How to balance family and professional needs during the pandemic [PODCAST]

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“The reality of being a medical practice owner is that we are small business owners and very vulnerable to the impact of COVID. Having previously worked in the telemedicine industry and because I am a psychiatrist, I initially felt that I was in a good position to adapt to this crisis – and this has been overall true, but the reality is it hasn’t been so easy in other ways. I was able to transition to a full telemedicine practice rather quickly and seamlessly; I am fortunate that I have been able to work to some degree while some of my colleagues have not.

On the business side, I have had a significant decline in my overall revenue because patients were, especially for the months of March through May, seeking less health care overall, didn’t have sufficient privacy for telehealth sessions, or even simply preferred to wait for in-person visits to become available. As you know, New York was hit particularly hard, so this has been a prolonged situation of waiting until the coast is clear. Despite decreased revenues, operating costs remain at their pre-COVID levels – I am carrying the expense of my office rent and utilities, malpractice insurance, and other insurances, for example, accountant, biller, receptionist, and none of those expenses will be decreasing anytime soon if ever. I am the only clinician in my practice, but I would like to be able to rehire and re-expand my practice again but am facing some challenges in hiring due to poor cash flow.”

Sharon M. Batista is a psychiatrist.

She shares her story and discusses her KevinMD article, “7 tips to balance family and professional needs during the pandemic.”

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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. Today on the show, we have Sharon Batista. She’s a psychiatrist, and she wrote the KevinMD article “7 tips to balance family and professional needs during the pandemic.” Sharon, welcome to the show.

Sharon M. Batista: Oh my God, thank you for having me. It’s so awesome to be here.

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

Sharon M. Batista: In a nutshell, I’m a board-certified psychiatrist, trained in New York, living in New York, in private practice on the Upper East Side in Manhattan. I’ve been doing that for, oh my God, like 10 years now, and I’ve really been through a lot. I think I’m thriving and enjoying it, but I’ve been through a lot of growth and a lot of change in that time. I’ve been teaching on the side, just volunteering and doing some other things in the community to try to help out and stay up to speed and involved. But my private practice is my livelihood, pretty much my professional everything, I’ll call it, and something I’m super proud of, being both a business owner and a medical professional.

Kevin Pho: Great. And how has the pandemic affected your psychiatry practice?

Sharon M. Batista: How hasn’t it affected my practice? And maybe that goes for many of us. Being a solo practice owner and business owner, I’ve seen a lot of changes, a lot of changes, even financially and otherwise, because some of my patients are worried or can’t afford their care, worried about what’s coming next in the economy. So my patients have had job loss, meaning also insurance loss or insurance coverage changes, and all of these things have had a huge ripple effect. Some people who need care have not been getting care. Some people are getting more care now, finally, as I think there’s a bit of a moment of respite later now in the pandemic.

But in March and April, I had a tremendous loss of, I’ll call it business, even though it’s kind of a colder word for it. I was not seeing so many patients. We were all kind of isolating and just watching and waiting to see what was going to happen in our world. And being in New York, New York was hit so hard. Many people I know of were sick or were worried about getting sick, understandably, and it just had a tremendous negative effect on the health of my practice, if you want to talk about the business side for a second.

And of course, on a more personal side, a clinical side, it’s been stressful. We’re kind of all in it together, but we’re all affected differently, and so navigating that was a huge game changer. The world was kind of normal before that, whatever that means, in terms of our lifestyle and what we thought was going to happen from one day to another. And then come mid-March, most of us didn’t really know what to expect, myself included.

Kevin Pho: And we’re speaking towards the end of October. Are you seeing patients live, or are you still seeing patients virtually, or right now is it a blend between the two?

Sharon M. Batista: Right, that’s a great question. I know colleagues who are doing both, or even seeing patients in person exclusively, although that’s the minority in terms of what I’ve observed. Myself, personally, I’m only seeing patients by telemedicine at this time. I just don’t feel it’s warranted, since my practice is in the city, to have people taking the subway to come see me, waiting in the waiting area, that kind of thing. It’s an unnecessary exposure, but that’s my personal take on it.

