Success in Medicine

Dr. Meena Julapalli is a pediatric dermatologist, one of only about 400 in the country.  This was a fascinating conversation, because she relays her journey from academic dermatology to a direct care practice, as well as her work on creating resources and conducting workshops on the path to joy. 
One of the fascinating topics we discussed was the different approaches to providing medical care. In medical school and in training, we are often exposed to academic medicine, and sometimes private practice. But there are different types of medical practice, and Dr. Julapalli started what is known as a direct care practice.  In a direct care practice, patients pay a set fee to see the physician. Patients know ahead of time what that fee will be, and there are no surprises.  In her previous academic dermatology positions, she would sometimes see as many as 50 patients a day. In her current position, she may see nine patients a day, which allows her the space and time to fully respond to her patient concerns.  She describes the setting as a micropractice, where she keeps her overhead low by paying attention to expenses and using a virtual assistant.
Dr. Julapalli is also the founder of The Joyful Path, whose mission is "to help children build the intuition of how to nourish their mind, body, and soul so that they may live, love, and serve generously with an open heart, intention, and purpose." Dr. Julapalli has been involved for the last 20 years with support groups and camp programs throughout the country, as well as leading workshops. She is also the author of two children's books about joy, as well as a mindset coach for kids, world explorer, and amateur swing dancer.
I found this a fascinating conversation, because it highlights that there are many ways to approach a particular challenge, whether that’s the challenge of providing the type of patient care that you wish to, or the challenge of helping children beyond the ones that you care for in your practice.
www.BluebirdDermatology.com

www.TheJoyfulPath.org

My interview with prenatal genetic counselor and researcher Lauren Westerfield is a fantastic lesson in how to approach challenging career decisions.

The framework and approach to impending burnout that she describes in this episode is very thoughtful and analytical--and has proven effective. 

Ms. Westerfield works in both clinical practice and research as the research study coordinator for an NIH-funded multicenter study. She is based at Texas Children's Hospital and the Baylor College of Medicine.

One of the things that struck me about her conversation, and that she highlighted, is that many of the discussions about burnout are on "how do you move onto the next thing". By contrast, her approach provides an option for staying in a position in a more sustainable way, because that’s also an option for resolution of burnout. She wanted to stay in a great institution, doing work that she loves.

For those who would love to stay in a career or a position that they love, this is an inspiring episode about how making deliberate changes and having challenging conversations can lead to great outcomes. 

I really enjoyed speaking to Dr. Stefanie Simmons, because her work with the Dr. Lorna Breen Heroes' Foundation is an example of how advocacy in action can lead to change, even over the course of just a few years.

Dr. Simmons is the Chief Medical Officer of the Dr. Lorna Breen Heroes' Foundation. Over the course of her career, she has served as a clinician, an educator, a healthcare executive, and now Chief Medical Officer.  In this conversation, we speak about her advocacy work, and how the foundation has been able to make significant strides in promoting healthcare well-being.

In speaking with her, she is clearly energized by her mission: to support healthcare providers in rediscovering the joy in their work, in order to improve the quality of their lives and improve the care that they provide to patients.  She explains that her work is focused on advocacy, awareness, and advancing solutions.

As part of her work with the foundation, she meets with state and federal legislators. She also conducts outreach to healthcare organizations to increase the awareness of the drivers of burnout. The foundation also helps to advance solutions to accelerate the pace of change, including via the Impact Well-Being Campaign.

The goals of the foundation include, among others, safeguarding access to mental healthcare for healthcare providers. The work of the foundation began with the tragic death of Dr. Lorna Breen in the spring of 2020. One of the contributing factors to Dr. Breen's mental health crisis and suicide was her fear that if she sought treatment, she would lose her medical license. This fear stemmed from the fact that many states ask questions on licensing applications as to whether physicians had "ever" been treated for a mental health condition. 

The foundation and other organizations have been working to change these questions. Instead of asking about past treatments, the focus should ideally be on current physical and/or mental impairment.  In 2021, there were 17 states that avoided the use of invasive questions about past treatment for mental health conditions. Now, there are 27 states, and 11 more are considering making changes. This is a remarkable improvement over the course of just a few years. 

 In this episode, Dr. Simmons shares her own experience of postpartum depression, and how she did not seek care because of concern about licensing issues. One of the things that has motivated her throughout her career is her wish to leave this place and the rules that govern us better than she found them.

For students interested in advocacy work, or how they can continue to advocate for professional well-being as clinicians, this episode provides inspiration and actionable takeaways.

Dr. Stefanie Simmons, Chief Medical Officer, Dr. Lorna Breen Heroes' Foundation

The Dr. Lorna Breen Heroes' Foundation

More on how to start a medical school chapter of the organization

My post on KevinMD on why doctors are afraid to seek mental health treatment

I really enjoyed speaking with Dr. Marcy Youngdahl, a Family Practice physician who is the Director of Integrated Counseling and Health Services at Trinity University in San Antonio. I always enjoy speaking with physicians who have been strategic in their career choices, moving from one setting that was not ideal to another setting where they are strongly energized at work.

I was also excited to speak with Dr. Youngdahl because this is an area of medicine that I did not know much about previously. In this conversation, she highlights what drew her to College Health.

There are important lessons here on how important it is to connect with your values when you are developing your career.
More on Dr. Youngdahl

American College Health Association

For students interested in Urology, he also provides some great advice on how to position yourself for success.
More about Dr. Khera

--He is a patient safety researcher and Professor of Medicine, and is committed to researching and developing resources to promote patient safety and diagnostic excellence in clinical practice. 

