Episode 068: Burning at Both Ends of the Candle

Speaker 1: You're listening to Your Practice Made Perfect, support, protection, and advice for practicing medical professionals, brought to you by SVMIC.

Brian: Hello. Thanks for joining us on this week's episode of our podcast. My name is Brian Fortenberry. Today we have a great topic. We're going to be discussing women in medicine. We're also going to be talking a little bit about work-life balance and something we're going to get more familiar with, the Brave Enough movement, and to discuss all of these things, we are privileged to have Dr. Sasha Shillcutt. Dr. Shillcutt, thanks for being here.

Dr. Shillcutt: Thanks for having me. I'm excited to chat with you all today.

Brian: Well, we really appreciate you taking the time. Before we get started really deep diving in on these things, tell us a little bit about yourself, about your work, the passion that has led you to spearhead this Brave Enough movement that we're going to talk about.

Dr. Shillcutt: Sure. I am located in Omaha, Nebraska, where I am an Associate Professor of Anesthesiology at the University of Nebraska Medical Center. I work in the cardiac operating room as a Cardiac Anesthesiologist. I also am a Vice Chair in my department, and approximately three to four years ago, I recognized, wow, I looked really good on paper and I had a significant amount of publications and grants and research and a lot of good academic clinical productivity, and I looked great if you were to look at my CV and all of my accomplishments. I was really fighting clinical burnout and professional burnout in my personal life, which was having a significant effect on my family. And at that point, I recognized that I had isolated myself significantly away from friends and I needed some friends, so I changed some things about my life. Some priorities, my health.

My work-life balance was pretty out of whack, and so part of that growth and getting my work-life balance back into a good positive swing of the pendulum so to speak, was investing in friendships again. I started a small group of women physicians, about nine women doctors. I asked to join a group and basically asked them to be a support system with me. And from that grew a very large Facebook group into about 8,000 women doctors, and then my friends who were women that were not physicians said, "Hey, we want to read what you're writing and we want to be involved in the community because we are also facing similar issues." And that's when I started the movement, Brave Enough.

Brian: Wow, and we're going to talk more about that. That is phenomenal, and the importance of it cannot be underestimated here. Let's get started, first of all, just kind of looking back and doing some research. You're very involved in helping other physicians and healthcare professionals in achieving really the wellbeing you were talking about in their personal and professional lives. Talk a little bit about why it's so important that we talk about that today.

Dr. Shillcutt: I think it's important, as we all know in our healthcare systems, we can identify that the likelihood of a physician burning out is pretty high within his or her career. And it's positively correlated with not just the number of hours that you're working, but the type of bureaucratic things that you are now forced to do as a physician that at one point was not the majority of your work. And we know that there have been studies published that show that the average physician spends two hours in front of a computer for every one hour in front of a patient, and the problem is that there is a disconnect between what really motivates us to work hard, long hours and what we're actually doing. And that disconnect can lead to problems such as physician burnout, cynicism, emotional exhaustion. Which can then basically cost a health system significantly, not just financially, but more importantly, it can end up in hurting patients.

I think it's really important that we talk about these things both as individual factors that we can help, but also institutional factors. Since I went through burnout and I experienced it, and I thought to myself [you know] at one point, "Here I am, this highly educated, qualified person who has spent hours in developing my expertise, and yet tomorrow I don't want to go to work. I would rather go to teach yoga or serve soft serve ice cream."

Brian: Sure [laughs].

Dr. Shillcutt: It's kind of crazy, right? And so when you get to the point where you actually don't feel engaged and you don't want to go to work and you don't even know if you can do your job to the best of your ability, something's broken.

Brian: Yeah!

Dr. Shillcutt: And I think that it's really important that we investigate that, because medicine is human work, and that is what is so amazing about it...

Brian: That's a great point.

Dr. Shillcutt: ... is it's such human work. But it also has the potential, because it is human work, to burn you out at a faster rate.

Brian: The awareness that you had that you were getting to that point of burnout and that you needed to do something is key, I believe, and the fact that you've been willing to not only realize it but then say, "Hey, there are probably other people out there facing the same type of issue, and I want to help them," I think goes a long way to your following here.

