“She kept quiet, but she had planted the seed.

Interestingly I did not talk much about work during the appointment, so her question stirred my thoughts. Why did she think it was work-related? I started to look at my daily routine. I was able to recognize where I needed to set boundaries at work. At home, I delegated some simple chores to the kids. I must say kids are excellent learners if given the right directions. Small steps and changes made my life much more manageable. My somatic symptoms went away along with my stress.

I owe it to my PCP for recognizing what I was struggling with and bringing it to the surface for me to address it.”

Sirosh Masuood is a psychiatrist.

She shares her story and discusses her KevinMD article, “When primary care helps a psychiatrist.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at kevinmd.com/rate, and subscribe at kevinmd.com/follow. Today on the show we have Sirosh Masuood. She is a psychiatrist, and she wrote the KevinMD article “When primary care helps a psychiatrist.” Sirosh, welcome to the show.

Sirosh Masuood: Thank you, Kevin, for inviting me to your platform. I’m really glad to be a part of it.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Sirosh Masuood: Yeah. So I’m a psychiatrist by profession, based in Maryland right now. I started my psychiatric training in 2007 in New York, at a very busy hospital affiliated with Mount Sinai, and then I completed my fellowship in CL psychiatry, which at the time was the North Shore system; it’s called the Northwell Health system at this time. Since then, I have worked different jobs. I have worked in an outpatient setting, in a hospital, with a private group, in nursing home consultation, and in hospital consultation, and now I have my own practice. In addition to medication management, I also offer TMS, and I also provide therapy for my physician colleagues. So that’s where I am right now.

Kevin Pho: So it sounds like you’ve practiced psychiatry in different venues. After reflecting on your experience, what would you say are some of the challenges and rewards of practicing psychiatry today?

Sirosh Masuood: Since I have this vast experience treating different types of populations, it was very interesting how socioeconomic status affects your mental health and how your professional life affects your mental health. I have worked with the chronically mentally ill, and I have worked with highly educated professionals, so that’s a very wide range of psychiatric disorders and mental health. I’m glad that I have this experience, and I can use it at my private practice now. So it’s very interesting, and every setting was different for me, and I learned different skills in every setting.

So it was working with not only the patient population. When I worked with a private group, it helped me establish my own practice. When I worked in a hospital setting, it helped me establish relationships and understand the importance of the other physicians and the role of other physicians in patient care. So as a whole, it was an interesting journey up to now.

Kevin Pho: So it goes without saying that we need more behavioral health specialists. Now, for those medical students who may be listening to this podcast, tell us: What do you love most about your job?

Sirosh Masuood: So I like that I can connect with the patient on a very personal level. Mental health is very broad. For a medical student, when they rotate through only the inpatient setting, I tell them to experience outpatient as well. It’s completely different. You have to find your fit. My interest was in the medical setting, so that’s where I specialized. So for med students, I also tell them to shadow someone or work somewhere in the hospital to see what consultation work is like.

The inpatient work is very different from outpatient work, versus consultation, versus nursing home consultation. So it’s very wide. It has so many different avenues to choose from. It’s not only the chronically mentally ill, it’s not only depression, it’s not only bipolar. There’s so much that you can do in this field. You just have to find your style, you have to find your interest, and work in that direction.

Kevin Pho: All right, let’s transition into your KevinMD article. It’s titled “When primary care helps a psychiatrist.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Sirosh Masuood: Yeah. So I would start with this: I always wanted to write, but I never had enough time. I was always busy with work and home; there was no time. Now that I have my own practice, not only can I manage my time better, but my stress level is down, so I’m able to work on the things I always wanted to do, and that’s how I started writing, with this article.

What I captured in the article was pretty much my struggle as someone with my training and my childcare needs and my kids and my family. When I started my training, my son was one and a half years old. My husband is also a physician. At that time, he was a fourth-year resident. Thankfully, he didn’t have to take any calls, but my schedule was q3, q4, like every third night, every fourth night, so it was a very busy program. We were new in New York. We didn’t have any family support, and we had a very limited social organization. We knew only the residents from the hospital, so there was very much no support.

