Minimizing Medical Burnout: Yale Podnos Of The Oncology Institute On How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout
An Interview With Dan Rodrigues
Listen to your physicians — If clinicians don’t feel valued and important, they may disengage. At TOI, we have an elected group of physicians on our Executive Committee. I have a strong partnership with this group and lean on them to help make decisions that affect our practice.
The pandemic was hard on all of us. But statistics have shown that the pressures of the pandemic may have hit physicians and healthcare workers the hardest. While employment is starting to return to pre-pandemic levels generally, the healthcare sector is lagging behind with a significant percentage of healthcare workers not returning to work. This is one of the factors that is causing a shortage of doctors. Some experts say that the US may soon be short almost 124,000 physicians. (See here for example) What are hospitals and medical practices doing to help ease the extreme mental strain of doctors and healthcare workers? What are hospitals and medical practices doing to help solve the scourge of physician and healthcare worker burnout?
To address these questions, we are talking to hospital administrators, medical clinic executives, medical school experts, and experienced physicians who can share stories and insights from their experience about “How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout”. As a part of this series, I had the pleasure of interviewing Yale Podnos, MD Chief Medical Officer & President of Practice The Oncology Institute.
A native of Southern California, Yale D. Podnos, MD, MPH, FACS, attended New York University, graduating with a degree in biology. He attended graduate school at the Harvard School of Public Health and medical school at the University of California, Irvine School of Medicine, where he also completed his residency in general surgery.
After his residency, he completed a fellowship in surgical oncology at the City of Hope. After training, Dr. Podnos joined the faculty at Duke University and later became the Chairman of the Department of Surgery and Director of Surgical Oncology at UNC Rex Healthcare in Raleigh, NC.
In practice, his specialties are surgical care of patients with pancreatic, hepatobiliary, melanoma, and esophagus cancers. He has authored over 60 scientific publications.
Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?
I grew up in Los Angeles. I was precocious and curious. As a result, I did well in school but also got into a lot of trouble. My curiosity led me to science as I always wanted to know how things worked. As a sophomore in high school, a friend’s father who is a pathologist knew of my love of science and let me watch him do an autopsy. Though I initially went as an excuse to miss a morning of school, I left the hospital knowing I wanted to practice surgery. The spatial relationships of organs to each other, their individual physiologic purposes coming together to become an organism, and how (and why) they interacted with the mind and spirit definitely became the tenets by which I based my career.
What or who inspired you to pursue your career? We’d love to hear the story.
Medicine is the only career I ever seriously considered as I always had (and still have) incredible physician mentors in my life. This began as a young child with my grandfather who was a Family Practitioner. I admired how he cared about people and those people, in turn, cared about him. I decided at the age of 4 that I wanted to be like him. In medical school, residency, and fellowship I had the fortune of learning from talented surgeons who were smart, technically outstanding, caring, and fun. Those are all things I’ve tried to emulate in my career.
Surgery appealed to me because it is both manual and cerebral. You start an operation with an objective and plan and, hopefully, leave the OR with both completed. Surgical Oncology further appealed to me because of the meaningful relationships I built with my patients and their families. When a cancer patient was referred to me, they were often recently diagnosed and facing one of the most terrifying and vulnerable stages of their life. The opportunity to help them through that experience is a privilege that I do not take for granted. From an intellectual perspective, I enjoyed the extremely complex nature of the patients, disease pathologies, operations, and multidisciplinary treatments.
What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?
As a practicing physician, I was able to very intensely affect peoples’ lives one at a time. As a Chief Medical Officer, I am fortunate that I can affect care for many more people with the programs that we implement at The Oncology Institute (TOI). Leading the clinical programs for a growing practice like TOI requires constant innovation and creativity. While there are always several exciting projects in the works, there are two in particular that have the capacity to significantly impact patients experience and outcome.
A primary focus area for 2022 has been expanding and enhancing our Quality program. While TOI has always implemented evidence-based clinical pathways and rigorous expectations around patient experience, we are always looking for ways to implement new best practices and ensure consistent implementation of all policies as we grow. Through our Quality program, we are able to report on these measures, identify best practices, and quickly deploy those best practices across the entire 60+ clinic practice.
To further satisfy my inner science geek, I am working with our research institute, ICRI, on ways to improve and expand our clinical trials program. We are very proud that ICRI has always been a leader in community-based clinical trials programs with one of the most robust offerings outside of an academic institution. With more than 170 open trials, TOI patients have consistent access to advanced treatments well before they are available in most other sites. Because we serve a diverse, often underserved population in their communities, we offer clinical trials to patients that may not otherwise be able to access those services by removing the many barriers to accessing clinical trials such as health literacy, language, and travel requirements. Those factors make participant populations less diverse than the general public, leading to a disparity in access and limitations to research efficacy.
You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?
Empathy — I believe that the ability of a leader to identify with colleagues and understand their lived experience is critical. Understanding the perspectives, motivators, and impediments of your team builds trust and leads to better policies and programs. I firmly believe that we have been successful at TOI because we not only take outstanding care of our patients, but we take care of each other.
