“Far from signaling weakness, asking for and receiving help is not only a sign of strength, but a sign of courageous leadership. And so, I ask you to put on your own oxygen mask, and then to reach out and help your colleagues put on theirs, too. As physicians, the trauma we’ve experienced through our decades-long education and training, through our competitive medical culture, and through years of silence and self-sacrifice have created a common bond and an unspoken understanding. We must give ourselves the love and compassion that I know is deep within each of us, and we must help each other to do the same. Our greatest power comes from standing in support of each other, together. And it is the only way forward.”

Tammie Chang is a pediatric hematology-oncology physician and co-founder, Pink Coat, MD. She can be reached on Instagram @tammiechangmd and at her self-titled site, Tammie Chang, MD.

She shares her story and discusses her KevinMD article, “Fellow physicians, what is our path forward?”

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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. Subscribe at KevinMD.com/follow. Today on the show, we have Tammie Chang. She is a pediatric hematology-oncology physician, and she wrote the KevinMD article “Fellow physicians, what is our path forward?” Tammie, welcome to the show.

Tammie Chang: Thank you so much for having me, Kevin.

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

Tammie Chang: You bet. Everything about my life today has come out of the darkest period of my own personal life, five years out of training, when I was so severely burnt out that I actually was suicidal. I bring this up very openly. I know you talk with thousands and thousands of physicians, Kevin, and I know now that I’m not alone. One in five physicians has considered suicide, and we have the highest rate of suicide of any profession, and women physicians are at an even higher risk. We’re at 400 percent higher risk of dying by suicide than women in the general population. So everything about what I do today has come out of that place.

Kevin Pho: So as you were going through those darkest times of your journey, tell me, who did you turn to? How did you pull yourself up from those depths?

Tammie Chang: I reconnected with one of my closest friends. We were in an eight-year medical program together at Brown, so my medical school classmate Luisa Duran and I reconnected after not being in touch for years, because our medical training and our lives get so busy and stressful and crazy. We connected and realized that we both actually shared a similar story of burnout and severe isolation. Honestly, that’s actually why we came together to create Pink Coat MD, which is a platform to help all women physicians thrive. And honestly, I think through Pink Coat MD we’ve saved ourselves and are now helping hundreds and thousands of other women, so that makes it all worth it to us to be able to do this work.

Kevin Pho: One of the things that you mentioned was the disparity in terms of suicide rates between male and female physicians, and I think the statistic you quoted was 400 percent higher. What are some of the reasons behind that?

Tammie Chang: I think we have such a culture of burnout and self-sacrifice in medicine. When we take women, who are socialized and raised to be helpers, to be givers, and to be caretakers, and then we also take them and put them in medicine, it amplifies that that much further. I do believe that the heart of why women in particular are struggling is that they struggle to set boundaries to protect themselves and their own well-being.

Kevin Pho: All right, so let’s transition into the KevinMD article that you wrote. It’s titled “Fellow physicians, what is our path forward?” Now, for those of you who 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?

Tammie Chang: Absolutely. I wrote it during the height of the Omicron wave, and this was at the time when our health care system was pushed to the brink. All of us really were pushed to the brink. We were on the precipice of, honestly, buckling under the weight of everything, the numbers and the staff shortages. And I actually began to see so many almost horrifying parallels to the time I spent working in a Liberian hospital in West Africa after residency, shortly after the Liberian war ended, and that really struck home for me.

What I really came to recognize, and I shared this in the article, is: What is our path forward as physicians? Our health care system is crumbling, and we are quitting and dying by suicide at record rates. What can we possibly do to have a future, right, in this field, as physicians together? And really, I do believe, and I know you know this too, and all of your listeners, everyone listening, we have an unspoken bond and understanding among us as physicians, because we have survived so much through our training in all those years, and even in the workplace now. It is a tough job that we have.

And so what I really stress in this article is that we must put our own oxygen mask on first. We are not able to help others unless we’re OK, and we have to help each other do it, because we have not been trained in a culture that has been supportive of that, right? Asking for help, or even receiving help, has honestly been perceived as weakness, and it’s not. It’s absolutely strength. It shows that you have the self-awareness to recognize that you might need some help, and I seriously believe that that’s self-leadership. And that’s the model that I know all of us want to model for leadership. We want to model that for our children and for future generations.

Kevin Pho: You mentioned that there were some parallels between what you saw during the COVID pandemic and your time in West Africa. So tell me some of those parallels.

Tammie Chang: Yeah. I was a pediatric resident at the time. I was med-peds, but specifically acting as a peds resident. We had at least three or four dozen children die in the course of three weeks, four weeks, and they were all regular things that would be no problem in the Western world. I spent time resuscitating children in the emergency room, none of whom would survive. And then there were also choices that we had to make. I saw it every single day. We didn’t even try to resuscitate those who we knew wouldn’t make it, or who would need a higher level of care that we couldn’t provide, or who would use up resources that could be used to save someone else who had a better chance of surviving. I saw so much of that during the Omicron wave.

Kevin Pho: You mentioned that a lot of physicians are certainly at their lowest point. They suffer from things like moral injury and burnout. Tell us a story, a case study, something that either you experienced yourself or that your colleagues can share, a story that really illustrates that point.

Tammie Chang: I’m the medical director of provider wellness for my large health care system, and I support and coach physicians and APPs every day. I’m lucky enough to have others share their very personal, vulnerable stories with me as part of that. I still remember one story from, actually, a group of critical care physicians sharing how hard this all has been. In particular, they’ve seen the sickest of the sick, but they also have to withstand being yelled at by patients’ families every day, accusing them of killing their loved ones, because they didn’t believe that COVID exists, or that vaccination was a thing, or even real. And for them, the first thing they said was that they have no compassion left. They saw themselves angry and crying in ways they never had in their entire lives, at the heart of caring for the patients that they’ve dedicated their lives to.

