.

Julie Celebi (21:37)
and

Ami Doshi (21:43)
I kind of sat with that and then I had the opportunity to do work facilitating and I realized like I'm a facilitator of conversation, of connection, of people's own empowerment and progress. And then a big sort of reckoning came with the fact that I was a mother and a wife and those were the identities that really mattered to me.

It took some...

redefining, broadening my version of what an identity was. And also realizing there was this

inner disconnect that made me feel this veil of inauthenticity between me and whoever it is that I'm connecting with, which weighed on me because relationships are really important to me tried to really pay attention to what, what,

the universe was telling me and what people around me were pointing out to get to that place of this is a job, this is not who I am. And I can reimagine who I am and who I get to be

Julie Celebi (22:42)
I've actually been really grateful for, Ami's constant encouragement of us to think about our core values. I think that that's been so foundational to make sure that you are mindful of who are you really? What do you hold dear?

Lindi (22:43)
I really

Julie Celebi (22:57)
And how do you stay in alignment with that always? Because it is so easy, as a woman, as a mother, everyone else's needs, right? And then how do you come back to what's important to me? And how can I make sure that I have that compass, that North Star to be able to come back to that?

And I feel like it's something that I've fallen back on a lot with like the making sure I'm creating space to reflect and vision and process. And if I am feeling like this sense of, know, something's not quite right, what is going on here and how do I move back to stay on track towards where I want to be?

But yeah, what matters? My perspective here and this is my life.

Lindi (23:42)
No, I I just resonate with that. feel I spent 10 years becoming one version of myself in medicine and then it's been taken me the next decade after that to kind of unwind all that and realize, there's so much more to me. I think you're right about the values because caring for others is such a key to who I am and who I want to be. And these days, gosh, I still get surprised that how many ways there are to care for others. Medicine is one way I can do that.

But the joy my neighbors get when I drop off a kind of warm loaf of sourdough bread, I'm like, they're so happy. It's so easy to make a difference to other people in all these ways, if you can bring all of yourself to this. So from this kind of experience that I think we've all had, for each of you, what were the decisions and maybe the personal strategies that you had to make and adopt?

that helped you re-energize and restore this passion for your work or even tweak your work and go in a different direction.

Julie Celebi (24:45)
You know, interestingly, feel like making wellness a part of my job forced me to prioritize it because that was just where I was starting from, right? Is like kind of being a workaholic just way over identifying the physician self as who I was. Like that was my identity. the only way for me to break out of that and heal myself and get right honestly was, OK, well, let me just pocket it into to

the identity that I'm already sort of all in on. And then it sort of helped me, I feel like, reset. But yeah, being able to have the protected time to be thinking about different strategies to support the wellness of my colleagues, but also myself, and realize, like, I don't want to be a fraud. I want to be, you know, like, walking the talk. And so I feel like that having that support and the professional development to be able to...

to do that was really good. Having kindred spirits like Ami and others, mentors in this space to really just help me remember to be who I am and live authentically, be able to have embraced vulnerability and find connection and human times. I have so appreciated the coffee dates that Ami and I have. It just helps me kind of pause and remember.

These are the things that matter in life. And not get so caught up. And I think just doing the basics too, like getting into therapy on a regular basis, getting out of my own crazy thoughts and be able to sort of reset, get perspective, and realizing that my wellbeing is non-negotiable, that I actually need to make sure that I set aside time for sleep and physical activity and things like that,

I just kept cutting corners with that and my health was suffering from it. I think just re-centering myself in my life and continuing to come back to that regularly through practices of like processing, connecting, writing, all of those strategies have been really crucial for me to stay honest in this work.

Lindi (27:04)
Maybe just before Amish is, I'm just curious, how did your workplace react to you coming into it with this very different kind of attitude mindset? Were they receptive to that? Did you get some resistance or tension? Because I'm sure that also meant you saying no to some things, which you used to say yes to.

Julie Celebi (27:21)
Mm-hmm.