Dr. Shillcutt: Yes. I think it's really interesting because we tend to kind of look at other people and think, "They probably have it all together. They're doing okay. I must be the only person who may be silently struggling with anxiety or with just feeling the funk that you don't want to get out of bed in the morning and go to work because you're totally, completely exhausted and emotionally empty." And then you sit down and actually talk to one or two people and you realize that "Wow, everybody's in the same boat. The problem is we don't have time to actually discuss it."

Dr. Shillcutt: I always tell people that we can all make a difference, even individual physicians just looking out for our partners, and if you're feeling burned out, you feel yourself kind of becoming overwhelmed, it's okay to withdraw from paper and from projects.

Brian: Right.

Dr. Shillcutt: You know, no one's gonna die if you withdraw from paper or projects. But when you start to feel yourself not be able to even communicate with the people in your life who you're closest to, when you start to withdraw from those people, that is a red flag. So you can withdraw from paper projects, not from people. And I'm not talking about withdrawing from pen pals, you know?

Brian: Right.

Dr. Shillcutt: I'm talking about your closest people.

Brian: Your support system.

Dr. Shillcutt: Yeah. Then you probably are burned out.

Brian: Absolutely. And most people that I know, and I won't mention any names, that have what I call their ‘real life’ and their ‘social media life’. On the social media, it's always they're taking pictures of these perfectly prepared meals for their children as they go off to school, and hashtag #bestlife and all of that, but then in reality, they're really hurting and suffering. And I think you have done some stuff regarding social media. You had a recent article in the New England Journal of Medicine, Social Media and the Advancement of Women Physicians. It discusses the role that social media plays, especially as new generations enter into medicine in the medical world, and specifically the influence of the advancement of women in medicine. I wanted to deep dive into that topic a little bit more. How is social media helping or hindering physicians today?

Dr. Shillcutt: I tend to look at social media as just an extension of society.

Brian: Yes.

Dr. Shillcutt: And I think people can classify social media as either all good or all bad. Well, it's just an extension. It's just another modality of how we connect, and there are good and bad aspects of connecting with other people. Just the same, there are good and bad aspects of social media, but I always tell people, "You control it. You are holding the iPad or iPhone or whatever you are. You're in charge of your feed, and you're in charge of how often you participate in social media."

I tend to be fairly restrictive to participate in connecting with other women in medicine, because that is the need that has fulfilled me. And when I say that, I mean both professionally and personally, because I have connected with women on social media and collaborated with them academically to give talks, to write abstracts, to do research, to write manuscripts, to advance medicine. So it has been extremely positive for me in that aspect. Personally, I have connected with women, other women in medicine and other women in other specialties or even other professions, that have allowed me to establish friendships, network, feel that I'm not such an imposter because they're facing similar struggles. So I think it is a really powerful tool, because a woman may be more apt to discuss something like maternity leave or how to negotiate for a new contract in a group with other women than she would maybe in the workplace.

Brian: Absolutely. And I think you make a fantastic point of being able to use social media in that positive manner. You have done a good bit of work in the area of women physicians, correct? And tell us a little bit more about that.

Dr. Shillcutt: Yeah. I really did not think that this was going to be my passion. Five years ago, if you told me that I would be leading a group of women physicians, I would kind of look at you like, "Huh?". Because to be really honest Brian, I've had success in my career, just kind of marching along to the beat of everyone else's drum. And I started really in my mid-career as the more I advanced in medicine, the more I felt pushback and the more I felt alone as a woman. And it was interesting because I thought, "Wait a minute, shouldn't this be getting easier? I'm advancing, I'm gathering skills and expertise. Shouldn't I be feeling like one of them in the club now that I actually have street credibility, so to speak?"

Brian: Right [laughs].

Dr. Shillcutt: But it's opposite, because I actually felt more obstruction and bias the more I achieved, and I realized as I looked around that I was the only woman around the table. And I actually shared with a couple of my male colleagues who are very close friends and supporters, and they were like, "Well, just keep doing what you're doing, because it's working." And I'm like, "Well, where are the women?"

Brian: Right. Yeah.

Dr. Shillcutt: They're like, "Sasha, do not get on this soapbox, because you will actually probably be stunted in your academic growth." And at that point, I really faced a crossroads. I thought, "Okay, I'm not doing this for Sasha. I'm doing this for my daughter." I have three sons who I adore and a daughter who I adore, and I just believe that my daughter should have the same opportunities and rights, and education, and pay, and promotion as my sons. I really, truly believe that. And I knew at that point I needed to start kind of encouraging women, because I saw them shrinking back at a certain point in their career.