And I also feel, because my practice involves both, whether it’s assessing medically, medication management, or doing psychotherapy, that talking with a mask for 10-12 hours a day would be really fatiguing for me personally and would prevent me from really expressing myself, and maybe my patients from expressing themselves, if I have to wear PPE for their session. So I made the call to stay telemedicine for the time being, and probably for the foreseeable future into the winter, to stay telemedicine 100 percent.

Kevin Pho: Now, for those other clinicians who are also seeing patients virtually, what’s the number one tip that you’ve learned over the last few months that you could share with them?

Sharon M. Batista: I would say to pace yourself a little bit. It’s really easy, living the, I’ll call it Zoom life, as I like to say, or the COVID life, to just schedule yourself in some unlimited way where you’re working multiple hours in a row with no break. It’s easy to forget to eat breakfast, myself included, or have a drink, or get up and stretch your legs. We don’t have our commutes anymore. We don’t have these times of day where we naturally step away from the desk because we have to, or we need to, or we’re scheduled to. We have to get on the train to go home, or drive our car, whatever it is.

So we needed to build in, I think, some other routines to make this workable and make it more kind of human and normal, including moving your body, even for 10 minutes here and there, and including a break for a snack, even if it’s a tiny thing. I’ve got my, actually, I have a carton of blueberries right here. You can’t see. Well, I could show you. And hey, it’s there for a reason. It’s there because I don’t want a chance of forgetting to give myself a little nutrition so I can keep on going. But then having a real break is important too: having an end time in your day, having a time that is off-limits and that’s just for you, or your family if you have a family, or whatever it is. That’s important too.

Kevin Pho: Right. So let’s transition into your KevinMD article, “7 tips to balance family and professional needs during the pandemic.” Now, for those who haven’t read your article, can you just walk my audience through it and maybe share the story of why you decided to write it?

Sharon M. Batista: Writing a blog post is pretty new to me, to be totally honest, and it’s something I thought about and sort of said, “Oh, maybe one day,” and never got around to. I’ve written before professionally, but for journals, and I have a book. But these major life changes that we’ve all been going through, and I’ve been going through personally, were weighing on me during the pandemic over this time. One thing is the shock of March and April, and, as time went on, just kind of the gradual shifts month to month and how it was wearing on us, on me and on our family as a family.

And I’m not saying my situation is unique per se, but I felt an urge to kind of share that, or get the message out, and connect with people on these levels that I have: how I’m affected as a business owner, as a physician, as a potential front-line worker, although I’m not currently on the front line per se seeing patients in person, and as a mother. I’m a mother of two very young kids, and that’s a whole thing by itself, and very stressful in a time like this. So I felt that, being a part of this thing that we’re all going through but are affected by differently, I wanted to express that.

And then, at the same time, I am a part of a group of women physicians called the American Medical Women’s Association, and our mission is to be the professional home to support women doctors, including in areas like career advancement and work-life balance, but now also including physician mental health. Mental health has been underrecognized as a concern for physicians, even though physicians themselves are impacted just as much as, and differently than, non-physicians in terms of their mental health needs. And so I just felt that getting our word out as AMWA, and getting our word out as me as an individual, connecting all these levels and finding ways to provide support, was really compelling and made me motivated to write this article for your blog.

Kevin Pho: Now, can you share some of those seven tips with my audience?

Sharon M. Batista: Yeah, definitely. I’ll share one of my favorite ones, which is one of the ones that makes me laugh the most whenever I think about it, because I wrote in your article something along the lines of, “Lower your standards, and then if you think you’ve lowered them, lower them a little bit more.” I might be missing the wording exactly, but it’s the one that I come back to time and again.

Being a working mom, I’ve always been like, “Yes.” “Can do” is my philosophy: can do with the extra activities, can do with the arts and crafts, even though there’s only so much you can do if you’re working the way I have, just as one person, can do with making the meals, the laundry, and so on. This is real life. I’m a human. I have laundry. But in COVID especially, keeping those really high standards, high goals, and expectations for myself, well, before, it was motivating and it was a feel-good. During COVID, it actually caused me to feel bad, because I was not able to meet my own expectations for our quality of life, for my children’s happiness and fulfillment and stimulation.