Yes. Well, you know what's funny is I feel like people kind of stopped asking me to do things because they're like, she's just going to keep saying yes. Like, we're not evil. We're not going to just keep piling it on. So interestingly, I feel like one of the big pivots for me was when I had sort of applied for a role in our department that I didn't end up getting. And I was like amazed. was like, but I've done so much for you all. But I think what it came down to is they're like, Julie, how?

Ami Doshi (27:30)
I'm

Lindi (27:32)
yeah, it got recorded.

Julie Celebi (27:51)
How would you do this thing? And so it just made me realize like, my God,

I

need to like really, tap back how much I'm doing, go from the 150 % to maybe 100 % of just that effort.

And if anything, hopefully they believe in me more and think that I'm, again, having that alignment with what I sort of expect of others and challenge others to do for their own wellbeing that I am demonstrating that. So I'm grateful that I've had really supportive colleagues and leadership to keep me on the right path.

Lindi (28:26)
I must admit if your colleagues say to you, they stop giving you things to do, that's a good sign as well. Like maybe you've done enough. I mean, how about for you? What personal strategies have really helped you, I think, live more fuller and kind of find your passion again?

Ami Doshi (28:41)
Yeah,

I've always been somebody that in times of struggle, I reach out to people. so I really leaned into the people around me. So at the time that I was probably most struggling with burnout, I'd already been seeing a therapist for years, which was...

helpful, but I began to realize like so much of my what we're talking about is work related and you know, I don't know if my therapist is equipped to address this with me and so I sought out a coach.

which was really pivotal for me. And it was through that coaching that I identified my core values. And like Julie said, the reason I harp on it so much is because it was so pivotal for me personally to identify what those values were. And that middle of the night sobbing, you know, 2 a.m. was that, my gosh, I'm so out of alignment. know, family and health were at the top of my values and...

both were suffering because of my work. so...

I think that became this motivation of I can't just leave it at that. And I'm also really lucky to be surrounded by a lot of wonderful humans, Julie included, who provide connection, but also are very accurate mirrors and will tell me how it is.

and I had other friends who inspired me because they too walked away from the thing they were supposed to do in medicine to serve themselves and so I really just deepened those relationships and

explored that and you know I think eventually I threw all of this I found the courage to step down from the leadership role that was probably most responsible for my burnout and simultaneously kind of take steps to advocate for what I was looking for as far as flexibility and having a more profound ripple effect and

and things like that. I felt so indebted to these humans that afterwards, what I call afterwards, like when I feel like emerged on the other side of this burnout mountain, I had a gratitude celebration and invited my mentors, the friends who had supported me, my therapist, my coach, you know, and just to...

because I don't think I could have navigated it without them. And of course, my husband is a huge part of this.

Lindi (31:20)
Yeah, I really hope and I think you both just sharing so openly and honestly today is already building that community for people who may be quite alone and isolated. Just hearing your experiences will hopefully make others feel like, I'm not the only one. And I think as soon as we can break through that, I'm the only one experiencing it, it really opens up so many different possibilities for people.

and telling oneself that you're not selfish. I know for me that's a big thing that if you don't care for others but care for yourself, it immediately feels selfish and reframing that is so crucial. You both have also been part of the Stanford Compassionate Communication Fellowship and I would love it if you could share a little bit more about the connection between compassion and communication and how that serves as an antidote to burnout.

Ami Doshi (32:13)
Yeah, so it's at the Sanford Institute of Empathy and Compassion at UCSD.

and,

there's, this beautiful Center for Compassionate Communication and, practicing palliative medicine. That's very dear to my heart. And I think...

my experience there was the first hour of my fellowship and it was my God, I found my people. These are the humans who love the things I love and feel the things I feel. it's this movement to weave compassion deeper into what we do. Cause I think that is one of the unfortunate.

Julie Celebi (32:41)
I'm

Ami Doshi (32:51)
consequences of burnout is that compassion falters.

So I see compassion as a way of being and something that should just be imbued into who we are and how we show up, whether it's mother, doctor, leader, whatever it might be. communication is how we do that, right? it's how you express to the other in your relationship that you care and that you

are witness to their suffering and want to do something to ease it.