So I had my challenges with child care. Since I started, the training was not easy. During my first year, I questioned several times, “Was it the right time to start the training? Should I have waited another year?” So it was tough doing it all by myself and my husband. When I finished the training and started the fellowship, I also had my daughter, a six-month-old. So it was somewhere between the fourth year and the fellowship that I decided I have to work part-time. My husband has always worked a full-time job, so finances were not an issue, but I felt one of us has to be more flexible, one of us has to be more available to the family, for the kids, and that’s how I decided that the one of us to do part-time would be me.

The first job I took was where I trained. It was a very busy outpatient practice, and I signed up for a 24-hour workweek schedule. All my attendings and my colleagues started questioning me. They were like, “You were not offered a full-time job? There’s so much need. You should ask. You should negotiate.” So I found myself explaining to them that I want to do part-time; that’s my choice. That was also interesting, because everyone has their own life, their own stage of life, and their needs are different.

But as I continued my schedule, somewhere between 24 hours and 20 hours at every job, it was mostly the women physicians who actually appreciated it. They validated it: “Yeah, of course.” They envied me, that they cannot do it for whatever reasons. So I got my validation mostly from women physicians.

After New York, we moved to Maryland, and again, I kept my work part-time in different settings. The one that I settled at was hospital consultation work. I love my job. It was a moderately busy hospital, but I think the main issue was I was the only psychiatrist in the hospital. I signed up for a 20-hour workweek. I was going daily from 9 to 1 or 1:30, that kind of schedule, so the goal was to pick up my kids daily and take care of the rest of the stuff. But it started building up. As we all know, my phone wouldn’t stop ringing. I would be answering phone calls till, like, 5 p.m., 6 p.m., while I’m on the road taking care of the after-school activities and picking up the kids and all that. I would always be on the phone, answering or fixing, or on weekends and vacations, I was available.

So I think, as I look at the broader picture, the problem was that I was the only one in the hospital, so I felt I was responsible. There was no covering physician when I went on vacation. Although there was someone covering, still, since everyone had my cell phone, if I didn’t respond, they would text me. So it kind of started building up, and I didn’t mind it. I didn’t even realize it; I was enjoying it. As I said, I love my work. I never complained about my work. I thought, “This is the expectation. This is the demand of the job, and I have to do it.” And at home, things were not getting easier. More stuff was happening, so I was not getting help there either.

So I started to get exhausted. I started having all these somatic symptoms: headaches, shoulder pains, nonspecific body pains. I was tired and fatigued, but I was functioning fine. So when I had my annual physical with my primary care, I was convinced either I have hypothyroidism, I have vitamin D deficiency, I have anemia, or I have all of the above. So I told my primary care to get me tested, and she ordered everything, but she told me, “Do you plan to cut down on your hours?” And I was looking at her like, “I’m working 20 hours per week. I cannot cut even further.” And I didn’t even discuss my work with her, so that also surprised me.

So I came home, and all my labs came back normal, and then I was like, “Why did she, then, just say that?” So I started looking at my work-life schedule. On paper, yes, I was doing 20 hours of work per week, but no, it was not really. It was a bit more, and then it’s the stress, right? If you’re getting a phone call at 5 p.m., it’s not for a regular thing. It’s like some emergency is going on, and they need immediate intervention. On the weekend, since there’s no one else, and in the hospital setting, psychiatric emergencies are different, they need the answer there and then. So I would be curbsiding on the weekends, and it was not a 20-hour job anymore.

So I started sorting out things. I started looking at my schedule, I started setting boundaries at work, and I started getting my kids involved at that time. Whatever they could do, I asked them to start helping out, and it’s not only that they were helping me; it also helped them become an individual, an independent individual. So I started sorting things out, basically. And this is actually pre-COVID. I’m not even talking about the pandemic time; that I will probably write about another day as well. But it helped, sorting things out. My stress level came down, and I was less tired. So that’s how, basically, I came up with writing this, because I wanted to share, and I feel that a lot of physician colleagues do experience that and do not realize what’s happening.

Kevin Pho: So one of the things that you mentioned was setting boundaries, both at work and at home. Give me an example of how you set boundaries at work.