Kevin Pho: And when clinicians come to you with stories and say things like they have no compassion left, what are some of the things that you say in response to that?

Tammie Chang: I think the very first thing we have to do is to give them that space to acknowledge it, and to be a safe and supportive listener, a partner, and not try to fix it or offer solutions. Because often when people are in that space, they are not in a place to even be open to a solution yet. We have to allow them to go through it, to heal and come out of it, and then we can talk about what to do next. But really, to me, I think the most important part is to hold that safe space for them.

Kevin Pho: We’ve been talking about clinician burnout on KevinMD for several years now. We talk about it on this podcast, especially during the pandemic over the last few years. And I’m interested, just from your lens, have you noticed that the needle has moved? Have we given enough awareness to burnout, and if so, do you think enough is being done over the last few years?

Tammie Chang: I’m so grateful that this has been part of your conversation for so long, because it is now being magnified, right? And I think this is maybe one of the few silver linings of the pandemic, which is that it has completely heightened this entire discussion of burnout, not just among physicians but in health care overall. I truly believe now we are finally at a time where it’s front and center. Every health care organization is struggling to find solutions right now.

There was that recent headline in Forbes from that Elsevier survey that reports 75 percent of health care workers will likely leave the profession by 2025, right? I mean, that’s huge. What are we going to do if there’s no future, if there’s no one to take care of anyone? Who’s going to take care of us? Who’s going to take care of our families, Kevin, all of our families? Who’s going to take care of us when we’re older? We have trained for a lifetime to care for others, and yet there’s going to be no one left before too long unless dramatic strides are taken right now. And so I think this is our time and our opportunity. We have to, or there won’t be a future.

Kevin Pho: Now, you mentioned that you were the wellness officer of your health care system. From a systems level, what are some of the things that we can do to help alleviate these symptoms of burnout and moral injury?

Tammie Chang: We know that 80 percent of burnout is system level. It’s not because of a lack of resilience on the part of the individual. And so 80 percent of our responsibility is to do that, not just as an individual health care system but as a nationwide health care system. And so yes, there are things we can absolutely do on the individual organizational level. It’s what I do every single day. We put foundations in place to truly foster a culture of wellness, to make things as efficient and streamlined as possible for physicians, especially in the EMR charting, which is the greatest pain point for most physicians today, in addition to providing resources for personal resilience. That we can do on an individual organizational level.

But it’s much more complex than that. It’s nationwide. It’s our reimbursement system. It’s the requirements we have for billing and for documentation, all these pain points, all the things that are causing the moral injury, taking us away from time with our patients, which is what brings us meaning and joy and purpose. We spend most of our time now in front of the computer. That’s where the change has to happen, or we won’t honestly be around in this field much longer. So what can we do?

Kevin Pho: It sounds like there’s a little bit of tension there. I think with a lot of the solutions that we have to alleviate burnout, more time with patients, seeing fewer patients, there is a little bit of tension with the financial realities of a lot of health care systems. So you are kind of caught in the middle of both worlds. So what’s the path forward for something like this? Where do you see the next few years leading when it comes to resolving that tension?

Tammie Chang: I think many of your listeners, writers, and podcast hosts have also shared the same message, which is that all of us have to be part of leading that change, us as physicians. No one is going to care about this more than us, right? And we want this for our own children and the next generations. It’s not just right now. We’re talking about the future, right? Our legacy is in our lifetime. What can we do to make things better for the future generations? So I think we have to lead that change, whether it’s from a national legislative perspective or individually, locally, at home in our own organizations. It’s lifting up our voices and doing it together.

Kevin Pho: You have a lot of connection with administrators. What’s their view, people who are non-clinicians? What’s their view on the issue of physician burnout? Because when you and I talk, of course, we see the world one way, but when you talk to administrators and management, how do they view physician burnout?

Tammie Chang: I think it’s so tough, because I actually find, certainly in my own experience, that the vast majority are extremely compassionate and understanding, and yet they feel trapped when it comes to really making massive change, because of the restrictions on health care and the business of health care. It’s that tension you talked about with the business of health care, which has dramatically changed, right? It’s evolved rapidly in the last decade, two decades, in health care in the United States. And so there’s that tension of decreasing reimbursements and less financial stability overall for health care organizations, and yet greater and greater pressures on physicians, which is then driving burnout. They get it. They are struggling just as we are to find solutions.

And I think the key message that I have to share with your listeners too, because I have the window into both worlds every single day, is that our administrators are struggling too, and they want the best thing. They are good people doing the best they can with the limited choices they have. That’s what I see every day.

Kevin Pho: We’re talking to Tammie Chang. She’s a pediatric hematology-oncology physician, and she wrote the KevinMD article “Fellow physicians, what is our path forward?” Tammie, I understand you recently wrote a book. Tell my audience about that.

Tammie Chang: It’s called Boundaries for Women Physicians: Love Your Life and Career in Medicine. And I wrote it, actually, because of the first KevinMD article I wrote last year, which inspired me to write this book. It’s because I think boundaries are the heart and the key to how we can all love our lives and careers more fully, and especially as women.

Kevin Pho: So what are some of the key takeaways that you want readers to come away with after reading your book?

Tammie Chang: For everyone, too, regardless of gender, really, what I want most for all of us, and every single one of your listeners and readers, is to give yourself that same kindness and compassion that I know you strive to give to your patients and to others. So when you have the self-awareness to recognize that you may not be OK, that you might need some help, that is strength. It’s not weakness. And you are modeling that leadership for your children and for the next generations to come.

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

Tammie Chang: Put your own oxygen mask on first, and help your colleague do the same.

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

Tammie Chang: Thank you so much for having me.