I see it as a huge tool to, in our daily practice, deepen our relationships if we can communicate with compassion. And we've talked a lot about how relationships and community are themselves so important in combating burnout.

I hope that we just create sort of this landscape of compassion and compassionate communicators so that as we're moving through our work days and our lives,

maybe it's just a little trickle that's kind of emanating from each one of us. you know, I know that sounds kind of rainbows and unicorns, but I think

Julie Celebi (34:00)
I'm here for it.

Ami Doshi (34:01)
beautiful about compassionate communication is it's not a heavy lift. think we can, there's elements of it that we can incorporate without a tremendous amount of effort and yet the impact can be so profound. And so on the personal level, it can serve us from burnout, but I would love to think that we can really impact the culture that we're all in with that.

Lindi (34:22)
Julie, can you maybe just tell us a little bit more about what that kind of fellowship entailed? I think it's quite a new idea for many people who may be listening and then how it affected you as well.

Julie Celebi (34:33)
Yeah, so it was it honestly flew by we would spend like an entire day together and normally you think you go to a like Conference and eight hours can feel like 80 hours But we would be together and the time would fly by because we'd be in doing all of this small group work kind of theater-based activities role plays Arts basically integrating arts and humanities doing like visual thinking strategies. We'd like look at a piece of art and you know talk about it we would read, know read a

chapter about the experience of a black man in the emergency department and what does that mean and what are all the kind of perspectives of the people who are involved and it just helped engage so much rich discussion and reflection.

For me, I feel like the biggest like mind opener was just recognizing where I was in all of it. Like what was my lived experience, my lens, and how was that informing the way that I was engaging with people? It definitely...

was when I started paying more attention to myself in the process, it helped me be able to be, again, more kind of centering of my, how is my wellness being impacted by the ways that I was engaging with people? That there's ways to be a compassionate communicator that can still protect your heart and set healthy boundaries.

really is so powerful, I think, to be able to model that to my learners as well. And we have a whole compassion course that we teach in the medical school. It's now required of all first and second years. So really helping them see that this is just foundational to being a good physician. And also, I think it pairs so well with the wellness work that we do, because again, that ability to just lean in deeply to

compassionate presence with others so fuels back to yourself and has been the ultimate burnout prevention to me going forward and something that I like to model to as many people as I can so that, we can exactly have that ripple effect that Omie was talking about and change the culture and help people see, like, this is saving us all when we can show up in this for others.

Ami Doshi (36:48)
I wanna.

Lindi (36:49)
I think that's such a

unique opportunity because it feels like it's bringing who you are into the workplace as much as a way of caring, not just what you do for someone, not just the prescription or the process that you do for someone else.

Ami Doshi (37:03)
The first session we did in the fellowship was called, Who Am I? Who Are You? And that really, that seemed to me to be the question that we were being asked throughout the entire fellowship and speaks to what you were just saying, Lindy. think that it is about how do we bring that in. So that was...

a catalyst, think, in many ways, just being constantly asked to reflect on some version of that core question, who am I and who are you and how do we relate to one another.

Lindi (37:35)
And so maybe taking this experience that you've both had, how have you integrated that back into your workplace and what other kind of strategies have you found to be effective to reduce burnout amongst your colleagues or other health workers?

Ami Doshi (37:54)
Julie, you've done so much for your department. You should start.

Julie Celebi (37:59)
You know, I feel like if anything, the best way that I've been able to show up for people now as a wellness leader is by like actually doing the work myself. And people are like, you seem happier now. You seem more like you're kind of like doing all of the, you're in better balance. And I think that that is sometimes the most powerful thing to help other people feel like.

can do that. I can create the life that I want and have that sort of professional fulfillment and that joy. And so I think that's been a lot of it is like modeling, you know, the ability and the accessibility of joy and medicine that we can do hard things with help, advocating for people to kind of ask for what they need.