And so I had to start to kind of cut corners, but in a healthy way, and say, “OK, you know what? The Instant Pot is the best thing on earth. It’s like sliced bread.” I can throw a bunch of chicken breasts in there with a bunch of spices, and then get some tortillas, and we have dinner, and I didn’t have to actually cook it, besides put it in, close the thing, let it go, and then open it later. Hey, it’s not the level of cooking that I’m accustomed to, but it’s still food, it’s still nutritious, it gets the job done, and we’re not wondering what’s for dinner. Oh, well.

Same thing with takeout. Same thing with other conveniences. I’ve had everything possible delivered that can be delivered, I think. And while it’s certainly a luxury, and certainly there are limitations, there’s spending time in line, because that is still reality in the stores where I live, that you’re in line, social distancing, with limited capacity at some of the stores. I’m not going to take someone else’s spot if I can afford not to. Let someone else who really needs to be there in person do that, because they can only get the things they need that way, and I’ll get it delivered. It costs a little extra, but hey, it’s less time outside, especially with kids. I can’t bring my kids to the store, so then what do we do?

So it’s less time spent on errands in that kind of way, and more time on internet errands, but it pays off. I can order the groceries at midnight when I’m watching some TV and relaxing, and get two things done at once, and then it’s done. I don’t have to think about it. So those are simple things, but actually, they’ve gone a long way to me feeling like I have a little bit more free time, since there’s less free time in this Zoom COVID living situation.

Kevin Pho: I think that’s one of the biggest challenges for physician parents, of course: managing kids, with most of them being remote or hybrid, in their professional life. We’re speaking, again, towards the end of October, and some say we’re at the cusp of a third wave of the pandemic. Now, over the past few months, when it comes to, again, balancing both your personal and professional life, what are some other tips that you could share with my clinician audience who may be going through the same situation as you are?

Sharon M. Batista: You know, honestly, perfect doesn’t exist. There’s no perfect balance. There’s no perfect option. And that’s been a take-home lesson for me that I’ve kind of implied here, but that is one thing. And so what does that mean in reality? That might mean that you’re not going to be the perfect parent, or you’re not going to be the perfect doctor, God forbid.

And so I’ve had to be honest with some patients, even, and turn some patients down in terms of some things that they’ve needed or wanted, and said, “Let’s find some other ways. If this was a year ago and we had our lives together, I’d be able to do everything you’re requesting, and I’d be happy to help you and give you more of my time. But right now, I have to stretch my time in a different way to meet these different needs. And so that means that I can’t, for example, see you at the time of day you’re accustomed to. I can’t see you in the place that you’re accustomed to, in the way you’re accustomed to, and that may not work for you. If it doesn’t work for you, I understand, but there are some limitations.”

And so I think being honest about one’s life limitations is one thing that I would add to the list that I didn’t say in your article. It’s been really helpful for me to be really open and human with my patients, that I’m going through this too, and this is pretty much, or was, I think, a nightmare. I don’t know how else to say it, for many of us. And that means we’re not superhuman. We have real things to take into account, and sometimes that means that we’ve got to do that thing tomorrow, or, “Let’s check back in a month,” or, “You know what? You’ve been doing really well. Maybe we’ll regroup when you feel there’s a need, and catch me up over email.” And those are things that we may not usually do in clinical practice. We want to see our patients more and do more, but these are different times.

Kevin Pho: I think that’s a great tip when it comes to setting limits with patients, and as physicians, we’re often not used to that. We always want to do whatever we can to help patients. How difficult was it for you as a physician to set limits with your patients, and how long did it take you to come to terms with that?

Sharon M. Batista: Probably like you, I mean, I don’t know your situation 100 percent, but a lot of us were kind of in the crossfire, the crosshairs, I guess you’d say, and I get those expressions wrong all the time. So when it hit, even though we sort of saw it coming, when these cases started happening, especially in New York and California, I was like, “Oh, gee, this is concerning.” Most of us were caught off guard, so most of us had to hurry up and make a plan, and it was a haphazard kind of plan, spackled together with a little super glue or something. And then we had to figure out whether that plan was a temporary plan, because most of us, I think, imagined, “Oh, we’ll stay home for a couple of weeks. See you later.” I mean, I even had those thoughts. I was in denial. I was like, “OK, see you soon.” Well, here it’s October, and I’ve seen very few people in person, a select few, but very few people in person in terms of my personal life, like family, for example.