Good communication skills — If your team doesn’t understand the company’s direction and vision — and feel engaged with that vision — it can be extremely difficult to accomplish your goals. Clear, effective communication is paramount for happy, productive teams. This was a skill I learned as a surgeon over many years. To ensure a safe and productive operation, it was essential to be able to direct the team and keep them communicating with one another.
Be the example of the traits you’d like to see in your team — it is a lot easier to ask people to do something if you are doing it or have done it. One of my most memorable mentors and examples of servant leadership was the senior partner at my previous practice. He took ownership of every problem and was always to first to volunteer to help. In no time, the rest of us would volunteer for difficult tasks so he wouldn’t have to. His ability to lead by example motivated the rest of us to go the extra mile.
Ok, thank you for all of that. Let’s now shift to the main focus of our interview about minimizing medical burnout. Let’s begin with a basic definition of terms so that all of us are on the same page. How do you define “Physician and Healthcare Worker Burnout”? Does it just mean poor job satisfaction? Can you explain?
I’d define burnout as a spectrum of feelings that includes physical, mental, and emotional stress that negatively affects job performance and satisfaction. This usually arises from various negative experiences such as stress, overwork, underappreciation, or disengagement from the decisions or vision of the practice. Any of these feelings can be compounded by outside factors like the pandemic or personal matters. Being able to foster an environment that reduces burnout and identifies its symptoms early on is critical for individual and team satisfaction.
How would you define or describe the opposite of burnout?
The opposite of burnout is a sense of fulfillment, engagement, and connection with your work, your teammates, and your patients.
From your experience, perspective, or research, what are the main causes of Physician and Healthcare Worker Burnout?
Oncology is a stressful field. Providers are constantly dealing with life-or-death decisions and conversations. There are significant demands placed on providers, both from an administrative and productivity perspective and from patients and their families. Treating someone through a life-threatening diagnosis and subsequent care requires emotional intelligence and empathy and, while it is extremely rewarding, is quite demanding.
I’ve also witnessed colleagues feeling disengaged in environments where the business goals and medical needs do not always align. This is why I believe it is critical for organizations to have clinician leadership to ensure patient needs and clinical outcomes are at the forefront of every business decision.
Have you seen burnout impact your own organization? Can you give a first-hand description of how burnout can impact the operations of an organization?
Burnout can happen anywhere, which is why prevention and early detection is critical. At TOI we’ve developed robust benefits and an intentional culture to increase satisfaction and reduce burnout for our providers. Compensation and recognition go beyond a salary and health insurance. We employ features like a mentorship program and extra time off for medical volunteer work, and we’ve seen how it can lead to a healthier and happier workforce.
In my role as Chief Medical Officer, I closely monitor the early signs of burnout. Most often, these are patient and teammate complaints and an unexpected drop in productivity. As part of our culture where we take care of one another, we approach it with a desire to first find the cause (professional or personal). Recently, I noticed one of my top performing physicians suddenly struggling with completing charts and had some complaints from staff about temperamental behavior. Noting this was entirely out of character for a physician who’s been part of the practice for many years, I gave the MD a call to learn more and learned that there were personal issues that were causing distraction. This is a strong, valuable member of our team, so instead of issuing a reprimand, we adjusted the schedule to help with work/life balance while other areas of life could get their necessary attention. We now have a physician who feels supported, is meeting targets again, and we avoided potentially losing a valuable clinician.
Does your practice currently offer any mental health resources for providers or clinical staff? We’d love to hear about it.
In addition to the benefits and programs mentioned before, we offer a robust Employee Assistance Program that includes mental health support and other practical life resources. Taking care of each other is a main tenet of our practice. We do our best to foster relationships between our clinicians so they feel comfortable speaking with each other. We start these relationships as soon as someone starts by pairing them with a mentor. The mentorship program regularly brings our teams together for social gatherings, routine check-ins, and professional development. Something as simple as a dinner with colleagues allows for personal relationships and trust to be forged. I am incredibly proud that we have built a team that leans on one another, both professionally and personally.
In my work I have found that streamlining operational efficiency with digital transformation and automated processes helps to ease the workload of providers and clinical staff. Has that been your experience as well? Do you think that streamlining operational efficiency can be one of the tools to minimize medical burnout? We’d love to hear your perspective.
Technological solutions can be a valuable tool for operational efficiency as long as they result in less work for the provider or lead to better patient care. Both outcomes are equally rewarding for providers. We do need to be wary of technologic tools that result in more work (clicks) for the clinicians without offering concomitant improvements.
Fantastic. Here is the main question of our discussion. Can you share 5 things that hospitals and medical practices can do to reduce physician and healthcare worker burnout?
- Listen to your physicians — If clinicians don’t feel valued and important, they may disengage. At TOI, we have an elected group of physicians on our Executive Committee. I have a strong partnership with this group and lean on them to help make decisions that affect our practice.