and also advocating within our institutional systems to do that. I think we had like a huge primary care redesign that happened over the last several years. Kind of getting back to what I was talking about with like the refill request after hours, the patient, you know, calling in with chest pain during my workday. we actually started figuring out how we could offload these things so that physicians were not feeling as burdened to hold all of that. So really kind of.

creating a much stronger, more robust, like team-based care approach in primary care has been just huge. The fact that I can now go work on the ward service and focus on my critically ill patients and not have to like chase after my like clinic inbox that I know that we now have an NP who is hired to help.

provide this inbox coverage or that I can go on vacation now and I don't have to beg a colleague to cover me because we have systems in place to actually do that. So just really being able to assemble that team of support so that we can continue to do the hard, really professionally satisfying work and everybody sort of top of license and doing their part to deliver.

know, excellent care. think that has been so foundational to supporting people's wellbeing.

Lindi (40:16)
And it's this shift of perspective of like, I am responsible to caring for someone versus we are responsible and we share that load and we find joy in doing that together as well, I'm sure. Amidi, have in.

Ami Doshi (40:28)
I just want to say Julie's

superpower is role modeling. She is, she really is very open and authentic and vulnerable and walks the walk and I've just seen her do it again and again. And it's inspired me to also do the same.

Lindi (40:32)
You

Ami Doshi (40:48)
I'd like to think the fact that I myself have kind of walked this burnout journey makes me better equipped to serve others in improving their own fulfillment and...

just makes me more approachable, more relatable. Again, there's some authenticity in whatever I'm sharing or attempting to do.

You know, we've talked a lot about community and how critical that is and burnout. I know Vivek Murthy just highlighted some of the same in his parting prescription. And I have seen that even when community building is the byproduct of whatever the wellness intervention is, it tends to lift all boats and, you know, improve morale. And we've started a number of

Julie Celebi (41:33)
Hmm.

Ami Doshi (41:42)
peer mentorship programs and some curated cohorts and we have division chief small groups.

during the pandemic, I started a peer support program that was a universal opt out. So our department is very large, over 300 people. And we decided, I decided that the pandemic itself qualified as an adverse event. And so all

faculty in our department were assigned a peer supporter who we trained up and they just reached out to say, hey, checking in, how are things? And some people were like, I don't want to hear from you again. And that's perfectly fine. And others were like, let's grab coffee or meet via Zoom.

Julie Celebi (42:18)
You

Ami Doshi (42:22)
what I appreciate is that now we had 35 people in our department who were trained in compassion, in listening, and in being a peer supporter. so much more important than the formal outreach and whether we get referrals or not is when they bump into their distressed colleague in the hallway. How do they respond?

Sometimes I've just like reached out to somebody who I'm like, you seem off. Do you want to grab lunch? And again and again, you hear it's those small group opportunities where you can be open and you can learn from one another and you can be free and you feel connected. And I think that's been really an important strategy, whether it's the primary strategy or.

byproduct.

And knowing that there's this cadre of people out there who were trained to respond in those moments that we can't.

plan for. think that's what I really hope can...

Again, change the culture. a big passion of mine is the impact of leadership on wellness of healthcare workers. And, you know, there's literature out there that talks about just how strong a lever it is. And so I have really, leaned into how can we

bring together compassion and leadership so that we create leaders who promote wellness.

Lindi (43:44)
I'd like to ask you as well. I mean, there's so much talk about burnout and I'm sure in your departments that sometimes it becomes kind of a trite term and everyone's like, just not another discussion about burnout. Yet you've already mentioned some of the words I feel which makes it more authentic, compassion, leadership. How do you go about?

ensuring that the seriousness of it is recognized and not that it just becomes another yoga session at lunchtime kind of activity.

Julie Celebi (44:17)
Yeah, I I think that as wellness leaders, fortunately, we get to have these systems discussions all the time about these are an issue. And the fact that we've had the institutional support of our time to be able to do this work is huge, right? So we are literally getting protected time to advocate for this. It has become an institutional priority. So I think that that has made it easier for us.