Luckily, I’m very fortunate. My patients, by and large, were going through it and understanding, and so I didn’t have a lot of challenges of being in conflict with anybody. Everybody was experiencing it differently. There was some crisis there. There were times where I was just like, “Oh my gosh, if the pandemic hadn’t happened, none of this would have happened to you. It’s awful.” But we were able to work really collaboratively, because everybody, including myself, was honest about what was going on. And I think also being receptive, that “If there’s a way I can help, I’m happy to. Let me know what you think.”

Finding out from the patient what works for them and what they need: Do they need a different option? Do they need another, maybe the addition of a therapist or something? Do they need to see their primary care doctor because they have health concerns that are going unmet and I’m the only doctor they’re talking to? So wait a minute, I can intervene and get them some help. So keeping the communication open and flexible has been a real help.

And so a lot of psychiatrists, I think, are variable in how much we use other kinds of communication. Of course, we’re in the Zoom wave right now. I was doing telemedicine before all of this, so I felt OK with that side of things. I was kind of prematurely like, “I’ve got this.” But then there are other things, like how much you’re using email, and how much volume there is, and how many messages and faxes and all that. It’s standard in our practice to have these kinds of forms of communication, but it became more so. And so, to be flexible about allowing people to email updates, for example, that you’d usually kind of save for their assessment in the office, whether you see them every month or every few months, being in touch in that way. And these are non-billable ways, right? And that’s a thing when you’re a business owner: where you’re spending your time, and whether it’s on a revenue-generating thing or a thing that’s just a thing you do because it’s the right thing and helps get you through.

Kevin Pho: We’re talking to Sharon Batista. She’s a psychiatrist, and she wrote the KevinMD article “7 tips to balance family and professional needs during the pandemic.” Sharon, can you recommend any resources to my clinician audience that can help them balance both their personal and professional life?

Sharon M. Batista: Absolutely, I’d be glad to. One resource I want to recommend, and this is going back to what I like to remember: I’m human. Physicians are people too, regardless of, say, easy tips and tricks. Some of us are more affected than we think we should be, or than is called for, or are feeling even stuck or in need of help. So whether it’s professional help or it’s calling colleagues, these resources are crucial.

I found that, going back to places where I have professional homes, like the American Medical Women’s Association, I have an amazing, supportive community of female doctors from all disciplines of medicine, and we talk, and we’re on committees together working on projects, including a mental health initiative we have going on, including about physician suicide. That’s been a really great resource. I’m a psychiatrist, so I go to the APA meeting with my APA colleagues online. We’ve done some online meetings. And there are other colleagues, local colleagues who are also in private practice, who own medical offices just like myself, and we’re talking individually and in small groups: “How are you affected? Are you in the office? Are you not in the office? How are you getting your PPE? Are you stressed? How are your kids? Oh my gosh, where’s your child care?” Just touching base about how you’re affected and getting support has been tremendous for me. And I recommend, if you’re not feeling connected, if you’re feeling more isolated and disconnected, that’s one way that you can get that help in a non-mental health kind of way.

The other way is to take advantage, and physicians so rarely do, of actual mental health treatment, even if temporary. There’s great treatment to be had. Yes, it may take researching to find the right fit for you, but getting a recommendation for a great therapist, to be able to talk about these stresses even for a few sessions, could be something, or a psychiatrist, if you think a medication can be a help.

Kevin Pho: And my final question, Sharon: What is the take-home message that you want to leave with the KevinMD audience?

Sharon M. Batista: I guess one of optimism, in a way. This is an ongoing pandemic. It’s, I think, a great adversity for many of us, and I just shared my story. My story is a little bit unique to me, although there may be universal things that resonate. But none of us is trapped. That is, I think, my take-home message. Sometimes there aren’t always immediate solutions, and it may be a matter of putting one foot in front of the other to just get through it until you feel like it’s a time that you can really overcome whatever it may be. And I think, with that, there’s always a way, or ways, to manage and figure out how to manage better. So whether it’s, like I said, holding yourself to some softer standards, lowering your standards, making the situation workable, or giving yourself a break, a pause where needed, a day off here and there, these are unusual times, so our same standards cannot apply.

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

Sharon M. Batista: Oh my gosh, it’s a pleasure. Thank you.

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