That is the purpose of Brave Enough, and that's why I started the community. It's really been amazing because I've had so many women reach out to me and say, you know, "I read this that you wrote and it really resonated with me, and because of that I was able to go negotiate," or, "I was able to ask for a promotion," or, "I put myself out there on this committee and I got on the committee." And I've also had a lot of men say, "Thank you for the message you're spreading because we want to encourage more women to be involved and we really appreciate it." So, I think it's been a challenge, but it's why I called my company Brave Enough, because I needed a daily reminder to be brave enough.

Brian: Your work in this area certainly has not gone unnoticed. As a matter of fact, in 2016, your peers awarded you the National American Medical Association's Women Physicians Inspiring Physicians award, which is an incredible honor. And as you just talked about, for not only women now, but future generations to come, women in medicine are critical and gender equality is an incredibly important topic. Any insight or advice that you might have for fellow practicing women today beyond what we've already briefly discussed?

Dr. Shillcutt: Well, I think it's taken me a while, and I don't have it all figured out. I'm still working on navigating being a voice for women and really just navigating my own career, but I will tell you that one thing I have learned is when you are criticized, or when you maybe feel like bias is coming at you, it likely means you've taken a step forward.

Brian: Right.

Dr. Shillcutt: And you should actually see it as a compliment, which has taken me a long time to understand this, because we think, okay, we're going to go along and we're going to just check all the boxes, and then some fairy godmother is going to come out of the sky and be like, "Dr. Shillcutt, you have achieved all these things. We are going to give you pay and promotion and all these things just like we would give Bob." But that is not the case. So you have to actually step forward and you have to be your own fairy godmother. And when you do that, you're probably going to surprise everyone around you and people are going to be like, "Wait a minute, why do you think you can do that?" Even other women will be like, "Wait a minute, why are you stepping forward?"

Brian: Right.

Dr. Shillcutt: So you have to actually see that that obstruction is a positive sign. It means you're stepping forward. It doesn't mean that the answer will always remain no. I think I've gotten really comfortable with the word "no." I probably get told "no" five times before I get told "yes."

Brian: Right.

Dr. Shillcutt: That's just reality and it's okay.

Brian: You know, that is so true. If you never meet obstruction or criticism or pushback, that means you're not pushing forward, right?

Dr. Shillcutt: Yes, exactly. And I think for women, we are not as confrontational as men. Even my children, if you look at how my boys play versus my daughter, my boys are like punching. They think fighting is fun.

Brian: Yeah, absolutely!

Dr. Shillcutt: They grow up fighting, and they think it's part of their sport and it's fun, and I think the way that women are raised, we achieve by staying in line, raising our hands, waiting to be called on. So then when we transition to a career, we're not used to getting dirty. We're not used to the rough and tumble. So we can kind of pause and go, "Wait a minute. Oh, I didn't get picked that time? I guess I'll just keep my hand down." And so it's a different playing field, and it's dominated in healthcare. 80% of the leaders in healthcare are men. That's just factual, so I think that we have to understand that it's okay to assert ourselves as leaders and we're probably going to hear "no" some of the time. We are going to get pushback. That's good, it means you're stepping forward. Keep going.

Brian: The title of your blog and your conference, and we talked about a movement a bit earlier, I love the title, Brave Enough. That really does say so much, and you have this blog and then you have a conference as well.

Dr. Shillcutt: Yes. In 2019, it will be in September. I'm so excited. It's going to be a phenomenal conference. We have women in law, women in healthcare, executives coming to teach us so many things about everything from work-life integration to negotiation, to finding your voice. And what I really love is amplifying the voice of other women, so we're going to recharge and we're going to take a call to action, and it's such a great time for women to connect, so I'm thrilled about the conference.

Brian: Is this something that you plan to continue in years to come?

Dr. Shillcutt: Yes. We're just going to continue to grow this conference. I also am putting on a small retreat in January with just 30 women, and I teach online classes for women that want to go through kind of an introspective 12 weeks, so lots of fun things that I've enjoyed creating and doing in my spare time.

Brian: And of course you have the blog as well, correct?

Dr. Shillcutt: Correct.