We're in an institution at UC San Diego that gets it. We're in that wellbeing 2.0 phase. We don't have to sort of make the argument. I mean, we still have to make the argument for various pieces, but we at least have the support to continue doing this work and to be the advocates that we want to be. There's a lot of places where people are being basically volun-told into this, right? And they're sort of, again, the culture takes advantage of these folks who...

care a lot about it and they're doing it out of the goodness of their heart and that's just not sustainable. So I think that that has made it easier for us.

Ami Doshi (45:22)
having the community of

wellness leaders who are beating the drum of this needs to be addressed at the systems level, this needs to be addressed at the systems level, has really helped in ensuring that wellness doesn't become about pizza parties and yoga. I found it helpful to call that out upfront that, I'm gonna talk about wellness, some of you will wanna roll your eyes, but what I mean by wellness is not.

Julie Celebi (45:49)
I'm

Ami Doshi (45:52)
meditation, I mean that's great for those individuals. What I mean is how do you live your best life, right? And be your best self again, personally, professionally. Some people prefer to talk about it as professional fulfillment. sometimes finding the language, depending on the audience, I think is helpful, but always calling it out and recognizing that...

this is a big issue, culture change takes time, we're not gonna solve this problem overnight. And being explicit about both the individual role and the organization's role, I think has been really helpful.

And so on one hand, naming it makes the difference. On the other hand, I would say with an approach in our department is that, I...

realize that everything ties to wellness and wellness ties to everything. And so we don't always have to call it about wellness. So when I am bolstering our mentorship program, that's actually going to improve people's wellness because now they're getting better mentorship and have the opportunity to do some of this journeying that Julie and I did with the support of people. But I don't have to call it.

wellness per se. And similarly, when we're providing leadership development for the division chiefs, that should trickle down and improve people's wellness, but I don't have to call it a wellness intervention. And so I think just recognizing how pervasive it is and, and that you can impact it in a thousand different ways. so, you know, some people are eager to be part of the,

Mentorship Excellence Committee, even if they don't want to be on a wellness committee, right?

Julie Celebi (47:26)
.

Lindi (47:30)
I you already said that at heart you're an educator and Julie, everything that has been shared as well shows your leadership in modeling this. And I'm wondering what do you share with the younger generation, because they're so key to changing the culture. And what are the two or three key messages that you share with them, maybe ones that you wish someone shared with you?

at the start of your career.

Julie Celebi (47:54)
Honestly, I feel like the younger folks are better at advocating for themselves than I think a lot of us are. So if anything, are already halfway there. I think just reminding them, ask for what you need. And just had this conversation in our compassion course the other day is remember that you are more than just the white coat. And to...

Remember your identity and what matters to you what your passions are and stay true to that because that is what is going to give you the staying power For the long term and just recognizing like we are imperfect human beings and that's okay We have to fight the perfectionism the everything needs to be just right Because that is what fuels more suffering and emotional distress so really just encouraging people to

embrace their imperfections and be vulnerable with trusted folks so that they can continue to show up authentically.

Ami Doshi (49:02)
I get to work with third year med students as a mentor clinician. And usually in my first session, one of the things I'm sharing with them is what Julie just mentioned. Have you got this far by being a very high achiever and probably having some perfectionism and you're surrounded by other high achievers?

The start of clinical medicine is when you learn like, okay, you're not always gonna get it right. And we have to be okay with imperfection and learning and the art of it. so, because I think that's a big shift of, what do you mean it's not all about, about getting it perfect. And so I do share that. think the other two,

pieces of advice that I would share would be to find your people and lean into them and, you know, be there for them as well. But find your people and recognize that those people might change over time. But to always also be on the lookout and to kind of have a

a radar that's always surveilling, whether it's for people or for opportunities or for probably most importantly glimmers. I like to call them of, know, what, what was it that that person said? Like, why are you still thinking about that a day later or.

Julie Celebi (50:29)
you

Ami Doshi (50:37)
you know, why do you feel so good after walking out of this teaching session? I think we focus a lot on the things that don't feel good, but just these little nudges that we sometimes get that are saying like, something about that calls to me to really focus on those and chase those down. Cause I think that's where we find where our purpose and joy lie.