--His research on how to improve missed or delayed diagnoses has impacted many, and his research on how to improve the use of electronic health records (EHRs) has been used as the basis for policy changes by the Center for Medicare Services (CMS). He has also worked with the World Health Organization on patient safety issues. 
--One of the things that struck me during our conversation was how his career has been so mission-driven, starting with his observation of missed diagnoses during his years of practice as an internist in rural East Texas. Those experiences inspired him to seek out a research career, and later helped guide his efforts to impact policy.
--At the same time, although he is very mission-driven, he describes how important perseverance and discipline have been throughout his career.
--For anyone struggling to make an impact in an area about which they are passionate, his career path is inspiring.  In this episode, he shares the story of how he transitioned from clinical practice to a research career. Although he has a storied career now,  his early failures are an important part of his story. 

--As he explains, it took him several years and 12 failed grant applications before he was finally able to move into his career as a researcher.

--When I asked him what kept him going, he described his passion for the area of patient safety, but he also emphasized the importance of perseverance and the discipline to keep submitting grant applications.

--He is also deeply committed to translating research findings into policy change, and he talks about the associated challenges.

 --He describes several ways in which his groups' research findings have been used to guide policy and practice.

--He and his colleagues developed a checklist for health systems on how to implement and use EHRs more effectively. In 2021, this work was adopted by the CMS as a quality measure to assess implementation of the EHR.

--For students or physicians who are seeking to impact the systemic forces shaping medical care, this is an inspiring episode.

--This was an enlightening and inspiring conversation with Dr. Lavannya Pandit, a Physician-Scientist at the Baylor College of Medicine. 
--Dr. Pandit is a clinician who also performs scientific research. She is a Pulmonary Critical Care physician on staff at the Michael E. DeBakey Veteran's Affairs Hospital in Houston. She is Director of the Pulmonary Hypertension Program there and serves as an Associate Professor at the Baylor College of Medicine.
--Her research centers on the physiologic and molecular mechanisms of pulmonary vascular disease.
--Her mission is to advance understanding of vascular disease.

--In this episode, Dr. Pandit describes her work, which is focused on serving her patients, particularly the veterans who have fought for our country. As a scientist, she also spends time applying for competitive grant funding, mentoring, reviewing, and conducting research.
--An overview of physician-scientists has noted that their numbers in the United States are decreasing rapidly for several reasons. However, clinicians who are closely involved in understanding the challenges of a particular disease have important insights into research questions.

--In this episode, Dr. Pandit describes her path to becoming a physician-scientist and provides advice to medical students.

More on Dr. Lavannya Pandit

Published research by Dr. Pandit

Dr. Huang began her career as a faculty member at the Baylor College of Medicine, and later was in private practice for over a decade. She then returned to training to complete a fellowship in breast imaging at the MD Anderson Cancer Center.  

In speaking with her, it is clear that she has a deep commitment to developing minimally invasive treatments for breast cancer, and she is now the founder and Director of the MD Anderson Cancer Center, Department of Breast Imaging Breast Cryoablation Program. 

This episode also provides some great insights into how a physician can overcome burnout.  Although Dr. Huang was in a very successful private practice, she felt that she was getting burned out. This was not due to the amount of work, but rather because her goals had changed.  She found herself wanting to change the world a little bit, and specifically the world of breast imaging and breast cancer treatment.  She explains that working through that process has made her practice of medicine ultimately stronger. She worked to evaluate several areas: What were the sources of her discomfort? What brought her satisfaction? What could she change? Was there something new she could add?

This process ultimately led her to return to training and now, as a faculty member, she treats breast cancer patients with minimally invasive treatments while running clinical trials.

About Dr. Monica Huang

Dr. Abbey Vandersall is the Vice President of Quality and Clinical Services at AMSURG, an organization that maintains over 250 ambulatory surgical centers (ASCs) across the United States. Her work encompasses patient safety and quality, as well as other areas that impact clinical care such as operations, strategy, policy, and government affairs. In this episode, she shares her journey from medical student to consultant to healthcare leader.
One of the things that struck me about our conversation was how energized she was about innovation, strategy, and making a positive impact on patient care. She has a lot of wisdom to share for medical students. 

· One of her points that really resonated with me was that your passions at age 18 or age 30 may not be the same as those at age 50, because your passions change, your experiences change, and the world around you changes. It's important to recognize that. 

· When you’re thinking about career decisions, she encourages students to think: “What problem do I want to solve?"

· She also recommends that students investigate areas that intrigue them. For herself, she was absolutely fascinated during a lecture on the business of healthcare in her third year of medical school, and she later explored a summer experience in consulting.

· One final piece of advice that she shared to medical students was to not be afraid to reach out to people that you don’t know. She says that people are often far more willing to help than we would realize.

AMSURG: https://amsurg.com/

Dr. Abbey Vandersall LinkedIn: https://www.linkedin.com/in/abbey-vandersall-md

Dr. Andru Zeller is a primary care physician who is focused on fair trade medicine. He founded the Simply Salud Clinic in 2004 as a family-centered, fair trade, integrative medical practice for people of limited economic means.

Dr. Zeller completed a family practice residency, followed by a fellowship in rural health. He talks about the strength and power of medicine, but also some of the challenges, especially the cost of healthcare faced by patients of limited economic means. This inspired him to develop a practice focused on fair trade medicine. The clinic is a sustainable business, and continues to serve himself, his family, and his community.  In this episode, he speaks about his mission as well as the associated challenges. 

He has been very intentional about how he wants to make an impact in healthcare, and he has developed several innovations.

To learn more about Dr. Zeller and the Pain Scan System, please see these links:

Simply Salud
painscansystem.com