- Have trusted relationships — Foster relationships between colleagues. This was particularly difficult during the pandemic shutdowns. To make up for that, we regularly seek opportunities to get our staff, clinicians, and non-clinicians, together to socialize and discuss issues concerning the practice. This affects so many parts of the practice, from patient satisfaction to weekend sign-outs.
- Physician leadership in all areas of the business — We are fortunate at TOI that we have many senior physician leaders. As people who’ve spent much of our professional lives taking care of patients, we understand the views, concerns, and desires of practicing physicians. This is incredibly beneficial to patients, as clinician and patient interests are so often tightly aligned.
- Follow through on concerns — This goes back to the first two ideas. Clinicians feel more engaged and will continue to give feedback whenever they feel their feedback is important to administration and acted upon. To reinforce this, we have a section of our newsletter entitled “You Said, We Did” where we list the feedback given to us in administration and the actions we took as a result. I think our staff really appreciate it.
- Comprehensive compensation — Compensation shouldn’t stop at salary and medical benefits. We encourage our staff to use their vacation and offer additional time for volunteer work and medical missions. As a public company, we also are able to share ownership with the clinicians by granting equity in a variety of ways. With this, they have ownership in the practice, much like traditional partnership in private practices.
What can concerned friends, colleagues, and life partners do to help someone they care about reverse burnout?
There is nothing more valuable than simply being available to listen and serve as a confidant. Sometimes a loved one could need help identifying that they are experiencing burnout before they can even make a plan to improve their situation. Once they decide how they want to proceed, continue to support them without judgement so they can find their own path to a more fulfilling experience. This may range from adjusting a schedule to accommodate work/life balance to a large career change (like becoming a full-time administrator ☺).
What are a few of the most common mistakes you have seen people make when they try to reverse burnout in themselves or others? What can they do to avoid those mistakes?
I think there are two major lost opportunities for those who are suffering from burnout. The first is letting the symptoms get too severe before addressing the cause. It is easy to ignore burnout, especially when it become chronic, but the longer you ignore the symptoms, the more difficult it can be to reverse. After a while, a simple schedule adjustment won’t change the feelings of helplessness and loneliness that often accompany burnout.
A second common mistake is not asking for help. This can be from a spouse, friend, colleague, or mental health professional. As physicians we are reluctant to ask for help because we are the ones that others seek for assistance or care. Asking for help makes many of us uncomfortable. However, if we wait to change direction until we are miserable and don’t seek advice or counsel, we may lose the vital perspective that others may have. Unfortunately, burnout is common in medicine. There is a good chance someone you know suffered from it and can share valuable insights on how to overcome those feelings. Remember that you don’t need to face burnout alone. Confiding in a friend or mentor can help you find solutions early and return to a more balanced state.
It has been said that our mistakes are our greatest teachers. Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?
I’ve made a lot. But I do try to learn from them. When I was in practice, I was asked to develop a physician compensation plan after merging two groups together. I sat alone in an office for 6 weeks with an Excel spreadsheet developing what I thought was the perfect plan to solve all of the problems I identified with the current plan. After unveiling it to the team, it was immediately and uniformly criticized and unanimously rejected. I realized that without input into the process, people will be suspicious of it. I spent the next few months interviewing my partners, asking their perspectives, and soliciting their feedback along the way. After going back to the team to learn what they envisioned for the program, we launched a successful plan that was well-accepted and contributed to our future growth. It’s the same lesson we spoke about earlier regarding burnout. Clinicians want to have their voices heard and feel that they are part of the processes that affect their lives and practices.
Ok, we are nearly done. Because of your role, you are a person of significant influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.
Value-based care is already a movement that is gaining ground in the world of primary care. I joined TOI because I saw how broken our healthcare system was and the role the $200B oncology industry had on that system. At TOI, we have the unique experience to have been practicing value-based oncology care for 15 years. As a believer in the great benefits of value-based care to our society, I would implore more oncologists to dedicate their practices to value-based oncology. As more physicians weigh outcome and cost, we can better use new technologies like predictive analytics and next generation sequencing to help a greater number of patients.
I am so proud of the example TOI is setting as the leading value-based oncology provider. By focusing on clinical outcomes and patient satisfaction, we are contributing to a more sustainable healthcare system.
How can our readers further follow your work online?
You can learn more about the important work of me and my colleagues at The Oncology Institute by visiting theoncologyinstitute.com or following us on LinkedIn.
This was truly meaningful! Thank you so much for your time and for sharing your expertise!
About The Interviewer: Dan Rodrigues is the founder and CEO of Kareo, a Tebra company, a leading provider of cloud-based clinical and practice management software solutions for independent healthcare practices and billing companies. Rodrigues is known for his visionary leadership in the healthcare technology industry. Rodrigues’ future-forward expertise has led companies such as Scour and Skematix. He is highly committed to providing patients with a seamless, digital experience in healthcare. Rodrigues’ business insights have been featured in publications including Forbes, Fierce Healthcare, and AP News.
Minimizing Medical Burnout: Yale Podnos Of The Oncology Institute On How Hospitals and Medical… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.