Julie Celebi (50:46)
Okay.

Ami Doshi (50:58)
And then lastly, I would say it's not gonna look how you think it's gonna look. 15, 20 years into our careers, not doing what we thought we would be doing in our med school applications and in our residency applications. So just being open to, will change and that's okay. That's part of the process.

Julie Celebi (51:10)
Yeah.

Lindi (51:22)
feel you both are almost bringing the art back into medicine. The being, not just the doing, the communicating, the connecting, which is much deeper than just, I don't know, sometimes we've lost that, this autistic, creative side to caring for another human being. So that's really beautiful. Julie, you wrote a really poignant poem capturing your experience and it would be great if you would be willing to read that for us.

Julie Celebi (51:51)
Okay. It's called The Flare.

Sometimes it's easier to keep pushing through, to roll up the windows and hit the gas. And maybe your tires are almost bald, needle teetering on the empty line, oil change way past due, and there's a funny sound under the hood, but if you hum just right, it blends into the background music. And then the battery dies, and you're stuck with silence and stillness. And it gets a little cold at night, and you rummage in the back for a blanket.

and wait for a jump. But no one's coming. You drove so far and left everyone behind. The flashes through the window were a dizzying display and now it's just darkness. And you wonder how things got so worn. And you're tired. so tired. But you remember there's one flare in your trunk. And you wonder if it's worth it. And a tiny voice says, yes.

and with a deep breath you add a flame and suddenly you're not alone in the cold anymore. You drive the speed limit now and you watch out for the check engine light and look out for stranded vehicles along the way these days because this baby's got some mileage and it's going the distance.

Lindi (53:20)
It sounds even more touching hearing you read it. Thank you so much for sharing it in your own voice. It's a good moment to just take a take that breath and let it sink in. As we end, I'd like to come back to that question I asked you in the beginning. Now that you've been through this experience, you've been on this road, the tank almost ran empty. What now inspires and energizes you to continue?

Julie Celebi (53:22)
Thank

See you.

Ami Doshi (53:26)
Give me chills.

Julie Celebi (53:27)
Ugh.

Lindi (53:50)
on this road, working in healthcare.

Julie Celebi (53:58)
I know the struggle that I felt is a struggle of many and I think I know that the more that I can share my story that others will resonate and benefit So that's how I keep embracing that vulnerability that I mean was talking about is I was like I need to Not worry about me because this could save someone else so as much as I can

share my story and help others realize that they deserve to be well. I literally have that on the top of my like to-do list when I have all my like obsessive compulsive like what are the things I have to do? At the top it says you deserve to be well. this is what matters in the end and so just constantly using that mantra for myself, using it for others and continuing to bring that fierce advocacy towards that end.

to my colleagues, for myself, my colleagues, my learners, my patients. This is sort of the drum beat that I keep coming back to.

Ami Doshi (54:56)
for me it's all about the possibility of creating that ripple effect and it's in all the areas. I love the opportunity to work with residents who are going to go on to become pediatric cardiologists but now are equipped with some

from their time with the palliative care team that they can imbue into the way they care for their complex heart disease patients and just again communicate with more compassion. I think any opportunity to facilitate connection again has an exponential impact.

all these opportunities to create these small groups and facilitate these meaningful conversations really keeps me inspired. And then I think leadership, as we talked about, has such a profound ripple effect that I feel very driven to cultivate that compassionate leadership in healthcare because I think if we can do that, then it will.

the impact will reach not just the people that are being led, not just the physicians and the nurses, but most importantly the patients and the families that we're caring for.

Lindi (56:15)
You are both amazingly passionate caregivers, leaders, I think human beings, and your stories, I believe, are the things that will help people by listening to this. And so I thank you for just doing one more thing to put a light in the world and to try shift the culture in healthcare. we really appreciate your time to do that and your willingness to share. Thank you so much.

Julie Celebi (56:45)
Thank

Ami Doshi (56:46)
It was a pleasure to have this conversation with both of you.