Sirosh Masuood: So my hours were 9 to 1 every day. Before, what I used to do was, if I got a consult at, like, 12:50, I would do it, right? But the consult takes a good 45 minutes, the initial consult. So I started to sort those things out. Unless it was an acute emergency, like an acute, acute emergency, I did not take the consult after 1 or at 12:50, because there’s no way I will finish at 1. I stopped taking phone calls on the weekends. The days, I still continued, because if I saw a patient and there was some issue, I had to answer. But weekends, I stopped curbsiding. I stopped taking the phone calls. I made sure that I go on vacation, and I send, like, 100 emails to everyone, like a voicemail, that I’m not available, to make everyone aware. And that kind of trained everyone. Everyone realized, “OK, she is not on call on the weekend.” And then also the system, then, I realized that there’s a need for additional coverage. There’s a need for weekend coverage. So I think at work, this helped.

Kevin Pho: Now, when you set those boundaries, how difficult was it for you to do that, and did you get any pushback? Did you get any people to say, “Hey, you used to do this, but now you’re not doing it anymore”? How difficult was it for you to set those boundaries at work?

Sirosh Masuood: I think for me, to say no to a consult was harder. It needed a lot of repetition: “OK, this is not an urgent consult. It can be seen tomorrow. We always have 24 hours to see a consult anyways. The patient is not getting discharged today.” So it was a lot of education. Did I get pushback? Not really, because they understood. I would say nobody. They probably were surprised that I didn’t pick up the phone on the weekend, but on Monday, if someone mentioned that, I decided to say, “No, I was not on call,” and that was the fact.

Kevin Pho: I hear everything that you’re saying, because similar to you, I work part time. I work about 20 hours a week doing internal medicine primary care, and I empathize with exactly what you’re saying. When I’m on call, you get phone calls from the nursing home at all hours of the day. And even when you’re off, just having that pager, you’re not really off, having that stress of a potential call that you need to intervene on. So I absolutely understand what you’re saying.

Sirosh Masuood: Yeah, no, I think it took a few months for the hospital to adjust, but I don’t recall having any pushback, because per contract, I was doing more than what was expected. So I did not. And basically, I had to stand my ground.

Kevin Pho: We’re talking to Sirosh Masuood. She’s a psychiatrist, and she wrote the KevinMD article “When primary care helps a psychiatrist.” Sirosh, I think that your message will resonate with a lot of physicians in terms of potentially cutting back hours as a way to kind of solve some of the issues dealing with the Great Resignation when it comes to physicians. There’s a lot of burnout, of course, and it’s very difficult to practice medicine full time, because even though you’re only working 40 hours a week, that 40 hours is really close to 100 hours a week when you take call and do all the paperwork and bureaucracy. So for those physicians who are interested in setting boundaries and cutting down, after reflecting on your experience, what kind of advice can you give to these physicians?

Sirosh Masuood: So I would say you have to prioritize your needs. What applies to me may not apply to someone else, so you have to prioritize what’s right for you. What are your needs? What are your family’s needs? What kind of financial responsibility do you have? What are your supports? Do you have family who you can rely on? Or are you financially stable, so you can outsource a lot of responsibilities at home, so that not everything comes down on your shoulders? And then again, boundary setting, boundary setting everywhere. You’re one person; you can be at one place at one time. So we don’t have to challenge ourselves. Although, I think, with me also, that’s what I did. I took pride in that: “Yeah, I’m a champion. I’m doing it all.” And I did it all, but at the expense of exhaustion and physical symptoms.

So whenever you interview for a job, I would say you have to be very clear about what your needs are and what your family’s needs are, and negotiate. See if the job is right for you. You don’t have to take the job just because. For this job also, I negotiated. The job was a full-time job. It was a combination of consultation work and PHP work. Before I went in for the interview, on the phone, on my introductory call, I asked them, “Would you consider part-time?” And then they asked me, “Why? Are you concerned about your family?” And I said, “Yes, I have small kids. I’m not intending to do full-time. If you are going to be flexible about it, then I can come and interview.” And they were very nice about it. They accommodated my hours. They accommodated whatever I asked for at that time.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Sirosh Masuood: So I would say nothing is more important than your health. If you’re taking care of yourself, you can be a better doctor, you can be a better parent, a better partner, or whatever your role is. So self-care comes first. Be aware of your needs, and recognize what your body is telling you. If you’re having symptoms just like what I described I was having, it’s your body beeping. It’s giving you an alarm; it’s giving you signals. So stop, take a break, analyze, reorganize, sort things out, and then restart. We do not need to tough it out.

Kevin Pho: Sirosh, thank you so much for sharing your time, story, and insight, and thanks again for being on the show.

Sirosh Masuood: Thank you very much.