Brian: We will, in our show notes, put information and links to try to get people connected with you that are interested in doing that. I'm assuming if they follow you there or go to a website, they will be able to get future events that you're a part of, correct?

Dr. Shillcutt: Absolutely. We are expanding the retreat and other offerings such as our conference to women in healthcare, women in other specialties such as law, education, and so we have some other women outside of medicine who are also attending the conference. I'm really excited about that, because I think when we kind of start to cross multi-disciplines, that's when we really start to learn other skills that have worked in other areas, and so I'm really excited about the diversity.

Brian: Absolutely. And what we will do is, when this podcast, people might be listening to it at different times. Like I said, we will connect them in the show notes portion of our podcast so they can get connected to see what future events at whatever time they are listening might be coming up that they could get in contact with you.

As we get ready to kind of wrap up here, Dr. Shillcutt, you've done a lot of work obviously with women in medicine, but a lot of the things that you've talked about, you were talking early on about that work-life balance, that really applies to both men and women and you've done work there. What advice would you give to both women and men in medicine when it comes to that work-life balance and that burnout you were talking about?

Dr. Shillcutt: Absolutely. It affects both genders, and it's really important that we lookout for one another. I think that we have to recognize that our institutions and our cultures within our institutions must change. We have to recognize that we are part of the culture, and I think we sometimes underestimate the power we truly have. And I think it's time that when physicians connect, a lot of things can happen. When they connect with executives and healthcare leaders within their institutions or their departments, a lot of positive change can happen. And I also think that we have to really take a look at what we can control. I mean, I can't control perhaps the operating room schedule, let's say, but I can control the fact of how much vacation I take, and sometimes I find myself going six months without taking a week of vacation, and then I wonder why I can't even function.

Dr. Shillcutt: I think it's really important that we do some introspection and we look at ourselves and what we can control, and I try to give myself 30 minutes a day of my own time. That doesn't sound like a lot, but 30 minutes, actually, to find in your day where you unplug from other people and devices? For me, it is so important, and I tell people that to do that you actually have to remove something in your life.

Brian: Yeah.

Dr. Shillcutt: I always tell physicians when they come up to me after I give talks, and they're waiting to talk to me and ask me like, "What's the one thing I can do?" Look at your daily schedule and see what you can get rid of, because everybody has something they can get rid of, and then replace that with 30 minutes of you-time. Maybe it's getting to the office 30 minutes earlier, shutting your office door, and doing a 15-minute meditation app. Maybe it's laying on your office couch and just sipping a cup of coffee for 30 minutes before you start your day and getting your mindset.

Brian: Sure.

Dr. Shillcutt: Maybe it's going for a walk with your dog in the evening. For every person it's different. But it's so important, first, that you figure out what you're going to remove, because if it was as easy as just adding 30 minutes, we would all have done it, right?

Brian: Yeah. Exactly. And the thing that I'm hearing is it has to be intentional. You can't just, "Oh, I hope I get to that." It definitely has to be intentional, correct?

Dr. Shillcutt: Absolutely. And for me, my hour is from 5:00 to 6:00 in the morning. And it's funny because you would think that that hour is safe and protected, but I can't tell you how many times that hour is really...people will start encroach on that hour. They're like, "Well, can you come and present at 6:00 AM?" And I've had to say, "No, I can't, because actually, that is Sasha's hour. That is my sanity, and so I have to protect it." And the other thing is, I think some people, we judge each other for how we do self-care. Self-care is not selfish. It is so important, and we have to stop judging how we take care of ourselves, how each person individually takes care of themselves because it's different for every person.

Brian: It absolutely is. I know in my life balance, just like you, having children, that adds a whole ‘nother spectrum to this, and once you have children, as you know, there is nothing sacred anymore. There are no hours without a locked door.

Dr. Shillcutt: Right. Exactly. Exactly.

Brian: Dr. Shillcutt, I cannot thank you enough for joining us today. This has been incredible information. As we've mentioned earlier, we're going to put a lot of this information down in our show notes, so that they can get in contact with you and on your social media presence out there. Thank you so much for joining us.

Dr. Shillcutt: Thank you.

Speaker 1: Thank you for listening to this episode of Your Practice Made Perfect with your host, Brian Fortenberry. Listen to more episodes, subscribe to the podcast, and find show notes at SVMIC.com/podcast.

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